How social workers can use attachment theory in direct work

By Professor David Shemmings

Attachment theory has always been a popular lens through which to assess parent-child dynamics (and close relationships generally), but it also has much to offer social workers when trying to help and support families.

Attachment-based interventions are beginning to spark an interest among practitioners, partly as a result of a recent NICE review of attachment research and looked after children. I don’t like the term ‘intervention’ personally as it suggests getting in the way of something, so I use ‘help and support’ instead.

There are at least three key messages that emerge from the evidence when considering how social workers can use attachment theory and research in their direct work with families.

1. A safe haven and a secure base

Firstly, research tells us that workers temporarily need to offer what John Bowlby called a ‘safe haven’ and a ‘secure base’ – somewhere to feel safe when you’re struggling but then use as a place from which to venture out into the world again – to support family members towards change.

Therefore if the worker has an insecure childhood history, she or he will need to understand how the past is likely to get in the way of them being a secure base. In addition, however, they need to know how to behave as a ‘secure’ person would when trying to help and support family members; what Sonja Falck and I have referred to as ‘Fake It Till You Make It’.

Professor David Shemmings will be giving more in-depth advice on putting attachment theory into practice in his training session at Community Care Live.
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Exploring how the past might be affecting the present will need to become a central feature of social workers’ supervision if practitioners are going to work more to help families rather than ‘assess them to death’.

Unresolved loss and trauma in the carer’s past can often impede progress when working with a family but it is more difficult for social workers to help if this activates their own ‘ghosts in the nursery’. Good super/vision (the origin of the word provides what should be the true definition – getting someone else’s perspective means together you can see the overall situation more clearly) will help quieten such ghosts.

2. Bringing the inside…out

Secondly, workers must understand the inner worlds of children and their carers. We specifically need to be aware of children’s experiences of unpredictable, anxiety-provoking behaviour from maltreating carers leading to ‘fear without solution’. These experiences may show themselves as disorganised attachment behaviour to a trained practitioner.

‘Mentalisation’, a key concept in contemporary attachment theory and research, is a very helpful tool when working with parents. We need to bring the ‘inside out’ to understand how best to help a parent struggling to meet their child’s needs. (Yes, the reference to the Disney/Pixar film is deliberate! See it and you’ll quickly ‘get’ what mentalisation is and how it relates to your work.)

Specifically we need to know what the parent thinks their child has in their mind about them. (This is different from what the parent thinks about their child). A worker might be worried about marked ‘negative intentionality’ – repeated statements containing strong indications that, for example, my son hates me, and/or ‘persecutory attributions’ such as she’s doing that deliberately to get at me.

Interestingly, the best way we know of to increase accurate mentalising capacity is to give the parent lots of experience of being understood. To do this, the practitioner needs to have the empathic qualities we call ‘intelligent kindness’ and ‘unsentimental compassion’ at all times, but most especially when a parent is ‘testing’ them (unconsciously) to check out whether or not they really ‘do care’. For example, a parent may find ways to push the limits of a worker’s patience to see if you will reject them or show irritation.

3. Coaching using video

Finally, there is an increasingly strong evidence base that the opportunity to watch oneself parenting on film, with a sensitive and supportive worker, is the most effective attachment-based intervention. Watching the video together, the practitioner can support the parent’s strengths while encouraging new, more synchronous parenting and sensitively-directed discipline and boundary-setting (yes, the bit all of us that are parents find tricky at times!).

After much practice, we can give what Mary Dozier who developed the ‘attachment and biobehavioural catch-up’ (ABC) method calls ‘in the moment coaching’ – supporting parenting as it’s happening, without the need for filming.

The idea is for the family to do some structured activities together, including some that are more difficult. For toddlers you could try reading a book together or a ‘don’t touch’ task. Then suggest to the parent that they try and increase the number of times they ‘follow the child’s lead’ (Mary Dozier’s term).

Professor David Shemmings PhD is professor of child protection research at University of Kent and visiting professor of child protection research, Royal Holloway, University of London