ATTACHMENT THEORY FOR PRACTICE
Click on this LINK for details of our Attachment Theory course.
Background to Attachment Theory
Attachment theory is strongly promoted by the DoH / DfES as an effective theoretical base for social work practice. It has “become of age” with significant new research from many sources both supporting (in many ways) John Bowlby’s original formulation and greatly extending the scope of the theory well beyond its power as an assessment tool into intervention methodology.
Any theory that is used for practice should have both explanatory and predictive power. Attachment theory has both in great abundance. Its role within practice situations should assist the analysis of what is observed and help to predict what will happen if nothing is done and, if that is judged unacceptable, help point the way toward planning intervention and predicting the result.
The price of emotional harm is high and if it continues for any extended period it will be significant. This will be true no matter the actual type of harm the child is suffering or is likely to suffer. Few parents would wish their child to become out of control or conduct disordered, become criminal and spend years in prison, or suffer serious mental ill health. Those parents who say they don’t care may already be unwittingly pointing you toward a different, more legalistic, solution.
It goes without saying that partnership with the service user is essential. Commanding change to happen has about the same chance of working as commanding the National Lottery to come up with your numbers. We cannot act like Canute and simply shout stop! However, sadly, we have known social care workers who have thought they could do just that. Plans which are nothing but a series of commands are not worth the paper they are written on. But instead, Attachment theory can be used to “paint a picture” of the future with and without intervention. In this sense, you are selling a story of what will be or what might be not just for the immediate future, but one, two, five, ten or more years down the line and how this might be circumvented. The five outcomes of the Children Act 2004 require us to look far into the future where young children, in particular, are concerned. Any “Risk Assessment” which fails to do this is just not a risk assessment at all.
Introduction to the Theory
Attachment
theory sprang from Bowlby's dissatisfaction with Freudian
psychoanalysis, but it
draws heavily for its inspiration on the Object Relations school of
psychoanalytic practice led by Melanie
Klein. In essence, Bowlby sought to
clarify the developmental implications for the child as it interacts within a
dyadic relationship with its mother or main care giver. Clearly, these two
"objects" (carer and child) are in relation to each other and it is
the evolving dynamics of this relationship, for better or worse, that became the
subject of Bowlby's interest.
Attachment theory is a
theory built of many levels. It draws heavily on ethological
studies, systems
theory and aspects of psychoanalysis. In more recent times, child development
and neurological studies have greatly extended the depth of the theory.
It
can be applied to other non-Western cultures but the significance of what we
call "attachment styles" may need to be interpreted within the norms
of the specific culture of origin as well as referenced to the culture the child
may now find itself within. This is neither a simple nor easy process and expert
assistance may be required.
Nevertheless, we can go a long way with just a simplified version of the theory and although, as in all theory of whatever type, it seems that the world divides into neat little boxes, please bear in mind that here we attempt only to illustrate the worth of Attachment theory and not “prove” its truth (that is too much a task) or even demonstrate its true depth, complexity and usefulness. That is a task for another time and place.
Attachment
for Bowlby was the process of a child forming a secure relationship with its mother.
This process is spatially defined in that it is proximity to the caregiver that
is the prime goal for the child, or indeed, most young animals. A key concept is
the idea of a "feedback loop" characterising the child's proximity
promoting behaviour. For example, the child cries and mother hears the cry and
responds by cuddling the child and the child ceases to cry. This sort of pattern
of child distress followed by positive response by the caregiver is repeated
over and over again in the child's early life making for a positive and
developmentally fruitful bonding for the child. If the child receives negative
feedback then the attaching process is frustrated in some way and the child is in
some manner said to be "deprived".
This
process is known as the Arousal – Relaxation Cycle:
The
period between birth and 6 months of age Bowlby called “Orientation and
Pattern Recognition”. We know today just how important this early stage is
from the intense negative effects noted in some East European Orphanage children
subjected to severe emotional neglect from birth. The principal pattern the
child (normally) perceives is that of its main caregiver's (usually the mother
but it doesn't have to be) responses to the child which involves looking,
smiling, talking, feeding, cleaning and so on. This early experience provides
the beginning foundation of an "inner working model" which is best
thought of as a set of memorised "patterns" which the child learns as
he / she develops through the stages. But be very careful of the word
“memory” here. The child has no words and such “memories” seem to be
akin to spatial – temporal emotional maps of the child’s “proximity
space.”
