The Search for Light Between the the matter-of-fact way in which she walked me through her experience of Eva and her and tried to soothe her by picking her up

Disorganized Attachment: The Search for Light Between the the matter-of-fact way in which she walked me through her experience of Eva and her and tried to soothe her by picking her up, but that Eva acted as if she "just isn’t behaviors. Cracks of Pain and Hope interested in that." We explored ways Gail might be able to soothe Eva and let her know she was there without physical touch. I then asked if we could try one of her ideas in that By Danielle Davey, MSW, IMH-EG While working to remain present to the unfolding story, I noticed a question fighting for moment. my attention, like a toddler tugging on my shirt needing me to see what he was seeing When a child has a secure attachment, he or she can explore the surrounding world that instant. The literal question I had heard so many times before in the classroom kept We both moved from our chairs to the floor to test our hypothesis. I sat near Gail and safely, trusting and knowing that their parent or primary caregiver will welcome him or popping into my head, "what about the baby? where’s Eva?" For a new infant mental Gail sat close to Eva. I gently spoke first as the narrator, telling Eva that Gail was right her back with open arms. When she lived with her mother and father, Eva’s parents were health clinician, mustering up the courage to ask a question-even one as obvious as there and that she would be there when she was ready. We sat together in silence for her primary attachment figures whom she would turn to in times of distress for comfort this-can leave us wanting to run for the door. I waited, not only to take a moment to quite some time until Gail finally spoke. She said only two words, but two words that and safety. However, Eva experi and witnessed abuse and neglect at the hands of turn down my inner critic for not wondering this sooner, but for an opportune time to truly resonate with a child like Eva. Two words that would symbolize our work, and that her parents until she was removed from her home at 27 months of age. Eva was caught wonder out loud, "Where is Eva?" with genuine curiosity. Gail looked at me and then we would continue to carry with us throughout our time together. Gail quietly said, "I’m in a terrorizing bind between the drive to seek safety from her mother and father, who pointed underneath the table. I remember the high-pitched sound the chairs made here." at times were the root cause of the distress and unpredictable fear or harm she was against the hardwood floors as we pushed them out from the table in unison, still locking experiencing. When a child must constantly live in this bind, searching for a way out and eyes with one another. It felt like an unspoken agreement between the two of us that Some time passed after Gail spoke, and Eva slowly began to unfold and untuck herself living in an unsolvable state of fear, disorganized attachment emerges. neither would move first, that we would look together. I wonder, reflecting on this limb by limb until, eventually, she peeked her head up. She stared at us with her bright moment now, if we also silently and mutually agreed that from now on were going to be blue eyes; her brown curls all swept up in a messy ponytail high atop her head. We sat Both of Eva’s parents struggled with drug abuse, mental health concerns, poverty and in this together. there together, with Eva and Gail not moving. Stillness filled the air like a thick fog. The their own trauma histories. These and many other factors put Eva and her older siblings calm did not last long, and soon Eva was off into the kitchen. She got onto the counter at risk for abuse and neglect, as well as the development of disorganized attachment.| Eva, now 30 months old, was lying on her side at Gail’s feet under the table curled up in and opened cabinets, grabbing at anything she could reach. Plastic cups, bowls and plates After their home caught fire, Child Protective Services (CP5) was called. There had the fetal position. Her limbs were tightly tucked and woven into one another, covering crashed to the floor around her. Then, Eva was on her tiptoes with her fingertips barely already been several other calls and a pending investigation, so CPS wanted to remove her head, which was folded into her chest. Gail and I came back together above the grazing a bag of chips that sat atop the refrigerator. She moved her hand continuously in the children. table. I asked what seemed to work to pull Eva out of this? What did not work? Gail said a sweeping motion until she knocked the entire bag onto the floor, chips flying However, the mother was willing to sign that Eva could not tolerate physical