Therapeutic caregiving – why conventional is vital

We know that . . .

We do that . . .

These are all-too-familiar responses to endeavours to promote conventional aspects of caregiving and relating as part of a therapeutic approach to the care of children who are experiencing, or who have experienced, adverse life events and adversity.


So why recommend conventional approaches to caregiving and relating as part of a therapeutic approach to care?

In my opinion, recommending conventional approaches to caregiving and relating represents our best chance of promoting a common language and understanding among adults in a care and management role across environments (eg home and school) and consistency in their implementation across time.

Consistency is vital to the care of children recovering from adverse life events and adversity*. Consistency of care experiences represents the optimal condition for new learning; including learning that they are good, capable and deserving, that adults are reliable and dependable, and that the world is predictable and safe place. Inconsistency mimics the circumstances under which adverse life events and adversity occurs, thus perpetuating their negative impacts on the developing child.

Recommending conventional approaches to caregiving and relating that are therapeutic reassures caregivers that they are a person of worth and that their efforts on behalf of the child are worthwhile. Not only is it intended to be validating, but a process is facilitated whereby the caregiver becomes more aware of those occasions when they exhibit the therapeutic caregiving or relational behaviour and, in turn the response of the child. Therapeutic caregiving and relational behaviours are anticipated to promote a positive response in the child, which is rewarding and reinforcing of the behaviour. Rewarded behaviour remains in the caregivers repertoire, thus promoting consistency in the child’s experience of care, and facilitating conscious adherence to a therapeutic care approach.

Recommending conventional approaches to caregiving and relating that are therapeutic for children promotes feelings of self-efficacy and wellbeing for caregivers, which are vital to the longevity of their endeavours. As these therapeutic aspects of caregiving and relating are rewarded both intrinsically (the caregivers experience) and extrinsically (the child’s reaction), they become consistent and predictable aspects of the child’s experience of care.

Recommending conventional approaches to caregiving and relating that are therapeutic for children enriches their lives, and those of their caregivers.


*Pearce, C. (2016), A Short Introduction to Attachment and Attachment Disorder (Second Edition), London & New York: Jessica Kingsley Publishers

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Parental CARE: Implications for Attachment Security and Disorders

Parental CARE: Implications for Attachment Security and Disorders

A webinar with Colby Pearce

Saturday 20 May 2017, 10.00am – 1.00pm, London, UK time

 In the same way that an infant’s attachments develop in association with their experience of who cares for them, the type of attachment relationship or attachment style is dependent on the type of care they receive.  At this practical and engaging webinar, we carefully examine the inextricable linkages between quality of caregiving and developmental pathways for both attachment security and attachment disorders. Colby Pearce helps us conceptualize these linkages by using a descriptive model that refers to the consistency, accessibility, responsiveness and emotional connectedness (CARE) of caregiving experiences and explains how each of these aspects impact not just developmental pathways, self-conceptualization, social relatedness and adversity resilience; but also aid our understanding of the two main forms of attachment disorders according to DSM-5: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).

Through case vignettes and interactive discussions, the webinar helps us comprehend:

  • how deficits in the CARE model can explain the development of attachment disorders
  • why we observe compulsive re-enactment of maladaptive interactions when care arrangements change
  • in therapeutic settings, how we can interpret the exhibition of controlling, manipulative and / or deceptive and deceitful behaviours
  • the situations where caregivers can experience feelings of revulsion and loathing towards the attachment-disordered careseeker
  • when grossly deficient CARE may be the best explanation for disturbed presentations (RAD and DSED)
  • how the tenets of CARE can be built into our therapeutic engagements

The webinar will be especially useful for psychotherapists, psychologists and counsellors who are interested in learning how to integrate specific attachment-related interventions in their work with clients.

Colby Pearce is an Australian Clinical Psychologist, author and consultant. Across a career spanning more than twenty-five years he has made important contributions to professional endeavours in the fields of child and adolescent mental health research, child protection and therapeutic child care. He is the author of two books and a number of periodical articles, though he considers that the recently-released second edition of A Short Introduction to Attachment and Attachment Disorder (Jessica Kingsley Publishers) should count as a third book; such is the extent to which the first edition has been revised and updated. He consults in Australia and in Ireland and has extensive experience in teaching and training professional audiences. He is the author of the Triple-A Model of Therapeutic Care, which is currently being implemented in Donegal, Ireland, as part of a three-year programme of support for foster carers.

