Antonia Bifulco (Centre for Abuse and Trauma Studies) - Attachment and child trauma: implications for assessment and treatment of families

Attachment theory has proved to be a very effective framework in explaining how childhood trauma, interpersonal style, parenting and vulnerability to stress and depression can be related. The implications go across generations, for example to the early life of adults in determining how they make relationships and parent, and through to their children who may be prone to the ill-effects of problems in relationship style. The two different generations implicated create challenges for effective assessment and for choice of treatment.

A programme of research which examined childhood maltreatment, adult attachment style and clinical depression in London community women is described, together with its sequel examining inter-generational transmission to adolescent offspring. Childhood maltreatment was common in both generations and most attachment styles were insecure. Clinical disorder occurred in half of both generations. This was mainly depression and anxiety in the mothers, but also included substance abuse and conduct disorder in the young people.

As yet there has been no formal use of the ASI in a clinical evaluation or other systematic intervention. However, the assessment and the associated findings of the model can be applied within a number of approaches, including CBT, parenting training and family therapy. However use of the ASI assessment in filial/play therapy with children and parents has shown positive results in informing therapy. Some illustrations are provided from families where the child has been referred for help, with a focus on problems in attachment style of parents with consequences for child’s behaviour and distress.

Biography:
Professor Antonia Bifulco is a Lifespan psychologist and Head of the Department of Psychology at Middlesex University. She is also co-director of the Centre for Abuse and Trauma Studies, which seeks to combine health, social care and criminological approaches to issues of abuse. Her research over 30 years, is widely published and she has investigated the family circumstances around a range of abuses, and the consequences for later life adjustment, relationships and depression. For example, neglect or abuse in childhood increases risk of depression in adulthood threefold and in adolescence five-fold. She is now increasingly working with health and social care services over the ‘translation’ of research into practice, and the use of interview assessment tools in practice settings.

In her research Antonia favours the use of intensive semi-structured interview measures which she and her team have developed. For example the Childhood Experience of Care and Abuse (CECA) interview to assess individuals’ early life neglect and abuse through narrating their experiences. This is an effective way of both collecting and understanding life experience. It is not always easy for people to talk about their neglect or abuse, but having a semi-structured interview administered by a researcher in a non-judgemental and confidential manner can aid with reporting. This is a method which clinicians also have adopted.

The model Antonia and her team use for understanding the consequences of childhood abuse, is an attachment model. This argues that early maltreatment damages trust and leads to greater difficulty in making close supportive relationships in adulthood, through attachment styles which are overly anxious, avoidant or disorganised. To assess attachment style the team use the Attachment Style Interview which examines the supportiveness of close relationships as well as attitudes around trust, autonomy, fear and anger to close others. Insecure attachment style has impacts on clinical disorder, but also on parenting behaviour which can endanger intergenerational transmission of risk. However, these impacts can be reversed through positive relationships and treatment. Understanding the relationship of the various risk and resilience factors across the lifespan and inter-generationally can aid clinicians in their use of different interventions to effect change.