The child does not say to itself “That person is safe and this person
isn’t”, but nevertheless, something is recorded in the child’s fast
developing neurology which manifests behaviorally as something child protection
workers can recognize as “frozen watchfulness” (more extreme) or “approach
– avoidance” from just one year old.
The
Arousal – Relaxation Cycle is especially important in defining how the
fundamental “Attachment Style” of the child forms. We call this the “Root
Style” and it is essentially in place when the child is a year old and
probably extant several months before. However, within Bowlby’s original
formulation, the next stage he called “Set Goal Attachment” developing
between 6 months and 3 years of age. In situations where “secure attachment”
is developing well this stage will see the continued strengthening of the Root
Style into fully-fledged secure attachment. Between 18 months and 3 years the
role of language will become increasingly more important and will bring into
play other attachment cementing behaviours such as the importance of family
rituals like birthdays, religious occasions, reminisces and comparisons in which
the child features and listens concerning the relationships and emotional
importance of other family members. All these experiences go to comprise what
Bowlby called the “Inner Working Model” (IWM) which is best thought of as primarily
an unconscious structure which lies deep at the core of mental structure.
We
liken it to an onion with the central core being of secure attachment (if all
has gone well) and more and more rings of reinforced security extending ever
outward.
The
rings which are laid down post about 18 months will be more and more
characterized by verbal memory but will still be mainly emotional in nature and
will reflect the child’s experience in terms of the early (brain) regulation
of its emotional state. The regulatory brain state seems to be set within the
first 4 months of life. But it will not be until the child (for most children)
gets past 4 years of age before verbal and cognitive competence will begin to
have the power to position and locate experiences within verbal memory. The
onion rings may also be thought of as “coping strategies” (defence
mechanisms) that the child will have brought into play to ensure its survival in
adverse circumstances. But more on that later.
Attachment
Styles
An hypothesis of Attachment theory is that the “norm” is set around the concept of “secure attachment”. This is one example of what the theory calls “Attachment styles”. There are four main styles and firstly we discuss them in terms of child behaviour:
SECURE
ATTACHMENT (Type B)
These children display clear attachment behaviour after both the first and second separation from the mother. They call after her, follow her, look for her – sometimes persistently- and many finally start to cry, showing clear signs of distress. They react with happiness when the mother returns, reach out their arms, want to be consoled, and seek physical contact. Shortly thereafter they become calm and are able to return to play.
AVOIDANT
ATTACHMENT (Type A)
These children react to separation with little protest and display no clear attachment behaviour, such as following the mother to the door or crying. In general, they continue to play, although perhaps with less curiosity or persistence. Occasionally they follow the mother with their eyes when she leaves the room, so it is clear they do register her disappearance. After her return, they are apt to react to her with avoidance, and they do not ask to be taken into her arms. Usually there is no intense physical contact.
AMBIVALENT
ATTACHMENT (Type C)
These children demonstrate the greatest distress after separation and cry intensely. Their mothers upon return are not able to calm them quickly. It generally takes these children longer to achieve emotional equilibrium. Sometimes they are not able to return to play, even after several minutes. When their mothers pick them up, the children express a desire for physical contact and closeness while at the same time behaving aggressively toward their mothers (kicking, hitting, pushing, or turning away).
DISORGANISED
ATTACHMENT (Type D)
A number of children cannot be placed in any of the above categories although children at the extreme high ends of the Avoidance or Ambivalence spectrum may well be thought of as “disorganised”. Even infants classified as securely attached on the basis of their main behavioural strategy may demonstrate short periods of disorganised behaviour, such as running toward the mother, stopping short halfway, then turning around and running away from her, increasing their distance. That is, the movements of such children may appear to momentarily ‘freeze’. In addition there may be observed repetitive stereotyped behaviour and movement patterns. It appears that the child’s attachment system has been activated but cannot express itself in clear behavioural strategies.
A Word of Warning about Theories and Words
All theories lay down how certain words are to be used. In the philosophy of scientific theory (scientific metatheory) certain terms are called “theoretical terms”. The “attachment styles” of Attachment theory are such “theoretical terms” within the theory. This means that you must use them very carefully and not how you would within ordinary language. To say of a child: “Billy has a strong attachment to his mother” makes sense in the ordinary language of everyday life but it makes no sense within Attachment theory. What you probably mean is that Billy is securely attached to his mother. But you may mean that Billy illustrates strong feelings in an Attachment related way. This is a different story as Billy can still be “strongly attached” to a carer within any of the four main styles as above and this includes insecure styles.
