10 Lessons from 10 years on the Frontline: 6, Attachment and Trauma

By Richard Devine (07.09.2020), Social Worker for Bath and North East Somerset Council.

Originally I had intended to write a blog with 10 pithy lessons from my experience of being a social worker since I qualified in 2010. What I have done instead is write 10 lengthy (ish) lessons, each amounting to the equivalent of a blog. Therefore, given the length of each one, I am going to share one every working day for the next two weeks (hoping that I can finish the final two before next week!). I cover a range of topics from relationship-based practice to decision making and removing children and time management. Each of these topics reflects my current understanding after a decade of working as a child protection social worker. If I were to imagine myself writing this 10 years ago, or even 5 years ago, I suspect I would be embarrassed at how little I understood. Therefore, I can only assume I will think the same about what I have written in these 10 lessons in a few years’ time. Some of you will be further along with your understanding than I am, and if this is the case I would appreciate feedback and critique. None of what I write about is static – they represent my best understanding of issues in a moment in time.

Lesson 6: The importance of understanding Attachment and Trauma

Introduction: 

I became interested in attachment studies early on in my career, and this was partly accidental. When I began Social Work in 2010 I was curious about the underlying causes of the presenting issues of the individuals I was working with such as domestic abuse, substance misuse, and mental health. I was interested in the ‘perpetrator’ as much as the ‘victim’ as both appeared to play out strategies developed in childhood, albeit in adulthood, without awareness. Each time I would ask a parent how, where, and why difficulties emerged in their functioning, I would be directed back to childhood experiences. Consequently, I began looking at research and different theoretical frameworks to help facilitate my understanding of how childhood experiences impacted upon development in a way that led to individuals developing coping mechanisms that appeared self-destructive. The primary exclusion criteria I applied to research and theory was whether it was applicable and relevant to my practice. That is, what knowledge/theory is available that would improve my ability to be an effective Social Worker. I eventually came across the Dynamic Maturational Model by Dr. Patricia Crittenden in 2014. I was immediately impressed by her insight, knowledge, and the high level of applicability of her ideas to my work as a Social Worker. Several years later, I am still fascinated by her theory and consider it to be one of the most important and useful theories I have encountered.

What is attachment?

What is attachment? It depends upon which attachment paradigm you refer to. There are (at least) two schools of thought when it comes to attachment. The first is ABC+D, which is underpinned by Bowlby, Ainsworth and then Main, Solomon, George, Hesse (and many others). This is the theoretical framework that most practitioners know about. It involves Ainsworth’s original patterns, but also includes the concept of disorganization. The second, and less well-known model, is the Dynamic Maturational Model (DMM). This DMM is underpinned by Bowlby, Ainsworth, and then Patricia Crittenden. Crittenden’s model involves Ainsworth’s patterns but she has extended these patterns (A3-8 and C3-8).

What is the DMM?

The DMM is described as a bio-pyscho-social theory of human development and adaptation. That is, we are biologically predisposed towards forming an attachment with a primary caregiver, which in turn shapes our psychological development. Our psychological functioning, shaped in the context of our biological needs, then interacts with society and culture bi-directionally, and this process has profound implications for how we deal with thoughts, emotions, and relationships. It is a theory about how we organize ourselves pyschologically and relationally, in particular, how we organize around danger.

What have I learned from the DMM?

The DMM is an unbelievably rich, systemic, and insightful framework that has revolutionised the way I understand and help children and families. It is beyond the scope of this blog to outline all that I have learned but I will summarise a few key points: 

• As a result of our biological/genetic predispositions, our interactions with our primary caregivers, and our wider family/social context we develop attachment patterns, or in DMM terms, self-protective strategies. These strategies are not categorical. An individual is described as using an attachment pattern or self-protective strategy, and not is an attachment strategy. 

