This case study explores Parent and Child Therapy (PACT), an attachment-based intervention for mothers and children experiencing intractable relationship distress originally developed by Heather Chambers (a Child Psychotherapist and Family Therapist working in New Zealand). We describe the use of PACT with a mother–child dyad presenting a history of severe abuse and neglect. The child had been diagnosed with Conduct Disorder and co-morbid Attention Deficit Hyperactivity Disorder. We consider the themes arising in the therapy, the emotional process experienced by the mother and child, the initial outcome and 10-month follow up. The case study indicates that PACT can be learned and used by practitioners outside of the team that conceptualised and developed it. The case highlights the links between externalising difficulties and attachment disorganisation and points to PACT as a promising treatment for the chronic sequelae of early interpersonal childhood trauma. The need for research and possible directions of this research are discussed.

Liz Mackenzie's involvement with family therapy began in 1978 at the Psychiatry Department of the Adelaide Children's Hospital. She contrasts the field then and now, naming some of the dysfunctional facets of family therapy. She became manager of a specialist foster/residential program in the non-government sector, definitely the most difficult, extending and satisfying period in her working life. In 2007, she is back where it began for her, in the (renamed) Women's and Children's Hospital, working in a Child and Adolescent Community Health team

This article addresses the clinical issue of selecting assessments of attachment that are relevant to decision making for families. The validity of three commonly used methods of assessing attachment in preschool-aged children was compared using a sample of 51 low-income mother–child dyads. Thirty-eight of the children had been abused or neglected. The dyads were seen in a Strange Situation that was classified using each of the three methods: (a) the Ainsworth-extended method, (b) the Cassidy-Marvin (C-M) method, and (c) the Preschool Assessment of Attachment (PAA). Validity was evaluated in terms of maltreatment status, maternal sensitivity, child DQ, and maternal attachment strategy. The PAA and C-M classifications matched in only 37% of cases. The Ainsworth-extended method differentiated secure versus insecure children on two variables. The C-M method differentiated secure versus insecure children on one variable. The PAA differentiated secure versus insecure children on all four variables and subgroups on one. Moreover, it was tied to other family relationship variables in meaningful ways. If applied in clinical settings, these three methods would result in very different groups of children being seen as safe and at risk. We argue that clinicians cannot afford to be uninformed about the validity of alternative means of assessing attachment.

Children organise self-protectively in response to anxiety-provoking or dangerous parental behaviours. When children's self-protective responses are extreme and persist over time, they may come to the attention of health professionals in the guise of emotional, behavioural or somatic symptoms. A parallel phenomenon is that harmful parental behaviours may be embedded in the emotional processes of the intergenerational family unit, reflecting the parents' own experiences of comfort and danger, as well as the particular manner in which these experiences have been integrated into the parents' current functioning. Using a case study of a three-year-old girl with medically unexplained urinary retention, the article explores how information about attachment relationships and unresolved parental loss or trauma can inform our understanding of implicit, anxiety-driven processes within the family, and to facilitate family interventions and symptom alleviation. The case shows that the Dynamic-Maturational Model of attachment has significant applications in the areas of family therapy theory and practice, psychosomatic medicine and consult-liaison psychiatry.

Serious and life-threatening illnesses in the infant population present complex theoretical and practical challenges for both the family unit and hospital staff. These challenges operate at a minimum of three levels, namely the infant's internal system, the parent–infant relationship and the acute medical context. This article describes infant-directed singing as an intervention in restoring an attachment bond disrupted by serious illness. In particular, the following will be considered: the need for family focused interventions within the acute medical setting, the usefulness of attachment theory in the acute care context; a technical description of infant-directed singing and a cybernetic conceptualisation of the relevant staff–mother–infant interactions.

The extent to which students feel accepted, valued, respected and included in the school has recently surfaced as one of the most important predictors of adolescent mental health (particularly depressive symptoms). The school environment is an established predictor of school connectedness, but we set out to examine whether parental attachment predicts both adolescents' perception of the school environment and school connectedness. A study of 171 high school students from years 8 to 12 showed that parent attachment strongly predicted both. We also confirmed that the relationship between parent attachment and school connectedness is not a direct one but that parent attachment influences individual differences in the way adolescents perceive the school environment, which in turn influences school connectedness. This finding shows how multiple systems might be interlinked in influencing wellbeing in adolescents, and confirms the importance of intervening at the double level of both the family and the school system.