Developing an Attachment and Engagement-Part II

This blog is a second in a two part series on attachment and engagement. The following are more of the key points to think about as you develop an attachment with the autistic individual:

1) Compliance by the therapist to the child will be important at first: a) use your knowledge of autism to inform how you use yourself with the child, b) believe that there is a child inside who wants to come out, c) your job is to gain access to the world of the child, d) the child will resist your presence until they accept you, e) The child will allow you to be a presence in their world, f) you do this through play therapy, g) it will be important to join the child in the activities or ‘non-activities’ that they may be doing, h) it may seem like the child is not playing appropriately (unconscious communications that need to be interpreted), but you need to remember that they are doing the best they can, i) as you are with the child continue a dialogue not expecting at first that they will join in. For example, if the child is touching a piece of jewelry you are wearing, do not stop them. Comment something like this “it seems like there is something about the jewelry that you like” or if the child is picking his lips, you might comment “it looks like there is something you are trying to get to”. Interpret all behaviors of the child, i.e. “are you hitting me because you want to be close to me?” You like to run away because you feel free and to have boundaries seems like it is stopping your forward movement of development.”

J) how you approach the child is crucial. It is through your behavior, that the child will allow you to come into their world. At first, this will not be something that you can “see”, but it is a process of earning the child’s trust. The child needs to be allowed to make the internal decision to accept you, k) make a game out of making yourself visible to the child i.e. when Mike ran away, I ran after him. We played a game where he would run and I would catch him. I also made myself present when walking with Mike by periodically stopping and calling to him that I had stopped and asked him to come back to me. Eventually he would and we could have pleasant walks with each other, l) let the child lead the way and as the therapist you become a partner who will not let go of the relationship. Someone needs to hold onto the relationship and it is going to be you because the child cannot hold on to you yet, m) play activities that the child likes, n) you will need to be speaking all the time. Name (symbolize) what the child is doing all the time – for example, you are throwing the ball, I am catching the ball. In a sense you are naming and symbolizing for the child. It may feel like you are talking to yourself, but you need to believe the child can hear you. They just cannot show you they know. If they could, they would be able to use themselves and if that was true they would not be autistic,

o) a constant goal is to understand, validate, accept and recognize the child. This should be in the back of your mind always as you are working with an autistic child, P) teach the child through nonverbal communication how it is to be in a relationship. Much of the early mother/child relationship is based on implicitly learned experiences. For example, we learn how to treat others by how we were treated early in our relationships with our parents, q) echolalia is an example of a child having none to very little self-agency. They repeat back what others say because they do not have ownership of any words for themselves. The only words they have are what they hear. Remember this child is doing the best she can. She is using her environment with whatever means she has. For a child using echolalia, that is the only method the child can communicate at that time in space, r) insist on making yourself present with the child. Do not give up. Remember that you are unconscious to them and your job is to become conscious to the child. Their fear will make this very difficult at first. Do not give up and s) use projection with the child. Remember the child cannot talk and use herself, but she can use projection to talk about herself. In other words she talks by referring to herself as “you.”

2) You are always working with the attachment. This is something that develops over a long period of time. It is a long-term process.
3) It is through the attachment process that you will not only be developing an attachment, but also the child will be leaning to trust you. As this trust evolves, the child will be able to experiment with new behaviors because he feels safe enough to do so.
4) As you are always working with the attachment, there are other specific techniques that you can also incorporate (limited only by your own creativity).
5) At some point, the child will make a decision to attach to you. In other words, the child will allow himself to be influenced by you. He will tell you this by how he allows himself to be in relationship with you. Signs to watch for are – willingness to follow your requests, compliance, talking when they did not talk previously, and use of “me” or “I” versus “you”, pointing at an object or echolalia.