Never use the word ‘attachment’ again

    Top tips from David Shemmings' attachment knowledge and practice hub for Community Care Inform Children

    Photo: Gary Brigden

    Attachment theory plays a vital role in many social work decisions but can easily be misapplied. Community Care Inform Children’s knowledge and practice hub for this topic provides social workers with up-to-date information on the latest research and theory in this area and how to use it in practice with children and families and court work.

    Here are three key tips by David Shemmings, professor of child protection research at the University of Kent and visiting professor, Royal Holloway, University of London and attachment trainer who has written nine quick guides on different aspects of attachment and provided tools and videos.

    number-1Never say ‘good attachment’

    It is important to be precise in your language. Records often say something like ‘Mother does not have a very strong, secure attachment to the baby.’ But when talking about attachment in a professional context, parents shouldn’t have an attachment relationship with a baby; that should be described as a ‘bond’. It is babies who attach to their parents.
    Try not to talk about ‘good’ or ‘strong’ attachment – probably you mean secure. A child can have a strong attachment to someone they are very insecure with. For example, the surviving children of Fred and Rose West probably have very strong attachments to their parents, one of whom is dead and one is in jail.

    Similarly, avoid using the term “attachment problems” and never refer to “attachment disorders” as this is a restricted psychiatric or clinical diagnosis.

    2

    Don’t get preoccupied with ‘insecure’ attachment either

    Around 30 to 40% of children (and adults) are insecurely attached to a parent and this is not in itself necessarily a problem. What social workers really need to be concerned about is disorganised attachment behaviour; the specific set of temporary behaviours seen when children are experiencing’fear without solution’.

    Community Care Inform subscribers can find a wealth of information in the attachment knowledge and practice hub including quick guides to assessing attachment in parents and carers, the role of attachment in adoption and foster care and step-by-step guides to using tools such as guided parenting tasks, using observations to help parents’ mentalise, plus much more.

    If your organisation is interested in buying a subscription to Community Care Inform, please email our helpdesk or call 020 8652 3787.

    This can be fear of the carer and/or fear for the carer – the person who is supposed to provide comfort or protection so the child has no way of managing their anxiety. If a child regularly experiences this kind of fear, because of abuse (including emotional abuse) or witnessing domestic violence, for example, the effect can be traumatising. Practitioners should ensure they know and have had training on recognising disorganised attachment behaviours.

    3

    You don’t need to use the word “attachment” at all

    It is quite possible to provide reliable evidence focused on attachment relationships without actually mentioning the word ‘attachment’. Think in terms of providing the court with In-depth observations that detail the interaction between child and parent and capture the ‘child’s eye view’. Observations of different aspects of the child’s routine at different times of the day can evidence a parent’s sensitivity, availability and attunement and provide a rich and invaluable source of attachment-based information.

    You can also use observations of the child in other settings such as nursery, school or with foster carers to discuss in detail differences in the child’s presentation and behaviour in those circumstances.

    Using specific observations of behaviour helps you avoid lazy’ thinking – a tendency to draw on a simple, global description such as ‘attachment problems’, rather than trying to understand the underlying dimensions of what’s going on. It is also an easier way to explain and justify what you mean to parents or the court.

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    16 Responses to Never use the word ‘attachment’ again

    1. Londonboy August 9, 2016 at 2:01 pm #

      As the parent of an autistic young man who entered the Care system I live in fear of the ‘Attachment police’ – Social workers are completely out of their depth with him with the Attachment compass all return to, to navigate no matter what the problem.
      My husband and I have attended parenting classes ( 30 plus hours each) and also receive family therapy. Both have value-Parenting Classes showed me where our son had veered off normal development – somewhere around aged 2? and family therapy means I got to meet the person who gives clinical oversight to the team supporting our son.

      Mis-applied Attachment theory results in tremendous harm for lots of reasons – it encourages lazy thinking and lazy practice. It gives a false impression that all have solutions to problems when they hav’ent even begun to understand the problem.

      It should come with a health warning it is so toxic to autistic children and their families

    2. Ruth August 9, 2016 at 3:59 pm #

      This is a really helpful article and has given me further areas to research. Thank you

    3. londonboy August 9, 2016 at 9:10 pm #

      Many families with Autistic children are fearful of asking for help when they desperately need it. Where autism in child is misconstrued as attachment disorder as a result of poor parenting, parents and professionals are placed in an adversarial relationship.

