Interpersonal Neurobiology of Poverty and Trauma Informed Care Trish Thacker, MSW, LICSW Program Director Minneapolis Harbor Light Center For more information

Interpersonal Neurobiology of Poverty and Trauma Informed

Care

Trish Thacker, MSW, LICSWProgram Director

Minneapolis Harbor Light Center

For more information or to schedule a training please contact: Trish Thacker [email protected]

Trish Thacker, MSW, LICSW Program Director, Salvation Army Harbor Light

Center Clinician for 17 years Advanced training in: IPNB, trauma, EMDR,

forensics, narrative therapy, addictions

Who’ s here today?

What are you hoping to get out of today’s session?

Introductions

I encourage you to:1) Ask questionswrite down questions or raise hand and ask…will also have q & a before break

and before session ending2) Take care of yourself…stand etc if

needed

Expectations for today

This is a simplified presentation, whittled down to core concepts.

What is presented today provides a basic structure.

A blueprint. A framework of understanding.

This presentation illuminates a process and is merely

a place to begin …

Complexity Disclaimer

Hand Model of the Brain

Interpersonal: of or relating to relationships or communication between people

Neurobiology: the anatomy and physiology of the nervous system

The Nervous System: The system in the body that controls internal functions of the body and receives, interprets, and responds to

stimuli

Interpersonal Neurobiology Primer

DEFINITIONS

THE MIND:• the emergent, self-organizing process that shapes and

directs how energy and information flow across time• shaped by the interaction of experience and gene

expression• Represents a complex system

• Characteristics of a healthy, complex system:• F - flexible• A - adaptive• C - coherent• E - energized• S - stable• Therefore, an individual with “good” mental health will

generally exhibit these characteristics


DEFINITIONS

• Mirror Neuron system:• fires both when a person acts and when the person

observes the same action performed by another• Wiring which allows for attunement, empathy ,and

connection

• Attunement:• to bring in to harmony; the feeling of being “at one” with

another human being• Shared emotional states• Powerfully influences others


DEFINITIONS

Attachment:

• a deep and enduring emotional bond that connects one person to another across time and space …”feeling felt”

• Defines and effects how we perceive people and the world

• Tends to be determined by the attachment style or strategy of the primary care giver• Every child grows up in a different family• Same parent can have different attachment style

with each child


CONCEPTS

• Types of Attachment:

• Secure – earned secure• Insecure• anxious/ambivalent• dismissive/detached• disorganized/traumatic

Concepts

CONCEPTS

Secure - earned secure attachment• Contingent communication

• perceive cues• interpret accurately• respond appropriately• in a timely manner• most of the time

• Auxiliary containment – foundation for later integration

• When injury occurs, the repair is made


CONCEPTS

• Insecure – anxious/ambivalent attachment• Parent with “unfinished business” – past intrudes into

present• Available inconsistently

• Insecure – dismissive/detached • Relationships as tasks and people as roles – few

memories, • Unavailable

• Insecure - traumatic/disorganized• Biological conundrum – drive toward and away• Parent is a source of fear or pain



CONCEPTS

Developing mind

Mirror neurons

Attunement with other

Attachment style

Integration and containmentIntermittent integration/containment

Rigid/unavailable integration/containmentFragmented/sparse integration and intrusion/no

containment

World is good and I’m okWorld is unpredictable and I’m nervousWorld is cold/unhelpful and I’m separateWorld is scary and I’m unprotected

Influences perception and interpretation

How does this work??

• We are influenced by, and we influence, people and environments

• Our minds will filter/define experience and perception based on our history to date (this is not static)

• We will act/react/respond in accordance with our self-defined experience and perception

• Our interaction with people and environments will effect which genes are turned on and which are turned off (gene expression)

• Our life experiences influence genetic coding and the wiring in our brains and bodies (epigenetics)


CONCEPTS

Side Bar

Emerging field of Epigenetics refers to external modifications to DNA that turn genes "on" or

"off” without changing the DNA sequence Epigenetic change is a regular and natural occurrence but can

also be influenced by several factors including age, the environment/lifestyle, and disease state.