Remember: to say of a child that it is "attached" is merely to say that its attachment system has been activated. To say of a child that it is "strongly attached" or "poorly attached" just means that there is manifest attachment behaviour of some sort (but we don't know which).
The moral of the story is to be clear on the use of theoretical terms and be especially clear about your behavioural descriptions of what exactly the child does and what exactly the parent does. Time after time I read case recording which is woolly and totally useless to assist in reconstructing attachment styles.
Another aspect of confusion within Attachment theory lies in the use of the words "attachment" and bonding". In its strict use, Attachment Theory says of the child that it "attaches" to its main care giver and that the main care giver "bonds" with the child. The two terms are not interchangeable.
Attachment Styles and Adults:
As the child develops into an adult the IWM onion (rings) grows larger and larger and ever more complex. The child must learn to negotiate the outside world and even the most secure and well-adjusted child will soon learn that others are not always kind and trustworthy. But what happens if, from the start, parenting is not as good as it should be? Those onion rings will take on a different character from that of the secure child. We have seen what can happen with children in terms of the Attachment Style typologies above. But how will it manifest years down the road as an adult?
How Disorganised Attachment can resolve into various versions of Personality Disorder is outside the scope of this piece. However, the two main defence “Root Styles” of ambivalence or avoidance can be traced within groupings of the principal typologies of Personality Disorder, especially within the DSM classification system.
Click on this link if you wish to read more regarding trauma and mental ill health.
What is Avoidance and Ambivalence?
At the core of Attachment theory lies genetic inheritance and the long evolutionary history of DNA. The substance at the core of our being has been around for a very long time and from that incontrovertible fact we might hazard a conjecture that it is pretty effective stuff at surviving. The “Attachment system” in terms of the Arousal – Relaxation” cycle is built in. Human babies and other animal babies don’t get a choice. The “Fear / Flight system” is built in. Again, neither we nor other animals have a choice. The “Exploratory system” is built in. From the word go, babies are exploring their environment and responding to external stimuli. Indeed, we now know this happens from just 8 weeks gestation, never mind from birth. We also know that the new born brain is “unregulated” with respect to emotion and that a “neurological task” for the new born infant is to set the regulatory responses of its emotional system. Why this is so is almost certainly a result of evolutionary inheritance and maximising the chances of survival. From an evolutionary point of view any “system” (the brain) which is born fixed is at a considerable disadvantage in responding to stress within its environment. Much better to build in genetic flexibility and turn genes on or off in accordance with what stress is actually experienced. If the stress is low then secure attachment can follow.
Under Responding (Avoidance) and Over Responding (Ambivalence)
The child has two fundamental defence structures at its disposal. But what we understand by "choice" is almost certainly not part of it. Why one child “over responds” and another “under responds” is probably a function of their own particular genetic inheritance. Quite possibly this may be connected to introversion and extroversion but empirical studies seem inconclusive. All we know is that the regulatory system is indeed regulated by the child adjusting to its environment in ways which behaviourally indicate either a dampening down (under responding) or exaggerating distress (over responding). In terms of the IWM both responses indicate insecurity but the behavioural manifestation of what constitutes the IWM is very different in each case. It is very tempting, but obviously wrong, to imagine what is inside the child’s head in terms of verbal description. But the young child has no words. We are back to what seems to be something akin to emotional salience maps recorded within the child’s early neurological patterning. The trigger for this pattern (Type A) or that pattern (Type C) is probably genetic in origin, but as in our onion metaphor, once triggered and reinforced (it is found to work in relieving stress), it will "cement in" and set the scene for life unless radical and profound change is offered to the child in the early period of its life. This is of key importance because you will NOT get back what would have been no matter how you try. The "life chances" of the child will have significantly altered. Nevertheless, a great deal can be done to compensate. But the right interventions are essential.
Paths to Insecurity
The causative path of a child having to defend itself by under or over responding will be to do with the nature of parenting that the child has received.
