Adolescent Focused Family Therapy
Summary
The article by Turunen, Haravouri, Punamaki, Soumalainen & Marttune (2014), focuses on the role or effectiveness of attachment system activities in helping adolescents recover after trauma caused following a school shooting. The study focused on an educational institution that combined a Vocational Education Centre and a University of Applied Sciences in the rural town of Kauhajoki, Finland. In September 2008, a student at the institution shot dead ten people inside the educational institution. This included nine of his classmates and his teacher. He also damaged property within the institution and threatened other people causing them fear and terror before eventually committing suicide.
The study aimed to analyze the link between attachment system activities with mental health outcomes and posttraumatic growth (PTG) among the students that were exposed to the school shooting in Finland. The researchers hypothesized that the students who had developed a secure attachment with their primary caregivers would report a lower level of posttraumatic stress disorder (PTSD) as well as lower dissociative symptoms. Apart from that, the students with a secure attachment would report higher levels of PTG. This is opposed to students with insecure-avoidant and insecure-preoccupied attachment style.
The study was carried out over two years at the National Institute for Health and Welfare with the help of personnel of the educational institution as well as the aftercare providers. The population of the study was all the students that were present at the time the shooting took place. They were all asked to participate. However, out of 389 students who were asked to participate, only 236 (60.7%) students agreed to take part in the study hence forming the study’s sample. The researchers collected data using a questionnaire. The respondents were supposed to participate in the study at three-time points. 4 months, 16 months, and 28 months. It is important to note that not all the respondents participated in all three stages. 180 students participated at 16 months while only 137 students took part in the study at 28 months. However, the researchers did not associate the decisions made by the students to fail to show up for the study in its later stages to the severity of exposure to the school shooting and symptomatology.
From the questionnaires filled by the participants, the researchers were able to group the students according to the attachment style that best suited them. 99 (45%) of the respondents were grouped under secure. 80 (35%) were put under the avoidant attachment style while 50 (22%) were categorized as having preoccupied attachment style. The results also proved their hypothesis right. This is because at 4 months after the trauma participants who were securely attached showed significantly lower levels of PTSD symptoms compared to those with preoccupied attachment style. The same was also observed at the 16 months mark. However, to some point, their hypothesis was wrong since the respondents classified as having an avoidant attachment style also showed lower levels of PTSD symptoms when compared to participants with preoccupied attachment style. However, this was only observed at the 4 months mark.
In addition, respondents with securely attached style and those with avoidant attachment style did not differ statistically in terms of PTSD symptoms. This is both at the 4 months and 16 months’ marks. It is important to note that at the 28 months mark, the survivors with both secure and insecure (avoidant and preoccupied) attachment styles did not differ significantly in terms of the total level of PTSD symptoms they exhibited. In addition, at the 4 months and 16 months marks, respondents with a secure attachment style also showed lower levels of hyperarousal and avoiding symptoms compared to those with preoccupied attachment style. As with PTSD, respondents with an avoidant attachment style did not differ with those who had a secure attachment style in terms of avoiding and hyperarousal symptoms at the 4 months and 16 months mark. However, at the 28 months mark, the avoidant attachment style participants showed higher levels of intrusive and hyperarousal PTSD symptoms than the secure attachment style respondents.
The results also showed that at the 4 months mark, the participants with a secure attachment style had lower levels of dissociative symptoms compared to preoccupied attachment style participants. However, those with an avoidant attachment style did not differ with those that had a secure attachment style in terms of the level of dissociative symptoms exhibited by the participants. Finally, at the 16 months mark, both secure and avoidant attachment style participants differed from those with preoccupied attachment style. In relation to PTG, the results showed that the total Posttraumatic Growth Inventory (PTGI) was not associated with any attachment style at the 16 months and 28 months mark. At the 16 months mark, respondents who had avoidant attachment style showed lower levels of PTG than those with preoccupied attachment style. Similarly, at the 28 months mark, those with avoidant attachment style showed lower levels of PTG compared to participants with secure and preoccupied attachment style. Here, the respondents with a secure attachment style did not differ from those who had a preoccupied attachment style.
