Medium 9781855755055

Child-Centred Attachment Therapy: The CcAT Programme

Views: 1261
Ratings: (0)

This book describes the development of the Child-Centred Attachment Therapy (CcAT) model of working with children with attachment difficulties. The authors describe, in a vivid and accessible manner, the complexities involved in supporting parents in their struggles to respond positively to the needs of children who have been traumatised by their early experiences. After many years of working with a number of families with children who act out their hurt through difficult behaviours, the authors offer their insights to help both parents and professionals to understand and deal more effectively with such behaviours. The CcAT therapists give an impressive account of their belief in a therapeutic approach that focuses on attachment and protection as prerequisites for promoting healthy relationships.

List price: $19.99

Your Price: $15.99

You Save: 20%

Remix
Remove
 

16 Chapters

Format Buy Remix

CHAPTER ONE: The long-term impact of attachment difficulties on families

ePub

Introduction: learning from family stories

All carers and therapists—like the children, families and adults we work with—will have had to deal with key attachment, separation, and loss issues at some time or other in their lives. Many might have joined the caring professions in an unconscious attempt to rework their family scripts, heal from deep wounds of the past, or, as wounded healers, to try to understand or make reparation to others representing hurt children and other family figures from their childhood, as in “Emily’s story”, below.

It is likely that John Bowlby’s prodigious work, Attachment, Separation and Loss, was fuelled by his early life experiences. His sensitivity to the plight of young children separated from their parents, and his intuitive awareness of the importance of mourning, may have been deepened by his own unacknowledged loss at the age of four of his beloved nursemaid, Minnie, who had helped to care for him since birth.

Louis Cozolino (2006, p. 19) argues that therapeutic work requires the inclusion of our personal experience, which is just as important as scientific evidence. As therapists, we learn all the time from our clients, and we are likely to be more affected by certain stories that echo our own family narratives. Such stories tend to inform our therapy practice, consciously or not, and add to a rich and inexhaustible source of learning about the human condition and our varying reactions to it.

 

CHAPTER TWO: Background to the development of CcAT: a programme for fostering mutual attachment between child and carer

ePub

The story of CcAT Phase 1: 1995-1996

Just as each family has its own complex history, with members contributing different perspectives, so do projects such as this I one. The four CcAT therapists involved in the pilot (Maggie Gall, Margaret Saxby, Pauline Sear, and myself) came to it with our own family stories, and conscious and unconscious motivations for wanting to make a difference to children living outside their families by helping them to form healthy new attachments.

All four of us were agreed that we wanted a “child-centred attachment therapy”; hence the name, CcAT, rather than the adult-or parent-centred therapies that seemed to prevail at the time. This did not mean that control-hungry children should be allowed to take over, but that the carers should be supported in staying in charge as parents while respecting their child as a little person in his or her own right, with individual needs and feelings and personal and family stories.

Therefore, we felt very strongly that intrusive holding therapies were contraindicated for children who have already been physically, sexually, and/or emotionally abused. We agreed at the outset that physical holding would not be part of the therapy, unless it occurred spontaneously in a session, initiated by either the child or carer. In any case, as CcAT therapists, we would not engage in such holding.

 

CHAPTER THREE: From theory to practice: CcAT as a "working model"

ePub

Gemma’s story1

Born in the war-torn East End of London, Gemma spent her first three years in a house shared by two families: Aunt Doris, Uncle John, and two cousins, Ronnie and Frances, occupied the downstairs. Upstairs lived little Gemma with her Mum, Dad, and Nan. She was a happy little girl until the day she was sent to a faraway county called Yorkshire, evacuated there to keep her “safe from all the bombing”, the grown-ups said. But no one ever explained to little Gemma why she was the only child in the whole family to be sent away for three long years.

Decades later, travelling by train to Yorkshire as an adult suddenly brought back to Gemma all the repressed memories of her painful exile as a small child. As soon as she entered St Pancras Station in London, Gemma had a flashback to being very small and frightened. She suddenly remembered standing all by herself on a platform crowded with crying children who were being sent away like herself, with no parents to comfort or reassure them.

