Disruptive, angry, and challenging behaviours used to be attributed to ‘bad kids’ and parents were warned that they must not ‘spare the rod and spoil the child’. It subsequently became apparent that this was not the best approach as entrenched childhood difficulties may morph into delinquency in adolescence or distressing anxiety and depression. With a broadening of the lens we included primary care givers, who most often were mothers, but once again unhelpful explanations appeared which laid blame on the carer. Leo Kanner, who gave the first description of autism in 1943, explained the condition as being caused by cold, unemotional parenting of the infant and coined the phrase ‘refrigerator mother’.
Fortunately, our perspective has widened further and there is now a rich literature which recognizes the centrality of attachment difficulties as a function of wider family and societal elements and family attachment-based approaches to address these.
Attachment Family Therapy
The central premise of these therapies is that unhelpful attachment templates that prevent a parent responding sensitively and appropriately to their child’s calls for care, underpin many of the childhood difficulties that present to therapy. There are a number of models based on attachment theory all of which focus on repair and strengthening the bonds of safety and security between caregivers and their child. While the intervention is well studied in adolescence there is little work done for this as an approach to childhood difficulties which are often the first point of entry into the helping system.
Are these Approaches Suitable for Children?
Attachment Based Family Therapy, a manualised and evidence – based family therapy model developed by Diamond et al (2014) was originally developed to treat depressed and suicidal adolescents and has subsequently been adapted for use with adolescents and young adults presenting with a range of disorders. As a ‘roadmap’ for therapy it is organised around five therapeutic tasks. However, it is primarily a conversational therapy that requires language and mentalization abilities beyond most children.
Recognising this and the more general difficulty therapists have including children, Van Vlierberghe et al (2023) developed a tailored programme for 8- to 12-year-olds. Like the previous model, it comprises five tasks beginning with a focus on strengthening relationships rather than a goal of controlling or changing the child and uses guided imagery and dolls to evoke and reactivate emotions. Sessions are held with children alone where drawing, games, puppets, role-playing and talking, with humour or phantasy are used to build an alliance with the child and understand their preferred modes of expression. Subsequent sessions are with parents alone to build alliance and parents and child together to repair parent-child ruptures and promote trust by building secure base interactions. The final task works to consolidate skills developed in previous sessions and considers the broader system, including the digital world in which the child and family live, which will pose challenges to their relationships.
In Conclusion
This adaptation of a well-researched model for adolescents provides another avenue for work with children that ensures they can be active participants in the process of change at the most fundamental level of relationships.
Van Vlierberghe, L., Diamond, G., & Bosmans, G. (2023). Middle childhood attachment-based family therapy: Theory and model description. Family Process, 62, 1040–1054. https://doi.org/10.1111/famp.12887
