Prise en charge pluridisciplinaire des liens d’attachement chez l’enfant : cas clinique

Abstract

Bowlby's theory of attachment (1958) helps to understand the relationship between parent and child. Attachment refers to an affective bond between infant and caregiver. The child identifies as principal attachment figure the person bringing comfort and security. Other people are considered as subsidiary attachment figures whom the child mobilizes in the absence of the principal attachment figure. When distressed, the child seeks proximity and physical contact with specific and innate behaviors. Once the needs are met, the security base allows exploration of the environment. The repetition of these experiences leads to the development of internal working models which concern the representations of oneself and others. They serve as filters to understand the environment and to help the child assess, predict and choose the behavior to be realized. The type of attachment developed by infants depends on the quality of care they have received. There are four identified attachment types: secure, insecure avoidant, insecure ambivalent and insecure disorganized. The quality of the tie of attachment has repercussions on the development of the child (mental, physical, intellectual, emotional and social). It is also associated with certain psychological difficulties (anxiety, depression, psychotrauma). In practice, we meet regularly with children and their parents whose follow-up needs to refocus on the bonds of attachment. However, there are few articles or research presenting the way and the particularities of taking care of the insecure attachment style. In this article, we present a clinical case of a multidisciplinary therapeutic follow-up of a mother-child relationship with ambivalent attachment ties. We describe the evolution of the follow-up according to the significant moments, the stages of development of the child and the therapeutic spaces proposed (psychomotor, educational and psychological). Therapy includes sensorimotricity, internal working models, early schemas, trauma desensitization, narrative and parenting support. We expose the specificity of the therapeutic framework and the interest of acting jointly to allow the establishment of a secure attachment link. This framework is container and protection for everyone. It influences the therapeutic follow-up and adapts to the symptoms and development stage expressed. This device has enabled the creation of the therapeutic alliance and moves from an insecure attachment style to a secure attachment style. It is an evolutionary and singular therapy with each relation.