Attachment 10/18/16. Mary- Jo Land Registered Psychotherapist. Mary-Jo Land, R. P. 1. Developmental Trauma: The Brain, Mind and Relationships:

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1 Developmental Trauma: The Brain, Mind and Relationships: Mary- Jo Land, R.P. Priceville, Ontario Mary- Jo Land Registered Psychotherapist Attachment Trauma Adoption Attachment Brain Trauma Mary-Jo Land, R. P. 1

2 Relationships Brain Mind Developmental Trauma: Domains of Impairment (Cook et al, 2005) Attachment Physiology Cognition Emotion Regulation Behaviour Regulation Dissociation Self Concept C. MARY-JO LAND Attachment Defined Attachment refers to the quality of a child s connection to or relationship with parents. Mary-Jo Land, R. P. 2

3 Attachment behaviour is seeking safety seeking comfort and seeking help to get needs meet. Attachment is: found in all mammals necessary for survival of the individual necessary for the survival of the species Attachment is: an innate process a mid- brain process a drive, like defense, mating, nurturing Mary-Jo Land, R. P. 3

4 Attachment is: how an infant joins the human race is life threatening if attachment threatened Attachment is a reciprocal process to bonding (parents bond to their infants) occurs only in the context of a relationship with a nurturing adult Attachment is: not a conscious choice qualitatively lasting resistant to change Mary-Jo Land, R. P. 4

5 Attachment is formed in utero (last trimester) through to end of first 18 months formed as the brain is developing in structure and function Attachment is: critical to healthy brain development the context in which brain development occurs Attachment security the best predictor of life long physical and mental health 5 Key points to remember: 1. Children function according to the degree of safety and security experienced in their first three years. 2. If parents were frightening or neglectful, attachment difficulties may be created. 3. A child cannot be disciplined out of this problem. 4. A child needs to experiencenurturing parents / adults. 5. Nurturing experiences rebuild trust and security. Mary-Jo Land, R. P. 5

6 Attachment Outcomes: SELF Good? Loveable? Worthy? Attachment Outcomes: OTHERS: Good? Safe? Trustworthy? Available? Attachment Outcomes: THE WORLD: Safe? A place to explore? (curiosity, learning) Mary-Jo Land, R. P. 6

7 10/18/ C. MARY- J O L AND C. MARY- J O L AND Secure Attachment Outcomes Capacity for Emotional Self- regulation Behavioural Self- regulation Regulates the ANS Mary- Jo Land, R. P. C. MARY- J O L AND 7

8 Secure Attachment outcomes Capacity for: Reading Social Cues Reflective Capacity Self and Others Theory of Mind Trauma MEMORY AND REGULATION What is trauma? (Threat of) harm to self or loved one Overwhelming fear Unescapable Mary-Jo Land, R. P. 8

9 Developmental Trauma When trauma occurs within the caregiving relationship Parent is frightening or frightened Physical, sexual, emotional abuse within the family environment Neglect (lack of food and lack of parent interaction: both life threatening) Repeated separations, losses of parent figures, many caregivers and / or placements Developmental Trauma: Domains of Impairment (Cook et al, 2005) Attachment Physiology Cognition Emotion Regulation Behaviour Regulation Dissociation Self Concept Attachment Impairments Needing, but fearing, closeness with a parent Mistrust Lack of reciprocity: the give and take in relationships SHAME (I am bad, unworthy and unloveable) Mary-Jo Land, R. P. 9

10 Self- concept Deep Shame: I am not worthy of love I am bad I am unlovable I don t belong and I never will because: see above Poor body image Poor sense of separateness Physiological Regulation Impairments Eating Sleeping Elimination Arousal Dysregulation Motor coordination Sensory Processing / Integration Pain perception Increased life- long health risk Physical problems that are psychologically based Emotion Regulation Impairments Deep Shame from abuse and neglect Feelings get too big, too fast Feelings get out of control causing out of control behaviour Not able to label feelings, feelings are all mixed together Child did not experience adequate soothing and comforting as a young child to learn to regulate emotions Mary-Jo Land, R. P. 10

11 Behavioural Regulation Impairments When feelings get too big, behaviour gets out of child s control Aggression, Raging Self- harm Destruction Difficulty with self- monitoring and self- limiting Diminished response flexibility Cognitive Impairments Developmental Delays or uneven development Learning Disorders / Difficulties Continuous Scanning of Environment (Attention Disorders?) Impairments in Executive Functioning Decreased curiosity, interest in the world Theory of Mind Lying Stealing Dissociation: a functional response to traumatic experiences Poor integration of parts of self Separation of trauma parts Amnesia for traumatic events More than one identity (rare) Various states of consciousness Vague, zoned out Shut down Mary-Jo Land, R. P. 11

