Thursday, 3 March 2011

Attachment Triage

In trauma response, Triage (pronounced /ˈtriːɑːʒ/) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately.The term comes from the French verb trier, meaning to separate, sort, sift or select. (Thank you Wikipedia)

I think I mentioned once that my children used to slow-crawl-chase each other around the house. It was adorable. I loved it; I thought they were learning to play together. But now I know what was really going on: Pink was trying to hunt Blue down and kill him.

If Pink could be granted one wish, I think that it would be this: to be an only child. She sits on my lap and when Blue comes close, she uses her new, shiny boots to aim a kick at his head. He tries to join in reading with her and she bites him on the hand, hard. He sits next to her on the floor and she scratches his face. He makes any kind of move into her personal space and she sets up such a shrieking that I start to worry about what the neighbours must think. (She does get into trouble about this, by the way, but this is about attachment rather than discipline so I'm going to leave that topic alone).

And I think - Pink, what's going on? You shared a
womb with this boy. I look back at the time when we got our referral, and almost want to laugh. Oh babies, my babies I would say to their photo. You have already lost a mother, and now are going to be torn away from everything you have ever known. I can't imagine the pain you will feel. Then I would weep a little bit and, choked with emotion, say but babies! You will always have each other. And I would stroke their pixellated little faces and smile a teary smile.

For children who had lost so much, it seemed like such an astonishing blessing for them to have not just a sibling, but a womb-mate. Their other half, their other self, the other one who was right there at their own beginning. I assumed that being twins would mean they would have a head-start, attachment-wise. I thought that even if they didn't like us, they would have solace in the deep familiarity of a twin. I always assumed that their two-ness would be a source of instinctive comfort to them, but right now, it seems that the reverse is true.

Because it's not just Pink's dislike of Blue that makes things complicated. When two become three, it's possible that uneven attachment within the family unit will result in triangulation. But what about when two become four? There are so many new dyads going on when two children are adopted at once, and it all begins to feel not just difficult but frankly, pretty mathematically complex. So what's the word for what happens at our house? Square-ation? Diagonalisation? I think the technical term is probably hot mess.

I drew an attachment-o-gram for the people in our house, sometime in December. This is what it looked like:
Mummy loves everybody. Daddy loves everybody. Pink loves everybody except for Blue. Blue loves everybody except for Mummy.

Yeah, Blue loves everybody except Mummy. I am not saying that lightly. I wanted, more than anything, to be able to feel like everything was either fine or travelling towards fine. But as time went on and Pink became more and more secure (clingy, at times, but a normal kind of clingy, not an 'I'm terrified you're going to leave me' kind of clingy), I could see an increasing contrast between the two of them and by the time I sat down to draw this diagram, I knew that the arrow between the two of us mostly only went in one direction.

I don't think I appreciated, before we adopted, just what a spectrum there is in attachment. I knew about RAD, but I guess I thought that if we didn't face RAD then everything would be pretty much fine. And our babies were so young when we adopted them. Three months! And some children suffer much more neglect than they did, for much longer, and form new attachments easily. But because Blue was only three months old when he came to us, because he was held to be fed, because his sister seemed to attach so well, it can be very easy to minimise just how awful his early experiences were. It can be very easy to forget how totally logical, how totally understandable it would be if they continue to affect him. And I was aware that all children are different - some cling, some run. I didn't want to turn into the sort of mother who would drag my toddler off to the psychotherapist or the hypnotherapist or the aromatherapist for imaginary emotional problems, problems created in my own fevered imagination, problems invented to feed my own need for drama.

And for a while I hoped that this was only one of those imaginary problems. It never used to seem like a pattern, just an agglomeration of bad luck. He's sick. He's tired. He doesn't dislike me, he just prefers his Daddy. When he wasn't very cuddly, or didn't want me if he hurt himself then okay, that might just be personality. But when he rejected me and snuggled deeply into the lap of a stranger one week at the library - and then someone else, the next week, and then another again, and started doing the same at church - then, I was worried. Not calling-the-adoption-agency-for-emergency-suport worried, but worried enough. He would show a lot of signs of security - checking in, chatting, really good eye contact - and then lots of signs of insecurity - inappropriate stranger behaviour, ignoring me, a rigid body when he was being held by me - all in the same day. I watched him, and I found out some things that I wish I had never needed to know.