The Avoidant Child has a parent who may well attend to basic needs but is lacking in stimulation and emotional warmth. The child has to withdraw and essentially learn to amuse itself. The result, if uncorrected, will be an IWM that is insecure but defended by what seems to be a wall built around the insecure core. This wall is protected at all costs by the avoidant person who will not let emotional aspects of life touch him or her. This will even extend to avoiding physical touch.
The Ambivalent Child has an emotionally needy parent. The parent may be “all over” the child one minute but ignore the child the next. It is what suits the parent rather than what meet the needs of the child. The child’s response is to "up the ante" and ensure attention. Ambivalent children are often dramatic, show temper tantrums and are usually hyperactive and attention seeking.
This in-built genetic flexibility is life long. As an adult, you might be as secure a person as they come, but should you be put under stress, your own particular predilection for over and under responding will kick in. Either you will withdraw into yourself and blame others or you will seek reassurance through emotional display. When the stress has gone you will revert back into your normal secure self. Insecure people are "stuck" in one or other modes of responding.
The Onion and Other Defence Structures
It should not be forgotten that Attachment theory is built upon the apparatus of psychoanalysis. Both Sigmund Freud and his compatriots, and most notably his daughter Anna Freud, uncovered many “mental tricks” and behavioural manifestations which they termed Defence Mechanisms. Most of these defences seem to be unconsciously driven devices which help relieve stress. As in the fundamental defences of over and under responding they are probably genetically driven “neurological programmes” which form the character of each successive coping strategy “ring” built around the onion core. Some defences are plainly not unconscious as in suppressive denial. For example: I am conscious that I don’t like something so I deliberately avoid or evade exposure to the object or thought. When we get to looking at the “signs and symptoms” of Disorganised Attachment many of these symptoms will be the result of the (mostly unconscious) adoption of defence mechanisms a la Freud which the child has unconsciously “kicked in” to relieve stress within its environment but which are maladaptive within a caring environment.
Child Maltreatment and Disorganised Attachment
Emotional harm is by far the most serious form of harm a child can suffer in the longer run. We are obviously not talking about fatal or disabling injury but emotional harm is insidious in its effects. All types of abuse to a child involve emotional harm. Physical harm hurts but so does the psychological meaning of realising that your carer has hit you and hurt you. Sexual abuse hurts in the same way. But as soon as the child realises that it has been “used” for sexual gratification by the person who should protect, so the awful psychological meaning of the event hits home. Neglect involves mostly omission: not providing emotional warmth, stimulation, guidance and boundaries, stability, safety and basic care all conspires to an emotional vacuum for the child. And lastly, there is direct emotional harm: bullying, belittling, devaluing, double-binding, unfavourably comparing and so on. All these things twist the mind of the child.
The effects of emotional harm can be seen when the child is a year old within the “test” known as the Strange Situation.
The Strange
Situation is conducted when a child is
between 12 and 18 months of age, in a playroom specially outfitted for the
purpose.
Neither the mother nor child is familiar with the setting, so it represents a
‘strange situation’ for both. The entire procedure consists of eight
episodes, each of which lasts for 3 minutes and is videotaped for subsequent
evaluation (Ainsworth & Wittig 1969;
Ainsworth et al., 1978)
v First and second episode: Mother and child enter the unfamiliar playroom. After a short period of acclimation, the curious child begins to explore the unfamiliar and attractive toys. The mother assists her child in playing only to the extent that it is absolutely necessary. In general, the mother sits in a chair and can observe her child playing. Some mothers read while their child is playing at their feet.
v Third episode: A stranger enters the room, and does not speak at first. After 1 minute the person begins to talk to the mother, and a brief dialogue ensues. The children generally react to the stranger with curiosity or slight anxiety and decrease their distance from their mother; or they may become somewhat more inhibited in their play. During the third minute of this episode, the stranger tries to make contact with the child by offering to play with him or her (the stranger is lively and animated during this last minute of the episode, though not coercive).
v Fourth episode: When she hears a tapping signal, the mother leaves the room without saying goodbye to the child, as instructed. We generally observe that the child follows the mother with his eyes, calls after her, or even begins to cry. Sometimes the child follows the mother to the door, behind which she disappears for a short time. The stranger tries to console the child or to divert him with play. This effort succeeds to varying degrees and sometimes not at all. The episode is curtailed if the child cannot be comforted.
v Fifth episode: After a 3 minute separation, the mother calls the child’s name and then comes back into the room. She picks him up and tries to console him as needed. As soon as the child has quieted down, she allows him to begin playing again. In general children themselves want to return to playing. The stranger leaves the room shortly after the mother returns.
