Conference Agenda

Group Based Attachment Intervention, developed for children aged 0-3years, is directly informed by reflective functioning (RF). This presentation will show how RF is at once the mechanism of change and one of the desired outcomes. GABI uniquely includes therapy for parents (parent group component), for children (child play group), and parents and children together in a group. The program integrates dyadic play, facilitator modeling of a mentalizing stance, and video feedback on brief parent-child interactions that are discussed in the parent group. The video is used to activate the attachment system, with the primary purpose being to provide an additional tool to facilitate reflective functioning. Parents are encouraged to reflect on the possible meanings of their interactions with their child within a context of privileges the parent who was filmed and honors the potential of the parent–child relationship to thrive. All groups are facilitated by trained therapists and trainees. There are no contracts and parents can attend as frequently as three times per week. Research evaluating the effects of GABI has demonstrated improved maternal supportive presence and dyadic reciprocity and reductions in maternal hostility and dyadic constriction. These gains are indicative of increasing caregiver curiosity about the child’s mind, enhanced affect tolerance during distress, and more flexible, coherent caregiver narratives about self and child—markers of strengthened RF.

PCIT is a parent training program for behavioral problems among preschoolers and early school- age children, originally derived from behavior modification/social learning principles. Using live, in-the-moment clinician coaching of the parent while they interact with their own child, the parent learns to deliver positive feedback for desired behavior, to restrict attention for undesired behavior, and to deliver non-violent forms of discipline. It has been adapted for a host of other populations, including children with emotional problems, toddlers, preteen children, and maltreating caregivers. It is a well-established intervention for the treatment of oppositional and defiant behaviors as well as other externalizing problems. In form, PCIT shares many of the same features as interventions directly derived from the attachment tradition. Also, data suggests that PCIT improves many attachment-related constructs, including caregiver sensitivity, the quality of the parent-child relationship, and parental reflective functioning. Not surprisingly, some recent discussions of PCIT included reviews of these attachment-based outcomes and occasionally offered an attachment-based rationale for the intervention. This presentation will review these studies and commentaries and ask the question, “Can an intervention derived from the behavior modification/social learning tradition be considered ‘attachment-based?’” The implications of different answers to that question will be explored.

Adolescence is a period of rapid neurodevelopmental, affective, and social change, involving profound transformations in child and parent identities and in their relationship. Grounded in attachment theory and informed by a developmental focus on adolescence, the Connect program targets the core building blocks of attachment security: parental reflective function, sensitivity, dyadic emotion regulation, and shared partnership. Using emotionally engaging live role-plays and guided reflection exercises delivered in a group-based context, parents strengthen their capacity to “step back”, reflect, and regulate their own emotional responses with self-compassion. Strengthened by the reflective capacity of the group, parents are encouraged to “step into” their child's subjective experience, fostering curiosity about the attachment-related meanings underlying adolescent behavior. As parents acquire and build a relational toolkit, they are better equipped to remain emotionally present and responsive during challenging parent–child interactions, strengthening mutuality and partnership within their relationship and supporting adolescent emotion regulation. Parent self-reflection is woven throughout Connect, with supportive and structured exercises that help parents revisit their own childhood experiences with caregivers and consider how these shape their current feelings and behaviours as parents. Robust treatment outcomes across RCTs and implementation studies are well established, including significant and sustained reductions in adolescent mental health and behavioral problems, parenting stress, and parental depressed mood. Treatment outcomes should not, however, be conflated with treatment mechanisms and processes. This paper presents evidence related to inferred attachment-related mechanisms within Connect and considers whether, and why, evidence matters in defining, developing and evaluating attachment-based treatments.

Discussant for The Nature of Attachment Based Interventions: Are There Necessary and Defining Components and Does it Matter?