The study concluded that the students with a secure attachment style stand the best chance of recovery after a school shooting trauma. Students who had either insecure-preoccupied or insecure-avoidant were more vulnerable. Such students need to receive help in different doses, timing, and modalities. Students with preoccupied attachment style are most vulnerable especially in the wake of trauma and often express their distress openly. Apart from that, their despair is easier to recognize among the three attachment styles. Therefore, it is easier to offer them support. Students with avoidant attachment style are the most difficult to reach. This is because despite them having persistent posttraumatic symptoms, they do not express their distress or even seek help.
Bowlby’s Attachment Theory
As a therapist, I would use Bowlby’s Attachment Theory with the students who have been exposed to school shootings in order to come up with the appropriate intervention measures that will help them recover from the traumatic experience. It is important to note that school shootings cause feelings of fear and horror amongst the students. According to Turunen et al (2014), students who survive such ordeals often suffer from trauma-related symptoms. These include PTSD symptoms, anxiety, acute stress disorder (ASD), and depression. However, Turunen et al (2014) note that the survivors are affected differently by such traumatic events. This is because the survivors often have different resources that help them with their recovery. Such resources relate to the survivors’ personality, worldviews, and social relations (Turunen, 2014). When recovering from trauma caused by horrific events such as school shootings, the success of recovery is boosted by the manner in which survivors’ regulate their emotions. According to Turunen et al (2014), John Bowlby’s attachment theory is helpful in understanding the differences among people in regards to stress regulation and the coping strategies they use when faced with traumatic stress. The theory is used to describe the important role that attachment to a reliable caregiver plays to the healthy psychological development of children. It also tries to explain the detrimental effects on the mental health of children when such reliable attachments are either disrupted or lost (Gold, 2011). According to Bretherton (1992), Bowlby’s attachment theory helped shape people’s thinking about the ties that children form with their mothers and the disruption of such ties through separation, deprivation, and bereavement. For example, Bowlby observed that children would often experience distress when separated from their mothers. Additionally, children’s anxiety did not diminish even when being fed by other caregivers. The attachment theory contradicts some theories such as the behavioral theory of attachment that holds that children become attached to their mothers because she feeds them. Attachment, according to Bowlby, is evolutionary (McLeod, 2017). Children are born with a natural desire to form attachments. Since the caregiver provides security and safety for the child, attachment becomes adaptive as the child’s chances of survival are increased. Bowlby came up with four characteristics that described attachment. First is proximity maintenance. This is the desire of children to be near the people that they have become attached to. The second characteristic is the fact that caregivers act as safe havens for children. As such, children often return to the attachment figure for comfort and safety whenever they are afraid or are threatened. Third, is the caregiver’s role as a secure base. Children use their attachment figures as ‘security bases’ from which they can explore their surroundings. Lastly, children often experience anxiety whenever their attachment figure is absent (separation distress). Over the years, John Bowlby’s original work has been expanded with researchers suggesting different types of attachment styles.
According to Cherry (2020), there are three main styles of attachment. These are secure attachment, ambivalent attachment, and avoidant attachment. Each attachment style manifests uniquely in young children as well as when they grow up. For secure attachment style, the children are often visibly upset when the caregivers they are attached to leave. They are also visibly happy when they return. When frightened, these children seek comfort from their caregivers. It is important to note that while these children do accept comfort from people apart from their caregiver, they usually prefer people they are attached to strangers to strangers. Cherry (2020) notes that these children are often described as less aggressive, less disruptive, and more mature when compared to children with other attachment styles. As they grow up, these children have trusting relationships that tend to last longer. This is because they tend to share their feelings with friends as well as partners. They also tend to have high self-esteem. One notable characteristic of these people is the fact that they seek out social support. This would explain the fact that they are in a better position to recover from traumatic experiences as they are confident that they will receive protection, comfort, and relief when faced with such situations (Turunen et al, 2014).
