Psychotherapy What is an attachment therapist
Attachment psychotherapy Attachment-based counseling and psychotherapy,
3 Attachment psychotherapy Attachment-based counseling and psychotherapy, a series in ten volumes by Karl Heinz Brisch The knowledge of attachment theory can be used in many ways for attachment-based counseling and therapy at all ages, with the diagnosis and treatment being very different depending on the age of the patient . Using many examples from clinical practice, the series provides an introduction to the basics of attachment theory and the diagnostic methods and steps of attachment-oriented counseling and therapy from infancy to adulthood. Each volume contains a chapter on the specific fundamentals of attachment psychotherapy for the respective age group. Clients or patient group, numerous detailed and commented therapy examples. The individual volumes deal with the following topics: pregnancy and childbirth (already published), infancy and toddler age, kindergarten age. Further volumes in preparation.
4 Karl Heinz Brisch Infant and Young Childhood Attachment Psychotherapy Attachment-based counseling and psychotherapy Klett-Cotta
5 Klett-Cotta by JG Cotta sche Buchhandlung Nachhaben GmbH, founded 1659, Stuttgart All rights reserved Printed in Germany Dust jacket: Roland Sazinger Using a photo by Svetlana Fedoseeva Fotolia.com Set by Kösel Media GmbH, Krugzell Printed and bound by Friedrich Pustet GmbH & Co. KG, Regensburg ISBN Bibliographic information from the German National Library The German National Library lists this publication in the Deutsche Nationalbibliogra e; detailed bibliographic data are available on the Internet at <.
6 Contents Thanks Foreword Introduction Part 1 Attachment psychotherapy General principles of attachment psychotherapy and attachment-based counseling Five phases of attachment psychotherapy Interval treatment Special principles of attachment psychotherapy for parents with infants and toddlers The transgenerational transfer of parents' experiences to their infants and toddlers Part 2 Bond development in infancy and toddler age Healthy development The importance of secure attachment in human evolution and the development of infants Protection and risk factors The importance of the father The importance of other attachment figures and the attachment pyramid Part 3 Treatment examples crying disorders and excessive crying Example: Diagnostics and therapy for an infant with insatiable crying attacks
9 8 CONTENTS Part 4 Primary prevention through "safe Safe Education for Parents" Special variants of the SAFE program SAFE -Special Crèche SAFE -Special for parents with premature babies SAFE -Special in mother-child homes SAFE -Special for parents with mental illnesses SAFE - Special for adoptive and foster parents Part 5 Summary and Outlook Literature About the author
10 Thanks I would like to thank all parents and children as well as colleagues through whom I was able to gain a wide variety of therapy experiences, because these have been incorporated into the case histories of this book. Without this clinical experience I would not have been able to write this book. Thanks to the great commitment of Dr. Beyer from Verlag Klett-Cotta was able to quickly produce this volume in the series on attachment psychotherapy at the publisher. Without the great commitment of Birgit Vogel, who in turn quickly and reliably created the rough version of the manuscripts for this book from my dictations, this publication would not have been possible so quickly. Special thanks go to Mr. Thomas Reichert, who, despite the time pressure, took over the editing and whose feedback and suggestions for corrections made this book much easier to read.
11 Foreword This book is the second volume in the series »Attachment Psychotherapy Attachment-based Counseling and Therapy«. He focuses on the development time of infants and toddlers. In this book, the basics of attachment-oriented psychotherapy are first explained in detail and the special features for the age phase of the first to third year of life are presented. Many case studies show how the various symptoms of children are related to the life stories and early attachment experiences of the parents from their own childhood. The attachment-oriented psychotherapy and counseling as well as the diverse methodical approaches, including trauma therapy and video-based interaction diagnostics and treatment, are presented on the basis of many case studies and should thus become clear for the reader. A special focus of the treatment examples is on the problems that arise when parents endanger the development of their children through their own psychological problems, psychiatric illnesses, even violence in the partnership. * The developmental age from birth to three years is particularly important of great importance because this is where the neural development processes and the networking in the brain are created. The children's early experiences with their attachment figures play a particularly important role here. The examples are intended to clarify how, on the one hand, early disturbances can arise during this time. they thus paradigmatically reflect the problem and the type of approach of attachment-based counseling and therapy. All names are fictitious.
