DESCRIPTION

Many of the children referred to The Institute for Attachment & Child Development, Inc. (“IACD”) for treatment initially undergo what is called a two-week intensive program of therapy. In this therapeutic approach the child, parents (and when appropriate, other family members), and a hometown therapist participate in at least thirty hours of daily therapy over a two-week period. This short-term, but intense, format provides an array of clinical advantages when treating highly resistant, controlling, non-trusting children. The consistency, continuousness, and focus of daily therapeutic contact create a context in which the child’s defenses are reduced, his motivation is increased, and a trusting therapeutic relationship can be established. This therapy, however, was never intended to be a “magical cure” even though significant and dramatic changes often occur during the two-week experience. Intense confrontation of emotional issues, in conjunction with nurturing and strong support, “opens the door” for conventional therapy to be more effective. No matter what gains are achieved in the two-week intensive, however, follow-up therapy is essential, in our experience. Another advantage of IACD’s intensive therapy format is our ability to directly observe and modify family relationships and dynamics. Parent-child, marital and sibling issues become evident in these daily therapy sessions. We also encourage referring therapists to participate in the daily treatment process, whenever possible. This increases the likelihood of effective follow-up for the child and family, as well as providing training and supervision to mental health professionals interested in learning about this mental health problem.

THE TEAM

At IACD, a multi-disciplinary treatment team approach is used consisting of therapists, therapeutic foster parents, psychiatric consultant, clinical director, hometown therapist, placing parents and child. Each member of the treatment team plays a vital and distinct role. The success of this treatment is dependent, to a large extent, on each member of the team fulfilling their particular role within the context of the team. Their individual roles are defined more specifically by the treatment plan, which the team develops for each child and family that participates in treatment at IACD.

ATTACHMENT DISORDER DESCRIPTION

IACD was started thirty-two years ago for the purpose of treating children with Attachment Disorder. Attachment Disorder results when there is a serious interruption of the bonding cycle during the early critical stages of life, from conception through the first 26 months. This may be due to a difficult pregnancy, maternal stress or trauma, separations from primary caretakers, sexual abuse, physical abuse, psychological abuse, neglect, maternal depression or other mental illness, frequent change of caretakers, foster care, adoption, parents with inadequate parenting skills or unrelieved pain of the child due to chronic illness.

Children with Attachment Disorder do not learn to trust; they become oppositional, angry and often dangerous to themselves and others. They are unable to give and receive affection in a healthy way. They lack cause and effect thinking and frequently do not develop a conscience. For them, being in control of everyone and everything has become a survival technique. As a result, these children will not allow themselves to be parented. They suffer from one of the most difficult emotional and behavioral conditions. Unfortunately, society is seeing an increase in the number of children with Attachment Disorder. If left untreated, these children with Attachment Disorder have the potential for creating tremendous damage--for themselves, for others, and for society. Many will face a lifetime of incarceration. We are all affected by this unconscionable, but treatable, condition in some way.

SYMPTOMS:

• Inability to give and receive affection in a real way
• Lack of eye contact on parental terms
• Indiscriminate affection with strangers
• Marked control problems; extreme defiance and anger
• Destructive to self, others, animals, material things; accident-prone
• Manipulative, superficially “charming”
• Stealing
• Hoarding and gorging food
• Preoccupation with fire and gore
• Lack of impulse control and cause and effect thinking
• Learning and speech disorders
• Lack of conscience
• Lying about the obvious
• Poor peer relationships
• Persistent nonsense questions and incessant chatter
• Inappropriately demanding and clingy
• Parents appear hostile and angry

Most of these children have been through many different types of therapy which have proved to be ineffective for them. Most traditional therapy is based upon mutual trust and respect and the ability to form a therapeutic relationship. It also depends upon emotional honesty. These are not qualities possessed by the Attachment Disordered child. In fact, these children have been described by others as “extremely poor candidates for therapy”.

