Registered Clinician
Attach.org
Association for Treatment and Training in the Attachment of Children
http://www.attach.org/regmembnonpri.asp
Attachment & Bonding Issues
Treatment Protocol
The families that I see for attachment and bonding issues are generally
having significant to severe emotional and behavioral problems in these areas. I
work with children, adolescents, and adults who are experiencing attachment and
bonding issues. With children and adolescents, I believe they must be treated
within the context of the family, and that strengthening family/parenting bonds
is the primary focus of treatment. Many, but not all, of the families I work
with have been seeking extensive knowledge and help concerning of RAD and other
attachment or bonding issues for years. However, the immense difficulties of
these issues, and the lack of knowledge among professionals has frequently
exasperated them. They have usually done all they know to do and are still
experiencing significant loss, grief, and anger. My focus is on enhancing and
extending their knowledge and helping them understand how it applies to the
difficult issues of day-to-day life within their family.
My doctoral training (Michigan State University, Ph.D., 1981) was primarily
based on Erikson’s Developmental Stages and Ego Psychology, both of which
emphasize the developmental tasks, and risks, of psychological difficulty during
the first 3 years of life. This has continued to be a strong foundation in my
beliefs about the needs of children, as well as the patterns in the difficulties
we adults experience. I was also trained in EMDR (1994, Level I and II), by
Francine Shapiro, the founder of EMDR. I participated in intensive case
consultation using EMDR and working with intensive case consultation and
research during my subsequent 7 years of independent practice in Colorado
Springs, Colorado. I have worked in Texas as a therapist/case manager for foster
children and therapeutic foster care parents. Additionally, I have 3 years of
recent experience working in a children’s neurobehavioral residential center
with children who present as dysregulated and rageful. A number of these
children were adopted from orphanages or gypsies in Eastern European Countries,
or experienced abandonment, abuse, neglect, and loss of attachment in various
settings in the U.S. and other countries. I am experienced in referring to
medical professionals, neuropsychologists, occupational therapists, recreational
therapists, and other needed professionals.
Description of Processes
My initial meeting is with the parent(s), and includes a strong clinical
interview. In general, I prefer to listen to parents talk with me about their
history, and their experience of it, although at times I will also ask families
to complete historical or other information in writing. The clinical interview
will include historical information about psychosocial information, treatment,
medical, educational, and developmental information, as well as cognitive and
intellectual functioning, family functioning and previous diagnoses. When
possible, I prefer the family bring or later provide written pertinent
information in these areas. Generally, initial sessions will be about 2 hours in
length, but I am flexible with this, given the needs and complexity of history
of the family. Later, I want to meet with the parent(s) and the child together.
I ask that the parent(s) read and sign an Informed Consent and Contract about my
outpatient treatment (per professional standards and Texas law.) The frequency
of treatment and length of sessions are determined with the family, according to
the needs of the family.
My experience of over 25 years has been broad and allows for individualized
needs of both individuals and families. I work with a wide variety of patients,
and (in addition to attachment/bonding issues), specialize in trauma and stress
reduction (including EMDR work), grief and loss, depression, executive and life
coaching, and family evaluations.
Treatment Planning
Plans for treatment will be made conjointly with my recommendations and the
parent’s determination of their ability to follow them. I only wish to engage
and continue in treatment if the parents and I can agree on an appropriate
treatment plan. Once that is established, we work with the child or children to
help them understand and also work towards those goals.
This plan can, of course, be assessed at various intervals, and I ask that the
parents give me continuing feedback, particularly when they have concerns.
My treatment techniques are intended to generally follow those of the Attachment
and Bonding Center of Ohio. I believe in telling children the truth and helping
them deal with it. I think their fantasies are far wilder and disturbing to them
than the truth. I utilize grief and loss work for both parents and children.
When appropriate, and when the family agrees, I use EMDR for trauma reduction. I
think developing and continuing to work on “life timelines” works wonders, for
both parents and children. I utilize trauma exploration and resolution. I teach
children to follow their appropriate parental instructions and leads. I work on
reinforcing good, appropriate boundaries. I use activities (especially those by
Greg Keck, Ph.D., Regina Kupecky, L.S.W, and Arleta James, PCC of the Attachment
and Bonding Center of Ohio) that enhance parent-child bonding. I address
attachment or other relevant issues which the parents have in their own lives.
My patients are encouraged to read or refer to Parenting the Hurt Child: Helping
Adoptive Families Heal and Grow and Adopting the Hurt Child: Hope for Families
with Special Needs Kids (both by Gregory Keck, Ph.D., and Regina Kupecky, L.S.W.),
and the other information through the Attachment and Bonding Center of Ohio (abcohio.com),
including “Supporting Brothers and Sisters: Creating a Family by Birth, Foster
Care, and Adoption” by Arleta James, PCC.
There are numerous others resources that parents find helpful, including
Facilitating Developmental Attachment by Dan Hughes, Ph.D., Parenting with Love
and Logic and also Parenting Teens with Love and Logic by Foster Cline and Jim
Fay; Uncontrollable Kids: From Heartbreak to Hope by Foster Cline and and
Telling the Truth to your Adopted or Foster Child: Making Sense of the Past, by
Betsy Keefer and Jayne Schooler. . I provide parents with references to these
and other very helpful books and websites.
Safety/Risk Management
The parents are either in the room, or observing (with the child or adolescent’s knowledge) during attachment/bonding therapy. I do nothing to restrict breathing or cross boundary issues with my patients. My work is geared towards enhancing the parent/child bond in a safe, comfortable, nurturing manner.
Evaluation/outcomes/follow-up
After treatment is terminated, I encourage families to contact me to both give me feedback and discuss on-going concerns. My philosophy is that therapy is best when it is intermittent throughout the lifespan. I encourage them to return to “touch base” and “fine tune” their work.