Fourie, E. (2014). Training needs of caregivers in institutions regarding the care of children with...

Training needs of caregivers in institutions regarding

the care of children with attachment disorders

by

Elsa-Marié Fourie

201284316

Submitted in partial fulfilment of the requirements for the degree

Magister Artium Socialis Scientiae

(Clinical Social Work)

in the

Department of Social Work

of the

Faculty of Humanities

at the

University of Johannesburg

supervised by

Prof Adrian D. van Breda

13 November 2014

ii

Affidavit

This serves to confirm that I, Elsa-Marié Fourie, ID Number 670613 0016 088, Student number

201284316, enrolled for the Qualification Masters in Clinical Social Work in the Faculty of

Humanities herewith declare that my academic work is in line with the Plagiarism Policy of the

University of Johannesburg, with which I am familiar.

I further declare that the work presented in this minor dissertation is authentic and original unless

clearly indicated otherwise, and in such instances full reference to the source is provided. I do not

presume to receive any credit for such acknowledged quotations, and there is no copyright

infringement in my work. I declare that no unethical research practices were used or material gained

through dishonesty. I understand that plagiarism is a serious offence, and that should I contravene

the Plagiarism Policy, notwithstanding signing this affidavit, I may be found guilty of a serious

criminal offence (perjury). This would among other consequences compel the UJ to inform all other

tertiary institutions of the offence and to issue a corresponding certificate of reprehensible academic

conduct to whoever requests such a certificate from the institution.

Signed at _____________________on this ___________day of _______________ 2014.

Signature______________________________

Print name_____________________________

STAMP COMMISSIONER OF OATHS

Affidavit certified by a Commissioner of Oaths

This affidavit conforms with the requirements of the JUSTICES OF THE PEACE AND COMMISSIONERS OF OATHS ACT 16 OF 1963 and the applicable Regulations published in the GG GNR 1258 of 21 July 1972; GN 903 of 10 July 1998; GN 109 of 2 February 2001 as amended.

iii

Acknowledgements

I would like to thank God for granting me this opportunity to further my studies and for His all-

encompassing Grace experienced during this time.

For my parents who have always encouraged me to persevere through their own example.

To my supervisor, Prof Adrian van Breda: thank you for your patience, professionalism, and

sharing of your amazing knowledge. Without your guidance, I would not have been able to finish.

To the University of Johannesburg: thank you for granting me the opportunity to further my studies.

For my colleagues: thank you for your support, friendship and love during this time. You have

made this a period of enjoyment, enrichment and partnership.

To the Child and Youth Care Centres: thank you for your willingness to assist and participate in this

study.

To the participants: without you this study would not have been possible. Thank you for your time

and honesty.

To my family and friends: you have supported and encouraged me during times of difficulty and

uncertainty. I have found favour in your eyes.

iv

Abstract

This qualitative study focuses on the exploration and description of the training needs of caregivers

who work in Child and Youth Care Centres (CYCCs) with children with attachment disorders.

Information was gathered through focus groups and key informants. The sample of participants in

the focus groups consisted of caregivers who had at least two years working experience in the

current CYCC and who had six or more months experience in working with children with an

attachment disorder. The key informants were two social workers who had experience of working

with children with an attachment disorder as well as experience of working in CYCCs.

Findings indicated that caregivers experience six major interpersonal challenges in working with the

child with an attachment disorder as well as seven major organisational challenges. The

organisational challenges were initially not part of the objective of the study but were incorporated

because the caregivers highlighted it as a challenge experienced by them. Interpersonal challenges

experienced by the caregivers include the behaviour of these children, while the organisational

challenges include a lack of time as well as a lack of debriefing opportunities for the caregivers. The

caregivers have learned certain lessons from looking after these children. One such example is that

their non-verbal behaviour plays an important role in how they approach these children. They need

to, for example, keep their hands in their pockets while they approach these children and not to

wave their hands all over the place. Training which the caregivers found assisted them the best in

working with children with an attachment disorder was training which was relevant to their work

situation as well as practical.

Based on the objectives of the study and its findings, recommendations are made which include:

caregivers to receive training on what the terms attachment and attachment disorder entail. It was

evident that caregivers need support from their organisation as well as the necessary training to

equip them with skills to work with the child with an attachment disorder.

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Table of Contents

Affidavit..................................................................................................................................................................... ii

Acknowledgements ................................................................................................................................................... iii

Abstract ..................................................................................................................................................................... iv

Table of Contents ....................................................................................................................................................... v

CHAPTER ONE: INTRODUCTION .......................................................................................... 1

1.1 Background and rationale ............................................................................................................................... 1

1.2 Problem statement ........................................................................................................................................... 4

1.3 Goal and objectives of the study ...................................................................................................................... 6

1.4 Overview of research methodology ................................................................................................................. 6 1.4.1 Research design ................................................................................................................................... 6 1.4.2 Population and sample ......................................................................................................................... 7 1.4.3 Data collection ..................................................................................................................................... 7 1.4.4 Data analysis ....................................................................................................................................... 8 1.4.5 Rigour and trustworthiness ................................................................................................................... 9 1.4.6 Ethical considerations .......................................................................................................................... 9

1.5 Definitions of key concepts ............................................................................................................................ 10

1.6 Outline of the chapters .................................................................................................................................. 11

1.7 Conclusion ..................................................................................................................................................... 12

CHAPTER 2: LITERATURE REVIEW ................................................................................... 13

2.1 Introduction ................................................................................................................................................... 13

2.2 Attachment .................................................................................................................................................... 13

2.3 Intergenerational transfer of attachment patterns ....................................................................................... 17

2.4 Internal working models ............................................................................................................................... 18

2.5 The influences of separation from a primary caregiver on the attachment style formed by a child ............ 18

2.6 Secure and insecure attachment .................................................................................................................... 20 2.6.1 Secure attachment .............................................................................................................................. 21 2.6.2 Insecure attachment ........................................................................................................................... 22 2.6.2.1 Insecure-avoidant attachment ............................................................................................................ 22 2.6.2.2 Insecure-ambivalent or anxious attachment ........................................................................................ 23 2.6.2.3 Insecure-disorganised attachment ...................................................................................................... 24

2.7 The relationship between caregivers and children with attachment disorders ............................................ 25

2.8 Behaviour of children with attachment disorders......................................................................................... 27 2.8.1 Oppositional behaviour ...................................................................................................................... 27 2.8.2 Oppositional Defiant Disorder (ODD) ................................................................................................ 27 2.8.3 Reactive Attachment Disorder (RAD) ................................................................................................ 28

2.9 Children with attachment disorders in residential care ............................................................................... 28

2.10 Training needs of caregivers working with children with attachment disorders ......................................... 29

2.11 Conclusion ..................................................................................................................................................... 31

CHAPTER 3: RESEARCH METHODOLOGY ....................................................................... 32

3.1 Introduction ................................................................................................................................................... 32

3.2 Research goal and objectives ......................................................................................................................... 32

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3.3 Research design ............................................................................................................................................. 32

3.4 Population and sampling strategy ................................................................................................................. 35 3.4.1 Population ......................................................................................................................................... 35 3.4.2 Sampling strategy .............................................................................................................................. 35

3.5 Data collection methods and tools ................................................................................................................. 37 3.5.1 Pilot study focus group ...................................................................................................................... 38 3.5.2 Participant preparation for focus groups and data collection ................................................................ 38 3.5.3 Data collection tool: The ‘questioning route’ ...................................................................................... 40 3.5.4 Focus groups with child-and youth-care workers ................................................................................ 41 3.5.5 Finishing of the sessions .................................................................................................................... 44 3.5.6 Recording and transcribing ................................................................................................................ 45 3.5.7 Follow-up sessions with the caregivers ............................................................................................... 46 3.5.8 Interviews with key informants .......................................................................................................... 46

3.6 Data analysis .................................................................................................................................................. 47

3.7 Trustworthiness ............................................................................................................................................. 49 3.7.1 Dependability .................................................................................................................................... 49 3.7.2 Confirmability ................................................................................................................................... 50 3.7.3 Credibility ......................................................................................................................................... 52 3.7.4 Transferability ................................................................................................................................... 53

3.8 Ethical considerations ................................................................................................................................... 53

3.9 Limitations of the research methodology ...................................................................................................... 55

3.10 Problems experienced .................................................................................................................................... 55

3.11 Conclusion ..................................................................................................................................................... 56

CHAPTER 4: RESULTS ............................................................................................................ 57

4.1 Introduction ................................................................................................................................................... 57

4.2 Introduction to the participants .................................................................................................................... 57

4.3 Themes ........................................................................................................................................................... 58

4.4 Theme one: Interpersonal challenges experienced by the caregivers in caring for a child with an

attachment disorder ...................................................................................................................................... 59 4.4.1 A child with an attachment disorder ................................................................................................... 59 4.4.2 Behaviour of a child with an attachment disorder................................................................................ 64 4.4.3 Relationship with a child with an attachment disorder ......................................................................... 68 4.4.4 Feelings experienced by caregivers who work with children with attachment disorders ....................... 69 4.4.5 The caregivers’ family ....................................................................................................................... 75 4.4.6 What does the future of a child with an attachment disorder look like? ................................................ 76

4.5 Theme two: Organisational challenges experienced by caregivers in caring for a child with an attachment

disorder .......................................................................................................................................................... 78 4.5.1 The number of children per caregiver ................................................................................................. 78 4.5.2 Communication within the institution ................................................................................................. 79 4.5.3 Lack of time ...................................................................................................................................... 81 4.5.4 Social workers within the CYCC ........................................................................................................ 82 4.5.5 Debriefing ......................................................................................................................................... 84 4.5.6 Management style .............................................................................................................................. 86 4.5.7 Discipline .......................................................................................................................................... 87

4.6 Theme three: Lessons learned by caregivers in caring for a child with an attachment disorder ................ 88 4.6.1 Coping with the behaviour of a child with an attachment disorder ....................................................... 90 4.6.2 Forming a relationship with a child with an attachment disorder ......................................................... 92 4.6.3 Disciplining a child with an attachment disorder ................................................................................. 95

4.7 Theme four: Training needs of caregivers .................................................................................................... 97

4.8 Conclusion ..................................................................................................................................................... 99

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CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS ............................................ 101

5.1 Introduction ................................................................................................................................................. 101

5.2 Aim and objectives of the study................................................................................................................... 101

5.3 Research methodology applied in the study ................................................................................................ 101

5.4 Summary of major findings ........................................................................................................................ 102 5.4.1 Major interpersonal and organisational challenges experienced by caregivers in caring for children with

attachment disorders ........................................................................................................................ 102 5.4.2 The strategies/lessons that the caregivers have learned to help them work with children with attachment

disorders .......................................................................................................................................... 104 5.4.3 The caregivers’ training requirements regarding their care of children with attachment disorders....... 104

5.5 Recommendations for social workers regarding the skills development requirements of caregivers caring

for children with attachment disorders ....................................................................................................... 105 5.5.1 Attachment ...................................................................................................................................... 105 5.5.2 Behaviour and disciplining of these children..................................................................................... 107 5.5.3 Relationship..................................................................................................................................... 107 5.5.4 Feelings experienced by caregivers .................................................................................................. 108 5.5.5 Communication ............................................................................................................................... 109 5.6.6 Social workers ................................................................................................................................. 110 5.6.7 Characteristics caregivers should have when working with a child with an attachment disorder ......... 110

5.7 Conclusion ................................................................................................................................................... 111

References .............................................................................................................................................................. 113

Appendixes ............................................................................................................................................................. 120 Appendix A: Information letter .................................................................................................................. 121 Appendix B: Participant information sheet and consent form ...................................................................... 123 Appendix C: Questioning route .................................................................................................................. 125 Appendix D: Information on attachment ..................................................................................................... 128 Appendix E: Flip chart for constructing themes .......................................................................................... 131 Appendix F: Extract of a transcription from a focus group.......................................................................... 134 Appendix G: Extract of colour coding of the above transcription................................................................. 137 Appendix H: Extract of the field notes from the session which did not record.............................................. 139 Appendix I: Extract of the field notes made prior to commencement of the focus groups ........................... 140 Appendix J: Extract from the journal which was kept ................................................................................ 141 Appendix K: Notes made of recordings of the focus group which were listened to and which was not

transcribed. ........................................................................................................................... 142 Appendix L: Extract from feedback received from key informants ............................................................. 143 Appendix M: Notes make during feedback sessions .................................................................................... 146

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Chapter One: Introduction

1.1 Background and rationale

This study explores the training needs of caregivers of children in residential care who have

attachment disorders. Social workers supervise the care work of caregivers, thus the capacity of

caregivers to care for children with attachment disorders is a key part of social work practice in

residential settings. Social workers need to determine if caregivers have the ability to identify these

disorders and if they would be able to act accordingly (Nell, 2008). Wikipedia (2007) defines a

caregiver as a person who sees to the needs of a child: this person can be a parent of a child, a foster

parent, or someone who takes responsibility for the child. This study focuses on alternative

caregivers (specifically the childcare workers in children’s homes) and not on primary caregivers

(e.g., a child’s parents).

Caregivers in Child and Youth Care Centres (CYCCs) are required to take care of children who

have been removed from their current caregivers. Most of these children have been exposed to

traumatic events or crises, which has resulted in them being placed in CYCCs. Brown (as cited in

Florio, 2010) stated that the mental health field acknowledges that caregiving is one of the most

stressful undertakings in a person’s life. The reality of what caregiving entails appears to not always

be what caregivers imagine it to be, and this often contributes to the caregivers’ levels of stress

(Florio, 2010). The Framework for Social Welfare Services (2013) was developed to improve the

integration of the social welfare services that should be rendered by those in social services.

Proposals were made concerning the workload ratios for the different professions including

caregivers.

The first scenario allowed for 80% time for the caregivers to provide care which entails 32 hours

per month for linking with families and 26 cases per month. Scenario three allowed 70% of the time

of the caregivers to be providing care, 20% for the compiling of care plans and 22 cases per month.

Working with children with attachment disorders also appears to contribute further to the

caregivers’ stress levels, since they are faced with various challenges in this regard. These

challenges are not only of an interpersonal nature, but also of an organisational nature. The work

situation of caregivers who were approached for this study appears to differ from what is proposed.

For example, they have between 10-12 children they are responsible to render services to on a long

term basis. This number already proves to be a challenge for the caregivers and due consideration

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should be given to lowering this number. Scenario three includes 20% of their time for the

development of care plans. This will address the need the caregivers expressed to be trained on the

development of an IDP for each child. How realistic the time allocation is of 70% for the rendering

of services will remain to be seen; the participants indicated that the lack of time to spend with each

child is a challenge.

One of the interpersonal challenges caregivers experience in working with a child with an

attachment disorder is the forming of a relationship with these children. Forming a relationship with

a child with an attachment disorder might pose a challenge because these children did not learn, at

an early age, how to form an attachment with their primary caregivers. These children do not know

what a relationship with a caregiver, with whom they can feel safe, entails. Bowlby (as cited in

Kobak & Madsen, 2008) indicated that a person’s level of feeling safe and secure is the result of the

attachment that a person had with an available and responsive caregiver. According to Ainsworth

(as cited in Holmes, 1993), children will cling to their primary caregiver, in order to be protected

from danger when threats are experienced. If a child does not have an attachment figure he or she

can turn to, it can negatively impact the ability of the child to form an attachment with the

caregiver, as well as his or her ability to form relationships later in life. Freud (as cited in Bowlby,

1979) argues similarly that there is a link between our earlier years and the adult we become. Freud

maintains that the foundation of our emotions lies in our early infant and childhood years, and his

investigations point towards a link between what has happened in a person’s earlier years and the

personality formed at a later stage (Bowlby, 1979).

In light of the above argument, it appears that a caregiver would therefore need to understand the

impact a child’s history has had on the child’s functioning, in order to understand his or her role in

the child’s life. Ziv (2005) argues that a caregiver should provide a child with attachment disorder

with the assurance that he or she will be protected from harm, will not be abandoned, and will

always be loved. If the caregiver does not provide this assurance, it could increase the anxiety levels

of the child. What could, for example, contribute to the increase of a child’s feelings of

abandonment or anxiety levels, is the fact that caregivers in CYCCs are given time off (e.g., a

week). If the caregiver leaves for a week or more at a time, children with attachment disorders

might then feel that a caregiver is once again abandoning them, or that the caregiver does not

actually love them. The caregivers might also leave the CYCC altogether (e.g., resign) and be

replaced by another caregiver: this could have the same negative impact on the child.

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Children might have formed insecure attachments if they were abandoned, abused, or if they had

multiple caregivers. Howes and Hamilton (as cited in Howes & Spieker, 2008) state that children

might be less secure if their previous care situations varied often and if they did not learn to trust

their caregivers. Because of this, Howes and Ritchie (as cited in Howes & Spieker, 2008) feel that

the child who has a history of insecure attachments, who feels that adults cannot be trusted, or who

sees adult caregivers as unavailable, will not easily respond to the sensitivity of the average

caregiver. Ainsworth and her colleagues (as cited in Holmes, 1993) found that children whose

mothers responded to their needs formed secure attachments, while the children whose mothers did

not respond to their needs were, in contrast, likely to form insecure attachments.

Attachment can be described, according to Hughes (2009), as the child’s relationship with his or her

primary caregiver (e.g., a parent). It does not, however, refer to the parent’s relationship with the

child because the parent does not form an ‘attachment’ with their child; parents form, instead, a

‘loving relationship’ with their child. The child also turns to the parent for security, and not the

other way around. Van den Boom (as cited in Ziv, 2005) found that a brief mother-infant interaction

intervention had a significant influence on the attachment security of the infants three months after

the interaction, confirming the link between the sensitivity of a caregiver and the attachment

security of an infant.

Ahnert, Pinquart and Lamb (as cited in Howes & Spieker, 2008) confirmed that the sensitivity of a

caregiver might be influenced by the type of care situation. They indicated that the security

experienced in a child and caregiver’s relationship is determined by the warmness and sensitivity of

the caregivers towards the child, as well as their ability to monitor not only each child’s needs

separately, but also the needs of the whole group. The attachment children form with their primary

caregivers in early childhood tends to influence their future relationships. If children were separated

from their primary caregivers for extended periods of time, it could impact negatively on the ability

of the children to form relationships (attachment) with others. While working in hospitals and

orphanages in the 1950s, Bowlby (as cited in Ringel, 2012) noticed the impact that separation from

their mothers had on the development of children, and the sense of loss the children experienced as

a result. Bowlby concluded that children have a major longing for their mothers and that they

experience a severe sense of loss if they are separated from them.

Bowlby (as cited in Holmes, 1993), the father of attachment theory, argued that a child’s separation

from a primary caregiver for an extended period of time, between birth and age five, often resulted

in the child not having the opportunity to form an attachment bond. This extended separation from a

4

primary caregiver at an early age, Bowlby added, is one of the possible main predictors of a

criminal personality in adulthood. Not having a reference of what an attachment bond entails might

also influence the child’s ability to form trusting relationships, as well as impact negatively on his

or her behaviour.

The difficult behaviour of a child with an attachment disorder appears to be a challenge to manage.

It is not only the parents of children with attachment disorders who find it difficult to manage their

children’s behaviour; alternative caregivers in institutions have also found it challenging to manage

their behaviour. Their behaviour can include anger, depression, anxiety, emotional detachment,

emotional distress, and personality disturbances (Bowlby, 1979). Bowlby (as cited in Holmes,

1993) stated that in the absence of their parents or primary caregivers, children can also respond

with anger and vandalism. This behaviour is difficult for the caregivers to manage. According to

Howes and Spieker (2008, p. 321), no study has yet been conducted to link the “state of mind” of

the caregiver regarding attachment and the attachment security experienced by the child with an

attachment disorder. They have found, however, that the views of a child’s caregivers can have an

impact on whether attachment security will develop between the caregiver and the child, or not.

This was found to be especially the case where the child differed in ethnicity from the caregiver.

In a study conducted by Howes and Shivers (as cited in Howes & Spieker, 2008), they determined

that they could predict that the relationship between a caregiver and a child would be insecure when

the child displayed difficult behaviour when he or she was admitted into the institution. It appears to

be important for caregivers to be able to understand the child with an attachment disorder and his or

her subsequent behaviour, in order to be able to help this child learn how to form positive

attachments.

1.2 Problem statement

Having been employed as a statutory social worker at a non-governmental organisation (NGO) for a

few months (after an absence from statutory social work for 15 years), I was confronted with cases

of children, especially boys between the ages of nine and twelve, who presented with difficult

behaviour. Their behaviour included soiling themselves, fighting with the other children, being

disruptive in class, breaking property, entering property illegally, absconding from school, and

swearing at others. One of the boys was in Weskoppies, a psychiatric hospital, for observation. I

realised that this boy strongly needed his mother’s unconditional love, but she could not give him

the love he needed because of her own upbringing and relationship with her parents. I also realized

5

that finding placement for these children in alternative care was not easy because of their difficult

behaviour. The CYCCs I approached prefer not to take children who have presented with difficult

behaviour. A workshop on attachment enabled me to realise that some of these difficult children

had an ‘attachment disorder’ and that this was the source of their difficult behaviour.

I was present with the one child who was admitted into the CYCC. I observed how the caregiver

(house mother) immediately did not accept this child, almost as if she immediately decided that she

did not like him. Not surprisingly, the child was moved to another house not long after, and later

was removed from the premises because of his difficult behaviour. His teachers also appeared not to

be able to manage his behaviour. My experience led me to conclude that tolerance for and

understanding of these children is limited.

Moreover, I realised that these children could be helped; I saw that change was possible when

caring adults, who could persevere, were involved. One of the ways to assist these children is for

the caregivers to provide a safe environment. An environment that is experienced by the child as

‘safe’ and ‘predictable’ might assist him or her to realise that adults can be trusted, that the

disciplinary measures that are in place are meaningful, and that there are adults who can actually

ensure the safety of the child (Blaustein & Kinniburgh, 2010). The response of the caregivers

towards the child’s behaviour also needs to be predictable.

In an attempt to reduce the negative behaviour of girls in a residential treatment centre in New

York, called St. Mary’s-in-the-field, Powell (n.d.) explains that a behaviour modification plan was

introduced. Problems that were experienced in that case included the lack of money to provide

acceptable rewards and personnel resisting the use of certain disciplinary measures such as a ‘time-

out’. Despite this, negative behaviour was reduced, as well as the number of children who were

discharged because of their negative behaviour. Sterkenburg, Janssen, and Schuengel (2008)

conducted a study in which they implemented a combination of attachment therapy and behaviour

modification to treat children with difficult behaviour. It was found that the participants in their

study learned positive behaviour more easily from someone who had attempted in their past to form

a relationship with them, than from someone who they were only acquainted with. Once the

relationship was established, the difficult behaviour of the children was radically reduced.

Caregivers experience various challenges when working with a child with an attachment disorder. It

is my experience that not all caregivers in institutions receive the necessary training on what

attachment entails, how to understand and deal with children with attachment disorders, and how to

6

deal with the difficulties in forming a relationship with these children. Because it is the caregivers

who mainly work with these children, I therefore felt it necessary to determine what training they

need to assist them in working with these children. Caregivers are ideally placed to play an

important role in developing or restoring the capacity of a child with an attachment disorder to

relate well with a caregiver. Because limited information is available on the training needs of

caregivers working with a child with an attachment disorder, this study focuses on their training

needs, as well as the challenges they experience in working with these children. By addressing the

caregivers’ training needs, caregivers might be able to assist a child with an attachment disorder

more effectively.

1.3 Goal and objectives of the study

The goal of this study is to explore the training needs of caregivers who take care of children in

residential care with attachment disorders.

Based on the goal of the study, the following objectives were determined:

1. Explore the interpersonal challenges experienced by caregivers when caring for children

with attachment disorders;

2. Describe the strategies/lessons that caregivers have learned help them relate better to

children with attachment disorders;

3. Identify what the caregivers’ training requirements are with regard to their care of children

with attachment disorders; and

4. Make recommendations for social workers regarding the skills development requirements of

caregivers of children with attachment disorders.

1.4 Overview of research methodology

1.4.1 Research design

A qualitative approach was used to obtain the data for this research. Harding (2013) describes

qualitative research as an approach that involves fewer people and is able to obtain more in-depth

information than quantitative research. This approach also enabled me to obtain more information

through exploration. Exploratory research was seen as appropriate for this research because there is

a limited amount of information available regarding the training needs of caregivers in institutions

that care for children with attachment disorders (Fouché, & De Vos, 2011).

7

1.4.2 Population and sample

The population was defined as the caregivers from three CYCCs in Gauteng. These three CYCCs

were purposively selected because they were within close proximity of my home, I had had prior

contact with them, and the staff at the CYCCs consented to take part in this research. The

population is inclusive of race, culture, and gender. Only females participated in the focus groups

because caregivers in these CYCCs are either predominantly or only female. Samples of between

five and seven caregivers were purposively selected from the population at each institution.

According to Rubin and Babbie (as cited in Strydom, 2011b) purposive sampling allows for the

obtaining of a sample of observations that would contribute to a more in-depth understanding of the

research problem.

The criteria the sample (caregivers) had to adhere to were:

Two years of working experience in this specific institution;

A minimum of six months experience of working with children with attachment disorders;

and

Those who have an interest in children with attachment disorders.

The participants (caregivers) participated in the focus groups voluntarily. The sampling method was

chosen in order for the best possible information to be obtained regarding the research topic.

1.4.3 Data collection

I made use of focus groups, which allow for probing for more information and exploring the

meaning of what was said (Walsh, 2001). A Questioning Route was designed to assess the training

needs of the caregivers who work in CYCCs with children with attachment disorders. The

Questioning Route is used, according to Greeff (2011), as a guide during the discussion. It assists in

determining the questions to be asked and allows for more questions to be asked, where necessary.

The Questioning Route consisted of questions that addressed four themes:

1. The caregivers’ knowledge and understanding of what attachment entails;

2. The relationship between the caregiver and the child with an attachment disorder;

3. What strategies/lessons the caregivers have adopted to help them relate better to children


4. The caregivers’ training needs for working with a child with an attachment disorder.

8

Information on these four themes was obtained from the caregivers who participated in the focus

groups and from two key informants.

The research was conducted in two phases: (1) focus groups with the caregivers; and (2) interviews

with key informants. For the second phase, the two key informants were purposively selected based

on the following criteria (Rubin & Babbie, as cited in Strydom & Delport, 2011): they are social

workers by profession (this helped to ensure the disciplinary lens for this study), they have

residential care experience, and their expertise is in working with children with attachment

disorders. The purpose of the key informants was to verify the information obtained from the

caregivers and to obtain more information where necessary. The focus groups were conducted at the

CYCCs where the caregivers worked.

The focus group discussions were recorded so that detailed transcriptions could be made. Follow-up

sessions were also held with two of the three focus groups, in order to determine whether I

understood correctly what the participants had said during these sessions. Greeff (2011) indicated

that the advantage of recording a session is that the researcher can then focus on the discussion and

how to direct it. If the researcher has to take notes while conducting the interview, he or she might

not be able to do this. According to Winston (2012), a transcription is made when what was said is

typed or written down, word for word (verbatim), into a document. Since transcribing is a very

time-consuming process, it was necessary to hire an assistant to transcribe the majority of the focus

group discussions.

1.4.4 Data analysis

According to Babbie (as cited in Schurink, Fouché, & De Vos, 2011, p. 399), qualitative analysis is

the “non-numerical examination and interpretation of observations, for the purpose of discovering

underlying meanings and patterns of relationships.” It is these “meanings and patterns of

relationships” that are going to serve as evidence in answering the research question.

The data was analysed in conjunction with the initial research question and objectives. During the

analysis process, themes were identified and then coded. Schurink et al. (2011) indicated that

similar codes may overlap. Where this happened, I read the transcriptions again to ensure that I

understood the context of what was said and to determine whether the coding was done correctly. I

also read the field notes that were made during the follow-up focus groups to ensure that I

9

understood the information correctly and that the coding was done correctly. Referring back to the

research questions assisted in determining whether the information provided by the caregivers was

relevant to the study or not.

1.4.5 Rigour and trustworthiness

Rossouw (as cited in Delport & Fouché, 2011) stated that findings need to be credible. The methods

which were used to generate the findings need to therefore be trustworthy. The participants were

purposively selected because they needed to be familiar with working with children with attachment

disorders and know what working in a CYCC entails.

Making use of exploratory research enabled me to ask not only the questions on the Questioning

Route but also those questions that arose from their input: this helped to ensure that participants’

responses and input were captured and understood accurately.

The information was recorded and transcribed; this meant that the recordings could be listened to

again while reading the transcript simultaneously, to ensure that what the participants had said was

captured accurately. I also conducted member checks via follow-up focus groups to ensure that I

had understood their input correctly, and to identify and eliminate any biases I had towards anything

they had said. According to Maxwell (2013), this is the most significant way of ensuring that

participants were understood correctly, and for eliminating biases of the researcher. Making use of

triangulation also assisted in ensuring the credibility of the study. Triangulation is, according to

Schensul (2012), when the input from various sources on the same data is compared and examined

in order to better comprehend the topic. In this study, focus groups were conducted and the input

from two key informants was obtained on the findings.

1.4.6 Ethical considerations

Babbie (as cited in Strydom, 2011a) stated that the basic rule of ethics in research is that it should

not harm anyone who is participating in the research. The participants need to be protected against

any possible harmful effects that the research or study might produce. One of the ways of ensuring

the safety of the participants was to provide them with a ‘Participant Information Sheet and Consent

Form’ (Appendix B) prior to conducting the focus groups. In this form, the possible ethical issues of

the study were explained; this included the fact that they were not going to receive any form of

payment for participating in the study.

10

Participants were also informed that their participation was voluntary and that the sessions were

going to be recorded. The participants were requested to sign the consent only if they were willing

to participate in the study on a voluntary basis and consented to having their responses recorded

(Appendix B). Once these signed forms were received, I commenced with the focus group.

Participants were also informed that their identifying details would be kept confidential. Their

names have, for example, been replaced with other names in order to ensure confidentiality.

1.5 Definitions of key concepts

Attachment: The term attachment refers to “an emotional bond between individuals, based on

attraction and dependence that develops during critical periods of life and may disappear when one

individual has no further opportunity to relate to the other” (Barker, 2003, p. 32).

Attachment theory: Bowlby (1979, p. 127) describes attachment theory as “a way of

conceptualising the propensity of human beings to make strong affectional bonds to particular

others and of explaining the many forms of emotional distress and personality disturbance,

including anxiety, anger, depression, and emotional detachment, to which unwilling separation and

loss give rise.”

Attachment disorder: Barker (2003, p. 32) defines attachment disorder as “a developmental

condition in which the individual is unable to form normal and needed emotional bonds with

caregivers and others. This has been shown to result in serious, negative, long-term effects on social

and emotional development.”

Secure attachment: Children whose behaviour reflects that of securely attached children are

thought to have felt that their caregivers were more consistently available to them emotionally.

Children who have formed a secure attachment also tend to explore their environment more

(Sadock & Sadock, 2007).

Insecure attachment: Barker (2003) describes insecure attachment as a form of attachment where

children do not want to explore their surroundings, or want to relate with others, because they do

not feel safe even if their caregivers are present.

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Caregiver: The Merriam-Webster Dictionary (as cited in the Encyclopedia Britannica Company,

n.d.) defines a caregiver as someone who gives first-hand care to another person. Caregiver in this

study refers to the caregivers in the CYCCs relevant to this study and not to the primary caregivers,

for example the parents of the children.

Residential care facilities: ‘Residential care facilities’ in this study refer to child and youth care

centres as stipulated by the Children’s Act 38 of 2005. “A child and youth care centre is a facility

for the provision of residential care to more than six children outside the child’s family environment

in accordance with a residential care programme suited for the children in the facility” (Children’s

Act 38 of 2005, p. 177). Barker (2003) defines residential care facilities as places that provide

housing for those who do not have homes, or who cannot continue to stay in their homes due to

various reasons.

