DDP is a treatment approach to trauma, loss, and/or other dysregulating experiences that is based on principles derived from attachment theory and research and incorporates aspects of treatment principles that address trauma. It is a family-centered treatment, with the child’s attachment figures actively involved.
DDP involves creating a safe setting in which a child can begin to explore, resolve, and integrate a range of memories, emotions, and current experiences, that are frightening, shameful, avoided or denied. Safety is created by insuring that this exploration occurs within an intersubjective context characterized by nonverbal attunement, reflective dialogue, acceptance, curiosity, and empathy. As the process unfolds, the client creates a coherent life story—or autobiographical narrative, crucial for attachment security and strongly protective against psychopathology. Therapeutic progress occurs within the joint activities of co-regulating affect and co-creating meaning.
Primary intersubjective experiences between a parent and infant contain shared affect (attunement), focused attention on each other that amplifies the child’s enjoyable experiences while reducing and containing his stressful experiences. It involves a congruent intention to understand the other/be understood by the other, and is done through contingent, nonverbal (eye contact, facial expressions, gestures and movements, voice prosody and touch) communications.
These same early parent-child experiences, fundamental for healthy emotional and social development, are used in therapy to enable the child to rely on the therapist and parents to regulate emotional experiences and to begin to understand these experiences more fully. Further understanding develops through engaging in affective/reflective (a/r) dialogue about these experiences, without judgment or criticism. The therapist maintains a curious attitude, facilitating the client’s ability to explore and understand life events and behaviors and develop a more coherent life-story. This process may be stressful for the client, so the therapist will frequently “take a break” from the work, go slower, provide empathy for the negative affect that may be elicited, and repair the treatment relationship.
The PACE attitude
The primary therapeutic attitude demonstrated throughout DDP sessions is one of playfulness, acceptance, curiosity, and empathy (PACE).
A parent, or other attachment figure, is present in her child’s psychotherapy. Their role is to:
1. Help him to feel safe.
2. Communicate PACE, both nonverbally and verbally.
3. Help him to regulate negative affect such as fear, shame, anger, or sadness.
4. Validate his worth in the face of trauma, loss, and shame-based behaviors.
5. Provide attachment security regardless of the issues being explored.
6. Help him to make sense of his life so that it is organized and congruent.
7. Help him to understand the parents’ perspective and motives towards him.
A person’s symptoms are often his unsuccessful ways of regulating frightening or shame-based memories, emotions, and current experiences. Confronting a child to stop engaging in these symptoms may increase their underlying causes. In helping the child in therapy and at home to regulate the affect associated with the symptoms, and to understand their deeper meanings, the symptoms are more likely to decrease. At the same time we may need to address the symptoms through increased daily structure and supervision or through applying natural consequences for them. Again, however, the issues will be addressed more effectively when done with PACE rather than routine anger, rejection, harsh discipline, or other shame-inducing actions.
Asking a child to address frightening or shame-based memories, emotions, and current experiences, is asking him to engage in an activity that is emotionally stressful. So it is crucial that we maintain an attitude characterized by PACE to reassure the child that he is not alone in that painful experience. The child has developed significant symptoms and defenses against the pain, most often because he was alone in facing it originally. When we help to carry and contain the pain with him, when we co-regulate the affect with him, we are providing the safety he needs to explore, resolve, and integrate the experience. We do not facilitate safety when we support a child’s avoidance of the pain, but rather when we remain emotionally present when he is addressing and experiencing the pain.
For a caregiver and therapist to remain present for a child during periods of dysregulation, they need to have resolved any similar issues from their own attachment histories. The significant adults in the child’s treatment need to address any areas of fear or shame in their own lives that are similar to what they are asking the child to address. Individual or joint treatment for the parent(s) may be necessary prior to, instead of, or during this family-focused treatment.
Routine features of DDP:
Playful interactions, focused on positive affective experiences, are an integral part of most treatment sessions when the client is receptive.
Shame is frequently experienced when exploring experiences of negative affect. Shame is always met with empathy, followed by curiosity about its development, organization, exceptions, management, and impact on the narrative.
Emotional communication that combines nonverbal attunement and reflective dialogue and is followed by relationship repair when necessary, is the central therapeutic activity. All communication is “embodied” within the nonverbal.
All resistance is met with PACE, rather than being confronted.