 

CHAPTER FOUR: Phase 2 of the CcAT Programme (1996): brief evaluation of the pilot project: our learning from adoptive families

ePub

Our local Social Services Department accepted an initial proposal to pilot CcAT, over a six-month period in 1996, with two adoptive families in the north-east and two in the south-east of the county. However, almost immediately there was a change in plan as the north-east team had staff changes and with drew from the project. The CcAT team of four therapists in the south-east, based at a family-finding unit, worked in pairs with families A and B, with the intention of then taking on a further two families for the pilot.

This plan proved to be untenable since three of the workers had recently suffered bereavements, as had their team leader. Each of them needed time off to deal with their grief. Where this was not fully acknowledged, the worker herself then became ill, so that subsequent work with the CcAT family had to be carried out at a slower pace to allow her more time off for grieving.

Grief work cannot be rushed

This was such important learning for CcAT that we did not get it at first, despite the many family losses through illness, accidents, anddeath that staff at the family-finding unit had suffered from the outset of the project. We reluctantly postponed for a few weeks the start of work with our pilot families, but only because, coinciden-tally, Mr A and Mrs B had also suffered parental losses, which meant the additional loss of a grandparent for the children in their new families.

 

CHAPTER FIVE: Phase 3 of the CcAT Programme (1997-2007) CcAT as an independent attachment therapy with birth, extended, foster, adoptive, and step-families: our further learning from families

ePub

CcAT as therapeutic assessment

Our pilot project with adoptive families taught us that truth-telling is an essential boundary in our therapeutic work with children, adults, and families, keeping both them and us safe. (see Figure 16 and Chapter Six). They could otherwise find themselves in potentially abusive situations through our collusion with their parenting failures or “acting out” of old unconscious scripts in response to the child’s learnt behaviours.

Our ongoing work with our control group families C and D (described in Chapter Four, above) highlighted these points of learning, as we realized that the CcAT Programme could easily be adapted to meet the needs of birth, extended, foster, and step-families too.

Indeed, the “child protection” element integral to attachment work suggested that CcAT could be used very effectively in “therapeutic assessments”, by helping struggling families to safely contain children who might otherwise have to be removed from them because of Social Services’ concerns (see Chapter Six).

 

CHAPTER SIX: Re-evaluating CcAT: its potential in child protection work

ePub

Risk assessments in child protection work

There are unrealistic public and legal expectations that the risk of child abuse and/or severe neglect can always be accurately predicted by social workers and/or medical, health, and/or psychological experts. These unremitting outside pressures highlight fundamental concerns and contradictions in child protection and fostering and adoption work:

•  workers’ personal, professional and social values and accountability;

•  the wish to give vulnerable children an optimal experience of family life, even if this means placing them with complete strangers;

•  the impossibility of ever being sure that an abused child will not be at risk again, either within his birth family or with new carers who have been assessed as being “safe”.

Social workers have a duty to protect children from suffering “significant harm” through severe neglect or abuse by carers whomay well have been exposed to the same while growing up. Such parents might even themselves have been in the “care system” when young. Despite the Department’s best intentions and endeavours, they may not have been adequately nurtured or even protected from abuse and/or neglect while in foster care or children’s homes.

 

CHAPTER SEVEN: CcAT therapists' learning and users' perspectives; professionals' perspectives

ePub

A local authority perspective

When I left the family-finding unit where CcAT had been developed, I did independent work using the same principles to help adoptive families facing disruption. The results were positive and, by stripping relationships back to the bare bones, families learnt to reappraise their ways of reacting to each other. In 1999, I was appointed as a local authority Permanence/Adoption Manager. In this role, I commissioned the CcAT team to work with some of the adoptive placements near breakdown. The team were also invited by the child-care team to do family assessments for the courts where parenting was not considered to be “good enough” to keep the child safe.