1.6 Outline of the chapters

Chapter one presented an outline of the research in order to provide a clear picture of the study. The

sections, which were provided in this introductory chapter, included the background information

and rationale for the study, the problem statement, the goals and objectives of the study, an

overview of the research methodology, and definitions of the concepts used throughout the study.

Chapter two contains the literature review. The literature review emphasises the key theories and

literature that are relevant to the research topic. This chapter includes a description of key concepts,

including attachment, internal working models, and secure and insecure attachments. The literature

review also explores how the separation from a primary caregiver influences a child’s attachment,

the different forms of insecure attachment, the relationship between caregivers and children with

attachment disorders, the behaviour of children with attachment disorders, residential care, and the

training needs of caregivers.

Chapter three presents the methodology of this study. This chapter provides the details on the

design, methods, tools, and analysis that were used to conduct the study. The methodology that was

used allowed the caregivers the opportunity to provide information regarding the research topic and

express how they experience taking care of a child with an attachment disorder.

Chapter four presents and discusses the findings from this study, which have been categorised

according to the four research questions that were outlined in the introductory chapter. Chapter four

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presents these four categories and relates the findings in these categories to relevant literature.

Chapter four also presents and discusses the feedback that was obtained from the key informants on

the information provided by the focus group participants. This feedback has been integrated into the

different categories where applicable and relevant.

Chapter five provides several recommendations in response to the findings that were made in this

study, as well as whether future research is recommended in this regard. The recommendations that

are made relate to the different themes, which include interpersonal and organisational challenges

experienced by the caregivers in taking care of a child with an attachment disorder, and the lessons

they have learned that assist them in taking care of a child with an attachment disorder.

Recommendations are also made regarding the training (skills development) that the caregivers

have identified that they require and which would, according to them, assist them in taking care of a

child with an attachment disorder.

1.7 Conclusion

Caregivers in residential care appear to find it challenging to take care of children with attachment

disorders. This thesis argues that some of the challenges experienced by caregivers might be

addressed by relevant training in this regard. This chapter provided a brief introduction to the

purpose of the study, what attachment entails, and some of the challenges experienced by the

caregivers. These challenges include, for example, the behaviour of children with attachment

disorders and how their early bond with a primary caregiver influences their ability to form trusting

relationships later in life. This chapter also provided definitions of terminology which will be used

throughout the study, and a brief explanation of the methodology that was used and the processes

that were followed in order to conduct this study.

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Chapter 2: Literature review

2.1 Introduction

This study aims to determine the training needs of caregivers working with children with

attachment disorders in CYCCs. This study is also aimed at providing recommendations that could

be used by social workers when training caregivers, in order to assist caregivers who work with

children with attachment disorders. Attachment and the processes of attachment between caregivers

and children have been extensively written about (Brisch, 2011; Bowlby, 1979; Gerhardt, 2004;

Hughes, 2009). Limited information is available, however, on the training needs of caregivers in

CYCCs who have to form an attachment with children with attachment disorders. As such, this

study will contribute to this empirical gap in the literature.

This study draws on attachment theory, which argues that attachment formed at an early stage

between a child and a primary caregiver has an impact in the child’s development and functioning

later in life. The founding parents of the attachment theory, John Bowlby and Mary Ainsworth (as

cited in Hughes, 2009), emphasised in their work the importance of the attachment between a

primary caregiver and a child and how it can influence a child’s relationships later in life. Their

contribution is acknowledged in this study.

2.2 Attachment

Bowlby (1969) describes attachment as the seeking and maintaining of proximity to another person.

Bowlby (1979) also describes attachment as the inclination of humans to form strong bonds with

significant others. A significant other can be seen as someone that the person wants to maintain

closeness with, and who is perceived as someone who is sturdier and sensible, such as the mother or

father of the child. Golding and Hughes (2012) argues that attachment is the unique emotional

connection a child forms with his or her primary caregiver and that the child wants to feel safe and

secure with this person. According to Ainsworth and Bowlby (as cited in Hughes, 2009),

attachment is characterised by a relationship that is enduring and that includes a particular person

with whom the child wants to have regular contact. Perry and Szalavitz (2006) described attachment

as the memory a person has of the relationship he or she had with their primary caregiver. This

relationship forms the template we apply to our relationships with others throughout life and is

14

already formed at an early age. Botes and Ryke (2011) state that attachments are formed between a

child and his or her primary caregiver from birth until they are around 18 months old.

The attachment a child forms with a primary caregiver depends on the kind of relationship the child

has with that person. For example, the child might have a positive attachment with his or her mother

but not with his or her father (Smith, 2011). If a baby is cared for by his or her primary caregiver

then he or she will feel safe, happy, and relaxed; the baby will learn to first trust his or her

caregiver, and consequently, other people. Bowlby (1979) describes the forming of an attachment as

a process whereby the primary caregiver is available for the child, is quick to respond to the needs

of the child, and is able to discern when to intervene if the child seems to be heading for danger. A

baby would, for example, attempt to maintain proximity to the primary caregiver by crying when

that primary caregiver (e.g., the mother) leaves the room. If, however, a baby’s needs are not met by

the primary caregiver, then he or she will learn not to trust the primary caregiver, and consequently,

others.

Freud (as cited in Bowlby, 1979), who was a psychoanalyst, attributed the attachment between a

mother and her child to the fact that she was breast-feeding the child. Her breast was, according to

Freud (as cited in Bowlby, 1979), the child’s object of love. Evidence has indicated, however, that

babies will become attached to their mothers even if they were not breastfed (Bowlby, 1979). As

such, attachment behaviour is primarily a social process, and an infant can form an attachment with

any primary caregiver and not only with the breastfeeding mother.

According to Hughes’s (2009) definition of attachment, a child can be attached to a parent, but a

parent should not be attached to the child. If a parent is ‘attached’ to a child, it would mean that the

child is the parent’s secure base from where the parent would explore their environment and to

whom the parent would return if they felt threatened or in danger. When a parent needs comfort or

protection, the parent is supposed to obtain it from other adults and not from the child. The parents’

reference of their own attachment to their primary caregivers could, however, negatively influence

their approach to their child, such as expecting the child to act as their secure base.

Bowlby (1979) described a secure base as when people know that there are one or more people who

they trust and who support them and who they know will come to their aid if they were to

experience difficulties. People tend to be at their happiest and they appear to be able to develop

their talents better when they have a secure base. The early relationships a child has with his or her

family proved to be crucially important because the attachment they formed and the secure base the

15

family prove to be for the child a platform for the child’s lifetime of relationships. If a child’s

family acted as a trustworthy, secure base the attachment the child formed with them would in

Ainsworth (as cited in Fox & Hane, 2008) stated that a positive reference of an attachment with a

caregiver is formed by a child whose mother (primary caregiver) is not only attuned to the needs of

the child, but also acts upon those needs. Ackerman and Dozier (2005) indicated that children who

have a negative frame of reference of others might adjust it if they are placed with caregivers who

make an effort to be attuned to their needs. According to Ainsworth and Bowlby (as cited in

Hughes, 2009), the child feels in this relationship that he or she receives the necessary care and

protection and experiences fear or stress when being separated from that person.

Mary Ainsworth conducted research with babies who were 12 months old, by taking note of what

their behaviour entailed when their mothers (primary caregivers) were present, when their mother

left the room (being separated from their mother), and when she returned to the child. This was

called “The Ainsworth Strange Situation.” From this research, Ainsworth (as cited in Smith, 2011)

classified attachment into three groups: ‘secure’, ‘insecure-avoidant’, and ‘insecure-ambivalent’.

Main and Solomon (as cited in Smith, 2011) extended this theory by identifying a fourth

classification, which they saw as ‘disorganised-attachment’.

The four attachment types that Ainsworth (as cited in Smith, 2011) and Main and Solomon (as cited

in Smith, 2011) and Gerhardt (2004) identify are described as follows:

1. Secure attachment: Babies with secure attachment become upset when the mother leaves

the room, but are easily comforted when she returns.

2. Insecure-ambivalent attachment: Babies who develop anxious-ambivalent attachment

protest loudly when their mother leaves and are not really comforted when she returns.

3. Insecure-avoidant attachment: Babies with avoidant-attachment do not seek a connection

with their mother, and thus they do not get upset when she leaves and they often reject her

attempts to comfort them.

4. Insecure-disorganised attachment: These are the babies who react in a confused way

when their parents enter the room. They are not sure whether they can trust their parents

who have been responsible for also hurting them. They respond to their parents by

approaching them but then turning away from them.

The manner in which a parent approaches a child protesting their departure has a significant

influence on the child’s forming of an attachment with a caregiver. Caregivers therefore need to be

16

made aware of the role that they play in this process and need to be provided with the necessary

skills to know how to approach and address children with attachment disorders (Smith, 2011).

Children’s attachment to their parents will be negatively impacted if they are maltreated by their

parents or if they are exposed to trauma because of their parents. Smith (2011) stated that

maltreatment has the biggest impact on a child who is three years and younger because of the

vulnerability of the child at that stage. Maltreatment or exposure to trauma can lead to the forming

of a negative attachment between the child and his or her caregiver, which might impact negatively

on the child’s future relationships and his or her mental health. According to Adolf Meyer (as cited

in Brisch, 2011), a person’s psychological development is influenced by the trauma he or she has

experienced in their childhood, and psychological illnesses are often the result of the inability of a

person to respond positively to these psychosocial stresses.

Smith (2011) stated that the forming of attachments is a basic need amongst people because it not

only assists them to survive, but also protects them. The forming of an attachment is seen as

something that is as important as the need for food and sex. Another need that links closely with the

need for food and sex is a child’s need to explore their surroundings. A child’s growth and ability to

form positive relationships with others are impacted positively if his or her caregivers are available

to serve as a safe platform from where he or she can explore their surroundings. If the child feels

threatened, for example, he or she will return to the safety of their caregiver before exploring their

surroundings again. Forming of positive relationships in conjunction with exploring the

surroundings assists the child to develop to his or her full potential (Smith, 2011).

The child’s development can be threatened, according to Bowlby (as cited in Smith, 2011), if the

child feels unsafe or if he or she is separated from their primary caregiver. Bowlby (1979) stated

that if the separation is not voluntarily, emotions experienced by the child could include anxiety and

anger. Smith (2011) argues that attachment relationships assist people with dealing with stress and

with managing their own emotions. Attachment relationships can also assist the child to develop a

sense of self and can contribute to the reduction of their distress levels (Sprinson & Berrick, 2010).

It appears that the forming of a positive attachment between a child and his or her primary caregiver

entails that the child feels safe and secure, and that all of their needs are met in this relationship.

Forming of a positive or negative attachment early in life can impact on the child’s functioning later

in life. If a child does not have the opportunity to learn what positive attachments entail due to

being maltreated by his or her primary caregivers, this can impact negatively on the child’s mental

17

health. Forming a positive attachment with a primary caregiver will protect and support the child

and contribute to his or her positive development.

2.3 Intergenerational transfer of attachment patterns

Howes and Ritchie (as cited in Ritchie & Howes, 2003) stated that children might transfer past

negative experiences with caregivers onto new caregivers. According to Makariev and Shaver

(2010), some studies support the idea that attachment patterns can be transmitted from one

generation to the next. Golding and Hughes (2012) argue that a caregiver’s own relationship history

will influence the way they form a relationship with, and take care of, their children. Ballen,

Bernier, Moss, Tarabulsy, & St-Laurent (2010) stated that if caregivers have unresolved attachment

issues with their primary caregivers, their behaviour might be characterised by an inability to show

affection towards a child, lack of interaction with others, muddling of roles, and disruptive

(atypical) behaviour. This statement is based on the assumption that the securely attached person

can deal with stress more effectively than those with insecure attachments. If a primary caregiver

experiences difficulties with attachment, the caregiver might not be able to form a secure

attachment with his or her child, and as a result, the child’s attachment style might also be insecure.

Johnson and Courtois (2009) indicated that a child who develops secure attachment has role models

who demonstrated how to confidently interact and form relationships with others. Children model

the behaviour of their caregivers and might imitate their relationship with their caregivers, whether

a secure or insecure attachment has formed between them. When securely attached children become

adults, they are able to model to their own children how to effectively regulate their emotions. They

are also able to provide their children with the necessary support and care. Adults with an insecure

attachment, however, might be less likely to provide their own children with care of a sensitive

nature (Makariev & Shaver, 2010). Children raised by parents who struggle to form and maintain

secure relationships may also form an insecure attachment in their later relationships.

Transmitting an attachment style from one generation to another is therefore another factor which

could influence the child’s ability to form secure attachments. Interventions, such as therapy that

aims to change the insecurity experienced by the various generations, will not only benefit the child

and his or her parents, but also society as a whole because it could possibly prevent delinquent

behaviour in these children at a later stage. The reference a child has of forming a relationship is

referred to as his or her internal working model and will be described in the following section.

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2.4 Internal working models

Internal working models are defined by Makariev and Shaver (2010, p. 316) as “conscious and

unconscious mental processes, acquired through repeated interactions in close relationships, which

affect a person’s expectations and actions in social contexts and the person’s main methods of

coping with or regulating emotions.” An internal working model is the reference that a person forms

of what a relationship entails due to his or her previous experiences in relationships with primary

caregivers. The more negative children’s early experiences are with attachment relationships, the

more set they will be in their beliefs of themselves or others (Sprinson & Berrick, 2010).

According to Sprinson and Berrick (2010), an internal working model cannot be changed easily and

it is actually very resistant to change. According to Bowlby (as cited in Holmes, 1993) the internal

working model of a secure person will consists of his or her perspective of whether they see

themselves worthy to be cared for and to receive attention from their caregivers. The internal

working model also includes the expectations and beliefs a child has of how a caregiver should care

for and respond to him or her (Fairchild, 2006). The manner in which a person would respond to

others due to previous attachment experiences can be referred to as attachment strategies. Johnson

(2003) refers to attachment strategies as the manner in which a person processes and deals with his

or her emotions. The person develops his or her own unique behavioural and cognitive strategies, as

well as strategies to regulate the self. These strategies not only influence their way of thinking and

feeling, but also their conduct (Davis & McVean, 2009).

Since a caregiver might have formed positive or negative strategies, they need to not only be aware

of their own attachment experiences and how it influences their forming of a relationship with the

child with an attachment disorder, but also need to be aware of the child’s attachment strategies that

he or she might not be willing to change. Separation from a primary caregiver could have also

contributed to the child forming strategies of a positive or negative nature.

2.5 The influences of separation from a primary caregiver on the attachment

style formed by a child

According to John Bowlby (as cited in Goldenberg & Goldenberg, 2008), a child develops secure

attachment when his or her main developmental needs are met. An infant who has developed a

secure attachment would therefore reach out to his or her caregiver for protection when being

threatened. Those children who have developed insecure attachment will internalise their insecure-

19

or anxious-attachments when they feel threatened; these children will, for example, not reach out to

their caregivers for protection. If children are either separated from or experience a lack of contact

with their primary caregivers, their ability to form relationships can be severely impacted (Bowlby,

as cited in Johnson & Courtois, 2009). The developmental stage of the child at the time of

separation can also play a significant role.

Children who were separated from their primary caregivers for extended periods of time during the

first three years of their life can come across as reserved and as keeping themselves separate from

other children (Bowlby, 1965). The characteristic behaviour of an infant who has been separated

can include, according to Bowlby (1965), apathetic behaviour, being silent, not being joyful, and

not reciprocating a smile. This is seen as a kind of depression and the child will also often be sleep

deprived, will not be eating well, and will be losing weight. These children do not have the ability

to form attachments (relationships) with others and would hardly ever have friends. They might

appear to be able to socialise with others, but these relationships would still be characterised by a

lack of emotion and depth.

The feelings of a child who is separated from his or her primary caregiver and placed in alternative

care can include anxiety, rage, hopelessness, and the feeling of remorse (i.e., they blame themselves

for their situation) (Bowlby, 1965). A study was conducted in the USA to determine the degree of

security of two groups of children: children who are allowed to have contact with their family and

children who were not allowed to have any contact and were completely separated from their family

(Bowlby, 1965). It was found that the children who had some contact with their previous caregivers

were more secure than those who did not have any contact. Bowlby (1965) concluded from this

study that children should not be separated from their parents permanently and that regular contact

is necessary. One of the reasons for this is that alternative care cannot provide the child with the

nurturing and love that he or she needs and thus the child will always see alternative care as a

temporary arrangement.

Bowlby (1965) believed that a link exists between a child being separated from his or her primary

caregivers between birth and the age of five and criminal behaviour later in his or her life. Studies

conducted in this regard showed that the appearance of loss (e.g., a child loses their parents before

the age of ten through death or separation) with a group of delinquents was twice as much as with a

group who were not delinquents (Bowlby, 1965). Separation can also lead to emotional distress, as

seen in children who suffer from separation anxiety.

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (as cited in Sadock &

Sadock, 2007) describes separation anxiety as when a person experiences extreme and unfitting

levels of anxiety when they are separated from a primary caregiver. Herbert (2005) indicates that

this anxiety must be so severe that it interferes with normal activities, for example, on a social and

academic level. A child suffering from this form of separation anxiety might have formed an

‘insecure’ attachment with his or her primary caregivers, while a child who does not experience this

form of anxiety might have formed a ‘secure’ attachment with his or her primary caregivers.

Children’s separation from their primary caregivers appears to have a significant influence on the

kind of attachment that the child will develop or suffer from, even more so if the child was

separated from his or her primary caregivers at an early age. Having some form of contact with

primary caregivers appears to benefit children who were separated from them, more than having no

contact at all. The attachment style these children developed tended to be more secure than those

who had no contact with their primary caregivers. Separation from primary caregivers can also lead

to emotional irregularities (e.g., anxiety) in a child suffering from insecure attachment. Caregivers

in CYCCs should therefore not ignore the impact separation has on a child with an insecure

attachment and should attempt to have empathy and understanding for them.

2.6 Secure and insecure attachment

Davis and McVean (2009) found that people developed secure or insecure attachments in response

to the manner in which their primary caregivers interacted with them during the first few years of

their lives. Their attachment style (secure or insecure) appears to then remain basically the same

throughout their lives. According to Herbert (2005), the most important social task in the first 12 to

18 months of a child’s life is to develop secure attachments with their primary caregivers and

significant others. Whether children are going to have a sense of security, confidence, or optimism

for the rest of their lives is assumed to be based on the ability of their mother (primary caregiver) to

respond to their needs promptly and with affection. Care should also be provided on a continuous

basis. How the primary caregiver will respond to the child’s needs influences the child’s

expectations of others.

According to Gerhardt (2004) our expectations of others and their behaviour are something that is

formed in our brains without us being conscious about; this happens during infancy. It reinforces

our behaviour in relationships later in life. If a baby had negative experiences with his or her

caregivers during infancy he or she will expect others to behave in the same manner and this will

21

negatively impact relationships of the child. A primary caregiver needs to be aware of his or her

own feelings and how to regulate them effectively in order to be able to notice their baby’s feelings

and emotions and to regulate them effectively. Managing negative conditions like anger in a

relationship is according to Gerhardt (2004) a challenge because if the primary caregiver is not

comfortable with these feelings he or she might respond to their child in a negative manner. The

child might for example then learn not to show his or her feelings anymore. The child of a caregiver

who does not help the child to regulate his or her emotions learns according to Gerhardt (2004) that

there is no help with the regulation of his or her feelings. The child then tries to subdue his or her

feelings but these attempts normally fail. The style of attachment disorder which is then formed is

avoidant attachment.

How the negative attachment that is formed between a child and his or her caregivers influences his

or her relationships later in life is described by Bowlby (1979) as that the child might suppress his

or her anger towards his parents. This repressed anger might persists into adulthood and then be

directed towards someone else in his or her life for example a wife, husband or child. It appears

therefore to be necessary to learn how to form healthy attachments (relationships) early in life in

order to enjoy positive relationships later in life.

2.6.1 Secure attachment

According to Bowlby (1969), people with a secure attachment style had primary caregivers who

provided consistent, reliable, and appropriate responses when it was needed. They also learned at an

early age that caregivers can be relied on in times of need. People with secure attachments therefore

tend to feel loved and to see others as reliable, loving, and caring. According to Smith (2011),

infants who have developed a secure attachment know that their caregivers are available and that

they will respond to their needs in an appropriate manner. Secure infants also know that they can

explore their environment because their primary caregivers act as a base that they can turn to if their

safety is threatened. Since a secure child will get distraught when their primary caregiver is not

present, they would experience their primary caregiver’s return as very positive and would then be

able to continue playing.

Various areas can be influenced by a secure relationship. Hughes (2009) indicated that these can

include a child’s ability to control their physical urges and emotions, their independence, their

tenacity, their interaction with others, their compassion, their ability to resolve issues, their

academic progress, their verbal expression, and their self-image. Children who experience secure

22

attachment will be independent as adults and will only depend on others when it is really necessary.

According to Johnson and Courtois (2009), the responsiveness of caregivers will determine whether

a child will seek proximity to them. The quality of the interactions between children and their

caregivers during stressful situations is one of the main factors that will determine the attachment

style of the child.

2.6.2 Insecure attachment

If primary caregivers do not respond promptly to their child’s needs, they might develop a

disruptive relationship that could lead to various problems such as an inability to regulate emotions

(Courtois & Ford, 2009). Feelings experienced by the child suffering from insecure attachment can

include anger, suspiciousness, dissociation, mood changes, and fatigue, which can all intensify over

time. Social isolation, for example, can intensify to become detrimental aggression towards others.

The attachment styles of those who have formed insecure attachments can be described as insecure-

avoidant, insecure-ambivalent or anxious, and insecure-disorganised.

2.6.2.1 Insecure-avoidant attachment

Davis and McVean (2009) indicated that insecure-avoidant attachment is formed when the

caregivers’ behaviour is consistently rejecting. These caregivers would rather withdraw when their

child experiences an episode of distress than provide comfort to the child. Because of this, these

children learn that others are not likely to be available to provide comfort to them. According to

Nicholson and Parker (2013), the mothers of children with insecure-avoidant attachment often

dislike being touched themselves and would speak to their babies in a sarcastic manner.

These children would therefore down-play their need for proximity and comfort from others. They

would be uncomfortable with intimacy and would find it painful to depend on others, or find it

difficult to express their physical or emotional needs to someone else. According to Nicholson and

Parker (2013), these children would often not be upset when they are separated from their mother

and they might also not respond to her efforts to interact with them. These children might also

interact with strangers and not their primary caregiver, or they might not be sociable with either

strangers or their primary caregivers.

Children suffering from insecure-avoidant attachment have learned to function independently from

their caregivers (Smith, 2011). They do not use their caregivers as a secure base from where they

23

can explore their surroundings, as is the case with a securely attached child. Walker (2008)

indicated that children with this attachment style will hide any distress that they might experience

and would appear to be fine (happy and experiencing secure attachments), while it is actually not

the case. According to Pistole (as cited in Smith, 2011), the adolescent suffering from an avoidant-

attachment might try to escape people touching him or her in a consoling manner, but will endure

sexual activities. Caregivers are needed who can notice and admit the need of the child that needs to

be consoled, even when the child’s verbal and non-verbal behaviour indicates the opposite.

2.6.2.2 Insecure-ambivalent or anxious attachment

Davis and McVean (2009) indicated that children who developed the anxious attachment style were

likely to have had parents who did not respond to their needs. These parents might also have been

more intrusive and would have acted on their own impulses and needs rather than on those of their

children. Children with anxious attachment also tend to have fewer skills in physical interactions.

They are unsure whether their caregiver is accessible to them or not, and whether they are loved by

their caregiver (Smith, 2011).

Characteristic of this attachment style is the strong need for closeness and intimacy and the fear of

separation or abandonment. Levy and Orlans (2003) stated that the child who developed insecure-

ambivalent attachment tends to be clingy, demanding, and hyper-vigilant towards rejection. These

children also tend to be preoccupied with the moods of their parents, they fear separation from their

parents, the parents struggle to soothe them, and they would act childishly or controlling in an

attempt to connect. These children want to enforce closeness with another person because they

expect the person to leave them. They would therefore experience frustration because of their

inability to obtain their goals of intimacy and the forming of a relationship. They are prone to seek

reassurance excessively, which could hinder them from exploring their surroundings (Smith, 2011).

Nicholson and Parker (2013) found that children with this attachment disorder tend to restrict the

exploration of their surroundings and tend to respond ambivalently towards the mother upon her

return. According to Davis and McVean (2009), children with anxious-attachment also tend to have

poor communication skills, poor conflict management, and high levels of conflict, criticism, and

violence. Walker (2008) states that children with this attachment style tend to send out a message to

their caregivers that they are not fine while they actually are. McMahon (as cited in Smith, 2011)

indicated that those suffering from anxious-attachment tend to use sex to cope with stress and to

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feel worthy. Those suffering from anxious-attachment will also tend to be younger when they start

having sexual relationships.

Caregivers are needed who are able to placate the levels of stress these children experience,

understand their need for closeness, and who can encourage them to explore his or her

surroundings.

2.6.2.3 Insecure-disorganised attachment

Main and Hesse (as cited in Juffer, Bakermans-Kranenburg, & Ijzendoorn, 2005) determined that

there was a link between the mindset of parents who have experienced trauma and their children’s

disorganised behaviour. Parenting that is highly unresponsive can provoke the child to fear: this can

in turn cause disorganised attachment. Walker (2008, p. 54) stated that children with this attachment

style can experience extreme levels of “fear and anxiety.” According to Alexander (2003), insecure-

disorganised-attachment is related to the experience of abuse. The child might present with

conflicting behaviour (e.g., in a situation of fear) and seek comfort from the parent who is

responsible for causing the fear (the parent abusing the child), while also trying to avoid that same

parent (Smith, 2011). Children with this attachment style have experienced severe trauma such as

violence and several losses (Levy & Orlans, 2003). Trauma experienced by a child in their early

years is, according to Smith (2011), often the result of a negative experience with their attachment

relationship during these early years. Smith (2011) stated that children can be disorganised with one

parent but not necessarily with the other parent. Children suffering from insecure-disorganised

attachment were not protected from the violence or trauma by the primary caregivers who were

supposed to protect them.

Dozier et al. (as cited in Ballen et al., 2010) stated that foster parents with an unresolved attachment

history were more likely to have foster children with this disorder. It was also determined that foster

parents with a self-doubting mindset might also contribute to a foster child forming a disorganised

attachment. The reason for this might be that the child was already exposed to the negative

behaviour of their primary caregivers before being placed in foster care. It is therefore not just

exposure to extreme parenting (for example abuse) that can cause the child to develop disorganised

attachment. The attachment style of children growing up in institutions can also be impacted

negatively by their relationship with the caregivers. Voira et al. (as cited in Zeanah & Smyke, 2005)

found that 65 per cent of children who were reared in Greek institutions had relationships with their

caregivers that were characterised by disorganised attachment. In contrast, the relationships of only

25

25 per cent of children who grew up with their families were characterised by disorganised

attachment.

According to Hughes (as cited in Walker, 2008), a child with disorganised attachment might feel

that they need to protect themselves. They might do this by manipulating or intimidating others in

an attempt to control others (Smith, 2011). Cook et al. (as cited in Smith, 2011) argue that children

whose attachments were gravely impacted are more sensitive to stress and find it very difficult to

control their emotions on their own. These children also find it very difficult to control the

behaviour they exhibit because the feelings of their past might be overpowering for them at times. It

appears that in order for some of them to be able to cope with these overwhelming feelings, these

children use alcohol and drugs to obtain numbness. According to Smith (2011), the use of drugs and

alcohol amongst youth who have experienced trauma in their past is understandable because drugs

and alcohol can numb their emotional condition and awareness. Alcohol was found to be used the

most because it “acts as a central nervous system depressant” (Smith, 2011, p. 133). Emotions that

alcohol can assist a child to numb can include fear and anxiousness.

2.7 The relationship between caregivers and children with attachment

disorders

Something that caregivers need to understand when attempting to form a relationship with a child

with an attachment disorder is that the child might be of two minds regarding the forming of a

relationship with a new caregiver. Goldsmith et al. (as cited in Smith, 2011) indicated that the

reasons for this might be that they are yearning to return to their primary caregiver while at the

same time want to form a relationship with their new caregiver. How the caregivers respond to the

child in this regard can contribute positively or negatively to the child’s view of relationships.

Sprinson and Berrick (2010) see the response from a caregiver as being able to either confirm or

disconfirm the child’s working models (beliefs) of what relationships entail. If a child formed an

insecure attachment due to the relationship with his or her primary caregiver, for example, then the

child will expect other adults to respond in the same manner.

If the behaviour of the ‘new’ caregivers is in line with the child’s expectations, the child’s working

model will be confirmed. If, however, the ‘new’ caregiver approaches the relationship with the

child in a different manner (e.g., a manner that encourages the child to form a secure attachment),

the working model of the child will not be confirmed; the child will therefore have to adjust his or

her working model. Caregivers therefore have the opportunity to change a child’s negative

26

expectations and reference of what a relationship entails by forming a secure attachment (positive

relationship) with the child.

Children with an attachment disorder normally do not develop a consistent and secure working

model of relationships or a positive reference of self-trust. According to Courtois and Ford (2009),

children can learn to mistrust others if they feel unprotected, neglected, blamed, and

psychologically overloaded by adults. Attachment theory is, according to Sprinson and Berrick

(2010), concerned with how the relationships between caregivers and children assist the child to

regulate his or her self. As the child grows older, he or she is supposed to be less dependent on the

caregiver for assistance with self-regulation and must be able, at an older age, to self-regulate their

emotions. For example, if children are afraid, the younger children would normally approach their

attachment figure for safety and protection. As children grow older, however, they are supposed to

have acquired the necessary skills to be able to comfort themselves.

Caregivers need not only to be aware of the influence that their relationship has on these children,

but also need to have the necessary skills to take care of the children with attachment disorders and

assist them to change their internal working models. The troubled behaviour of these children often

makes it very difficult for caregivers to assist them to change their internal working models. One

attribute that can assist caregivers to form a secure attachment with a child with an attachment

disorder is being attuned (sensitive) to the needs of the child. Other attributes include being

optimistic and being dedicated to the care of the child (Ritchie & Howes, 2003). Caregivers need to

be sensitive to the needs of these children because these children can then learn how to form a

trusting relationship from them.

Healing is possible for these children when they are given the opportunity to regress. This kind of

behaviour assists in the restoration and forming of attachments from a healthier point of view.

Bowlby (1965) found that healing could take place when children are given the opportunity in some

institutions to behave childishly in comparison to their actual age or development stage. This

childish behaviour can include allowing them to speak in a baby-like manner, allowing them to

drink from a baby bottle, or feeding them with a spoon. One boy who was observed in an American

institution stopped the baby-like talk and no longer wanted to be spoon-fed after two months

(Bowlby, 1965). Caregivers therefore need additional knowledge, skills, and support to be able to

understand these children and to teach them what trusting relationships entail.

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2.8 Behaviour of children with attachment disorders

Luborsky and Barrett (as cited in Larsson, 2012) indicated that there is a link between the

experiences a child had during his or her childhood and the resulting negative behaviour in

adulthood. Ritchie and Howes (2003) stated that children who demonstrate hostile behaviour,

sadness, and inhibited behaviour might have a poor history of relationships with adults. The

behaviour of a child who has not formed a secure attachment might consist of impulsiveness, a poor

self-image, being emotionally unstable, faring poorly at school, lacking the ability to grasp abstract

concepts, and the inadequate development of conscience. The child might also be reserved or aloof,

aggressive, and might cling childishly to the caregiver (Bowlby, 1965). A child clinging childishly

to the caregiver is, according to Bowlby (1965), expressing a need to be mothered.