THE THERAPY

At IACD, we would define the term Attachment Therapy in the following manner. The term Attachment Therapy describes a wide range of therapeutic processes which may include inner child work, re-parenting, cognitive restructuring, holding, and psychodramas (role playing), among others. The goal is to help a child develop the capacity to trust and love, and by doing so, to live a happy and productive life. Occasionally holding the child in a non-restrictive nurturing way is an important part of Attachment Therapy. The nurturing holds facilitate a positive connection between parents/therapist and the child, and to provide a safe environment for exploration of feelings and confrontation of behavior.

During therapy, IACD uses highly trained therapeutic parents to help the child learn to live and love in a healthy family environment. The goals of treatment are to help children with Attachment Disorder, and their families, find more effective ways to meet their needs. Therapy occurs on multiple levels--cognitive, affective, behavioral, interpersonal and spiritual. Each child is unique. A thorough assessment of the child within his/her family forms the basis for an individual treatment plan. This assessment includes social history, psychological testing, medical assessment, family assessment, review of previous treatment, psychiatric evaluation, etc

TREATMENT INVOLVES:

• Identification of feelings
• Validation of child’s feelings
• Encouragement of appropriate and safe expression of those feelings
• Education as to origin of feelings
• Resolution of early trauma through revisiting the circumstances, reframing the trauma, healing the trauma, empowering the child to grow beyond the trauma
• Working through grief and loss issues
• Cognitive restructuring of faulty thinking patterns, attitudes, and perceptions
• Increasing child’s self control abilities
• Reshaping behavior to more appropriate and socially acceptable levels
• Enhancing a child’s self esteem
• Helping child to develop positive sense of identity
• Improving social interaction patterns by focusing on respect for others and reciprocity in relationships
• Helping child to develop thoughtful decision-making skills
• Helping child to accept responsibility for his/her own behavior
• Helping child to develop the capacity for joyful play
• Helping child to experience and accept loving, nurturing care
• Helping parents learn effective parenting techniques that shape behavior while nurturing the child
• Helping parents identify and alter negative parent-child interaction patterns
• Helping parents resolve their own issues of grief and loss

Although this therapy is sometimes intense, it is always sensitive to the child and to the family. Both the child and the family are respected and cared for. Self-defeating behaviors are confronted. Individuals are asked to work very hard to face the difficult issues which perpetuate these self-defeating behaviors. Confrontation and intensity are important parts of the therapeutic process, but the process includes so much more. The therapeutic process experienced through The Institute for Attachment & Child Development, Inc., is loving, nurturing, respectful, empowering and effective. No harmful or potentially harmful techniques are utilized.

We find this treatment to be highly effective when used by trained professionals in a clinical setting with specific children.

NEUROFEEDBACK TRAINING

Our Neurofeedback program offers a remedy not previously available for reactive attachment disorder. It appears to address the core symptoms of sense of self and other, of emotional bonding, and of empathy, setting the stage for meaningful psychotherapy and re-parenting. Reactive attachment disorder is, at its foundation, a disorder of brain regulation. Neurofeedback challenges the brain to regulate itself more competently in the emotional realm.

THERAPEUTIC PARENTING

Therapeutic parenting is an approach to treating children and training parents of children with severe emotional disorders. The therapeutic parent is a highly skilled and trained individual who works in conjunction with the treatment team to treat the child in the therapeutic milieu of a family. The expertise and involvement of the therapeutic parent are the foundation of this unique approach. The therapeutic parent creates a therapeutic environment in which the team treatment plan is implemented on a 24-hour basis.