      The reality is that AD in autistic children is very difficult to diagnose. It requires a specialist multi-disciplinary assessment. SW’s should be very wary of making a judgement about attachment/poor parenting for this reason where autism is suspected
      See . (http://www.aettraininghubs.org.uk/wpcontent/ uploads/2012/05/5.4-Moran-paper-attachment.pdf]
      and
      [http://drawingtheidealself.co.uk/drawingtheidealself/Downloads_files/Coventry%20Grid
      %20Version%202%20-%20Jan%202015.pdf]

      Autistic children relate to the people around them including their families differently to their on-autistic peers. This can sometimes present as an ‘odd relationship’ between children and parent that is difficult to pin down.

      Social care professionals do not have skills/training to establish whether parents could
      have undiagnosed autism as this can explain poor interactions with social workers
      including poor social skills, problems interacting in meetings etc. Social workers may feel
      that because of parental non-engagement and in light of the child’s difficulties, they ‘have
      no alternative’ other than to take the child into Care.

      SW’s need a lot more training about Autism to counter-balance the current obsession with Attachment theory. They risk causing real harm otherwise.

    4. Tonya Harrison August 9, 2016 at 9:33 pm #

      Having heard David shemmings lecture in May this year, I had been inspired on his messenges around using our observations strongly and confidently to describe ‘relationships’, their functioning and impact of these…. Terminology were all so much more at ease with and able to formally use, hypothesise, understand and intervene with!

    5. Ellie August 10, 2016 at 9:56 pm #

      It concerns me that there are a number of people who appear to be using this Social Care forum as a means by which to unfairly criticise Social Workers, and to “blow off” at them concerning the subject of Autism. Is that not somewhat inappropriate? I have seen similar posts by someone with the tag “PlanetAutism”. Surely, if you have concerns regarding a specific Social Worker who is perhaps working with you, and your Autistic child, you should address those concerns TO SAID SOCIAL WORKER, and/or THE PLACE THEY WORK – airing them on a forum such as this seems a little… well… wrong!

      Whilst it may be true that some Social Workers need a lot more training in respect of Autistic Spectrum Disorders (I understand that this is actually the correct term, as opposed to Autism), this is NOT the case for all of them. Indeed, only a limited number of Social Workers actually work with people classed as Autistic Spectrum, and one would hope that, since they have chosen to go into this specialism, they WOULD have received training relevant to this range of disorders. Others may come into contact with people who are Autistic Spectrum during the course of their work – but this is NOT their speciality, so it can only be expected that when they encounter somebody who does have an Autistic Spectrum disorder it is perfectly acceptable for them to seek advice and guidance as to how to work in such a situation. Nobody can know everything!

      Furthermore, there is no current “obsession” with Attachment Theory – it is merely one of many theories which may be utilized in working with people. Ideally a good Social Worker would be cognisant of various different theories, and could consider the application of one, or many, when working with service-users. Here, it is important to remember that theories are just that – theories. They are NOT prescriptive, or dogmatic, in the sense that they dictate, or must be followed. Rather, they are there to act as reference points, and to help Social Workers (and other health and care professionals, too) to hypothesize about the nature of a service-user’s condition, presentation or problem, and hypothesize about possible solutions. A decent Social Worker will then discuss any hypothesis with the service-user and both will work together to find a solution to the situation in hand. This is how it SHOULD work. I do understand that to service-users this sometimes may appear NOT to be the case. However, it is important to remember that in a time of austerity measures, Social Workers are faced with dwindling resources, so often, when service-users do not receive the care package that they wanted, or expected, this is NOT down to the individual Social Worker, but rather to the bureaucratic pressures of budgetary constraints – mandates that have filtered down from on high!

      I will add that when it comes to the application of theories, Attachment Theory can be as relevant to a given situation as any other. Indeed, in some situations it can be very helpful. The fact is that solutions to service-users’ problems, or needs, are not always simple, or easy to find immediately. Sometimes that can be trial and error; other times they can require considerable discussion, testing, and “tweaking” to get right. This is a fact of life – when ANY of us encounter adversity, we do not always have ALL the answers, and a solution, immediately to hand. Perhaps in this sense, the BEST Social Work is organic in nature – it flows from the development of a good working relationship between Social Worker and service-user. Good Social Work accepts that there are different solutions that work for different people, and allows service-users to have control over the process of finding a solution that suits them.