12 FOREWORD 11 but how, on the other hand, a change for the children and also for the parents can be achieved through very early interventions, each including the life story of the parents. This volume is aimed at everyone who works with parents, infants and toddlers and accompanies them on their development path, such as paediatricians, general practitioners, midwives, child and adolescent psychiatrists, psychiatrists and psychotherapists, nurses and carers, psychologists, Advisors, social workers, employees of the youth welfare office and social services, pedagogues, curative pedagogues, physiotherapists, educators and pastors and ultimately also to young parents. Karl Heinz Brisch
13 Introduction The first three years of life, with which this book is concerned, are of fundamental importance for the development of a child, because it is during this period that the psychological foundation for later life is laid. A healthy motor, cognitive, social and emotional development of the child can be achieved on the basis of a secure bond. However, this phase can be accompanied by a variety of difficulties and disorders, in that the infant and toddler develop a variety of symptoms, which challenge the parents themselves, but also the practitioner, to find solutions. After presenting the general principles of attachment psychotherapy and the special form of attachment psychotherapy for parents with infants and toddlers, in the second part of the book I describe the development of attachment during the first three years of life. After I begin by describing healthy development, protection and risk factors are presented. These can either support or complicate the development of attachment in one way or another, so that the parents may need attachment-oriented support and therapy for themselves. This is illustrated by the following various therapy examples. In the third part, various complications and their attachment-oriented treatment are described from the perspective of attachment theory. Here I also go into the experiences of the parents in their own history, which as risk factors can in uence the development of the child; Parents' experiences of neglect and violence as well as psychiatric illnesses are explained using case studies and their significance for the development of infants and small children. Separation anxieties, losses in the early development phase, getting used to the crib as well
14 INTRODUCTION 13 Further disorders in the context of care outside the family are important issues that parents are confronted with today and which concern them very much. The therapy examples conclude with descriptions of the attachment-oriented support of parents who suffer from the sibling rivalry of their children, or of parents who have to worry about the development of multiples, with all the stressors and attachment difficulties associated with them. In the fourth part of this book I describe the possibilities of primary attachment-oriented prevention with the program "SAFE Safe Education for Parents" that we developed. This program has already been explained in detail in Pregnancy and Childbirth, the first volume of this series, so that only variants of the SAFE program or SAFE special courses are described here, e.g. B. those starting after the birth, for adoptive and foster parents, for parents with premature children as well as the use of SAFE courses in mother-child homes. The book closes with a summary and an outlook that points to the attachment-oriented work with parents and children of kindergarten age, as described in another volume on attachment psychotherapy or attachment-based counseling and therapy.
15 PART 1 Attachment psychotherapy General principles of attachment psychotherapy and attachment-based counseling Attachment-based counseling and therapy, also referred to below for short as attachment psychotherapy, is not an independent therapy method. Rather, it is about adopting a bond-oriented perspective in diagnostics and treatment. It can be combined with and integrated into very different schools of therapy and methods. * A basic requirement for starting attachment-based psychotherapy is that there must be a secure external framework. First of all, external stressors, especially social stressors such as unemployment, poverty, homelessness, but also stressors from close attachment and relationship persons should be reduced as much as possible. Furthermore, a basic requirement is that there is a secure »inner framework«. This means that the affected clients are capable of adequate stress and affect regulation in everyday life. This requires a certain emotional security and a certain degree of stabilization. If these prerequisites are not met, then inpatient rather than outpatient counseling or attachment psychotherapy should be considered. A secure external and internal framework as a basic requirement for psychotherapy is always so early and so * The first pages of this part repeat representations from the first volume of this series, as they form the general basis of the following and are necessary for its understanding, especially for Readers who have not read the first volume.