During the two-week intensive, the child usually stays with a therapeutic family. The parents have the opportunity to stay at IACD’s charming and historic lodge called William’s House for a reduced rate of $55 a night for each room used. Alternatively, parents can stay at a nearby motel and come to IACD every day for treatment sessions. The child usually does not stay with his parents. Instead the child receives 24 hours per day therapeutic care at the treatment home of the therapeutic foster parents. Parenting techniques that have been found to work for children with attachment disorder are used in the treatment home and throughout the two week intensive are taught to the placing parents. The placing parents spend time in the therapeutic home observing and learning the new parenting techniques. The placing parents thereafter take the child on “practice visits” to their lodgings, local restaurants and other appropriate places to practice using these new techniques with their child. These newly learned parenting techniques teach the child to think through and make appropriate choices, to accept responsibility for their actions, and to develop an “inner voice” (conscience). These newly learned techniques allow the placing parents to be empathic in dealing with the child, but at the same time allow the child to learn from his/her own experiences. As the child learns to trust and love, the child’s beliefs change. The child no longer believes that he/she is worthless and the world is hostile. Instead, the child’s now believes that he/she is worthwhile and capable and the world can help him/her to grow.

FOLLOW-UP TREATMENT:

Once the two-week intensive is completed, the work continues. On the last day of the two-week intensive therapy a follow-up treatment contract is written and signed by all team members. This contract is agreed to by all parties involved in the future care of the child and specifies what will be done by all parties contributing to the continued care of the child. It includes specific time frames, goals and measurements as well as contingency plans. This follow-up treatment plan is the springboard for the child who is beginning a new life. Good communication between IACD’s clinical team, the hometown therapist, the therapeutic family and the placing family is imperative. The team effort allows for the exchange of a variety of ideas. It also provides for the continuity of care with the follow-up therapist.

Most of the time, the placing family departs from IACD with a sense of enthusiasm. This enthusiasm, however, is also accompanied by feelings of inadequacy and fear of failure. Parenting skills learned in treatment seem rough and unnatural at first. It often takes time and practice for the placing parents to incorporate these new techniques into the family life style with a sense of ease. To help the family adjust to and maintain these new ways of interacting, a member of the treatment team keeps weekly contact with the family during the first month following treatment.

During the two-week intensive, the child has gained structured guidelines for behavior and has experienced specific exercises to foster trust and reciprocity within relationships. The child has been emotionally open to the possibility of warmth and love. After the initial two-week intensive is completed, however, therapy must be maintained and follow-up services provided or there is little chance of lasting success. Even with a well-structured post intensive follow up plan, the child can be expected to occasionally revert to old patterns of behavior. When this happens everyone must be ready to address this back sliding by the child. This is a time that tests the resolve, commitment and creativity of everyone. It is a dangerous time in the relationship between the child and his family. But with a good follow-up plan, team support, good communication, and strong parenting techniques, this difficult stage can be positively addressed.

Important to success is the personal and marital strength of the placing parents. They are encouraged to improve communication styles and develop ways to minimize stress while learning to re-parent and nurture their child. Attachment therapists instruct placing parents that the number one rule in effective parenting is to take care of themselves. On-going therapy to resolve personal issues that impact parenting is often recommended for the parents. During the treatment sessions, parents learn to reinforce reciprocity, foster responsible behavior, and maintain structure with their children.

For the child, the true test of the ideal reciprocal behaviors and regard for others is out in the “real world” of challenges and choices. When returning home after the two-week intensive, if parents are able to regularly and consistently employ tools learned in treatment, the child’s chances of trusting others enough to apply reciprocal behaviors and attitudes are dramatically improved. Approximately 6 - 8 weeks following the two week intensive, the therapeutic parent will visit the home to provide additional support and training.

IACD maintains “formal” contact with the family for at least one year following treatment at IACD. In truth, numerous families and children maintain contact with members of IACD’s staff for many years after treatment. During that year following treatment, behavior checklists regarding the child are filled out by the placing parents and reviewed by the treatment team. This forms the basis for on going suggestions and support.

FEES: Two-Week Intensive Fee Schedule

CHILD

The center of our treatment team is the CHILD. The child is the focal point of treatment, as well as the most vulnerable member of the team.

FAMILY

The next focus of treatment is the child's FAMILY. Families not only need to heal from the trauma of living with and loving an emotionally disturbed child, but they also need new skills so they can effectively serve as treatment team members.

