I serve children who have suffered disruptions in significant attachment relationships. The disruption is often related to maltreatment in the form of abuse and neglect, but may also result from other causes (e.g. chronic pain in infancy, temporary separation from caregiver).
I am committed to providing effective treatments that aim to resolve the symptoms related to their trauma. Strengthening attachment and relationships, developing improved living skills, and processing unresolved trauma and grief are the goals of my treatment.
I provide training to birth families, foster families, and adoptive families to assist them in understanding their child(ren) and to develop therapeutic parenting skills which are critical to the child’s success in overcoming barriers to attachment. The therapeutic approaches for helping children and families are described below:
My treatment approach is based primarily on three models of treatment:
Dyadic Developmental Psychotherapy (DDP)
Description: DDP is a family centered treatment approach that aims to strengthen attachment and resolve trauma. At its core is the use of a safe setting where a child can begin to explore, resolve, and integrate a wide range of memories and emotions. This includes addressing the child's current experiences that are frightening, shameful, avoided or denied. The therapist and parents/caregiver work together to provide attunement to the child and maintain an attitude of PACE (playfulness, acceptance, curiosity, and empathy).
Building the Bonds of Attachment: Awakening love in Deeply Troubled Children, Daniel A Hughes, 2006.
Attachment Focused Parenting, Daniel A Hughes, 2009
Description: Theraplay is an engaging type of therapy. It aims to replicate healthy parent-child attachment relationships and uses four dimensions to do so. Each session includes structure, engagement, nurture, and challenge activities. Theraplay helps the child replace inappropriate coping behaviors with healthy, creative, age appropriate solutions by offering activities which aid in self-control and self-regulation. Theraplay also aims to increase the child’s self esteem by emphasizing the child’s strengths and positive attributes. Finally, Theraplay increases the positive interactions between the child and caregiver through emotionally attuned, interactive, physical play; thus enhancing the relationship.
Theraplay: Helping Parents and Children Build Better Relationships Through Attachment Based Play, 2nd Ed., Ann M. Jernberg & Phyllis B. Booth (1999).
Narrative Attachment Family Therapy
Description: Children develop beliefs about themselves and the world based on their early experiences with caregivers. Children with negative experiences form negative beliefs, such as “I’m bad”; “I don’t deserve love”, “I can’t be safe”. This belief system drives the child's feelings about themselves and their behavior. Children who think they are bad act bad. This treatment approach attacks the mistaken beliefs (also called internal working model). Parents intuitively know their child’s deepest needs and emotions. With this approach, they create a story, with a protagonist or hero with whom the child can best identify. Through the process of telling the child the story that identifies the child’s key struggles, parent’s empathy provides a pathway of attunement to their child. This is a critical factor in strengthening attachment
Parenting With Stories: Creating a Foundation of Attachment for Parenting Your Child, Melissa Nichols, Denise Lacher, & Joanne May, 2002
Connecting With Kids Through Stories: Using Narrative to Facilitate Attachment in Adopted Children, Denise Lacher, Todd Nichols & Joanne May, 2005
Integrated Treatment Approach
I provide education to assist families in understanding why their child struggles. I agree with Ross Green, author of “The Explosive Child” that kids behave well when they can. If kids are not behaving well (and thus not feeling well internally), I work to understand why and provide necessary interventions. To aid in this process, I screen children for the common problems that children with attachment issues have, including: sensory processing, auditory and language processing, and challenges related to in utero substance exposure. When necessary, I refer to the other professionals who diagnose and treat these common co-existing conditions.
My treatment approach is grounded in the latest research. The work of researchers and clinicians, such as Dr. Bruce Perry ( http://www.childtrauma.org/ ), Dr. Alan Schore ( http://www.allanschore.com/ ) , and Dr. Daniel Siegel ( http://drdansiegel.com/ ) have shown the inter-relationship between brain functioning and attachment relationships. The therapy approaches I use are consistent with what these experts have determined to be effective in treating children with attachment problems.
Children are not worked with in isolation. Parents/guardians are a critical part of the process. The adults are involved in a number of ways. First, they are present for family therapy, including the three models described above. In addition, I work with caregivers without the child present to focus on developing a therapeutic parenting plan. Finally, individual and couple therapy may also be recommended to caregivers as a means to help strengthen the family unit.