Chapter Four
Adult
Attachment Assessment
If the intention of
therapy is to change parent behavior in order to increase the child’s sense of
safety and security, to help them attune to their child and demonstrate it, then
understanding what drives the parent is essential to treatment. Identifying the parent’s attachment style,
understanding their trauma history, and joining in their parenting journey are
the keys for me in helping parents help their children heal and grow. Reviewing clients’ trauma history and
attachment styles also provides context for helping couples and individuals in
their relationships whether the issues are communication, finances, and
intimacy or grief, mental illness, and substance use. Certainly some issues are best and most
quickly addressed with present focused cognitive-behavioral and future focused
solution focused treatment. But when
working with children no one can ignore the impact of early attachment,
developmental history, and parenting style to their overall health and functioning. And when working with parents no one can
ignore the impact of the way they were parented and their ideas about
parenting. Every time I have ignored by
better judgment and moved ahead with parent-child treatment without
investigating the parents’ history and relationship style, the issues have
stalled any progress.
Using Mary Main’s Adult
Attachment Interview as a guide, while certainly not trained or following the
protocol, I use a brief set of structured questions that help reveal for me and
the client some of the roots of the challenges they have in parenting and
relationships in general. The format,
order, and tempo of the interview are important. They allow the answers to come unfiltered and
unprocessed revealing often unconscious beliefs, feelings, and thoughts that
drive present behavior. I say slowly
with no additional explanation, “Please give me three adjectives that describe
your childhood.” Then, I ask for an
experience that goes with each of those adjectives, and I wait. I do not explain the question or give
examples. Then, I ask the client to
describe how their relationship with, first, their mother, and then their
father developed from infancy to adulthood and how it may have changed along
the way. The follow up question here is,
“Did you ever feel separate or rejected by your parent?” Then, “Was there anyone else to whom you felt
close; an older sibling, aunt, uncle, grandparent or family friend?” After these questions, I ask about the
person’s journey to parenthood with some set-up. “From an early age, and for both boy and
girls, we usually have ideas about if, when, how we might become parents and
what kind of parent we will be.” Then I
acknowledge that the reality of parenting rarely matches our ideal and ask,
“What are your parenting challenges?
What do you find most difficult about parenting, or parenting this
specific child?” Finally, I ask how the
client parent best learns, that is, how I may coach or support them. This has to do with the parent’s learning style;
audio, visual, or kinetic. “Some people
like to read and do, watch and do, or learn by doing.” This exchange usually takes 10 to 15 minutes
per parent.
I conduct the interview with clients in
individual sessions and with couples together.
Sometimes couples may be hearing this material for the first time in
this way, and sometimes one partner will prompt the other with an example. While it may be more accurate to do this
interview individually with each member of a couple, the interview is so brief that
it does not seem to make much difference.
Neither does it seem to make much difference if one or the other partner
goes first, giving the other a head start thinking about their answers. It feels more valuable if the client answers,
“off the top of their head”, or “what comes to mind first”, but it is also
helpful for partners to hear the other’s answers. This self-disclosure and self-reflection often
leads to some surprising insights and the beginning of empathy and
understanding, which is the whole point.
In terms of interpreting
the information from this brief interview, I am listening as much to the depth
and tone as to the content and coherence of the answers. The first answer adjectives may include
happy, fun, adventurous or sad, lonely, and poor. Based on the adult attachment styles
identified by Mary Main, these descriptors are not as important as what comes
next. If the examples of childhood
experiences are consistent with the adjectives it demonstrates some coherence
in the person’s understanding of their life story. For example, a lonely childhood in which
parents were divorced or absent makes sense, describing it as happy with no further
detail does not. I have heard parents
describe a painful childhood in which parents were clearly abusive. This does not necessarily predict adult
relationship problems. One client reported
a happy childhood but with no memories before the age of six. The partner reminded the client that they
were ill as a child spending a lot of time in the hospital. The parent seemed disconnected from their own
suffering. The couple was asked to care
for a boy with anxious attachment, the result of inconsistent care by parents
with drug addiction, and a teenage girl with avoidant attachment, the result of
multiple foster care placements. The boy
was very needy and demanding. The girl
seemed independent and wanted nothing to do with adults. One can see that the mother with the
dismissive adult attachment style, who could not feel empathy for herself, would
have difficulty feeling for these children.
You might predict that the mother would find the boy annoying and
needing of medication or another placement.
On the other hand, she would be unlikely to see the need to reach out to
the teenager until it was too late. In
the first session, she was most concerned about how to decorate their rooms
before their arrival. In contrast
another parent reported a sad childhood in which his parents were addicted to
alcohol nearly causing a divorce and lots of conflict in the family. The parents subsequently achieved sobriety,
the parents and children became closer in adolescence, and the client used
therapy to process his childhood. This
earned security gave him the ability to be reflective about his own experiences,
and his wife’s, and thus more likely to be able to be responsive to their
children’s feelings. Next, the questions
about relationships with parents and times of rejection reveal whether the
parent experienced acceptance and empathy from their parents, and thus have the
ability to provide it to their children.
If the parent experienced repair of a disconnection with their parent
they are more capable of repairing the inevitable disconnections with their
children. A parent once described an
abusive childhood at the hands of her father who she had cut out of her
life. It was not the fact that the
breach had not be repaired but that the wounds were still very raw, a
preoccupied adult attachment style, that made it difficult for this parent to
tolerate a child with a disorganized attachment style, his neediness and anger,
without taking it personally. To be sure
developing secure attachment requires both the anxiety of need and satisfying
the need, the rupture and repair of relationship. This is what Daniel Siegel (2013) describes
as “the dance of attunement”. In the
parent-child relationship, the parent leads the dance and has the
responsibility to correct the missteps; disconnections can lead to stronger
connections if parents have the self-awareness and self-control to make the
necessary adjustments. Parents do it all
the time when they hear a baby cry and through trial and error find what sooths
the infant.
