Two weeks ago, I had the extraordinary blessing of welcoming our newest grandson, Jonah Avery, into the world and supporting him in his first week of life outside the womb! Just as I was reminded almost three years ago with the birth of his big brother, Levi Benjamin, these little beings are true miracles, and they are completely at the mercy of their caretakers. At our Institute trainings, we talk a lot about the power and importance of secure attachment. It is the literal foundation upon which everything else in life is subsequently built. When you have the privilege of spending time with a newborn, you profoundly understand their helplessness and their vulnerability. You experience just how inherently fragile and dysregulated they are and how they are completely reliant on co-regulation for their very survival. Aside from a primitive sucking reflex, their comfort comes from movement, touch, physical and emotional nurturance, and the soothing, reassuring voice of primary caretakers.

When a newborn and young child receive these essential life-giving and life-enhancing experiences, they can thrive. When attachment is insecure: dismissive, ambivalent, or disorganized, the child remains dysregulated and responds with withdrawal, anxiety, or terror. Whatever your clients’ presenting problems are, and whatever else you are addressing in treatment, it is essential to look at the client through the lens of attachment and to understand the historical context and relational template they were given.

"The fact that more than 50% of children do not experience consistent, predictable, safe, secure attachment enough of the time is horrifying, and it goes a long way towards explaining the adverse sequalae and overwhelming challenges they endure as they move through life." ‍

We now understand that attachment directly impacts a child’s developing brain architecture, and without the constancy of secure attachment, neglect and abuse flood their developing brains with cortisol, the stress hormone that undermines healthy neuronal connections and growth.

In addition to assessing for early attachment patterns, provide the psychoeducation to clients so they can make a connection between those formative experiences and the subsequent impact they have on trust, security, self-esteem, intimacy, and self-worth. It is equally helpful to remind clients of the power of neuroplasticity: the brain’s malleability and its capacity to grow, change, and heal. Despite early experiences of insecure attachment, the reparative aspects of the therapeutic relationship can never be underestimated. 

Therapists provide powerful, consistent experiences of secure attachment, and it is never too late for clients to benefit and thrive from those interactions. It is my wish that every child receives the love, compassion, and attention that my grandsons are blessed to experience.  And when we work with clients who, through no fault of their own, were not given what they needed and deserved, may we have the wisdom, creativity, strength, and support to provide the compassionate repair that will help them to heal.

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Clinician's Tips:

- Secure: caretaker is attuned, present, and consistently willing to meet their child’s needs without shaming them for having those needs.  Child’s response: secure, calm, confident

- Dismissive: caretaker is unavailable, disengaged, rejecting, unwilling or unable to meet the child’s needs. Child’s response: emotionally shut down, avoidant and overly self-reliant

- Ambivalent: caretaker responds inconsistently and unpredictably, fluctuates between enmeshment, available, and then disengaged. Child’s response: anxious, confused, afraid of rejection

- Disorganized: caretaker is either frightened by the child’s needs or frightening to the child, responds only with fight, flight or freeze reactions. Child’s response: fear, rage, fawning or withdrawal