Developing an Attachment and Engagement

This blog is a continuation of the goals of Relational Therapy. In this discussion I will emphasize how the caregiver or therapist can set out to develop an attachment and engagement with individuals with Autism Spectrum Disorders.

Goal II: How to develop a model of attachment and engagement

1) An incomplete attachment causes the child to not have the use of himself. In psychological terms this is called “lack of self-agency.” The degree of agency for each autistic person varies from low to high; 2) The person with autism does not attach as one would expect in “typical” relationships (See previous blog); 3) The work with people with autism is much more difficult than with “typical” individuals. Most therapists at some level identify with aspects of their clients. For example, if you have ever been anxious or depressed, you can empathize with a patient who is anxious or depressed. How you would work with depression with the typical client will seem more straightforward and make more sense than with an autistic individual. With typical patients you might explore their thought processes, and or what happened that might have caused the depression. In other words, you would talk with the client by having a two-way dialogue. People with autism cannot do this. They do not have access to themselves (lack of agency) so they cannot name their feelings or have a two-way conversation that makes sense or is familiar to most. Thus the approach with the person with autism is not clear-cut, but more circuitous and unfamiliar for most therapists; 4) Most therapists do not have a model to empathize with their autistic client. Part of the work with this population is to understand autism so one can develop a means for empathy; 5) It is important also to not expect the same compliance from your autistic client as compared with your typical client. An incomplete attachment precludes working with this population in the same way you might work with a typical client (at least at the beginning); 6) Keep in mind that all “autistic behaviors” are communicating something important for you to understand. (See blog on autistic behaviors).

The following are some of the key points in working with the attachment and engaging with the autistic individual (This section will be broken up into two parts. The second part with appear as the next blog in the following week): 1) First you need to accept that it will be difficult and it will be up to you to encourage the attachment. The child/adolescent cannot be responsible for the awakening of the attachment although the child is ready to complete the attachment process; 2) You will need to go into the child’s world (know the particular child) versus demanding that they accept your world. This is an ongoing part of the therapy; 3) Let your client take the lead. In other words, let the client determine what will happen in therapy even though it does not make sense to you; 4) Use every moment with the child to attach; 5) It may not look like the child is attaching; 6) Do not give up on the child; 7) Always talk with the child as if they understand you and hold onto the belief that they can develop.

The blog next week will continue this discussion on how to gain an attachment with autistic individuals.