16 GENERAL PRINCIPLES 15 aim for the long term as possible (Brisch 2010 a, b; Grossmann & Grossmann 2012). In the following I describe different phases of attachment psychotherapy. Five phases of attachment psychotherapy Phase 1: In the initial phase, it is always of great importance that the therapist can establish a secure emotional, therapeutic bond framework. The clients / patients have a wide variety of attachment disorder patterns and attachment difficulties when they want to establish therapeutic contact with the therapist in the initial phase. Here it is very important that the therapists know the different patterns of attachment as well as attachment disorders in order to adjust to the bizarre variants of interaction patterns and the establishment of contact and still give the patient the opportunity to establish a secure relationship in the sense of a therapeutic bond . This is what the therapist must do first. When a patient z. If, for example, with a pattern that avoids bonding, he does not keep an appointment that he has designated and agreed to as urgent, a therapist could conclude that he is not interested in the therapy. However, this would be a false conclusion, since it is not uncommon for patients who avoid attachment to have a desire for therapy, but at the same time only hesitantly, delayed or not at all attend the therapy appointments at the beginning. Here it is necessary for the therapist to inquire over the phone and not let the therapy fail immediately because the appointment agreed for the first contact was not kept. For the establishment of a therapeutic bond it is of great importance that the therapists proceed with maximum therapeutic sensitivity. But this means that they have the ability to
17 16 ATTACHMENT PSYCHOTHERAPY to have acquired beforehand through appropriate training; There may be "natural talents" who inherently have great therapeutic sensitivity, all other therapists must learn this as part of their training through appropriate supervision, feedback, video training and the like, otherwise there would be no good prerequisite for establishing a secure therapeutic bond to be able to. As before, however, training in therapeutic sensitivity is not a core component of every therapeutic training, this applies to all therapeutic schools. Phase 2: When the patient slowly feels more secure in the therapeutic relationship, he will begin to explore his life story and his current con icts and problems a little more, in other words: to report to us. It is important to know that there is a balance or mutual dependency between the developing security of attachment and the beginning of exploration, which means in concrete terms: When the security of attachment increases and the patient feels more secure, the joy and willingness to explore is automatically activated. Conversely, this means: If the patient becomes afraid during therapy or we as therapists frighten him through our posture, gestures, facial expressions, type of intervention, he will automatically use his ability to explore and thus also the report on his current difficulties and problems or limit his life story. Separation experiences, losses and traumatic experiences are of particular importance for attachment therapy work, because these activate the attachment system most according to the attachment theory approach. In therapy, exploration should "go along" more with topics relevant to attachment and should also focus on them and work in a less con ict-centered manner. So it is less about the con icts between desire and fear that arise from different perspectives in life history and from different
18 GENERAL PRINCIPLES 17 developmental psychological phases may have resulted, but rather a bonding history that specifically focuses on issues relevant to bonding. The adult attachment interview (AAI; cf. Main et al. 2003) is an excellent opportunity to conduct a very structured attachment history. (The questions of the AAI can be found on S in Brisch 2010a.) When working with pregnant women, expectant fathers and young parents, the attachment interview can also include questions about whether the relevant people have lost important people or about deceased children Pregnancy interruptions, miscarriages and stillbirths can be added. Phase 3: The patient makes new experiences of attachment in the relationship with the therapist, experiences security and emotional support accordingly, with which the therapeutic attachment relationship stabilizes and grows; At the same time, due to initial disappointments and irritations in the security of attachment in the transference, he will begin to project old experiences of losses and separations and stressful experiences onto the therapist. This means that there is a transfer of ties in therapy; This means that the patient transfers his attachment wishes and fears to the therapist. B. Will activate and stage attachment trauma in the relationship with early attachment figures in the relationship with the therapist. The topic of “separation” can be particularly relevant at the beginning and at the end of the lesson, caused by separations associated with the setting such as the end of the lesson, anticipated interruptions in therapy, for example through vacation, unforeseen interruptions e.g. B. by illnesses of the therapist. All of these separations can "shake" the client's attachment system, for example if the patient has experienced traumatic separation experiences, or they can "stress" them, so that they relate their attachment-relevant experiences in the transference
