Exploring the practice elements of attachment-based interventions : a distillation-and-matching review

Abstract

BACKGROUND : Attachment-based interventions enjoy a growing evidence-base for their effectiveness. These interventions may be decomposed into practice elements and studied for how they may cluster differentially for different children. Exploring this could reshape how attachment-based interventions are applied, potentially enhancing their utility. OBJECTIVES : To apply the Distillation and Matching Model to the empirical literature on attachment-based interventions to identify practice elements common across these interventions and to describe their occurrence for target populations. METHODS : In this systematic review, across 60 studies, 23 practice elements were extracted from 45 intervention protocols that were tested in trials to be effective on attachment, sensitivity, and/or parent–child interaction outcomes. RESULTS : Findings show that practice elements were most differentiated for child age (≤ 6 months; 7 months to 11 years; 12–18 years) although further differentiations were found for location, ethnicity, and risk status. While there is similarity across practice element profiles regarding the use of relationship-building, video-feedback, psychoeducation, and home-based approaches, some distinctions were observed. Interventions for younger infants frequently involved direct demonstration and modelling, while those for older infants and young children consisted of feedback-based approaches. Interventions for vulnerable, at-risk parents consisted of intensive guidance, while those for groups indigenous to North America benefitted from a comprehensive, multifaceted package of practice elements. Interventions for adolescent-aged children were frequently implemented in parent-group format, involving role-plays and discussions between parents, with limited direct involvement of the child. CONCLUSIONS : These distinctions may inform differential clinical applications of attachment-based interventions informed by the needs of specific populations.