Unresolved Trauma in the Adult Attachment Interview

Introduction

Carla and her baby son Diego were referred for an attachment assessment after six months in a parent and baby foster placement. Carla had been known to Social Services as a child, due to concerns about neglect and familial violence. She was never in care herself, but she did live with her grandmother from fourteen to eighteen. Because of this history, combined with worries about her relationship with Diego’s father, Carla was asked to go into a foster placement with Diego when he was born. Care proceedings were issued in the family court, so that plans for Diego’s future could be made speedily if Carla was deemed unable to care for him. A parenting assessment had already recommended that Diego be adopted by the time of the attachment assessment.

At the time of assessment, Diego was six months old and Carla was twenty. The assessment comprised an Adult Attachment Interview for Carla and CARE-Index to assess the quality of the parent-infant interaction. This article is written to show how the Adult Attachment Interview helped understand Carla’s behaviour towards her son, and directed us toward a treatment plan.

Observation of the CARE-Index

The CARE-Index revealed a big surprise. About halfway into the three-minute interaction, Diego watched a toy as his mother jiggled it, but his interest faded. He looked enquiringly at the camera and she looked up too, smiling happily. His eagerness began to take on a distressed sound and his face scrunched up in worry, as if he might cry. There was no apparent reason for this. He flailed an arm, lightly brushing his mother’s cheek. She grabbed her cheek as if she were hurt; her face froze in a blank expression, with eyes and mouth closed, and she cried out ‘Op!’ She was still for an instant, then she smiled and kissed Diego on the head, vocalizing to emphasize the kiss. Diego was unaware of what happened. He played a bit, sometimes looking bewildered, sometimes happy, and occasionally worried or distressed for no apparent reason. She wiped her eye (thus not seeing him) during a distressed-looking moment.  Diego seemed almost to be trying to engage the camera person. The play seemed not to take shape, but both stayed engaged. As the camera was turned off, Diego had just flung his arm upward again and ‘hit’ his mother’s face. She pulled back with a strong pain expression, then the screen went black as the camera was turned off.

Although the dyadic synchrony was deemed to be in the normative to mild risk range, there were these two moments of very great discrepancy when Carla behaved as if she had been attacked and hurt by her son, even though there was no force to Diego’s ‘hit’. The first instance was followed immediately with a kiss.

Analysis of the AAI

Could the AAI reveal why Carla was excessively attuned to the possibility of painful violence and why she might, in a truly violent moment, choose affection as the means of resolution?

Carla didn’t recall her early childhood well, but the history she did provide included her mother leaving her and her siblings with her boyfriend for several days when she was 7; her mother marrying ‘loud, violent Big Bob’ when she was aged 9 or 10; ‘random’ people visiting the family home; Carla staying away from home aged 11 or 12 years; shutting her finger in a door when she was age 8 or 9 years; and having pneumonia and smashing her Achilles tendon when she was 13 years old. Ironically, although Carla was physically and sexually abused by Big Bob, he was often the only person who stayed to care for her and her siblings. Accepting him and being affectionate, even when he hurt her, was probably protective when her mother had abandoned her.

Analysis of Carla’s AAI revealed many outstanding characteristics. Most notable was the absence of pain in her accounts of times when she had been hurt; her describing herself as having deserted her mother; a sense of her being absent from her own life, especially with her mother; a section suffused with sexuality when asked for an episode of being comforted; and there being no normal childhood episodes - every story was about rejection, injury, hospitalization or hurt animals. In one highly imaged episode right at the end of the interview, Carla tells us about a deer who had to be put down because it had so much trauma it couldn’t survive. If we imagine that the deer was representing Carla’s trauma, we get a sense of how difficult it was for her to talk about her painful childhood experience openly and clearly. This in turn can help us understand why Carla reacted as if her son had hit her in the CARE-Index when the blow did not occur.

Carla seems to perceive Diego as a man and, based her own past experience, she vigilantly guards against unpredictable moments of violence from him. When she perceived that a violent act occurred, she reacted instantly. Such a reaction is typical of a trauma response and one that is entirely consistent with her history. The kiss that followed also suggested the entwining of aggression and affection in Carla’s mind, also typical of trauma from family violence.

For Diego, there is the risk that, if this sequence recurs, he will think women like violent men. Unwittingly, Carla could be training the next bully or spouse abuser.

Treatment recommendations

The assessment concluded that Carla couldn’t care for Diego safely at that time, but that with services being provided to meet the gap between what Diego needed and what she could provide, this may be possible in the future. Therapy for trauma was recommended with an emphasis on 1) defusing her unresolved trauma regarding sexual violence; and 2) helping her to see how she has carried her fear into her relationship with Diego. Once her trauma responses were calmed, therapy to help her access omitted and blocked information was recommended.