touch, especially when upset. She had tried holding everywhere. This all happened in a matter of seconds. Gail ran to her and grabbed her off Eva and her szblings went to live over guardianship to an aunt and uncle her, but she said Eva "just isn’t interested in that." Gail said that she allowed her to sit the counter. Gail and Eva quickly fell into the dance that Gail had earlier described to me, so the children did not have to go into there, because she was afraid to do anything that might cause Eve to go into one of her but now I was seeing the live version. When Gail firmly told Eva "no," Eva froze like a with her aunt, uncle and their foster care. She was also willing to go into temper tantrums. I asked if she could describe to me what those temper tantrums statue. She threw herself backward onto the hardwood floor and banged her head so children, making a grand total of looked like. She described how Eva would hurt herself and others. She bit, hit, kicked hard that just the thought of the thud still makes me shudder. She began to scream and an inpatient drug rehabilitation facility. and threw herself onto the floor. tossed her body around on the floor while biting at her hands and arms, ripping at her B children under one roof The mother was also pregnant. CPS was flesh. She reached for her ponytail and began to frantically pull at her hair, removing not going to allow the new baby to go pieces by the handful. Gail ran over to her and gently restrained her. I watched as pain home with the parents; therefore, the and panic washed over Gail’s face like a tidal wave, leaving a blank stare as she held this aunt and uncle agreed to take the baby screaming, flailing child. I left their home that day wondering, "How am I going to do this? when mom gave birth. Eva and her This isn’t what I expected! How can I help this child and this family?" Were those some of the very thoughts and questions Gail had asked herself? siblings went to live with her aunt, uncle and their Light Peeking out from the Darkness children, making a grand total of eight children under one roof. The aunt sought out services for the children shortly after their arrival. Due to Eva’s age, she was referred to About a month and a half into our work together, in addition to developing Eva’s sense infant mental health services. But this is only one part of Eva’s story. I want to tell you a of safety, we had also begun to think about ways to help Gail become more attuned to little about where she was, but also about how far she has come. Eva’s needs. This was important because we had identified that Eva, who had very little language, might not communicate, cue or signal her needs as clearly as other young children. I watched and wondered week after week as Eva and Gail showed me how they related to one another. The intensity and frequency of Eva’s behaviors were unlike any I What About the Baby? Where’s Eva? had ever seen in a child before. Over time, a pattern that felt ritualistic in nature became I will never forget my first visit with this family. This was only my second or third case as apparent. a new clinician. I was eager and anxious for the opportunity to apply all that I had learned in school to the real experience of being with families. I remember walking up to When Eva became distressed-though the triggers were never predictable-she would run the house on a crisp autumn day, leaves crunching at my feet and paperwork in hand. "to" and sometimes "at" Gail. Gail anticipated Eva’s arrival with learned hypervigilance, Gail, Eva’s aunt, greeted me at the door. She was a short woman, in her early 40s, bracing herself, eyes open wide and locked onto her every movement. Eva arrived like a wearing blue jeans and a grey hooded sweatshirt. She brought me to the kitchen table freight train but slammed on the brakes the moment she reached Gail. Going toward that looked as though it had been cleaned and well prepared as the place that we were comfort and then freezing is a hallmark example of an incoherent strategy in a child with to meet. I simply asked Gail to tell me a little more about Eva and what brought her to I asked what she thought Eva needed when she was so upset, and Gail responded, "I a disorganized attachment relationship. Although Eva momentarily sought out her aunt, treatment at this time. As listened to the story, I remained attuned to and curious about don’t know.. Help. Someone there." I reflected that Gail understood what Eva needed she was afraid of being hurt based on many experiences with her biological parents. Reflections from the Field: Celchris the Airvie Foron the Findt Colchrating 40 Yours Vime ! Reflections from the Field: Cele Association for Infant Men Michigan Association for Infant Mental Health Michigan Association for Infan