The CcAT philosophy offered struggling birth mothers a chance to explore their own experiences of being parented when young. Rather than just assessing their current parenting skills, which were poor, by allowing mothers the opportunity to address long buried traumas in their own childhood, the team helped these mothers to recognize the reasons why they felt and acted as they did. Abuse, bereavement, domestic violence, dysfunctional family life, andpoverty; we all know these create vulnerable young adults but, when they go on to have children of their own, we somehow expect them to parent well! Social Services will often commission psychological or psychiatric assessments of failing parents, often in tandem with parenting assessments, but such assessments do not equate with treatment. That is the uniqueness of the CcAT Programme.

 

CHAPTER EIGHT: A future for CcAT: spreading the word among professionals

ePub

We had discovered early on the flexibility of CcAT in work with birth, extended, foster, adoptive, and step-families. We went on to use the Programme in therapeutic assessments for Social Services and the Courts where the placement or attachment needs of a child or siblings were in question. Often, there were also child protection concerns, and/or contact, identity, and multi-cultural issues to be considered. CcAT principles have provided a useful framework within which to assess any or all of these. Ironically, I have carried out some of this work in recent years with colleagues at the Post-Adoption Centre in London, whose own pilot project twelve years ago inspired us to create a Child-Centred Attachment Therapy programme for local use.

A further development was to introduce CcAT in 2005 to an independent therapy clinic which was already well established in providing adult mental health services locally. As waiting lists for local Child and Family Consultation Service appointments extend up to a year or longer, we had wondered whether CcAT could collaborate with the clinic and help to reduce this waiting time for children and families who might benefit from brief attachment therapy.

 

CHAPTER NINE: Overall learning from CcAT: who can benefit

ePub

Even as early as our six-month pilot project in 1996, through E 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.

1.  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.

2. 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 gapbetween 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.

 

Appendix A1: CcAT child's attachment behaviours

ePub

 

Appendix A2: CcAT parent's attachment questionnaire

ePub

 

Appendix B: Life story work and life story books

ePub

Health warning: this can be very painful work for the child and adults involved, leading to regressive behaviours.

Compiling a life story book without involving the child and/or family and foster carers and other significant persons in the child’s life, as appropriate, is not life story work, which is both griefwork and celebration. Arrange a “life celebration day” for the child.

Life story work is a collaborative process, which can take weeks, months, even years, to help a child or young person to understand who they are, where they have come from, why they are where they are now, and who have been the important people in their lives.

Compiling a life story book is a means to that end: it is both a tool and an outcome. Depending on the child’s age and understanding, she may require more than one book—even perhaps a series of simple “graded” books/photograph albums with pictures and simple captions—to help her understand why she is where she is at a particular time.

There may be simpler or more informative books for her to look at on her own, or in the company of trusted carers or others important to her. At least one simple version should be always accessible to her, for when she needs to read or hear her own story, perhapseven as a favourite bedtime story when young. The child needs to be aware that the book belongs to her, and does not have to be shared with anyone (adult or child) who might misunderstand or misuse it. Looking at it together allows her to express her feelings.

 

Appendix C: Structure of CcAT Programme

ePub

 

Appendix D: CcAT work with carers

ePub

 

Appendix E: CcAT child-centred work

ePub

 

Appendix F: Ascertaining the wishes and feelings of children

ePub

New learning can be painful. It may undermine our confidence in what we thought we knew, took for granted, and leave us deskilled. We may have feelings of loss, insecurity, and feel overwhelmed by the demands made on us, before we slowly integrate new learning with the old.

We have all been a child once and so have the innate capacity to communicate with other children now. The more we are aware of our own inner child, the easier it is for us to empathize with other children.

1. Humility: the willingness to suspend adult beliefs and precon ceptions about a child and her situation; to really learn from the child what it is like for her.

2. Observation skills: practise observing children of all ages in interaction with each other and their families, but discreetly! In trains, buses, supermarkets, doctors’ surgeries, playgrounds, adult environments, etc.

3. Be aware of your own feelings (countertransference) when observ ing interactions between a child and an adult. Sometimes verypainful feelings from our own childhood can be stirred up in us when we see a child being treated without respect or affection. We may defend against such feelings, which trigger hurtful memories from our past, by “identifying with the aggressor” (adult)—rather than with the “victim” (the child we are observing in the present, or the child we were once).

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000020389
Isbn
9781780493671
File size
2.97 MB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata