The Neurobiology of Attachment-Focused Therapy - Enhancing connection & trust in the treatment of children and adolescent by Jonathan Baylin and Daniel A Hughes 

The focus of this book is set with a quote from Colwyn Trevarthan Emeritus Professor of Child Psychology and Psychobiology, University of Edinburgh.
“If we are to protect young children from harm …we will have to value more and give response to what children bring to human life-the eager spirit of their joyful projects beyond their seeking to survive.” 

How can therapists and caregivers help maltreated children recover what they were born with: the potential to experience the safety, comfort, and joy of having trustworthy, loving adults in their lives? 

In order to address this question this book shares the work of Dan Hughes and Jon Baylin in their development of a science based model of attachment focused therapy that links clinical interventions that are informed by an understanding of brain functioning on attachment and relationships. Thus Dyadic Developmental Psychotherapy (DDP) is linked to neurobiological processes.

Neuroscience shows that negative experiences lead to the development of a neural “alarm system” called the mid brain defence system linked to chronic defensiveness- the core of blocked trust.

The treatment is to target the mid brain alarm system – the part of the brain sensitised by pain suppression and chronic defensiveness evident in children who have developed blocked trust –the suppression of inherent relational needs due to poor care. 

The prefrontal cortex is activated in order to support new learning and move from mistrust to trust. This is done through techniques of reversal learning, fear extinction, memory reconsolidation, reflection, and reappraisal. The therapy ensure adults send messages of approachability and trustworthiness into child’s brain. i.e. not being defensive adults in order to ensure provision of comforting enjoyable experiences with adults. Safety is key in developing this trustworthy environment. 

Underpinning this approach are the key DDP elements of PACE – playfulness, acceptance, curiosity, empathy which are utilised by the therapist in work with children, parents and families. 

The content of the book is laid out in such a way that the reader is informed by the new science of attachment and the bio behavioural processes of trust, mistrust and trust building. This is rich and informative. The focus then leads on to the means of change in the brain functioning in order to bring about therapeutic intervention. There are summaries for some chapters (those providing theoretical background) which are an excellent learning aid. The chapters on intervention are very well illustrated with clinical examples which bring alive the approach as well as reminding the reader of the pain for the children and families involved. 

In drawing the book to a close the focus is directed to the future and the possible expansion of the DDP model looking at more processes to decrease chronic stress and defensiveness. 

The linking of the constantly developing information on brain functioning with attachment focused therapy is very successfully achieved in this book which will provide those working with children and families with potentially both an increased body of knowledge and an improved skill base.

​Ann Rooney
Consultant / Trainer

There is no better guide to how children develop their rich emotional, relational, and creative lives than is the wisdom of Colwyn Trevarthen, Jaak Panksepp and Phyllis Booth.  In this book, all three make it clear that reciprocal play--play that involves joy and delight, magic and music, often rough and tumble, always engaging in the back and forth of spontaneous encounters and movements--is a central component in the full development of children.  
            
In the first chapter Trevarthen and Panksepp summarize clearly their view of human development:  “We are born with a moving body, ready to share its rhythms and melodies of joy or anguish.  Our vitality is by nature that of a dancer or musician, and this intelligence in movement gives us signals to be shared. (p. 39).”   In the Forward, Booth gives us a brief glimpse of how Winnicott saw play between the child and psychotherapist as being at the heart of the creative changes that such meetings attempted to foster.   Play too, is the central core of Theraplay, a treatment modality developed by Booth that moves play from the focus on the symbolic play of traditional therapies to the reciprocal, expressive, movements of delight and engagement that occurs within Theraplay between the child and therapist and the child and parent. 
            
Attachment theory and research stresses the importance of safety that is established in the infant-parent relationship within which the young child learns within joint activities with the parent to regulate their affective states and begin to make sense of the world.  The reciprocal, moment-to-moment engagement--often characterized by music and  rhythms that have been called “the dance of attunement”-- between infant and parent is the foundation for the child becoming safe to explore the larger world of relationships with peers and developing interests.  Through reciprocal play, the rich inner world into the minds and hearts of others--family and friends--becomes open to the child.
            
When children have had the misfortune of developing a troubled or disorganized attachment with their original caregivers, these children need to develop relationships with their new caregivers that feature the presence of comfort (for attachment) and joy (for companionship).  Repetitive nonverbal communications that express empathy, delight, interest, and wonder are central in these children learning that they are able to trust these caregivers.  Joint activities that involve music and dance, spontaneous intentional movements requiring a shared focus and cooperation are important ways to engage these children to develop their trust.  Similar activities with their peers are often crucial both in helping the child to both return to the past with joint activities that they had needed but did not receive, as well as moving into the future into groups of friends. 
            
Inclusion, Play, and Empathy offers a great variety of ways to become engaged with children who have had difficult beginnings while guiding them to participate in those spontaneous, joint activities of creative play that they desperately need.  Music and dance, but also all sorts of shared intentions and activities, are presented in this book as ways that will facilitate children’s neuroaffective development in group settings.  Therapists from many countries and all persuasions share their insights attained through their creative therapies that are likely to offer ideas for engaging children to both parents and professionals alike.
 
These programs cannot replace the child’s need to develop safe relationships with their primary caregivers characterized by comfort and joy.  However they may well complement such relationships and, in fact, the child’s participation in these crucial experiences of play with peers, maybe actually help them to become more open to exploring a closer relationship with their caregivers.  The therapies presented in this well-edited book are excellent examples of “therapies that enhance the deep creative and restorative powers of human nature (p.49).”

Dan Hughes PhD
​Founder of DDP