 Webinar Schedule:

9.45am: Online Registration

10.00am: Session 1: Parental CARE, Attachment Security and Attachment Disorders

  • The basic tenets of the CARE model
    • Developmental pathway implications
  • What do Attachment Disorders look like?
    • CARE and Attachment
    • CARE and Arousal
    • CARE and Learning

 11:30am: Break

 11:45am: Session 2: Enriched CARE for better outcomes

  • Maladjustment and the role of promoting Attachment Security
  • Holding appropriate developmental expectations
  • Proactive needs provision
  • The prerequisites for Attachment Oriented Therapy
  • Illustrative case examples and discussion

 1:00pm: Close

To register, visit:

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CARERS must CARE – Lessons on attachment from Colby Pearce

Lynne PeytonIt was such a privilege to be asked recently to write a review for Colby Pearce’s second edition of a ‘Short Introduction to Attachment and Attachment Disorder’.

Colby Pearce is one of the leading experts in attachment and as a clinical psychologist, he has interacted with hundreds of children over his long career. His writing is informed by his considerable experience and he has a huge amount of empathy with children who have experienced early childhood trauma.

I want to summarise just a few of the core insights on attachment from this latest guide.

  • Attachment is the term used to describe the dependency relationship children develop towards their primary caregivers.
  • An attachment figure is someone who provides physical and emotional care, has continuity and consistency in the child’s life, and is emotionally invested in the child.
  • Human infants are not born with attachments already in place with their primary caregivers. This special relationship emerges over time.
  • Attachment theory was developed by John Bowlby and colleagues to describe the relational variables in the development of the mother infant relationship and the importance of the relationship itself on the successful adaptation of the young child to life more generally.
  • Children can form multiple attachment relationships.
  • Infants form attachment to the person or persons who they experience to care for them physically and emotionally on a continuous period.
  • Pearce Identified that carers must be experienced by the child as Consistent, Accessible Responsive and Emotionally connected. Hence his C.A.R.E. model:

              C – Consistent -consistent care is where an action is consistently followed by a                           desired outcome.

              A – Accessible care means the parent is present and available physically and                               emotionally to the growing child.

              R – Responsive carers accurately interpret the child’s signals and directly address                     their needs

              E – Emotionally connected carers “tune in” to the infant and reflect a similar                               emotion back.

(Tronick’s ‘still face’ experiments vividly demonstrate the distress experienced by youngsters when a previously playful parent adopts a ‘dead pan’ expression and stops engaging with the child)

  • Early attachment experiences contribute to a child’s sense of self and self-worth. It also forms the basis for future relationships as, if children experience parents to be consistent, accessible, responsive and emotionally connected, they will develop emotional resilience in their engagement with the rest of their world.

Having established the basis for healthy attachment, Pearce goes on to consider how attachment  can be disrupted through early childhood experiences of abuse, neglect and other trauma. He offers effective forms of treatment for attachment disorders.

This is an essential read for Social Workers, teachers, foster carers and residential care staff. It is available from Jessica Kingsley Publishers:

Lynne Peyton

Tackling Childhood Neglect(Lynne is a childcare expert, leadership coach and consultant to social welfare organisations. Lynne consults internationally. and is the author of Tackling Childhood Neglect:

Originally published here

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Foster Carers report Model of Care Interesting and Helpful

AAA-Model-of-Therapeutic-CareThe Health Information and Quality Authority (HIQA) is an independent authority established to drive high-quality and safe care for people using health and social care services in Ireland. HIQA monitors foster care services against the National Standards for Foster Care, published by the Department of Health and Children in 2003.

In September and October 2016 HIQA conducted an assessment of foster care services in Donegal, Ireland. This is what HIQA said about the implementation of the Triple-A Model of Therapeutic Care to foster carers in Donegal:

The area had also recently piloted training in a particular therapeutic model of care with 22 of their foster carers. This model focused on helping foster carers create a care environment where they were emotionally available to children in care in order to help them create healthy attachments based on trust. Foster carers who had completed the course told inspectors they found it interesting and helpful in their role as foster carers. Social workers received training in the model of care during the course of the inspection and there were plans to extend this training to all foster carers.

