Use of Attachment Language by Professionals in Children’s Mental Health Notes

Attachment theory and associated terms are drawn upon widely in clinical and social work practice with families. There is a notable gap in research exploring how the use of these concepts and terms influences care. This article describes a critical discourse analysis of child and adolescent mental health service (CAMHS) clinical notes exploring the use of attachment related discourses for a sample of 30 cases. The case notes typically documented intensive professional activity (meetings; correspondence; assessment; therapy) and cross service discussions about children who were at serious risk of harm due to social and psychological difficulties. We identified the following themes: 1) Lack of Assessment; 2) Conceptual Confusion; 3) Care Pathways; 4) Conversations with Children and Parents. Attachment related language was used for multiple reasons: an attempt by professionals to call for action from another service (e.g. change of placement), giving more power to professionals who might not otherwise have access to terminology that describes their concerns from a “clinical” perspective; offering an explanation for chronic issues resistant to the interventions offered by services; a means of locating the cause of problems within actors not currently involved in the child’s life; a shorthand way of describing complex presentations not easily described within a diagnostic framework. The study identified concerns about how these terms are used in practice and the impact on care provided to children and families. We make recommendations for policy changes, further research, and for practitioners and academics to work collaboratively.