The emotions that can be experienced by these children when they are separated against their will

from their significant others (e.g., their parents) might include feelings of anxiety, anger,

depression, and detachment (emotionally) from others, which can subsequently influence their

behaviour. Some of these children with an attachment disorder might see the world as a dangerous

place and might feel the need to be wary of others. They might also feel that they do not deserve

love (Holmes, 1993), while others might form shallow and mostly fleeting relationships (Botes &

Ryke, 2011). The behaviour that some of these children who have an attachment disorder present

with, is described in the following sections.

2.8.1 Oppositional behaviour

Children might express their experience of failed emotional attachments through behaviour that can

include a disregard for discipline and aggressive behaviour that might not be socially acceptable.

The result of this behaviour could lead to the child and parents being rejected by others and not

being accepted into society (Herbert, 2005). This can impact further on the child’s reference of

relationships, in a negative way.

2.8.2 Oppositional Defiant Disorder (ODD)

Herbert (2005) indicated that Oppositional Defiant Disorder (ODD) is a more extreme form of

oppositional behaviour. It takes root because the parents are not able to guide their children’s

coercive behaviour, often because of socio-economic, emotional, or social reasons. Parents ought to

be able to guide their child’s behaviour in such a manner that children will obtain impulse control at

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a later stage. Children with this disorder have anti-social, aggressive, and defiant (disobedience)

behaviour. As indicated in the DSM-IV-TR (as cited in Herbert, 2005), ODD can be diagnosed in a

child when four of the following criteria are met:

1. The child easily loses his or her temper;

2. The child is argumentative with adults;

3. The child does not comply with an adult’s rules or requests;

4. They do not take responsibility for their own mistakes, but always blame others;

5. The child is very sensitive (touchy); and

6. The child has a streak of vindictiveness.

Herbert (2005) stated that although disobedience is common in children, the difference with a child

who has ODD is that their behaviour persists and intensifies over time. One of the ways to treat this

disorder is to train the parents to change the attitudes and actions that contribute towards and

maintain this type of behaviour.

2.8.3 Reactive Attachment Disorder (RAD)

According to Lansdown, Burnell, and Allen (2007), children who are suffering from Reactive

Attachment Disorder (RAD) are characterised by defiant behaviour towards authority and their

inability to trust grown-ups. Some of the characteristics of deviant behaviour include: children

acting in a socially acceptable manner in order to get what they want, or being affectionate with

people they do not even know (Herbert, 2005). These children might also be cruel to animals, and

be very aggressive towards others or their self. They might also be very bossy, controlling,

manipulative, demanding, and impulsive. These children also tend to lack self-control, tend to lie or

steal, have no remorse or conscience, and will struggle to maintain friendships. Children with RAD

will also lack trust in others, which will result in them not believing that others will take care of

them.

2.9 Children with attachment disorders in residential care

Children in residential care sometimes feel that they do not belong. One of the reasons can be that

they do not feel accepted by the personnel (Wigley, Preston-Shoot, McMurray, & Connolly, 2011).

They also sometimes feel unsure about their future. These feelings of uncertainty might be

attributed to the fact that these children do not always know which caregiver is working which shift

29

(e.g., which caregiver is going to look after them). Caregivers constantly change and attachments

that these children formed with previous caregivers are lost when these caregivers leave the CYCC.

These children can experience this as just another adult rejecting them, as was the case with their

primary caregivers.

Groark, Muhamedrahimov, Palmov, Nikiforova and McCall (2005) advocate the fostering of

bonding relationships between alternative caregivers and children. The children and caregivers they

involved in their study were from an institution in St. Petersburg, Russia that made provision for

children whose parents are deceased. They observed that the caregivers in these orphanages were

very anxious and depressed, they talked very little to the children, and they seemed distant in their

relationship with the children. As a result, the children in this institution exhibited behaviour that

was consistent with that of children who had formed poor attachment bonds since infancy. One of

the interventions used to improve the situation was to train the caregivers and encourage them to be

more caring and responsive to the needs of the children. Their results suggest that improved

relationship bonding by alternative caregivers improves the children’s attachment behaviour.

2.10 Training needs of caregivers working with children with attachment

disorders

In a study conducted by Wigley et al. (2011) that involved services rendered by caregivers and

social workers to children with attachment disorders, it was found that although caregivers and

social workers did receive training, this training only addressed the physical and safety needs of

children, and not the emotional needs that the children might experience. The caregivers also felt

that the physical needs were provided for by the social workers involved. The social workers’

support for problems experienced with the children on an emotional and behavioural level was,

however, limited.

A welfare organisation in the province of Kwa-Zulu Natal, South Africa, conducted a study with

children who have experienced both foster care and residential care. It was found that concerns

raised by these children regarding care in a CYCC included personnel who were not adequately

trained, exposure to less favourable influences from other children, and the fact that they felt that

only the strongest children survived the uncaring atmosphere (Perumal & Kasiram, 2009). Children

in this CYCC were more likely to turn to the other children for support because they experienced

that the caregivers were not available to provide them with the necessary emotional and physical

support. Recommendations made after conducting the above study included, according to Perumal

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and Kasiram (2009), that caregivers should receive regular training and that the training should

include: how to deal with their emotions when taking care of children, how to form trusting

relationships with these children, and what the law states about child care.

The needs of caregivers, which was identified by Kgole’s (2007) study, included, the need to know

how to handle a disturbed (emotionally) child and the need for therapy in a group context. The

caregivers also expressed the need for support from their families and the community, and the need

for regular meetings with other caregivers in order to discuss issues that affect all of them.

Caregivers need to be involved in the treatment of the child because they spend more time with the

child than the social workers and they could therefore provide valuable input in this regard. Jacobs

(2008) is of the opinion that it would be beneficial to the children who experienced trauma to be

assisted by their caregivers to let go of the defence mechanisms they have developed. These

children have a constant need to feel in control of their environment. Creating an environment

where the child feels safe and where he or she can trust the caregiver would therefore be ideal in

dealing with the situation. Caregivers should therefore receive the necessary training in order to

assist the child to let go of his or her defence mechanisms.

According to the study conducted by Jacobs (2008), it was found that the caregivers felt that they

did not have enough knowledge in how to parent a traumatised child. They were aware of what

attachment entails, but lacked the practical knowledge of how to help the child to trust them as

caregivers, and on how to form a new attachment with the child. The caregivers also felt that they

did not know how to work with the bereaved child or what the grieving process entails. They felt

that they needed to have the necessary skills to handle angry children and adolescents. Because

caregivers play such a vital role in changing the child’s internal working model, providing

caregivers with the necessary training in this regard is critical.

Caregivers play such a vital role because they can assist these children to become well-adjusted

adults who can contribute positively towards society. De Vos (as cited in Perumal & Kasiram,

2009) stated that caregivers play a significant role in helping the child to become an adult who can

be re-integrated into society. Bowlby (1965) stated that caregivers do need training and that their

job status should also be raised to that of a professional. Their roles should also be clarified so that

everyone involved can work together as a team when assisting the children. According to Bowlby

(1965), it is also necessary for the caregivers to be able to discuss the children they are looking after

on a regular basis, and to be able to discuss the difficulties they experience with them. The

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caregivers should be able to debrief on a regular basis, either in regular meetings with their

supervisor and/or their colleagues, or with a person not working in the same organisation as them.

2.11 Conclusion

The forming of a secure attachment with a primary caregiver appears to be important, especially

since it influences the child’s future development and future relationships, and as an adult. If a child

has formed an insecure attachment, it can impact negatively on his or her trust in adults and the

forming of trusting relationships. Children, who have been removed from their primary caregivers

due to maltreatment by them, might often suffer from insecure attachment even before being placed

in the CYCC. Caregivers therefore need to be knowledgeable on what attachment and attachment

disorders entail and what these children’s relevant behaviour might entail. Understanding and

having empathy for the behaviour of these children and the influence these children’s background

has on their development and actions might assist the caregiver to form an attachment with them.

These children also need to be taught by the caregivers what a trusting relationship with an adult

entails. It appears that caregivers do require training on how to deal with the traumatised child, how

to work with an angry child, and how to manage their own emotions while working with these

children. Providing caregivers with the necessary training and support in the CYCC might assist

them to teach the child with an attachment disorder about how to form trusting relationships.

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Chapter 3: Research methodology

3.1 Introduction

This chapter focuses on the methodology that was adopted for this research. It presents a step-by-

step account of the population and sampling strategy, the data collection process, and the data

analysis. Caregivers from three CYCCs were purposively selected to participate in three focus

group discussions and two follow-up focus groups. Data collected from the focus groups was

validated by two key informants who had experience in working with children with attachment

disorders in CYCCs. This study adopted Creswell’s (as cited in Schurink, Fouché, & De Vos, 2011)

understanding of the process of analysing qualitative data as a spiral that moves in analytical circles

and not in a set linear approach. Although the framework of this study’s research process is

presented as linear steps, these steps are not set because they overlap each other during the process.

3.2 Research goal and objectives

The goal of this study was to explore the training needs of caregivers who take care of children in

residential care who have attachment disorders.

The objectives of this study were to:

1. Explore the interpersonal challenges experienced by caregivers when caring for children


2. Describe the strategies/lessons that caregivers have learned to help them relate to children


3. Identify what the caregivers’ training requirements are with regard to caring for children




3.3 Research design

Blaikie (as cited in Fouché, Delport, & De Vos, 2011) compared a researcher who designs a

research project to an architect who designs a house. The researcher makes a statement and

motivates the decisions made in the planning of the research project, in the same manner that an

33

architect designs a house and can motivate the plan of the house: for example, why it is designed in

a specific way. According to Fouché, Delport, and De Vos (2011), research design entails focusing

on what the researcher wants to achieve and the relevant steps which are needed to realise this

outcome. Bickman and Rog (2009) stated that research design serves as the purpose of the project

and links the different steps in the research process (e.g., the design, and the collection and analysis

of the data) to the research question.

There are two research approaches in methodology literature, viz. qualitative and quantitative

(Fouché & Delport, 2011). The approach I selected for this research project is the qualitative

approach and it was informed by phenomenology. According to Creswell (as cited in Fouché &

Schurink, 2011) a study which is informed by phenomenology is a study which describe how

people experience a certain phenomenon. Bentz and Shapiro (as cited in Fouché & Schurink, 2011)

stated that it is the aim of phenomenology to understand the phenomenon or concept as experienced

by the participants and for the researcher to describe it as such. It is for this reason that the

qualitative approach was selected for this study.

The quantitative approach was not seen as an appropriate research approach because it is too

structured and every step in the research process is predetermined (Fouché & Delport, 2011). In

order to predetermine the answers, as is the case in a quantitative approach, one needs to already

know a lot about the topic: this was not the case in this study. Another reason why I could not make

use of the quantitative approach is because it does not allow for exploration. In a quantitative

approach, a statement is normally proved or disproved. In qualitative research, however, the

answers are explored in order to capture and give an account of the meaning that the caregivers

attach to the problem (Fouché & Delport, 2011). Exploration was required because the research

question appeared to be an area which has not yet been fully examined and explored. Making use of

qualitative research that allows for exploration can also make it possible to formulate a hypothesis,

which can lead to further research (Marshall & Rossman, 2011).

The qualitative approach was also selected because it allowed me to document the life experiences

of caregivers. Lincoln and Guba (1985) found qualitative research more applicable where humans

served as the instruments through which data was obtained. It appeared that humans participated

more readily in interviews, for example, because interviews comprise of activities that come

naturally to people (e.g., listening and talking). Since my research question was designed to

establish the training needs of caregivers working with children with attachment disorders, and

34

because so little was known about this question, the best way to obtain these answers was to

interview the caregivers directly.

The caregivers were provided with an opportunity to describe, in their own words, their experiences

of the situation (Boeije, 2010). In this case, the caregivers were asked to describe their experiences

of looking after children with attachment disorders. Qualitative research is defined by Boeije (2010)

as the process of understanding and describing how people experience a social occurrence. This

approach allowed flexibility and contact with the caregivers, whose experiences I wanted to

understand. A flexible approach was required for this study because the perspectives that caregivers

had with regard to the research problem were not yet known. It is for this reason that Jorgensen (as

cited in Boeije, 2010) stated that the research problem can be constantly redefined as new

information is acquired.

A flexible approach also meant that the collection and analysis of data could be adjusted as new

information was obtained, or in response to problems/challenges. For example, the first session with

Focus Group 2 did not record because I did not realise, at the time, that the ‘record’ button was not

pressed. Fortunately, I realised this later that day and immediately made notes, from memory, of the

discussion, and who had said what. I then approached the two key informants via email and

requested their input in answering some of the questions. One of the two informants replied and

answered the questions. A follow-up focus group was then conducted with Focus Group 2 and I

referred back to their first session and what they had said then. I also repeated most of the questions

and obtained their input, which was recorded. Initially, I had decided to include only Focus Groups

2 and 3 in the data analysis because Focus Group 1 was intended only as a pilot study. However,

because the first session (out of two sessions) with Focus Group 2 was not recorded, I decided to

include all three focus groups in the analysis. One of the positives of including Group 1 was that

information that neither of the two other focus groups provided could be included. For example,

Group 1 referred to training they had received in the format of role-playing (acting out) certain

situations, a process they found practical and useful. A flexible approach to collecting and analysing

the data, as permitted within a qualitative research approach, therefore made these kinds of

adjustments to the methodology possible, in response to the inevitable challenges of conducting

research in the real world.

The qualitative approach lends itself to exploration. Information could be obtained by making use

of exploration, from which important categories could be identified. Predetermined categories for

the coding of data were identified, such as challenges experienced by caregivers, lessons they

35

learned in this regard, and what their training needs were for working with children with attachment

disorders. Despite these predetermined categories, however, I had to ensure that the categories were

flexible and open to change in response to ongoing data analysis (Marshall & Rossman, 2011). For

example, a category which was not emphasised in the ‘Questioning Route’ activity, but was

identified during the data analysis, was ‘organisational challenges experienced by the caregivers

working with children with attachment disorders’. Although it was not my intention initially to

include organisational challenges in the study, it was highlighted by the participants and was shown

to be key issue. Organisational challenges were identified as a key issue that also impacts on the

participants’ relationships with children with attachment disorders. In light of this, I decided to

include organisational challenges as another category in the study. Challenges experienced by the

caregivers working with children with attachment disorders therefore include interpersonal

challenges, as well as organisational challenges. Here again, the qualitative, exploratory approach

allowed me, as the researcher, to be surprised and guided by the data.

3.4 Population and sampling strategy

3.4.1 Population

Lincoln and Guba (1985) define a population as people or places that are grouped together because

of shared denominators. The residents of South Africa, for example, represent a population, as well

as social workers working at NGOs. Krueger and Casey (2009) describe homogeneity as something

that a group has in common and which a researcher is interested in. It can be, for example, the

group’s age, occupation or experience that they have in common. In this research study, it was the

caregivers’ occupation and their experience of working with children with attachment disorders that

were identified as the common denominators. Lincoln and Guba (1985) stated that the greater the

homogeneity among the population, the greater the precision will be when drawing conclusions.

The population for this study was defined as the caregivers who care for children with attachment

disorders and who work in CYCCs in Gauteng.

3.4.2 Sampling strategy

Henry (2009) describes sampling as a process of selecting a subgroup from a population, from

whom data will be collected. According to Fouché and Delport (2011), a sample represents a small

portion of a larger whole. I sampled the participants purposively, a process defined by Silverman

(as cited in Strydom & Delport., 2011) as selecting specific people to participate in a study because

36

their characteristics can contribute positively to the study. According to Rubin and Babbie (as cited

in Strydom & Delport, 2011), purposive sampling allows one to obtain a sample of observations

that could contribute to a more in-depth understanding of the research problem. I selected the

participants purposively because I needed participants who were likely to contribute the most

information about the research problem (Tashakkori & Teddlie, 2009). Creswell (as cited in

Strydom & Delport, 2011) stated that it is not only the participants who need to be purposively

selected, but also the sites where the research is going to be conducted. Sampling was thus

conducted in two stages: (1) sampling of sites, and (2) sampling of participants.

The first stage of sampling entailed selecting three CYCCs from the 88 registered CYCCs in

Gauteng (Van Breda, 2015). I used availability sampling to select the first two sites for my research

(Marshall & Rossman, 2011), by approaching CYCCs with whom I had had prior contact and who

were located close to my home, thus reducing travelling costs. To obtain permission for conducting

my research at these CYCCs, I first contacted them via email. Once I had received a positive

response from the CYCC, I then e-mailed them the ‘Information Letter’ (Appendix A) and

‘Participant Information Sheet and Consent Form’ (Appendix B). To select the third CYCC, I

contacted a CYCC that I had contact with in another province, asking them for a contact name at

one of their centres that was situated closer to my home, in Gauteng. This third CYCC was first

contacted telephonically, and then followed up with an e-mail that contained the ‘Information

Letter’ and the ‘Participant Information Sheet and Consent Form’.

The second stage of sampling involved purposively selecting five to seven child- and youth-care

workers from each of the three selected CYCCs. The participants were selected purposively to

ensure that they were knowledgeable about and could provide significant insight into the research

problem (Tashakkori & Teddlie, 2009). Maree (as cited in Strydom & Delport, 2011) argues that it

is vitally important to select participants who can contribute significantly to the research project.

Certain criteria therefore had to be drawn-up before I could select the participants for this study.

The criteria that the caregivers had to adhere to were as follows: they had to be working for two or

more years in the same institution and they had to be working with children with attachment

disorders for a period of six months or more. The participants also needed to have some interest in

children with attachment disorders and they were required to take part in the study on a voluntary

basis.

Since the caregivers from Focus Groups 1 and 2 were knowledgeable on the topic and had

experience in working with children with attachment disorders, this resulted in lengthy

37

contributions from them. The caregivers from Focus Group 3, on the other hand, did not know what

attachment disorders entailed, at first. I therefore held an information session (Appendix D) before

commencing the focus group. As the information session progressed, these caregivers recognised

that some of the children they were working with had attachment disorders. Lengthy contributions

were therefore also obtained from Focus Group 3 during their focus group. I attempted to eliminate

the possibility that a participant who had no experience in working with children with attachment

disorders might form part of the sample. This was attempted by forwarding the ‘Information Letter’

(Appendix A) and the ‘Participant Information Sheet and Consent Form’ (Appendix B) to the

coordinators. These letters were sent before the dates for conducting the focus groups were

determined.

I asked the coordinators to provide each prospective participant with the ‘Information Letter’ and

the ‘Participant Information Sheet and Consent Form’. I also asked the coordinators to obtain the

signed consent forms from the participants. Lincoln and Guba (1985) state that participants should

be completely informed and should sign a consent form that is appropriate to the study. My consent

form included the following information: my contact details, the reason for the study, and

information on participation. The information about participation included that participation is

voluntary and that the participants could withdraw at any time. The voluntary participation of the

selected caregivers was confirmed verbally when we met, and on these consent forms. According to

Bloor, Frankland, Thomas and Robson (2001), an information letter with the contact details of the

researcher should be given to the participants. This enabled them to contact me prior to the focus

group with any questions they might have or if they could no longer attend the focus group. I was

not contacted by any caregivers prior to the commencement of the focus groups.

Once the caregivers had signed the consent forms, the coordinators and I determined a suitable time

and date to conduct the focus groups. Focus Groups 1 and 2 were conducted in the morning, during

the time that the caregivers were not on duty. It was more difficult to obtain a time that suited Focus

Group 3 because the caregivers were working different shifts. The number of participants (sample

size) required for each focus group was five to seven caregivers, as stated in the ‘Information

Letter’ that was forwarded to the coordinators at each CYCC.

3.5 Data collection methods and tools

This research was conducted in two phases: (1) focus groups with caregivers at three different

CYCCs, and (2) interviews with two key informants. The findings from the analysis of the focus

38

group data were forwarded to the key informants for commentary, in order to determine whether the

information obtained was trustworthy.

3.5.1 Pilot study focus group

Marshall and Rossman (2011) describe the advantages of a pilot study as firstly, being able to test

various ways in which to conduct a study, and secondly, to support the reasoning behind the choice

of a certain strategy. Sampson (as cited in Marshall & Rossman, 2011) indicated that a pilot study

can assist a researcher to identify possible problems and gaps in data collection. Krueger and Casey

(2009), for example, describe how a researcher can pilot test certain ideas by giving participants

three to five choices, then asking them to discuss the positives and negatives about each option and

their reason for selecting the one that they liked best.

Focus Group 1 was only intended to serve as a pilot study. I found, however, that the data that I had

collected from this group was as rich and useful as the data that I had obtained from Focus Groups 2

and 3. I therefore decided to include data from the pilot study in the final dataset. When conducting

the pilot focus group (Focus Group 1), I realised that obtaining information on the caregivers’

training needs was challenging, despite the use of the probing questions that were listed on the

‘Questioning Route’. During the first session with Focus Group 1, the caregivers steered the

discussion away from a particular question I had asked, and discussed instead their emotions

regarding a traumatising incident that had taken place at the CYCC. I found that when I

acknowledged their feelings and said that I might be able to speak for them through this study, they

focused back on the question that I had initially asked and started giving valuable input on their

training needs.

3.5.2 Participant preparation for focus groups and data collection

Liamputtong (2011) stated that the room or setting where the focus group is going to take place

must be prepared beforehand. I prepared the rooms in advance by arranging the material that would

be used, the equipment and the refreshments. I arranged with the coordinators for tea and coffee to

be provided and I supplied refreshments. I tested the electronic equipment that I was going to use

beforehand. Liamputting (2011) also recommends that participants sit in a circle, which allows

them to have eye contact with all the group members. The facilities that were made available at the

CYCCs allowed Focus Groups 1 and 3 to sit in a square formation, while Focus Group 2 sat in a

rectangular formation. It appeared that eye contact was still established between the participants,

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although more effort might have been made by participants in Focus Group 2 because they had to

turn their heads towards one another when they were addressing each other.

I arrived at the location earlier than the agreed time, in order to welcome the participants as they

arrived. Before the groups started, I obtained the outstanding consent forms (Liamputtong, 2011).

As recommended by Stewart, Shamdasani and Rook (as cited in Liamputtong, 2011), each

participant was given a name tag on which they wrote only their name. I also wore a name tag.

Name tags helped to form a bond between the participants and me because we could use peoples’

names more easily and readily when addressing them. The name tags also placed us on a more

familiar footing with each other.

To start the focus groups, I introduced myself to the participants and explained the reasons for why

I was conducting this research. I then asked the participants, in a humorous manner, whether they

were attending the focus group voluntarily or whether management indicated that they should

attend. The caregivers stated that their participation was on a voluntarily basis.

Dressing in the same manner as the participants can, according to Babbie (2008), encourage the

participants to cooperate and give useful responses, whereas if a researcher dresses very formally,

for example, the participants might hold back on their input. What I wore was informal, yet

professional, and it coincided nicely with their dress code.

Babbie (2008) also states that the researcher needs to show sincere interest in the participants

because of all the questions he or she plans to ask. I therefore had to ensure that I was sincere in my

approach to the caregivers. My experience of the caregivers, at first, was that they were distant. I

attributed this to the fact that they did not know me and also because I was a social worker.

According to their feedback regarding their communication with social workers inside and outside

of their organisation, it appeared that some of the caregivers had not had positive experiences with

social workers in the past. I therefore had to attempt to overcome this ‘barrier’ by, for example,

acknowledging that I, as a social worker, do not know what it entails to live with children with

attachment disorders like they have to, and I was honestly interested in understanding their views on

this.

Once I explained the purpose of the focus group to the participants, I asked them if they understood

what ‘attachment’ and ‘attachment disorder’ meant. Focus Groups 1 and 2 had a clear

understanding of what ‘attachment’ entailed. As mentioned in Section 3.4.2., a short explanation of

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what ‘attachment’ and ‘attachment disorder’ meant was given, prior to the commencement of the

first session with Focus Group 3, because the caregivers in this focus group did not know what

those terms meant. The opportunity was also given to all the focus groups to ask questions with

regard to the terms ‘attachment’ and ‘attachment disorder’.

As part of the preparation, I also showed all the participants the voice-recorder that I planned to use

and confirmed that everyone consented to having the discussion recorded. At this point, I normally

started to record the session. I then explained the format of the discussion in terms of, for example,

the time that was allocated for the session, which was 90 minutes. The participants were also

informed of the headings of the four sections. I emphasised at this point that each participant’s view

was acceptable: there were no right or wrong answers, even if one person’s views and responses

differed from someone else’s (Liamputtong, 2011). Emphasising this proved to be valuable because

some of the caregivers referred to this before they gave their input. The participants were also

informed at the beginning of the focus group that they were welcome to help themselves to

something to eat and drink at the end of the session.

3.5.3 Data collection tool: The ‘questioning route’

According to Maxwell (2009), research questions indicate what the researcher would like to

understand, while interview questions assist in obtaining the data required to understand the

research problem. One of the data collection tools I used was the ‘Questioning Route’ (Appendix

C). This tool is the focus group equivalent of an interview schedule (Krueger & Casey, 2009, p. 35).

I constructed the Questioning Route by grouping the questions into four categories:

1. Knowledge and general understanding;

2. Relationship between the caregiver and a child with an attachment disorder;

3. What strategies caregivers have learned will help them to relate to children with attachment

disorders; and

4. Training needs of caregivers.

These four categories were chosen because they link to the research objectives. According to

Liamputtong (2011), researchers have to prepare for focus groups in order to ensure that all the

relevant themes are discussed. By compiling the Questioning Route, I could ensure that all the

necessary themes were discussed.

41

Each theme consisted of a main question with between three and six sub-questions. Creswell and

Clark (2011) stated that the questions relating to the main question should not be more than five to

seven questions, and that the questions should all be open-ended. Open-ended questions do not start

with the word ‘why’ but, for example, with the word ‘what’. The reason for this, according to

Creswell and Clark (2011), is that the word ‘why’ indicates that an explanation is needed rather

than an understanding, whereas the word ‘what’ helps to meet the aim of qualitative research, which

is to gain an in-depth understanding of the research question. Since this research explores a

relatively unexplored territory, the use of open-ended questions was beneficial for gaining an in-

depth understanding of the research problem (Greeff, 2011).

Making use of open-ended questions also assisted in getting to know, as best as possible, what each

participant was thinking (Neuman, 2003). Open-ended questions had the advantage that they gave

the participants the opportunity to express themselves in their own unique way. No predetermined

words or phrases were given to the participants to choose from, which made this possible (Glicken,

2003). An example of an open-ended question was: ‘What challenges do you experience in the

forming of a relationship with these children?’ Glicken (2003) stated that the answers to questions

are not as vital as the questions that are asked. I agreed with him and felt that the questions

determined not only the quality of the answers, but also the focus of the discussion. Open-ended

questions also assisted in determining whether the research questions were answered.

Questions that can be used in a focus group (as per Liamputtong, 2011) can include ‘stating

questions’, which are more specific. ‘Direct questions’ are another form of inquiry, but should be

kept for later in the discussion because the participants need to give their own opinion first.

‘Indirect questions’, for example in the format of projecting questions, could assist in not just

obtaining information about the attitudes of others, but also of the participant (they might not

communicate it directly initially). The researcher may also make use of questions that provide

structure or which assist with interpreting what the participants have said (Liamputtong, 2011).

‘Structuring questions’, for example, can assist the participants to conclude the one theme and to

start focusing on the next theme. The ‘interpreting question’, on the other hand, assists the

researcher to make sure that he or she understood the participant correctly.

3.5.4 Focus groups with child-and youth-care workers

Morgan (as cited in Greeff, 2011) describes focus groups as a technique used in research to obtain

data regarding a particular topic, through a discussion in a group context. According to Krueger and

42

Casey (2009), a focus group consists of people with certain characteristics who can provide

information in a focused discussion, in order to assist others in understanding the research topic.

Focus groups would not be suitable, therefore, if the participants did not have knowledge or

experience of the research topic.

A focus group is described by Bloor et al. (2001) as a discussion between six to twelve participants

on a given topic. Krueger and Casey (2009), however, indicated that the ideal size for a focus group

is five to eight participants. Groups larger than this are more difficult to manage and all the

participants do not necessarily get sufficient time to give their input. Bloor et al. (2001) agree,

explaining that a large number of participants can prove problematic since the participants might

feel that the time available for them to air their views was limited. For example, a group consisting

of nine participants that is conducted in 90 minutes provides limited time for each participant to

raise their views. Focus groups consisting of four to six participants are becoming more prevalent.

Smaller groups are easier to control, and participants might feel more comfortable in smaller groups

(Krueger & Casey, 2009). A disadvantage of smaller focus groups is that it limits the amount of

information or experiences which the participants bring to the group. A disadvantage of bigger

groups, on the other hand, is that more outgoing participants might dominate the discussion in

larger groups, leaving little room for others to participate.

Because it was necessary for the participants to have adequate time to share their experiences, I

limited the total number of participants in each focus group. The number of participants therefore

ranged from five to eight caregivers who had experience in working with children with attachment

disorders. I decided to conduct smaller focus groups because I needed to understand the caregivers’

viewpoints on their experiences as well as obtain in-depth information of these experiences

(Krueger & Casey, 2009).

According to Stewart, Shamdasani and Rook (2009), focus groups are advantageous because data

can be collected more quickly from a group compared to the time it would have taken to obtain the

same amount of data from individuals. The focus groups also gave me the opportunity to interact

with the participants directly. I could therefore ensure that I understood their contributions correctly

and was able to probe for more information, where necessary. I also returned to Focus Groups 1 and

2 to conduct follow-up focus groups (see Table 1) in order to ensure that I understood correctly the

information that they had provided. I did not conduct a follow-up focus group with Focus Group 3

because I decided to include the valuable information provided by Focus Group 1 in the study, and

not to use it as the pilot focus group anymore. The aim, as per my proposal, was to include the

43

information obtained from two focus groups. The data provided by Focus Group 3 was however

weak in comparison to the data obtained from Focus Groups 1 and 2 and the data from Focus Group

1 was therefore included. Despite the fact that the follow-up focus group of Focus Group 2

recorded, valuable information was still lost due to the session that did not record.

Table 1: Description of the five focus group sessions

Number of

participants

Was the session

recorded?

Was the session

transcribed?

Focus Group 1, Session 1 6 Y Y

Focus Group 1, Session 2 5 Y N

Focus Group 2, Session 1 8 N N



The discussions were monitored, directed where necessary, and recorded. The duration of each

focus group was between 84 minutes and 120 minutes. According to Stewart et al. (2009), the

duration of an average focus group is between 90 minutes and 150 minutes. Bloor et al. (2001)

stated that if participants took part in a focus group without being paid, it is courteous to not take up

more than two hours of their time. The reason for conducting the focus groups at the CYCCs was

because it was convenient for the caregivers, the location was easily accessible for them, and no

extra time was needed for the caregivers to travel to and from the focus group discussions. Despite

this convenience for the caregivers, only three participants out of the eight initial participants

attended the second session with Focus Group 2.

Stewart et al. (2009) argue that an additional advantage of focus groups is that it enables the

participants to respond to each other’s input. The participants are thereby reminded by the other

participants of any additional information or input that they could contribute to the discussion. This

contributes to additional data being obtained, which would not have been the case if individual

interviews were conducted. The disadvantage to this can be, however, that this interaction could

have possibly influenced a participant’s views. Having less control over the information that is

shared and the interaction within the group can prove to be a disadvantage (Litosseliti, 2003). For

the more experienced researcher however, this might prove to be an advantage because having

information in the participants’ own words can outweigh the disadvantage.

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Further limitations in conducting focus groups, which Litosseliti (2003) identifies, include the bias

of researchers and the possibility of researchers influencing the direction of the discussion in order

to answer their own prejudices. Analysing and interpreting the information collected from the focus

groups proved to be difficult because of the explorative nature of these focus groups.

The ability of the researcher to observe and analyse the interaction of the participants and the

quality of the information provided by the participants is vital to the success of a focus group

(Paton, as cited in Krueger & Casey, 2009). This greatly influenced the inferences that were made.

