Book Review: The Neurobiology of Attachment-Focused Therapy
Carl was a four-year-old boy who had experienced considerable neglect and periodic physical abuse during the first three and a half years of his life. According to Catherine, his foster mother, he reacted instantly to situations of distress with rage outbursts, and these tended to be as unpredictable as they were frequent.
Carl’s story is one of many shared within the pages of The Neurobiology of Attachment-Focused Therapy: Enhancing Connection & Trust in the Treatment of Children and Adolescents by Jonathan Baylin and Daniel A. Hughes. Their book is a guide for practitioners who are working with children and adolescents that have suffered from abuse and neglect, and therefore struggle with issues related to blocked trust. Both authors bring their years of experience as practitioners to the pages of their book and it is clear that their knowledge of the topic is vast and profound.
The Neurobiology of Attachment-Focused Therapy is not simply a textbook of neurobiology; the authors take this particular aspect and transform it into a guidebook for practitioners. Laying a firm foundation of neurobiology at the beginning of the text, Baylin and Hughes prep their readers for understanding how attachment-focused therapy can begin to rewrite the mappings of the brain to overcome the damage of abuse. Readers would be advised that the book does not provide a comprehensive guide to neurobiology or neuroanatomy. Therefore, there are some that may find additional resources are necessary to fully understand brain functions.
One of the best explanations provided by the authors to describe the minds of maltreated children is in the following sentence: “Maltreated children are forced, in a way, to shift into a trajectory of brain development more suited for life in the wild than for living in very safe environments.” Understanding where the brain is starting from when a child is brought into therapy gives the therapist a greater understanding of where to begin with treatment. Baylin and Hughes go on to explain:
“From a brain-based perspective, the core goal of attachment-focused treatment is to disarm the child’s overdeveloped threat-sensitive system and awaken the suppressed attachment system by getting the child to see, hear, and feel signs of safety in their current environment of care.”
Baylin and Hughes discuss in detail Dyadic Developmental Psychotherapy throughout the text which they write is a “model of treatment that is squarely focused on providing the kind of safe, trustworthy experiences with adults” that can help young children move beyond blocked trust and begin to experience a more open experience. Perhaps one of the most interesting discussions surrounds Affective-Reflective (A-R) Dialogue. The authors argue that this particular communication method is most congruent with how our brains communicate. Thus, when a maltreated child is expressing anger and the clinician uses A-R dialogue, the child will likely experience empathy from the therapist and feel heard and understood without judgment. The authors use an example of a 13- year-old girl named Colleen to illustrate this particular practice.
Baylin and Hughes also explain the approach that they describe as PACE: Playfulness, Acceptance, Curiosity, Empathy. The authors explain that this approach allows for the practitioner to interact with a mistrusting child in a way that will eventually encourage engagement. They breakdown each step of PACE to explain how they are interpreted by maltreatment and can potentially encourage the therapeutic process. PACE is elaborated on later in the text from the context of assisting parents in incorporating the practice into their daily lives with children. This practice goes against many parents’ natural responses and requires a deep awareness and mindfulness in the moment. However, the authors encouragement of PACE is a difficult one to ignore. They write:
“PACE is like ‘brain whispering’ or ‘amygdala whispering,’ a form of enriched nonverbal communication that goes deep into the child’s brain, straight to the center of mistrust and helps the medial amygdala switch from social defensiveness to social engagement, that open engaged state in which the child can see signs of safety and tolerate sharing personal space with a caring caregiver.”
As they move beyond PACE, the authors explain potential expansions of their model in their final chapter. Most interestingly, they include alternatives such as massage or music to encourage openness. To be clear, this particular chapter is short and while the authors supply references to support these suggestions, clinicians would be wise to proceed with these on a case-by-case basis. The authors acknowledge that the alternatives that they suggest “may play a role in the integrated model of attachment-focused treatment, in conjunction with the core relational processes of DDP.” I would recommend that practitioners read Neurofeedback in the Treatment of Developmental Trauma by Sebern F. Fisher.
Baylin and Hughes have created quite the resource for practitioners working with abused and neglected children. Their elaborate description of the methods of DDP in practice through examples provides a close look at the impact of their approach. Both informative and touching, The Neurobiology of Attachment-Focused Therapy is a magnificent addition to a therapist’s toolbox.
The Neurobiology of Attachment-Focused Therapy: Enhancing Connection and Trust in the Treatment of Children and Adolescents
Jonathan Baylin and Daniel A. Hughes
Hardcover, 304 pages