Treatment is directive and client-centered. Directives are frequently modified, delayed, or set-aside in response to the child’s response to the directive.
The therapist is responsible for insuring the rhythm and momentum of the session. The therapist insures the development of a coherent story line through his matched, regulated, affect, accepting awareness, and clear intentions.
Extracts from: DEVELOPMENTAL TRAUMA DISORDER: Toward a rational diagnosis for children with complex trauma histories Bessel van der Kolk, MD(Psychiatric Annals 35:5 May 2005, Pp.401-408)
“Traumatized children rarely discuss their fears and traumas spontaneously. They also have little insight into the relationship between what they do, what they feel, and what has happened to them.” P.405
“The PTSD diagnosis does not capture the developmental effects of childhood trauma:
The complex disruptions of affect regulation;
The disturbed attachment patterns;
The rapid behavioral regressions and shifts in emotional states;
The loss of autonomous strivings;
The aggressive behavior against self and others;
The failure to achieve developmental competencies;
The loss of bodily regulation in areas of sleep, food, and self-care
The altered schemas of the world;
The anticipatory behavior and trauma expectations;
The multiple somatic problems, form gastrointestinal distress to headaches;
The apparent lack of awareness of danger and resulting self endangering behaviors;
The self-hatred and self-blame;
The chronic feelings of ineffectiveness.” P. 406
“Treatment must focus on three primary areas:
Establishing safety and competencies.
Dealing with traumatic re-enactments
Integration and mastery of the body and mind.” P. 407
“Unless this tendency to repeat the trauma is recognized, the response of the environment is likely to replay the original traumatizing, abusive, but familiar, relationships. Because these children are prone to experience anything novel, including rules and other protective interventions as punishments, they tend to regard teachers and therapists who try to establish safety as perpetrators.” Pp.407-408.
COMPLEX TRAUMA IN CHILDREN AND ADOLESCENTS, A. Cook, J. Spinazzola, J. Ford, C. Lanktree, M. Blaustein, M. Cloitre, R. DeRosa,R. Hubbard, R. Kagen, J. Liautaud, K. Mallah, E. Olafson, B. van der KolkPsychiatric Annals, 35:5 May, 2005, 390-398.
Domains of Impairment in Children Exposed to Complex Trauma
4. Behavior Control
Six Core Components of Complex Trauma Intervention:
4. Traumatic Experience Integration
5. Relational Engagement
6. Positive Affect Enhancement
Dan Hughes’ Attachment-focused Parenting with Traumatized, Attachment-resistant Children Aim to maintain the PLACE Parenting attitude:
To facilitate a child’s capacity for fun and love:
1. Provide reciprocal intersubjective experiences
2. Stay physically close.
3. Integrate and resolve own issues from own attachment history.
5. Be emotionally available to the child in times of stress
6. Have only safe Surprises
7. Maintain physical contact with your child
8. Make choices for him and structure his activities.
9. Encourage reciprocal communication of thoughts & feelings, shared activities
10. Use humor and gentle teasing
11. Maintain basic safety and security
12. Provide opportunities to imitate parents
13. Encourage spontaneous discussions of past and future
14. Have routines & rituals to develop a mutual history
To facilitate effective discipline (shame-reduction and skill development):
1. Stay physically close.
2. Make choices for him and structure his activities.
3. Set & Maintain your favored emotional tone, not your child’s
4. Accept thoughts, feelings, and behaviors of child
5. Provide natural and logical consequences for behaviors
6. Be predictable in your attitude, less predictable in your consequences
7. Re-attune (repair the relationship) after experiences that create shame
8. Interrupt cycles of resistance with time in or “mom time”
9. Match his affective expression of emotion, not the emotion (fear, anger) itself.
10. Use permission, thinking, practicing, having limits, being supervised.
11. Employ quick, appropriate, anger, not habitual anger or annoyance, and then repair the relationship.
12. Clarify with empathy that it is the child’s problem not your problem
13. Use the child’s anger to build a stronger connection
14. Reciprocal communication of thoughts and feelings
15. Be directive and firm, yet be attuned to the affect of your child
16. Greatly limit your child’s ability to hurt you, either physically or emotionally.
17. Integrate and resolve own issues from own attachment history.
The importance of physical presence
Maintaining physical presence is the primary way that parents discipline toddlers. Parents are aware of their toddler. They “keep an eye on her” and “an ear on him” constantly throughout the day. They are near their child, so that the child takes their presence for granted and gradually comes to rely on their knowledge about what to do. Their child also constantly engages in “social referencing” whereby (s)he watches her/his parents’ nonverbal reactions to know whether or not someone or something is dangerous or safe. They develop their primary knowledge of self, other, and the world through relying on their parents’ minds and hearts. The parents’ presence gives the child the sense of safety necessary to explore and learn about the world.