For example, I did not always realise when the discussion steered away from the topic or the

question that was asked. With Focus Group 2, the discussion at some stage focused more on the

general challenges experienced within the organisation than on the challenges experienced working

with children with attachment disorders. Once I realised this, I attempted to focus the discussion

back onto the topic and question at hand.

3.5.5 Finishing of the sessions

I finished the sessions by indicating that the focus group discussions were almost finished and by

informing the participants that I was asking the last question (based on the Questioning Route).

Once they had answered the last question and any other probing questions which followed from this

question, I summarised the sessions by stating what I had heard the participants say. I also

acknowledged the contribution that they make in the CYCC and their input in the focus group

discussion. I then asked the participants if there was anything else that they wanted to add, which

they felt I or we had left out, or if there was anything they would have liked to ask. This gave the

participants the opportunity to raise any questions that they may have had (Liamputtong, 2011).

Once the participants gave their final input and started talking in general, I concluded the session by

thanking them and by informing them that their participation and input were valued. I also informed

the participants, at this point, that a follow-up session was going to be conducted and that the

purpose of this session was to confirm that I had understood correctly what they had said, and that it

would not be as lengthy as the first session. The participants then helped themselves to some food

and something to drink. Because the participants were relaxed while enjoying the refreshments, it

gave me the opportunity to obtain clarity on some of the points that were discussed during the focus

group session (Liamputtong, 2011). I found that when I conducted the second sessions with Focus

Groups 1 and 2, the participants were more relaxed and spoke more openly than during and after the

45

first sessions. This could possibly be attributed to the fact that I was no longer a complete stranger

to them.

3.5.6 Recording and transcribing

Four of the five focus group sessions were recorded: the first sessions with Focus Groups 1 and 3,

and the second sessions with Focus Groups 1 and 2. Three of these sessions were then transcribed:

the first sessions with Focus Group 1 and 3, and the second session with Focus group 2. As

mentioned earlier in this chapter, the first session with Focus Group 2 did not record because I had

pressed the ‘on’ button but not the ‘record’ button. This was unfortunate because I felt that this first

session with Focus Group 2 was an excellent account of the caregivers’ experiences. Because the

first session with Group 2 was not recorded, the decision was made to also transcribe the first

session with Focus Group 1, in order to expand the dataset and provide key input which might have

otherwise been gained if the first session of Focus Group 2 had been recorded and transcribed.

Marshall and Rossman (2011) describe the difficulties of transcribing the spoken word, for

example, having to judge where to place a semicolon in a sentence. Some of the non-verbal cues,

which contributed to the meaning of the discussions, might also have been lost because I did not use

a video recorder. I did, however, listen to the recordings of each focus group more than once,

especially of the transcribed focus groups; this assisted me in identifying additional information and

cues given by the participants, which I may have missed at first. After conducting the first session

with Focus Group 1, I listened to the contents, made notes, and then had a follow-up focus group

with the same participants, three weeks later, in order to determine whether or not the meaning I

had attributed to their input was correctly understood. The transcription of the first session with

Focus Group 1 was completed at a later stage.

I conducted the follow-up session with Focus Group 2 a week after the first session (which did not

record) with this group. To repeat the exact same situation as the first session was not possible

(Schurink et al., 2011). It was not easy to follow-up with this group, since I had no recording to

listen to and I only had the notes that were made directly after realising that the session was not

recorded. It might have been better if I had allowed more time (not only a week) for the caregivers

to arrange another group, because more caregivers might have been able to attend if it was held at a

later stage. I was nervous, however, because I felt that I had ‘lost’ valuable information from this

session’s discussion, and I wanted to try and get these participants’ input recorded as soon as

possible.

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3.5.7 Follow-up sessions with the caregivers

Once the first session with Focus Group 1 was transcribed, I met with the caregivers for a second

time. During this follow-up session, the information obtained from their first session was discussed

with the caregivers to determine whether it was correctly understood and to clarify any

misinterpretations (Appendix M). After the follow-up session with Focus Group 2, I also asked the

two social workers who work at the same CYCC for feedback, via e-mail, regarding some of the

questions on the Questioning Route. I did this because the number of participants was limited (only

three). One of the two social workers responded to my request and provided feedback via e-mail,

which I incorporated into the findings.

I did not conduct a follow-up session with Focus Group 3 because I decided that Focus Group 1

would not just be seen as a pilot test group anymore, but the information from this group would also

be included in the dataset. Since the ideal for this study was to include input from two focus groups,

I felt that it was sufficient to include the data from the two sessions with Focus Group 1 and not

hold a second session with Focus Group 3.

3.5.8 Interviews with key informants

Krueger and Casey (2009) indicated that the use of other data collection methods is beneficial

because if the various methods provide results which overlap, it increases the confidence in the

findings and thus the overall study. For this reason, I approached two key informants to provide

commentary on my findings from all the focus groups. They provided commentary in the form of

track changes on the electronic copy of the findings from all the focus groups. The input from the

key informants was valuable because it assisted with obtaining a deeper insight into the data. For

example, some of the caregivers learned that they need to set an example for the children and that

they can do it through the way they interact with their own family. One of the key informants

provided a deeper insight when she stated that: “I have experienced that the most effective childcare

workers are those who are grounded within stable family circumstances themselves.”

According to Neuman (2003), a key informant should have the following qualities in order to make

the best possible contribution: they should know the area of expertise very well and actually be

involved in the specific topic of research. I therefore used the following purposive sampling criteria

to select the key informants (Maree, as cited in Strydom & Delport, 2011): they should be social

47

workers by profession, which ensured the disciplinary lens for this study; they have residential care

experience; and they have expertise in working with children with attachment disorders. I consulted

with my supervisor in order to identify the most appropriate informants.

Both key informants had previously worked at CYCCs as social workers. At the time of the study,

they were still rendering services to the CYCCs, while also being involved in their own private

practices. I presented the two key informants with the findings from the focus group studies in the

form of a draft of my chapter 4. I invited the two key informants to provide commentary on the

findings from these focus groups and asked them to identify any further training needs for

caregivers who look after children with attachment disorders. The key informants provided

feedback by making changes to, and writing comments on, the Microsoft Word document that

contained the compiled findings: these were all sent via e-mail. The key informants received a

financial payment for the time that they invested in this (Appendix L).

3.6 Data analysis

I used Creswell’s data analysis spiral because the research was conducted in analytical circles and

not in a linear manner (Schurink et al., 2011). I developed a framework to guide the thematic

analysis. The analytical steps included managing, planning and organising the data for analysis;

repeated revisions in data-collection strategies and the information obtained; writing field notes on

emerging ideas; and identifying themes that emerge. Further steps included the repeated reading of

the transcripts, coding of the data according to categories, and analysing the data by making

comparisons (Schurink et al., 2011). Findings were tested against the original data and literature,

and then interpreted (Schurink, Fouché, & De Vos, 2011).

I started by reading each transcript a few times. The repeated reading of the transcripts helped me to

form a picture of the input that was given and the data that was collected. Schurink et al. (2011)

highlight how important it is for the researcher to read the transcripts multiple times before he or

she starts identifying the themes. The repeated reading assisted me in identifying the codes, and

later with adjusting or changing the coding of the data, where necessary.

After immersing myself in the transcripts, I began the process of coding the data. Coding is

described by Grinnell and Unrau (as cited in Schurink et al., 2011) as the process of identifying and

labelling the categories that emerge from the data. According to Flick and Charmaz (as cited in

Schurink et al., 2011), coding can be done in various ways, for example, by coding each sentence,

48

each line or each paragraph. I labelled the data by highlighting it line-by-line in a different colour,

according to four categories: definitions and descriptions of what constitutes attachment disorders

(yellow); challenges of caring for children with attachment disorders (green); lessons learned by

caregivers (blue); and caregivers’ training needs (pink).

Multiple readings of the transcripts helped me to adjust the coding where necessary, for example,

where I obtained insight that a certain line should rather be colour coded according to ‘challenges

experienced by the caregivers’ (green) and not ‘lessons learned by them’ (blue). Once I had done

this line-by-line coding on the transcripts, I started writing down short phrases or key concepts of

what was highlighted on the transcripts, onto small, coloured pieces of paper; these coloured papers

were then placed under the identified theme, on a big, blank sheet of paper (see an example in

Appendix E). This meant that if a participant identified, at the start of the focus group (within the

first few paragraphs of transcript), a challenge that she had experienced with a child with an

attachment disorder, while other challenges were only mentioned later, I still grouped all this data

under the same category. Data which presented on a regular basis, or patterns that were identified,

were written down in single words (words which could best describe the theme/issue). In order to

keep track of where a particular theme/issue came from, I numbered each line and each transcript;

the line number and the transcript it belonged to were thus also written on the coloured paper that

contained a particular word/phrase. This made it easier to refer back to the transcripts when I could

not remember the context of the discussion or what was meant by it. Once the data was categorised

into themes, I had to determine whether all the identified themes were applicable to the study and

which themes were referred to by more than one focus group. By asking myself whether the theme

was discussed or referred to by more than one focus group or participant, I was able to group the

themes further and in this way, could also reduce some of the data.

I then started writing up the findings which emerged from the data analysis. I condensed any of the

findings which were similar and referred back to the transcripts to include actual phrases that the

caregivers had said. At this point I also reflected on what is said in the literature about the particular

findings and included these references in the write-up of the findings. Once approved by my

supervisor, I forwarded this document to the key informants for commentary. I adjusted the

structure of the findings after reading through the document again and realising that some of the

information was still quite similar and could therefore be condensed further. I also changed the

names of the participants in order to ensure confidentiality.

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3.7 Trustworthiness

Lincoln and Guba (1985) described trustworthiness as the ability to convince others that the study

and its findings are worth taking note of. Rossouw (as cited in Delport & Fouché, 2011) asserts that

findings need to be credible. The methods, which were used to generate the findings, need to

therefore be trustworthy. The questions that I needed to ask myself, in order to enhance the

trustworthiness of the methods and thus the credibility of the findings (Lincoln & Guba, 1985),

were:

How will I enhance confidence in the findings and prove that the findings are the ‘truth’ for

the caregivers and the context of the study?

How do I determine whether the findings can be applied to other caregivers in the same

context?

Could I determine whether the findings were consistent? If I were to conduct the study

under similar circumstances, would it generate similar results?

Did I remain neutral throughout the study? Were the findings the result of the caregivers’

input rather than my own bias or perspective?

I enhanced the trustworthiness of the data by purposively selecting participants who have

experience in the field and who were able to report on the phenomenon under investigation. The

participants had at least six months’ experience in working with children with attachment disorders

and most of them had been working at the institutions for two years and more. The participants also

had an interest in children with attachment disorders.

3.7.1 Dependability

Dependability is described by Mertens (2012, p. 29) as paralleling reliability: this “means that there

is consistency in the measurement of the targeted variables.” According to Schurink et al. (2011, p.

420) dependability is also the researcher’s attempt to account for “changing conditions in the

phenomenon chosen for study as well as changes in the design created by an increasingly refined

understanding of the setting.” Dependability also refers to whether the research process was

conducted in a logical manner, if records were kept of the process, and whether it was audited

(Schurink et al., 2011). According to Lincoln and Guba (1985), an inquiry auditor determines

whether the process that was followed during the study was satisfactory; if he or she finds it

acceptable, they agree to the dependability of the study. The inquiry auditor also inspects the

product, which includes looking at the data that was obtained, looking at the findings and the

50

recommendations that were made, and considering whether the recommendations are supported by

the necessary data.

To increase the dependability of this study, I used the same questioning route for all three focus

groups. The participants were therefore asked the same questions, as per the questioning route. New

questions that were not on the questioning route were asked when the participants gave input that

necessitated a follow-up question (i.e., exploration taking place). The purpose of these questions

was to clarify and understand what a participant had said. After I conducted the first focus group, I

did not find it necessary to adjust the questions on the questioning route. Although I did realise after

making use of the questioning route the first time that it was not easy to get answers from the

participants on what their training needs were, I did not feel that it was necessary for me to change

the questions on the questioning route. I saw the difficulty of getting responses from participants on

their training needs as related more to issue of these participants not knowing how to articulate their

needs, rather than the structure of the questions themselves.

3.7.2 Confirmability

Confirmability is described by Mertens (2012) as when the findings are ‘objective’: this indicates

that there is no bias present. Confirmability is ensured by providing proof of where the data was

obtained and by providing extracts from the data to support the findings. Lincoln and Guba (as cited

in Schurink et al., 2011, p. 421) indicated that confirmability is when “the findings of the study

could be confirmed by another.” Evaluation in this case takes place by focusing on the data and not

on the ability of the researcher. Lincoln and Guba (1985) indicated that the main technique to

establish confirmability is by means of the confirmability audit. Halpern (as cited in Lincoln &

Guba, 1985, p. 319) identifies several ‘audit trail categories’ and I applied these to my research as

follows:

Raw data: This included the recordings of the four (out of the five) focus group sessions. It

also includes the transcripts of the first session with Focus Groups 1 and 3 and the transcript

from the second session with Focus Group 2. Two pages of one of the transcripts are

attached (Appendix F) as an example. I then coded each line of the transcripts according to

the different, emerging categories, by using a different colour for each of the four main

categories (Appendix G).

Data reduction and analysis products: These included the field notes (Appendix H) that I

made after the first session with Group 2, once I had realised that the recording had failed.

For these notes, I wrote down as much as possible of what I could remember of what each

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member had said. The data reduction and analysis products also included the field notes

(Appendix I) that I had made before the commencement of the focus groups, which

indicated who sat where. Some of the identifying details of the participants were also added

then, or were added during the conduct of the focus groups, or soon afterwards. While

listening to the recording of the focus group that was not transcribed (session 2 with Focus

Group 1), I also made notes of what was said, who had said what, and the time (on the

recording) that it was said. By making notes of certain information from the recordings, I

was able to condense (reduce) the data (Appendix K).

Data reconstruction: After coding what was said from the transcriptions, I condensed the

findings by writing key words or phrases that summarised the information onto coloured

paper. These were then put on a poster under the headings of the different themes (Appendix

E). This method gave me the flexibility to place the findings (coloured paper) under a

different theme if I found, at a later stage, that it was more suitable under another theme. I

then started writing up all this information. I obtained the feedback from the key informants

via e-mail and included this in the write-up of the data. An example of one of the key

informants’ feedback is attached (Appendix L).

Process notes: I kept a journal (Appendix J) of what I did as part of the research process.

The keeping of process notes also proved vitally important; by keeping the research

proposal, for example, I was able to reflect on and determine whether the original intentions

were addressed in the study.

Confirmability was facilitated by giving a step-by-step account of how the data was obtained and by

keeping an audit trail of how the data was processed analytically. This provides evidence that my

interpretations are grounded in the data (Lincoln & Guba, 1985). Lincoln and Guba (1985) stated

that an audit trail is vitally important when a study is conducted, and records should be kept because

it assists in, for example, cross-referencing and prioritising the information obtained. Various steps

were taken in the process of ensuring the confirmability of the findings. According to Lincoln and

Guba (1985), these steps include tracing the findings that seem strange back through the audit trail

to the notes that were taken when that data was first collected (e.g., the focus groups). I did this

when I needed to clarify the context within which something was said. I also had to ensure that the

conclusions that were made from the information obtained were logical. To determine whether the

conclusions drawn were logical, I looked at how I had analysed the data, if the categories were

correctly labelled, and if the conclusions that were drawn and the interpretations made were made in

relation to the data obtained.

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3.7.3 Credibility

Schurink et al. (2011, p. 420) argue that credibility is obtained when one is able “to demonstrate

that the inquiry was conducted in such a manner as to ensure that the subject has been accurately

identified and described.” The researcher needs to reflect on whether they have presented the

participants’ views and input correctly and accurately. One way that a researcher can improve the

credibility of a study is through triangulation (Lincoln & Guba, 1985). Maxwell (2009) defines

triangulation as the collection of data through various methods. This can improve the credibility of

the findings and interpretations (Lincoln & Guba, 1985) by generating overlapping findings. I also

referred back to the transcripts, the poster, and the results in Chapter 4 to ensure that the

information was captured and presented accurately.

Triangulation can also help to reduce various risks, such as bias. According to Royse (2008),

triangulation can be described as the obtaining of information from various sources or when a

variety of techniques are used to collect data, in order to determine if similar trends can be

identified from the data. It also allows for double-checking, in order to identify irregularities or

distorted information. In this study, I used the two key informants as a secondary source; by giving

commentary on the findings, these two informants were able to help me ‘double-check’ the input

that I had obtained from the focus groups.

Credibility was also enhanced because I made use of member checking. Marshall and Rossman

(2011) define member checking as the researcher asking the participants if he or she understood

them correctly. In my case, this involved giving the participants feedback on my analysis of their

accounts, during the follow-up sessions. Cutcliffe and McKenna (as cited in Boeije, 2010) stated

that participants then has the opportunity to confirm whether the researcher’s observations and

interpretations of their account of their experiences were accurate. The follow-up sessions with two

of the three focus groups also gave me the opportunity to determine whether their responses were

consistent with the initial session and if I had understood them correctly. These follow-up sessions

and the fact that I had asked myself questions throughout the session, such as whether there is

something hindering the caregivers from being open about the topic, contributed to the credibility of

the process (Neuman, 2003).

What became apparent during the first focus group sessions with Focus Groups 1 and 2 was that the

caregivers appeared to not be that comfortable with giving input. I felt that this hesitation might be

because the caregivers knew that I was a social worker. During the focus group discussion, the

53

caregivers indicated that they had a negative perception of social workers because they felt, for

example, that social workers in the institutions did not listen to them. Once I had indicated that I did

not know what their work entails, that there was no wrong or right answer, that their input was

going to be treated as confidential, and that their contribution might assist other caregivers, they

appeared to be less wary of me and participated more readily.

3.7.4 Transferability

Transferability is described by Mertens (2012, p. 29) as when “the results of a study can be

generalised to other samples from the same population.” To enable transferability, the researcher

needs to provide adequate information on the participants, as well as where the research was

conducted. It can then be decided by those who want to conduct a similar study, whether or how the

information can be transferred to their own setting. Lincoln and Guba (as cited in Schurink, Fouché,

& De Vos, 2011) see this as the qualitative alternative to external validity in quantitative research.

Transferability is described by Schurink et al. (2011) as the possibility that the findings of a study

can be transferred from one situation to another. Transferability is often seen by traditional

methodologists as a weakness in the qualitative approach (Schurink et al., 2011).

Lincoln and Guba (1985, p. 316) stated that the naturalist would often only provide a ‘thick’

description and then leave it up to those interested to conclude whether the findings can be

transferred from the research situation to another situation. I improved the transferability of the

study by using three CYCCs and by providing extensive quotations from participants, especially

where their input overlapped: this also led towards thick descriptions of the findings. Making use of

triangulation also assisted with enhancing transferability.

3.8 Ethical considerations

The key ethical considerations for this study were confidentiality, informed consent, avoidance of

harm, voluntary participation as well as debriefing of participants. Confidentiality is when personal

details are provided to the researcher on condition that they will not be shared with anyone else

(Royse, 2008). To ensure the confidentiality of the participants in this study, the identities of the

participants and the CYCCs were kept anonymous. No information is included in the research

report that could point to a specific participant or the CYCCs where they work. The recordings that

were made of the focus groups were only made for the purposes of this study and will not be

54

released to others. The transcriptions of recordings have been stripped of identifying information,

such as names of people and places.

Data was collected from organisations which I did not work for. This reduced any bias or personal

subjectivity which I might otherwise have had if I did work for these organisations. Participants

were provided with an information sheet about the study ahead of the focus groups and data

collection. Participants were asked to sign a consent form for their participation, for the audio

recording of the data collection, and for their information to be used in the research study.

Plagiarism was eliminated and monitored by submitting the research through the ‘Turn-it-in’

plagiarism screening programme.

According to Strydom (2011) participants can be harmed not only in a physical manner but also in

an emotional manner. The participants therefore have to be informed beforehand of the impact a

study could have on them in order for them to be able to withdraw if they want to. Physical harm

can come to participants in for example their work situation (they might lose their work) if the

researcher does not keep the participants’ input confidential. The participants were informed

beforehand of what the study entails by providing them with the necessary information (Appendix

A and Appendix B). The study and the purpose of the study were again discussed before the

commencement of each focus group and time was allowed for questions by the participants if

something was unclear.

Before the commencement of each focus group the researcher also confirmed with the participants

whether they were participating in the study on a voluntary basis. Rubin and Babbie (as cited in

Strydom, 2011) stated that participation should be voluntary and not compulsory. The participants

confirmed that they were attending the focus groups voluntarily. The participants were debriefed

after each session which appears to have been of benefit to them as well as the study.

McBurney (as cited in Strydom, 2011) stated that the debriefing of participants entails that they can

discuss their feelings regarding the study immediately after the session and can ask questions they

might have. It is during this debriefing session that the researcher, according to Babbie (as cited in

Strydom, 2011), can learn of mistakes that were made in the research process and can correct it.

Participants were given the opportunity after each focus group to discuss their feelings regarding the

questions that were asked as well as their experience of participating in a focus group. These

debriefing sessions assisted me in ensuring that I understood what was said, correctly.

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3.9 Limitations of the research methodology

The fact that I am a social worker could have limited the caregivers’ responses to the questions,

since some of them had negative perceptions of social workers.

The Questioning Route assisted with structuring the questions and making sure that all the

necessary questions were asked. Despite this, some of the caregivers deviated from the questions

asked and I had to sometimes re-focus the group back to the question at hand.

Writing field notes while the focus groups were in process proved to be a challenge because writing

during the focus group sometimes interfered with the flow of the discussion. For example, the

participants would often stop talking while I was busy writing. I therefore tried to make field notes

quickly before the commencement of the focus groups or once I had arrived home, so that I could

focus my full attention on listening to and guiding the discussion. These field notes included the

seating arrangements of the participants, their age and how many years they had been working at

the current CYCC. I neglected to get some of this information from some of the caregivers and had

to approach them afterwards, or at the follow-up session, to obtain these details from them.

Contacting some of the participants after the focus groups proved difficult, since some had either

left the organisation, or for most of them, there was only one contact number or e-mail address

where they could be reached at the CYCC.

3.10 Problems experienced

Problems experienced while conducting the study included the following:

The tape recorder did not tape the first session of Focus Group 2. When I held the second

session of Focus Group 2 in an effort to ensure that I had recorded their views, only three of

the original eight participants attended.

Despite forwarding the ‘Information Letter’ (Appendix A) and the ‘Participant Information

Sheet and Consent Form’ (Appendix B) to the participants prior to the conduct of the focus

groups, not all of them received these letters beforehand. Focus Group 3 still did not know

what the term ‘attachment’ entailed, despite sending them the information letters.

Not all the caregivers who participated in the study had two or more years of working

experience in the same CYCC, as required by the criteria for selecting participants. Three

participants, for example, had only one year of working experience in the same CYCC,

while one participant had only nine months. The participants’ total years of experience

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working in CYCCs were between five years and 36 years, excluding one participant who

had only nine months of experience in total.

3.11 Conclusion

The research methodology, as discussed in this chapter, provided a framework for how the data was

collected, analysed and processed. The study adopted a qualitative approach and was exploratory in

nature. The decision to make use of the qualitative approach was guided by the aim of the study,

which was to gain an in-depth, ‘thick’ description of caregivers needs when looking after children

with attachment disorders. The methods and the process that was needed to obtain the data were

decided on before starting with the study. Five focus group interviews were conducted with three

groups of child-and youth-care workers working at three CYCCs. Follow-up sessions were held at

two of the three centres; the third was omitted because I initially did not envision that all three of

the focus groups would be included in the study. The focus groups consisted of three to eight

participants each. The participants comprised of caregivers who had experience in working in

CYCCs with children with attachment disorders.

A Questioning Route was used to guide the focus group discussions. Notes were made before and

after the focus groups. Data was analysed and themes were identified. Interviews were held with

key informants and the data was reduced and condensed after reading through the write-up of the

findings a second time.

Input from the two key informants, who were social workers with experience working with children

with attachment disorders in CYCCS, was included in the findings. The findings were narrowed

down by excluding categories which did not relate directly to the research questions.

The next chapter will present the findings of this study, which were obtained from the participants

in the focus groups and from the key informants. This chapter will also reflect on relevant literature

and how the findings relate to this literature.

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Chapter 4: Results

4.1 Introduction

This chapter presents and discusses the findings of the study. Data that was collected from the focus

groups and two key informants are presented and interpreted in relation to the themes that emerged

from the findings. The findings are discussed in relation to the theory and the objectives of the

study. The findings indicate that working with children with attachment disorders is not only an

interpersonal challenge, but also an organisational challenge for the caregivers. The findings also

indicate that caregivers need assistance and training in how to work with children with attachment

disorders.

4.2 Introduction to the participants

The participants and key informants were the primary sources for the data. Their demographic

profiles are tabulated below (Table 2).

In addition to the participants in Table 2, Lorraine is a social worker at the CYCC where focus group one of the two

focus groups which were conducted, did not record. Her input was obtained on some of the questions in an attempt to

gather more information from this specific CYCC since information was lost because of the failed recording. Her age at

the time of the study was 33. She has been working in the CYCC for 3 years and her total number of years working in

CYCCs is three years. She does not live on the premises, was single at the time of the study and she had no children.

The total number of participants was therefore 19 and one social worker because Lorraine did not comply with the

sampling criteria of being a caregiver.

The total number of participants who were single at the time of the study was six, seven were married, one was a

widow, three were divorced and one’s marital status was unknown. The participants who were living on the premises

were 12 in total, those living off the premises were six and the living arrangements of one of the participants are

unknown. Nine of the participants had no children, six participants had children who were independent, the status of

one in this regard is unknown and the number of participants whose children are living with them are two. The two key

informants were both married, they did not live on the premises and both had children who were still dependant.

Because some of this information was obtained at a later stage, not all the relevant information were available, hence

the ‘unknown’ in some cases.

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Table 2: Demographics and important information about each participant in this study

Participants* Age at time of

data collection

Years

working at

CYCC

Total experience

in CYCCs (years)

Live on

premises? Marital status/children

Alice 52 5 10 Yes

Amo 26 6 6 No Single, no children

Annalise 66 18 18 Yes Divorced, children

independent

Elizabeth 68 7 7 Yes Married, children independent

Jenny 66 16 19 Yes Divorced, children

independent

Juanita 55 1 6 Yes Married, children are

independent

Leonie 37 5 15 Yes Married, children live with her

and her husband

Lerato 46 6 7 No Single, no children

Lindsey 44 9 months 9 months Yes Divorced, children

independent

Lizzy 45 5 25 No Single, no children

Louise 50 1 30 Yes Single, no children

Nomvula 33 5 5 No Single, no children

Pat 57 1 30 Yes Married, no children

Riana 46 3 17 Yes Married, have children who

live with her on campus

Sandra 41 3 23 No Married, no children

Sonja 59 36 36 Yes Widow, no children

Thandeka 8

Thea 61 15 17 Yes Married, children independent

Zanele 40 5 9 No Single, no children

Key Informant

1 (social

worker)

39 13 13 No Married, two dependent

Children

Key Informant

2 (social

worker)

41 15 15 No Married, two dependent

children.

* Names of the participants have been changed to ensure anonymity

4.3 Themes

The following themes, which are presented under the various sections and sub-sections in this

chapter, are identified in relation to the objectives of this study (Table 3):

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Table 3: Identified themes and sub-themes in this study

Themes Sub-Themes

4.4 Theme one: Interpersonal challenges

experienced by caregivers in caring for a

child with an attachment disorder

4.4.1 A child with an attachment disorder

4.4.2 Behaviour of a child with an attachment disorder

4.4.3 Relationship with a child with an attachment disorder

4.4.4 Feelings experienced by caregivers who work with children with

attachment disorders.

4.4.5 The caregivers’ family

4.4.6 What does the future of a child with an attachment disorder look

like?

4.5 Theme two: Organisational

challenges experienced by caregivers in

caring for a child with an attachment

disorder

4.5.1 The number of children per caregiver

4.5.2 Communication within the institution

4.5.3 Time

4.5.4 Social workers

4.5.5 Debriefing

4.5.6 Management style

4.5.7 Discipline

4.6 Theme three: Lessons learned by

caregivers in caring for a child with an

attachment disorder

4.6.1 Coping with the behaviour of a child with an attachment disorder

4.6.2 Forming a relationship with a child with an attachment disorder

4.6.3 Disciplining a child with an attachment disorder

4.7 Theme four: Training needs of the

caregivers

4.4 Theme one: Interpersonal challenges experienced by the caregivers in

caring for a child with an attachment disorder

The caregivers identified interpersonal and organisational challenges experienced by them when

working with a child with an attachment disorder. The interpersonal challenges experienced by

caregivers vary from one caregiver to another and are unique to each person. One caregiver might

find, for example, that forming a relationship with a child with an attachment disorder is more

challenging than balancing their own family life, in terms of the time they spend with these

children. Another caregiver might, however, find his or her challenge to be just the opposite. The

interpersonal challenges experienced and identified by the caregivers working with children with

attachment disorders include the behaviour of these children, what it entails to form a relationship

with these children, the feelings and emotions experienced by the caregivers while caring for these

children, the impact taking care of these children has on the caregivers’ own families, and what the

future of children with attachment disorders might look like.

4.4.1 A child with an attachment disorder

Working with children with attachment disorders poses various challenges to caregivers. One of the

challenges experienced by caregivers is that the caregivers feel that they have to keep on trying to

help these children to heal, but that their efforts do not always seem to make a difference. The

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caregivers feel that they have to continue to try and help these children despite not necessarily

seeing any healing take place. Another challenge for some of the caregivers is trying to understand

how some of these children, who have been maltreated by their primary caregivers, continue to

protect the perpetrators, and how they continue to live in a fantasy world where these perpetrators

can do nothing wrong. It appears that it might have been easier for the caregivers to deal with the

child’s hurts if they knew the perpetrators received punishment, and if the child could acknowledge

that what the perpetrator did was unacceptable. Some of these children have a misconception of

what love means because of their history.

For some of these children, sex means that they are being loved and the caregivers face the

challenge of keeping these children apart in order for them not to have sex with one another. The

caregivers do not always agree with the manner in which the children are being kept apart because

according to the caregivers, the children do not learn to interact properly with the opposite sex. The

caregivers also identified several interpersonal challenges: the lack of feelings shown by these

children, the children’s inability to trust others, the children’s fear of forming of an attachment, and

the children not wanting to be touched. Caregivers are faced with the challenge of positively

impacting these children’s reference of what a relationship entails, despite being confronted by the

challenges mentioned.

Pat: “As childcare workers working here, we have to build-up so much in that child because to

me that’s a broken child. It is like a broken ornament that you are trying to stick together: a

piece of that broken ornament might keep falling off, but you got to try and try to put that piece

back.”

Key Informant 2: “I do not fully agree with this statement.” She was referring to the statement

made by Pat. “I have seen that children can change if the childcare workers are trained and

equipped to work with these children. I feel this is a huge problem in South Africa. Childcare

workers working in residential care settings are not always trained to work with children with

attachment problems. Some childcare workers who I have worked with before were not even

familiar with the term ‘attachment problems in children’.”

Key Informant 1: “Unfortunately the results of the care offered by childcare workers are often

only noticeable much later, when the child has reached adulthood.”

It appears that some caregivers might feel that children with attachment disorders cannot heal or

change. Key Informant 1 stated that change in these children might only be noticeable at a later

stage; hence caregivers might perceive that healing is not taking place. When change does take

place, the caregivers are not necessarily present because the child could have left the CYCC by

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then. Change appears to be possible, according to Key Informant 2, when caregivers are suitably

trained to work with these children.

Another interpersonal challenge caregivers experience is when some of the children with

attachment disorders protect the perpetrators who have maltreated them. According to the

caregivers, these maltreated children sometimes appear to live in their own fantasy because they

refer to the perpetrator, sometimes their own father, as somebody who cannot do anything wrong.

