Integrating Play Therapy in the Home-Based Setting Module

Module Sections:

Factors Influencing Attachment

Personal safety is a fundamental attribute of attachment security. Humans are most successful when there is a strong sense of personal safety and this sense begins in infancy. When safety is threatened, a person will seek security often through fight, flight or freeze. When children are in exploration of their world, they are exploring relationships with others and relationships with others plus objects or events. This exploration is characterized by primary and secondary intersubjectivity () Primary intersubjectivity is the discovery of the infant and parent relationship or person-to-person relationship. Secondary intersubjectivity is the discovery of the infant's world specifically, people, objects and events or person-to-person-to object relationship. Hughes describes the three important aspects of intersubjectivity – shared affect, shared attention and shared intentions . Shared affect is what Hughes refers to as affect attunement. "Through attunement, the infant feels receptive to and connected to his parent, and also is able to begin to regulate his affective states through first co-regulating his affective state with his parent's affective state ." (p.3) In infancy the basic interactions such as eye contact, facial smiles and expressions, voice tone, movements and gestures influence the infants ability to discover her parent as well as herself. When those verbal and nonverbal communications are absent or minimal the infant learns she is not important and begins to struggle with being able to develop other socialization abilities or behavior problems that often bring a child in for therapy. It is for this reason that understanding a parent's attachment history is critical in treating the child with attachment issues. When a parent is able to respond to the child in a consistent and reciprocal manner, that parent is able to create a strong sense of security for the infant. Inability to do this could result in the child being unable to engage in trusting relationships with the parent and others. Their sense of the world and relationships could be skewed.

Assessing Attachment

Cain (2006 ) reports on Mary Ainsworth's research in Uganda and Baltimore with home-based work and the identification of three patterns of attachment. Main and Soloman (1990) later added a fourth pattern. Ainsworth identified the three styles through the use of an assessment called the "Strange Situation Behavioral Assessment. The four styles of attachment described in Cain's work are:

  1. Secure: A child who is securely attached has a bond with a caregiver that is based on trust and consistency. The caregiver responds with warmth and is responsive and sensitive to the child's needs. The caregiver is sensitively attuned to the infant and learns to differentiate between the cries for hunger, comfort, diapering or other issues. The securely attached infant is affectionate and easily comforted. As a toddler they are problem solvers and can accept help when uncertain or having difficulty with a task. The child is becoming self-reliant, is curious and sociable.
  2. Insecure-avoidant: The avoidant child's play tends to have many unresolved conflicts. These children struggle with fantasy play and tend to be aggressive in their play and relationships. As they age they become more sullen and oppositional. They seek to prove to others that they can do anything without help and do not need others to get needs met. The avoidant child typically has had a parent who was uncomfortable with physical touch in infancy and typically avoided physically comforting the child. One would expect these children to have spent more time in cribs or car seats rather than in a caregiver's arms or lap.
  3. Insecure-ambivalent: The ambivalent child often lacks self-reliance skills, has little interest in problem solving and may appear distressed and whiney. This child will often be very clingy and have difficulty disengaging from the caregiver reacting with anger or passivity when the caregiver is unpredictable in response to the child. The child may be coercive and timid in response to the inconsistent responses of the caregiver. It is not uncommon that the relationship with the caregiver becomes a pursuer-distancing one that is unfulfilling to both.
  4. Insecure-disorganized: The disorganized child has developed extreme ways of dealing with situations. The child often has experienced severe abuse and neglect and is unable to organize responses to situations. This child may seem disoriented most of the time unaware or frozen. Common mannerisms may be rocking, pulling their ears and avoiding eye contact. The caregiver has been resistant to requests for contact from the child. In addition, the disorganized attachment has been linked to maternal depression, substance abuse and poverty.

Understanding the child's behavior in relationship to these four attachment styles is necessary to determining the appropriate treatment strategies for the child. It is also necessary in determining the ability of the parent or caregiver to participate in treatment. A thorough developmental history is a significant part of the attachment assessment. It is the assessment process that determines the type of play therapy to integrate into the treatment process.

Audio Companion: Integrating Play Therapy