David Oppenheim, Ph.D. University of Haifa, Israel Douglas Goldsmith, Ph.D.

1. Separation and Reunification: Using Attachment Theory and Research to Inform Decisions Affecting the Placement of Children in Foster Care David Oppenheim, Ph.D. University of Haifa, Israel Douglas Goldsmith, Ph.D. The Children’s Center, SLC, UT

2. Plan for today • Introduction and basic principles of attachment theory • One child’s story of attachment, separation, loss – and attachment • Misapplication of Attachment principles in: Theory Assessment Intervention

3. Attachment Theory • Formulated by John Bowlby and Mary Ainsworth to account for the impact of early separation and trauma on the child • Has revolutionized our views of development, psychopathology, and clinical work • Is the most prominent theory today regarding early socio-emotional development

4. Attachment Theory • Is empirically based and supported by research • Is particularly useful in thinking about permanency issues

5. Basic Principles: Forming Attachments • The child is highly motivated from birth to form and maintain attachments to a few caregivers • Attachment has survival value • Children will do whatever is necessary to maintain their attachments and to achieve security • The baby uses the attachment figure as a “secure base”

6. Cooper, Hoffman, Marvin &Powell , 2000

7. More basic principles:Attachment Security • Attachment figures become “psychological parents”. • All babies attach but the security of the attachment depends on the caregivers responses to the child • Sensitivity: Reading the infant’s signals accurately and responding to them appropriately • Insightfulness: Seeing things from the child’s point of view; empathic understanding of the child’s experience

8. Cooper, Hoffman, Marvin &Powell , 2000

9. Cooper, Hoffman, Marvin &Powell , 2000

10. Attachment: Infancy and Beyond • Early attachments lay the groundwork for later development • Children form Internal Working Models of their attachment relationships • The legacy of early attachment is reflected in children’s relationships with others, self-regulation, emotional openness.

11. Separations from attachment figures • Are challenging for young children – and for all of us! • The child experiences separation as a threat to the availability of the secure base. • The degree of challenge will depend on the degree of threat • Often involves separation not only from the parent but from everything familiar

12. Separations • Strong reactions will occur when separating from nurturant parents - but also from abusive parents! • Under certain conditions separations can be traumatic and have devastating consequences.

13. Separation reactions Follow the sequence of • Protest (anxiety, anger) • Despair (sadness, withdrawal) • “Detachment” (recovery, renewed interest in the world).

14. The Case of Sara • Placed for adoption upon discharge from the hospital • 5 months of age legal adoption is not completed • Sara enjoys a loving relationship with her parents • The parent child relationship is marked by reliable, emotionally attuned, and responsive care

15. The Case of Sara • Allegations of neglect arise • Sara is removed from the home at the age of 10 months

16. The Case of Sara Shelter home for four days Second foster home for one week Third foster home for eight weeks Adoptive home

17. The Case of Sara • Upon arrival to the adoptive home Sara stares blankly, refuses social interaction, and is oblivious to pain after undergoing a medical procedure • Believing that Sara is available for adoption her name is changed

18. The Case of Sara • At the age of 15 months Sara is responding well to her new environment • First adoptive family hasn’t seen her for 6 months and want her returned to their care

19. The Case of Sara • Should she return? • Who are the “psychological” parents? • Does she remember her first adoptive parents? • She’s so young that she won’t remember anything and can be returned without distress • Sara is a “resilient” child

20. The Case of Sara • The internal working model – viewing the world through Sara’s eyes • Assessing “risk” • Could reunion reactivate feelings of loss? • Utilization of second adoptive parents as a secure base • Impact of no contact

21. Common misunderstandings: Theory • There is a critical period in which attachments are formed. Early childhood is critical, but there is no point when security cannot be damaged • A secure attachment provides “inoculation” Secure attachments serve as buffers, not inoculations

22. Common misunderstandings: Theory • Secure children are resilient and therefore can be separated Resilience involves a relationship between the child and the environment; it is not a fixed trait “in” the child • Security or insecurity are personality traits. Security is a property of a relationship, not a child

23. Common misunderstandings: Theory • We can predict children’s development based on their early attachments Developmental predictions are probabilistic. The balance between risk and protective factors is key.

24. Common misunderstandings: Theory • Children do not become attached to maltreating parents (or can easily detach from them) Children attach to maltreating parents and separation will be experienced as a loss Removal must always be seen as a last resort; focus on repair of the caregiving relationship • Children’s relationships with their mothers are the most important Children can develop attachments to several caregivers

25. Common misunderstandings: Theory • Children do not have memories of their early years, and therefore they do not have lasting impact. Children do not have declarative memories but may have procedural memories encoded in their IWMs

26. Common misunderstandings: Observational Assessment • An observation in the office or at home can be used to assess the child’s attachment Contexts that are not stressful may reveal very little about the child’s attachment Casual observations of untrained observers, without the aid of video, and in unstructured situations are of very limited use • Pleasurable play is an expression of a secure attachment Attachment is most apparent in stressful situations

27. Common misunderstandings: Observational Assessment • Clinging or seeking closeness is an expression of a secure attachment If desperate, children will cling even to complete strangers, but they will not serve as a secure base • Conflict is an expression of an insecure attachment Conflicts are integral to healthy relationships; the issue is their negotiation

28. Common misunderstandings: Observational Assessment • Protest during separation is an expression of an insecure attachment (or, conversely, of a secure attachment). Protest during separation indicates that an attachment bond exists; it tells us little about the child’s security • Ignoring the caregiver, particularly upon reunion, is a sign of non-attachment (conversely, is “normal”) Avoidant children are attached to their caregivers; the avoidance indicates insecurity, particularly experiences of rejection

29. Common misunderstandings: Assessment • A secure child has secure relationships with everyone Children can have different attachments to different caregivers • Strong emotional and behavioral reactions before or after a visit with the birth mother are indications of maltreatment by the birth mother or insecure attachment to the foster parents. These kind of reactions are expected separations reactions and tell us little about the child’s experience

30. Common misunderstandings: Assessment • Separations and reunions are the only contexts in which attachment can be assessed May be not very stressful for older children; the issue is activation of the attachment system • We know how to perform a “Bonding Assessment” We don’t! And what does “bonding” have to do with it anyway?

31. Common misunderstandings: Intervention • Children do not develop attachments to foster mothers Children develop attachments to their foster mothers, and their quality depends on the care the mother provides • The intuitive capacities of foster mothers are sufficient “Normally” sensitive mothers often need special help when providing care to foster children

32. Common misunderstandings: Intervention • Intervention can help children in periods when placement has not yet been determined It is extremely difficult to implement psychotherapeutic interventions when the child’s fate is uncertain • Problems in the relationships between foster children and their parents are due to faulty parenting/damaged children. Problems are products of relationships, and the key involves helping develop a good “fit”

33. Common misunderstandings: Intervention • Reminders of the birth mother are distressing; therefore they should be avoided (context: short separations) We should think of what promotes the child’s confidence in the continued availability of the “secure base”

34. Common misunderstandings: Intervention • Children who do not speak do not understand language. Therefore, talking with them about the transitions they are experiencing is useless (and changing their name is insignificant). Expressive language lags behind receptive language; children understand much more than they can express