For the full report follow this link:


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Further information about Colby

Source: Further information about Colby

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Therapeutic Childcare – The CARE Approach

Colby Pearce Attachment National Psychology Exam

Earlier this year I set about revising and updating A Short Introduction to Attachment and Attachment Disorder. The second edition is available from December 2016. As part of the revision process I considered what we might mean when talking about therapeutic care of children. This is the CARE Model I came up with:

Be Consistent – Children develop and learn (including new ways of relating) best in a stable care environment where there is consistency in caregiver approach to the child’s care and management across caregivers and across time.

Be Accessible – Children benefit from an enriched experience that their carers are available to them. They learn this best when carers attend to them before the child has done anything to draw attention to themselves.

Be Responsive – Children benefit from an enriched experience that their inner world is understood and their needs will be responded to without them having to go to great lengths to make it so; either through behaviour that communicates internal states or inordinately demanding or deceptive behaviour to secure a response to basic needs (such as the need for attention, acceptance and physical sustenance). Communicating understanding of their inner world in words used by their caregiver and through proactive needs provision is vital for enriching the child’s experience and new learning about caregiver responsiveness.

Be Emotionally-Connected – Children benefit from the experience that their emotions are felt by their caregivers. Their experience of connection is enhanced and the foundations for empathy and self-regulation are promoted. Through their caregivers making an emotional connection with the child’s emotions and restoring calm themselves, the child will themselves be calmed, with the result that the child will to explore a range of emotions (thereby promoting emotional growth) and develop their own capacity for self-regulation of emotion.

13754277_10207024040505557_6258179799568697908_nFor more information about the CARE model and the CARE approach, secure the revised and updated second edition of A Short Introduction to Attachment and Attachment Disorder, available December 2016.

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Therapeutic CARE and the Triple-A method

As a practising Clinical Psychologist and as a father to three boys I often think of child-rearing as akin to being a farmer who grows crops.

The farmer expends significant effort preparing the soil and sowing seeds. Then the farmer waits and hopes. The success of his endeavours is dependent on his preparation of the soil and climatic conditions through the growing period. Until his crop is reaped, the farmer is never completely certain of the outcome of his endeavours.




Similarly, in order to grow up happy, healthy, well-developed and well-adjusted, children require a range of experiences and responses to their needs that, in combination, constitutes child-rearing. The colours on the picture opposite represent important experiences and responses to needs that constitute good CARE.




Black Page




The results of our endeavours in child-rearing are not always obvious, and there may be dark times where we doubt the effectiveness of our endeavours on behalf of our children.






Whole Child




However, little-by-little, where there is good CARE, the whole child will shine through.








Neglectful CARE




Unfortunately, not every child is offered the important experiences and responses to needs that constitute good quality CARE with a consistency that promotes their development, wellbeing and adjustment.





Neglected Child


Where CARE is neglected, the whole child in all of their potential cannot shine through.

In order to be whole, these children require adults in a caregiving role to enrich their experience of CARE and fill in the gaps.

This is the primary task (Kahn, 2005) of therapeutic care; getting back-to-basics and offering enriched experiences of CARE that promotes the child’s development, wellbeing and adjustment.







In the forthcoming revised and updated Second Edition of A Short Introduction to Attachment and Attachment Disorder (available December 2016) I describe in detail what is good quality CARE, how it benefits outcomes for the developing child, and how to enrich CARE to promote attachment security and associated positive developmental, behavioural and mental health outcomes for children.






AAA-Model-of-Therapeutic-CareIn the Triple-A Model of Therapeutic Care I provide a therapeutic CARE framework and a step-by-step approach to the implementation of a therapeutic care approach to children recovering from abuse, neglect and insecurity.


To register your interest in purchasing the revised and updated Second Edition of A Short Introduction to Attachment and Attachment Disorder, please email me at

For more information about the Triple-A Model of Therapeutic Care, currently implemented as a therapeutic care approach among TUSLA foster carers in Donegal Ireland, please click here.

To cite this article, please use the following:

Pearce, C (2016). Therapeutic Care and the Triple-A Method. Attachment and Resilience:


Kahn, W. A. (2005) Holding Fast: The Struggle to Create Resilient                         Caregiving Organisations, Hove and New York: Brunner-Routledge.