• The DMM identifies a range of patterns/strategies. Describing someone or their attachment pattern as ‘avoidant’ or ‘ambivalent’ is useless and unhelpful because it is a gross simplification and too indiscriminate. In the DMM, there is a spectrum on which someone can be ‘avoidant’. For example, if a child grows up with a depressed and emotionally unavailable mother, the child may use a ‘compulsive caregiving’ strategy (A3) which involves inhibiting and suppressing his/her feelings, and attempting to meet the needs of the depressed mother in the hope that the depressed mother will offer increased comfort as a result of this adaptation. If that makes no difference, however, then as the child grows older he/she may utilise a ‘compulsive self-reliant’ strategy (A5) in the context of relationships being uniformily disappointing. This results in the child inhibiting emotional feelings (i.e. sadness, rejection, anger at lack of comfort) and developing an over-reliance on the self. If the mother made a recovery from her depression and the child was then able to rely upon mother once again, he/she may learn over time to be less self-reliant, compulsively caregiving, and begin to express his/her feelings once again. The point is, is that attachment patterns are not fixed, but as the title of the model suggests, they are dynamic and can change through maturation. 
• There is a wide degree of variability in the experiences of individuals within the ‘normative’ range (B1-5, A1-2, C1-2). This means that in the absence of danger, individuals are capable of adapting, with low risk of incuring psychological problems, even in the context of insensitive, inconsistent or rejecting caregiving. I found this to be an optimistic insight as it shows the resiliency, or more accurately, the adaptiveness of individuals who receive less than optimal caregiving experiences.  
• It is only when danger is introduced into the live’s of developing individuals, particularly in the context of insensitive parenting, that the development of more sophisticated self-protective, and typically maladaptive strategies is necessitated. This highlighted to me what Crittenden already knew, that ‘danger is the problem’, and therefore in working with children we should seek to ‘change the danger, not the child’ (Crittenden, 2016: 33).  Any intervention, therefore, that involves improving the developmental outcomes in a child’s life should prioritise minimising the danger within the child’s life. 
• It is difficult to understand trauma without understanding attachment. I have read a great deal about trauma, but I have found DMM’s perspective the most useful. Very briefly, traumatic events can result in not enough information being carried forward (dismissed) or too much information being carried forward (pre-occupied).  Dismissing the trauma protects the person from dealing with the pain associated with the traumatic event or loss but can prevent the person from acting self protectively when a similar event re-occurs. Pre-occupying trauma or loss keeps information about the past traumatic event fresh in the person’s mind so as to increase the probability of recognising a recurrence of the event so as to act defensively; however over attributing risk and danger increases likelihood of acting self protectively when there is no real risk or danger. Both of these responses are often unconscious, that is, the person is unaware that past experiences shape their functioning in the present.
• The DMM posits that attachments patterns could be best described as ‘strategies used by adults to solve problems in relationships related to self-protection and danger’ (Crittenden & Landini, 2011: 13). It is a strength based and compassionate approach encourages practitioners, to interpret ‘dangerous parental behaviour’ as ‘misguided protective behavior that is carried from childhood (when immaturity required psychological shortcuts) to adulthood, when it is misapplied’ (Crittenden and Baim, 2017: 398). This approach has created a shift in my practice that ‘respects parents’ accomplishment of surviving adversity … acknowledges their intention to protect their children better than they themselves were protected, and … affirms their potential to continue to learn’ (Crittenden & Baim, 2017: 398). 
• It is not experiences that necessarily define psychological functioning, but rather the meaning and representation derived from experiences (Crittenden & Baim, 2017). This is a promising insight because it demonstrates that some individuals, despite facing substantial adversity, can psychologically adjust from such experiences (including us!).  

Conclusion: 

I came across this fable some time ago, and I can’t for the life of me remember where I found it (If anyone knows please let me know) and I wrote it down because I liked it so much. 

A person who sees a child in the river drowning and fighting for life while engulfed in a powerful current, reaches in to save the child, sees another child and then another in a continuing experience, and starts yelling to passers-by to come and help save the drowning children. The passers-by come to assist, but one refuses, saying ‘I’m going upstream to find out who is throwing these children in the river and to stop that person.

In my opinion, this fable is analogous to what the DMM offers. It offers you the knowledge, skills, and tools to look beyond the superficial presenting problems and identify the underlying, deep rooted, and often implicitly represented causes for the presenting issues. Whilst it is not futile dealing with the presenting issues, it is more effective to identify the underlying issues, by going upstream, metaphorically speaking, and finding out who is throwing the children in the river.  

If you have found this interresting/useful, you may wish to consider scrolling down further, and join 130+ others in signing up for free blogs to be sent directly to your inbox (no advertisements/requests/selling). I intend to write every fortnight about matters related to child protection, children and families, attachment and trauma.  Or you can read previous blogs here

By Richard Devine (07.09.20)

If you are interested in learning about the DMM, then you may want to check out Rebecca Carr Hopkins here. She provides brilliant, highly engaging and incredibly informative training on the DMM.

Bibliography: 

Crittenden, P.M. (2008) Raising Parents: Attachment, parenting and child safety. Cullompton, Devon UK: Willan.

Crittenden,P.M. and Landini, A. (2011) The Adult Attachment Interview: Assessing Psychological and Interpersonal Strategies. New York: W.W. Norton & Co 

Crittenden, P.M. (2016) Raising Parents: Attachment, Representation and Treatment,(2^nd ed.) Abingdon, Oxon: Routledge

Crittenden, P,M & Baim, C (2017). Using Assessment of Attachment in Child Care Proceedings to Guide Intervention. In Dixon, L et al. What works in child protection: an evidence based approach to assessment and intervention in care proceedings. John Wiley & Sons Ltd.