I found out that it is easy to project feelings of love onto any reasonably contented infant, but that a child who can move suddenly shows where their heart really lies. I found out that I really had expected my children would prefer mother over father, even if I had never said it out loud.I found out that keeping a child mostly at home might be wise for a hundred different reasons, but that it can give a false sense of security that comes crashing down once the child actually spends time in a situation where stranger interaction is inevitable. I found out that when Blue picks strangers to snuggle up to, he prefers brunettes. I found out that nothing throws insecure attachment into sharp relief like a sibling whose attachment seems to be fine. I found out that a child can show a lot of signs of secure attachment and then a lot of signs of horrifyingly insecure attachment within the same day, the same hour. I found out that nobody in my 'real life' has any idea what this means. I found out that attachment issues aren't necessarily two-sided. In fact, I felt like a teenager again as I remembered just how painful it was to fiercely love someone who didn't seem to love me back.

And I found out that each time I tried to draw him in, to get closer, I had Pink screeching and pushing him away.

I cannot possibly explain just how big an issue this was. Because of course - she needs me too. If she wants to cling, I want to let her cling. And which child do you think is more likely to be picked up - the child who is grabbing my legs, saying 'mu-mmy! mu-mmy!' (yes, that's FINALLY happening) or the child who is running as fast as he can in the opposite direction, covered in his sister's bite marks? Yeah, you guessed right.

I wasn't deciding to prioritise her over him, it was just sort of happening. Hour by hour, day by day, she was getting the lion's share of the attention. The number one Big Thing I have learned, parenting two children, is this: It's not possible to put two people's needs first at the same time. Not possible. Sometimes their needs coincide, but often they don't and that means that a lot of my day is spent making split second decisions that essentially reduce to: right, which one of you is going to lose this time? This is fairly trivial when they are both thirsty and want a drink, or hot and need their jackets taking off. But when they both need therapeutic parenting my brain feels like it is going to just give in and finally explode.

Call me stupid, but I did not realise how difficult this would be when we decided to adopt two at once. Overall, I think we had excellent adoption preparation. Our homestudy involved months and months of weekly visits from the social worker, so you'd hope so, right? We covered the usual adoption topics in considerable depth, and I feel like we went into this as well prepared as was possible. We discussed attachment. We discussed race. We discussed discipline. We discussed food. We discussed our own childhoods. We discussed pretty much everything, I thought - but we never discussed the realities of adopting two un-attached children at the same time. We were asked one question about multiples during our assessment, and I improvised wildly and said something like we would treat twins like any other siblings, siblings who happen to be the same age. And our social worker said Yes! Absolutely! and ticked a box, and that was that. I think that they were just wanting to check I didn't want twins to be a pair of dolls to dress up in matching outfits, and my answer reassured them. (As if I would do that!
What do they think I am?Some kind of monster?) And so we were approved for twins. But we were never asked the question how are you going to do all the one-on-one attachment activites you've waxed lyrical about if you get more than one? Where do you plan to put baby #2 when you are babywearing #1? How do you propose to do all of those slow sweet silly games with your child that rely on focused, individualised attention if your other child is clinging to your leg and biting her brother's foot? Do you plan to keep one of your children in a stasis booth for part of the day while you do attachment stuff with the other one, and then swap? Because frankly, lady, that's the only way your plans are going to work.

The truth is, I had no idea at all just what it would mean to be working on attachment with two kids at the same time. I'm going to insert all the usual disclaimers about our twin referral here - very lucky, extremely grateful, yes indeed, no question. But seriously, no idea.

With twin-life in general, when people say 'oh, twins, how DO you cope?' my most frequent answer is: Triage. And I say it like I'm joking, but I'm sort of not. Sound extreme? You're welcome around here on a rainy afternoon, just after naps, anytime. The irony is, I make jokes about how having twins is all about triage, but I never noticed how I was utterly failing to properly triage the attachment situation that was staring me right in the face. The whole idea of triage is that you don't just care for the patient who is screaming the loudest, you care for the patient who needs intervention the most. On a battlefield, the person shouting the loudest is probably going to be okay, and I think that it's probably the same with children. The child who is wrapped around my knees, showing me she wants me and needs me, isn't going to get forgotten. The child who is quietly ignoring me probably needs connection much, much more. I was being an idiot, and letting the important get crowded out by the urgent.

