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The Trauma and Attachment Group (TAG) program: An ethnographic exploration of an intensive dyad-based group intervention for traumatized youth

  • Author / Creator
    Ashton, Chandra K. K.
  • The notion that positive relationships between primary caregivers and children may mitigate the behavioural effects of early developmental trauma has been well detailed in the literature. More specifically, it has been suggested that for a child managing the adverse effects of early developmental trauma, working within a secure dyadic relationship (i.e. both the primary caregiver and the child) may aid in the development of healthier interpersonal relationships and social functioning. A complex clinical intervention titled the Trauma and Attachment Group (TAG) program was developed to address behavioural and relational impacts of early developmental trauma, but its efficacy has never been formally examined. This program appears to be unique in that it focuses on the caregiver/child dyad in a group setting. TAG was designed to impact 3 separate treatment outcomes: (1) to increase caregiver/child attachment; (2) to decrease trauma-related symptomology in children; and (3) to increase caregiver reflective functioning skills. The overall ethnographic design of this research relied on several data collection strategies. The first involved quantitative research in which pre- and post-test data from cohorts enrolled in the program from September 2011-December 2014 was retrospectively analyzed. The second strategy was to carry out a detailed retrospective chart review on selected charts from the quantitative sample. The third method used was to carry out a focus group and informal interviews with those facilitating the TAG program, as well as individual interviews with caregivers who participated as a part of a dyad in the program during the years represented in the quantitative component of this study. Two initial research objectives were proposed: (1) To assess the effectiveness of the TAG Intervention in creating changes in attachment, trauma symptoms and caregiver reflective functioning. And (2) to learn more about the mechanisms of the program that may facilitate those changes. The major findings from this evaluative, ethnographic investigation suggest that the TAG program may be effectively meeting its three major outcome goals. To answer the first research objective, analysis demonstrated a statistically significant increase in child/caregiver attachment and supported a trend towards a reduction in child-experienced trauma symptoms, after participation in the TAG program. Caregiver reported scores also revealed improvements in the caregivers’ reflective functioning at the end of their involvement in the program. To answer the second objective, thematic analysis of a focus group and interviews with TAG facilitators and interviews with caregiver participants of the program provided insight into 3 major themes that may substantiate changes reflected in TAG treatment outcomes: “Relationship as locus of change”; “Group process”; and “Psychoeducation-based content”. Examination of the focus group transcripts also highlighted the way in which the relational approach embodied by the facilitators may have impacted the way they delivered the material (psychoeducation) to the dyads in the group. The effort facilitators appeared to place into creating “felt safety”, a sense of belonging, and a purposeful coming together under a shared experience may, in fact, have modeled an environment that promoted change. Therefore, in addition to providing support for the proposed effectiveness of relational intervention for healing attachment-related trauma with children aged 5-11, the results of this study contribute to current therapeutic recommendations that caregivers be included in treatment, that outcomes may be improved through group participation, and that facilitation of psychoeducation can improve outcomes. The TAG study suggests that an attachment-focused, multimodal, multi-level intervention, combined with the introduction of a healthy and focused relationship, may be the key to promoting change in relationships challenged by the adverse effects of early developmental trauma. Further evaluation may help more clearly define potential demographic and program components that contribute to the success of the program, as well as to explore the costs associated with the feasible provision of such care in the general population.

  • Subjects / Keywords
  • Graduation date
    2016-06:Fall 2016
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R37P8TT0N
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • Department of Psychiatry
  • Supervisor / co-supervisor and their department(s)
    • Dr. Peter Silverstone (Department of Psychiatry)
  • Examining committee members and their departments
    • Hannah Pazderka (external)
    • Esther Fujiwara (Department of Psychiatry)
    • Ian Winship (Department of Psychiatry)
    • Linda O'Neill (University of Northern British Columbia)
    • Karin Olson (Department of Nursing)
    • Andy Greenshaw (Department of Psychiatry)