Bridging Research and Practice: Our Clients Who Are Adopted and their Families. Norman E. Thibault, PhD, LMFT

Transcription

1 Bridging Research and Practice: Our Clients Who Are Adopted and their Families Norman E. Thibault, PhD, LMFT

2 Thank You in Advance: Baylin, J. (2013). Behavioural epigenetics and attachment. The Neuropsychotherapist, 3, Oct-Dec. Becker-Weidman, A. (2006). Dyadic Developmental Psychotherapy: a multi-year follow-up. In New Developments in Child Abuse Research. S. M. Surt, Ed., Nova Science Pub. Golding, K. S. (2007). Exploring dyadic developmental psychotherapy. Attachment focused therapy for children experiencing difficulties feeling secure with caregivers [PowerPoint slides]. Retrieved from Hayes, B (Illustrator). How early experiences alter gene expression and shape development. Retrieved from

3 Ever Wonder.? Do birth parent genes set a child s path for good? What exactly is the sensitive-period of attachment? If a child is traumatized during the sensitive-period of attachment, can that be reversed? Why do children adopted at birth sometimes demonstrate symptoms consistent with children who were adopted later in life? Don t children naturally outgrow impulse control issues as they mature? At what age does the quality of a parent s care have a long-term impact on their child s development?

4 Let s Talk About Neural Development Pre-Birth Children develop neurologically in the context of relationships. Some hypothesize that this process begins as early as the 5 th week of pregnancy. Epigenetics the environment, even prenatally, can shape the way your genes unfold. How?

5 Let s Talk About Neural Development

6 Let s Talk About Neural Development Pre-Birth Children develop neurologically in the context of relationships. This process begins as early as the 5 th week of pregnancy. Epigenetics the environment, even prenatally, can shape the way your genes unfold: Holland Blockade in WWII Women pregnant during 9/11 Some changes that occur in the fetus during pregnancy can be passed on to later generations. Repetitive, highly stressful experiences can cause epigenetic changes that damage our managing of stressors later in life.

7 Epigenetics & Adoption What woman, when thinking or considering adoption, is not going to have elevated levels of cortisol or other stressors? Our prenatal environment prepares us to survive in the environment into which we are expected to be born. What does this say about the impact of adoption on any newborn infant?

8 Rats Let s Talk About Neural Development Post-Birth Humans Two Tasks: Social Engagement Self Defense

9 Neural Development

10 Brain Malleability and Effort by Age

11 Synapse Density

12 Let s Talk About Neural Development Post-Birth Early life adversity creates developmental stress disorders which impact social engagement or defensiveness. Development of the circuit connecting prefrontal cortex to the amygdala and other regions may be compromised. This circuit between the prefrontal cortex and the limbic system forms the core neural highway for self-regulation throughout life. When it is inhibited, it is more difficult later in life to regulate emotions, behavior, cognitions, and attention. Harder to learn from new experiences and to change one s mind about past experiences.

13 Let s Talk About Neural Development Post-Birth Amygdala: Provides infants with an implicit way of detecting threats. Can be buffered by responsive parenting through the decrease of stress hormones such as cortisol and norepinephrine, while promoting the release of oxytocin. Oxytocin plays several roles in humans: Promotes social approach behavior Facilitates the formation of social memories Enhances Theory of Mind and Empathy Reduces stress reactivity and self-defensiveness. If a guardian is neglectful or causing pain, the amygdala will see that person as a source of pain or fear, setting up a potential conflict between approach and avoidance. This is Complex Trauma.

14 Let s Talk About Neural Development Post-Birth

15 An Epigenetic Model of Attachment-based Intervention Dr. Baylin asks: What kind of relational processes have the power to alter early patterns of gene expression in the amygdala so as to shift its functioning towards social engagement and way from reflexive defensiveness? Environmental Enrichment Re-engaging children when they are past the sensitive period for attachment learning. Our task is to create opportunities for safe, yet unexpected, social experiences, which can poke the brain into a state of alertness, surprise, and curiosity and launch a renewed social learning experience. This involves catching a mistrusting child off-guard by responding in a way that is not predictable, especially as compared to previous caregivers, by being open and by not being defensive.