Some of the caregivers appear to find it difficult to understand why these children would protect the

perpetrators. Training is therefore acknowledged as critical for the caregivers to develop the

necessary skills that will assist them to work with children who protect their perpetrator.

Louise: “But she protected her family because she knows anything she says … she’s very

intelligent … anything she says … they were going to send her mother or father or whoever was

in her life … they were going to take them away.”

Key Informant 1: “We need to consider that the abusive relationship could be the only kind of

relationship that the child knows. The childcare worker then has the challenge to ‘teach’ the

child that relationships could also be loving and caring.”

Key Informant 2: “Children often protect the perpetrators when they do not feel emotionally safe

or when they are threatened. This issue can be resolved if the child receives sufficient individual

trauma therapy from a trained therapist, and if the childcare worker understands and is trained

to care for this child. The therapist and childcare worker needs to work together very closely.”

Golding and Hughes (2012) stated that these children might protect the perpetrators because they

blame themselves for what happened, and because they feel that it is not possible for them to be

loved. It might be the only relationship the child has ever known, as Key Informant 1 highlights,

and caregivers are faced with the challenge to teach these children what a positive relationship

entails. It appears that caregivers might be able to assist these children in this regard, if they receive

the necessary training and if they are provided with an environment where they can feel safe.

The caregivers are expected to keep the boys and girls separate from one another in order to prevent

them from having sex with one another. The children’s relationship with the perpetrators, who are

sometimes their primary caregivers, influences their concept of what ‘love’ is; these children

therefore have a distorted understanding of what love entails. If, for example, their father raped

them, the child might think that to be raped is to be loved. Some of the caregivers felt the way in

which the CYCCs dealt with this, by keeping the children separate, is unnatural and neglects to

teach the children how to interact appropriately with the opposite sex.

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Riana: “They don’t know what love is … what real love is about. For them love is money, food,

clothing, stuff like that. They don’t know what real mother love is. The girls then … for them to

show love to somebody … is by giving their body [ … and if somebody loved them, somebody

raped them.”

Louise: “They also just want you to love them and they fight for that position.”

Riana: “[It is not love but] possessiveness.”

Riana: “We have to keep them apart but we are doing it unnaturally, because now they never

learn to cope with the opposite sex.”

Key Informant 2: “This is true [that these children have a distorted understanding of what love

is] and that is why these children need specialised care. These children are mostly sexualised

and because of their distorted thinking, will easily get involved in sexualised activities with other

children. Even same-gender children need to be supervised.” [She indicated that she does not

fully agree with the statement that these children are being kept apart unnaturally]. “We need to

keep them apart in order to heal them, but as soon as they are healed, they can be re-introduced

into being close to and interacting with the opposite gender. I have been part of integrations like

this, with good results.”

Although caregivers feel that they have to keep boys and girls apart, Key Informant 2 indicated that

this is only necessary until healing has taken place. Due to the distorted understanding that these

children have of what love entails, they need to be first taught that love does not mean just having

sex or being raped, before they are allowed contact with the opposite sex.

According to the caregivers, some of the children do not only appear to be emotionally cut off, but

also appear to lack feelings and do not want to be touched. This poses a challenge to the caregivers

who must try to form a relationship with these children. Some of the caregivers felt that they cannot

have a breakthrough with these children because these children do not seem to trust others easily.

The children also do not know how to form a relationship with someone else; and when they do

trust someone, their relationship with this person can become very unhealthy. It appears that if

caregivers do not receive the necessary training, they might lack the skills required to address these

challenges. They might also not succeed in forming relationships with children with attachment

disorders.

Louise: “Trauma … causes them to be afraid and takes them long to attach to whomever. [These

children would sometimes describe their lives as] a mess.”

Thea: “They don’t want to be touched.”

Jenny: “He trusts the house mother but he is still wary of the other people. It sometimes takes

quite a while for them to actually trust you.”

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Lorraine: “If they do form trust, the relationship sometimes gets unhealthy and the child gets

very easily disappointed. They also will always test you to see if you still care for them, by

negative behaviour.”

Lizzy: “[It is] difficult for the children to reach out to them.”

Sonja: “Some of them just don’t know how to cope with adults. They cannot form a positive

relationship with anybody.”

Key Informant 1: “The childcare worker has such a challenge to understand each individual

child’s needs. Some do not want to be touched and others are clinging to the childcare worker

constantly.”

Key Informant 2: “Children with attachment problems do not trust adults and therefore it takes

them very long to trust, especially if they have been moved from one home to the other. Some

children will unfortunately never learn to form a secure attachment with an adult. Often they

want to be touched, but they do not know how to react to the touching. They will also push others

away if they feel emotionally insecure. They are often terrified of getting hurt emotionally and

therefore they will be very loving one day and push you away the next. The childcare worker

needs to know this, in order to keep on being consistent and not to take the rejection from the

children with attachment problems personally.”

Key Informant 2: “It is difficult to generalise on this point because I have seen children with

attachment difficulties who has managed to form very positive attachments with significant

adults in their lives. It did not come easy and therapeutic intervention (attachment therapy) is

often needed in these cases. Personality and genes also plays a role, and for some children it is

easier to attach than for others.”

Some of the children with attachment disorders appear to lack the necessary skills to form

relationships with others due to their lack of trust in others. According to the key informants, it is

important for the caregivers to not only understand these children, especially if they will be loving

one day and will push them away the next day, but also to not take their behaviour personally. It

appears that the caregivers also have to be consistent in their interaction with these children, in

order for these children to learn how to trust others.

According to Ritchie and Howes (2003), children who experienced, for example, neglect and abuse,

or whose parents presented with psychopathology, will find it difficult to trust new caregivers. From

their argument, it seems that these children would not trust the caregivers because they do not

believe that their caregivers will be able to provide them with a secure base that they can turn to if

they were to experience danger. Zeanah, Smyke, Kega and Carlson (2005) stated that the forming of

a positive relationship between a caregiver and the institutionalised child is possible but not likely.

They also stated that the caregivers’ interaction with and sensitivity towards these children might

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contribute to the forming of an attachment. It appears that the forming of an attachment with adults,

who these children do not trust, might be very difficult for them, but that, as Key Informant 2 and

Zeanah et al. argue, it is still possible.

The child with an attachment disorder poses a challenge to the caregivers because these children

lack interpersonal skills. It appears to be a daunting task to teach these children what real love

entails and what a healthy relationship entails. Although it is not easy and some of these children

might never learn to form trusting relationships, it appears that change is possible for some of the

children.

4.4.2 Behaviour of a child with an attachment disorder

The caregivers experience the behaviour of these children as a challenge and identified the

following behaviour that they might exhibit: aggressiveness, lying, sadness, stealing, swearing,

shouting, biting, kicking, screaming, spitting, bullying other children, not doing their chores, and

not accepting authority. They also described these children as demanding, clinging, isolating

themselves, rebelling against change, and not being able to remember from one day to another. It

appears that the behaviour of children with an attachment disorder can be linked to their emotional

status and their inability to manage their emotions. Children with an attachment disorder were also

described by the caregivers as emotionally immature because they would, for example, have

outbursts (laughing and crying) about anything, whether or not it was an appropriate response. The

caregivers also expressed their concern for their own safety when the children are aggressive

towards them or the other children.

The caregivers expressed their frustration with these children when, for example, the children tend

to forget what they were told to do and the caregivers have to repeat the same instructions several

times a day. These children also appear to exhibit their need for attention by being clingy, and by

being willing to do anything to please the caregiver. The other children sometimes get jealous

because of this and say that this child is the caregiver’s favourite; this would often result in the

jealous child bullying him or her.

According to the caregivers, children with an attachment disorder do not know how to express their

feelings and will act out in various ways. Even the smallest thing might ignite a negative response

from these children. The caregivers indicated that these children might not have the level of

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maturity needed to deal with certain feelings or emotions and because of this, might act out in an

effort to express themselves.

Lindsey: “And the behaviour comes out in the strangest ways because they can’t express that

they are feeling left out or that they are not getting enough [attention].”

Pat: “Because they haven’t got the maturity to adapt to any of those feelings [that] we have to

instil in them.”

Riana: “The smallest thing will make them shout at you.”

Key Informant 1: “Traumatised children often present with many different forms of behaviour

challenges. Often it is expected of the childcare worker to deal with all kinds of behaviour

challenges, which could leave them feeling exhausted and drained.”

Key Informant 2: “Children with attachment problems have never learned to regulate their

emotions in the care of their primary caregivers. A child learns to regulate emotions within the

secure attachment of their primary caregiver. The first two years of life is the most important

time to learn this behaviour. If this did not happen, you will see the results later in life. This is

also why it is important to teach children with attachment problems how to regulate their

emotions.”

Caregivers have to be well-trained in order to understand this behaviour. They also need to have the

skills to deal with the different kinds of behaviour exhibit by different children, otherwise the

experience might leave the caregivers feeling overwhelmed. Because these children were not able to

form a secure attachment with their primary caregiver at an early age, they did not have the much-

needed opportunity to learn how to regulate their emotions within that relationship. Hughes (2009)

argues that children who have developed a ‘secure’ attachment with a primary caregiver tend to be

more inclined to show positive emotional responses than the children who have formed ‘insecure’

attachments with their primary caregivers.

The outbursts and difficult behaviour appears to be a real challenge for the caregivers to deal with,

especially when they fear for their own safety. These children sometimes act very violently or

aggressively towards the caregivers, or to each other. The caregivers stated that they are also afraid

that they will get hurt, since some of the children have been quite abusive towards some of them in

the past.

Annalise: “I mean the boy that hit me like mad … he hit me so that I was blue like this … he was

only 10, 11.”

Louise: “They are hurting so much that they are just hitting and doing whatever because [of]

that anger that is in there and also because they have been bullied before.”

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Riana: “They will call you names, throw you with stuff, and spit in your face. The children with

attachment disorders will start kicking and screaming.”

Alice: “Hitting other children, not wanting to do chores.”

Amo: “Why you are afraid sometimes, we can get hurt you know.”

Key Informant 2: “[Caregivers getting hurt] does happen and I have experienced such incidents

before. But if the childcare workers are trained to handle this kind of behaviour, they will know

what to do. Often the childcare workers tend to handle the situation wrong and the child’s

behaviour escalates because the childcare workers tend to trigger the child. This often happens

when childcare workers raise their voices or becomes physical with the child. The childcare

workers need to learn how to de-escalate the situation when the child starts to act out.”

Fonagy et al. (as cited in Smith, 2011) stated that children, whose ability to regulate their own

emotions or deal with stress has been negatively impacted, might feel that they can only take

control over their anger for being rejected or abused by, for example, acting out in a violent and

aggressive manner. Some factors contributing to children’s violent and aggressive behaviour could

include experiences during their early years, their family, the area they grew-up in, and their

relationships with others (Smith, 2011). According to Pleasants, Snyder and Rogers (as cited in

Smith, 2011), one of the reasons for violent behaviour can be the child’s desire to bring about the

preservation of mental and emotional balance.

Children with an attachment disorder who are acting out in a violent manner are a reality, and

caregivers are correct to fear sometimes for their own safety. The caregivers need to receive the

necessary training to be able to deal with these situations and to assist the child to learn how to

regulate his or her emotions. It is sometimes the caregivers’ incorrect handling of situations (e.g.,

when they raise their voices in response to the child) that could trigger the child to respond badly. In

addition, this incorrect response is seen as something that does not help to calm the situation.

The child with an attachment disorder tends to forget the instructions from the caregivers. The

caregivers indicated that it is very irritating and frustrating to repeat the same things over and over

again. The caregivers do realise, however, that these children are not forgetful on purpose.

Jenny: “I go through a difficult patch with the children because you get frustrated and you get

irritable … because you are saying the same thing over and over and they are not listening.

Sometimes you feel that you are being rejected by the children and sometimes it feels …

fortunately it doesn’t happen too often that the children gang up against you.”

Riana: “They will forget that you just told them to go and brush your teeth. It cuts them off … the

trauma. They can’t remember.”

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Riana: “… tell them ten times in the morning to go and brush your teeth, go brush your teeth;

make your bed … every day. And it is not like they are stubborn or don’t want to do it. It is just

they can’t remember from one day to another day.”

Key Informant 1: “The traumatised child is often cut off from his or her senses because trauma

enters the internal world of the child, through their senses. Hearing, seeing, smelling, and

tasting is done in a different way when the child was exposed to trauma. The childcare worker’s

interpretation can be that the child is naughty, but this behaviour could be linked with their

exposure to traumatic experiences.”

According to the key informants, these children tend to forget seemingly simple instructions

because they have been traumatised. The caregivers need to remember that it is not because the

child is naughty, but that it might be because of the trauma experienced by the child.

According to the caregivers, some of these children have a longing or need for attention more so

than other children. These children might show this need for attention by being very clingy or by

doing anything to please the caregiver. The other children might then feel that these children are

being favoured by the caregiver and would bully them. Caregivers feel that they need wisdom in

how to deal with this.

Leonie: “They want all the attention for themselves.”

Elizabeth: “Then they get jealous of each other.”

Sonja: “Clinging, clinging, always clinging.”

Jenny: [She described the children’s need for attention as being so great that they are even

willing to page through her knitting books; even the boys] “just so that they can be there.”

Thea: “She is always around me.”

Sandra: [In describing the behaviour of the other children who might feel that the child is the

caregiver’s favourite, she explains how the jealous child will push the ‘favourite’ child away and

say] “You’re not one of us; you are the childcare workers’ pet.” [She explains what the

caregivers think of this] “We don’t see it as that. It is just that this child has got a problem … or

what is it?”

Key Informant 2: “This is often seen in children who have developed an insecure ambivalent-

resistant internal model of attachment. These children will attach and smother the childcare

worker, but will also easily reject the childcare worker whenever they feel threatened.”

The demand these children place on caregivers for attention could be overwhelming. The

caregivers’ response to this might be interpreted by the other children incorrectly: for example, the

other children might think that the caregiver is favouring this child. According to the key informant,

the child with an attachment disorder might want to attach to the caregiver the one day, only to

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reject the caregiver the next day. Caregivers need to not take this personally and to understand why

the child exhibits this kind of behaviour.

The behaviour of these children, which the caregivers are exposed to, includes being shouted at,

screamed, and swore at. Some of these children cannot manage their emotions and are emotionally

immature. Their behaviour, as a result of this, requires the caregivers to have certain skills in order

to be able to effectively manage the challenging behaviour of these children. One of the skills that

the caregivers would need is, for example, to know how to protect themselves and the other children

when these children are acting out aggressively towards them.

4.4.3 Relationship with a child with an attachment disorder

Forming a relationship with a child with an attachment disorder is a challenge, according to the

caregivers, because these children do not know what a trusting relationship entails. This can be

attributed to the history and background of abuse or neglect by the very people the child should

have been able to trust. Some of the caregivers described the situation these children could have

possibly grown-up in, and the circumstances they could have been exposed to:

Pat: “My input would be that they had terrible difficulty: I would say … from their birth, not

being wanted. They had no parental guidance in their surroundings of where they’ve been and a

lot of the children are looking after the children because the mum and dad are not available.”

Riana: “[When these children were smaller they] were never given that attention that a mum is

supposed to give a child from birth. So when they get to an age of six, seven, when we get them,

they don’t know about attachment. They don’t know how to bond with somebody. They don’t

know what love is … what real love is about.”

Sonja: “They have been hurt very badly and now they would rather hurt other people before they

get hurt themselves again.”

Amo: “They can’t... they don’t know how to form a relationship.”

Key Informant 2: “I agree, but it is as if the childcare workers sometimes forget where the

children come from when they work with them. Childcare workers need to know the background

of the children in their care, in order to understand and to develop empathy for these children.

The children’s trauma can also cause to traumatise the childcare worker, or the childcare

worker can be triggered by the children’s trauma if the childcare worker has experienced

similar trauma. If this is the case, it might be difficult for the childcare worker to understand the

child.”

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Smith (2011) stated that children who have been severely abused have an increased possibility to

suffer from insecure attachment. Once these children are placed into care, their behaviour, which is

the result of this form of attachment, can negatively impact on their ability to form positive

relationships with their new caregivers. This can often result in the children being transferred to

other care facilities, and this leaves them feeling rejected once again. The reason why children with,

for example, an avoidant attachment and who have been removed from their primary caregiver find

it difficult to form a relationship with another person, might be because they find it difficult to

approach their new caregiver for help and nurturing. This can negatively impact on the relationship

between the caregiver and child (Smith, 2011). This might also result in the child feeling alone,

fearing another rejection, and behaving in a negative manner, while the caregivers, on the other

hand, might feel rejected by the child.

Mistreatment contributes to children forming insecure attachments and could negatively impact on

their ability to form secure attachments later in life. It appears to be very important for caregivers to

know the history of these children. This can assist the caregivers to not only understand the

behaviour of these children, but also to enable them to empathise better with the children. If the

caregivers cannot understand or empathise with these children, they might be inclined to not want to

form an attachment with the child, and the child might experience this as yet another form of

rejection.

4.4.4 Feelings experienced by caregivers who work with children with attachment disorders

It appears that caregivers face various challenges when working with children with attachment

disorders. They sometimes address these challenges by not feeling emotion anymore, forgetting, or

feeling emotionally drained. The manner in which the children respond to the caregivers appears to

be a challenge as well. For example, the children might tell the caregivers to leave them alone

because they are not their mothers. The caregivers also experienced feeling challenged when the

children expect a lot from them as caregivers and when the children are disappointed when they, as

caregivers, cannot adhere to their expectations. The caregivers found that they sometimes gang-up

against these children instead of correcting their behaviour. This happens more often when the

caregivers have told one another of the behaviour of a particular child, and then the other caregivers

show support towards the caregiver in this manner. This does not, however, always happen

intentionally: the caregivers sometimes, for example, just get tired of trying to help these children

without any positive response from the child.

Thandeka: [she referred to the ganging up against a child as] “secondary abuse.”

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Louise: [she described her feelings on this as] “it’s too much.”

Thea: “It is their behaviour...so if you try and try and it is always … they do not respond to you

… you get fed up.”

Key Informant 2: “This [secondary abuse] is a reality and really not in the best interest of the

concerned child.”

Key Informant 2: “[when these children tell them that they are not their mothers], childcare

workers should not take this personally, but should rather be trained to react to this statement in

a positive manner. This issue can be addressed with sufficient training to the childcare givers.

Childcare givers also need to be emotionally stable because if they are not emotionally stable,

they will not be able to cope with the demands of children with attachment problems.”

Key Informant 2: “Most children in residential care have attachment problems. I have not

worked with a child in residential care who has not had attachment problems to some degree.”

It appears that caregivers lose hope if the children do not respond to their efforts. The caregivers

would sometimes manage these children’s behaviour by ganging up against them. The caregivers

need to approach this challenge as the key informant states: by not taking it personally and by being

emotionally stable. The caregivers also need to receive the necessary training to make positive

responses more of a reality because most of the children in residential care appear to have, as Key

Informant 2 argues, an attachment problem to some degree.

In some of the CYCCs, the children are placed in different houses according to their age: children

up to the age of 12 or 13 are in one house, for example, while children aged about 13 to 18 are in

other houses. When a child turns 12, he or she is transferred to a house for older children in spite of

the relationship which already exists between the child and the caregiver. Some caregivers stated

that they eventually stop to care. They would, for example, close the curtains if they see one of the

children smoking or one of the children getting involved in a fight. According to the caregivers,

they initially enforced the rules of the CYCC, but then ceased to enforce it. What contributed to the

feelings of not caring anymore is that the caregivers do not see change in these children and that

they find this work to be emotionally draining. The caregivers also stated that they do not always

know what to do in certain situations and that they feel powerless.

Alice: “When you are working with this child, you want to see in a few months’ time or a year

there is, you know, a great change. [But] there is nothing and then you end up, you know, giving

up on that child. You give up on [yourself] also because I feel that I’ve failed this child … I am a

failure.”

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Riana: [She stated that the children who were innocent during the occurrence of the trauma

were more likely to change or recover from the trauma] “They didn’t grow up in this

environment … we will win with them.”

Alice: “After ten years you become redundant because it is emotionally draining this work …

you carry all these burdens of these children. A few years along the way you get tired and you

will become unproductive.”

Pat: “And it is not easy for any of us. It takes a lot of emotion and a lot of pain, but if you think of

what we are feeling, you can imagine what they are feeling.”

Sandra: [She explained that when the children shout at them, they experience feelings like] “you

become confused … angry … and you just don’t know what to do and sometimes you … you

become powerless.”

Key Informant 1: “Caring for these children often leaves the childcare worker feeling drained

and depressed. The successful implementation of childcare skills and techniques are difficult to

measure. Childcare workers often wish for the improvement of behaviour, in order to experience

success. This often leaves them disappointed when behaviour improves for a short period of

time.”

Key Informant 2: [Referring to the statement about ‘no change has taken place’]: “I personally

feel the system has failed the children if this is the case. But it is a reality [that is] usually due to

insufficient funding.

Childcare workers are not properly trained and children have not received the therapeutic care

and input they need.”

Florio (2010) stated that a person in a caregiver position is at risk of burnout and that the risk

increases the longer the caregiver is exposed to their clients’ trauma and crises. When it has

progressed so far that emotional exhaustion is present, such as, for example, the person starts

suffering from increased tiredness, memory problems, and depression, then he or she needs to

approach a professional for assistance.

The key informants acknowledged that caregivers want to see change in order for them to

experience success. It is unfortunately a reality that change is not always immediately visible or

measureable. Change does not always take place and one of the key informants ascribed this to

insufficient funding and a lack of training received by the caregivers. This could contribute to

caregivers experiencing burnout because their expectations are not met. The caregivers might also

lack the necessary training that could have assisted them in this regard.

The caregivers’ also reflected on situations when they would start to forget instructions they have

made, similarly to how the children would easily forget the instructions that they were given. The

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caregivers saw this as an example of them ‘becoming like the children’. According to some of the

caregivers, they have to make sure that they do not copy the children’s behaviour, such as sitting in

a ‘hole’ and blaming everything on everybody else. It was felt by the caregivers that the children

accomplished a lot with this negative attitude.

Riana: “You get just like them.” [She explained it by referring to the fact that her husband would

tell her], “I just told you the kettle is boiling! … In the first three/four years that you are a

caregiver, you give everything. But then you also hurt so bad at the end of the day, so you learn

with years to build a wall around yourself. You don’t let them come into your life. You’ve got

their entire trauma and on that you have your own trauma too, so it breaks you as a person.”

Key Informant 2: “They should not let this happen to them. Childcare workers need sufficient

training, and support, and time to rest. This is very immature behaviour from childcare workers

to become like the children. Childcare workers often lose their sense of self. They are often

trapped in the sense that they do not enjoy their work with the children, but they can’t move on,

usually because of financial reasons.”

It is a concern that caregivers would initially give their best in their work but would later build walls

around themselves due to hurtful experiences. These experiences can include being exposed to all

the trauma of the children and simultaneously having to deal with their own personal issues.

According to the key informant, the caregivers might be able to cope if they receive the necessary

support and training. It is unfortunate that caregivers appear to sometimes feel stuck in their work

and cannot leave because of their financial situation.

Communication channels within the CYCC also appear to be an issue that caregivers perceive as a

challenge: the children would sometimes, for example, run to management with the smallest thing

that their caregiver did wrong. This can impact negatively on the caregivers’ relationship with the

children because, for instance, caregivers might feel that despite everything that they have put into

this relationship, the children still do not hesitate to complain to management about them.

Pat: “But sometimes it hurts. It gets us down a little bit because we put everything into that child

and into that house.”

Key Informant 1: “Caring for these children takes place on different levels and there is often this

belief that management does not understand what childcare workers are going through.

Management often argue that sufficient training was offered and support systems are in place.

Sometimes it is experienced that childcare workers do not implement what they were taught.

Residential care remains a very complicated system with many issues and many challenges,

which filters through to all levels of childcare.”

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Key Informant 2: “The institution needs to have a protocol in place in order to address this

issue. From my experience, I can say that this is not the case with all childcare workers. If a

childcare worker manages to form a good relationship with a child, this will not happen. When I

used to be the manager of a children’s home, it was always interesting to note that it was only

the children of a few (but always the same) childcare workers who ‘ran to management’; often

with good reason.”

The key informants indicated that there are many challenges when working in residential care, as

well as a variety of viewpoints held by the caregivers and management. On the one hand, the

caregivers might feel that management do not understand their challenges, while on the other hand,

management might feel that caregivers did receive the necessary training but that they are not

implementing what they have learned. The key informants highlight from their experiences how a

child will not easily complain to management about a particular caregiver if that caregiver has

formed a good relationship with the child.

When I asked the participants how they cope with the demands of their work in a CYCC, many of

them expressed how they would be unable to cope without God in their lives. It appears that the

challenges of the work can be overwhelming for the caregivers at times, and it is their experience

that they can only deal with this challenging work if they rely on God.

Louise: “I say, Lord give me wisdom to deal with whatever … because they are all so different

… You sometimes don’t know how to deal with the one.”

Riana: “You won’t go from one day to another day without God in your life. There is too much

hurt … there is too much bad stuff around you the whole time.”

Thea: “I always said that working in the children’s homes keeps you on your knees to God, for

strength and patience.”

Leonie: “Working here has made me a strong believer that there is hope for these children.”

Key Informant 2: “People who become childcare workers because they see it as a calling from

God tend to cope better.”

It appears that some caregivers rely on God for the necessary wisdom to deal with these children

and to be able to deal with all the hurt around them. Key Informant 2 indicates from her experience

how those caregivers, who have seen their work as a calling from God, tend to cope better.

The caregivers’ own issues can also influence the quality of attention that they give to these

children. Caregivers have realised that they should rather withdraw first from a situation and calm

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down before addressing the child again because it might be their own issues which influence their

response to the child.

Lindsey: “I sometimes feel rejected by the children. I also had rejection issues with my father

who I’ve seen maybe three times in my whole life. All the important people in my life … my

grandfather died … my father disappeared...But still that initial rejection … it comes out as

anger sometimes.”

Louise: “There is some rejection in all of our lives.”

Sandra: “As childcare workers we are supposed to be always so subtle and so calm and

compassionate and we sometimes... [we feel like punching the child].”

Pat: “[It is] a challenge to stay positive.”

Key Informant 2: “This is very true and therefore very important that childcare workers need to

have a sound mind when they want to become childcare workers. Childcare workers need to be

screened for the effect of their own childhood trauma before they get employed. The motive for

wanting to become a childcare worker also needs to be pure.”

According to Hughes (2009), issues from a person’s past might create disorder in his or her

emotional and meditative functioning. If a person’s father used to scream at them or threatened to

send them away to live with another relative, then the feelings this person might have felt when

being screamed at and being threatened could re-occur in a similar situation in the present. If a child

behaves in a manner that causes the caregiver to remember the past, he or she might experience the

same feelings they had experienced in the past, or they might respond with anger or hopelessness.

If, however, the caregiver could turn to another adult for unconditional acceptance and support, they

might be able to relive the past events in a more positive frame of mind. With this type of support

and acceptance, hopefully the caregiver could relive those events with more confidence and be able

to better make sense of it and not feel overwhelmed again.

Caregivers’ own history could have a negative influence on their relationships with these children.

If they have experienced trauma as a child and have not dealt with it, the trauma experienced by the

children in a CYCC might disturb them. The caregivers’ history needs to therefore be taken into

account and whether he or she has dealt with it before they were employed as caregivers.

Caregivers can have a big positive or negative impact on these children and their history can

therefore not be ignored.

Working with children with attachment disorders can be very challenging. Caregivers are

confronted with various factors that can have a negative impact on them and that can leave them

feeling emotionally drained. Some of these factors include the caregivers sometimes feeling that

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they do not see any change with the children and how it makes them feel powerless. It is not only

the behaviour of a child with an attachment disorder that can pose a challenge to the caregivers; it is

also the input the caregivers experience from management and whether management are measuring

up to their expectations.

4.4.5 The caregivers’ family

According to the caregivers, their own families are sometimes negatively impacted when they work

in a CYCC. At two of the three CYCCs where the study was conducted, the caregivers lived with

their biological families on the same premises as the children they are responsible for. As was

illustrated in Table 2, seven of the 19 participants were married. Six of the participants had children

who were already independent and two had children who were still dependant of them. The

caregivers have separate flats/rooms that are either in the same house or are connected with a door

to the rest of the house. The caregivers felt that their families suffered especially during their first

three to four years of working at the CYCC because the caregivers gave their job their full attention

during those first few years. It also appears to be very challenging for the caregivers to be

confronted with similar situations at home. Their friends and families, for example, find it difficult

to visit them at the CYCCs because their visits are constantly interrupted by the children.

Riana: “But then you decide you can’t do it because then your family suffers badly … because

you can’t give then to your children and your husband. So you learn … you don’t let them come

into your life.” [Her own children felt that she was much stricter with them than with the

children from the CYCC].

Sandra: “My children are all teenagers … and all teenagers always got something to tell you. I

work with teenagers. I have already heard ten stories before I went home and when I go home I

just say, ‘Can you just keep quiet; I just need some time.’ I never go back to my own child and

say what is it that you really wanted to tell me. By the time I get back, the child say ‘hhhuhhh, I

forgot what I wanted to tell you’.”

Thea: “You know what happens here … usually you get estranged from your family because they

cannot come and visit you … because you don’t have time to visit with them because you are

always busy with the children … and afterwards they don’t come here anymore.”

Key Informant 2: “I think it is best for people to be childcare workers after their own children

have left the house, or if their biological children can be in an older life phase than the children

they care for. If not, it stays their responsibility to make time to spend with their own children as

they need their parents as well. Childcare workers should also try to keep their own children

away from the children they care for [if possible)].”

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The caregivers indicated that they find it challenging to balance looking after their own families and

being responsible for the children at the CYCC. The caregivers seem to end up either not giving

their own children the same amount of attention, or not really allowing the children from the CYCC

into their lives. Employing caregivers whose children have already left home, or who are older,

might eliminate this challenge for the caregivers. Since it is the caregiver’s responsibility to ensure

that his or her children at home also receive the necessary attention, it is important that caregivers

are given the necessary support to know how to find this balance.

4.4.6 What does the future of a child with an attachment disorder look like?

The caregivers painted the future for children with attachment disorders as very limited and

negative. The caregivers listed the potential negative examples as the possibility of being jailed,

experimenting with drugs, not coping with adult life, and a lack of stability. When discussing the

contributing factors to these poor outcomes for these children, the caregivers argued that the

children are too protected in the CYCC and that they are not adequately prepared for adulthood

before leaving the CYCC. Some of the caregivers also cannot understand why the children return to

their home of origin where the same undesirable situation still exists. Another challenge

experienced by the caregivers is that one generation seems to have an impact on the outcome of the

next generation. For example, one family called the “Rademeyers” (not the real surname) had some

members attending the same CYCC for the last five generations. There is therefore this

preconceived idea among the CYCC’s personnel regarding the “Rademeyers” because the history of

the family is already known to those working at the CYCC.

Riana: “But most of them … that is the way they grew-up. That is the way that mom grew-up.

That’s the way granny grew-up … so it is just a bad ricochet the whole time.”

Leonie: “But why do these children go back?”

Sandra: “I’ve seen them … we start running around looking for places with these children and

there is nowhere, and then they have to go back to that same full twelve … twelve people.”

Riana: “In the last 4-5 years, some of the kids that went out that had this attachment disorder

are already in jail.”

Pat: “I don’t think they would have a future. They wouldn’t have any stability in their lives or

any skills, trust.”

Sandra: “When the child goes out there … as that child said, he didn’t know how hard it is going

to be.”

Annalise: “They have to connect with people out of the children’s home when they leave us. In a

work situation, it is very difficult for that person to connect with other people in his

workplace...So he gets into trouble or even fired.”

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Elizabeth: “They cannot keep a job because they keep on running away from situations.”