Children lacking a secure attachment need physical presence just as much as does the toddler. They do not have the skills needed to internalize rules, control impulses, remember consequences of their actions, have empathy for others or feel safe. Allowing them to be outside of the parents’ presence, to make the “right” choice unsupervised, is a blueprint for disaster and failure.
The following is applied to the degree that the child requires structure and containment and involves:
1. Supervision. The parent is aware of the child at all times when (s)he is not sleeping. If the parent is out of visual contact briefly, the child is confined to an area (with a door alarm if necessary) where (s)he cannot hurt her/himself, others, or destroy something important.
2. The child sits, plays, works, or rests near her/his parent. The parent enjoys her/his company frequently with brief engagements.
3. There is a well-defined routine, alternating active and quiet activities, work and play, solitary and interactive activities
4. The parent chooses the activities, as well as much of the food, clothing, toys, etc. for the child, giving him/her the ability to choose only when she/he shows some readiness to make good choices, that lead to contentment and success.
5. The home is “child-proof”.
Fun and love
The parent provides numerous activities to become engaged with her/his child with reciprocal fun and love. The parent is attuned to the child’s emotional state and engaged with her/her in positive emotional, nonverbal communication throughout.
Feed, prepare food together
Hold, rock, hug, touch, massage
Wash, dress and comb hair.
Read and tell stories
Play on the floor: roll, crawl, rest among pillows.
Respond from 1-5. 1 represents very little; 5 a great deal of the characteristic/skill. Focus on adult’s abilities, not whether or not the child is receptive to the interaction.
1 = very little 5= very much
My perception of partner
My perception of self
Able to maintain a sense of humor
Comfortable with giving physical affection
Comfortable receiving physical affection
Ready to comfort child in distress
Able to be playful with child
Ready to listen to child’s thoughts and feelings
Able to be calm and relaxed much of the time
Patient with child’s mistakes
Patient with child’s misbehaviors
Patient with child’s anger and defiance
Patient with child’s primary two symptoms-
Comfortable expressing love for child
Able to show empathy for child’s distress
Able to show empathy for child’s anger
Able to set limits, with empathy, not anger
Able to give consequence, regardless of his response
Able and willing to give child much supervision
Able and willing to give child much “mom-time”
Able to express anger in a quick, to the point, manner
Able to “get over it” quickly after conflict with child
Able to allow child to accept consequence of choice
Able to accept, though not necessarily agree with, the thoughts and feelings of your child
Able to accept, though you may still discipline, the behavior of your child
Able to receive support from other adults in raising this difficult child
Able to acknowledge failings and mistakes in raising this difficult child
Able to ask for help from people you trust
Able to refrain from allowing your child’s problems to become your problems
Able to cope with criticism from other adults about how you raise your child
Able to avoid experiencing shame and rage over your failures to help your child
Able to remain focused on the long-term goals
Questions for Parental Self-Reflection
1. What was it like growing up? Who was in your family?
2. How did you get along with your parents early in your childhood? How did your relationship evolve throughout your youth and into the present?
3. How did your relationship with your mother and father differ? Were similar? Are there ways in which you try to be like/not like each parent?
4. Did you feel rejected or threatened by your parents? Where there other experiences in your life that were overwhelming/traumatic?
Are these experiences “still alive”? Continue to influence your life?
5. How did your parents discipline you? What impact did that have on your childhood? How does it impact your role as a parent now?
6. Do you recall your earliest separations from your parents? What was it like? Did you ever have prolonged separations from your parents?
7. Did anyone significant in your life die during your childhood or later? What was it like for you then and how does it affect you now?
8. How did your parents communicate with you when you were happy/excited? How did they communicate when you were unhappy/distressed? Did your father and mother respond differently during these times? How?
9. Was there anyone besides your parents who took care of you? What was that relationship life for you? What happened to them?
