Maria Tatzmann MSW, LICSW
Maria Marino and Associates
www.mariamarinoassociates.com
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1- Understand attachment
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2- Cultural underpinning of family structures
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3- Identify the most common causes and effects of
disorganize attachment and their prevalence in
minority populations
4- Identify possible interventions when working
with mothers and their children in your practice
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How does it work, why is it important?
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What can go wrong?
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What do we see in our practice?
Attachment is a reciprocal process by which an
emotional connection develops between an
infant and his/her primary caregiver .
Healthy attachment occur when the infant
experiences the primary caregiver as consistently
providing emotional essentials such as touch,
movement, eye contact and smiles .
The quality of the attachment becomes the
scaffolding for the development of trust or
mistrust, sense of self and the concept of
mastery. It shapes how the child relates to
the world throughout life, the quality of his
relations, and his ability to develop as a well
adjusted adult.
 Caregiver becomes
a regulating partner
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Physical, Mental Health Mother/Child
Temperament
Tuning
Trauma effects
Exposure to violence
Antisocial learned behavior
Dulling of emotions
Brain Development
Relations
Stimulation
Exposure.
Regulation Emotions
How do I deal with to my feelings
From satiated/aroused d/sad/glad/shamed
1-Secure attachment
◦ Consistent emotionally responsive caregiving results in a
secure attachment.
◦ Infant learns to use the caregiver to be comforted, to manage
arousal, to learn self regulation and self soothing
◦ They develop a balanced strategy of attachment and
exploration.
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Resolution of fear.
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Secure base of exploration.
◦ Flexible regulation of behavior, attention and emotion
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2-Insecure attachment
Tuning and temperament dissonance. Insensitive,
inconsistent, overly rigid caregiving often results in insecure
attachment.
The infant is able to be comforted by the parent/caretaker in
an indirect manner. Learns to manage arousal by
maladaptive strategies
Insecure attachment is classified as:
Avoidant/dismissive:
Minimizing strategy to maintain closeness,
minimizes distress, restrained explorations.
Resistant/ preoccupied:
Maximize strategy to maintain closeness,
maximizes distress, maintain vigilance.
3- Disorganized attachment
The inability of the child to be comforted by the
caretaker. Unable to manage arousal, achieve self regulation
or self soothing
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If the child experiences the caregiver as nonresponsive he/she might in turn respond by
being clingy.
If the child experiences the caregiver as overreactive he/she might in turn respond by
being avoidant.
If the child experiences the caregiver as
rejecting he/she might in turn respond by
being afraid, sad, feeling persistently aroused
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If this process is non existent or disrupted,
the child may not develop the secure base
necessary to support future healthy
development.
Disruptive factors may include indifferent
caregivers, invasive or painful medical
procedures, sudden traumatic separation
from mother ( hospitalization, incarceration
etc.) neglect, sexual or physical abuse,,
prenatal alcohol or drug exposure.
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Other issues of concern:
◦ Parent’s mental health issues, substance abuse
◦ Chaotic environment
◦ Unresolved trauma
◦ Domestic violence
◦ War and the effects of war
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Cultural values and attachment issues
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What adults teach children without noticing it.
 Type 1
 Traditional Family: Recent immigrants, little socialization,
language difficulties.
 Type 2
 Transitional Family: Role duality ( mothers are wage
earners, children speak English), generational issues are
more prominent.
 Type
3
 Bicultural Family: Everyone speaks English. Parents speak
their own language, children might speak but
understand.
 Type 4
 Integrated Family: Family adjust to cultural mores of the
community they live in.
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Definition of family and of who is the care
taker of a child is an extremely culturally
bound concept.
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Nuclear
Single parent
Tribal
Extended by blood or by
 ritual
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A common answer is the hope that they grow
healthy and well adjusted.
Across cultures this takes a very different
meaning
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Honor ancestors
Defend the family honor
Provide for elders
Have many children
Bring pride to family, tribe, village, nation.
College degree, good job
Be happy
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Identity is a concept passed on from adults to
children. Individuality, cooperation, common
good, responsibility for self, for others
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What do we call adults? Who do we listen to?
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Differences from when we were a village.
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In many groups who we feed is the definition
of family.
Who is responsible for the child if parents are
absent?
How we honor or care for elders, parents,
ancestors.
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How do I please my parents?
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What is my place in society?
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Who will take care of me?
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What is expected of me?
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How do I honor my teachings?
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How do I become an adult? A parent?
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Who are our clients?
 Why is it important and how do we find out?
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How did they get here?
◦ Family history. Immigration history,
What needs to happen to achieve a positive
outcome
What brings them to your door
 The school
 The neighbors
 My sister
What do Mom or Dad or both think?
Is there a problem?
Who is affected by the problem?
Who is the client?
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In working with young children, and their
families the DSM V does not provide an
accurate description of symptoms to achieve
an effective treatment plan.
The need to assess the relation is vital to the
effectiveness of the intervention.
DC 0-3 provides you with a diagnosis of the
relation. It becomes the map for your
treatment plan and intervention.
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Children live within the context of a family.
Unless you know the family you cannot be
effective.
Be aware that in many groups stories relate to
actual events. Do not question the logic of
the stories. Ponder the need to tell you.
Learn to ask the questions. If we don’t ask,
they wont tell us.
 Where
Mom and Dad were born?
 Where were their parents born?
 What do they know about their ancestors?
 What did they learned about parenting from
their families ( ghosts and angels in the
nursery)
 History of substance abuse, sexual abuse,
domestic violence, war, immigration, trauma.
 Consider the issue of specific historical
trauma on certain populations.
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Intergenerational conflict
In law conflict
Marital difficulties
Hostile dependent relation with sponsor
Role reversal, inadequate communication, split
loyalties
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Family migration and relocation history
 Pre-migration experience
 Migration experience
 Impact of migration on the individual and family cycle
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Losses:
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Significant family and friends
Material losses
Loss of community support
Spiritual community
Physical trauma
Psychological trauma
Adjustment problems
 Language,, housing, transportation, employment ,
child care, racism
 Different rates of acculturation of family members
 Community stigma
 Availability of support system
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Downward mobility
Status inconsistency
Long working hours
Language difficulties
Racism at work
Rural vs. urban living
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Degree of somatization
Medical history of patient and family
Western medicine vs. traditional healers
Family concept of mental illness, help seeking behavior
and treatment expectations.
 Symptoms
 Causes
 Relationship to post traumatic behavior
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Be aware you are treating Mom as well as the
relation.
Mom’s experience as a child as well as her
experience of being mothered are the silent
script in the relation.
Identify the ghosts, concentrate on the
angels.
As Mom becomes better at dealing with her
own issues her child will become better at
using the relation to meet his/her needs.
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Ghosts in the Nursery. ( Selma Freiberg)
 We learn to be parents from the experience of being
parented.
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Angels in the Nursery. ( Liebermann)
 Identify those moments or people in Mom’s past that
parented her well. The “angels” that helped overcome
negative experiences .