Family Attachment Narrative Therapy, an approach designed to heal the long-term effects of early childhood trauma, is based on the principle that early trauma and neglect can significantly impact attachment, development, and relationships. Practitioners of the approach, who believe caregivers to be the most crucial component in the healing process, incorporate caregiver narratives as a tool to help address and repair the unmet needs of the child or adolescent.

This approach to treatment is primarily designed for children between the ages of three and 21 who are experiencing issues related to adoption, disrupted attachment, and early childhood trauma, but it can be used to address other concerns and may also be beneficial to people seeking therapy for other reasons. 

History and Development

This approach, developed by Joanne C. May in order to address challenging relational, emotional, and behavioral issues resulting from early childhood trauma and neglect, combined her in-depth understanding of trauma and attachment theory with the therapeutic techniques of narrative therapy. The result of May's nearly four decades of working with children and families in foster care settings, adoptive homes, residential treatment facilities, and clinics, Family Attachment Narrative Therapy was officially established as a practice in 1995, The current treatment model, according to May, has been informed by hundreds of caregivers, whose narrative work contributed to the refinement of the theory and its practice.

Family Attachment Narrative Therapy is primarily developed from attachment theory and the work of researchers John Bowlby, Mary Ainsworth, Carol George, and Judith Solomon. Much of the approach is based on Bowlby's theory of early attachment and the “internal working model” that babies and children create of their attachment figures and their worlds—models that, as children approach new situations, may be characterized by certain preconceptions and biases that can affect their thoughts, emotions, and behaviors. 

Family Attachment Narrative Therapy Theory

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Largely based on attachment theory, or the idea that all children yearn for security, stability, and attentiveness from their caretakers, this approach holds that when children consistently receive these things, they are generally able to form a healthy attachment. When trauma, neglect, or abuse are present, however, both the internal working model and the attachment process are often compromised. This can have cognitive, emotional, relational, and physical ramifications: violence, abandonment, and physical or emotional harm are likely to distort a child's working model of their attachment figures. Children thus affected still attach in order to get needs met, but without having a dependable internal model from which to navigate the world, they may develop maladaptive methods of getting their needs met.

An important part of development occurs when children begin to explore their world, learning to use their caregivers as a “secure base” from which to venture out into their environment. They check back in with their parents for reassurance, and when parents are consistent and nurturing, they receive confirmation that they are safe and secure. Trauma, violence, neglect, or other abuse, however, can leave children feeling incomplete and insecure, and their constructed narratives may become disjointed, confused, or fragmented. This can hinder development, as traumatic events that occur early in life may effectively teach children they have no secure "base" from which to explore safely. In the case of physical abuse, for example, the parent often becomes a source of both fear and safety. Children who encounter this confusing relationship may experience anxiety or adopt controlling or demanding patterns of behavior. The process of attunement, which allows parents to enhance the bond they have with their child by meeting their needs, reflecting their language and experience, and establishing a common perspective, may also be disrupted or inconsistent in the case of trauma. 

Proponents of Family Attachment Narrative Therapy believe disturbances in the attachment between a child and the child's caregivers can often be repaired through the use of narratives, and practitioners of the approach support parents through the process of helping children rewrite disconnected narratives into positive, coherent stories. 

How Does Treatment Work? 

Family Attachment Narrative Therapy is meant to improve the bond between children and their guardians/caregivers. Before treatment begins, therapists trained in the approach conduct a thorough assessment in order to determine whether the family is a good candidate for the approach. If the program is recommended as an approach, the family begins an intensive treatment regimen that lasts approximately two weeks and consists of daily sessions. During this time, parents are trained to construct narratives—the primary tool employed by practitioners of this approach—that will facilitate the healing process for their child.

There are four types of narratives taught to parents and other caregivers during treatment:

  1. Claiming: Therapists support parents in describing how they would have liked to have parented the child as a baby. Parents are coached to imagine their child as a helpless baby in need of security, protection, and love, and they are encouraged to discuss their child's need for nurture, love, and protection. 
  2. Developmental: This narrative type builds on the Claiming narrative. Caregivers speak in the first person about the developmental stages of their child and share their hopes and dreams for their child's successful development. This is an opportunity for parents to educate the child about developmentally appropriate behavior and adaptability. Bonds between caregivers and children typically improve during this treatment, and children are often able to develop new skills and learn how to reframe or adjust their conclusions about their life experiences. 
  3. Trauma: In contrast to the Claiming and Developmental narratives, which are centered around attachment to the present parent, Trauma narratives are focused on healing the child's actual history. Therapists teach parents to tell third-person, fairy tale-like stories that feature a protagonist who experiences challenges similar to those faced by the child. These stories are intended to help reframe the trauma and redefine what it means to the child. 
  4. Successful Child: During this narrative development, parents use a third-person point of view to tell a story that highlights a capable protagonist who overcomes obstacles and achieves success. This narrative is intended to help the child internalize an adapted working model of their history and their world. This new working model can enhance attunement and attachment between parent and child and often also has the added benefit of improving the child's sense of self. 

