ATTACh
Accepted Definitions
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Attachment:
Attachment is a reciprocal process by which an emotional connection
develops between an infant and his/her primary caregiver. It influences
the child’s physical, neurological, cognitive and psychological
development. It becomes the basis for development of basic trust
or mistrust, and shapes how the child will relate to the world,
learn, and form relationships throughout life.
Attachment
Disorder:
Attachment disorder is a treatable condition in which there is
a significant dysfunction in an individual's ability to trust
or engage in reciprocal loving, lasting relationships. An attachment
disorder occurs due to traumatic disruption or other interferences
with the caregiver-child bond during the first years of life.
It can distort future stages of development and impact a person’s
cognitive, neurological, social and emotional functioning. It
may also increase risk of other serious emotional and behavioral
problems. Note: for a medical definition of Reactive Attachment
Disorder of Infancy or Early Childhood 313.89, see the Diagnostic
and Statistical Manual IV-TR.
Attachment
Therapist:
The attachment therapist will:
Promote
and enhance a healthy reciprocal attachment between the child
and the primary caregiver(s).
Be
well trained in sound attachment and bonding theory and principles
and child development.
The
attachment therapist’s primary focus of therapy is on the
attachment relationship, not on the child’s symptoms. Therefore,
the parent is an active participant in the therapy.
Practice
attachment and bonding interventions that meet ATTACh’s
safety standards.
Continue
to develop skills through education specific to attachment.
Use
supervision and professional consultation for personal support.
Support
the appropriate authority and values of the parents.
Provide
attachment-focused skills development for parents.
Take
an active and directive stance in working with the child and family
on core issues that they may find difficult to address.
Work
closely with the many systems affecting the child’s life,
such as extended family, school personnel and other professionals.
Attachment
Therapy:
Attachment Therapy denotes the focus of the therapeutic process
rather than a specific intervention technique. Attachment Therapy
can be of benefit to a person who has experienced early trauma
and disruption in primary attachment relationships. The most important
goal is to enable the person to form secure, reciprocal relationships
that the person can heal from the trauma and other psychological
disorders such as anxiety and depression caused by, or made worse
by, the disruption of early attachment.
There
are two primary areas of focus in attachment therapy. The first
is to build a secure emotional attachment between the child and
caregiver (or in the case of an adult in therapy, building the
attachment between the client and the therapist). It is crucial
to begin with this focus, since a trusting attachment relationship
affords the security essential to address these clinical issues.
Once the person is able to make use of a trusting relationship
to learn new information and skills, the focus then shifts to
healing the psychological, emotional, and behavioral issues that
develop as a result of the parent-child disruption and/or early
trauma. These clinical issues may include Post-traumatic Stress
Disorder, grief and loss, depression, anxiety, and neuropsychological
disorders. Attachment Therapy can encompass and integrate a variety
of treatment interventions. It is based on treatment theories
drawn from an array of relevant therapeutic approaches including
behavioral, cognitive, and psychodynamic. Attachment therapy can
be used with cases which range from simple to complex. As in other
therapies, complex cases are often best supported by an integrated
team approach.
Evergreen:
Evergreen is a city in Colorado which has been the North American
center for a wide variety of models of attachment work since the
late 1960’s. It is erroneously referred to as a synonym
for all attachment-based therapy.
Holding:
Although the term “holding therapy” has been used
in the past, holding is currently recognized as a technique which
can be one part of a more comprehensive treatment for attachment
issues during which other supportive therapeutic techniques may
be utilized. Essential components include eye contact, appropriate
touch, empathy, genuine expression of emotion, nurturance, reciprocity,
safety and acceptance. While a variety of holding positions can
be used, the physical safety of the client is the primary consideration.
Rage
Reduction:
Currently the term “rage reduction” refers to a therapeutic
goal, not a specific technique. Reducing the client’s rage
in order to facilitate more adaptive emotional regulation, cognitive
processing and relational capacity may be a goal of attachment
therapy. In the early years of attachment work, the phrase referred
to a confrontational and physically intrusive technique developed
by Robert Zaslow utilized to elicit rage in order to reduce resistance
and thereby facilitate the healing of the child.
Rebirthing:
Rebirthing is the name of an intervention which has been mistakenly
identified with holding therapy. The term actually refers to a
variety of processes designed to help people resolve trauma from
around the time of birth.
Restraint:
Restraint is the application of a physical, mechanical or chemical
force on a person’s body for the purpose of restricting
the free movement of a person’s body. Restraint is a safety
intervention. Restraint is indicated and permitted as an emergency
safety intervention for the protection of the person and/or others
and/or property. Restraint is an intervention of last resort;
it is not a therapeutic intervention.
Manual restraint:
A physical hands-on technique that restricts the movement or function
of a person’s body or portion of their body. The following
are not considered restraint: holding a person without undue force
to calm or comfort; holding a person’s hand to safely escort
them from one area to another; prompting or guiding a person who
does not resist to assist in the activities of daily living.
Mechanical restraint:
The use of a physical device to restrict the movement of a person
or the movement or normal function of a portion of his or her
body.
Chemical restraint:
The administration of medication for the purpose of restraint.
Seclusion:
Physically confining an individual alone in a room or limited
space from which they are prohibited from leaving.
Standards for safe restraint:
Restraint
is never used as punishment.
Restraint
is only practiced by those who have been specially trained in
safe restraint techniques.
Restraint
should never interfere with a person’s ability to breathe.
As early as feasible in the restraint process, staff should inform
the person of the behavioral criteria required for the restraint
to be discontinued.
Restraint should be discontinued when the individual meets the
behavioral criteria.
Restrained
persons should be monitored continuously for physical safety.
Due
to the high risk associated with restraint, institutional settings
such as hospitals require examination by a licensed doctor or
registered nurse or physician’s assistant, within one hour
of the restraint, whenever a restraint is maintained over 20 minutes.
This precaution may not be available in an outpatient setting.
However, if the client is still out of control, combative and
dangerous 20 minutes into the restraint, back-up medical assistance
may need to be called to insure the client’s safety.
