The role of affect regulation in developmental trauma: an empirical study of children in residential care

ABSTRACT

The focus of this study is the role played by chronic dysregulation of affect in the presentation and treatment of severely abused and neglected children. The study used narrative story stems to assess children at a therapeutic residential school at two time points, two years apart. The method of analysis was the Child Attachment and Play Assessment (CAPA) which uses three constructs: attachment strategy, trauma and loss, and affect regulation. As well as demographic information, data were collected on DSM-V diagnoses and adverse childhood experiences (ACEs). The results lead to consideration of the importance of understanding the role of affect regulation in developmental trauma. Viewing the children’s difficulties in terms of chronic dysregulation of affect may be a more productive way of trying to understand children’s presenting problems than ACEs or psychiatric diagnoses. The findings have important implications for the medical model of child assessment using DSM-V diagnoses. A clinical implication of this research is that defences against such levels of early trauma need time and investment.

KEYWORDS:

• Affect regulation
• developmental trauma
• Child Attachment and Play Assessment (CAPA)
• milieu therapy
• narrative story stems

Acknowledgments

Many thanks to Heather Price for her invaluable contributions to this paper.

Disclosure statement

Caryn Onions is employed by The Mulberry Bush.

Additional information

Funding

The Mulberry Bush funded this study.

Notes on contributors

Steve Farnfield

Steve Farnfield is a play therapist, social worker and formerly Senior Lecturer in Attachment Studies at the University of Roehampton where he founded the Masters programme of the same name. He is trained in a wide range of DMM attachment assessments and developed the coding system for the Child Attachment and Play Assessment (the-capa.com). His research now focuses on the assessment and treatment of developmental trauma in children.

Caryn Onions

Caryn Onions is a child and adolescent psychotherapist and practitioner researcher at The Mulberry Bush. She was the clinical lead between 2004 and 2017 and after completing research at The University of Exeter, set up Mulberry Research in order to research therapeutic practice with children and families, particularly in residential and education settings. Caryn also has an interest in parent-infant psychotherapy and clinical supervision.