Anticipating anger and abuse, she faced a dilemma of both wanting and being afraid of her keep Eva from hurting either one of them further. Eventually, Eva would shimmy not being a "touchy-feely" person. Gail opened a tiny window that day for me to begin parents. By 27 months of age, this belief was well-solidified as her working model and herself to the ground and break free from Gail’s grip. Eva then alternated between to see her internal working model and to understand what she brought to the continued in her relationship with her aunt. biting her hands and arms and ripping at her hair. She would throw herself onto the relationship. Learning more about Gail, I wondered about the challenges this dyad floor, slam her head on the ground and repeatedly bang her head. Gail would try to faced: a child who needed help to feel safe and secure and to accept comfort in times Eva would be momentarily frozen in time as Gail anxiously scrambled to restrain her in restrain Eva, and the cycle would begin again. At times, Eva would run from Gail into of distress, but who might not always be able to seek it; and a caregiver who struggled anticipation of what was to come. Eva would then begin to scream and hit Gail, trying to the bathroom, lie in the fetal position in the dark and cry alone. Gail expressed feelings with being needed and being close. bite at Gail’s arms and hands. Eva thrashed around as Gail held her in hopes that she of confusion and frustration; she felt that Eva seemed to calm down better when left could alone. When she tried anything, it "made things worse," and she just felt exhausted. Eva shook her head yes in agreement to working together to pick up the crayons. She Although this had become an all-too-familiar scene that happened multiple times within walked over to the table and picked up the crayon box. Gail and I picked up the crayons our two-hour visits, one day something shifted. Eva was coloring at the table and dropped one by one placing them into the box that Eva held. Eva delighted in her responsibility of the box of crayons onto the floor. She became very distressed and initially looked to Gail holding the box, and she gleamed with pride. I put words to this with a simple and started to walk toward her. Then she froze, threw herself onto the ground and started observation, and Gail was able to add, "Eva, thanks for holding the box." After we screaming, pulling her hair and biting herself. Gail started to go to her, but before she could finished, the two of them smiled at one another. Eva then walked over to Gail and gently get there, Eva ran into the bathroom and lay on the floor in the fetal position, limbs tightly pulled on her hand, bringing her to the kitchen to show Gail that she wanted something bound. Gail and I sat together in the moment. She broke the silence by anxiously saying to drink. something about Eva just needing to be in there. She said that she would come out when she was ready. She indicated that Eva did not want her and that, if she went in, it would There is a window behind the shower in the bathroom in Gail’s home. That day, the shower just upset Eva further. curtain was closed almost all the way, allowing just a sliver of light from the sun to pass through. I remember the ray of light touching the top of Eva’s head and shining onto Gail’s I reflected about what had happened right after the box of crayons fell onto the floor. I body, connecting the two of them in some way in that moment. But this was not the only wondered if Gail had noticed what Eva did first. Gail described the scene as Eva falling thing connecting the two of them. It would be several months later when Gail began to onto the floor and having a temper tantrum. I then described what I had seen Eva do share her own history with me; telling me stories of a similar childhood. I realize now I was first. She had looked to Gail and started walking toward her. I wanted to be careful of sitting with two children that day, afraid and alone in the dark, telling each one of them in implying that Eva "wants you" or "needs you," because this was early in our work and it my own way, "I’m here." might have been too much for Gail. I worried that my words might sound judgmental or ignite her inner critic for not noticing this herself, Gail laughed a little and said, "see! Hope for the Future How can I ever know what she wants?" I empathized with how confusing and I have been working with this family for over four years now, and our time together is frustrating it must be when a child they are pushing us away, but we coming to an end as Eva ages out of our program. When working with a child with know that they really need us. I wondered if, in this moment, Eva’s behavior was disorganized attachment, it is easy to feel lost or hopeless, just as they might feel. showing us one thing, while she really n ded something else. Gail and I decided to Although Eva was removed from her parents where the abuse and neglect had occurred, move together and sit outside of the bathroom where Eva lay in the dark, alone. this new dyad has had its own challenges and triumphs. Establishing a trusting working relationship was a slow process. As we sat outside of the bathroom door week after week, As we sat together, I thought out loud back to our first visit and wondered if Gail following Eva’s lead and letting her know Gail was there, a parallel process was occurring remembered the two words she had said to Eva underneath the table that day. Gail as I was showing up week after week letting Gail know I was there. This child (and seven initially looked at me, puzzled, but I watched a shift happen, as if someone flipped a other children) need so much from a caregiver who struggled herself with being too close switch, and the words were suddenly there. "I’m here," she said with a grin. She then or needed. turned towards the dark bathroom where Eva lay and said, "We are here, Eva, when you’re ready." We sat outside of the bathroom for a long time before Eva moved. Her first Today Eva, now 6.5 years old, is no longer engaging in self-harming behaviors. She does movement was small. She arely moving, just to make not have extreme temper tantrums and is doing fairly well in her second year of school, sure we were indeed still there. Gail and I looked at one another and smiled. Shortly after, with only occasional regressions. She frequently seeks Gail out for comfort in times of Eva got up and moved over to Gail, placing her head on Gail’s lap. I wondered if a gentle distress. Gail is working to be consistently available to her and is exploring what makes it hand on Eva’s back might feel ok to Gail and Eva. Gail gently placed her hand on Eva’s back difficult at times for her to do so. The greatest challenge and growing experience for me and then quickly asked if we could all clean up the crayons together. Gail then placed her as a clinician was being patient as I worked with this family, not judging them and using hands behind her, arching her back slightly and creating space between her and Eva, their dance to guide my work. Through the process, I have experienced so much growth making me wonder what physical closeness meant to her as well. as a clinician, and I will continue to use what I have learned from my work with this family. Although there is darkness in the past experiences of this child and this caregiver, the light Thinking back to our first visit when she described Eva as "just not being interested in that," of hope for their future shines bright. I wondered if she was really telling me something about herself. I kept this on a shelf in my mind and brought it forward later in our work together when Gail opened up about Reflections from the Fidd Celebrating 40 Yours, Valar deflections from the Field: Celebrating 40 Year, Volume I Reflections from the Field: Celebrating 40 Years, Volume Michigan Association for Infant Mental Health Michigan Association for Infant Mental Health Michigan Association for Infant Mental Health

reflection/reaction to the case studies. Try to relate these reflections to trauma, attachment (both child and adult), early relationships, trust, and what young children need from us. 

Disorganized Attachment

1. What are the risk factors that suggest that a referral for infant mental health services 

was appropriate?

2. Describe/explain the interactional patterns and behaviors that suggest a disorganized 

attachment?

3. Discuss the importance of the parallel process between the IECMH therapist and Gail; 

how did this play a role in building and repairing the way this caregiver and this child 

experience and understand relationships? 

4. Discuss ways that the IECMH therapist followed the aunt’s lead. Why might this be 

important in our work with families? Why or how was this particularly important with 

this caregiver?

5. The therapist wondered about the “goodness of fit” between this caregiver and this 

child. Have you ever felt this way about a dyad? If so, how did it inform your work and 

communications with this family? 

6. How did the IMH specialist attempt to follow the aunt’s lead? Why might this be 

important in IMH work? Why or how was this particularly important with this caregiver?

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