Profile of a Therapeutic Companion

In this paper, the profile of the therapeutic companion (T.C.) is drawn. This is a person, not
necessarily a psychologist, who has been especially trained to cooperate in a psychiatric
therapeutic equipment from a complementary position to the therapist in charge (T. Ch.). His
function is to accomplish the therapist's instructions which mainly aim to contain the patient's
anxiety and to give him pertinent responses to this symptomatic behavior. The link T. C.-T. Ch.
is examined; a fluid communication between the parties and permanent supervision of the
T.C.'s work is strongly recommended for a satisfactory therapeutic work. The indications for
the inclusion of the T. C. comprise psychotic decompensations in border-line patients, acute
psychosis and suicidal or aggressive behavior toward others. Special emphasis is laid on the
research possibilities of this procedure: "natural" observations can be made and
corroboration of hypothesis about therapeutic conduct can be attained. In respect to the
number of T. C. to employ in each case. It depends on the patient's pathology. Not always,
though, the theoretical convenience of only one T. C. all the time for some cases is feasible, due
to the emotional strain of the task. The probability of a betterment of the therapeutic
efficiency, together with the diminishment of time and cost of internment are some of the
advantages of this approach.

The Attachment Therapy Companion: Key Practices for Treating Children & Families
By Johannah Cousins

In order for a traumatized child to heal, that child must be able to form a lasting, loving
relationship with an older caregiver. Though this concept sounds intuitively valid,
attachment therapy, a developing field based on the idea that the most fundamental need of a
deeply emotionally-damaged child is a caring and reciprocal relationship with a parent or
other adult, is still in its infancy.
In The Attachment Therapy Companion: Key Practices for Treating Children & Families,
attachment experts Arthur Becker-Weidman, Lois Ehrmann, and Denise H. LeBow seek to
create a foundational text. Though they suggest that the book might be useful for caregivers as
well, it is designed as a manual for clinicians, outlining the existing best practices in
attachment therapy and organizing the field for the way forward. The text has an unfortunate
tendency to repeat itself and some of the later chapters feel insubstantial; still, the authors
have crafted a strong case for attachment therapy as an exciting theory deserving of further
research.
Attachment therapy is new enough that it does not yet have a fixed terminology, so the
authors wisely begin with a discussion of key definitions and concepts. The book is careful to
distinguish what it terms “attachment-focused therapy” from more heavily “touch-reliant”
techniques, explaining that, though touch may be involved in some successful attachment-
focused strategies, the focus of the therapy is building an emotional understanding and trust
between the child and caregiver. There is also an emphasis on the importance of reciprocity:
The child must not only feel the effects of the caregiver’s love and support but also feel that
the caregiver is affected by the child in turn. A major theme is that the caregiver’s place in the
therapeutic process is equally significant to the child’s, whereas the clinician “takes more of a
coaching or consultant role.”

The book argues that attachment is already the basis for many trauma-focused therapies,
though it may not always be explicitly labeled. By making attachment the specific target of
therapy for children who have experienced lasting trauma, the authors believe that clinicians
will be able to avoid frequently used but insufficient diagnoses such
as PTSD or bipolar disorder. The authors devote significant time to discussing the particular
difficulties of diagnosing and treating children, and claim that attachment-focused therapy is
especially suited to the developing minds of the young. They emphasize the necessity of a
flexible, individualized treatment plan and rely more on case studies and examples to guide
readers in working with their own clients than on step-by-step methodologies.
The Attachment Therapy Companion seems to do a fine job of consolidating current knowledge
in the field and paving the way for future developments. The chosen examples are presented
in a dialogue format that effectively demonstrates ways in which the clinician can strengthen
the child-caregiver relationship. The emphasis on careful listening and avoiding blame for
disruptive behavior, with the clinician playing the role of facilitator, provides a convincing
image; it is easy to picture the children in the chosen examples making significant progress.
However, it is a bit difficult to imagine a clinician reading this book and successfully
implementing its ideas without significant further research, as the text tends to be vague on
the beginning stages of the therapy. The book states that a prerequisite for these techniques is
a comprehensive assessment of the suitability of both child and caregiver, including “an
assessment of the child and the caregiver’s capacity to be insightful, responsive, sensitive,
reflective, and committed, and their state of mind with respect to attachment.” Yet it does not
offer advice on how to locate and enlist such a qualified caregiver. The book addresses the fact
that many traumatized children have difficult family situations when discussing behavior
management and treatment logistics but does not address the seemingly larger question of
how an attachment therapist would find a suitable caregiver in the lives of these children. As
the book argues that attachment-focused therapy is the best way to treat these children and
that the role of the caregiver is essential, the lack of strategies offered to find such a caregiver
is glaring.

Ultimately, the book seems a useful resource for clinicians interested in working with child
victims of lasting trauma—but it is not quite the foundational text it seeks to be. It is by no
means comprehensive, and its weaknesses call out for further research and further writings.
Considering the integral role of the caregiver and the significant emotional qualifications
required of him or her, it seems like the logical next book would be a primer for the caregivers
themselves. (Attachment-focused therapy puts an uncommon amount of responsibility on the
parent figure, so he or she deserves to be provided with an uncommon amount of clinical
information.) What The Attachment Therapy Companion does, however, is outline a new
therapeutic model that requires more psychological knowledge from the client. Though it
does not solve all of the problems of such a model, it proves the worth of its field.
The Attachment Therapy Companion: Key Practices for Treating Children & Families
W. W. Norton & Company, September, 2012