THERAPEUTIC FAMILY

The next team participant is the THERAPEUTIC FAMILY. They are intensively involved in the daily life of the child. They help the child learn to be a loving family member. They provide education and support to the placing family. They provide essential information to the treatment team regarding the child's behavior on a daily living basis. The therapeutic family is the "heart" of the treatment team.

HOMETOWN THERAPIST

The HOMETOWN THERAPIST serves as the coordinator of the Hometown Team. Many of our children come from other parts of the world. Reintegration of the child back into his/her family requires that a "hometown team" be established. The hometown therapist is a key ingredient in this team. The therapist will assist the placing family in understanding their child, in understanding their own response to their child, in providing support and/or developing support groups, as well as communicating progress to the treatment team.

THERAPIST

IACD’s THERAPIST provides intensive treatment to the child and encourages all members of the family to address their own issues. The therapist consults with the therapeutic parents regarding specific behaviors the child exhibits. The therapist determines the particular parental therapeutic interventions that are appropriate for the child and family. The therapist also provides support and assistance to the family in carrying out the plan for treatment. IACD’s therapist serves as a consultant to the hometown therapist, providing education and support.

PLACING AGENCY/CASEWORKER:

The referring agency or its CASEWORKER serves an important function as a supporting team member. Frequently, the caseworker helps to advocate not only for the treatment itself, but also helps with locating and securing the funding necessary for treatment. The caseworker has access to local support mechanisms and systems which are essential for the continued success of the family's treatment.

PSYCHIATRIST

The PSYCHIATRIST evaluates the child. Using the medical history, direct information from the family, and reports from the treatment team, an appropriate diagnosis is made by the psychiatrist. Often, the psychiatrist determines that the use of an effective medication regimen can be extremely helpful.

PSYCHOLOGIST

A PSYCHOLOGIST provides psychological testing, as necessary, to gather additional information for the treatment team to utilize in developing an effective plan of treatment.

COMMUNITY SUPPORT SYSTEMS

Sometimes, additional COMMUNITY SUPPORT SYSTEMS are involved which already may be in place or which may be developed by the hometown team. (This could include supportive family and friends. It should include trained respite care providers and a support group.) Efforts should be made to develop understanding supports within the educational, medical, therapeutic, legal, and social services communities.

THE INSTITUTE FOR ATTACHMENT & CHILD DEVELOPMENT PROGRAM

IACD, represented by the DIRECTOR OF CLINICAL SERVICES, oversees the therapeutic process and facilitates the building of a working team. The Director of Clinical Services helps to integrate governing legal guidelines, regulations and program philosophy with the treatment plan that will best help the child. The PROGRAM CLINICIAN gathers admission information, assists with creative funding options, and works with the team to support creative therapeutic interventions. OTHER IACD STAFF work with members of the team to keep appropriate records, deal with financial and legal matters, help with lodging advice, assist with other needs of team members, and generally work behind the scene to keep the IACD program running smoothly. When additional services are needed, these often are available through the IACD program, (e.g., relief, recreational, educational, ancillary treatment options, and follow-up services) and members of the IACD staff can assist with securing these services.

Each member of the treatment team plays a vital and distinct role. The success of this treatment is dependent to a large extent on each member of the team fulfilling their particular role within the context of the team. The roles are defined more specifically by the treatment plan which the team develops.

It is important to request help before things get too far out-of-control. "A stitch in time saves nine" is good advice when it comes to addressing your child's behaviors. Do not hesitate to ask for help. IACD’s staff is available to provide continuing support to families that have gone through our two-week intensive treatment program.

It is important to remember that your hometown therapist is a necessary part of this reintegration process. On-going therapy by a trained attachment therapist will help every member of your family maintain the gains you made during the two week intensive treatment at IACD and during the reintegration process. This ongoing therapy by a trained, hometown, attachment therapist will allow your family to continue to progress. Your therapist should help you to develop further parenting strategies that work for your child and should help to empower you in your role as parents. Insist on this.