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Q7. What do you understand by attachment based interventions? Discuss the technique used in attachment based interventions.
Attachment-based interventions are based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster cares.
Following are approaches used by mainstream attachment theorists and clinicians aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Dyadic developmental psychotherapy: For families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. The "dyad" referred to must eventually be the parent-child dyad. It involves creating a "playful, accepting, curious, and empathic" environment in which the therapist attunes to the child's "subjective experiences" and reflects this back to the child.
Child–parent psychotherapy (CPP): This approach to treating disturbed infant–parent relationships is based on the theory that disturbances are manifestations of unresolved conflicts in the parent's past relationships. The "patient" is the infant–parent relationship.
'Circle of Security': The aim is to present ideas to the parents in a user-friendly, common-sense fashion that they can understand both cognitively and emotionally. This is done by a graphic representation of the child's needs and attachment system in circle form, summarising the child's needs and the safe haven provided by the caregiver.
"Watch, wait and wonder", Cohen et al. (1999): It is based on the notion of the infant as initiator in infant–parent psychotherapy. The idea is that it increases the mother's sensitivity and responsiveness by fostering an observational reflective stance, whilst also being physically accessible. Also the infant has the experience of negotiating their relationship with their mother.
"Manipulation of sensitive responsiveness", van den Boom (1994) (The Leiden Programs): This intervention was based on Ainsworth's sensitive responsiveness components, namely perceiving a signal, interpreting it correctly, selecting an appropriate response and implementing the response effectively.
"Modified interaction guidance", Benoit et al. (2001): This intervention aimed to reduce inappropriate caregiver behaviours as measured on the AMBIANCE (atypical maternal behaviour instrument for assessment and classification). Such inappropriate behaviours are thought to contribute to disorganized attachment.
Feedback methods such as VIPP, CAVES and VIG: Videofeedback intervention to promote positive parenting (VIPP) aims to promote maternal sensitivity through the review of taped infant–parent interactions and written materials. Clinician assisted videofeedback exposure sessions (CAVES)and VIG (video interaction guidance)are the other two methods.
Attachment and biobehavioral catch-up (ABC): This an intervention programme aimed at infants who have experienced early adverse care and disruptions in care. It aims to provide specialized help for foster carers, targetting key issues: providing nurturance for infants when the carers are not comfortable providing nurturance, overriding tendencies to respond in kind to infant behaviors and providing a predictable interpersonal environment.
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According to attachment theory attachment behavior in adults towards the child includes responding sensitively and appropriately to the child’s needs. Attachment based interventions are based on this premise.
The various techniques that leverage this include Dyadic Developmental Theory, CPP, Circle of Security, Wait, Watch and Wonder, ABC etc.
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