The Ainsworth Attachment Clinic provides evaluation, and intervention-planning, professional training, and consultation regarding children from birth through adolescence who have experienced significant challenges or disruptions to their relationships and/or attachment bonds with their parents or other caregivers. Among the children who benefit from these services are those in CPS, foster or adoptive care, those having difficulties with custody/visitation arrangements, and those whose families have experienced trauma. 

The Clinic also provides training to other professionals in these same types of work. Among the children who benefit from these services are those in foster care or adoptive care, those having difficulties with custody/visitation arrangements because of foster care or parental separation/divorce, those whose families have experienced a traumatic event, those with a child with a chronic medical illness and those with behavioral and interaction difficulties such as defiant and disruptive behavior problems.

Fifty years of research internationally has shown that attachment-caregiving problems are among the best early predictors of current and future emotional, behavioral, relationship, educational and legal difficulties. Early interventions based on careful assessment of attachment-caregiving problems, including Reactive Attachment Disorders and other attachment problems, are known to reduce the likelihood and severity of these problems. They also reduce significantly the long-term health care, educational, and legal costs to a family and its community. It should be noted that the assessments and interventions by this clinic are based on academic, basic and clinical research on children and families, and are not affiliated in any way with “Holding” therapies.

Our specialized evaluation and treatment protocols require extensive training and certification. The clinic operates under the direction of Robert Marvin, Ph.D., a developmental, clinical and pediatric psychologist with over 45 years of experience in research, clinical work, and consultation in parent-infant, parent-child, and family interaction.

The Evaluation

Depending on the referral question(s), an attachment-caregiving evaluation focuses on the overall relationship between the parent(s) and child(ren), with special emphasis on the attachment-caregiving component of that relationship. The evaluation yields a detailed report that includes specific descriptions and assessment of:

• Patterns of parent-child interaction related to play and exploration,teaching, behavior management, and protection from a range of dangerous situations.


• Patterns of attachment-caregiving interactions between the child andhis/her caregivers.


• Nature and severity of attachment problems (e.g., Reactive AttachmentDisorder; Disorganized attachment; differential diagnosis of attachment problems vs. ADHD, ODD, or Bi-Polar disorder; differential diagnosis of attachment problems vs. developmental disability).


• The caregiver’s patterns of thought, feeling, and behavior related to attachment-caregiving and other parent-child interactions.


• Assessment of the type and level of risks associated with current patternsof interaction.Assessment of the type and level of therapeutic services needed by thefamily, including likelihood of positive response to treatment.


• Specific treatment goals and strategies.

Evaluation Procedures

The specific procedures employed will depend on the question or questions being
asked. In all cases, the procedures listed below will take place in the context of a
clinical psychological evaluation adhering to, or exceeding, current standards of
practice.

Standardized evaluation of the infant or child’s relationship to the Caregiver:

• Videotaped, standardized separation-reunion procedure.


• Assessments of child exploration and attachment behavior in free-play situation.


• Standardized assessment of the child’s internal working models of family relationships.


• Assessment of the child’s specific needs with respect to his/her attachment behavior.


• Assessment of the child’s patterns of affect regulation.

Standardized evaluation of the caregiver’s relationship to the child:

• Videotaped, standardized separation-reunion procedure.


• Standardized videotaped assessment of the caregiver’s play, teaching, discipline/behavior management, and affect regulation interactions with the child.


• Interview regarding attachment-caregiving interactions at home and in the community.


• Standardized interviews assessing the caregiver’s thoughts, feelings, and attitudes toward parenting this child, and toward intimate family relationships in general.


• Where appropriate, standardized interview assessing the caregiver’s “resolution of the child’s diagnosis.” (Reaction to Diagnosis Interview)


• Assessment of the caregiver’s ability to provide for the child’s special psychological needs.

Ancillary evaluations

When appropriate, the clinic will refer the caregiver(s) for a psychological (personality) evaluation. This evaluation would be conducted and billed for by an independent psychologist who is not familiar with the findings of the larger evaluation. The results of this personality evaluation will be combined with those from the child-parent evaluation. This practice provides increased confidence in the validity of the integrated findings.

Developmental evaluation of the child(ren), if needed, can be completed by our staff, or can be referred to another professional.

What Happens During An Evaluation?

The evaluation takes place on a single day when involving up to two relationships (e.g., 2 caregivers and 1 child, or 1 child and 2 caregivers). Evaluations involving a greater number of relationships typically require additional clinic visits. A typical one-day evaluation consists of:

• Interview with the referring individual/agency.


• Traditional clinical assessment of child and parent.


• Standardized observational procedures, as described above, with the child and caregiver(s) during the morning of the clinic visit, and standardized interviews with the caregiver(s) in the afternoon.


• Feedback of evaluation results to the family and/or referring individual/agency at a negotiated time.

Treatment Implementation

In addition to the evaluation services offered by The Attachment Clinic, treatment oriented consultation services are also available. This clinic has been involved in federally-funded translational research projects to develop, field-test, and implement evidence-based treatment protocols for families experiencing attachment-related difficulties.

The intervention framework we use combines Structural Family Therapy and The Circle of Security® Intervention, an evidence-based intervention based on Attachment Theory and research. In some cases we offer therapeutic services directly to the clients. More frequently, we offer ongoing consultation to community-based therapists who are working with the child and family in their own locality.

The consultation service typically involves:

• Evaluation as described above.


• As needed, didactic training for the therapist on parent-child relationship and attachment theory research, and clinical application as it applies to this particular case.


• In-depth review of evaluation results, including video-tape and interview transcript review.


• Direct feedback and on-going consultation with the child’s or family’s identified therapist or treatment team (either at The Clinic or over the phone). The consultation focuses on the use of the Circle of Security® intervention protocol.