On the other hand, children with ambivalent attachment style are usually suspicious of strangers. They show distress when separated from their caregivers. However, when reunited with them, these children do not seem comforted. When these kinds of children become older, they tend to be over-dependent and clingy. As adults, they cling to young children for security. Apart from that, they are usually reluctant to form close relationships with others. When they do, they are often insecure and worried that their partner does not love them. They are also easily damaged emotionally when relationships end. However, Cherry (2020) argues that this type of attachment style is not common. Finally, children with avoidant attachment style tend to avoid their caregivers. They do not actively seek out the comfort or contact of their caregiver. As such, they do not show a preference between a parent and strangers. In the later stages of their lives, they develop intimacy problems as they are unable, or sometimes unwilling, to share their thoughts and feelings with others. Therefore, they invest little emotion in social and romantic relationships (Cherry, 2020). In both ambivalent and avoidant attachment styles, the survivors of traumatic experiences find it more difficult to recover since they do not easily share their feelings with others. As such, they do not have readily available support systems to help them cope with such traumatic experiences.
Intervention: Psychodynamic Therapy
To deal with PTSD and other trauma-related symptoms, I would recommend psychodynamic therapy for the students that were exposed to the school shootings. This therapy proposes that behavior is often influenced by both conscious and unconscious motives. In addition, talking about one’s experiences and problems makes it easy to identify influences from their past that direct them to behave in a certain way. According to Marshall, Yehuda & Bone (2000), patients’ trauma symptoms are related to childhood conflicts and deficits that minimize the traumatic experience. Generally, the therapy is carried out in three phases. The stabilization and structure phase, trauma processing phase, and finally the reintegration phase. The first phase seeks to build a stable relationship between the therapist and the patient (Woller, Leichseiring, Leweke & Kruse, 2012). This encourages the patient to talk freely hence allowing their true thoughts and feelings to emerge without any difficulty. In addition, the therapist clarifies the patient’s impaired ego functions and encourages them to practice and exercise regularly in order to improve. The second phase helps to restore the patient’s capacity to represent traumatic experiences. Lastly, the third phase helps address the conflicts that the patient has to face after processing traumatic memories (Woller et al, 2012).
Questions
In this intervention method, the therapist ought to let the patient lead the direction of the conversation. The therapist mostly listens quietly. However, the therapist occasionally asks questions that will help guide the patient. Questions that are often asked by therapists include; ‘How does that make you feel?’ or ‘Does that remind you of anything?’ The latter question is usually very effective in getting the patient to recall past experiences that can be used to explain their current behavior. On the other hand, the former question tries to solicit the emotions that the patient has towards their traumatic experience. This will help the therapist in recommending techniques that will help the patient in overcoming such emotions and quicken recovery from trauma.
References
Turunen, T., Haravuori, H., Punamäki, R.-L., Suomalainen, L., & Marttunen, M. (2014). The role of attachment in recovery after a school-shooting trauma. European Journal of Psychotraumatology, 5(1), 22728. https://doi.org/10.3402/ejpt.v5.22728
Gold J. (2011) Bowlby’s Attachment Theory. In: Goldstein S., Naglieri J.A. (eds) Encyclopedia of Child Behavior and Development. Springer, Boston, MA
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28(5), 759–775. https://doi.org/10.1037//0012-1649.28.5.759
McLeod, S. A. (2017,). Attachment theory. Simply Psychology. https://www.simplypsychology.org/attachment.html
Cherry, K. (2020). The Different Types of Attachment Styles.
Marshall, R. D., Yehuda, R., & Bone, S. (2000). Trauma-Focused Psychodynamic Psychotherapy for Individuals with Post-Traumatic Stress Symptoms. International Handbook of Human Response to Trauma, 347–361. https://doi.org/10.1007/978-1-4615-4177-6_25
Wöller, W., Leichsenring, F., Leweke, F., & Kruse, J. (2012). Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse—Principles for a treatment manual. Bulletin of the Menninger Clinic, 76(1), 69–93. https://doi.org/10.1521/bumc.2012.76.1.69