attachment

Engaging Adolescents and Caregivers in Family Therapy

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“Do I have to do family therapy?”

Yep, that's such a common question I get from my adolescent clients at the start of therapy. Here are some other common questions and statements a therapist may receive in regards to parents and caregivers being a part of an adolescent's therapy process:

"So how much are you going to tell my parents?"

"I hate these family things; i just feel so awkward."

"Do I have to be in the room when you talk to my mom/dad/guardian?"

“I’ll talk to you, but I will not talk to my parents about this!”

“Why try, nothing is going to change!”

“They/she/he just doesn’t understand me.”

 

Do any of these sound familiar in your therapeutic work?

When reflecting on these common initial responses and questions about family therapy, it has been my professional experience that I see a clear pattern of fear, lack of trust and shame arise as barriers to adolescents getting their needs met by their caregivers. Additionally, many adolescents seem to have a common misunderstanding (and caregivers too) that family therapy is about pointing fingers and being the “problem” of the family. So with this in mind, I’m excited to share some strategies I use to build rapport, connection and trust with adolescents to empower them in engaging with caregivers in family therapy.

1) Be Transparent! In other words, BE REAL with your client. Adolescents are smart, clever and can read through any BS or tip-toeing going on in the room. I give them the direct and transparent version of confidentiality and expectations of what therapy entails. 

“I know you may or may not be wanting to communicate certain things with parents, but I want you to know what I must report immediately. Any safety concern including suicidal ideation/planning, abuse, neglect, witness to violence, and self-injury must be reported to caregivers or appropriate authorities. With that being said, there may be things that come up that you are not open to sharing but would be beneficial to do so in order to get your needs met from your parents/guardians. When this happens, I want you to know I will challenge but not force you, and together we can figure out the best way to schedule a family session around it when you are ready.”

 

2) Build trust immediately: I know this one is a given, but I start with every first session letting my adolescent client know that I don’t expect them to trust me right away in an effort to ease any tension or pressure someone might feel.

“I want you to know that I don’t expect you to trust me right away. Trust takes time and is earned so that’s exactly what we are going to do. We will take time to get to know each other. You can ask me any questions you need to about myself or the process. I’ll let you know if I can’t answer it for any reason. And I want you to know if I ever ask or discuss something that you are not ready to answer, you say so, and we will use the time for what you are ready for and need. This is your time and space, and I want you to feel safe.”

 

3) Share the responsibility and “workload”. It’s essential to dispel any myth or belief with the adolescent and caregivers that a) they are the problem child and b)your job is to “fix” them in some way. Again, this is where I use transparency in the first session or parent consult (as well as throughout ongoing treatment) to set clear expectations for all involved.

To caregivers: “I want you to know that if i’m working with your child, I’m working with you also.  In many ways, this work can be equal or more for the parent.  My job is not to “fix”. Rather, i’m here to provide assessment, education, skill-building and a safe space to process and build awareness so that you and your child can more effectively communicate, understand one another and connect in a meaningful way to address the barriers.” I always let adolescents know that I’ve had this conversation with the caregiver(s) as well so they know it’s a joint effort.

 

4) Empower the adolescent voice. I like to give my adolescent clients as much choice and opportunity to lead as possible when it comes to parent involvement. Here are a few different ways, I frequently go about this in session:

“Would you like me to check in with mom/dad alone or with you it the room?”

“Is there anything you’d like to share with mom/dad/caregiver from our session today?”

“Is it alright if we bring mom/dad in at the end to share any skills we worked on so they can practice it too?”

“Is it ok if I emailed mom/dad about (a specific one or two things from session) so that they can be more aware and better understand what you are going through or how to support you?”

“Is there anything you want to teach mom/dad today?”

“Would you like me to explain (specific pattern or skill) for you to caregiver with you in the room?”

“Would you want to do a family session with mom/dad on this? If so, when do you think you’d like to do it?”

 

5) Parent Coaching Sessions are a must! Along with letting parents and adolescents know that this is joint work, I let them know that some sessions will be just with the parent(s). I am transparent with the adolescent and parents about the purpose of these sessions from the start.

“These sessions with your mom/dad are NOT to report all that you’ve said or processed in session. Instead, they are an opportunity for you parent to explore their own barriers getting in the way of supporting or connecting with you. I will always let you know when i will be having a session with you parents in case you have any questions or anything you would like me to share or work on with your mom/dad.”

To caregiver: “These are sessions where you can explore challenging emotions, patterns, behaviors that you are struggling with that might be acting as barriers to your relationship with your child. The main goal is to empower you as a caregiver and strengthen your relationship.”

 

6) Provide Outside Resources to Caregivers and Adolescents from the start.

At the end of an initial session or consult, I provide at least one book and internet-based resource that will help parents get a head start on some of the topics and ideas we will be addressing in therapy. Throughout the process, I continue to provide both the caregivers and the adolescent ongoing supports based on what is coming up in therapy and what the family barriers may be.

Some of my favorite resources are:

Ted Talks: Especially for the adolescent and caregiver to watch together at times.

Wellcast videos: Here is one of my favorites, but they have them on all topics! I often show to adolescent in session and send to both caregiver and adolescent after session. https://www.youtube.com/watch?v=UMIU-Uo8cZU

Phone apps: mood meter, calm.com, Headspace are just some of my favorites.