      This is true of work with people who are on the Autistic Spectrum, and their families, plus carers. Different solutions work for different people. Attachment Theory may not work, or be relevant, to all. However, just a brief look online – as well as reading Journal articles and research papers – has shown me that there are many parents of children who are Autistic Spectrum (plus people who are Autistic Spectrum themselves) who DO feel that attachment oriented parenting, and Attachment Theory, work. Probably as many as those who do not. So, I guess it’s “horses for courses”! I know of at least five online “Blogs” written by parents of children who are Autistic Spectrum, who swear by Attachment Theory and attachment parenting. Take a look at the following examples from the net, which all relate to attachment and Autism (more correctly, Autistic Spectrum), and which would all tend to suggest that Attachment Theory may well have relevance in work with Autistic Spectrum service-users…

      http://www.ncbi.nlm.nih.gov/pubmed/15257669

      attachmentparenting.org/blog/2009/10/14/attachment-parenting-and-autism

      amt.sagepub.com/content/11/2/187.abstract

      http://www.academia.edu.3433490/Guide_to_applying_attachment_theory_in_social_work_practice

      http://www.myaspergerschild.com/2010/09/aspergers-children-and-attachment.html

      wrongplanet.net/forums/viewtopic.php?t=199875

      It is sometimes the case that “odd relationships” between parents and children are the result of either parent, or child (or perhaps both) being somewhere on the Autistic Spectrum. However, we cannot claim that this is the case ALL of the time. The sad fact is that in large numbers of cases where there is an “odd relationship” between parent and child, it is because of a huge range of issues that have nothing to do with Autism whatsoever, but are, rather, parental substance misuse, parental mental illness, parents who abuse and neglect their kids, domestic violence, unplanned pregnancy, teenage pregnancy, unskilled or unprepared parents, resentful parents (for example a mother who became pregnant through rape but kept the child because of guilt)…

      I would agree that when it comes to diagnosing specific things like Attachment Disorder, then yes, a multidisciplinary approach is prudent. I would also agree that this disorder is difficult to diagnose – not only in children who are Autistic Spectrum, but, indeed, in any child. Thus I would accept that a cautious approach is necessary. In my eyes, it would make sense, when dealing with what you describe politely as an “odd relationship” between parent and child, to consider ALL the possible eventualities. If abuse seems likely, do not rule out abuse. If parental mental illness, or substance misuse seems a possible factor, do not rule it out. If poverty, unemployment, stress, crises… if socio-economic factors seem to be taking their toll on family relationships, do not rule them out. Additionally, if the possibility of a family member (parent or child) having an Autistic Spectrum disorder rears its head, do not rule it out. It makes sense to cover ALL the possibilities, because we should be aware that in real life, these possibilities exist, and Social Workers work with real life people.

      Whilst I am not saying that providing training to help Social Worker work more effectively with people who are Autistic Spectrum, their friends, families and carers would not be a useful thing… I do feel that it is completely unjust to criticize only Social Workers. The real TRUTH is that NURSES, DOCTORS, PHYSIOTHERAPISTS, PSYCHIATRISTS, OCCUPATIONAL THERAPISTS, CARE ASSISTANTS, SPEECH THERAPISTS, CHARITY WORKERS… indeed, ANY worker who comes into contact with a service-user who is Autistic Spectrum can get it wrong. Thus, ALL would probably benefit from training, and regular training updates. After all, the training that workers are provided with, and the skills that they are supposed to develop as a result, should reflect the real world, and thus the nature of the work that they may be called upon to do.

      • Shona Brown August 11, 2016 at 8:37 pm #

        Thank you so much for this.

        A passionate but beleagered Social Worker in Edinburgh

      • HAJ August 12, 2016 at 12:00 pm #

        My understanding is that the use of capitals in text is in fact shouting, is this appropriate?

        • Ellie August 15, 2016 at 4:25 pm #

          I would have thought that the point of such an article, and the discussion forum that its comments section provides, is to discuss the issues raised within the article, and how they pertain to the role of Social Workers. The “nitpicking” policing of how people write responses is something I would have thought pretty unimportant by comparison. Perhaps “HAJ” (which, interestingly, I note is all capitals!), you would prefer that I had italicized words which I intended to emphasize? Unfortunately, I have not found a means by which it becomes easy, or quick to do so, whilst typing a response in this little “leave a reply” box!