10. If you had difficult times during your childhood, were there positive relationships in or outside your home that you could depend on? How did those connections benefit you then and how might they help you now?
Taken from Dan Siegel, Parenting from the Inside Out, (Tarcher/Putnam), 2003, p.133-4
Both you and your child are doing the best you can.
You both—at a deep level—want family life to improve.
Your lives, as they are lived now, are often very difficult for you both.
Your child is trying to establish safety by controlling the other.
Your child tries to be safe by avoiding everything that is stressful & painful.
His attacks (emotional, verbal, physical) on you & his resistance to you, reflect his fear of your motives for your nurture & discipline of him, his poor affect regulation, fragmented thinking, pervasive sense of shame, inability to trust, and lack of behavioral controls.
For her to change, she will need you to accept, comfort, & teach her.
You will need to validate his sense of self, while teaching him important developmental skills.
You will need to come to know her developmental age, and fine tune your expectations to match that age so that she will have success, not failure. Your physical and psychological presence are the foundation of your comforting and teaching her. Structure and supervision are crucial.
Under stressful emotional conditions, he will regress and revert to his solitary defenses that he used to survive in his terrifying, lonely past.
You will both have to work hard to learn how to live well. You cannot do her work for her, nor can you save her. You can comfort and teach her.
You will need support and consultation from trusted others if you are to successfully comfort and teach him. You will make mistakes and you need to face these, learn from them, and continue. Your own attachment/parenting histories will often be awakened as you raise your child. You will have to address anything from your past that has not been resolved in order to persist in your difficult parenting activities and responsibilities.
Core assumptions about Certain Behaviors of the Child
Behaviors: Argue, complain, control, rage, withdraw, not ask for help, not show affection, bang head to sleep, scream over routine frustrations, constant chatter, avoid eye contact, lie, steal, gorge food, socialize indiscriminately
Under the Behavior
Conviction that only self can/will meet own needs
Never feeling safe
Pervasive sense of shame
Conviction of hopelessness and helplessness
Fear of being vulnerable/dependent
Fear of rejection
Inability to self-regulate intense affect, positive or negative.
Inability to co-regulate affect, positive or negative.
Felt sense that life is too hard. Feeling “invisible”
Assumptions that parents’ motives/intentions are negative
Lack of confidence in own abilities
Lack of confidence that parent will comfort/assist during hard times.
Inability to understand why s/he does things.
Need to deny inner life because of overwhelming affect that exists there.
Inability to express inner life even if he wanted to.
Fear of failure
Fear of trusting happiness
Routine family life is full of associations to first family
Discipline is experienced as abuse/neglect
Inability to be comforted when disciplined/hurt.
Core Assumptions about Certain Behaviors of ParentsBehavior: Chronic anger, harsh discipline, power struggles, not ask for help, not show affection, difficulty sleeping, appetite problems, ignoring child, remaining isolated from child, reacting with rage & impulsiveness, lack of empathy for child, marital conflicts, withdrawal from relatives and friends, chronic criticism.
Under the Behavior
Desire to help child to develop well
Love and commitment for child.
Desire to be a good parent.
Uncertainty about how to best meet child’s needs
Lack of confidence in ability to meet child’s needs
Specific failures with child associated with more pervasive doubts about self.
Pervasive sense of shame as a parent.
Conviction of helplessness and hopelessness.
Fear of being vulnerable/being hurt by child.
Fear of rejection by child as a parent
Fear of failure as a parent.
Inability to understand why child does things.
Inability to understand why self reacts to child.
Association of child’s functioning with aspects of own attachment history.
Feeling lack of support and understanding from other adults.
Felt sense that life is too hard. Assumptions that child’s motives/intentions are negative.
Feeling that there are no other options besides the behavior tried.
PLACE Hughes, D. (2006). Creating PLACE: parenting to create a sense of safety. In Adoption Parenting: Creating a toolbox, building connections. MacLeod, J. & Macrae, S.(Eds.). Warren, NJ: EMK Press. Pp. 57-61.
A child can best be understood by focusing not so much on the behavior that you can observe, but rather on the nature of the child’s intentions which underlie the behavior. The child’s intentions include the thoughts, feelings, perceptions, and motives that are associated with the resultant behavior. Often these features of the child’s inner life are associated with previous events that were traumatic and/or shameful. Thus, the meaning of the behavior is often closely tied to the meaning of those past events in the child’s mind.
