Understanding Disorganized Attachment: Theory and practice for working with children and adults.

Simmonds, John

Understanding Disorganized Attachment: Theory and practice for working with children and adults

David Shemmings and Yvonne

Shemmings Jessica Kingsley Publishers

2011 240 pages 19.99 [pounds sterling]

The concept and framework of attachment have become core to the knowledge base of family placement. The observation of some children during separation and reunion with their primary caretakers raised questions about the original classification system when these children displayed unusual, bizarre or troubling behaviours that did not lend themselves to standard ratings of secure or insecure. So was born the concept of 'disorganised attachment' and since 1990 it has--alongside 'secure' and 'insecure'--made its own particular contribution to our deeper understanding of the concept and, in turn, child, adolescent and adult development.

Shemmings and Shemmings have produced a text that explores the nature of disorganised attachment with a strong emphasis on its relevance to practice with children and families where there is maltreatment. While disorganisation is a powerful theme throughout the book, there are constant references to the whole attachment classification system and its origins and implications. The first section outlines the theory and evidence base with a careful description of the development of attachment, the issues in identifying and measuring it and the relevant mediating and modifying effects. It is important to be reminded why disorganisation is not to be confused with disturbed behaviour and that when it does evidence itself, it does so within specific relationships. The current neuro-biological issues are explained with clarity, which is not to underestimate their complexity. Similarly, throughout this section the demanding issues of producing a valid and reliable evidence base are stressed, including some of the statistical challenges.

Part 2 explores disorganisation in relation to trauma and unresolved loss, with a detailed explanation of the importance of the emerging concepts of reflective function and mentalisation and their differences. The use of transcripts from the Adult Attachment Interview (AAI) and Story Stem interviews brings these issues to life for both adults and children. Other observations in natural settings clearly indicate the importance of these skills for all practitioners. A thorough reading of this section will enhance the interest shown in recent years in the capacity of prospective carers to demonstrate these qualities in order to manage the challenges that some children bring. In particular, the authors make it clear that there are no ready solutions to understanding and addressing these issues in assessment without specific training and support. Standardised measures are one important route to this but so are detailed observations, with the observer's reflective capacity and understanding playing an important part.

Part 3 explores interventions with a section on mentalisation and a detailed description by Phillips of the University of Leiden's video-based intervention used as described here in a family centre. A further chapter (with Young) explores the assessment of disorganised attachment and maltreatment (ADAM) in the context of the investigation of child protection concerns. The application of the concept of disorganisation through a four-day training in this challenging context is both very important and positive.

There is considerable material already available on attachment. The authors have done a magnificent job in distilling this material into a thorough review complemented by lengthy transcript material. This is not to underestimate the application needed to read this book and learn from it, but the value in doing so cannot be overstated. This is core knowledge for social work, health and education practitioners in both child protection and family placement work, and Shemmings and Shemmings have succeeded in demonstrating exactly why.

John Simmonds is Director of Policy, Research and Development, BAAF, London, UK