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Strengths-based therapeutic foster care

Triple-A is an approach to the therapeutic care of children that emphasises human connection. It is relational, practical and rooted in conventional caregiving practices. As such, it is an enrichment programme, as opposed to a wholesale alternative to conventional caregiving and relating. It is also strengths-based. A core premise is that people already do and know about the importance of the approaches recommended; albeit on an implicit (that is, semi-conscious) level. In Triple-A, we make therapeutic aspects of caregiving and relating conscious and organise them so that they are implemented mindfully and predictably with children.

Triple-A is not just a set of strategies. It incorporates a way of thinking about, caring about and relating with children. It also incorporates self-care strategies to support the caregivers.

Triple-A is represents a fusion of Attachment Theory, Neurobiology and Learning Theory. It’s broad applicability is represented in the author’s published works concerning attachment and trauma and the promotion of resilience in all children.

There is a five-module training package – spanning 2.5 days of training. Triple-A is available as a group training and implementation programme.

For more information visit here:

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Media Release: South Australian Program Embraced by Foster Carers in Ireland

Triple-A Day OneAn Australian-developed program for foster carers is receiving unreserved support in Donegal, Ireland.

Known as the Triple-A Model of Therapeutic Care, the program is currently being delivered by Secure Attachment Matters Ireland with support from TUSLA, the Irish Government Child and Family Agency.

In week 4 of a five-week implementation program, 100% of foster carers have indicated that they would recommend the program to others week by week; with many suggesting it should be compulsory training for all new foster carers entering the role.

Others have suggested that this is training all (foster) parents should receive.

The Triple-A Model of Therapeutic Care is authored by South Australian Clinical Psychologist, Colby Pearce. The three “A’s” in “Triple-A” stand for Attachment, Arousal, and Accessibility (to needs provision).  The program is based in the sciences of human relationships, brain development and learning.

There is a focus on achieving strong, enduring and therapeutic connections between deeply hurt and troubled children and those who care for them. The methods are practical, user-friendly and achievable.

There is also a focus on the wellbeing of those who care for these children. Being a foster parent can be a difficult and thankless role and foster carers can experience their own trauma upon being exposed to what has occurred to the children in their care.  Foster parents are vital to all our efforts to help children recover from abuse and neglect and lead happy, healthy productive lives. Any therapeutic caregiving program needs to focus on foster carer wellbeing as well.

For more information about Triple-A contact the author, Colby Pearce, at



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Foster Carer Wellbeing

Caring for children who are recovering from abuse and neglect is often a difficult and thankless vocation.

Children are inconsistently appreciative of your efforts on their behalf; if at all.

The professionals whose task it is to support you do not live in your house, in your shoes, and do not always seem to understand the challenges you face.

Just as the role of foster parent can be rewarding and fulfilling in those times and in those moments when the child in your care shows glimpses of joy in living and relating to others, the role of foster parent is also:

  • Exhausting
  • Overwhelming
  • Frustrating
  • Anxiety evoking.

The diagram below illustrates why this is a problem.

arousal and wellbeing

Arousal refers to the level of activation of our nervous system.

For later reference, it refers to how fast our internal ‘motor’ is running.

Arousal reflects our physical, emotional and psychological (mind) state.

arousal and wellbeing expanded

Arousal is like the temperature of your body. Too high or too low, there is a problem.

You cannot perform at your best as a carer  when you are feeling:

  • Exhausted;
  • Overwhelmed;
  • Frustrated; or
  • Anxiety.

As far as possible, you need to maintain a consistent state of wellbeing to perform at your best, just as you take active steps to stave off fever or hyperthermia. It is that important!

Over the four-week implementation programme for the Triple-A Model of Therapeutic Care, we recommend one evidence-based wellbeing task per week that is just for you and your own wellbeing. The tasks incorporate the promotion of realistic and helpful ideas about the contribution you are making to the recovery of a child who has experienced abuse and neglect. They also incorporate the promotion of behaviours association with wellbeing; just as Triple-A incorporates a mindset and behaviours for the promotion of recovery from abuse and neglect for the child in your care.

The Triple-A Model of Therapeutic Care is currently being implemented with TUSLA foster carers in Donegal, Ireland. For more information about Triple-A email me at

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