v Sixth episode: A second separation occurs after 3 minutes. After saying ‘Bye-bye, I’ll be back,’ the mother again leaves the room when she hears the tapping signal, and the child is left completely alone. Frequently; we now observe a stronger separation reaction in the child, whose attachment system has already been activated by the first separation. The child often follows the mother, calls out for her, begins to cry, and shows other signs of emotional distress.
v Seventh episode: After the 3 minute separation (or earlier if the child is very distressed) the stranger again enters the room, instead of the mother, whom the child expects. The stranger makes another attempt to console or divert the child.
v Eighth episode: The mother returns after a further 3 minutes, or earlier if the child is inconsolable. If he cries of approaches her, she soothes the child by taking him into her arms. Many, but not all, children return to play after a relatively short period of consolation, usually about 3 minutes.
Note that it is possible to undertake an informal version of this test simply by observing reactions within the family home. However, any conclusion must be considered as an hypothesis for future formal testing.
But what happens when the harm is beyond simply poor parenting and enters the realm of abusive? A child will immediately initiate its basic defences of under or over responding. But what if these don’t work too well? The avoidant child finds it can’t shut the parent off completely because the parent is still needed to enable survival. The ambivalent child finds its temper and dramatics get attention but a price has to be paid of getting shouted at or even worse. Unlike the secure child whose layering of the onion is characterised by ever widening and thickening reinforcements of emotional security, the abused child has to invoke other means of defence. All of these will be specific to counter the situation the child finds itself in. If the defence works to relieve any stress (even in part) it will be repeated and reinforced and incorporated over time into the child’s psyche and behaviour. If the child is now removed from that environment it is like a fish out of water. The child will react by trying to get back into the pond and it will do its utmost to recreate the “safety” (bizarre as this seems) of its original environment. It is this latter set of behaviours, which may last years in severe abuse cases, which substitute carers find very hard to cope with. Even when the child begins to progress any stress will cause the child to regress and revert back to original coping strategies. Over time this will decrease and eventually may almost stop.
Underlying the list of signs and symptoms shown below will be many of the psychoanalytically defined defence structures.
Disorganised Attachment Signs & Symptoms Checklist
- SUPERFICIAL AND CHARMING WITH STRANGERS
- GRANDIOSE ACTS OR EXTRAVAGANT CLAIMS / BOASTS
- RESTLESSNESS: NEED FOR STIMULATION AND ACTIVITY
- DISLIKE OF BEING TOUCHED OR HELD
- A LACK OF AFFECTION TO CARERS / BOSSINESS
- HIGH LEVELS OF RESENTMENT
- HIGH LEVELS OF ANGER, RAGE OR VIOLENCE – ESPECIALLY TO FEMALE CARERS
- CONSTANT BLAMING OF OTHERS
- LITTLE EYE CONTACT
- POOR HUMOUR / FEW SMILES
- LACK OF PLAY
- COERCIVE AND DEMANDING
- “CRAZY”, OBVIOUS LYING IN THE FACE OF PLAIN FACTS
- MANIPULATIVE LYING TO GAIN ADVANTAGE
- EARLY SEXUAL ACTIVITY
- STEALING AND CONDUCT DISORDERS
- ABNORMAL EATING PATTERNS (GORGING / STEALING FOOD / HOARDING / REFUSING TO EAT)
- POOR IMPULSE CONTROL
- HIGH BREAKAGE RATE OF TOYS AND OBJECTS
- POOR PEER RELATIONS
- LACK OF CONSCIENCE AND MORAL SENSIBILITY
- AGGRESSIVE TOWARD PEERS – INCLUDING THE SEXUAL ABUSE OF OTHER CHILDREN
- CRUELTY TOWARD ANIMALS
- PREOCCUPATION WITH FIRE, BLOOD, GORE AND WEAPONS – OFTEN EXPRESSED IN VIOLENT DRAWINGS / PLAY
- SELF-NEGLECT / POOR PERSONAL HYGIENE
(Adapted
from: Howe, Brandon, Hinings and Schofield (1999) Attachment Theory, Child
Maltreatment and Family Support)
See our LINKS page (at the bottom of the page) for further information on Disorganised Attachment.
WHAT TO DO?