Ignoring the child’s inner life, is to have only the most superficial understanding of him. To encourage the development and expression of his inner life we need to first make him feel safe. If he knows that he will be judged negatively for his intentions, they will remain hidden. To provide the experience of safety, a parent might consider PLACE.
PLACE—representing Playfulness, Love, Acceptance, Curiosity, and Empathy—creates a sense of safety that facilitates self-discovery and communication. PLACE also describes the nature of a home which serves both as a secure base for exploring the world and a safe haven where one can return when the world becomes too stressful.
PLAYFULNESS characterizes the frequent parent-infant reciprocal interactions when the infant is in the quiet-alert state of consciousness. Both parent and infant are clearly enjoying being with each other while engaged in the delightful experience of getting to know each other. Both are feeling safe and relaxed. Neither feels judged nor criticized. These experiences of playfulness—combined with comfort when he is distressed—serve as the infant’s original experience of parental love.
During frequent moments of playfulness, both parent and child become aware of how much they like each other. Playful moments reassure both that their conflicts and separations are temporary and will never harm the strength of their attachment. Playfulness also provides opportunities to convey affection when more direct expressions may be resisted. The child is likely to respond with less anger and defensiveness when the parent is able to convey a touch of playfulness in her discipline. While such a response would not be appropriate at the time of major misbehavior, when applied to minor behaviors playfulness keeps the behavior in perspective. The behavior is a threat to neither the relationship nor the worth of the child.
LOVE When the central motive for the parents’ interactions with their child, love enables the child to have confidence that what underlies the parents’ behaviors involves the intention to do what is in the best interests of the child. Love, when it is expressed most fully, conveys both enjoyment and commitment. At times one or the other is evident, but for the child to feel loved, he needs to be confident that commitment is always present even when moments of reciprocal enjoyment are not. The child needs to know that basically his parent “likes” him, enjoys being his parent, and looks forward to having fun together. While at times these moments may not be evident, there remains an assumption that this basic “liking” will return.
Fundamental to the sense of being loved is the child’s conviction that his parents will do what is in his best interests. The parent will do whatever it takes to keep him safe and to insure that his basic needs will be met and his rights will be respected. “Hard times” will pass without abuse, neglect, or abandonment because the child’s welfare is at the core of the parents’ daily motives, decisions, and behaviors with regard to their child. Children who have lost their first parents for whatever reason need ongoing signs that their relationship with their adoptive parents is permanent—that they will never be “given away” regardless of the crises or conflicts that lie ahead.
ACCEPTANCE Unconditional acceptance is at the core of the child’s sense of safety, value, and relaxed sharing with his parent. Within acceptance the child becomes convinced that his core sense of self is worthwhile and valued by his parents. His behavior may be criticized and limited, but not his “self”. He becomes confident that conflict and discipline involves his behavior, not his relationship with his parents, nor his self-worth.
While the behavior of the child may be evaluated and limited, the thoughts, feelings, perceptions, and motives of the child never are. The child’s inner life simply “is”; it is not “right” or “wrong”. Am I suggesting that if a child says to his parents that he does not like his brother and wishes that he lived somewhere else, such expressions are “OK”? Yes—and the fact that your child disclosed his inner life to you may well reflect his trust that you will not dislike him because he has such thoughts and wishes. If he is criticized for his inner life, he will most likely begin to conceal it as well as feel ashamed of that aspect of himself. When he is safe to communicate his inner life, his parents will be able to understand how he is struggling with his brother, the reasons for the struggles, and possible ways to reduce them. When he is not safe, the parent will be left with simply disciplining inappropriate behavior toward his brother, without addressing the underlying causes. When the child knows that his parents understand his dislike and wishes to have his brother “go away”, often his experience of his brother begins to change on its own, the behavior problems reduce on their own, and there is no need for the parent to “fix” the problem. When the inner life is not expressed and accepted, the parent is often constantly managing conflicts between their children.
Accepting the child’s intentions does not imply accepting behavior. The parent may be very firm in limiting behavior while at the same time accepting the motives for the behavior. In fact, this combination of making a clear difference between unconditional acceptance of intentions and presenting expectations regarding behaviors is probably the most effective way for your child to experience less shame toward self and more guilt toward others when he engages in inappropriate behavior. Inner-directed guilt, in the absence of pervasive shame, is probably the most effective circumstance for facilitating socially appropriate behaviors.