Lindsey: “They don’t have anybody to fall back on. It all just becomes too much and they cannot

cope.”

Amo: “They say that they would rather stay under a bridge than go back home.”

Key Informant 1: “Unfortunately it is difficult to break the repeating cycle, but I was fortunate

enough to be able to assist children with enrolments at universities during the time that I was

employed at CYCCs. The one or two success stories should be cherished and be remembered by

staff working at CYCCs.”

Key Informant 2: “It is a pity that the childcare workers feel this way because it seems as if they

have given up on the children before the children even had a chance to prove themselves. There

are a lot of children with attachment problems who get helped and who make a success of their

lives.”

Key Informant 2: “Children return back to the abusive situation for different reasons. This can

be addressed in therapy with the children and if children work through their trauma and get the

necessary support, they do not return back to those places.”

According to Bowlby (1965), the future of these children is negatively influenced by various

factors. One of these factors entails that when the child is accepted into alternative care, a plan (e.g.,

what actions need to be taken to solve the situation, in what period of time) is not compiled for the

child’s future. This results in the parents being unclear about their role and responsibilities towards

the child, which might impact negatively on their relationship. It might also lead to the parents not

making regular contact with the child anymore. Collins, Paris, Ward and Wade (as cited in Smith,

2011) found in one study that a little more than half of the sample reported positive relationships

with their family a year after leaving care. Fifty four per cent of the participants in another sample

stated that conflict was present and attributed it to their parents’ inability to parent. Some of the

young people in these cases preferred to be homeless than to continue living under those

circumstances. In many cases, the circumstances that led to their removal still existed after they left

the CYCC.

It appears that the caregivers generally expect that the future of some of these children is going to

be poor. It also appears that the caregivers feel that they cannot expect a different outcome if the

child is one of five generations who has entered the CYCC before. According to the key informant,

there is still hope despite the difficulty of breaking the generation cycle and she has experienced

success stories that she feels should be cherished. It is felt by the caregivers that not enough is being

done by those involved to prepare the child sufficiently for leaving the CYCC. The family is also

not prepared for the child’s return, and positive relationships between the children and their family

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are not encouraged enough. The reasons the child was removed from his or her family might still

exist and the child who is not left many options upon departure from the CYCC is often forced to

return to the same situation. This unhealthy situation is seen as a contributor to the caregivers’

expectations of a poor outcome for the future of these children.

It appears that it is possible, to some degree, to reduce the challenges experienced by caregivers on

an interpersonal level. One of these strategies includes making sure that the caregivers have no

unresolved issues and that they are stable, before they are employed. Ensuring that the caregivers

have received the necessary training and are equipped with the necessary skills to be able to do this

work appears to also be vitally important, since these challenges could otherwise drain them

emotionally. A thorough investigation should be conducted in order to determine what the

caregivers’ views and expectations are with regard to the different role players and the children with

an attachment disorder. The attitude of the caregiver and how he or she would approach challenges

is also important to consider, since a negative attitude would not assist them to deal with these

challenges constructively.

4.5 Theme two: Organisational challenges experienced by caregivers in caring

for a child with an attachment disorder

Although organisational challenges were initially not part of the study, it proved to be of significant

importance to the caregivers. According to the caregivers, their relationship with a child with an

attachment disorder is severely impacted by these organisational factors. Organisational challenges

experienced by the caregivers include the number of children each caregiver has to work with and

how communication between the caregivers, social workers, and management takes place within the

organisation. The limited time caregivers have available to spend with these children, certain

aspects relating to working with social workers within the CYCC, and the role of social workers

working at organisations outside of the CYCC are all issues that the caregivers argue are challenges

they experience. Additional organisational challenges include the lack of debriefing opportunities

for the caregivers, the management style within the organisations, and how children within the

organisation are disciplined.

4.5.1 The number of children per caregiver

According to the caregivers, the number of children in each house, which is often around ten, is an

organisational challenge that negatively influences the caregivers’ ability to form a close

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relationship with these children. Some of the caregivers felt when they have to look after ten

children, it is not possible to form a relationship with all of the children and it is very difficult to

monitor the whereabouts of all of them in the home.

Annalise: “I think we have too many children. I think if you could work with eight or nine

children … I think it will be better if the houses are smaller.”

Amo: “Maybe you can work with ten children and have a relationship with only one child …

have a relationship with ten children … that is faking.”

Annalise: “It is very difficult to have a relationship with 12 different girls … it is impossible. You

have to run the house. So when you only have one child with the disorder, it is ok. But all of our

children have disorders. Even your relationship with the children will be better if there is less

children. Over the weekend when there is just six or seven, it is better … it is like heaven.”

Key Informant 1: “The ideal situation would of cause be to have fewer children within each unit.

Finances often contribute to adding to the case loads of childcare workers and social workers.”

Key Informant 2: “It is very difficult to work with ten traumatised children with attachment

problems in one house unit. This is not the ideal, but if this is what the government expects, one

needs to make it work as best as you can.”

Ritchie and Howes (2003) describe how the ratio of ten to 20 children for one caregiver in a

Romanian institution resulted in none of the children showing a preference towards any of the

caregivers. On the other hand, when the ratio was four children to one caregiver, 90 per cent of the

children showed a preference for a caregiver (Ritchie & Howes, 2003). It appears that the number

of children per caregiver in South African CYCCs might remain the same unless sufficient funding

can improve the situation. Having a high ratio of children per caregiver does not seem to be in the

best interest of the child or the caregiver. The children might not learn to form a trusting

relationship with the caregiver if the ratio is high, as seen in the case of the Romanian institution.

From both the Romanian example and the experiences of the caregivers interviewed in this study, it

appears that a lower number of children per caregiver would enable children with attachment

disorders to form an attachment with their caregiver, and vice versa.

4.5.2 Communication within the institution

The caregivers felt that they are not being listened to by the social workers or management. They

explained how they were not involved in decision making, which made them feel left out. The

caregivers gave the example of when a decision is made for the children to go home for the

weekend and the caregivers disagree. The children would be sent home regardless and then the

caregivers would have to deal with the child’s difficulties once he or she returns from home. Some

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of the caregivers also felt that their power is taken away (their hands have been ‘cut off’) by the

social workers when there is, for example, an issue between the caregivers and a child, and the

social workers intervene. The caregivers argue that in this case, the social workers would listen to

the child, form their own opinion, and then tell the caregivers to treat the child better or to be the

adult in the situation. The caregivers explain how they already know they should do this and that

they feel chastised unnecessarily by the social worker in this regard.

The caregivers indicated that they do not receive the necessary information regarding new children

who are admitted into the CYCC. This information includes, for example, the name or age of the

child, whether the child is on medication or not, what the child is allergic to, what the child’s

background information is, and the reason for the child’s removal from their home to the CYCC.

The caregivers also felt that when they cannot make any decisions, the children can sense that they

are hesitant to make decisions, and thus it discredits the caregivers’ authority over the children.

Riana: “Help us understand each child. Don’t just tell us it is confidential. Tell us in advance

that a child is coming into the house. We don’t have a clue what this child is about. If a child has

just been abused and we get them, we have to treat them different to when they were abused a

year ago.”

Amo: “They don’t tell us information about the child.”

Sonja: “You never know what’s going on.”

Riana: “Then you get these people that are highly trained and they say that the book says you

must do it this way … and you can sit there and try to explain to them that this is not going to

work with this specific child, but they don’t listen.”

Pat: “Please listen to me. I am not doing it to be spiteful or being funny. There is a reason for it.

Please listen to me. I think if people actually sat down … from up there … and actually sat down

and actually listened to us, as the child care workers … as the mothers, as the house parents in

the house and took more advice from us, from what to do … I think we would also have a little

bit more of an easier run.”

Key Informant 1: “This is a challenge which will unfortunately remain within the very

complicated nature of residential care.”

Key Informant 2: “This may be due to poor management and is not supposed to happen as it can

de-motivate the childcare workers. Childcare workers need to be included more. This is true that

they are not always included and I personally feel that they should be heard and included more

in the treatment plans of the children. Social workers sometimes do misuse their authority, but

childcare workers do also sometimes feel threatened by the social workers’ position. There is a

role for both and they need to be a team, and to distinguish their roles clearly. Childcare

workers need to feel more empowered.”

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Caregivers find it challenging to deal with newly admitted children when they do not receive the

necessary information on these children. The communication between caregivers, social workers,

and management also appears to be a big challenge for the caregivers. The issues around the

provision of information about new children and the communication between the various role

players appear, however, to depend on the management style. As identified by the key informants,

issues which add to these organisational challenges include the abuse of authority by some social

workers and caregivers feeling threatened by the social workers’ position (of authority) in relation

to theirs. Whether these issues will be improve or remain the same depends, as one of the key

informants indicated, on whether the caregivers and social workers’ roles are defined clearly and if

they are able to work as a team with other role players.

Being moved from one house to another impacts negatively on the ability of caregivers and children

with attachment disorders to form relationships, and results in the attachments that already existed

being broken and ending. A shortage of staff contributes to the increase of the pressure experienced

by the caregivers, which might also affect their relationship with the children.

Riana: “The post is frozen. So now we only have two to do all that. We are really short-staffed

and there is a lot of pressure on all of us.”

Riana: “After more than four years taken away from kids that you have worked with and put

everything in … and put into a new house is just … that’s trauma.”

Key Informant 2: “This is true, and de-motivation to childcare workers. It is a pity when a

childcare worker needs to move houses, but often management are stuck in a situation where

there is no other choice.”

Caregivers are sometimes moved from one house to another without having a choice. The

caregivers discussed how this experience is very traumatic, especially in the cases where they have

formed relationships with these children over a long period of time. It would also not necessarily be

in the best interest of these children who might have started to form attachments with their current

caregiver. It appears, however, that management does not always have a choice in whether a

caregiver should be moved to another house or not.

4.5.3 Lack of time

The participants find it challenging to spend adequate amounts of time with each child because the

time they have available is limited. They also feel that there is not enough time available for them

and the social workers to communicate with one another regarding the children or incidents relating

to the children. Some participants leave the premises of the CYCC after they finish their shifts. That

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leaves them with little time to spend with the children after school. During this time, they have to do

homework with the children, allow time for play, and take them to therapy. In order to address this

issue of limited time, the participants explain how they eat lunch with the children because this

allows them to have a chance to talk with the children and spend more time with them.

Lindsey: “One-on-one time is critical. If they don’t get that, you don’t get them.”

Leonie: “Don’t tell them you’ve got something else to do now. If they want to talk now, you sit

with them and you talk. I will tell them: Listen, alone time with this child now. After five minutes,

alone time with that one. And they like it … they like it because they feel so special.”

Amo: “And being a good listener is on top of my list.”

Lindsey: “It is the individual attention that they desperately need. It is very difficult. It is

exhausting. [I also feel that] homework takes such a big chunk of time.”

Amo: “And another thing is … you can see how much time we have spent with you talking about

this. We never got this time with them [social workers] … only a few minutes … because I am on

duty … she is on duty … do you really think we can sit this long?”

Key Informant 1: “I have experienced that the most successful childcare workers are those who

are sensitive to the needs of each individual child. The ideal will always be to have more one-on-

one contact with these children. This issue has been raised many times before while working

within residential care. Lack of proper funding will always be an obstacle.”

Key Informant 2: “This is a general problem. Good time management is very important, but

even then it might be difficult to get everything done.”

The participants have realised that they need to spend individual time with the children and that

listening to the children is very important. The lack of time available makes it very difficult,

however, for the participants to do this. Despite good time management, this might remain a

challenge. More funding might make it possible to employ more caregivers and to reduce the

number of children per caregiver. If this could happen, more time might be available for the

participants to spend with each child.

4.5.4 Social workers within the CYCC

The participants experience challenges with regard to social workers from within the organisation

and from organisations outside the CYCCs. One of these challenges is that the participants feel that

social workers do not assist the families at home to change their situation. Children then remain in

the institutions for longer periods than they need to. The participants stated that social workers often

play the role of a granny who is there to spoil the children, while the participants see themselves as

the parents who has to enforce discipline. The participants also felt that the child’s family puts up a

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front for the social worker so that the social worker is more inclined to let the child spend a

weekend at home. The participants find this challenging because they feel that the social workers

are not doing anything about the children’s home circumstances.

Riana: “The outside worker does not live with those children 24/7 and see what this child is

going through when this child comes back. The mom and dad are putting up this front.”

Alice: “They are not dealing with the situation at home so the child can go back there … so I

think it is the organisations … that they are not doing enough.”

Key Informant 2: “The attachment relationship needs to be between the child and the childcare

worker. The children are not supposed to form a strong attachment with the social worker. They

can have a good relationship with them, but their trusting relationship needs to be with their

childcare workers.”

Bowlby (1965) stated that it is vital for children to remain in contact with their parents, and that

their parents should receive the necessary assistance from the social worker. The parents and their

child should be involved in planning for the future. This critical planning for the future, with the

support of parents, appears to not be receiving the attention it needs from the social workers.

Moodley (as cited in Perumal & Kasiram, 2009) stated that social workers in South Africa do not

have the necessary skills or enough resources to assist families to, for example, change their

destructive behaviour.

One of the key informants highlights how the caregivers’ expectation that social workers should

form an attachment relationship with the children with attachment disorders is incorrect. The key

informant argues further that the role of each of the role players needs to be clarified. The

participants stated that not enough is being done to improve the home circumstances of the child in

order to ensure the child’s return home as soon as possible. It appears that the home circumstances

of these children might not change because the social workers that come from outside organisations

are not adequately equipped to assist these families.

Challenges the participants experience with the social workers from within the CYCC includes:

they feel the social workers do not discipline the children and that the role of the social workers are

more that of a granny (spoiling the children and not disciplining them) while theirs is more the role

of the parent. The participants also felt that the social workers take on the role of the nurturer, while

the participants have to exercise tough love.

Jenny: “It seemed to me that they were just the goody-goody person and you are the bad wolf.”

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Sandra: “It makes it easier for you guys to mother and granny … and … we are the mothers and

the social workers are more the grannies. You know … the grannies are more the nurturers …

spoiling … and we are more like the mothers.”

Amo: “With social work there is lot of … too much nurturing.”

Annalise: “They must have the nice relationship with the child to be able to work with the child,

so the child never gets reprimanded by the social worker.”

Key Informant 1: “It has always been a challenge for social workers within residential care to

clarify their role within the institution. Different levels of role players have different expectations

regarding what social workers should or should not do.”

Key Informant 2: “It is not the role of the social worker to discipline. If this is true, it is a

problem because the child care worker is supposed to do the nurturing. Social workers often do

nurturing because childcare workers fail to do it.”

The roles social workers and caregivers fulfil do not seem to be understood by all involved. The

participants feel, for example, that social workers should discipline the children and should form an

attachment with these children, while social workers do not see this as their responsibility.

According to the key informant, the caregivers should be the ones playing the role of the nurturer,

and not the social workers. The contradictory expectations of all of the role players appear to be an

ongoing challenge within residential care.

4.5.5 Debriefing

Some of the participants also experienced confidentiality as a very big challenge. In some of the

CYCCs, the caregivers are not allowed to discuss the children with one another and they have found

that they have to keep all of their emotions to themselves. The participants feel that this issue

impacts negatively on their ability to form a relationship with the children and that it also

contributes to their stress levels. If the caregivers raise concerns about a certain child, the caregivers

are always reminded by the social workers or management that they need to remember that these

children have been through a lot of trauma. The participants felt that they are well aware of the

children’s past trauma, but that they, as caregivers, need support in dealing with these children and

do not want to listen to social jargon. The participants also felt that the word ‘trauma’ is pushed

down the children’s throats and that the children are therefore quick to tell the caregivers that they

have been ‘traumatised’.

Jenny: “So I think that is important to us … to have somebody to talk to and that understand

your situation and not just say you are the bad one.”

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Pat: “When I came here, they said that you don’t talk or discuss your things or your problems or

talk to another childcare worker.”

Annalise: “You lose your self-respect. That is the worse for me. Swearing at the children …

.because you don’t have an outlet.”

Riana: “So you have to keep everything bottled up in you. I cannot go to Leonie and talk to her

because I know that she also have ten girls.”

Louise: “You sometimes don’t know how to deal with the one. You know … love is not enough.

Because of confidentiality, we cannot talk to whomever. We have to get somebody from the

outside.”

Riana: “Because if you go to management and you ask them: ‘I’m so cross with this child, I want

to … ’, they say: ‘but you must remember that they got trauma’. Don’t tell me a child has

trauma. I mean, it’s logical! But that is the answer you get … so you don’t go to the social

workers.”

Pat: “You have got to have an outlet. And I don’t want to go and sit with somebody who has got

a whole lot of jargon of social whatever and all that.”

Key Informant 2: “If the childcare worker have been trained and knows what trauma really

means, they will not have difficulty using it themselves. I have been working with childcare

workers for a long time and we often discuss the children’s trauma and I have not found them

feeling threatened to use the word ‘trauma’. I have also trained the children I work with on the

meaning of trauma and have never perceived it as being received negatively.”

Key Informant 2: “I agree that childcare workers need to have an outlet. I do not feel that the

social workers of the children are necessarily the people to fulfil this role. At some agencies,

there are senior childcare workers who can fulfil this role. Childcare workers also seem to relate

better when it is another childcare worker they can talk to. A senior childcare worker is a good

choice for this role. It would also be good if childcare workers can receive psychotherapy when

they need it, especially if the children trigger their own childhood trauma.”

Perumal and Kasiram (2009) stated that debriefing should be part of the services that are rendered

to caregivers, since they are sometimes exposed to very disturbing situations. It has been suggested

to the caregivers that they meet in a group with other caregivers in order to have the opportunity to

talk to others about their difficulties and debrief amongst their peers. The groups could also become

opportunities for the caregivers to share ideas and lessons, so that they can learn from each other

and assist each other to deal with the various challenges.

Caregivers might be able to deal better with the challenges posed by working with children with

attachment disorders if they had the opportunity to debrief on a regular basis. A suitable person to

facilitate these sessions might be someone from outside the organisation (e.g., a senior caregiver)

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who understands their situation, has the experience of dealing with similar situations, and would

know to use certain terms (e.g., trauma) appropriately. Because caregivers are sometimes exposed

to very disturbing situations, debriefing should be a compulsory part of their work.

4.5.6 Management style

Some of the participants stated that management would sometimes question the child in front of the

caregiver in order to determine whether the caregiver was telling the truth. According to the

participants, management has no idea what being a caregiver entails. The participants felt that they

are sometimes unfairly disciplined by management because management would ask them whether

they have proof that the child was going to hurt them when they acted in self-defence. The

participants stated that management do not care about them, since they would not enquire first about

the caregivers’ well-being after an incident. Management would rather ask where the caregiver was

at the time of the incident. The participants indicated that they need more rights in the organisation

because the children are allowed to go to management to complain about the caregiver while the

caregiver is not even aware of it.

Riana: “If you try and say what happened, they bring the child in front of you and then question

them to see if you are really speaking the truth.”

Pat: “So no matter what the hell is happening on this campus, you are here for the children. We

need a little bit more rights as childcare workers. If a child does not like something in the house,

they are allowed to write it down and run up to management with their little piece of paper

without us even knowing about it.”

Pat: “[Management] need to trust us more as childcare workers, and our decisions.”

Riana: “[Management] don’t have an idea what house mothers are really about. In their eyes,

we make the food and that’s that.”

Key Informant 2: “Again, if the childcare worker is confident and mature, sufficiently trained,

and if there are good management structures in place, this is not supposed to happen. Some

childcare workers also sometimes feel mistreated all the time because of their own personal

issues.”

The participants indicated that they have limited rights in the organisation and that management

should trust them and the decisions they make more. It seems that effective management structures,

well-trained caregivers, and caregivers who do not allow their personal issues to interfere with their

work could promote more positive working conditions.

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4.5.7 Discipline

The participants found that punishment in the CYCCs is very limited and that the children are aware

of this. It seems that there are sometimes no consequences for the children’s actions. An example

was given of a child who physically hurt the one caregiver and nothing was done about it.

Jenny: “It was very difficult because he had this power and if he couldn’t get his own way, he

will say ‘I will scratch your car’.”

Lindsey: “At that moment, they should be really dealt with in a way that there are consequences

to their actions. They just seem to get away with it.”

Annalise: “The punishment here is actually very limited. There is not much you can do with a

child and they know it. So it is difficult to punish them … especially the boys.”

Key Informant 1: “There are many theories with regards to behaviour management and it

remains a challenge to implement effective behaviour management, considering the unique

needs of each individual child.”

Key Informant 2: “There are always consequences for bad behaviour. Childcare workers often

say this when they do not like the consequences that management suggests.”

It appears that the disciplining of children has become a major challenge for the caregivers.

Corporal punishment is no longer allowed in South Africa, and Section 12 of the South African

Constitution Act 108 of 1996 states that nobody are allowed to treat another person in a harsh,

heartless or humiliating way (as cited in Maphosa & Shumba, 2010). This is making the

disciplining of children difficult since alternative methods that have been used by teachers, for

example, have proven not to be quite as effective. Alternative methods that have been used include

meeting with the parents of the child that needs to be disciplined and/or giving that child menial

tasks. In some instances, the child’s parents do not cooperate with the school and thus the child will

continue with their bad behaviour. Caregivers are faced with the same challenges when making use

of alternative disciplinary measures.

When the caregivers become overwhelmed with a particular child’s behaviour, they might withdraw

themselves from the child or choose to limit their help to that child. The child might then feel

isolated while the caregivers continue insisting that the child should adjust his or her behaviour, but

without the necessary support from the caregivers (O’Gorman, 2012). Children might not be able to

adjust their behaviour without the necessary support from their caregivers. Sterkenburg et al. (2008)

stated that the forming of an attachment relationship with children who do not have secure

attachments might impact positively on their behaviour. Through this relationship, children are

taught how to regulate their emotions. This can in turn have a positive impact on their behaviour.

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The attachment-based behaviour therapy, as described by Sterkenburg et al. (2008), focuses on the

forming of an attachment before addressing the behaviour of the child. Without the input and

support from their caregivers, these children might not be able to modify their behaviour. Forming

an attachment with a child might be more effort than giving corporal punishment, but it appears that

behaviour can still be changed within the context of a secure relationship; corporal punishment is

therefore not the only means to achieve this, contrary to what some of the caregivers argue.

Organisational structures, procedures and protocols to be followed should render the necessary

support to caregivers working in CYCCs. An organisation’s operation can severely limit the types

and quality of services that are rendered to the caregivers looking after children with attachment

disorders. For example, if caregivers are not given the opportunity to debrief on a regular basis, they

might start to suffer from burnout and would not then be able to provide the necessary attention and

support to a child with an attachment disorder. Effective communication between the social

workers, management, and the caregivers appears to also be a major challenge for the caregivers.

One of the key examples of this, as expressed by the caregivers, is when the caregivers are not

involved in the decisions that are made regarding the children. The structures, procedures, and

protocols that are put in place should contribute to the caregivers’ attempts to act in the best interest

of the child with an attachment disorder.

4.6 Theme three: Lessons learned by caregivers in caring for a child with an

attachment disorder

The participants have learned certain lessons through their experience in working with children with

attachment disorders. One of the lessons they have learned is that they need to set an example to the

children by, for example, how they talk to their own family. Some of the participants indicated that

they were able to attend a course that provided them with some of the skills for dealing with

difficult behaviour. When a child acts out, they have learned that they can calm the situation by

drawing the child’s attention to something else. This situation, as well as listening to the children

who always repeat their stories, often requires lots of patience from the caregivers.

Some of the participants felt that not knowing about the behaviour of certain children (and/or only

knowing a bit about their background) prior to their admittance into the CYCC helped them to work

better with the children. Some participants felt that if they knew about the child’s behaviour

beforehand, they would have a preconceived idea of the child and would thus approach the child

warily. To form a relationship with these children, the participants learned that they need to be

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sensitive to the children’s needs, they should have clear boundaries, and they should be aware of

what messages their non-verbal behaviour is conveying. The participants realised that knowing their

own triggers could assist them and help to not impact negatively on their relationship with the child

with an attachment disorder. What the participants have noted with regard to the disciplining of

these children is that they should discipline all the children in the same manner, and that they should

be sensitive when communicating the rules to these children.

One of the lessons the participants appeared to have learned is that their own norms and values have

an impact on their interactions with the child with an attachment disorder and that they need to set

an example for these children. One of the ways that the caregivers set an example is through their

interaction with their own family. If their husbands or wives, for example, were to talk to them in an

inappropriate manner within hearing distance of the children, the caregivers would probably lose

credibility with these children: this was seen as something that could negatively impact on the

caregivers’ ability to form a relationship with the children.

Pat: “I have a house father that is my co-worker and we work as a family … and I run my family

unit with my nine girls.”

Juanita: “The way I was brought up with my mother and my father was good. I can look back

and say thanks mom and dad, and try and do that with the girls in the house.”

Pat: “It is on your role model, on your morals, and principals of your own life. If your husband

speaks badly to you or down to you, and the children hear it, what do they think?”

Key Informant 1: “Wonderful insight. I have experienced that the most effective childcare

workers are those who are grounded within stable family circumstances themselves.”

Key Informant 2: “I personally feel that childcare workers need to be trained before they start

working. Often childcare workers do not know what they signed up for before they start working.

Often they are not emotionally ready for this challenge.”

The participants have learned that they need to set an example for these children through their own

actions. Some of the participants have also realised that their own stable family background laid the

foundation for them to be able to take care of these children. The key informant confirmed that she

has found that caregivers who have stable families tend to be more effective as caregivers. Taking

care of these children remains a huge challenge, however: one which caregivers need to be

emotionally well-equipped for.

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4.6.1 Coping with the behaviour of a child with an attachment disorder

The participants have found that in order for them to cope with the behaviour of children with

attachment disorders, they need to have the necessary skills. To calm a child down, who is acting

out, requires skills which could possibly be obtained through training. The participants explained

how knowing the previous behaviour of a newly-admitted child would make them wary of the child

before they have even met them. The participants found that with a child with an attachment

disorder, they need to calm the child first if he or she is acting out. They can calm the child by, for

example, focusing the child’s attention on something else (e.g., the shoes he or she is wearing).

Riana: “I tried it with one of the boys and it really worked. He was just staring at me. And the

only thing I focused on was his shoes and where did he get these shoes … and it really worked.

When they are calm, they can talk to you and then you can ask them what really happened?”

Key Informant 1: “Wonderful strategy. This also needs to be shared with other childcare

workers.”

Training of the caregivers seems imperative in order for them to learn various strategies to apply

when faced with challenging situations. Without acquiring the necessary skills, the caregivers might

be overwhelmed by the children’s behaviour and might not know what to do in these challenging

situations.

The participants indicated that in order for them to work with children with an attachment disorder,

they need a lot of patience. For example, they have to listen to some of the children telling them the

same thing over and over again, until the child is ready to move on.

Alice: “You have to have patience. You have to be committed to that child. If you can win one

child and make a difference, then you have done your job.”

Leonie: “Patience. You must have patience.”

Riana: “Patience because they will tell you one thing and they will tell it to you over and over

again, and by the hundredth time they will go on to the next step. Then you know they have

worked that stuff out and they will move on to the next step.”

Key Informant 2: “This is very true, but difficult to maintain.”

The participants have learned that patience is an attribute which assists them in dealing with the

child with an attachment disorder. It might be difficult to be patient constantly, as the one key

informant argues, especially if the caregivers are faced with other challenges as well.

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Crying in front of the children when they swear at them, lie to them, kick them, or say hurtful things

is, according to the caregivers, not the appropriate response. The response they found more

effective in situations where a child throws something at them, for example, is to throw the object

back to the child and to have a ‘so-what attitude’ when these children swear at their husbands or

their children.

Jenny: “I often tell them whatever you do for me, I can do myself or get someone else to do it …

so you are not that indispensable.”

Riana: “Within a day or two they will see your weak point. And they will push you on that weak

point. Never cry in front of the children if they hurt you. Because they will call you names, throw

stuff, and spit in your face. But all the bad things … never ever show that you get hurt … never.

Because then you have lost them. If they throw you with something … well … pick it up and

throw them back. Otherwise you have lost them. If they swear at your husband or swear at your

kids, so what? You must have that attitude or else they have found your soft point.”

Key Informant 2: “I feel that it may be allowed for childcare workers to cry in front of the

children, especially because we want the children to learn how they can regulate their emotions

and how to empathise with someone. I would not react the way the children do, as this can

trigger the children to react more; and also I do not think that is setting a good example. We

cannot expect children to treat us with respect if we do not treat them with the same respect.

Childcare workers need to be positive role models to the children.”

Although the participants experienced that they should rather not cry in front of the children, the

key informant argues that the opposite is true. One of the reasons for this, the key informant argues,

is that the children can learn from this experience how to emphasise with someone. According to

Kobak and Madsen (2008) children who have reached the end of infancy and whose caregivers

exposed them to open communication as well as sensitive care were capable of communicating

more effectively with their primary caregivers. Open communication between a caregiver and a

child appears to provide a child with more confidence in the availability of his or her primary

caregiver. If the child and primary caregiver’s relationship are characterized by a secure attachment

the child will communicate negative feelings he or she might experience to the primary caregiver

(Kobak & Madsen, 2008). The primary caregiver in this relationship will then be able to understand

the child’s needs and will be able to respond in a manner which will reassure the child. Responding

to the children in the same manner that they acted towards the caregivers (e.g., crying or throwing

something back at them) might not encourage them to communicate openly, or to treat others

sensitively or with the necessary respect.

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One of the things that some of the participants found assisted them in coping with the children’s

behaviour is when they are not informed about the children’s behaviour prior to the child’s

admittance into the CYCC. They felt that they needed to know about the background of the

children, but not their specific behaviour before they were admitted to the CYCC. Although the

caregivers are sometimes only giving the basic information about a child due to confidentiality

reasons, they explain that this is sometimes a good thing because it ensures that they do not form

any preconceived ideas about the children (because of their previous behaviour) before they meet

them.

Louise: “Because of the confidentiality, we don’t get their files. When the girl comes in the

house, we just get basics and you now have to pick up and go with the flow. You are actually

lost.”

Alice: “But I prefer not to be told about that behaviour of that child because I will judge the

child according to what you told me. Why don’t you just let me get to know the child?”

Sandra: “I feel when a child comes in for the first time, it is better not to know. You will

eventually get to that file, but when you know immediately this one is a convict or this or that,

you are already on your guard. So you see … if you don’t know somebody, you will actually be

yourself and you can get to know that person. Then you can go back to the file. Maybe something

tells you that child portrays something completely different to the file. In most cases, it is like

that.”

Amo: “Telling that person what the behaviour of that child is … in a way it influences the way

that the childcare worker will be working with that child.”

Key Informant 1: “There is value in this strategy, but different childcare workers have different

opinions about this issue.”

Some of the participants feel that if they know what the child’s previous behaviour entailed, it

would negatively influence their approach to the child. According to the key informants, not all

caregivers feel the same way on this issue. Caregivers do need to approach these children without

prejudice and need to accept them unconditionally. It appears that it might be the most effective

approach to give caregivers the opportunity to manage what they need to know regarding a child in

conjunction with the social worker, in order to facilitate their most positive and effective response

towards a newly-admitted child with attachment disorders.

4.6.2 Forming a relationship with a child with an attachment disorder

According to some of the partcipants, they have learned that having clear boundaries, being

sensitive to the needs of these children, and approaching these children in a warm and friendly

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manner can assist them to form a positive relationship with them. What also influences their ability

to form a relationship with these children is the caregivers’ non-verbal behaviour. For example, the

participants have learned that they need to keep their hands in their pockets and not to use their

arms excessively when they meet a child.

One of the things that the participants have learned is that although they cannot force a child to

confide in them, they sometimes have to push a child a little bit towards confiding in them. Noticing

small things about the child and then discussing it with the child was also identified by the

caregivers as something that had a positive impact on their relationship with the child. The

participants explained how noticing something small about a child makes the child feel cared for.

