Holding out hope

Unless a severely disordered child, with a history of abuse or neglect receives some kind of help there is a strong chance that they find life hard and could end up recycling the abuse or neglect they suffered when they go on to become parents themselves.

Children with attachment problems often do very badly at school and are frequently excluded.

They find it hard to make friends and form loving secure relationships often ending up in abusive partnerships. Some can become so depressed and despairing that they become suicidal.

But professionals are now recognising the importance of identifying and treating attachment disorder.

At one of the leading centres in the UK, the Keys Attachment Centre, they have been consistently turning round difficult cases into success stories.

The approach they use is almost like rebirthing a child so that they can go back and learn how to bond and trust people all over again.

The therapy involves a process of holding, although before anyone envisages children being forcibly restrained, all those taking part have to give their consent to the therapy before it is carried out.

That said, the treatment often induces extreme emotional reactions in a child - the tactic being to fight fire with fire.

The relationship between the maltreating parent and the child, although damaging, was nevertheless intense. An equally intense therapeutic relationship is therefore needed to overcome and counteract the child's commitment to that parent.

The agenda for these children is to control rather than engage people which denies them the very experiences that they need. The aim of the Keys approach is to break down a child's defensive mechanisms that block them giving and receiving the love and trust of other people.

Therapists aim to recreate the healthy bonding cycle that happens between babies and their mothers and educate the child about his or her early experiences and how it is those that are causing the difficulties they now face so that there anger can be redirected, justifiably towards their abusers rather than their new adoptive family or foster carers.

The point of holding therapies is not to manipulate emotional pain but to allow the child to release those emotions and memories. Some children scream in rage while others just sob with pent-up grief.

At Keys, the holding process is explained to the children and their current carers and before it begins they have to agree to participate.

Although there is often verbal resistance to being 'held', Keys has not yet had a child who has refused. If they did, the first response would be to negotiate a way forward.

The child is asked to lie across the lap of the two therapists and/or the parents with a cushion under their head and their right arm round the back of the lead therapist.

Without the agreement of the child, 'holding' is not attempted.

Children are prone to fidget or distract themselves under these conditions to avoid emotionally engaging with the therapist while maintaining self-control. They have to be discouraged from doing this. Eye contact is extremely important in aiding the bonding process.

The held child typically goes through four stages:

1. Resistance and anger
2. Acceptance of the other's control
3. Sadness and pain
4. Increased trust and secure attachment behaviour.

The most significant aspect of the holding is what occurs after these pent-up emotions have been released and the child is in a state of total relaxation.

Relinquishing control allows children to accept, often for the first time, the love and concern of others.

The child is able to give and receive eye contact, to accept nurturing, feeding, touching, rocking, hugging. The child is able to trust he is not alone in the world and there are people who will take care of him.

After all, he has just shown his worst side and has not been hurt or rejected. He has attempted to hurt others and they did not reciprocate. They stayed calm and accepting of him.

After the holding the therapist aims to develop the child's understanding of themselves and rebuild a positive image of themselves.

The physical proximity provided by 'holding' allows both child and therapist to access feelings that are not always verbally expressed and helps to recognise those emotions, and to label and understand them.

By doing this, children can begin to see themselves as worthy and loveable rather than as unloveable, bad and deserving of abuse. Other people can be represented as available and caring, and not as unavailable, unpredictable and hostile.

According to Sheila Fearnley, clinical director of Keys, children need to be able to say things like: 'My father sexually abused me. I hate him for that and I am upset and very angry that my mother was uanle to protect me.'

"These children have 'lost' a great deal. It is not until they have connected with their experiences and grieved their losses, that they can begin to resolve early traumas," she says.

Professor David Howe of the School of Social Work at the University of East Anglia believes that these sorts of treatments, while not a cure-all, do hold a lot of promise of helping a child with attachment disorder.

He says: "The clinical and anecdotal evidence of the value of specialist attachment-based treatments is strong. However, rigorous controlled studies are lacking."

Research is currently underway in the US and at Keys to evaluate these kinds of approaches.

Click here to look at a case study of a typical attachment disordered child.

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