16 What is Dyadic Developmental Psychotherapy? Therapist and parents work together with the child. Playful, Accepting Curious, Empathic Creates and environment that facilitates healthy relationship development. Offers increased sensitivity, availability, and responsiveness. Co-regulates emotion and co-constructs meaning. Builds trust. Facilitates intersubjective experience and secure attachment. Contains anxiety and supports exploration. Our staff mentors can apply these concepts.

17 Epigenetic Model of Attachmentbased Intervention A child s immediate experience is different than what the child might have expected when they are in their typical state of mistrustfulness. The new attachment figure (or staff) and the child become co-creators of experiences that are different, unique, unexpected, which then create unpredictable reactions in the child. DDP with an emphasis on PACE concepts may be a formula for creating the epigenetic changes required to promote the shift from defensiveness to openness. Teaching these concepts to our staff is crucial for treating children who have suffered complex trauma.

18 Epigenetic Model of Attachmentbased Intervention PACE concepts could promote epigenetic changes in a child s brain: dampen the reflexive defense system by promoting oxytocin flow into the amygdala and turn on stimulative neurochemistry, especially dopamine, to support new learning and a state of curiosity about the new attachment figure that reopens the child s mind to attachment-based learning. An adult seeking to apply the concepts of PACE may be able to deactivate the child s defense system, at least transiently. Research on 5:1 Ratio (Relationship Bank Account)

19 Epigenetic Model of Attachmentbased Intervention This brief stimulation of the child s defense system would very likely actuate the early gene system to tag brain cells in the amygdala, conveying in a way that this new adult is different from frightening adults from the past. This difference of perception would, in turn, then trigger: The hippocampus to help compare the present experience to the past; The lower regions of the Prefrontal Cortex The orbitol region, specializing in learning and remembering social contingencies and reversal learning ; And the Anterior Cingulate Cortex, which is involved in fear extinction and in resolving conflicts between old, habitual ways of reacting and new ways of behaving. Our staff caregivers are vital to this process.

20 Keeping the PACE: Concepts A Playful stance can diffuse a situation and help the child to stay with an intersubjective experience. Intersubjectivity is primarily a here-and-now, you-and-me experience in which both are sharing joint attention as well as similar affect, intention and meaning. (Dan Hughes, 2004).

21 Keeping the PACE: Concepts Acceptance unconditional positive regard reduces mindless defensive reactions. Being non-judgmental helps a child to be open to intersubjective experiences of self, others, and events.

22 Keeping the PACE: Concepts Curiosity leads to understanding, which serves to increase acceptance of the child, his or her internal experience, and reasons for the behavior. It serves to create psychological safety.

23 Keeping the PACE: Concepts Empathy lends itself to support the child experiences the therapist, staff, and his or her parents as on the journey as they explore their past and current experiences.

24 Co-Regulation Child s affective response to the experience is being coregulated by the adult s affective response. As the adult responds to the child s affective states, nonverbally and verbally, they mark the affect with an empathic, congruent response. This helps the child to create a secondary representation of the original affect and leads to the capacity for reflective thought. Maintaining/re-establishing attunement during negative affective experiences prevents the child from entering into a state of affective, behavioural, and cognitive dysregulation. The child can experience shame or terror and not be full of shame or terrorized. The child IS STILL special to the [staff]. Dan Hughes, 2004

25 Co-Construction of Meaning Development of Reflective Abilities: The child s attention is being held by the adult s attentive stance. The adult also provides words so that the child can gradually identify and more fully express his/her inner life. Through this vulnerable relationship process, the child is able to co-construct the meaning of his or her experience. The child integrates the meanings given to the experience through the interwoven perspectives of therapist, parents, adults, and self.

26 In Summary: Adult Staff Adult staff use empathy and curiosity, accepting child s resistance and helping him or her to stay engaged. As the staff accepts and is curious about the child without being judgemental, including shame of the past, a new non-shame based meaning is coconstructed. When the child dysregulates, the staff remains regulated, using acceptance and empathy to coregulate the intense affect, and to co-construct new meaning, reducing the shame of this experience. This impacts the amygdala, neural substrate, and the PFC in positive ways. The result is new attachment-based learning.

27 Thank you! Norman E. Thibault, PhD, LMFT x Three Points Center E 2700 S Hurricane UT 84737