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Treating Attachment Issues in the Field

Posted by Matt Hoag, Ph.D., Clinical Psychologist on May 14, 2014

1matt resizedResearch indicates that adopted adolescents are at higher risk in areas including school achievement and problems, substance use, psychological well-being, physical health, fighting, and lying to parents.While adoptees account for 2% of the child population in the US. (US Census, 2000), they account for roughly 18% of Second Nature’s recent outcome study sample. This difference in percentage calls attention to this population and the need to better understand their treatment needs and investigate how wilderness treatment addresses these needs.

Many adolescents present with attachment issues due to loss issues related to adoption or ongoing relationship issues. The American Academy of Child and Adolescent Psychiatry suggests attachment disorders are “characterized by serious problems in emotional attachments to others” which often begin in early childhood and continue through one’s life. These attachment difficulties with parents and caregivers typically affect mood, behavior, and social relationships in significant ways.

This absence of proper attachment experience contributes to several challenges as the young person focuses on controlling and distancing herself from others- especially parents, teachers, staff, and therapist. The adolescent or young adult experiences a sense of empowerment from being controlling, oppositional and defiant. They struggle with reciprocity in relationships. They often avoid needing others, asking for help, and most forms of positive interaction.

A number of defenses are present with adopted participants, and while defenses can be used in an adaptive manner in stressful situations, they have significant negative long-term impact on the ability to form healthy relationships. Several examples include:

  1. Over idealizing the birth mother, which allows the adoptee to avoid and deny the perhaps painful reality,
  2. Denial enables the adolescent to avoid grief or rage they experience internally,
  3. Displacement allows the child to project onto adoptive parents the feeling and perceptions that she has been feeling towards birth parents,
  4. Dissociation occurs when the client separates himself from intense feelings of shame or profound feelings of worthlessness,
  5. Projection also occurs when the young person acts in an inappropriate manner, and then suggests that their parents are rejecting them because they do not accept their behavior.

There are a number of characteristics within wilderness programs that help with subtly challenging these defense mechanisms with the express intention that the adoptee becomes conscious of, and can voluntarily adapt:

  1. Consistent mentors immersed in the milieu for 8 days in a row, instead of 8-12 hour shifts in other treatment modalities
  2. The ability to identify and process emotions in the moment
  3. Encourage verbal expressions of emotions (show AND tell)
  4. Explore choices for expressing and coping with emotions
  5. Explore consequences of choices—“you can’t fool Mother Nature”
  6. Build comfort with calm vs. chaotic environment
  7. Work together with a group, mimics adopted family
  8. Parent visits—way to be competent and have something to offer
  9. Movement—hiking and activities
  10. Affection regardless of response—especially when their defense typically elicits a rejection response

Wilderness therapy provides an opportunity for the young person to recapitulate the physical, emotional, and interpersonal characteristics that are found in the secure parent-child attachment. Many characteristics of the wilderness provide support as they experience and work through these relationship difficulties. When I work with and train staff, I emphasize treatment basics like:

  1. Structure—providing limits and boundaries that are consistent and predictable, and not applied with emotional reactivity. This structure provides the person with attachment concerns a safe place to work through issues of trust and loss.
  2. Attunement—having an understanding of the teen or young adult’s defense strategy and what his or her needs are. It is important for staff to be aware of what the young person may be feeling and reacting to in their environment.
  3. Empathy—being warm, caring, and compassionate. Balance is especially important for caregivers in supporting the emotionally reactive young person.
  4. Positive Affect—it is vital to maintain a positive attitude when the person is acting out. This interrupts the dysfunctional pattern of the person rejecting others and receiving an angry or abusive response. It is extremely important for the staff/therapist to regulate their emotions, and not take the rejection personally.
  5. Emotional Accountability—role modeled by Instructors when the Instructor does feel rejected or insulted by client. This role-modeled ownership and reflection on very old patterns reinforces the opportunity for clients to sincerely account for their power in relationships.
  6. Support/Reciprocity—this occurs by guiding the relationship, which is based on mutual respect and sensitivity.
  7. Revisiting—this process occurs when revisiting significant traumatic experiences such as separating, abandonment, abuse, neglect, etc. This allows for the identification of the person’s beliefs (“I am bad”, “I am unworthy of love”) or thoughts (“it is my fault I was given up for adoption”), so that they can be addressed.
  8. Exploring the Grief and Loss Process—allowing them to feel and express loss related to loss of primary attachment figures in their life.

It is important to acknowledge that attachment issues take time and many forms of practice to address and work through, that treatment in a wilderness program represents a step in the longer-term treatment process. The wilderness setting is a valuable treatment modality due to the close relationships and the opportunity to develop trust in a smaller group of people as one begins to address and become aware of these issues. An awareness of these basic principles is vital in the treatment of the person struggling with attachment issues.

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