19 18 ATTACHMENT PSYCHOTHERAPY and can also reveal it for the therapist. Here it is important that the therapist understands this staging of the transference of ties, which is usually associated with fear, anger, disappointment and hope for more security and stability. At the same time, real traumatizations from childhood or the past of the patient will also become an issue, as the separation experiences from the therapy usually, as we say, "trigger" him so that he suddenly becomes more intensely involved in old, unresolved traumatic experiences perceives all associated feelings. (In American, "trigger" is the trigger on the rifle.If this is cocked up to a pressure point and finally beyond, then when the pressure point is exceeded the ball is released, the shot goes off and can no longer be stopped or held back; It is similar with old, unprocessed affects: if they are aroused from memory by other stimuli, they come more and more to the surface of the affective experience. If the affective pressure rises above the "pressure point", then there is a sudden affective overexertion and an outbreak of affects; these can neither be "brought back" or controlled.) Experience has shown that such triggers from previous losses and experiences of separation or traumatic experiences can be achieved do not avoid; they are also quite desirable once a stable therapeutic relationship has been established. Because then the experiences with one's own unprocessed affects can be kept in the therapeutic attachment relationship, processed and processed anew in a protected, secure therapeutic attachment relationship and thus also integrated. In contrast to the earlier traumatic situation, the client now has a therapeutic attachment figure at his side, so that he no longer has to fear the violent affects. It is now possible to process old traumatic experiences accordingly. Other therapeutic methods, such as EMDR
20 GENERAL PRINCIPLES 19 (Eye Movement Desensitization and Reprocessing) (Hofmann 2014; Hofmann & Besser 2003; Brisch 2013 b), nden application. Many therapeutic methods, including creative methods such as art, music and movement therapy, can be used to integrate affects that have not yet been processed. Basically, it should be noted: With the old unprocessed attachment traumatizations, which the client survived with the corresponding emotional wounds, the biggest problem is that the affects associated with these experiences were split off or dissociated. In the therapeutic relationship, these affects can be revived and activated with the appropriate experiences, e.g. B. also through the transfer of bonds. Due to this activation, it is now possible, on the basis of a helpful, real, secure therapeutic attachment relationship, to process the old unprocessed affects again and also to connect them with the corresponding stories or narratives of the experience, so that the experience can be integrated . Phase 4: If more and more of these old affective experiences can be positively processed and integrated, the patient (or client) usually has more "room" with his affects to "breathe and act" and more opportunities to change his real relationship. As a rule, the patients then report that they have had new experiences with people outside of the therapy. At the same time, an intense phase of grief work begins. As a rule, patients can now realize what their life could have been like if they had not had this or that traumatic experience of separation and loss. At the end of the therapy it will be possible to see that the patient has changed his original attachment representation, which can be avoidant, ambivalent or even disorganized and that he is perhaps for the first time becoming involved in the therapeutic relationship.
21 20 ATTACHMENT PSYCHOTHERAPY experienced and integrated as well as “emotionally stored” a feeling of emotional security. We then speak of an earned secure bond (cf. Main 1995) of a security that was first brought about by the therapeutic process, in other words: could only be acquired or gained through the therapy. During the grief phase, the patient can feel very bad again at times; They are depressed, suicidal and sometimes quarrel with their fate that they had to go through such agonies and terrible experiences in their childhood and so many opportunities and developments in their lives were barred from them. It is important that this phase can be adequately worked through and experienced in the therapeutic relationship, i. H. enough space is required for the mourning work. If a client has gone through many attachment-related separation and loss experiences, there is enough reason to really grieve about this too. Often the violent feelings of pain and grief have never been brought into a relationship before, so that now, in the therapeutic relationship, for the first time consolation, support, understanding, recognition of suffering and loving accompaniment can be experienced in grief. This is exactly the opposite of what the patient has often experienced before: namely, denial of the pain, real trauma, no recognition of the painful and painful experiences that were rather trivialized or denied as such. Phase 5: When more and more traumatic material and attachment affect-laden experiences have been processed, the patient can increasingly explore new paths outside of therapy, get involved in new relationships, but also in new professional activities and other ways of exploratory exploration of life . For the first time, he can think about saying goodbye to therapy, but at the same time this phase is also filled with fears
22 22 ATTACHMENT PSYCHOTHERAPY As the entire history of the patient with his or her specific injuries is known, such therapeutic interval treatments can usually begin without any major delay or "warming up" phase. It is an experience that I keep having patients sit down and, even after years in therapy, continue as if they had the last lesson yesterday (Brisch 2010 a; Bowlby 1995). Special basics of attachment psychotherapy for parents with babies and toddlers Parents with babies and toddlers are, in relation to their children, in the middle of building bonds. While they are required to develop a secure bond with their children and, in turn, to give them the opportunity to bond securely to them, to their father and / or mother, through sensitive interactions, the parents are at the same time to a large extent with the problems busy every day. The baby has to be swaddled, fed, breastfed, and properly cared for and supported in the event of illness. Many childhood illnesses are actually nothing special, but when they affect the first baby, everything is so new that the parents often think about it, every infection, the fever, the stuffy nose, the first childhood illness, the vaccination, the first diarrhea, the first constipation feel overwhelmed. Even if you already have several children and react more calmly to these things, many things, such as infections and teething and also the reaction to childhood diseases, turn out to be so different that the parents have to repeatedly adjust to the respective baby and its reactions. The specialty of the attachment-oriented therapy and counseling in this age phase of the child is that on the one hand the attachment feelings of the parents and their attachment experiences from their own childhood, which in some cases even affect the previous
