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Issues of Disruptive Attachment and Countertransference in the Treatment of a Young Boy Infected with HIV

A capacity for self-regulation involves the ability to organize and modulate experience adaptively. Deficits in self-regulation interfere with the development of a cohesive self. This article presents the treatment of a fragile and traumatized child infected with HIV with an insecure attachment style who experienced difficulties in self- and interactive regulation. Precarious and disruptive attachment experiences compromised his emotional development. Attachment theory is used as a paradigm to understand such deficits in affect regulation. Shifts and disruptions in the capacity for self-regulation were imposed on the child's adaptive functions by mismatched interactions with the parent and by an unpredictable, neglectful environment.