CURIOSITY without judgment, is crucial if the child is to become aware of his inner life and then communicate it to his parents. Curiosity does not mean adopting an annoyed, lecturing, tone and demanding, “Why did you do that?” Curiosity involves a quiet, accepting tone that conveys a simple desire to understand your child: “What do you think was going on? What do you think that was about?” The child most often knows that his behavior was not appropriate. He often does not know why he did it or he is reluctant to tell his parent why. With curiosity the parents are conveying their intention to simply understand “why” and to assist the child in such understanding. The parents’ intentions are to assist the child, not lecture him and convince him that his inner life is “bad” or “wrong”.
With curiosity, the parents convey a confidence that by understanding the underlying motives for the behavior, they will discover qualities in the child that are not shameful. As the understanding deepens, the parent and child will discover that the behavior does not reflect something “bad” within the child, but rather a thought, feeling, perception, or motive that was stressful, frightening, and/or confusing and seemingly could only be expressed in behavior. As the understanding deepens, the child becomes aware that he can communicate his inner distress to his parents. There is no need for the inappropriate behavior. The behavior does not reflect his being “bad”. He is much less likely to engage in that behavior again, since there is no need for it. He is also more able to step back from the behavior, be less defensive about it, and experience guilt about it.
For curiosity to be experienced as helpful it is not communicated with any annoyance about the behavior. Nor is it presented as a lecture that provides an excuse to “process” a behavior in what amounts to rational blaming. Curiosity is a “not-knowing” stance involving a genuine desire to understand and nothing more. When it leads to the child developing a deeper understanding of himself and a deeper sense that his parents understand and accept him, it will—when combined with empathy—naturally lead to a reduction in the inappropriate behavior much more effectively than will focusing on behavioral consequences.
EMPATHY enables the child to feel his parents’ compassion for him just as curiosity enables the child to know that his parents understand him. With empathy the parent is journeying with the child into the distress that he is experiencing and then feeling it with him. When the child is sad or in distress the parent is feeling the sadness and distress with him. The parent is demonstrating that she knows how difficult an experience is for her child. She is communicating that her child will not have to deal with the distress alone. She will stay with him emotionally, comfort and support him, and not abandon him when he needs her the most.
The parent is also communicating her strength and commitment. The pain that the child is experiencing is not too much for her. She is also communicating her confidence that, with her sharing his distress,it will not be too much for him. Together they will get through it.
Empathy enables a child to develop his affective resources so that he can resolve and integrate many difficult emotional experiences. He will be able to manage such experiences without being overwhelmed by anxiety, rage, shame, or despair. Curiosity enables a child to develop his reflective resources that will enable him to understand himself more deeply including his intentions underlying his actions. With both empathy and curiosity the parent lends herself to her child for the purpose of his developing the affective/reflective skills necessary for him to be able to act in ways that are in the best interests of both self and other. Researchers are increasingly clear that it is deficiencies in these affective and reflective skills that are often at the core of behavioral problems.
In essence PLACE focuses on the whole child, not simply his behavior. It facilitates attachment security and the closely related affective and reflective skills needed to maintain a successful and satisfying life. The child discovers that he is doing the best that he can, he is not “bad” or “lazy” or “selfish”. Through PLACE and the associated attachment security, he is discovering that he can now do better. He can learn to rely on his parents and they will facilitate the development of his inner life and behavioral choices in a manner that he could never do on his own. Then as he experiences PLACE first hand, time and again, these same qualities will become part of his stance toward others. He will clearly know that both intentions and behavior matter. He will also know that both “self” and “other” matter.
Finally. to return to the beginning, and speak of safety. When we angrily lecture and scold our child about his behavior and our assumptions about his equally unacceptable thoughts, feelings, perceptions, and motives, our child does not feel safe. He is likely to become shameful, isolated, and defensive, all of which will reduce the likelihood that he will change his behaviors. If instead, we relate with PLACE, he will be likely to feel safe even when his behavior is being limited. He too will strive to understand his inner life and associated behaviors. Feeling safe that the “self” is not being attacked and that his attachments with his parents are still secure, he is likely to become motivated to change his behavior. When his inner life is respected, valued, felt, and understood, first by his parents, and then by himself, his difficult behaviors are likely to lose much of their reason for being.
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