Daniel Hughes demonstrates, in this volume and in his Facilitating Developmental Attachment: The Road to Emotional Recovery (Jason Aronson, 1997), an astonishing understanding of what it is to be a child damaged by insidious combinations of abuse, trauma, and loss. But his understanding goes way beyond sweet empathy and directly into practical, methodical, principled methods of looking after such damaged children and bringing them back to humanity: where impulses to "hurt back" are managed, where affection is given and received, where the everlasting need to be in control can be relinquished, where one has a shot at living without terror.
Dr. Hughes is a practicing clinical psychologist in Maine, specializing in direct clinical work with abused and neglected children. But he has become known internationally for his supportive consultations with foster and adoptive families, and with therapists struggling to bring about change with these children. Struggling foster parents, who are quick to spot fraud but who also recognize truth when they see it, fill auditoriums for his lectures, around the US and Europe.
In Building the Bonds of Attachment, we are treated to an intimate walk along the developmental/clinical path with Katie, from infancy through domestic violence, abuse, parental rejection, and, eventually, multiple foster placements and disruptions. We are permitted to peer into several foster homes that will turn into failed placements while learning almost firsthand about the cementing of narratives in Katie that will teach her to never trust, to never permit herself the luxury of vulnerability, and to always struggle for control of every social interaction. We watch therapists fail, too, as they naively imagine that talking-or even playing-with toddler Katie, then pre-school Katie, will make a lick of difference. Finally, we watch a particular foster parent dig in and, against all odds, begin to break into the secret and terrifying inner world of this child. It becomes clear to us why foster parents' efficacy must sometimes be measured in reverse terms: the more they love, the worse the child's behavior becomes. It begins to make sense why attachment is the most feared state imaginable for children like Katie-why, in other words, it is appallingly naive to think that "love is enough."
Once this last foster mom digs in, however, the work has just begun. An incredibly intuitive, persistent, principled consultant stays with foster mom day after day, week after week-as she wants to give up, struggles with where to find the energy to fight Katie's inner demons yet again, worries about what her other children are not getting as Katie sucks up all the air in the room. We learn about the seductiveness of a "good day," when foster mom imagines a breakthrough, only to be greeted the next morning with raging, controlling Katie once again. We see that Katie's "recovery" will be defined by fits and starts, by simultaneous testing of foster mom's resolve and of the several voices inside Katie about the meaning of love and commitment and vulnerability.
The picture is made more poignant as the author sprinkles in entries from the foster mom's journal and verbatim recordings of sessions with the consultant. Ever so slowly, we begin to see shifts in Katie's viewpoint on the world. We see her work through one memory of her original home-life after another, and with these, elements of her representational models begin to loosen.
This is not a romantic story. But I have assigned it to several foster families, only to have them tell me that it represents the clearest image of one of their own damaged foster children that they have ever read. Several have said the book made them think again about a previous, failed placement-wishing they could now try again, armed with these principles and these images of persistence. It is, above all, a real story: immensely practical, clinically sophisticated, entirely readable.
What are the implications of Hughes's book for those of us in prenatal and perinatal psychology? Katie's recovery is based entirely on a careful understanding of her prenatal and perinatal experience: an understanding that is often missing in clinical care of children, leading to disastrously naive clinical interventions and loss of hope all around. We in prenatal and perinatal psychology have so much to offer to child and adult psychotherapy, to earnest and struggling home visitors in Early Head Start, to foster and adoptive parents, to child welfare agencies-indeed, to many who are devoted to looking after young children but who often move ahead with parenting, advice, policy-making, or legal action utterly unapprised of the child's actual and perceived experience in utero and in the early months of life, and of the ways those experiences inform the child.
Daniel Hughes rattles us with this book. Katie's story has developmental continuity, from her life inside a young mom who did not want her and was woefully unprepared to look after her-much less love her-through a perinatal life full of exposure to rage, violence, affective unpredictability, and affective dullness. But Hughes tells us that we are all of a piece, from prenatal life onward. No one should dare to tamper with us-or make decisions about us-without knowing where we have been and what lessons we thought we were supposed to learn: lessons that inform our behavior every day. If nothing else, we should read this book to remember why we have worked so hard to understand prenatal and perinatal life, and to see again the practical implications of what we know.