Attachment, shame and empathy in dyadic family therapy

The aim of this reflective piece is to explore the under-recognised contribution of shame to disorganising attachment–caregiving relationships. The first hypothesis is that ‘shame without solution’ is a part of a core and enduring emotional wound central to relational trauma in infancy and associated attachment disorganisation. The second is that dominance and submission hierarchies, order and control are potent defensive adaptations employed to stabilise ‘shame without solution’. Children exhibiting profoundly disturbed behaviours, stemming from intergenerational cycles of trauma and distress, are disproportionately represented in child protection, intensive family support and child mental health services. Despite being set up to support these children and their families, the most distressed mothers too often disengage, feeling blamed even by compassionate therapists who work hard not to alienate them. If the mothers disengage, the mothers and their children are left without professional support. Arising out of this theoretical work are recommendations that support constructive and effective working relationships with these families, originally articulated in Parallel Parent and Child Therapy (P-PACT; Chambers et al., 2006). The first recommendation is to provide mothers with the support that we want the mother to give the child. This means meticulously avoiding reinforcing the negative self-view typical of these mothers. The second recommendation is to prioritise empathy for the mother and the mother–child relationship early in treatment. For many practitioners, this second recommendation will conflict with their natural desire to prioritise empathy for the child, especially when the mother's capacity to do so is compromised. Experience and theory support the adoption of these recommendations to avoid perceived blame of the mother (and all members of the family), a critical shift to establishing engagement.