Maria Tatzmann MSW, LICSW Maria Marino and Associates .

Considering Cross Cultural Issues in

Attachment Therapy

Maria Tatzmann MSW, LICSWMaria Marino and Associates

www.mariamarinoassociates.com

1- Understand attachment

2- Cultural underpinning of family structures

3- Identify the most common causes and effects of disorganize attachment and their prevalence in minority populations

4- Identify possible interventions when working with mothers and their children in your practice

Objectives

How does it work, why is it important?

What can go wrong?

What do we see in our practice?

Concept of attachment

What is attachment

Attachment is a reciprocal process by which an emotional connection develops between an infant and his/her primary caregiver .Healthy attachment occur when the infant experiences the primary caregiver as consistently providing emotional essentials such as touch, movement, eye contact and smiles .

The quality of the attachment becomes the scaffolding for the development of trust or mistrust, sense of self and the concept of mastery. It shapes how the child relates to the world throughout life, the quality of his relations, and his ability to develop as a well adjusted adult.

Caregiver becomes a regulating partner

Why is it important

Physical, Mental Health Mother/ChildTemperamentTuning

Trauma effects Exposure to violence Antisocial learned behavior Dulling of emotions

What influences attachment:

Brain DevelopmentRelationsStimulationExposure.

Regulation Emotions

How do I deal with to my feelingsFrom satiated/aroused d/sad/glad/shamed

Attachment affects:

1-Secure attachment

◦ Consistent emotionally responsive caregiving results in a secure attachment.

◦ Infant learns to use the caregiver to be comforted, to manage arousal, to learn self regulation and self soothing

◦ They develop a balanced strategy of attachment and exploration.◦ Resolution of fear.◦ Secure base of exploration.

◦ Flexible regulation of behavior, attention and emotion

2-Insecure attachment

Tuning and temperament dissonance. Insensitive, inconsistent, overly rigid caregiving often results in insecure attachment.The infant is able to be comforted by the parent/caretaker in an indirect manner. Learns to manage arousal by maladaptive strategiesInsecure attachment is classified as:

Avoidant/dismissive: Minimizing strategy to maintain closeness,

minimizes distress, restrained explorations.

Resistant/ preoccupied: Maximize strategy to maintain closeness,

maximizes distress, maintain vigilance.

3- Disorganized attachment

The inability of the child to be comforted by the caretaker. Unable to manage arousal, achieve self regulation or self soothing

If the child experiences the caregiver as non-responsive he/she might in turn respond by being clingy.

If the child experiences the caregiver as over-reactive he/she might in turn respond by being avoidant.

If the child experiences the caregiver as rejecting he/she might in turn respond by being afraid, sad, feeling persistently aroused

IF :

If this process is non existent or disrupted, the child may not develop the secure base necessary to support future healthy development.

Disruptive factors may include indifferent caregivers, invasive or painful medical procedures, sudden traumatic separation from mother ( hospitalization, incarceration etc.) neglect, sexual or physical abuse,, prenatal alcohol or drug exposure.

What can go wrong

Other issues of concern:

◦ Parent’s mental health issues, substance abuse

◦ Chaotic environment

◦ Unresolved trauma

◦ Domestic violence

◦ War and the effects of war

Cultural values and attachment issues

What adults teach children without noticing it.

Attachment within a cultural context

Type 1Traditional Family: Recent immigrants, little socialization,

language difficulties.

Type 2Transitional Family: Role duality ( mothers are wage

earners, children speak English), generational issues are more prominent.

Type 3Bicultural Family: Everyone speaks English. Parents

speak their own language, children might speak but understand.

Type 4 Integrated Family: Family adjust to cultural mores of the

community they live in.

Families within a Culture

Definition of family and of who is the care taker of a child is an extremely culturally bound concept.

Nuclear Single parent Tribal Extended by blood or by

ritual

What is a family

A common answer is the hope that they grow healthy and well adjusted.

Across cultures this takes a very different meaning◦ Honor ancestors◦ Defend the family honor◦ Provide for elders ◦ Have many children◦ Bring pride to family, tribe, village, nation. ◦ College degree, good job◦ Be happy

What does a parent hope for her/his children

Identity is a concept passed on from adults to children. Individuality, cooperation, common good, responsibility for self, for others

What do we call adults? Who do we listen to?

Differences from when we were a village.

How adults teach values to their children

In many groups who we feed is the definition of family.

Who is responsible for the child if parents are absent?

How we honor or care for elders, parents, ancestors.

What adults teach children

How do I please my parents?

What is my place in society?

Who will take care of me?

What is expected of me?

How do I honor my teachings?

How do I become an adult? A parent?

What children learn

Who are our clients? Why is it important and how do we find out?

How did they get here?◦ Family history. Immigration history,

What needs to happen to achieve a positive outcome

Interventions in children’s mental health within a cultural context

What brings them to your door The school The neighbors My sister

What do Mom or Dad or both think?Is there a problem?Who is affected by the problem?

Who is the client?

Whose problem is it?

In working with young children, and their families the DSM V does not provide an accurate description of symptoms to achieve an effective treatment plan.

The need to assess the relation is vital to the effectiveness of the intervention.

DC 0-3 provides you with a diagnosis of the relation. It becomes the map for your treatment plan and intervention.

Who is the client?

Children live within the context of a family. Unless you know the family you cannot be effective.

Be aware that in many groups stories relate to actual events. Do not question the logic of the stories. Ponder the need to tell you.

Learn to ask the questions. If we don’t ask, they wont tell us.

A thorough family history

Where Mom and Dad were born?Where were their parents born?What do they know about their ancestors?What did they learned about parenting from

their families ( ghosts and angels in the nursery)

History of substance abuse, sexual abuse, domestic violence, war, immigration, trauma.

Consider the issue of specific historical trauma on certain populations.

Questions we often do not ask

Intergenerational conflict In law conflict Marital difficulties Hostile dependent relation with sponsor Role reversal, inadequate communication, split

loyalties

Generational issues

Family migration and relocation history Pre-migration experience Migration experience Impact of migration on the individual and family

cycle

Immigrations issues

Losses: Significant family and friends Material losses Loss of community support Spiritual community Physical trauma Psychological trauma

Degree of loss and traumatic experience

Adjustment problems Language,, housing, transportation, employment ,

child care, racism Different rates of acculturation of family members Community stigma Availability of support system

Cultural shock

Downward mobility Status inconsistency Long working hours Language difficulties Racism at work Rural vs. urban living

Work and Financial Stress

Degree of somatization Medical history of patient and family Western medicine vs. traditional healers Family concept of mental illness, help seeking

behavior and treatment expectations. Symptoms Causes Relationship to post traumatic behavior

Physical health and medication history

Be aware you are treating Mom as well as the relation.

Mom’s experience as a child as well as her experience of being mothered are the silent script in the relation.

Identify the ghosts, concentrate on the angels.

As Mom becomes better at dealing with her own issues her child will become better at using the relation to meet his/her needs.

Concurrent work with mom and child

Ghosts in the Nursery. ( Selma Freiberg) We learn to be parents from the experience of being

parented.

Angels in the Nursery. ( Liebermann) Identify those moments or people in Mom’s past that

parented her well. The “angels” that helped overcome negative experiences .

Working with Ghosts and Angels

Parting thoughts