          At the end of the day, if a relevant point is made in a person’s comment, then do we really need to care whether they write in capitals, all lower-case, italics, or a mix of the three? It’s immaterial! With the attitude that you have adopted, you may as well spend all day simply criticizing each and every comment on the basis of its punctuation, and grammatical content – pretty pointless, given that such activity detracts from the real purpose of reading said comments – which is to understand and appreciate the content.

          If you wish to be really “nitpicking”, then there are innumerable comments on this “Community Care” website that contain poor spelling, poor punctuation, and poor grammar… Do you comment on them all? Even within this article, above, there is an error (possibly the result of editing) which leaves a sentence reading as follows…

          “… the specific set of temporary behaviours which are seen when children are experiencing’fear without solution'”.

          No gap between experiencing and fear. Did you complain about that?

          Grow up!

          • HAJ August 19, 2016 at 12:11 am #

            In capitals as it is my initials Ellie, there is no need to be rude. I was endeavoring to say, politely, that the way you write is in fact rather oppressive. “Airstrip Won” and “A Social Worker” have probably been clearer. This is the first time I have responded to a comment on this site, the way in which you write makes me very uncomfortable.

            • Moses September 5, 2016 at 6:09 pm #

              I actually find Ellie honest and not patronising at all. The information she provided are very useful.

    6. Londonboy August 11, 2016 at 3:49 pm #

      I do support social workers including those who work with my son – I really wish they knew about autism.

      On the subject of neurodisability and Autism awareness

      Please can you support the Amendment to the Children and Social Work Bill relating to this

      http://ihv.org.uk/news-and-views/news/ihv-supports-amendment-children-social-work-bill/

    7. londonboy August 13, 2016 at 1:13 pm #

      Last comment – promise!

      I find the fervour of those that promote attachment based practice frightening, Many declare themselves ‘passionate’ in their adherence and ‘inspired’. Personally I would trust someone ‘committed to good outcomes’ before I would engage with someone ‘passionate’ about a theory predicated on ‘experts’ observing, noting etc rather than listening to the people they supporting… but then I’m just a service user.. what do I know?

    8. Ellie August 15, 2016 at 5:04 pm #

      As noted previously, much of this comments section appears to have deteriorated into one person’s (“londonboy”) criticism of Attachment Theory based upon his personal experiences of a child with autism. He makes the comment…

      “I find the fervour of those that promote attachment based practice frightening”…

      Well, I find the fervour of somebody so vehemently, and vociferously, opposed to attachment based practice – especially when it is based only upon their own perspective, without considering the perspective of others – equally, if not more, frightening! Not only has “londonboy” failed to consider the fact that article, itself, admits Attachment Theory can be misapplied, and therefore seeks to address Social Workers; failings in doing so; he has also made the generalized assumptions that all Social Workers know nothing about autism, and that it is somehow wrong to believe in attachment based practice because, as he insinuates, it is …

      “predicated on ‘experts’ observing, noting, etc. rather than listening to the people they are supporting”.

      Since when? I can only assume that “londonboy” has had the dreadful misfortune of coming into contact with some particularly awful Social Workers! Whether Social Workers use Attachment Theory, or not, the nature of Social Work involves a dialogue with service-users that should involve listening to the people they support. How, otherwise, do they know what to do to address service-users’ needs? This is a part of being “committed to good outcomes”, irrespective of application of theory.

      The one thing that I have noted, however, is that nowhere does “londonboy” give a concrete example of the problems he cites. He gives NO examples of work with his son that demonstrate a Social Worker’s lack of autism awareness. NOR does he provide examples demonstrating clearly that Social Workers using Attachment Theory get it wrong. NOR does he show ways in which Social Workers have not listened.

      IF, as he implies, he has genuine issues that confirm the use of Attachment Theory within Social Work as inappropriate, or wrong, then why not share what they are? Just how can Social Workers be expected to understand the criticism of such a theory, if no examples of its inappropriateness – especially if it is claimed it is wrong to use it with people who are autistic – are given. To merely state that attachment based practice is somehow wrong because people may be “passionate” about it, or feel “inspired” by it, is beyond ridiculous. Social Workers are perfectly capable of using any number of theories as a basis behind their work – including Attachment Theory – and yet still listening to service-users. The use of a specific theory-base does NOT automatically preclude listening! It should not!