23 SPECIAL PRINCIPLES OF ATTACHMENT PSYCHOTHERAPY 23 linguistic time with their own parents go back, become unconsciously activated. Feelings of security, care, fears, and loneliness are activated in this way, which the parents themselves experienced as children, i.e. as babies or toddlers. On the other hand, this leads to the fact that the parents behave very differently when dealing with their infant and its care, depending on their respective requirements. As the therapy examples in this volume will show, parents who have experienced protection and security themselves and who have been able to establish a secure bond with their own parents can now generally respond more sensitively to their child's signals; If they are unsettled by the children's developmental steps, they are able to quickly get help from their own attachment figures, but also from the pediatrician or in a baby clinic. Parents who grew up rather avoiding ties and whose signals in their own childhood were more likely to be reacted to with rejection, often try to cope with their worries on their own, and then only report to the children's clinic or pediatrician very late, do not take up offers of help, stop advice in a baby clinic or advice center for excess. They experience getting help as a failure, as they are deeply anchored in their attachment system and have stored the avoidant attachment pattern in accordance with the fact that they should actually be able to cope with all tasks and con icts and problems on their own. Parents who are ambivalent about attachment, on the other hand, tend to react overly sensitively and relatively quickly to the smallest signals from their child, on the one hand wanting to get help, but on the other hand canceling appointments again or simply not showing up because of the parts of their attachment pattern that avoid attachment. They will seek help, but at the same time feel guilty, as an inner part tells them that they should actually cope with all tasks on their own. These behaviors are for medical personnel
24 GENERAL PRINCIPLES 21 with regard to how the patient will be able to live and shape everyday life without the therapeutic support and the safety of therapy. Interval treatment For this reason, I always offer patients that they can return to therapy at any time if they are afraid again or if unforeseeable things happen or if they should find that the step of detaching and separating from therapy and saying goodbye is too done early. If the therapeutic attachment relationship was characterized by security and protection, patients will repeatedly fall back on the therapeutic relationship if they later find themselves in need, fear and horror and these feelings appear so threatening to them that they believe they cannot cope with them on their own to be able to. The treatment phases are then often shorter. I then refer to such repeated short treatments as "interval treatments". It goes without saying that in such cases the patient can fall back on the secure emotional therapeutic relationship of the previous therapy, since the therapeutic bond in the transference relationship between therapist and patient is not broken with the farewell at the end of the first therapy. Rather, the patient takes the inner, secure representation from the therapeutic relationship into his everyday life and can then fall back on it even in difficult, complex, fearful situations without actually having to go to the therapist or even contact the therapist. If, however, he cannot cope with the situation and it appears to him to be very stressful, it is an important experience and information for the patient that he can of course contact his "therapeutic safe base" at any time and tie in with the previous therapeutic process .
25 24 ATTACHMENT PSYCHOTHERAPY consultation hours assistants, but also a special challenge for psychotherapists and doctors. The “helper system” is normally set up to respond to calls for help and then to be available to provide support. But when those who call for help signal at the same time that they do not need help and can manage on their own, this is a classic example of a double message. This is not sufficiently understood in an average, "normal" communication; rather, there is a risk for everyone involved in the communicative system that the messages will be experienced as confusing. For this reason, everyone involved in the helper system, including the father, if only the mother is ambivalent, and the nursery teacher must know about such patterns of attachment so that, despite the ambivalent messages, they can maintain their offer of responding to attachment signals and providing help. even in the case of cancellations. It is not uncommon for such parents to turn up in the practice or in the children's clinic, usually shortly before the end of office hours, or they call the emergency number and report with a "guilty conscience": Actually, they say, they wanted to try to cope with the problem alone, the child's fever, a particular illness or other questions, but the problem has now escalated and so they urgently need immediate help and support. These "difficult" parents, who are well known to all in the helper system, are a real challenge, they cause anger and incomprehension and are not infrequently met with rejection or criticism, according to the motto: "Why didn't you come during office hours when your child has been there since the last." Nacht Ebert? 'This question is of course justified, a secure mother in the same situation would have seen the pediatrician long ago during the consultation; the attachment-ambivalent mother tries to solve the problem on her own because of her attachment-avoiding parts, as long as she somehow