And I'm pretty slow about these things, but eventually something clicked and I got it. I started to shove Pink off my lap and plonk Blue down there instead. Actually, I was pretty mean about it, sometimes. I would read Shades of People with him, and she adores Shades of People. So if she wanted to read along so that she could point at the giant infant on p14 and say 'bay-bee', she was going to have to suck it up and get deal with being close to him. And if she didn't want to, that was fine, but she was not going to shove him off my lap and sit there herself because Mummy has two babies, Pink-my-sweetie, Mummy has two babies, and Mummy loves you like crazy but Mummy loves Blue, too, because Blue is Mummy's baby just like YOU are my baby! And Mummy is having a cuddle with Blue right now, and it would be lovely if Pink wanted a cuddle too - we can all cudddle together! - but if she doesn't want to cuddle with Blue then she needs to play with a toy because Mummy is cuddling with Blue now, sweetie. And some of you are thinking no wonder your children are having trouble with speech and language if you use sentences that long to talk to them! but mostly I was just talking and talking to cover the sound of her screaming at me in protest.

But she got used to it. And more importantly, so did he. He started to relax with me much more. I spent a lot of time on the floor with him, crawling around, and letting him feed me stale cheerios that he found under the high chairs. And for a while, whenever someone asked me 'what do you do?' I would tell them about my job, but I would silently think I'm working on attachment with my son, that's what I do. I've always worked hard on attachment with them - always. But it's always been with them. It's only recently that I realised just how much he needed it to be with him.

And now suddenly, the last four weeks or so - it's like a switch has been flipped. He's always known I was The Mummy, but it seems that pretty much overnight he finally decided to stop shopping for a replacement. He will still go to other people for cuddles, but after a while he wants to crawl out of their laps and into mine. And then last week, he climbed out of his father's lap and into mine, and wouldn't budge. We went to the library again today and he snuggled with me all through the song time. He cast flirtatious glances over my shoulder at the other ladies, of course - otherwise he wouldn't be my Blue - but he wanted to stay with me. And when I come home from work he runs up to me and squeaks and wants a hug, most days, which sounds like a small thing but feels far from small to me.

And so here we are, for now. We haven't got there yet, wherever 'there' is, but I feel like the spiderweb of connections that we have is getting more and more tangled and dense and holding us together more tightly every day. I feel like I have learned a lot about attachment over the last few months, but the biggest thing has been - we couldn't have addressed this unless we had admitted it. Critically considering our attachment has not been easy, but I am profoundly thankful that I knew enough to realise that needing to work on our attachment did not mean that our family was failing. I'm convinced that we are more likely to fail our kids when can't imagine that attachment might ever be an issue for us, when we try to sweep these issues under the carpet. I try not to be strident (no, honestly, I do) but the more I see, the more I read, the more I learn, the more strongly I feel about this. Without turning into aromatherapy-panic-mothers, I think we owe it to our kids to be real about this when it's real in our lives, even if it does make us feel uncomfortable, even if it does remind us that our families are different when we would rather forget. I know that a lot of you feel the same - and if I had ever doubted that, this week would have shown me how wrong I was.

I'm sorry to report that we have seen less progress on the Blue-Pink dyad. They are starting to enjoy tickling each other, but unfortunately when Pink hits Blue, Blue has now started to hit back. So things aren't static there either - but that's probably a story for another day.


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  2. I need to write something now, NOW, when I'm at work, because I won't do it later, LATER, when I'm at home... working on attachment with my son.

    I really, really, really like this post Claudia. I really enjoy the other perspective (that being life with Blue and Pink rather than solely with Blue... or rather, Leone, as is my case). I really enjoy how you share. I really enjoy your words. I really appreciated the bit about understanding that just because you were working on attachment didn't mean that your family was failing.

    I really, really enjoyed your post- and I am so thankful you started this forum.

  3. This post is so fan-freaking-tastic that I think I need to get it tattooed onto my forehead. Our situation is a little different because instead of twins I have 2,3,4 year olds, but really we have a LOT LOT LOT of the same dynamic going on. Oh, and you're brilliant.

  4. The good news is that you seem to have determined the root of the problem and are hurtling headlong into a solution. Well done, you!

    The same issue you have with Blue and daddy, I had with Little Bit and my father (since there is no daddy around these parts). It is incredibly difficult to compete with a grandparent who brings video games and ice cream every week.

    I don't envy your having to cope with two at once...

