ORIGINAL PAPER Building a Secure Base: Treatment of a Child with Disorganized Attachment Karen Zilberstein Æ Eileen A. Messer Published online: 31 July 2007 Ó Springer Science+Business Media, LLC 2007 Abstract Treatment strategies for children with disorga- nized attachments are not well established. This population exhibits a large array of difficulties in social relationships and self-regulation, as well as numerous other co-morbid conditions. As such, treatment of children with attachment problems is complex and requires a multi-faceted approach. This paper explores current research and theories about disorganized attachment and then examines how that research helped shape the treatment of an 8 year-old boy. Keywords Disorganized attachment Á Self-regulation Á Reactive attachment disorder Á Child treatment Á Parent-child therapy Introduction Attachment disorders in children is an area of growing clinical concern. While individuals with secure attach- ments tend to have the best developmental outcomes, including the best responses to treatment (Dozier and Sepulveda 2004; Stubenbort et al. 2002), those with disorganized attachments show the greatest rates of psy- chopathology (Carlson 1998; Green and Goldwyn 2002; Solomon and George 1999) and can be extremely diffi- cult to treat (O’Connor and Zeanah 2003). Children with attachment disorders, by definition, have experienced inadequate early care and exhibit an inability to form relationships on which they can depend for security, care and as a base for safe exploration (APA 1994). Many of these children have also experienced abuse, neglect, or multiple placements causing a host of co-morbid symp- toms. This layering of early adverse experience compli- cates the clinical picture in that numerous conditions— including PTSD, aggression, oppositional behavior, school difficulties, mood disorders and/or attentional problems—must be sorted out and addressed concor- dantly (Byrne 2003; Zilberstein 2006). As such, the treatment needs of these children are quite complex and serious, and have broad ranging implications for later functioning. At present, researchers and clinicians studying attach- ment have developed measures of attachment and thera- peutic techniques for treating attachment difficulties in infants and toddlers, but the literature on school age chil- dren is less coherent. Attachment research and theory have not been translated into an understanding of the clinical manifestations of attachment problems in older children or into widely accepted clinical interventions for that age group. Psychometric measures of attachment status have only recently been established for older children (Kerns and Richardson 2005; O’Connor and Zeanah 2003; Steele et al. 2003) and case reports on this population tend to vary in regards to children’s backgrounds and presenting prob- lems (Zilberstein 2006). In fact, children with attachment disorders, while sharing some common difficulties and presentations, are not a homogenous group. Different types of early experience such as abuse, neglect, institutionali- zation, duration and extent of adverse experiences, differ- ent temperamental and genetic traits, IQ, cognitive ability and varying degrees of caretaker availability and behavior all influence a child’s presentation and suitability for different types of treatment. Because of this, and despite the fact that these children do share some common diffi- culties, treatment must be individualized. K. Zilberstein (&) Á E. A. Messer The Cutchins Children’s Clinic, 17 Brewster Ct., Northampton, MA, 01060, USA e-mail: eKaren@comcast.net 123 Clin Soc Work J (2010) 38:85–97 DOI 10.1007/s10615-007-0097-1