12 Key: Early Trauma Affects: Memory Integration and Self-Regulation C. MARY-JO LAND Memory SOMETHING FROM THE PAST, THAT INFLUENCES THE PRESENT AND SHAPES FUTURE BEHAVIOUR Implicit Memory v Present before birth (6 months gestation) v Only form of memory until 18 months v Feels NOW v Continues throughout life Mary-Jo Land, R. P. 12

13 Implicit memory Bitten by a dog as a young child Implicit memory component: 1. Dog 1. Perception 2. Pain 2. Somatic Memory 3. Fear 3. Emotion 4. Run 4. Motor Response 5. Dog is dangerous 5. Mental Model 6. All dogs are dangerous 6. Generalization 7. Subliminal cues (smell) 7. Priming The Hippocampus Starts to develop at 18 months Feels like THEN Shut down by alcohol, rage, fear (cortisol, adrenaline), explicit memories are poorly integrated Neural fibers connect elements of implicit memory with each other and to explicit memory Explicit Memory v Comes on line as hippocampus develops v Factual Memory v Autobiographical memory v Self in time v Implicit and explicit memories are linked together to create an integrated memory (makes sense) v Feels like THEN. Mary-Jo Land, R. P. 13

14 Memory formation during trauma: hippocampus shut down IMPLICIT v Elements fragmented v Hippocampus is not integrating v When recalled, feels NOW v No control over recall EXPLICIT v Fragmented v Blocked explicit v No time stamp v Recall by priming v Implicit memory only v Flashback or reliving Dissociation / Divided Attention v Hippocampus requires focal attention to integrate memories v Divided attention is adaptive in overwhelming fear v Hippocampus is not engaged, therefore no explicit memory formation v Implicit memory is still on line but elements may not be integrated Trauma Dis s oc iate Hippoc ampus failure Implicit only Ris k of flas hbacks Mary-Jo Land, R. P. 14

15 Trauma, Fear and the Brain Stimulus Orient Assess THREAT or non- threat Acute or Chronic trauma can cause an over assessment of THREAT. Goldilocks and the 3 Arousal Levels Arousal High: Fight Flight Freeze: Survival Mode Arousal Just Right: Seek attachment system, calm, alert Window of Tolerance WHERE WE CAN LEARN Arousal Low: Shut down: Prepare for the worst Fear- Driven Brain (Ogden, Minton and Pain, 2006 Too Much Arous al DYSREGULATED Window is very narrow: easy to flip out of the window Too Little Arousal DYSREGULATED Mary-Jo Land, R. P. 15

16 Traumatized Brain Cognitive Regulation Behavioural Regulation Emotional Regulation Cognition Behaviour Emotions Physiology Sensory Physical Regulation Sensory Regulation C. MARY-JO LAND Regulation and Dysregulation Regulated: In the window Able to experience, tolerate, and manage a range of emotions, both positive (e.g., joy, excitement) and negative (e.g., sadness, fear) without becoming overwhelmed Easy to regain an emotional balance Calm, receptive, and able to process thoughts and feelings Able to be curious, learn, explore Able to use language Higher brain areas are in charge. ABLE TO SEEK ATTACHMENT SYSTEM Regulation and Dysregulation Dysregulated overwhelmed, overwrought or shut down state limited ability to return to regulated state reactive, and may swing between arousal states Difficulty with reason, logic and language Mary-Jo Land, R. P. 16

17 Treatment Safety Enhance Attachment Enhance Self- regulation Enhance Joy Enhance reflective function Integrate Traumatic experience Cook et al, 2005 Cycle of Trauma and Brain Development 1. Repeated early trauma / neglect 4. Increased risk of pathological parent response 2. Child: altered brain function 3. Child s emotional and behavioral dysregulation (adapted from Becker- Weid man, p ersonal communication, presentations) Positive Cycle of Therapeutic Parenting 1. Therapeutic parenting strategies 4. Enhanced parent/child interactions 2. Child: altered brain function 3. Improved emotional and behavior regulation Mary-Jo Land, R. P. 17

18 Qualities of Safe Adult Calm Empathic Kind Curious Consistent Unconditional Positive Regard Playful Accepting Responsive Sensitive High Arousal Negative emotion Positive emotion Low Arousal 7. Respond 1. Send 2. Accept 6. Make Sense 3. Make Sense 5. Accept 4. Respond Contingent Communication Mary-Jo Land, R. P. 18

19 Safety Restore Disruption Repair Re- regulate Process Interactive Repair Time IN not Time OUT: Keep child close to safe adult PACE Playful Accepting Curious Empathic CONNECT >CORRECT > CONNECT 56 Mary-Jo Land, R. P. 19

20 Thank you! QUESTIONS AND DISCUSSION Resources Dan Hughes: Attachment- Focused Parenting Kim Golding: Nurturing Attachments Brazelton and Greenspan: The Irreducible Needs of Children Trauma and the Body: Ogden Minton and Pain The Body Keeps the Score: van der Kolk Mary-Jo Land, R. P. 20