According to the participants, children who experience that they are accepted no matter what they

have done might eventually learn to trust someone.

Alice “[If you show the children that you accept them no matter what, they will] be able to open

up.”

Elizabeth: “In the way that you are always there for them. No matter what they do wrong, they

know that you are always there for them. I think in the long term, the child feels that I can trust

somebody.”

Lindsey: “Treating each child as an individual. They are all different, so you must remember to

treat them like that.”

Riana: “Don’t force yourself onto them because then you break them … and it takes too long to

build a relationship.”

Alice: “The relationship is supposed to happen by itself. You don’t have to force it, but

sometimes they need a little push to be able to open up.”

Amo: “You know relationships are something that is really … it doesn’t just happen with

anyone”

Key Informant 2: “I agree with all of this.”

The building of a relationship with children with attachment disorders appears to be a very delicate

matter, especially since these children’s trust in others has been damaged. Every child’s needs are

going to be different and if caregivers can be sensitive to these needs and the boundaries of a

particular child, they might be able to teach the child what a trusting relationship entails.

The participants also found that they need to get down to the child’s level (e.g., sit down) when they

talk to these children because if they stand while talking to them, the children will start raising their

voices. Some of the participants also explained how they have to be good listeners; when a child

starts confiding in them, for example, the participants have found that they should not ask too many

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questions. The participants have also learned that they often just have to look at the child and

acknowledge that they are listening to him or her.

Amo: “And being a good listener is on top of my list.”

Riana: “If a child starts opening up, don’t ask questions. Just leave them [to talk]. Just

acknowledge that you are listening to them.”

Riana: “Don’t touch them in the beginning. See if they will come to you. Don’t go and try to hug

them because that is a ‘break or make’ moment. You have to learn when they want to be touched

and when not.”

Riana: “And get down to their level. Don’t stand up talking to a child. It never works. Because

then they start raising their voices. If you see they are looking down, you should also look down.

You keep on working … let them talk … because if you look at them, they will stop talking.”

Lindsey: “I sometimes think that the best response or the easiest answer comes from a calm

house mother.”

Leonie: “It does not work when you approach a child with your arms all over the place. Keep

them in your pockets.”

Key Informant 1: “Very good insight. Non-verbal behaviour often speaks louder than verbal

behaviour.”

Key Informant 2: “Childcare workers often need to learn to ground themselves when

confronting a child. They might have to sit down, lower their voices, and hold on to the chair

they sit on in order to keep their hands still.”

According to Hughes (2009), non-verbal behaviour emphasises what we are saying much more than

our verbal communication. If there appears to be an inconsistency between the verbal and non-

verbal aspects, the meaning attributed to the non-verbal behaviour is normally chosen. The non-

verbal communication of the caregivers might be the result of their own personal issues being

triggered by these children. Our tone of voice sometimes carries more weight than what we are

saying and caregivers need to be aware of this. The forming of a relationship with a child with an

attachment disorder can be compared to a dance, and the caregivers need to therefore follow the cue

given by the child in this dance.

The partcipants also felt that it was important to know their own personal triggers (e.g., if the

children do or say something that upsets them), in order for them to be able to manage it effectively

and not to allow it to negatively impact on their relationship with the child.

Amo: “It is important to know your triggers … that when they happen here, you are able to

control them.”

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Key Informant 1: “This is a very important issue. Often childcare workers, like people in many

other professions, have many personal issues. This has a huge impact on the implementation of

childcare.”

Knowing their triggers appears to assist the caregivers in managing challenging situations with

these children with attachment disorders more effectively. If caregivers are not aware of their own

personal triggers, it could negatively impact on their ability to form a relationship with these

children, as well as the healing of these children.

4.6.3 Disciplining a child with an attachment disorder

Having boundaries appeared to be very important because children with attachment disorders

appear to feel confused if there are no boundaries. The participants learned that all the children

should be disciplined in the same manner. They cannot, for example, feel sorry for the one child and

therefore treat and discipline him or her differently from the others. The participants recommended

that when the children enter the CYCC for the first time, the house rules should be given to the

children step-by–step, but that disciplining them should not commence immediately. The

participants argue that this will give the children time to adapt first. What the participants have

found is that the children close themselves up if the caregivers are very strict with them right from

the beginning.

The manner in which the caregivers explain the house rules to the children appears to be very

important as well: for example, the caregivers will not tell the children that they have to sleep in

separate rooms because they were abused, but would rather tell them that since all the children in

the house were abused before, there is an alarm in the house to make them feel safe. According to

the participants, the caregivers and the social workers also need to agree on the discipline to be used

in order for the children not to abuse the situation. One of the things the participants found assisted

them in disciplining the children is that the children know the Children’s Act very well. For

example, when the children state that they have rights, the caregivers would acknowledge this but

also use the opportunity to explain that these rights are also accompanied by responsibilities. What

appeared to help the caregivers in disciplining these children is to have consequences for their

actions in order to teach them to take responsibility for their actions.

Lindsey: “At that moment they should be really dealt with in a way that there are consequences

to their actions.”

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Thea: “Don’t give your power away. Be the responsible one in the house. The children must

know that you are the boss.”

Annalise: “[We should not be] buddy buddy [with the children because] it is very difficult to

take power afterwards if you make friends with them.”

Lindsey: “[Some of the caregivers deal with these children by] scream, shout, beg, plead, bribe,

and ignore.”

Thea: [She felt that to ignore them appears to work the best because then] “They realise that

they are left out and that it is their own doing.”

Sandra: “So you lay the rules out to the child, but you also have to give that child time to adapt.

You can’t just start disciplining that child immediately. You can correct it, but I don’t think

discipline needs to come into effect immediately … because the child needs to adjust.”

Key Informant 1: “There are positive and negative sides to this argument. Often management

strive towards consistency but there are personality aspects which play a role with regards to

implementing disciplinary strategies within different units.”

Key Informant 2: “Good boundaries provide security to an insecure child. I would like to

highlight again that all children in residential care have got some form of attachment problem.

Discipline needs to be consistent from the start. If the child goes to a home and there are no

rules, they might rebel later when rules are enforced all of a sudden.”

Hughes (2009) indicated that a child will tend to feel safe if he or she knows that no matter what

they do, their relationship with their caregiver is still in place. The child would also realise that their

caregivers are disciplining them because it is in their best interest, and not because the caregiver no

longer cares for them. Children appear to learn more from discipline under these conditions than

from a situation where the relationship between the child and his or her caregiver is threatened.

Consistency in disciplining appears to be very important, according to the key informants.

Providing good boundaries is also seen as key to providing the child with security. Ignoring these

children when their actions or behaviour necessitates it works best, according to some of the

caregivers, because these children feel left out if they are ignored. Feeling secure can be enhanced

for these children if they can experience that they are well-loved and accepted, even though they are

being disciplined.

Some of the lessons that the participants have learned is from experience, while some of these

lessons and strategies have been learned from the training that they have received in the past. There

exist different opinions amongst the participants on whether they want to know about a child’s

behaviour prior to admittance or whether they only want the details on the child’s background. It

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appears to be important for caregivers to be from stable home circumstances because they might be

more effective, as argued by one of the key informants. Lessons learned might not be applicable to

all the caregivers: the one caregiver might think, for example, that crying in front of a child is

effective while another might find it ineffective. It remains the caregivers’ responsibility and

discretion to apply the lessons that they have learned to a particular situation.

4.7 Theme four: Training needs of caregivers

The participants expressed very strongly their desire and need for practical training. The

participants seemed to be frustrated with some of the training that they had received previously

because they felt that it was not always applicable or helpful to their situation. An example of the

unhelpful training that the caregivers received was on philosophical matters, instead of practical

skills. The participants found instead that the “Response Ability Pathways” (RAP) training that they

attended over four days was very effective because it was practical, simple, and easy to remember

and understand. The RAP training provided the caregivers with important knowledge, for example,

on how to work more effectively with the youth. The course showed the caregivers how to form

relations and respect between youth and adults. According to this course, for example, children

need someone who can respond to their needs and not to their problems. This course provided the

practical skills to respond rather than react. The RAP training was developed from the Circle of

Courage model, which is based on Native American philosophies of child rearing (Reclaiming

Youth International, n.d.).

The participants also found that role-play training was very useful because it was practical and

helped them imagine themselves in someone else’s shoes. They felt that they were given the

opportunity to see how other caregivers would handle similar situations. The participants felt that

role-playing assisted them more than just sitting and listening to somebody talking.

Pat: “We want practical … we want practical, please, please! I think if you can get somebody in

that can come and do practical stuff with us...You know … like a boot camp.”

Riana: “It [the RAP training] took all the other training I did together and it is so easy.”

Annalise: “Because you see how other house mothers will act in certain situations.”

Key Informant 2: “Sufficient training to childcare workers is very important. Childcare workers

need to be trained in order to be specialists in their field of working. They need to feel proud of

their work and they need to feel equipped to do what they are doing.”

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It appears to be very important to the participants to receive training that is not only applicable to

their situation, but also practical. Discussing children, or role-playing with other caregivers about

various situations encountered in looking after these children, appears to benefit them more than

simply listening to someone speaking. With role-playing, the caregivers can observe what others

have done in similar situations and apply that knowledge.

Topics that were identified by the participants for training, and which they felt were necessary for

them to be able to work with the child with an attachment disorder, included:

How to deal with children at the CYCC or at home who have nightmares after a traumatic

incident.

They expressed a need to know whether they correctly answered questions that the children

might ask.

How to restrain children who are biting and kicking them or the other children and who pose

a danger to others?

The handling of conflict was also a topic the participants requested training on. The

participants fear to intervene when children are fighting because of being attacked or hurt

themselves.

o Riana: “Because most of them lose it. They go crazy. To talk them down … sorry it does not

work.”

o Amo: “And you have to make sure that you are safe as well. You are afraid sometimes to get

hurt.”

They expressed the need to be trained on how to deal with the children’s anger.

They also expressed the need to receive in-depth training on what attachment and a disorder

in that regard entails.

The participants stated that they experience a lot of emotion and pain while working with

these children. Training to assist the caregivers in dealing with their own emotions and pain

seems to be essential, especially if they do not have regular debriefing opportunities.

Training on how to form a relationship with a child with an attachment disorder, how to

approach these children, what to do and say, and their behaviour and disciplining them.

Some of the participants stated that they feel that if they do and say the right things, they

would be able to form a relationship with these children.

The participants appeared to feel traumatised themselves by the amount of trauma that the

children have to deal with. They felt that they get too few debriefing opportunities. Assisting

them in how to deal with this seems paramount not only for themselves, but for the children.

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Some of the participants expressed the need to be trained on how to complete an Individual

Development Plan (IDP) for each child and to then be able to update it on a monthly basis in

order to see if there is progress. They feel that this will enable them to determine, together

with the social worker, whether it is necessary to set new goals or to remove some of the

existing goals. The participants would also like to receive training about each child in order

to help them to understand each child.

The participants also felt that they need training on the different cultures of the children

being admitted into CYCCs. For example, how to cope with the different eating habits and

religious/traditional customs.

Some of the participants also expressed the need to receive training in non-verbal and verbal

communication.

o Riana: “Teach us that if a child does this with his hands, it is not going to happen.”

Follow-up training (e.g., repetition of previous training) was requested by the participants to

act as a reminder of what they have learned thus far. They also felt that it should not just be

the supervisors who receive training, but the rest of them as well. In some of the CYCCs, for

example, only the supervisors attended the RAP training.

Attending motivational workshops was thought by some of the participants to be necessary

for them because it could assist them with working with children with attachment disorders.

o Key Informant 1: “Good suggestions for training.”

o Key Informant 2: “This is a very nice list of topics for training and it would be wonderful if

all childcare workers could be trained in this. Training for childcare workers need to be

continuous [weekly]. They need to feel equipped in order to deal with the specific challenges

of the children in their house unit. Weekly meetings with social workers or other important

team players will also be recommended.”

4.8 Conclusion

This study was conducted in order to determine what challenges caregivers who work with children

with attachment disorders experience in CYCCs and to determine their training needs in this regard.

Challenges experienced by the caregivers were identified by the participants who participated in

this study’s focus groups. The participants identified various interpersonal and organisational

challenges that impact negatively on their work with children with attachment disorders. Some of

the interpersonal challenges experienced by the caregivers included the behaviour of the child, the

forming of a relationship with a child with an attachment disorder as well as feeling sometimes

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overwhelmed by the trauma the children have experienced. Organisational challenges included a

lack of time and debriefing as well as the style of management.

The challenges experienced by the caregivers are difficult to deal with without the necessary

training. Some of the participants indicated that the training they have received was sometimes not

applicable to their situation and also not very practical. An example which was used was training on

philosophical aspects. They stressed their need for training that is practical. The participants,

especially from the one CYCC, indicated that the RAP training they had received was practical and

effective, and it packaged and presented nicely all the previous training that they had received

before. The participants also found role-playing to be a very useful training tool because it helped

them to see what others might do in a particular situation.

Training needs expressed by the participants ranged from how to deal physically and emotionally

with the challenging behaviour of these children, assistance in understanding each child, and how to

deal with their own issues, which might be triggered by these children’s actions or communication.

It appears that training on how to deal with children with attachment disorders should start with the

communication between the social workers in the institutions and the caregivers. Participants

expressed the desire to be informed and trained by the social workers on, for example, why a child

responds in a certain manner and in assisting the caregivers in understanding each child. The

participants also want training regarding the drawing-up of an IDP plan for each child in order to be

able to monitor the progress of each child. The participants expressed the need to draw up the IDP

with the social workers. It appears that the caregivers desire to be part of the treatment plan of the

child and to be involved with the drawing-up of it, as well as with the decisions being made

regarding the children.

Despite the fact that some of the caregivers had extensive training, there still appears to be certain

issues that they need training for. For example, the caregivers need training on what the term

attachment entails, how to restrain an aggressive child, and how to intervene when two children are

fighting. Relevant training on a regular basis appears to be a necessity for the caregivers in order to

provide them with the necessary skills to cope with the demands of working with children with an

attachment disorder.

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Chapter 5: Conclusions and recommendations

5.1 Introduction

In this chapter, the aim and objectives of this study and the methodology used to conduct this study

are summarised. In response to the objectives set out at the beginning of this study, the key findings

from the data analysis are then provided. Finally, conclusions are drawn from these findings and

recommendations are made for social workers regarding the skills development of the caregivers

who work with children with attachment disorders. Recommendations are made that could, in my

opinion, best assist caregivers in CYCCs with taking care of a child with an attachment disorder.

5.2 Aim and objectives of the study

The aim of this study was to explore the training needs of caregivers who take care of children with

attachment disorders who are in residential care. The objectives of the study were to:

1. Explore the interpersonal challenges experienced by caregivers in caring for children with

attachment disorders;

2. Describe what strategies/lessons caregivers have learned helps them to relate to children


3. Identify what the caregivers’ training requirements are with regard to their care of children




5.3 Research methodology applied in the study

A qualitative research approach was used to capture and document the experiences of caregivers

who take care of children with attachment disorders. This approach allowed for exploration, which

was appropriate for this study due to the limited information that is available currently on the

training needs of caregivers in institutions who care for children with attachment disorders. The

discussions with the focus groups were recorded and transcribed, and written feedback on the

findings were obtained from two key informants.

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5.4 Summary of major findings

The major findings are discussed in relation to the objectives of the study. The objectives of the

study included exploring the interpersonal challenges as experienced by the caregivers in working

with the child with an attachment disorder. Organizational challenges experienced by the caregivers

in taking care of the child with an attachment disorder were not included in the objectives of the

study. Because the caregivers provided information in this regard, however, their voice needed to be

heard and the organizational challenges as experienced by them will be discussed as well. To

determine what assist the caregivers in relating to the child with an attachment disorder was the

second objective. The third objective was to identify the training needs of the caregivers in taking

care of the child with an attachment disorder, while the final objective was to make

recommendations for social workers regarding the skills development requirements of caregivers of

children with attachment disorders.

5.4.1 Major interpersonal and organisational challenges experienced by caregivers in caring

for children with attachment disorders

Six major interpersonal challenges experienced by caregivers in working with children with an

attachment disorder were identified. These include the child with and attachment disorder; his or

her behaviour; to form a relationship with a child with an attachment disorder; feelings experienced

by caregivers working with the child with an attachment disorder; the caregivers own families and

the future of a child with an attachment disorder. Seven organisational challenges were identified

which include the ratio of children to caregiver; communication between caregivers, social workers

and management within the organization; the lack of time; the social workers within the CYCCs;

the lack of debriefing opportunities there are for caregivers; the management style as well as how

these children are being disciplined within the CYCCs.

Caregivers find it challenging to care for a child with an attachment disorder because they find it

difficult to understand what the child have gone through, and how a child’s background shapes the

child’s responses to the caregivers. Other interpersonal challenged include how to approach each

child, how to manage their own expectations of these children, as well as their expectations of the

social workers and management. The behaviour of these children also poses a challenge because the

caregivers want to approach and deal with the child according to his or her age and/or

developmental stage, without realising that they actually need to meet the child where he or she is

emotionally at. These children do not have a reference of what a relationship entails which make

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forming a relationship with them difficult. The caregivers are challenged not to take the response

these children might show towards them personally.

Caregivers often find their work overwhelming and they sometimes struggle to address the many

challenges they face in a positive, constructive manner. It appears that balancing work and family

life is a major challenge for caregivers and that they sometimes feel forced to make a choice. The

caregivers find the future of these children to be a challenge because they have seen the negative

outcome of a few of these children’s futures. Despite seeing the negative outcome of the future of

some of the children with attachment disorders, the caregivers still find it difficult to break the

influence the parents or primary caregivers had on the child with an attachment disorder. Hence the

cycle continues from one generation to another.

The high ratio of children to caregiver poses a challenge to the caregivers because they find it

difficult to form a relationship with all the children if the ration is high. The caregivers regarded

communication within the organization as negative because they feel they do not receive the

necessary information about each child, they are not involved in the decision-making processes, and

some social workers abuse their positions of authority. Despite caregivers administering good time

management, they continue to find it difficult to spend sufficient time with each child.

Social workers within the CYCC and from organisations outside of the CYCC pose a challenge to

the caregivers because the caregivers do not agree with everything that the social workers do. The

caregivers also feel that the social workers do not do enough for the families of these children. A

lack of debriefing opportunities makes it difficult and/or impossible for the caregivers to deal with

the various challenges that they experience in their work. The manner in which management deals

with difficult situations between the caregivers and the children poses a challenge to the caregivers.

The caregivers’ personal issues and their attitude towards management might also negatively

influence how caregivers approach and work with management. The disciplining of the children in

the CYCCs appears to be a challenge, especially since new legislation prohibits corporal

punishment. Caregivers have to rely more on alternative disciplining measures such as behaviour

modification.

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5.4.2 The strategies/lessons that the caregivers have learned to help them work with children

with attachment disorders

Some of the lessons that the caregivers have learned to help them work with a child with an

attachment disorder include:

They need to set an example through how they conduct themselves. They need to have

patience, be sensitive to the children’s needs, and they should not show the children that

what they said has hurt them (e.g., not to cry in front of them).

In order to not be judgemental of a newly-admitted child, the caregivers felt that they only

needed to know about the background of the child not their behaviour. When a child

presents with negative behaviour, the caregivers have learned that they need to focus the

child’s attention onto something else.

Having clear boundaries, ensuring that their verbal and nonverbal communication is

congruent, and having an understanding of their own personal triggers.

5.4.3 The caregivers’ training requirements regarding their care of children with

attachment disorders

The caregivers asked for training that is practical. They mentioned that role-play and the Response

Ability Pathways (RAP) training were examples of applicable, practical, simple, and easy to

understand and remember training. Topics that were identified by the caregivers for training

included:

In-depth training on what attachment and an attachment disorder is, and how to deal with

the child with an attachment disorder’s response to trauma.

How to discipline the children and what verbal and non-verbal communication entails.

Training on how to compile and update an Individual Development Plan (IDP) in

conjunction with the social workers, for each child.

How to deal with the negative behaviour of children with attachment disorders and how to

manage the different cultures that the children represent.

The caregivers felt that attending motivational workshops is necessary for them and that

training should be repeated regularly.

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5.5 Recommendations for social workers regarding the skills development

requirements of caregivers caring for children with attachment disorders

Caregivers are confronted with various challenges when working with children with attachment

disorder and when working in a CYCC. To expect caregivers to work with around ten children, all

with some degree of attachment disorders, without having received the necessary training, is

unrealistic and unfair towards not only the caregivers, but also the children. In South Africa, the

Children’s Act (2005) stipulates the need for the care and protection of each child so that their best

interests and well-being are prioritised. It appears, therefore, to be in a child’s (in a CYCC) best

interest if the caregivers looking after the child are trained adequately to care for and protect the

child. Caregivers who are well-equipped and well-trained might be able to deal better with the child

who has an attachment disorder. Training for caregivers should thus not be seen as a luxury, but as a

necessity. Recommendations on what training the caregivers should receive regarding a child with

an attachment disorder are as follows:

5.5.1 Attachment

Caregivers should receive in-depth training on what the terms ‘attachment’ and ‘attachment

disorder’ mean. This should include training on when (i.e. age) and how an attachment is formed.

Topics to be addressed in this training should include:

What the different attachment styles entail and what behaviour the caregivers can expect

from children with different attachment styles.

The possible reasons why children formed these attachment styles with their primary

caregivers needs to be highlighted and discussed. Training should also be given on what the

behaviour of their primary caregivers entailed, which could have contributed to the forming

of their attachment styles and how it and the history of the children influenced their

development and current functioning.

What the internal working model of the child entails and how it influences the relationships

of the child throughout his or her life.

What caregivers can expect from children with attachment disorders regarding their

behaviour, emotions, their concept of self, and their concept of others (attitude towards

others).

Caregivers need to be trained on what the difficult behaviour of a child with an attachment

disorder means. Caregivers can then be more aware of the needs that the children are

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expressing through their behaviour and how they can address these needs (e.g., when a child

pushes a caregiver away, indicating they do not want to be touched, the child actually might

want to be touched but they might not know how to accept and reciprocate it).

The child with an attachment disorder might not have the necessary social skills to socialise

or communicate with others and they therefore might make use of various coping

mechanisms in order to deal with these inabilities. Caregivers should receive training on

these different types of coping mechanisms, and on how to teach children the necessary

social skills.

The definition of trauma, what it entails, and the impact trauma has on the child’s

development and functioning needs to be understood by caregivers.

Caregivers should be made aware of whether they can expect rewards from the child or

CYCC when working with the child with an attachment disorder. It appears that caregivers

have certain expectations that might be unrealistic and they should receive the necessary

guidance on what they can expect from a child with an attachment disorder. The caregivers

need to realise that these children might never learn to form attachments.

Caregivers need to understand and be prepared for the possible responses (like fantasising

about this person) a child might have towards a perpetrator who has abused the child and

who is also the child’s primary caregiver. Caregivers need the necessary skills to assist the

child in this regard.

It might assist caregivers to understanding the treatment plans chosen for each child if they

could be trained more generally on the various forms of abuse/maltreatment and the

different ways of treating it. It would be beneficial for the child if caregivers could support

the treatment plan and the execution thereof.

Training on how to supervise and manage the contact between a child with an attachment

disorder and the perpetrator, family, and primary caregivers, together with the social

workers, could benefit the well-being of the child. Children need to remain in contact with

family in order to ensure that the bonds between them are strengthened and not disrupted

further.

Caregivers should receive training on how to prepare the children for leaving the CYCC.

Caregivers therefore need to know how to teach the children the relevant skills to cope with

their unchanged home circumstances.

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5.5.2 Behaviour and disciplining of these children

The child with an attachment disorder can exhibit very difficult behaviour and the caregivers need

training on how to address these behavioural challenges. This training can consist of the following:

To make caregivers aware of what the root cause is for the behaviour of the children and the

possible reasons why they are acting out, screaming, shouting, or being angry.

Children who suffer from an attachment disorder might not know how to express their

feelings. Once caregivers, who work with the children on a daily basis, have received the

right training, they might be able to encourage the children to express themselves more

clearly.

Caregivers need to understand what emotional maturity and immaturity means, and they

need to have the necessary skills to guide the children to emotional maturity and to teach

them how to regulate their emotions.

Children with attachment disorders are sometimes very aggressive and caregivers need to

receive training on how to physically restrain children who act out violently. Caregivers also

need to know how to protect themselves and the other children from physical harm caused

by the more aggressive children.

Knowing how to respond to the children’s challenging behaviours is very important.

Caregivers therefore need to have the necessary skills to know how to calm a situation and

not escalate it. Caregivers need to acquire the necessary skills to defuse situations where the

children are involved.

The children with attachment disorders tend to forget simple instructions given to them by

their caregivers and it appears to be due to the trauma they have suffered. Caregivers need to

receive the necessary training on the effects of trauma on the development of a child and

what they can do to assist the children to manage this.

In most cases, the child with an attachment disorder has experienced rejection from their

primary caregivers. Caregivers need to be trained on what rejection entails, the issues the

children experience because of that, and how they can assist the children.

Training on effective behaviour modification methods also appears to be necessary, since

corporal punishment is no longer an option in South Africa.

5.5.3 Relationship

Caregivers find it very challenging to form relationships with the children when the ratio of

caregivers and children are so high. Another challenge for the caregivers is how to teach these

108

children what a healthy attachment entails. What makes it difficult for the caregivers is, for

example, the behaviour of the children. Aspects regarding the forming of a relationship with these

children that caregivers should receive training on are:

Firstly, the caregivers need to determine, acknowledge, be made aware of, and address their

own issues/triggers so that they can be aware of the impact this might have on their forming

of a relationship with the children.

Training on time management might help the caregivers to find more time to form

relationships with the children.

Training on how to create a safe (accepting, nurturing, and loving) environment for the

children, which can assist the children to trust others and form healthy relationships.

Training on what a healthy relationship entails and what caregivers can expect from the

forming of a relationship with a child with an attachment disorder. Training on the

requirements for forming a relationship with the children is also needed. For example,

caregivers should meet the child where he or she is at, be honest, and should encourage open

communication.

Caregivers need to know how they can show the children with attachment disorders that

they are loved unconditionally by them. Caregivers need to understand that consistency

when disciplining children with attachment disorders is key to letting the children know that

no matter what they do, they are still accepted by the caregivers.

How to change the child’s negative reference of what love means to that of knowing that

love means a trusting, healthy relationship that does not include having sex with an adult.

Caregivers need to learn how to win the trust of the children. Caregivers might win their

trust, for example, by being patient and sincere.

How to set boundaries when working with the children and what these boundaries should

entail. Children who do not know what a relationship entails might form unhealthy

relationships by clinging to the caregiver. The caregiver needs to know how to set a

boundary without the child feeling rejected by an adult again.

How to incorporate and allow each child’s uniqueness into the relationship.

5.5.4 Feelings experienced by caregivers

Caregivers need to receive training on how to manage their feelings regarding the challenges they

experience in the CYCC and in working with the child with an attachment disorder.

What does the concepts empathy and sympathy entail? Why caregivers need to have

empathy for these children.

109

The term ‘burnout’, what it entails, and the warning signs that caregivers should look out

for. Practical examples should be taught to caregivers on how they can prevent burnout (e.g.,

leave the premises on their ‘off’ days/times, and do activities with non-caregivers). What

personal boundaries entail and how to set them.

How to maintain positivity despite being exposed to so much negativity or poor

management.

How to manage the rejection that caregivers experience from the children? How to respond

positively and constructively towards negative remarks made by these children.

Training on how caregivers should manage their negative feelings towards the children.

What avenues caregivers can make use of to work through their negative feelings (e.g., talk

to someone and exercise).

Caregivers find it difficult to maintain a balance between their own family life and those of

the children at the CYCC, especially when they are working with very young children.

Caregivers therefore need to taught practical ways to manage this.

Training on what a ‘repeating cycle’ entails, how it can be broken, and what their role is in

this process. This could assist caregivers to not give up on children who have been attending

the CYCC from the same family (one generation after another).

Caregivers need to be prepared for the possibility that they might be exposed to various

challenges without opportunities for debriefing. They should be given the necessary skills to

manage a lack of debriefing opportunities. Caregivers also need to be provided with

practical suggestions on how they can put debriefing opportunities in place.

5.5.5 Communication

Effective communication between the different role-players (e.g., the caregivers, social workers,

and management) needs to be in place in order for all the role-players to be able to work as a team

and for the best interest of the children to be served. Time should be made to discuss the children’s

progress, difficulties experienced, and how to address them. The latter might entail an informal

training opportunity for the social worker to train the caregiver. Training that caregivers should

receive regarding communication within the CYCC can include:

What the communication channels (protocol) within the CYCC entail,

What verbal and non-verbal communication entails and what the child with an attachment

disorder is communicating with his or her non-verbal behaviour. A child might

communicate that he or she does not want to be touched, while it is actually the opposite.

110

Since listening is the most important part of communication, training should be provided on

how to listen to a child with an attachment disorder (to listen to the child immediately and

not to tell the child to wait until later). This would assist caregivers to understand these

children better.

The caregivers might benefit from training on how they could communicate their

frustrations and suggestions to management and the social workers in a professional, yet

assertive manner.

5.6.6 Social workers

Caregivers experience challenges with regard to working with social workers in the CYCC and

from organisations outside of the CYCC. Training which might assist them to deal with these

challenges can include:

What the role of social workers in the CYCC entails.

What the role of social workers in organisations outside of the CYCC entails, as well as

their workload.

The differences and responsibilities of the various role-players in the CYCC, including

management.

Social workers should be able to train the caregivers on what attachment disorders entails

and should be experts in caregiving. They should also be able to show the caregivers how to

draw up an IDP for each child, and how to adjust it on a monthly basis. If the progress and

the difficulties of each child could be discussed by the social workers with the relevant

caregivers on a regular basis, it could empower, encourage, and motivate the caregivers in

their work. It could also assist the caregivers to understand each child better. It might also

encourage teamwork, which could benefit not only the child but also could contribute to a

professional and amicable working environment.

5.6.7 Characteristics caregivers should have when working with a child with an attachment

disorder

Caregivers should be made aware that certain characteristics might be required from them when

working with the child with an attachment disorder. Caregivers should be screened for the

following characteristics when being considered for the position of caregiver:

Being consistent, stable, assertive, confident, and mature. Having stable family

circumstances, good self-knowledge, and patience. The caregivers should be able to

111

persevere despite not seeing any change in the child and they should not expect any reward

in return.

Caregivers need to be sensitive to the needs of the child with an attachment disorder and

they need to know how to address those needs.

Having a positive mindset would assist caregivers when working with a child with an

attachment disorder.

5.6.8 Recommendations for future research

The following recommendations can be made regarding future research on the training needs of

caregivers who work with children with attachment disorders:

How to improve the working conditions of caregivers in South Africa in order for them for

example to have more time available to form attachments with the child with an attachment

disorder.

Developing training programmes that address the various challenges faced by caregivers

working with the child with an attachment disorder.

Research on how the team approach (working together as a team in treating the child) can be

implemented in a CYCC in a practical manner and clarifying the function of the social

worker and caregiver in this regard.

The above recommendations were made considering not only the input that was given by the

caregivers during the focus groups, but also taking the best interest of the child into consideration.

In order to serve the best interest of the child, the concerns and frustrations of caregivers need to be

addressed and they should receive relevant training in order to equip them with the necessary skills.

5.7 Conclusion

Caregivers in CYCCs are faced with various challenges when working with children with

attachment disorders. It appears that not all of the caregivers are adequately informed and trained on

what attachment and attachment disorders entail. Because working with about ten children who all

suffer from varying styles of attachment disorders poses a real challenge to the caregivers, they

need the right assistance and support. One way of providing them with the necessary support is by

providing them with the necessary skills that relevant and practical training can provide. It is unfair

and also unrealistic to expect caregivers to deliver professional and effective services to a child with

112

an attachment disorder within the CYCC, without sufficient training on the above matters. Effort

must therefore be made to not only screen caregivers very carefully before employing them, but to

also equip them to work with these children. Equipping caregivers with the right skills to work with

children with attachment disorders is critical because this might be the only time that these children

can learn to form trusting relationships, break the generational cycle of attachment disorders, and

have a positive future.