26 SPECIAL PRINCIPLES OF ATTACHMENT PSYCHOTHERAPY 25 and then, often relatively late, to get help and to use the emergency service, often conveying the message that she probably could have solved the problem on her own. It is precisely such messages that trigger anger and irritation among those involved, because they are not immediately understood in a normal helper system; In particular, it is not clear to those involved in the helper system on which attachment patterns on the part of the mother or the parents these behaviors are based. If the parents are traumatized by their own earlier experiences, possibly from their own infancy and toddler days, if they have experienced violence, neglect, sexual abuse or worse, they will most likely show a disorganized attachment pattern, which then becomes a borderline in adulthood -Can represent personality symptoms. Such parents behave aggressively towards potential helpers or immediately reproach them; For example, they will call the pediatrician or the baby clinic and immediately reproachfully ask why they have not been given an appointment long ago, why they have to wait so long, why it is not their turn immediately even though they have only just entered the practice. You see yourself and your child as a special "emergency" that must be brought forward. They can hardly control their fear, their affects, their anger, disappointment that have something to do with their own early experiences of fear, panic and abandonment; they are easily upset, reproachfully unruly or resigned and disappointed, sometimes withdrawing. They often change the doctor, the advisory and helper systems, play them off against each other in their eyes. But this is only the expression of their enormous affective excitement, which comes about because the baby with its distress or its symptoms triggers its own early feelings of abandonment, fear and panic and these are then projected onto the helper system. The helpers are then insulted because they are incapable, not familiar with, not even
27 26 ATTACHMENT PSYCHOTHERAPY would know how to adequately help the baby in such a situation. In attachment-oriented counseling and therapy, it is necessary to see such parents against the background of their own early experiences, because only if these are included and perceived can the helpers meet the parents with understanding and in a relaxed manner. It is required of the whole system of all who work in it that the affects of these parents be retained and modified; the helpers are not allowed to "participate" by reproaching the parents, sending them away or criticizing them. In the worst case, the helpers could help the parents experience something with their baby that they experienced as an infant in their childhood: their fears were not seen, they were left alone, rejected and neglected. In this way, the story of the parents, forced by their behavior, would have been re-enacted and repeated in the medical or advisory system. Highly emotionally charged parents push the helpers into the position to act with them and to repeat their own de cites and experiences. The experience made and "saved" by such parents in their own childhood that they are not helped, that they have to cope with loneliness and abandonment themselves, they now experience similarly with regard to their infant; they are deeply disappointed, shaken, angry, that your child's point of view is not adequately addressed and he is not helped quickly enough. Other parents may be resigned to such a situation because of their early experience of abandonment and deprivation. They will then not answer at all, they may not even notice their baby's symptoms or do not register them as threatening. As a consequence, such parents would not turn to the helper system with their child at all. For the infant, the existence of such a part characterized by resignation and loneliness can mean that he is just as neglected and in
28 SPECIAL PRINCIPLES OF ATTACHMENT PSYCHOTHERAPY 27 his distress is not adequately treated and viewed as his parents experienced it themselves as an infant.This also makes it understandable that these parents often do not attract attention at all and only by chance or by detours do they come into contact with the youth welfare system or the health system with their frequently ill or neglected infant, so that help can only be organized relatively late. Under these circumstances, infants are at great risk and, in the worst case, can be affected by developmental disorders and damage because they could not be adequately cared for by their parents or even not cared for by representatives of the support systems. For such parents it is particularly important that there is clarity and structure in the therapeutic system and that outreach help is offered. All helpers involved have to coordinate and exchange ideas very well, because such parents sometimes tend to visit different helper systems such as children's clinic, pediatrician, counseling center, youth welfare office and confront them with their need. Sometimes these parents show a certain aggressiveness towards the caregivers and are overly concerned, or they deny that they need help and try in various ways to evade the carer systems. This also happens by changing the children's clinic or the pediatrician or even the place of residence; thus they evade the responsible youth welfare office. A bond-oriented counseling of these parents is urgently required, as the infant can be confronted with their own early experiences of loneliness, abandonment and also with violence and similar traumatic experiences when they grow up, cry, are in need, have attacks of anger, when you are confronted with the requirement to care for your child in such a situation, to give him protection and security, to set limits reliably and lovingly and to be constantly available emotionally.
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