Books: there are so many; here are a few favorites

The Gifts of Imperfection, Daring Greatly and Rising Strong by Brene Brown (also has great ted talks to introduce the concept of vulnerability and shame)

Whole-Brain Child, Yes Brain and Brainstorm by Dan Siegel and Tina Payne Bryson

Emotion Focused Family Therapy resources: This includes caregiver webinars and in-person workshops, book recs, links to articles, etc. All greatly support parent coaching and family work. http://www.emotionfocusedfamilytherapy.org and http://www.mentalhealthfoundations.org are two helpful websites.

Review/summary emails: These I send with adolescent permission to specifically review a skill, idea or new strategy that would be helpful for the caregiver or adolescent from session. This way, they can refer back to it as needed.

 

Engagement with adolescents and parents can be difficult at times, but I have found the more i’m able to focus on empowering families and setting clear expectations of what family work is and isn’t, the more willing adolescents and caregivers are to engage in the process. My goal is never to be the one the adolescents trust or “go to” the most, it’s to help them build that with their parent(s) or caregiver to be able manage their challenges and barriers in life in a sustainable and connected way.


Guest post written by Meaghan Burns Sablich, LCSW

Guest post written by Meaghan Burns Sablich, LCSW

Meaghan Burns Sablich, LCSW is a Licensed Clinical Social Worker, Licensed Colorado State School Service Provider and clinical supervisor with 10+ years experience in the field. Meaghan received her Masters Degree in Social Work from the University of Denver with a concentration in Families and Children. Meaghan has worked in a variety of therapeutic settings including inpatient hospital, residential treatment center, day treatment center, schools, non-for profit organization and private practice. Areas of clinical focus include: depression, anxiety, ADHD, eating disorders, family therapy and parent coaching, grief and loss, school/learning concerns and self worth work.

Adult Attachment: Creating Connections from Childhood

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I panic when I don’t hear from them. I just want to be left alone. I want to reassure them that I’m here for them. These statements may capture several examples of responses from clients in your office engaging in work around their relationships. One powerful perspective on the functioning dynamics of intimate partner relationships is to look through the lens of attachment. In other words, by exploring childhood attachment and how it sets the foundation for interaction within relationships, we can experience an increased sense of awareness on how attachment translates to current relationships from needs being met or ignored in our early childhood experience.

 

Bonding Background

The study of attachment can first be linked to Mary Ainsworth and John Bowlby in the 1970s. Mary Ainsworth devised the Strange Situation, an experiment that placed babies in a lab with their attachment figure/parent and observed reaction in the baby as a stranger entered the room, as well as each baby’s ability to be soothed when the parent left the room and later returned. Based on Ainsworth’s research findings, we were able to identify three types of attachment: secure, anxious, and avoidant. Mary Main, another colleague, later identified a fourth type of attachment called disorganized to capture responses that were inconsistent and unpredictable when exploring a baby and their attachment figure.  

 

Attachment Attributes

Secure attachment in childhood looks like a distressed infant that is easily comforted when the attachment figure engages them, such as picking them up and soothing them with soft voice, physical touch, and proximity. In adulthood, the secure attachment individual is highly desired for their ability to reassure their partner and present as calm, grounded, and confident in the relationship. Anxious attachment in children can be portrayed as significantly distressed when the parent exits the room, with increased difficulty to receive soothing or reassurance when the parent returns. In adult relationships, the anxious attachment individual’s anxiety prevents them from feeling reassured in the relationship and can drive their behaviors to present as needy, anxious, and sometimes paranoid that the relationship will fail or that they aren’t “good enough” for the relationship to work.  Lastly, the avoidant attachment type in childhood will manifest in a baby as unaffected, cold, disconnected, and unconcerned with the parent leaving the room as well as an inclination to self-soothe, such as engaging in thumb sucking or playing with toys independently. The avoidant attached child has learned to rely only on themselves in not having the parent fully present, which can occur when parents are working long hours away from the child, are inconsistent in their reactions to soothe the child, or can occur in response to a parent’s mental illness such as depression preventing interaction and ability to attach in healthy ways.  In adults, avoidant attachment continues the theme of self-sufficiency and “not needing anyone” in a relationship, preventing them from connecting at a deeper level with others and can be portrayed as reluctance to commit to a serious relationship.

 

Linking to Literature

With John Bowlby’s Attachment Theory in mind, Amir Levine wrote an insightful book called Attached, that explores intimate partner attachment more deeply and offers examples of adult behaviors that can provide insight or identification of attachment styles. For client use, there are also helpful YouTube videos that can provide a brief overview of adult attachment such as the one found here. Another author, Stan Tatkin, took the idea of attachment a step further by providing symbolic representation of attachment that can also help one identify their attachment style.

Secure Attachment: An Anchor

Anxious Attachment: A Wave

Avoidant Attachment: An Island  

The imagery associated with attachment styles can help a client identify their reactions and resulting behaviors in intimate relationships, as well as assist them in identifying their partner’s attachment style and needs.

 

Creating Connection

In supporting your clients with exploring their attachment, you may find yourself pursuing additional training, such as Emotionally Focused Couples Therapy (EFT) that encourages vulnerable connection in couples and supports healing of attachment wounds. Or perhaps you link your attachment work to Gary Chapman’s The 5 Love Languages or communication and connection strategies from John Gottman’s training for couples’ work. Whatever means you choose to further dive into attachment needs, educating your clients on the possibility of positive shifts, such as moving to more secure attachment with their partners, can support movement towards healthier relationships. Levine and Tatkin emphasize that relationship attachment can shift and a person can present differently in each romantic relationship over their lifetime. With this in mind, exploring attachment can support your clients in discovering their own attachment styles as well as assist them in connecting and fostering healthy attachment in their intimate partner relationships.