The idea here is that no one gets through
life unscathed, without experiences of separation, pain, or trauma. A secure adult attachment style does not mean
the parent had a perfect childhood but that they have made sense if not peace
with it and so is better able to take responsibility for their triggers when
they arise with their children. Children will “push our buttons”, but they did
not put them there, our parents did.
Knowing where our buttons are, and taking care to heal them on our own
and take care of ourselves, is essential to mindful parenting. Also, especially in adoption, children have
attachment styles that are the result of previous caregivers and experiences,
with strange coping behaviors like lying, stealing, and aggression. Adoptive parents can “take themselves off the
hook” for creating some of the behaviors, but make the commitment to care for
the child. Healing is in their
hands. Children do not choose to be
abused, and they do not choose to be adopted.
Their misbehaviors, intentional as they may seem, are not choices but
their attempts to cope with their own triggers.
Often the child’s trigger is the parent themselves, especially the safe,
nurturing parent. This is what Bruce
Perry describes as “relational PTSD”. The
child has difficulty accepting and believing in loving parenting. So, understanding the parents’ triggers is as
important as understanding the child’s.
I do not use this interview to determine the
parents’ adult attachment styles. That
would be unethical, unnecessary, and not particularly helpful. Instead, what is helpful is identifying the
parents’ triggers so I can notice them and help them manage them in present-day
interactions with their children. Is it
any wonder that a parent raised by a father with an alcohol problem finds his
son’s impulsive behavior so difficult to deal with? The father’s automatic response is to raise
his voice or leave like he did to avoid conflict with his father, both of which
disconnect him from his child who needs him close and calm. Knowing this helps him change his reaction to
a more effective response. One mother
whose adopted son was so anxious that he would not let her go to the bathroom
without banging on the door and who once drove away leaving her child at home
realized that she used to run away and hide anytime her critical father
demanded she do more work on the farm.
Knowing this helped her stay and tolerate her discomfort until her son
was comfortable that she would not leave him.
I keep and refer back to this
information often throughout the therapeutic process. Daniel Siegel provides excellent questions for
parental self-reflection (2003, p. 133), and I often suggest his entire book,
Parenting from the Inside Out, as homework for parents, in addition to a class
based on it.
Parents’ hopes and dreams about having
children, their motivations and reasons for becoming parents, often explain
their actions and emotions in facing current challenges. Again, whether we decide to have children or
not, to give birth or adopt, and there is huge social pressure do so, each of
us has fantasized about the kind of child we would have. Even if for a fleeting moment, we have
considered “our” child. Sometimes, that
fantasy is fully developed. We decide
the gender, we picture hair color, we pick the clothes, the school, the career. Nobody dreams of having a child with
challenges. Sometimes, we choose not to
parent and a child with challenges shows up anyway. Unplanned pregnancies and grandparents
raising grandchildren are two examples. And,
the contrast between our expectations and reality often cause conflict, grief
and loss. We experience pain and sadness
when our children are in pain and we cannot help them, or what we are doing
does not seem to be working the way we want.
As Kubler-Ross taught us, grief and loss is part of life, a process to
be identified and addressed. The last
stage she identified, acceptance, is better stated as readjustment. We do not get over loss, we get used to
it. We incorporate it into the story of
our lives. Grief and loss is a central
issue in adoption. Particularly, in
adoption, if parents have spent years trying to give birth or considering adoption,
they have also spent more time developing a picture of their “ideal
child”. Usually, adoptive parents are
even asked their preferences as to gender, age, and ethnicity, as if ordering
at a drive-through restaurant. Even if
their “real” child matches their preferences, he or she is not, cannot be, that
“ideal child”. Not even birth children
match up. Each child surprises their
parent with their uniqueness, their collection of abilities, personality, and
temperament. It is the discrepancy
between the ideal and the real that causes the pain. The real child exists. The ideal child never did, except in our
minds. Until we grieve, yes bury, the
ideal child, it is very difficult to accept the real one. And acceptance is the beginning of attachment
and healing. As therapists we are loss
managers, we run the funeral home.
Acknowledging this and guiding clients through it is part of the
treatment plan. Creating rituals can be
helpful as an intervention.
In terms of choosing interventions it is very
helpful to know the client’s learning style.
As therapists our shelves are full of books explaining symptoms and
diagnoses, exercises and interventions.
We learn in different ways, too.
A client who can read about their situation brings so much knowledge and
understanding into the session for work.
There may be little teaching or psycho-education that needs to be
done. Some clients take in everything we
say and benefit from our explanations and examples. Others really need not just our demonstration
of a technique but our coaching in trying it themselves, whether it is using “I
statements”, tone of voice, or playing with their children. A favorite time was when two beautiful,
smart, funny twin boys decided they did not want to follow their mother’s
instructions to shake my hand and walk out of my office. A loud tantrum ensued, two hours of
overturning chairs, dumping the contents of an ottoman, taking the wheels off a
table. When their mother pleaded or
placated, they cried louder, “You’re ruining my life! Let us leave.” They could have walked out at any time, they
never did. When I got quiet, and coached
the mother to stay calm, the chairs went upright, the puppets went back in the
box, and the wheels went back on the table with perfect cooperation and
skill. Stress created the tantrum, they
were testing whether they could trust their mother to hold her ground. Quiet calm created the safety they needed to
put their thinking caps back on, and a friendly handshake sealed the deal.