©2008 National Association of Social Workers. All Rights Reserved. 1 HIV/AID’S and Orphaned and Vulnerable Children: Consideration from an Attachment Perspective

©2008 National Association of Social Workers. All Rights Reserved. 1

HIV/AID’S and Orphaned and Vulnerable Children:

Consideration from an Attachment Perspective

Tracey Cardello, LCSW

Psychotherapist

Hicksville, NY, USA

Johannesburg, South Africa

Wednesday, October 15, 2008


Overview of Attachment Theory

• Observed 1st by John Bowlby late 1930’s

• “Strange Situation” observations 1st conducted by Mary Ainsworth

• Mary Main bridges the gap from children to adult with the “Adult Attachment Interview”

• Peter Fonagy studies PTSD and Intergenerational transmission of attachment with Holocaust survivors

• Mark Tomlinson studies attachment in South Africa.


Attachment Theory

• Humanistic way of understanding development which fits nicely “over” other treatment methods

• Sensitive to the role of the environment in child development

• Tested and replicated in a variety of populations and settings

• Predicts infant vulnerability and aims toward prevention



What is the Function of Secure Attachment?

1. Biological

2. Developmental

3. Repair / Restore


Biological

In the face of danger or stress the system is activated to alert (enlist) the mother of the need for protection or comfort


Developmental Function

In the absence of any threat, secure attachment provides a “safe base” from which a child may: explore, play and learn.


Resilience from Trauma

Attachment security helps to mitigate trauma and restore a sense of safety and equilibrium cause by a rupture in an important relationship.


4 Types of Infant Attachment

• Secure

• Insecure Avoidant

• Insecure Ambivalent

• Disorganized / Disoriented


Secure


Avoidant


Ambivalent


Disorganized



Attachment Trauma is Handed Down

Attachment security helps to mitigate trauma and restore a sense of safety and equilibrium.


Behaviors Which Contribute to Disorganization in Infants

• Physical or Sexual Abuse

• Bizarre Punishment

• Parental death or suicide

• Parental illness or Disease

• Caretaker Depression

• Witnessing violence

• Parental fear or panic

• Hostile or Intrusive Behavior


Children w/ Disorganized Attachment are at Higher Risk

• For developing depression, borderline and dissociative disorders

• Aggressive, reactive or violent behavior• Poor or rigid peer relationships• Lack of empathy• Alienation• Criminality


“At Risk” Children

Poverty, DeprivationHIV/AIDS, Orphan StatusDisorganized Attachment


Treatment Considerations with “At Risk” populations.

• Attachment intervention can begin in the maternity ward

• Attend to ‘vulnerable mothers” to help them help their children.

• Use tried and true social work principals of non-judgment and empathic listening.

• Be emotionally attuned and focus on experience, process, and affect.

• Challenge negative internal working models and assist in the creation of deeper meaning and new understanding.

• Model curiosity, healthy attachment, acceptance of emotions, reduction of shame and re- integration of trauma affect.


( Consistency + Repetition + Patience ) +

Secure Attachment =

Empathy and Compassion

Documents

©2008 National Association of Social Workers. All Rights Reserved. 1 HIV/AID’S and Orphaned and Vulnerable Children: Consideration from an Attachment Perspective