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Rachel,2 not yet 2 years old, stood looking at herself in the full-length mirror, a frown slowly overtaking her face. Deep in her throat began a low, grumbling growl. As the growl grew louder, she began hitting the side of her head and mov- ing slowly toward the mirror, her eyes glued to her own image. The growling became yelling, and she began slapping at herself in the mirror. I sat, stunned, unable to move or formulate a response. Her rage was palpable and deeply dis- turbing. Finally, I got up from my chair and went to her. I got down on my knees, gently held her shoulders, looked into her eyes, and said, “Rachel, this is not your fault! You are loveable and you are loved.” A DISORGANIZED TODDLER IN FOSTER CARE: Healing and Change From an Attachment Theory Perspective1 JANET MANN The Children’s Ark MOLLY D. KRETCHMAR Gonzaga University ZERO TO THREE May 2006 29 This article focuses on the remarkable story of a deeply disorganized child, Rachel, and her experience in foster care with Janet and Paul Mann, founders of the Chil- dren’s Ark. Rachel and her mother were referred to the Ark, an innovative intervention center for at-risk fami- lies, when Rachel was 10 months old. After 11 months at the Ark, Rachel was placed into foster care with the Manns. On the basis of Janet Mann’s professional immersion in attachment theory, object relations theory, and especially the Circle of Security protocol (Cooper, Hoffman, Powell, & Marvin, 2005), Janet extracted 6 “principles” that guided her caregiving behavior with Rachel. These principles included: (a) Communicating the message, “I am here and you are worth it”; (b) viewing negative behavior as needed; (c) reading cues and reinterpreting miscues; (d) “being with,” espe- cially during periods of intense emotion; (e) working consciously toward relationship repair when disruption occurs; and (f) developing awareness of one’s own state of mind. This article explains and illustrates these princi- ples through Janet’s experiences with Rachel and pro- vides candid insight into what hurt children need for healing and positive change. abstract This article presents a remarkable story of a deeply trau- matized child who, by great fortune, was placed into foster care with Janet and Paul Mann, founders of the Children’s Ark, Spokane, Washington (described below). Her story 1Portions of this paper have been presented at various training work- shops, including at Project Same Page, which was supported by the Paul Allen Foundation. We wish to thank Rachel and her family for allowing us to use examples from her experience with Janet to illustrate the princi- ples in this article. In addition to her family, Janet extends her gratitude to her clinical colleagues, Sandra Powell and Kent Hoffman, who walked this journey with her, enriching the experience. The Circle of Security Project along with Janet’s work, interactions, and experiences with Glen Cooper, Kent Hoffman, and Bert Powell drove and framed the principles outlined in this article. Correspondence concerning this article should be addressed to Molly D. Kretchmar, Department of Psychology, Gonzaga University, 502 E. Boone, Spokane, WA 99258-0054. E-mail:
[email protected] 2In order to protect the privacy and to respect the confidentiality of the child represented in this article, her name has been changed. Further, the child’s adoptive parents provided full consent to the use of her story and read a complete draft of the manuscript prior to its submission in order to confirm that they were comfortable with its contents. 21382_Pg29-36 5/1/06 6:57 AM Page 29 mailto:
[email protected] mailto:
[email protected] ZERO TO THREE May 2006 30 to them, about whether they are worthy of care, and so forth. Children with secure attachment histories have a sense of trust toward others and feel the self-worth reflected by the nurturing care they have received. In contrast, chil- dren with insecure histories are likely to view others as less available and less trustworthy and to have internalized a compromised sense of self (Weinfield, Sroufe, Egeland, & Carlson, 1999). Of greatest concern are children with disor- ganized attachment strategies. These children typically have caregivers who are either frightening or frightened, placing them in an irresolvable approach–avoidance bind; “the infant is presented with a paradox wherein the haven of safety is at once the source of the alarm” (Main & Hesse, 1990, p. 180). Stemming from this paradox, researchers expect that these children will carry forward highly dis- torted models of the self and of relationships; models char- acterized by deep mistrust, fear, rage, and possibly violence. Some theorists further speculate that disorganization is a precursor to serious psychopathologies (Crittenden, 1995; see also Lyons-Ruth & Jacobvitz, 1999). Children in the foster care system have likely suffered multiple attachment-related traumas, not the least of which is parenting that is traumatic and frightening. It is likely, then, that many of these children have insecure and/or dis- organized attachment relationships (Schofield & Beek, 2005). However, even when children have insecure and/or disorganized attachment relationships with their parents, being separated from these primary caregivers adds another layer of trauma (Charles & Matheson, 1990). For a young child, the very nature of separation is scary; even if what they had was abusive, it was at least familiar and perhaps even predictable. Children also have a remarkable capacity demonstrates how a predictable