Evidenced Based Practices for insecurely attached children and trauma

February 20, 2013

I am frequently asked about “attachment therapy” and “attachment parenting” and various treatments. Many books and others claim success with their approach and individuals often write glorious reviews of these approaches. Yet, we know that these approaches are NOT supported in the literature and withstanding the scrutiny of peers. As such, I wanted to just briefly compile a short list of assessments, tools, treatments and theory approved by Advocates for Children in Therapy that is evidenced based (researched and replicated with a control group) and a list of unsupported assessments, tools, treatments and theory. These can also be found on the Advocates for Children in Therapy website as well as literature such as Handbook of Attachment, Disorganized Attachment, Disorganized Attachment and Caregiving, Parenting Representations, Clinical Applications of the Adult Attachment Interview and others. I have also included a list of accepted assessment tools for assessing attachment quality.


Parent-Child Interaction Therapy (PCIT)

Kazdin Method for Parenting the Defiant Child

Attachment and Biobehavioral Catch-up Intervention

Circle of Security

Incredible Years

Adult Attachment Interview

Strange Situation

Attachment Q-Sort 

Attachment Story Telling Completion Task

Attachment Doll Play Assessment

Adult Attachment Projective Picture System

Caregiving Helplessness Questionnaire

Working Model of Child Interview

Parent Development Interview

Circle of Security Interview

Attachment Script Sets

Ainsworth Maternal Sensitivity Scales


Below is a list of treatments and interventions, tools and theories  NOT recommended:

  • Attachment Disorder
  • Attachment Therapy
  • Attachment Therapy Parenting
  • Beyond Consequences
  • Cline/Helding Adopted and Foster Child Assessment
  • Cline/Helding Adoptive Parent Attitude Assessment
  • Complex Trauma
  • Corrective Attachment Therapy
  • Critical Care Parenting
  • Dr Post’s New Family Revolution
  • Dyadic Developmental Psychotherapy
  • Emotional Deficit Syndrome
  • Family Centered Regulatory Therapy
  • Holding Therapy
  • Holding Time
  • Humanistic Attachment Therapy
  • Integrative Dyadic Psychotherapy
  • Nancy Thomas Parenting
  • Family Attachment Narrative
  • Pre and Peri Natal Psychology
  • Rage Therapy
  • Rage Reduction Therapy
  • Randolph Attachment Disorder Questionnaire
  • Reactive Attachment Disorder
  • Stress Model
  • Theraplay
  • Z-Therapy

On the Advocates for Children in Therapy Website, they list the names of proponents of the above treatments.  When entrusting your care and the care of your children to someone following one of these models, caution and care must be taken. While there may certainly be some benefits, there is a possibility of doing more harm than good. Remember, the motto of the creators of the Circle of Security state “Parenting in 25 words or less: ALWAYS be BIGGER, STRONGER, WISER, and KIND. Whenever possible, follow the child’s need. Whenever necessary, take charge.” Ensuring proper  treatment for your child is a take charge moment!!!

Reflections on Beyond Consequences Volume 1: Pseudo – Science Intervention!!!

December 9, 2011

Recently, an adoptive parent came to session  with a number of adopted children of different ages. One of the presenting problems was night waking and binging on food. This is a common problem with adopted children who experienced neglect. The client had read “Beyond Consequences”, which is a well established model in our community. I had not read it. I read an article online by the author, Heather Forbes, and it was well written and mostly in line with attachment literature. So, I ordered the kindle edition (for my IPAD – I love Apple!) and opened to the chapter on “Hoarding and Gorging.”

As I was reading, I was stunned when I got to this part:

Begin bottle-feeding your child… yes, begin bottle-feeding your twelve or even fourteen year-old. 

If a child needs it, regardless of his age, he will take the bottle. The simple gauge is this: if he does not need it,

he will not be inclined to take it. Remember that if the child did not receive sufficient developmental nurturing, 

then he has a barrier in his development. Until the barrier is addressed, the other levels are going to continue to stagger. 

The bottle-feeding should only occur while the child is in the parent’s arms. Forbes LCSW, Heather T. (2010-07-01).

Beyond Consequences, Logic and Control: Volume 1 (Kindle Locations 1139-1143).Beyond Consequences Institute, LLC. Kindle Edition.

Stunned. I hope you are having the same reaction.

She refers to children as having “attachment challenges” in her article online. No attachment expert would support the use of regressive means to assist a child in developing a healthy, secure adaptation. In my opinion, she has taken the opposite stance of the more aggressive, coercive “attachment correction” interventions. This type of regressive intervention is developmentally inappropriate to use with any child past bottle feeding age!! This is an intrusive intervention at best and continuing along the path of insensitive interventions for children. Do not do this type of intervention. It is akin to blood letting with leeches. It is pseudo-science, even with the endorsement she received from the son of the late and great John Bowlby. I also reviewed the professional literature and the Advocates for Children in Therapy DO NOT RECOMMEND Beyond Consequences. 

Heather Forbes has the general idea that the interventions are to be relationship based and behavior should be viewed as a reflection of experience. This is true.

According to research,  behaviors are often attempts to communicate needs or get needs met, previous coping strategies, and miscues based on distrust and fear of adults and close relationships. Attending to internal states and needs is also important such as distress, apprehension, and feelings of being out of control.

A child with difficult acting out/acting in behaviors needs help from the caregivers linking behaviors, thoughts and emotions. Caregivers remaining in the “Bigger, Stronger, Wiser, and Kind” position need to remember to take the initiative in approach, interaction, and contact with sentivity to a child’s lack of experience, join with a child when the child is distressed, aggressive, or fearful, assist in interpreting patterns of behavior, name feelings/thoughts/and links to behavior, support learning to seek help and comfort from the caregiver, and assist the child with practicing new behaviors and new interpretations of events. Bottle feeding a child past bottle feeding age violates the “WISER” position of  “Bigger, Stronger, Wiser, and Kind” caregiving.

The social/emotional relationship interventions ought to communicate at the child’s level, use gentle encouragers through natural means of eye contact (play catch, hide and seek), joint/shared attention (looking out the window at the bird on the tree together and enjoying the moment), and social referencing (the child ‘checking’ back in with the caregiver). Caregivers ought to encourage smiling and positive affect, and talk to the child about feelings…types, parts, and dimensions.

BTW: While I do agree that sometimes, the night time waking behavior is a miscue, that is, the child is distressed (scared, anxious), needs comfort, and seeks comfort not in the context of a safe relationship with the caregiver but through some other means, there is also some research has show that children with the night waking, night terrors, and sleep walking have to go to the bathroom.

Interventions for children should always be sensitive to the development needs and age of the child, gentle, and pass the “common sense” test!!

Please email, call, or contact our office for child development expertise!!


Ted Stein, L.P.C, N.B.C.C, B.C.P.C.C, A.F.C is a marriage, parenting and development expert. He has advanced training in infant attachment (A, B, C, & D) from the experts at the University of Minnesota, Alan Sroufe and Elizabeth Carlson; in toddler age attachment from William Whelan (University of Virginia and Mary B. Ainsworth Attachment Clinic), and  in adult attachment from June Sroufe, University of Minnesota. He has practiced therapy for 17 years and currently specializes in marriage therapy, parent capacity/risk evaluations, custody assessments, and attachment assessments. He is Accredited Forensic Counselor.


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