Application of a cognitive-behavioral protocol, enhanced with Acceptance and Commitment Therapy in a case of reactive attachment disorder of infancy with paraphilias
Roberta Bassani, Stefano Marchi, Roberta Menotti, Maria Giuseppina Canevisio
According to the theory proposed by John Bowlby, the attachment bond has a predictive value regarding the development of social skills, cognitive functioning, understanding of self and linguistic skills (Bowlby, 1996). The purpose of this relationship is to ensure the child safety and protection from harm. This case illustrates the application of cognitive-behavioral treatment to a 9 year-old child, institutionalized, with previous experience of neglecting family, who also manifests sexualized behaviors of clinical relevance. The therapeutic work consists of one weekly meetings over a two years period, aimed at building a relationship of trust to facilitate the learning of functional behavioral patterns primarily and emotional recognition. Clinical practice has also enlisted the appeal to Acceptance and Commitment Therapy and, in particular, to mindfulness exercises, in order to promote a positive knowledge of the body. The change in the relational quality established between the child and the therapist helped the child to develop new behavioral models that can be generalized also in other contexts (residing community and school). The therapeutic outcomes achieved involved a slight reduction of anxiety and depressive symptoms and a lower level of anger in the child. A decrease in post-traumatic stress values from activation and concerns regarding sexual issues was also achieved. Children victims of violence and/or abuse or mistreatment tend to continue to experience dysfunctional relationships of attachment relating to adults and while exhibiting their behaviors, the presence of the unresolved trauma is revealed. The child we treated was able to internalize the therapist’s norms and behaviors, in order to completely trust himself. He would try to experiment what has been acquired also in other living environments, proving to be more self-confident, at the emotional and physical level.
Keywords
Dysfunctional attachment, Sexualized behaviors, Case report, Cognitive-behavioral therapy, Acceptance and Commitment Therapy protocol, Mindfulness.