Bonds between caregivers and children typically improve during this treatment, and children are often able to develop new skills and learn how to reframe or adjust their conclusions about their life experiences. In addition to narrative, therapists often incorporate other techniques such as play therapy, audio-visual entrainment (AVE), and EMDR (eye-movement desensitization and reprocessing) to support families in processing any difficult emotions that arise during treatment. At the conclusion of the two-week period, the therapist make further recommendations for follow-up therapy, step-down treatment programs, or other treatment services. 

Issues Treated

This method is primarily used as an intensive approach to address family or parent-child issues, especially those related to attachment, such as:

  • Anxiety
  • Adoption and foster care issues
  • Separation anxiety
  • Posttraumatic stress
  • Issues related to abuse and neglect
  • Parent-child relational issues

Research has also demonstrated the efficacy of the approach in the treatment of eating disorders, sibling attachment issues, and certain behavioral concerns. One case study, conducted by May and published in 2005, showed that this therapy was an effective method to address bedwetting and food preoccupation in children. The approach can also be used to help children learn and master certain skills, so children affected by fetal alcohol syndrome or other conditions that delay or impact development may also see improvement with this approach. 

Caregivers who are angry, frustrated, or otherwise experiencing difficulty caring for a child who may be affected by attachment or other issues often see significant improvement in their own well-being with this approach. Therapists who offer understanding and support can help them regain their feelings of empathy toward the child as they rebuild or develop bonds. 

According to outcome data reported by the Family Attachment and Counseling Center in Minnesota, 92.5% of the children who completed their intensive program demonstrated improvement in functioning. 

Limitations and Concerns

Available research on the efficacy of this approach is promising, but there is no guarantee that every child who has experienced early childhood trauma will improve as a result of the program. Early exposure to drugs and alcohol, genetic conditions, or neurological issues might all impact a child's ability to successfully attach to caretakers. 

The readiness of parents and other caregivers to step into the role of “narrative therapist” to the child may be another limitation. Family Attachment Narrative Therapy requires that parents have the desire to repair and improve the attachment relationship; thus, therapists expect parents and caregivers to be willing and able to provide empathy, validation, forgiveness, and love. Parents who are angry with the child or unable to see past problem behaviors may not yet be ready to participate in the attachment work.  

Finally, the available literature and research on the methodology of Family Attachment Narrative Therapy is primarily geared toward foster and adoptive families. However, many therapists work with biological families who have been impacted by early childhood trauma, neglect, and abuse, and more information and instruction about working with biological families where abuse or neglect occurred would likely be helpful to the practitioners who work with this population. 

References: 

  1. Dallos, R. (2004, January 22). Attachment narrative therapy: integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders. Journal of Family Therapy, 26(1), 40-65. doi:10.1111/j.1467-6427.2004.00266.x 
  2. Family attachment narrative therapy intensive program. (2012). Retrieved from http://www.familyattachment.com/pages/narrative.html 
  3. Family attachment narrative therapy: Telling healing stories. (2003). MNASAP Family Voices. Retrieved from http://www.familyattachment.com/pages/healingstories.html 
  4. FAQs. (2012). Retrieved from http://www.familyattachment.com/pages/faqs.html 
  5. Lander, I. (2008, July 2). Using family attachment narrative therapy to heal the wounds of twinship: A case study of an 11-year-old boy. Child and Adolescent Social Work Journal, 25(5), 367-383. doi:10.1007/s10560-008-0132-2 
  6. May, J. C. (2005, July). Family attachment narrative therapy: healing the experience of early childhood maltreatment. Journal of Marital and Family Therapy, 31(3), 221-237. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16094814 
  7. Preliminary outcome data for the intensive outpatient program for children with attachment difficulties. (n.d.). Retrieved from http://www.familyattachment.com/pages/outcomes.html