      Workers in all professions may feel “passionate” and “inspired”. Many NHS staff, including most notably Nurses and Doctors, feel passionate about their work, and about the Medical Model of care that their work espouses. Service-users (“londonboy” included) should note that the Medical Model of care that the NHS is so passionate about, and inspired by, actually PATHOLOGIZES service-users by arguing that patients suffer from “disorders” that have a “physical” or “organic” origin/cause. This can be extremely demeaning and stigmatising for disabled and chronically-ill people – including people with disabilities such as autism – because the Medical Model seeks to locate the problem firmly within THEM. Ironically, I see few people (including “londonboy”) criticizing the Medical Model of care! Even though it can be so devaluing of service-users. For more about this, and the way in which the Medical Model of care demeans service-users (plus why Social Workers DON’T use it) try reading…

      “Pride Against Prejudice” by Jenny Morris, published by The Women’s Press.

      Social Work, including use of Attachment Theory, is being given an unfairly bad press – especially by people who don’t even seem to understand Social Work! It was Social Work – and NOT the NHS, Nurses or Doctors – that championed the rights of service-users to express themselves, and to be listened to. This is why Social Work adopted the Social Model of care, which is one in which people’s problems (such as ill health, poverty, homelessness, disability, and so forth) are seen as attributable just as much to socio-economic external factors, as they are to the person him/herself. For instance, the Medical Model says a person in a wheelchair is disabled because they cannot walk and need a wheelchair. This locates the problem in the wheelchair-user. The Social Model says a person in a wheelchair is not disabled by needing to move around using a wheelchair, but rather by the fact that society is set up so as only to recognize non-wheelchair users. This is why we have stairs, pavements with high kerbstones, and so forth. It is the fact that a society which overlooks the needs of wheelchair users by having stairs, high kerbs to pavements, etc. effectively disables the wheelchair user, that the Social Model highlights.

      Social Workers have bee active historically in advocating models of care that are PRO service-user in that thy seek NOT to pathologies service-user’s issues in the same way that the NHS and its Medical Model of care does.

      BEFORE people set out to “bash” Social Workers, and Social Work as a profession, perhaps they ought to consider the above!

      • A social worker August 15, 2016 at 6:39 pm #

        Ellie, you seem to have a problem with people exercising their right to free speech. More concerning still is your attack on those expressing misgivings from their personal experiences of attachment theory being used in relation to their autistic children. These people are social work users and they have every right to be critical. They are living with the consequences of social work decisions every minute if every day. Your attitude towards their comments is very concerning, as is the fact you appear to believe social workers are beyond reproach.

    9. Airstrip Won August 16, 2016 at 9:58 am #

      I feel I should apologise on behalf of the profession and the applied field of social work for the comments on this thread by a particular contributor, ‘Ellie’. The tone of her outpourings is entirely inappropriate and not befitting the manner in which social workers (if indeed Ellie is one) should interact with anyone, let alone service users, two of whom, having commented on the relevant issues, she singles out for particular criticism. I commend ‘Londonboy’ on his measured and helpful responses to Ellie’s pronouncements, many of which appear to be based on spurious claims and dangerous assumptions about social work and other professions.

      They say a little knowledge is a dangerous thing. Ellie in her somewhat patronising lecture on the medical model vs the social model rejects absolutely the medical model and, by implication, the vital contributions of medical professionals in the care arena, failing to recognise, for example, the contribution of nursing to the development of person-centred care (I would advise her to read some nursing journals – a strength of social work, after all, is that it draws from an eclectic knowledge base (it’s also a ‘weakness’ but that’s another debate)) and fails to recognise the irony in claiming social workers are “unfairly” criticised before going on to make grossly generalised statements about medical professionals and the NHS.

      Ellie’s assertion – delivered in quite confrontational terms, I have to say – that this is not an appropriate forum for service users to critique social work is particularly concerning given the dearth of spaces in which such debate is possible.

      I am confident I am not alone in seeking to distant myself from Ellie’s comments. She does not speak for social work or social workers in general and her outbursts are, I believe, cause for significant concern about her suitability for the profession.

    10. Azaria Jambo September 1, 2016 at 7:47 am #

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