  5. So glad things are starting to turn around. It's hard to look at yourself and find out what exactly is failing. We are working hard here too. I get it.

  6. I love this post. I love all your posts. The twin thing definitely poses unique challenges and it is hard to examine our own behaviors. You are doing great, Momma. Thanks for starting this dialogue. I am definitely gong to try to participate if I can find time away from working on all this with my own twins this weekend!!!

  7. You make me want to be a better mother. And you show me some ways that I could. But not right now because I need to finish my post on attachment. Oh, and I need to wash PJ's puke out of my hair. Post first, puke second - that's how I roll.

  8. Wow, wow, wow, wow. That was hard work. Kodos to you for seeing it, realizing it, facing it and dealing with it. That was amazing.

    You rock.

  9. YAY! It must feel sooo good.

    And wow is this stuff soooo similar to dealing with training animals... we had a very similar situation when feeding a pair of birds. Sounds weird I know, but conditioning is conditioning no matter the species eh? So fascinating.

  10. Fantastic post, Claudia! I think you are truly doing a stellar job. LOVE what you said about not being able to address a problem unless you admit it. So good. So true.

    Once again... thanks!!!

  11. I love the triage example (we talk about triage here at work - yes, in financial services :) but your example is much, much better).

    Love your story - you just write so well that I teared up when Blue squeaked for you :)

  12. I love reading what other kinds of attachment mayhem is going on with others- this whole project you've created has been most insightful. It's so isolating to think that we're all living in our own personal attachment miseries- just to prove that, I was shocked to think that you had your own version. I mean, your babies are cute. Your life seems so beautiful. And you're so articulate. So you couldn't have attachment issues going on at your house, right? We really needed to air all of this dirty laundry out. Reading all of the posts about attachment has inspired me to get out all of my adoption books and refresh my memory about all of this.

    That said, (here's where I turn into a little bit of a debbie downer) don't be surprised if you and Blue don't have your attachment problems replayed on and off from here on out. I've found that ours go away for a while, then rear their their ugly heads again when we're least expecting it. In some ways, though, it's a blessing because it means you have to maintain constant vigilance and awareness- that's always a good thing.

    On a philosophical note: it's sort of fascinating to me to think that our kids are so deep emotionally. In your situation, your kids were likely treated with the same care and experienced the same beginning to life. And yet, they're processing it so much differently.

  13. I needed a cup of tea warning at the beginning of this one :) Loved it, but I had to get up in the middle for a warmer uper.

    I love the analogy of triage. These kinds of things help me find a means to an end and it seems like it has helped you too. That's not to say that this is the end, but you already know that. :)

    I think this lends so much support against artificial twinning, especially adopting two at once. I once saw a couple in an airport with two unrelated children adopted from Ethiopia, both around 4 months of age, one boy, one girl. They had never heard the term artificial twins. Nuf said.

  14. This is a great post. Triage is a great way to explain having two same age children. Thanks for starting a great dialogue.

  15. I'm new to your blog, after seeing how many of my favorite bloggers had linked to you related to attachment. I'm so glad to be reading along now! This is a fabulous post, well-written but also so thoughtful and informative. I am still in the "waiting" phase of adoption, but I try to soak up as much as I can and this has given me many wonderful thoughts and ideas to consider. Thank you!

  16. I love everything you write but this maybe most of all. I'm in the midst of dealing with an attachment issue that has arisen after two and a half years of what seemed like happy normal bliss (or was it)? I'm trying so hard not to beat myself up about it, and your words helped. They just helped. Thank you.

  17. I LOVED this post. My two youngest are 9 months apart (one bio, one adopted). I remember when we got home with our youngest (adopted), both of them screaming (for extended periods) and me sitting on the floor (ocassionally crying) and for the first time ever as a mom completely not knowing what to do. Triage is a very good descriptive word. I think God everyday that our attachment came fairly naturally, but it is something not to take for granted because it did at first that it will always be that way. We are in process to adopt an almost 5 y/o (my babies older bio brother) and I KNOW I have a lot of reading and learning to do before he comes home. I am so so thankful for all the writings about attachment this week from my bloggie friends. It's like reading books in bite sized format, for free :) (and yes, I know I should read books too, but they aren't as much fun as blogs)

  18. So, so interesting Claudia. You are so wise. You figured out exactly what he needed and you did it. Amazing.Two at once was hard for us too, but at least one was old enough to do something when I had to hold the baby.Two needy babies would have been much, much harder.