The $1000 dollar question is what can be done about insecure attachment? The answer is a lot. But make no mistake - if we are talking about multi-agency input (Team Around the Child stuff) then everyone had better sing to the same hymn sheet or pack up and go home. The child is being done no favours by people doing their own thing. For example, many times I have seen social workers, carers and support staff working to one agenda and the school working to something completely different. Result = failure.
The main finding from research is the need for total consistency and good solid boundaries around the child. The modelling of security must be absolute and unwavering despite all the child will throw at it (remember the "fish out of water" as noted above). If the child is in care, changes of placement are an absolute no-no. To hell with procedural arrangements - it is a child's life we are talking about! An organisation which puts its own systems above the needs of abused children is an organisation which has lost the plot. The idea of moving a child simply because the carer is classified "short term" is just organisational abuse so far as I am concerned.
Getting Further in:
For
younger children, the research of Winnie Dunn on sensory processing patterns is apposite. Much of this can be extended (with
sensitivity) to older children. Kate Cairns has offered a whole dimensional
programme of adapting what she calls the “therapeutic environment” to meet
the needs of the child. This is all basic but key
stuff without which the child is going nowhere.
The
implications of the theory must be studied and understood. Coming on strong with
the touchy-feely stuff (cuddles) for an avoidant child in the early weeks of
placement is going to bring on adverse reaction. The opposite is true for
ambivalent children and a lack of touch-feely will likely cause behavioural
problems. It is true that we want to get to the point where the avoidant child
can begin to explore feeling and the ambivalent child can begin to put distance
into been overwhelmed by feeling. But slowly does it. Trust will be in short
supply.
But
I have been training foster carers many times and have heard with my incredulous
and disbelieving ears that some have been instructed that they mustn’t touch
the child. Really? If there is any semblance of truth in this then who is
abusing who here? Again, it is a child’s life we are talking about.
But I have found that some carers do tend to misunderstand good advice given on "safe
caring" so things may not be as bleak as I am sometimes given to believe.
Level 1 and Level 2 Interventions:
Osiris
call all the above “level 1” work. It comprises the basics of change.
Without it there will be no change. Simple as that. Some children will respond relatively
quickly. Others may take years to stabilise and begin to trust. In any event, the child must be
stabilised before you can move to “level 2” which is essentially doing Life
Story Work with the child. Attachment research shows that Life Story Work is the
best indicated treatment methodology for ALL children who have suffered abuse
and no matter WHAT the placement plan might be.
Please
get one thing straight right now – Life Story Work is therapy. It is
most emphatically NOT collecting photographs, teddy bears, sucking vests, toys
and reminisces of whatever type and so on. Collecting these things and arranging
them is called Life Story Book. It is not the
same thing. Gathering together the Life Story Book can begin early in a
child’s care or treatment programme. It is of critical importance and usually
comprises a whole box or several boxes of items. The Life Story Book should be
used within the Life Story Work to explore the meaning for the child of its
previous experience and help restructure that meaning in the light of the
child's new experience. We are talking about change in the way that the child
processes feelings whether or not the child is avoidant at root or ambivalent at
root and even the most disorganised (older) child will tend to one or the other. Life
Story Work may have to be done more than once depending on the age and
development of the child. And please don't think it is X sessions long either. It takes as
long as it takes.
The measure of success is how well the child can explore those things that it either avoided before or became overwhelmed by. The test will be the child’s own narrative of its life and its willingness to explore and enjoy new things. Easy? No it certainly ain’t! Remember that you cannot scrub out the past. The child has lived it. The task is to help the child come to terms with that past and construct a viable future.
THE END
We
have come to the end of this short introductory piece. We hope that you have found it useful
and it has whetted your appetite for more. And yes, there is a great deal more!
Please contact us for details of our training course which is based around the
above. The fundamental introduction to Attachment Theory is two days with a
further day extending the training on Attachment based Interventions.
We are also able to undertake (for Expert Witness, Pre-Care Proceedings (Public Law Outline), Kinship Care Assessments, Parental Assessments, Foster Care or Adopter Assessments) ) the Royal Holloway College: Attachment Style Interview - Fostering & Adoption.
Click on this LINK for details of our two day Attachment Theory course.
Extra day on Attachment based Interventions is available
There are several useful Attachment Theory links at the bottom of our LINKS page
Please contact us to discuss your requirements.