environment and secure, loving care providers can foster change even when a child is profoundly disorganized, deeply mistrusting, and full of rage toward herself and others. Along with their commit- ment to her, Rachel’s care providers’ solid understanding of attachment theory and their ability to translate theory into practice were central to the progress Rachel made. In this article, we use Rachel’s story to illustrate principles of care- giving grounded in attachment theory that we hope will provide insight to other care providers. This story is ulti- mately one of great hope, not only for this child but for the thousands of hurt children in foster care. Attachment Theory and Foster Care “Attachment theory,” first developed by John Bowlby (Bowlby, 1969/1982, 1973, 1980), asserts that children have a primary and essential need to be “in relationship” with their caregivers. To ensure our survival, our evolutionary history prepared us to seek closeness or proximity to our caregivers, especially under conditions of threat or vulnera- bility (e.g., presence of a stranger, illness). When caregivers are available and welcoming, seeking proximity is easy and children’s feelings of safety and security are bolstered. When caregivers are unavailable (physically, emotionally, or both), inconsistent in their responsiveness, or frightening in some way (e.g., abusive), seeking closeness becomes more difficult and children’s feelings of security and safety are disrupted. Bowlby (1969/1982) proposed that young children internalize “working models,” or representations about themselves and others that are based on their early attach- ment experiences. These models form the basis for chil- dren’s expectations about how others are likely to respond PH O T O : M A R IL YN N O LT 21382_Pg29-36 5/1/06 6:57 AM Page 30 to be connected to their caregivers, even their abusive or depressed or addicted caregivers; this attachment is primal and visceral—built into our species to help ensure our sur- vival (Bowlby, 1969/1982). Removing a child, then, even for the child’s welfare, is likely to be deeply threatening and disorganizing in and of itself. In addition, because the pre- sent foster care system cannot ensure permanent place- ments for children, many children experience multiple placements, involving multiple separation and loss experi- ences, which only compound children’s deeply disturbed sense of self and other (Charles & Matheson, 1990). The Children’s Ark: An Attachment- Oriented Solution The Children’s Ark was founded in 1994 by Paul and Janet Mann, who then had over 6 years of foster care experi- ence and had provided care for over 40 children. The Chil- dren’s Ark began as a foster care residential program in which mothers who had lost custody of their children were able to live, full time, with their children in a safe, struc- tured, therapeutic environment. The hope was to minimize the separation experience between the parent and child (Kretchmar, Worsham, & Swenson, 2005; Worsham & Kretchmar, 1999). Presently, the Ark functions as an evalu- ation and intervention center that allows for daily and extended visitation between children placed in foster care and their parents. At the Ark, parents join their children each week day, retain the primary caregiving responsibilities under the Ark staff’s supervision, and are required to work toward improving their capacities for parenting and self- sufficiency. In addition to being with their children, parents participate in educational programs and in the Circle of Security, a group-based intervention in which parents learn about their attachment relationships with their children and how to enhance these relationships (Cooper et al., 2005; Marvin, Cooper, Hoffman, & Powell, 2002). Rachel and her mother joined the Ark when Rachel was 10 months old. Rachel: A Teacher of Powerful Lessons Rachel was born into a chaotic family environment in which the abuse of her older siblings by her father had already attracted the attention of child protective services. With her father gone, Rachel remained under her mother’s care in an in-home dependency issued by the State of Washington. When she was 10 months old, she and her mother were referred to the Children’s Ark for services after Rachel was diagnosed with multiple delays and failure to thrive. Rachel and her mother participated in the Ark for 11 months during which time the Ark staff became increasingly concerned about Rachel’s safety in the home and the impact of Rachel’s home environment on her development. Rachel’s mother agreed to voluntarily place Rachel in foster care with Janet and Paul Mann. Janet Mann became Rachel’s primary attachment fig- ure. In her journey with Janet, Rachel was a powerful teacher about what all children, but especially hurt chil- dren, need to develop to their ultimate potential and about what even temporary care providers can do to begin to heal the pain of the child’s past. Janet, an experienced foster parent well versed in attachment theory, had the wisdom to listen to Rachel and to see through Rachel’s compli- cated behavior to her vulnerability and tremendous need. It is in Janet’s words that we tell Rachel’s story: After watching Rachel in the mirror, I was aware of pondering somberly how wounded she was. It was certainly clear to me that it was a dismal picture she carried in her head about how the world worked, whether or not she was valuable, how she would be responded to, and whether she could impact her world. Much of her rage seemed to be aimed at herself; somehow she carried the responsibility for