  19. You are all WAY too nice - I can guarantee that anybody who knows me in real life - eg my sister, hello L - will very willingly tell you that on a good day, I'm definitely a very average parent. (And on a bad day... well, I guess I wrote about that last month).

    SFM - yeah, that was totally me. "Time for a nap, babies, mummy has to write about attachment". (In my defence, they did need a nap. Honest).

    Mindy - no, not Debbie downer at all - just totally realistic, I think. I've found it so helpful to read about how many people have been workign on attachment for years and years - reminds me that I need to keep on working.

    cleanundies - I can't help thinking that there are probably a lot of not-twins out there who like each other a lot more than my two do! Julie, I get the impression that your two DO like being in the same room as each other - does that make it any easier to say 'not your turn' to them if you're dealing with the other?

    Kate - DEFINITELY no beating yourself up. Promise?

    And Shonda - yeah, it's like a free book on the interwebs this week! I am so much loving reading what everyone has written - I wish I could go back in time and send it to myself circa 2008. But better late than never, huh?

  20. I am SO going to write my own post about attachment now too. Really. Soon. Love your post! Some of it is so familiar, and yet I know it's totally different too. I don't have twins. Mine was adopted from Russia at 19 months. But I had 2 bio kids in the home already - one was 3.5 at the time of bringing #3 home. The sibling stuff has been BAD. Bad for us all. And it has affected attachment, and attachment has affected it. It's all so tangled and complicated, and tiring. So anyway, thanks for writing this. I will write one soon..

  21. OH, how this post resonated. Not for me, not exactly, but for my best friend. She adopted twins at 15 months of age and oh, how they struggled with attachment issues. It WAS triage for her. Constantly.

    We requested twins during our wait to adopt the Tongginator. Then I got to know Canuck K and learned all about Real Life With Adopted Twin Toddlers. I couldn't do it. I know I couldn't. We requested a singleton this time around.

    But as hard as it was, Canuck K rose to the occasion. And so are you. Thanks for sharing your experiences.

  22. First, thank you for creating this forum. Thank you.

    I can't tell you how touching this post is....sharing your journey and vulnerability. Thank you.

  23. Can I please put you on speed dial? Seriously.
    You rock. I haven't even started reading all the other attachment posts but this one, naturally, I am paying super close attention to...although our babies aren't genetic twins I imagine we'll face similar issues with having two babies at once....
    You are awesome!
    Speed dial.
    Yes indeed.

  24. Thank you SO much for starting this conversation. I have read so many great posts about attachment this week, learned so much, discovered a bunch of new-to-me bloggers who rock...and you gave me just the push I needed to take a good long look at myself and make some changes. Thank you!

    And, this post is awesome, as usual. It never even occured to me how much more complicated attachment would be with twins, though of course it's so obvious - thanks for including the diagram for those of whose brains have turned to mush. Good for you for seeing the problem and doing what needs to be done!

  25. oh twins...I have so much to say to you! So many things we share EXACTLY! and then so many things that are different. But yeah, twins. It's hard. I totally agree w/ the whole "who has to be ignored at this moment" method--it sucks so bad but in the moment you have to pick one to take care of sometimes. We never got any questions about twins either. then again we were told we'd most likely be matched w/ a 10 month old boy so we never bothered to think deeper on twins OR on infants or girls for that matter! (our b/g twins were three months also when we met them). life is getting a little better over here at our house also...I have so much to say to you but I"m just so very tired all the time :-) But I owe you an email...soon. I promise. When the twins start high school probably... xoxo-k

  26. Well, Claudia, this post has been extremely thought-provoking for me, given that we're in the process of adopting siblings (albeit quite a lot older). I've been wondering about this very thing, and you've given me a lot to think about. Thank always, you're brilliant in thought and writing.



  27. I am just catching up to all your great stuff here. You're going to have a lot to teach me because we're waiting on siblings - and that could mean twins - and I'm overwhelmed at the idea of dealing with attachment issues with two kids. Thanks for paving the way and writing so well about it!

  28. Found your blog today and every post I read has opened up a new thought window in my head. Thank you Claudia for this wonderful and very salient post (for me).

  29. You wrote this YEARS ago and I read it years ago, but now I am anonymous and crying because I have boy/girl twins with trauma and this is SPOT ON, this is us, this is EXACTLY OUR LIFE.


Over to you!