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FOREWORD FOREWORD

Often, much too often, families are challenged in the most complex and pervasive manner by relational trauma and attachment disturbances or disruptions that leave all family members mistrustful of each other and of the professionals who attempt to guide, support and help them to heal. Often, much too often, professionals focus on the behaviors of the parent or child that need to change, without understanding the roots of these behaviors, which often are the reasons that these behaviors are so resistant to change. Too often these behavioral strategies are not utilized by professionals who are trained in trauma and attachment or who are using strategies that are not congruent with this training. When relational trauma and insecure attachments prevent any semblance of safety for family members, there is little likelihood that they will have sufficient motivation and ability to try something new that is resting on a foundation of fear, isolation and shame.

All families exposed to significant trauma and attachment problems must first heal if they are to then begin the difficult but very rewarding process of developing the relational and developmental competencies needed if the family is to survive and even thrive. Healing Traumatized Children, by Faye Hall, Jeff Merkert and Dr. John Biever, presents a model of parenting and intensive family interventions that is based on central theories and research involving trauma and attachment. These interventions require a complex understanding of each unique parent, child and relationship along with sensitive, multidimensional responses to the current environment and its roots in the past.

The authors have developed an Emotional Cognitive Trauma Model of intervention that integrates the theories that are critical in family disorganization and mistrust and provides a guide for a practice that may lead to healing and restorative change, while being detailed and comprehensive. This model was developed as a wraparound program for very challenged families which were at risk for having the children placed outside their homes. It also has great relevance for the outpatient treatment of families whose challenges are less severe.

The authors do not pretend that helping families with pervasive problems will be easy. They ask a great deal of parents, but they ask this with empathy for how hard it is and with an attitude of compassion that avoids shaming and blaming. They provide guidance, with many practical ideas and resources along with a great degree of support. They help parents to feel safe by communicating an attitude that conveys confidence and hope, assuming that the parents have good intentions and appropriate goals for their children. Initially, they focus with parents on helping them to understand and develop their relationships with each other and their children. They then assist parents to develop their emotional and cognitive skills in a manner that will strengthen and heal rather than cause divisiveness and despair.

Hall, Merkert and Biever also help us all to see the importance of adopting a trauma lens to hold our perceptions of the behavior of both children and their parents. They give many examples of how our behavior interventions will change when we acknowledge the role of trauma in the development of troublesome behaviors. They equally show us how crucial it is to understand the negative internal working model of self and other held by many children who have experienced trauma and who have insecure attachments.

Often, we, as adults, forget that the deep safety that comes from a committed relationship with our partner is based on having confidence that the relationship is “for better or worse.” This frequently-heard phrase indicates that the relationship is bigger, stronger, and will outlast any particular conflict, disagreement or separation. The safety that comes from this conviction enables parents to address their relational problems rather than deny them and then to face them with the goal of improving the relationship rather than “winning” the conflict or hurting their partners.

Many traumatized children with significant attachment insecurities do not assume that their relationships with their parents are “for better or worse.” Lacking safety that the relationship is strong enough to handle a conflict, they react with deceit, rage, withdrawal or fear, avoiding the engagement needed to address and resolve a family problem. First and foremost, it is the task of the parents to convey that the relationship is “for better or worse” and “We’ll get through this together.” At the same time, the first task of the professional is to help parents develop their own sense of safety so that they can acknowledge their challenges and develop their competencies.

Because these children have experienced relational trauma, the authors stress the need to use “nurturing actions which far exceed the norm. Love, care, intimacy, touch and affection must occur every day and not be dependent on good behavior.” This core concept might well evoke a sense of “Of course that is the case if these children are going to learn to trust.” Regretfully, such guidance is often not stressed or even acknowledged in many intensive family treatment and support programs. Too often the primary emphasis is on behavioral consequences, without addressing the core sense of isolation, fear and shame that the children often experience, and have for years, prior to the development of their “problems.”

In short, this is a challenging book, full of important and creative understandings and interventions, needed to work with highly challenged, and challenging, families. There is no quick fix here, but there is a strong, comprehensive and integrated model for family interventions. Hope lies within this book but we need to see the importance of giving careful thought and sensitive engagement to each unique family that has lost its way in providing its members with the experiences of safety, comfort and joy.

If we keep our perception on creating the healing home, we may enable the family to embrace this goal and develop the necessary skills to attain it.

—Daniel Hughes, PhD

When child psychologists Faye Hall and Jeff Merkert invited me to co-author a book based on their team approach to helping children with attachment disorders and their families, I knew I had to participate. Hall and Merkert became certified to provide clinical services for families with dysfunctional “dynamics” via a category of treatment offered within Pennsylvania’s Behavioral Health Rehabilitative Services system, referred to as Family Based Mental Health Services. They became known throughout the central Pennsylvania area for their remarkable clinical success in applying the principles of Dr. Daniel Hughes’ Dyadic Developmental Psychotherapy (DDP) in the treatment of children with Reactive Attachment Disorder and other mental health diagnoses complicated by insecure attachments.

Since Dr. Hughes relocated from Maine to my outpatient campus in Annville, Pennsylvania, several years ago, Hall and Merkert have taken advantage of their opportunity for in-person monthly supervision with him. DDP involves a set of principles and techniques developed by Dr. Hughes to specifically address the emotional and relational difficulties that are typically present in children and adults with insecure attachment histories.

In this book, we reach beyond parents and clinicians as our target audience and into the extended community. This book is about children who, for various reasons, survive through their first several years of life without having developed the ability to securely attach to caregivers. It is about those caregivers—parents, adoptive parents, foster parents, daycare workers, teachers and others—who struggle to make a meaningful connection with them. But just as importantly, it is about the village in which the struggle to connect takes place: friends, relatives, neighbors, policemen, coaches, social servants, legal and political office holders, legislators and so on. This book illustrates how we all have a crucial role to play. But beyond that, it is filled with practical suggestions as to how we can fulfill that role.

The first part of the book focuses on the special parenting challenges presented by children with disordered attachment styles and ways to meet those challenges. Then, in the second part, the focus shifts to the assembled team of professionals who join together with caregivers and the child to address the attachment difficulties. We also discuss special environmental considerations necessary to meet the unique needs of the attachment-disordered child. The village dimension will be an important topic in this section in particular.

The next part of the book will discuss what the authors have called Trauma-Disrupted Competencies (TDCs). That is, it will address the ways in which the early childhood trauma that leads to attachment disorders causes the child to have serious difficulty with specific areas of function that we take for granted in children. Aware of these TDCs, we can then be on the lookout for them and utilize suggested means for helping the child to overcome them. The final parts of the book will focus on practical interventions and handouts that parents and “villagers” can utilize to help their traumatized children.

Faye Hall has experienced both the joy and anguish of working with children with an impaired attachment style from the inside out, as well as from the outside in. She raised an adopted son who had Reactive Attachment Disorder. We agreed that key parts of her narrative as a parent would help explain the content to the reader. Therefore, many chapters either begin with or contain a relevant passage from her narrative.

—Dr. John Biever