113

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Appendixes

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Appendix A: Information letter

Dear_______________________

Child and Youth Care Centres accommodate vulnerable youth from various backgrounds and home

circumstances. It appears that Child and Youth Care Centres have to deal increasingly more with

children with behaviour which is difficult to manage. The behaviour can include anger, depression,

vandalism, anxiety, detachment from others emotionally, emotional distress as well as personality

disturbances. This appears to increase pressure to adjust or change programmes at the Child and

Youth Care Centres in order to address the needs of these children and to assist the care workers to

manage and form relationships with these children.

Because of the difficulties experienced by care workers working with children with attachment

disorders, I decided to conduct research in order to determine the training needs of the care workers.

Care workers who work with children with attachment disorders are aware of the challenges they

face when working with these children. The care workers have also acquired experience regarding

what might be effective in caring for these particular children. Their contribution to the study might

enable other care workers to apply their acquired skills and knowledge more effectively in dealing

with these children.

We like to invite you to be part of the process of collecting data in order to validate this study. I am

approaching Child and Youth Care Centres (Children’s Homes) since children in these centres

normally stays at the Child and Youth Care Centres for an extended period of time. The care givers

can therefore have a noticeable impact on these children. The data will be collected by conducting

two focus groups sessions of 90 minutes each at two different Child and Youth Care Centres. The

data received will be verified with a follow-up session of 60 minutes with the care workers in order

to determine if what they said was correctly understood and interpreted.

There will be no direct benefit to your organization for participating in the study. However, your

participation as an organization, and that of the care workers in your organization, will assist us in

determining the training needs of care givers. Addressing the training needs of the care givers might

improve the care the children, suffering from attachment disorders receive. If you would like, we

could make the final findings of the study available to you.

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This research project has been reviewed and approved by the Higher Degrees Committee of the

University of Johannesburg. I could also attach the full proposal if you would like more information

on the design of the study.

If you are willing to assist with this project, we suggest the following for the way forward:

1. Coordinator: please assign an individual in your organization to coordinate the project

(hereafter referred to as the Coordinator).

2. The Coordinator will be provided by us with information letters and consent forms (this will

be at no expense to your organization).

3. The Coordinator will select from your organization a sample of care givers (between 5-7

care givers) who have six months experience in working with children with attachment

disorders, who have been working at your organization for two or more years and who are

interested in working with children with attachment disorders. The Coordinator will invite

them to participate, using the supplied information letters and consent forms.

4. If the care giver agrees to participate and signs the Informed Consent Form, then the

Coordinator will arrange an appropriate time and venue for the participants and the

researcher to conduct the focus group while being supervised by the Coordinator. The focus

group should be conducted at your organization, at a suitable time which will not disrupt

your organization or the participants.

5. The Consent Forms should be returned to me at my expense.

Please do not hesitate to contact me should you have any questions or concerns regarding the

conducting of the focus group at your organization.

Elsa-Marié Fourie

Clinical Social Work Masters

Student Number: 201284316

Cell: 082 290 7461

E-mail: [email protected]

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Appendix B: Participant information sheet and consent form

Dear _____________________

I would like to tell you about the research we are conducting and which we really would like you to

participate in. The research would entail you participating in a 90 minute group discussion

regarding the difficulties you experience when working with children with attachment disorders as

well as to explore your training needs in this regard.

To work with children with attachment disorders must be a difficult task. It is most probably made

more difficult when you have other children to look after as well as have household duties. Despite

the difficulties experienced by you caring for these children you will have acquired skills to assist

you in dealing with them. We would like to enquire from you what these skills entail as well as

what kind of training you feel could assist you in caring for these children.

The research will require your involvement in a focus group discussion of 90 minutes as well as a

feedback session of 60 minutes. The latter involves confirming the information obtained from you

during the first focus group and ensuring that it was well understood. We are therefore asking

whether you will participate in this focus group discussion. We need your permission before you

can participate.

What to consider:

We are not offering money or anything else to you for participating in the study. By

participating in the study you have the opportunity to assist other care givers who work with

children with attachment disorders to receive the necessary training in how to work with

these children.

The focus group will take about 90 minutes. Your input will be done anonymously. Your

honest views are very important to us and there are no wrong or right answers.

You may not be forced to participate in the study and you may withdraw at any time.

Participation is voluntarily.

The session will be recorded.

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This study has been reviewed and approved by the Higher Degrees Committee of the

University of Johannesburg.

Please sign the consent form if you are willing to participate and return the form to the Coordinator.

You may contact Elsa-Marié Fourie at 082 290 7461 or e-mail her at [email protected] if

you should have any questions.

By signing this form you indicate that you are willing to participate in this study voluntarily.

I understand the information and procedures described in the above. I hereby agree to participate

voluntarily in the study (focus group). I have received a copy of this form.

___________________

Name of Participant

____________________ __________________

Signature of Participant Date

___________________ ____________________

Signature of Witness Date

mailto:[email protected]

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Appendix C: Questioning route

Opening of Focus Group

- Tell participants in brief what kind of information I need from them

- Inform them about the purpose if the study

- Each person’s contribution is valuable and what they share won’t be criticize,

- There are no wrong answers

A. Knowledge and general understanding

Central question:

Sometimes children who have behaviour which is difficult to manage for caregivers are described

as children with an ‘Attachment Disorder.’ What does the term ‘Attachment’ mean to you and what

do you think it means if a child has a ‘disorder’ in that regard?

Prompting questions:

1. At what age does a child develop an Attachment Disorder?

1. Op watter ouderdom ontwikkel kinders bindings versteurings?

2. What contributes to the development of an Attachment Disorder?

2. Wat dra by tot die ontwikkeling van ‘n bindings versteuring?

3. What behaviour characterizes a child with an Attachment Disorder?

3. Watter gedrag is kenmerkend van ‘n kind met ‘n bindings versteuring?

4. What does the future of these children who does not receive help look like?

4. Hoe lyk die toekoms van hierdie kinders wat nie hulp ontvang nie?

5. Can a caregiver influence a child’s perception of a relationship?

5. Kan ‘n versorger ‘n kind se persepsie van ‘n verhouding beïnvloed?

B. Relationship between Caregiver and Child with Attachment Disorder

Central question:

Children who have been placed in a Child and Youth Care Centre normally do not come from ideal

home circumstances. It therefore may be a challenge for caregivers to form a relationship with

children suffering from an attachment disorder and being placed in the home. In addition, it may

also be difficult for caregivers to understand the needs of these children. What challenges within

yourself and within your organization do you experience in forming a relationship with children

suffering from an Attachment Disorder?

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6. Describe the relationship between you and a child with an Attachment Disorder?

6. Hoe lyk die verhouding tussen ‘n versorger en ‘n kind wat ‘n bindings versteuring het?

7. What challenges do you experience in the forming of a relationship with these children?

7. Watter uitdagings beleef u in die vorming van ‘n verhouding met hierdie kinders?

8. Is it personally very difficult for you to work with these children?

8. Is dit persoonlik baie moeilik vir u om met hierdie kinders te werk?

9. If yes: What interpersonal challenges do you experience when working with these children?

9. Indien ja: Watter interpersoonlike uitdagings beleef u wanneer u met hulle werk?

10. What hinders you from forming a relationship with a child who has an Attachment Disorder?

10. Wat verhinder u om ‘n verhouding te vorm met ‘n kind wat ‘n bindingsprobleem het?

11. Do your own attachment problems prevent you from relating to these children?

11. Verhoed u eie bindings probleme u om ‘n verhouding met hierdie kinders te vorm?

C. What caregivers have learned helps in relating to children with attachment disorders?

Central question:

You have gained experience through your own efforts (what you have learned through trial and

error) and maybe also through training you have received as a child and youth care worker and the

implementation of that training. You have learned valuable lessons over the years of working with

children who are suffering from an Attachment Disorder. What have you learned helps you in

relating to these children?


12. Through your experience, what have you found helps you relate better to these children?

12. Wat het u uit eie ondervinding geleer help om ‘n verhouding met hierdie kinders te vorm?

13. How do you approach these children when you first meet them?

13. Hoe hanteer u hierdie kinders met ‘n eerste ontmoeting?

14. If a new child and youth care worker was appointed, what would you tell him or her of how to

work effectively with children with Attachment Disorders?

14. Indien ‘n nuwe kinder- en jeugsorgwerker aangestel word hoe sal u vir hom of haar verduidelik

om effektief met kinders wat ‘n bindingsprobleem het te werk?

D. Training needs

Central question:

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You might have received some training regarding the forming of a relationship or working with a

child with an Attachment Disorder. What did this training entail and in what areas of forming a

relationship with a child with an Attachment Disorder did this training assist you or not assist you?


15. What training do caregivers need to form positive relationships with children with attachment

disorders?

15. Watter opleiding benodig versorgers om positiewe verhoudings te vorm met kinders met ‘n

bindings probleem?

16. What skills do caregivers require to work with children with attachment disorders?

16. Watter vaardighede het ‘n versorger nodig om met hierdie kinders te werk?

17. What do social workers need to know regarding the training needs required by caregivers

working with these children?

17. Wat behoort maatskaplike werkers te weet van die opleidings behoeftes van versorgers wat

werk met hierdie kinders?

E. Closing of focus group

- Mention when you ask the last question,

- Summarize the main points of discussion; ask if they agree with it being the main points and

say thank you to the participants for taking part in focus group.

- Ask them whether we have left anything out,

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Appendix D: Information on attachment

What does Attachment and Attachment Disorder entail?

Attachment

Every child needs a caregiver (adult) with whom they can form a relationship and who is tuned in to

them. The attachment figure is usually the mother, while the individual showing attachment

behaviour is usually the child. From birth, a child will form a bond (attachment) with their

caregiver. The caregiver is normally the mother, but can also be the father or any other person who

would be fulfilling the primary ‘care giving’ role of the child. Attachment is formed when the

caregiver, hereafter referred to as the mother, responds to the child when, for example, the child

cries. The mother’s response will be to pick the child up, smile at the child, talk to the child, cuddle

the child, feed the child, and/or change the child’s nappy. The mother therefore sees to the needs of

the child.

As the child grows bigger and begins to crawl, he or she will start to explore the world around them.

Because their mother is willing to actively partake in friendly interaction (Bowlby, 1979) and

provides the child with a secure base, the child will feels safe and would then start to explore their

surroundings by crawling around. When the child feels frightened or tired (Bowlby, 1979), he or

she will return to their secure base: the mother. This behaviour will continue throughout the child’s

life, even as an adult. As adults, we also operate from a secure base that we return to. This secure

base can be our family or any other person (base) that we have formed an attachment to. A person

who does not have this base might feel very lonely and without roots (Bowlby, 1979).

If a person suffers from a psychiatric illness (disturbance), they always show a weakness in their

ability to form a loving (affectional) bond with another person. It was found that if there were a

high occurrence of disturbed relationships during a person’s childhood (Bowlby, 1979) this led to a

condition of depression and a disturbed personality. If one looks at the childhood of a psychopath,

one finds that their childhood was most likely disturbed by their parents getting a divorce, their

parents being separated from each other, or even the death of one of the parents. Other events could

also have disturbed their childhood, which could have severely disrupted their bonds. Psychopaths,

for example, can commit acts against themselves (addiction, suicide), the family (neglect, cruelty),

or against society (crime).

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If a child was handled badly during the first one or two years of their life, he or she will become

insecure and mistrusting. If, however, the child was treated well (nurtured and feeling loved), her or

she will develop trust and security.

The behaviour of children with an insecure attachment disorder is troubled, which makes it difficult

for caregivers to work with them. The behaviour of children who have not formed a secure

attachment might be characterised by the following: they may see the world as a dangerous place

and feel the need to be wary of others. They may also feel that they do not deserve love and that

they are not effective (Holmes, 1993). Some may also form shallow and mostly fleeting

relationships (Botes & Ryke, 2011). The behaviour of children with attachment disorders might

include impulsiveness, a poor self-image, being emotionally unstable, faring poorly at school,

lacking the ability to grasp abstract concepts, and the inadequate development of conscience. It is

this combination of behaviours that makes it difficult for caregivers to take care of these children.

Herbert (2005) indicated that this anxiety must be so severe, that it interferes with normal activities

on a social and academic level.

Insecure Attachments

According to Makariev and Shaver (2010), children who have formed insecure attachments have a

higher potential to develop a form of psychopathology (clinical disorders), than those who have

developed secure attachments. The reason for this is that the securely attached person is more

effective in dealing with stress than those with insecure attachments. The attachment styles of those

who have formed insecure attachment can be as follows: avoidant attachment, anxious attachment,

ambivalent attachment, and disorganised attachment. These four different styles are detailed below.

The Avoidant-Attachment Style

Davis and McVean (2009) indicated that the ‘avoidant attachment style’ is formed when the

caregivers’ behaviours are consistent, but rejecting. These caregivers would rather withdraw when

their child experiences an episode of distress than provide comfort to the child. These children learn

that others are not likely to be available to provide comfort; they therefore down-play their need for

proximity and comfort from others. These children would be uncomfortable with intimacy. They

would also be uncomfortable depending on each other, or expressing their physical or emotional

needs to someone else.

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The Anxious-Attachment Style

Davis and McVean (2009) indicated that the parents of children who have developed the anxious

attachment styles were more likely to not respond to their needs, were more intrusive, and would

rather act on their own impulses and needs than on those of their children. These parents also tend

to have fewer skills in physical interactions. These children would deal with stressful situations by

making use of ‘hyperactivitating’ strategies in an attempt to force the unresponsive caregiver into

responding to their needs. A person with this attachment style characteristically has a strong need

for closeness and intimacy, has a fear of separation or being abandoned, and experiencs frustration

because of their inability to obtain their goals of intimacy and the forming of a relationship.

Children with anxious attachment are prone to seek reassurance excessively. According to Davis

and McVean (2009), they also tend to have poor communication, poor conflict management, and

high levels of conflict, criticism, and violence.

The Ambivalent-Attachment Style

According to Levy and Orlans (2003), a child who develops an ambivalent attachment tends to be

clingy, demanding, and hyper vigilant towards rejection. These children also tend to be preoccupied

with the moods of their parents, they fear separation from their parents, the parents struggle to

soothe them, and they would act childish or controlling in an attempt to connect. This child wants to

force being close to someone because they fear that the person will leave them.

The Disorganised-Attachment Style

According to Alexander (2003), disorganised-attachment is related to the experience of abuse,

usually at the hands of the parent or other primary caregiver. This type of attachment might also

include conflicting behaviour by the child: the child might, for example, approach but also avoid the

parent at the same time. In a situation of fear, the child might, for example, seek comfort from the

parent while also trying to avoid that parent. Levy and Orlans (2003) stated that children with this

attachment style have experienced severe trauma such as violence and several losses.

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Appendix E: Flip chart for constructing themes

132

133

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Appendix F: Extract of a transcription from a focus group

Pat: It is the circumstances completely of that child that has been neglected. Either from childhood

or teenager, going right through, until we actually receive that child through the courts and social

workers.

Louise: Trauma as a whole is a contributing factor for anybody. If you had trauma at home as a

child or as an adult is what we are dealing with here. Trauma that causes them to be afraid and

takes them long to attach to whoever. And like you were saying it takes them long to attach to

anybody.

SW: So would you say neglect and trauma is contributing factors for attachment disorders?

Louise: Yes trauma.

The children, sometimes they will rather hurt somebody else before they get hurt again. They

would rather hurt other people before they themselves get hurt again.

SW: What behavior characterizes a child with an attachment disorder? What is your experience?

Louise: Clinging, always clinging. And bullying. Because they have been hurt. They are just

hitting because of that anger and also because they have been bullied before.

Leonie: Yes I agree with them.

SW: What is the future of these children, who do not receive help, look like?

Bleak, jail. Back home they have to cope with the adult situation and then they can’t cope.

They wouldn’t have a future. They wouldn’t have any stability in their lives or any skills, trust, I

mean, us as childcare workers working here have to built so much into that child because to me that

child is a broken child. It is like a broken ornament. I you want to take a typical example. It is like

a broken ornament that you are trying to stick together. Pieces of that broken ornament might keep

falling off. You can try and try to put that piece back. And that is an example that I use. When I

135

did my training years ago, the trainer that trained me used it as a typical example that it is

something that is so sentimental, something that you want to try and help them preserve. And it is

not easy for any of us. It takes a lot of emotion and pain and if you think what we are feeling, you

can only imagine what that child is feeling. They don’t have the maturity to adapt. It is feelings

that we have to instill in them.

SW: And if you say jail … what did you mean by jail?

The boys, because they don’t accept any authority, they experiment with drugs, drinking, benzene,

you know, you name it and they try it. They don’t accept any authority from anybody. The girls

then, for them to show love to somebody is by giving their bodies and the boys are using drugs and

all that stuff, so what is the end point, I mean, the last 4-5 years, some of the kids that went out with

attachment disorder are already in jail.

SW: for what kind of offences?

Drug abuse. Selling drugs. Things like that. And the girls sell their bodies. I mean, for them that is

love, because that is the way they grew up. If somebody loved them somebody raped them. So,

give your body and that is love.

SW: Do they do it in the institution already?

Pat: Yes.

SW: Like prostitution? Is it that bad? To that degree or is it …

Riana: Yes, they do it for love. They think it is for love.

We actually separated them to protect them.

Each child is in their own room with alarm systems on but I mean, they enjoy themselves through

the windows. There is nothing that you can really do to stop them, because that is love to them.

SW: And Sonja … you said the future is bleak … what did you mean by that?

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Sonja: Most of them don’t know how to cope with adults…. They cannot form a positive

relationship with anybody.

If I can give an example … two of my girls … went out to. They moved to one of the satellite

houses. The one girl spoke to me last night. She said to me …In my house the girls are separate,

each in their own room. I watch them like a hawk. They moved out. They proofed that they can

cope in society … the one girl spoke to me on Whats App last night and she said that she’s done

something… I said what did you do? She said that she was suspended from school for the day

because she started to smoke and she was sitting on one of the boy’s lap at school and that was the

kind of thing I didn’t want them to do here. They didn’t have a chance to be with boys here. I think

for me I did over protect them, but I want them to stay with me until they are 21. I will look for a

husband for them, the right one, stuff like that, but it doesn’t work like that.

Riana: I think the big problem with our children is we let the kids grow up unnaturally because we

don’t let them mix, we don’t let the boys and the girls come together, we don’t let them speak to

each other as far as we can. Because we know, the moment … we had the incident yesterday where

a teacher was just turning her back and the kids started kissing and touching each other. They are

ten/eleven years old. They won’t stop there if you leave them … they will go all the way.

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Appendix G: Extract of colour coding of the above transcription

Focus Group 1 – 2013

Categories:

1. Texts concerning definitions/descriptions of what constitutes attachment disorder

2. Texts concerning the challenges of caring for kids with AD 3. Texts containing lessons learned 4. Texts containing training needs

Line Speak Text Codes

7 Pat It is the circumstances completely of that child that has been neglected. Either from childhood or teenager, going right through, until we actually receive the child by the courts and social workers.

Home circumstances contribute to neglect of child Children and teenagers

8 Louise Trauma as a whole is a contributing factor for anybody. If you

had trauma at home as a child or as an adult it will detach you a little bit too some extent and that is what we are dealing with here. Trauma that causes them to be afraid and takes them long to attach to whomever. And like Wendy was saying it takes them long to attach to anybody.

Trauma leads to AD

Children or adults Trauma leads to fear to attach Leads to fear of attaching to people Takes long to attach

9 SW So Wendy say neglect and you say trauma is contributing factors for attachment disorders?

10

Louise

Yes trauma. Trauma

11 Sonja The children, sometimes they will rather hurt somebody else before they get hurt again. They have been hurt very badly and now they would rather hurt other people before they get hurt themselves again.

Hurt others before they hurt them They have been hurt very badly (defensive – defense mechanism)

12 SW What behavior characterizes a child with an attachment disorder? What is your experience?

13 Sonja Clinging, clinging, always clinging. Clinging

14 Louise I think bullying, bullying. Because they’ve been hurt. They are hurting so much that they are just hitting and doing whatever because that anger that is in there and also because they have

been bullied before.

Bullying-they’ve been hurt Hurting so much-Hitting Anger

Have been bullied before

15 Leonie Yes I agree with them.

16 SW What does the future of these children, who do not receive help, look like?

17

Sonja

Bleak.

Poor outcomes

18 Riana Jail. Jail

19

Sonja

Back home they have to cope with the adult situation and then they can’t cope.

Don’t cope with adult life

20 Pat I don’t think that they would have a future. They wouldn’t have any stability in their lives or any skills, trust, I mean, us as childcare workers working here have to built-up so much in that child because to me that’s a broken child. It is like a broken ornament. I you want to take a typical example. It is like a broken ornament that you are trying to stick together. A piece of that broken ornament might keep falling off. But you

got to try and try to put that piece back. And that is an example that I use. When I did my training years ago, the trainer that trained me used it as a typical example that it is something that is so sentimental, something that you really want to try and help them preserve. And it is not easy for any of us. It takes a lot of emotion and a lot of pain but if you think of what we are feeling, you can imagine what that child is feeling. Because they haven’t got the maturity to adapt to any of those feelings

what we have to instill in them.

Lack of stability Lack of skills / Low trust Broken children Trying to fix broken children

Training from years ago It is difficult to care for them Feel emotion and pain Emotionally immature They lack feelings

Have to instill feelings in them

21 SW And if you say jail … what did you mean by jail?

22 Riana The boys, because they don’t accept any authority, they Boys don’t accept authority

138

Line Speak Text Codes

experiment with drugs, with drinking, with benzene, you know, you name it and they try it. They don’t accept any authority from anybody. The girls then, for them to show love to somebody is by giving their body and the boys are using drugs and all that stuff, so what is the end point? I mean, in the last 4-5 years, some of the kids that went out that had this attachment disorder are already in jail.

Experiment with drugs, drinking, benzene, any substance Girls show love by giving their body Misperception of what love is What is their future? Within 4-5 years of leaving CYCC in jail

23 SW For what kind of offences?

24 Riana Drug abuse. Selling drugs. Things like that. And the girls sell their bodies. I mean, for them that is love, because that is the way they grew up. If somebody loved them somebody raped them. So, give your body and that’s love.

Outcomes: Offences include selling drugs How they grew up: selling body is love Rape is love

25 SW Do they do it in the institution already?

26 Riana Yes

27 SW Like prostituting? That bad? To that degree or is it …

28 Riana Yes, they do it for love. They think it is for love. Sex is love

29 Louise We actually have to separate them to protect them. Separate to protect them

30 Riana Each child is in their own room with alarm systems on but I mean they enjoy themselves through the windows, the boys

and the girls. There is nothing that you can really do to stop them, because that’s love for them.

Own room and alarm systems Still continue with behaviour

Can’t stop them

31 SW SW: And Mary … you said their future looks bleak … what did you mean by that?

32 Sonja Some of them just don’t know how to cope with adults…. They cannot form a positive relationship with anybody.

Don’t know how to cope with adults Can’t form positive relationships with anyone

33 Leonie If I can give an example … two of my girls … went out. They moved to the satellite houses. The one girl spoke to me last night. She said to me …In my house the girls are separate, each in their own room. I watch them like a hawk. They moved out. They proofed that they can go out in society … the one girl spoke to me on ‘Whats App’ last night and she said that she’s done something wrong… I said what did you do? No I was suspended from school for the day, I started to smoke and

I was sitting on one of the boy’s lap at school and that was the kind of thing I didn’t want them to do here. They didn’t have a chance to be with boys here. I think for me I think I did over protect them, but I want them to stay with me until they are 21. I will look for a husband for them, the right one, stuff like that, but it doesn’t work like that.

Move to satellite houses Separate, own room Girls are watched closely Proofed that they can go out in society Outcomes: Suspended Behaviour: smoke, sit on boys lap

Strict: don’t mix with boys Over protect children Care but don’t have input into child’s life till 21 (limited input into child’s life)

34 Riana I think the big problem with our children is we let the kids

grow up unnatural because we don’t let them mix, we don’t let the boys and the girls come together, we don’t let them speak to each other as far as we can. Because we know, the moment … we had the incident yesterday where of the teacher just turning her back and the kids started kissing and touching each other. They are ten/eleven years old. They won’t stop there if you leave them … they will go all the way.

Children grow up unnatural in CYCC Boys and girls don’t mix When have contact – kiss and touch (can’t stop them) Kissing and touching in class 10/11 years old If leave them won’t stop - will go all the way

35 Sonja So we have to keep them apart. Keep apart

36 Riana We have to keep them apart but we are doing it unnaturally, because now they never learn how to cope with the opposite sex. They don’t know how to cope in a group. They don’t know how to cope when we leave them on the outside school because suddenly they are in this big classroom with thirty children where when they were young they were in a class with only two or three children and I think we do it unnaturally, but we have to because if we leave them Maria Klopper is going

to overflow with little babies.

Unnaturally Don’t learn to cope with opposite sex Don’t learn to cope in a group Don’t know how to cope in big classroom- 30 (used to 2/3) Otherwise have lots of babies

37 SW Is that only the sexualized children or is that all the children at Abraham Kriel?

38 Riana All the children on this campus are sexual abused children. We are a spez campus; we are not a normal children’s home. All our children were abused. All our children were sexually

abused.

Children on campus are sexually abused

39 SW Can a caregiver influence a child’s perception of a relationship? Do you feel that you as caregivers can influence their perception of a relationship?

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Appendix H: Extract of the field notes from the session which did not record

140

Appendix I: Extract of the field notes made prior to commencement of the focus groups

141

Appendix J: Extract from the journal which was kept

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Appendix K: Notes made of recordings of the focus group which were listened to and which

was not transcribed.

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Appendix L: Extract from feedback received from key informants

The key informant’s comments are presented in a different font.

It appeared that the caregivers felt that it is not always possible to help a child to heal and that it

does not matter how hard they will try to help that child that these children might always remain

broken. I do not fully agree with this statement. I do understand that it is extremely difficult to

care for children with attachment problems, but I have seen that children can change if the

childcare workers are trained and equipped to work with these children. I feel this is a huge

problem in South-Africa. Childcare workers, working in residential care settings are not always

trained to work with children with attachment problems. Some childcare workers who I have

worked with before were not even familiar with the term “attachment problems in children”. I

have also experienced that it is often difficult for childcare workers to work with these children, if

the childcare worker has her own unresolved childhood trauma/ attachment problems.

Pat:“..us as childcare workers working here have to built-up so much in that child because to me

that’s a broken child. It is like a broken ornament that you are trying to stick together. A piece of

that broken ornament might keep falling off. But you got to try and try to put that piece back.

Because they haven’t got the maturity to adapt to any of those feelings what we have to in still in

them”.

Despite the trauma (abuse, neglect) some of these children suffered by the hands of their caregivers

they still will continue to protect them. This sentence is a little bit unclear to me? They might also

live in their own fantasy world by referring to the perpetrator, sometimes their own father as

somebody who can do nothing wrong.

Louise: “But she protected her family because she knows anything she says, she’s very intelligent

anything she says they were going to send her mother or father or whoever was in her life they were

going to take them away”. Children often protect the perpetrators when they do not feel

emotionally safe or when they are threatened. This issue can be resolved if the child receives

sufficient individual trauma therapy from a trained therapist and if the childcare worker understand

and is trained to care for this child. The therapist and childcare worker need to work together very

closely.

One of the reasons why children who have been neglected or abused by their families continue to

protect their families might be as stated by Golding and Hughes (2012) that these children

perceived it as that they themselves are to blame for what happened, and that it is not possible for

them to be loved. For example, some of them might, when they are older still continue to attribute

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their neglect to their own shortcomings despite the fact that they’ve learned that other adults do not

agree with the actions of their primary caregivers.

One of the challenges experienced by the caregivers is monitoring the actions and whereabouts of

these children in order for them not to have sex with each other. Their relationship with their

primary caregivers, the perpetrators influenced their concept of what love is. These children appear

to have a distorted understanding of what love is and what love means. This is true and that is why

these children need specialised care. I was part of the team who developed and implemented the

specialised units on the Abraham Kriel, Langlaagte Campus. We did that in order to address these

issues. I am still involved in the therapy with these children and we have managed to reduce this

kind of behaviour tremendously. If for example their father raped them, they might think that to be

raped means that they are loved or that selling their bodies might mean that they are loved. Because

of this lack of understanding of what love is, and previous experiences, the caregivers are expected

to keep the boys and girls separate from one another in order to prevent them from having sex.

Sexually abused children need specialised care and therefore it is important to separate the

genders. These children are mostly very sexualised and because of their distorted thinking will

easily get involved in sexualised activities with other children. Even same gender children need to

be supervised.

Riana: “they don’t know what love is, what real love is about, for them love is money, food, clothing,

stuff like that, they don’t know what real mother love is. The girls then, for them to show love to

somebody is by giving their body and the boys are using drugs…..”.

Louise: “they also just want you to love them and they fight for that position”.

Riana [felt that it is not love but] “possessiveness”.

Riana: “If somebody loved them somebody raped them”.

Riana: “We have to keep them apart but we are doing it unnaturally, because now they never learn

to cope with the opposite sex”. I do not fully agree with this statement. We need to keep them

apart in order to heal them, but as soon as they are healed, they can be re-introduced into being

close to and interacting with the opposite gender. I have been part of many integrations like this

with good results.

4.4.1 Behaviour of the child with an Attachment Disorder

The caregivers described the feelings and emotions of children with attachment disorders as

children who lack feelings, who have been cut off emotionally by trauma, who do not want to be

145

touched and someone who the caregivers feel they can’t have a break through with. All of this is

true, but it is much deeper and experienced differently by every child.

Louise: “Trauma that causes them to be afraid and takes them long to attach to whomever”. [These

children would sometimes describe their lives as] “a mess”. Children with attachment problems do

not trust adults and therefore it takes them very long to trust, especially if they have been moved

from one home to the other. Some children will unfortunately never learn to form a secure

attachment with an adult.

Thea: “They don’t want to be touched”. Often they want to be touched, but they do not know how

to react to the touching. They will also push away if they feel emotional insecure. They are often

terrified of getting hurt emotionally and therefore they will be very loving one day and push you

away the next. The childcare worker needs to know this in order to keep on being consistent and

not to take the rejection from the children with attachment problems, personally.

Thea: “…and later when I can touch him, because he didn’t want to be touched as well. Then I

started to touch him and comfort him more and speak to him, he sort of got to play with the other

children as well. You can get them to respond afterwards”. I do attachment therapy with children

and childcare workers, where we introduce the touching in a very gentle and playful manner.

During the focus group discussions the following behaviour of children suffering from an

attachment disorder, were identified by the caregivers: aggressiveness, lying, sadness, stealing,

swearing, shouting, biting, kicking, screaming, spitting, bullying of other children, not doing their

chores and not listening/not accepting authority. They were also described as demanding, clinging,

isolating themselves, rebelling against change and not being able to remember from one day to

another. It appears that the behaviour of children with an attachment disorder can be linked to their

emotional status and their ability to manage their emotions. Children with attachment problems

have never learned to regulate their emotions in the care of their primary caregivers. A child

learns to regulate emotions within the secure attachment of their primary caregiver. The 1st two

years of life is the most important time to learn this behaviour. If this did not happen, you see will

see the results later in life. This is also why it is important to teach children with attachment

problems how to regulate their emotions. They might not have experienced a nurturing and loving

relationship and act out in an attempt to obtain attention. It

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Appendix M: Notes make during feedback sessions

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Fourie, E. (2014). Training needs of caregivers in institutions regarding the care of children with...

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