Even as early as our six-month pilot project in 1996, through our work with just four families we got increasing confirmation of our initial thinking about how CcAT could work, and of our intuitive belief in its effectiveness as prevention and early treatment of attachment problems. So, to recap from our learning, following the pilot project (see Chapter Four), the following is a summary.
Our belief is that there are not “problem children” but “families with problems”. The parents must be part of any therapeutic work that seeks to modify challenging or negative behaviours, because unless the parents change the way they respond to their child (i.e., reading cues successfully), the child will be unable to break the negative interaction cycle on their own. Even if the child’s behaviour can be changed, repeated negative responses from the parents will prevent true healing.
Within the attachment dyad, if interactions are not mutually pleasing, the relationship breaks down: parents need to feel needed and loved just as children need to feel secure, safe, and loved. If parents get nothing but negative responses, the gap between parent and child grows bigger, so that mutual distrust and rejection become the only way each knows how to respond to the other. If this pattern can be interrupted and replaced by a new cycle of mutually satisfying behaviours, the relationship can be healed and parents become protective of their child again, while she begins to feel more secure and trusting of them.
176 CcAT teaches all family members to be aware of cues and responses, since if cues are misread, they can inhibit attachment rather than engender it.
When children are placed for adoption, work begins immediately within the new family group, so we see the Programme as being preventive, as well as curative of any attachment problems. Using CcAT preventively, we consider its importance lies in helping parents to view attachment problems as a difference in family dynamics, given the new relationships, rather than pathologizing the child placed.
It is important for adoptive and foster parents to acknowledge that children placed cannot be expected to have a sense of belonging to the new family. A lot of the child’s anger and hurt, often expressed through bad behaviour, more appropriately belongs to previous carers, including their birth parents.
By encouraging parents to not take the misbehaviour as personally directed at themselves, and to deal with it on a more practical level (i.e., certain thought-through responses to particular behaviours), placements are less likely to fail because the adopters do not feel so overwhelmed and rejected on account of the child’s chaotic functioning.
The CcAT Programme helps parents to identify specific responses to various “non-attached behaviours”. They can then explore with the worker ways in which they can create a sense of trust in their child by responding positively and encouragingly rather than with anger and rejection.
It is also very encouraging for parents to look back and acknowledge their parenting skills and to witness positive changes, however small, in their children’s behaviour.
Hurt children in placement and their carers have a right to be supported. In working through child and adult issues at the onset of behavioural difficulties, an intensive therapeutic programme of interventions should be seen as major preventive work. This can result in positive changes from previous negative patterns and help both the child and carer to maintain his place within the family and promote their feelings of self-worth.
177 Where a child, for whatever reason, feels unattached and insecure, she is likely to seek help through unconsciously “acting out” her sadness, hurt, anger, and frustration in ways that adults perceive as misbehaviour (MisCUES).
Feeling rejected, the child will reject the carers in turn, so that their interaction becomes mutually ungratifying and, being painful to both, decreases. They have little or no “fun-time” together, leading to a further deterioration in their relationship and his behaviours.
The carers, if stuck in this downward “spiral of negative interaction”, will distance themselves emotionally from the child and are then unlikely to claim and protect the child as their own. If this continues, the carers place the child and themselves at risk of developing abusive interactions. This could lead to the child having to leave the family, so suffering further losses and hurt, and feeling even less able to trust again and form healthy new attachments.
What is therefore essential is to change the focus of the work from the child’s stated problem behaviours to improving family communication and relationships: in brief, their attachments.
We realized more clearly the interdependence of the different quadrants of the attachment–protection cycle (see Figure 17, p. 114): the direct expression of feelings by the child (cue); consistent and appropriate meeting of her needs (response) by the carer to create a secure base, with firm holding of boundaries. This helps the child to feel safely held, worthy of protection, and so to act more predictably, giving and receiving appropriate cues and responses to have her needs met. In turn, the carer feels validated as parent, and entitled to provide care to this particular child; so he claims and protects the child as his own, thus providing safety for the child and the whole family.
Firm holding by CcAT therapists of personal, professional, and family boundaries is crucial in this work, which often uncovers child protection issues. (See Figure 16, p. 113.)
178 We learnt, through comparing our longer and more open-ended work with our “control group” families C and D, about the value of doing focused time-limited work with families A and B, time also being an important boundary. This counteracts the tendency for individual or family work to otherwise be more woolly and drift indefinitely, with fewer long-term benefits for families in crisis and overburdened workers.
Play-work with children and families is an essential part of the CcAT Programme. It provides a means of communication between child and adult, a safe way of accessing the unconscious for both and of learning how to articulate that which could not be previously spoken about, or even thought of. It helps the adult to come down to child level, since both have to use play and imagination to depict their situation and empathize with each other. Parents are often astounded at the depth of understanding even very small children reveal through such play about how they feel and how they really view themselves in the family.
We learnt very early on about the value of co-working with every family in order to avoid collusion with either parent or child, or with couples in conflict. Having a therapist to work with the child individually, or in parent–child or family sessions, ensures that he has a “voice” of his own, and an advocate to represent his view to parents, who often do not wish to hear from a child what the underlying problems in the family are.
Especially where there are child protection concerns, it is imperative that we, as CcAT therapists, do not get drawn into countertransferential “acting out” of the parent’s childhood scripts or hooked into the child’s re-enactment of his old family scenarios. This means that the therapists co-working in pairs can take on different aspects of the child–parent split and, in peer supervision or external consultation, reflect on their own feelings and biases and share these, in a more digestible form, with the family (see “Sophie’s story”, Chapter Six).
Although we had devised “Child and Parent Attachment questionnaires” as quantitative tools for use with the families at the beginning and end of the CcAT Programme, we feel that ongoing self-assessment by family members is more respectful and valid. As Maggie Gall commented in her work with family A, 179regular reference to the questionnaires helped the parents to monitor for themselves little changes in their and the children’s attachment behaviours, and so confirmed for them the mutual bonding that CcAT supported.