This is especially interesting when we consider intergenerational poverty and the transmission What epigenetic changes may have occurred that influence the

generation that follow? Ex: childhood abuse and/or neglect leave markers in the

hippocampus that remain in the next generation and increase risk for mental illness and suicide

What about chronic stress, poor nutrition, no time for play etc?


Quick break to:

thinkbreathestandetc

• Poverty results when the lack of basic security simultaneously affects several aspects of people’s lives, when it is prolonged, and when it severely compromises people’s chances of regaining their rights and reassuming their responsibilities in the foreseeable future

• Poverty describes those who are poor and have little or no mobility.

• Chronic poverty occurs when people experience several forms of disadvantage at the same time. These combinations keep them in poverty and block off opportunities for improving their livelihoods.

Definitions of Poverty

Difference between being impoverished and being part of a culture of poverty

Those experiencing poverty often carry a sense of: Being marginalized Helplessness Dependence and resulting powerlessness Not belonging, separateness, singled out Reduced sense of history due to survival behaviors

Dynamics of Poverty

• Research indicates:

• Poverty and related chronic stress can biochemically dampen maternal motivation and sensitivity

• Increased stress due to lack of financial resources, reduced social support, and risky home and neighborhood environments directly affects parenting efficacy

• Poverty is associated with an up to 22-fold increase in risk for child abuse and neglect

• Chronic and acute stress from the basic lack of security that defines poverty causes increased limbic/amygdala maternal functioning that causes the mother to perceive their child’s need as hostile

Poverty and Attachment

• Because the negative effects of deprivation on human development tend to be cumulative, individuals with greater exposure to poverty during childhood are likely to have more difficulty escaping poverty as adults

• Chronic stress deposits an epigenetic biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands.

• childhood poverty is inversely related to working memory in young adults

• The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response

Poverty and Chronic, Acute Stress

The more poverty related stress the individual experiences,

the less capable they are to effectively manage stress, which contributes to keeping them in the chronically stressed environment

IPNB and Poverty

IPNB and Poverty

What happens to the brain when experiencing the conditions associated with

poverty?

What is trauma?

Individual trauma results from an event, series of events, or set of circumstances that is experienced, or witnessed, by an individual as physically or emotionally harmful or threatening

Trauma overwhelms/surpasses our current ability to cope

Trauma can be singular and/or cumulative

Traumatic reactions occur when action is of no avail

IPNB and Trauma

What happens in the brain and body when trauma occurs?

IPNB and Trauma

What can we expect from traumatized people and people groups?

Flipped lid - Brown-out/black-out state Triggered reactions vs considered responses Can be physically reactive Can be dissociated “loop” of conversation Disorganized/chaotic behavior (doesn’t make

“sense”) Elaborate back-story explanations Learned helplessness

IPNB and Trauma

What can we expect from homeless/traumatized people and people groups?

Unaware - ness of other people, ideas, causal relationships

False dichotomies – black and white thinking Rapid shifts in emotional state Difficulty making decisions All manner of presentation of fight-flight-freeze behaviors The “sprint” mentality (vs marathon) which increases

long-term suffering Exercising control in counterproductive ways (posturing, blame

casting, etc)

IPNB and Trauma

The acute and chronic stress experienced by those in poverty elicits the same brain response as trauma

And

People experiencing poverty have fewer physiological and socioeconomic

resources available to them to resolve the trauma…..

We are working with a population of people who are in various states of acute and chronic trauma

IPNB, Trauma, and Poverty

Trauma Specific Care = the care, the treatment itself

Trauma-specific intervention programs generally recognize the following: The survivor's need to be respected, informed, connected, and

hopeful regarding their own recovery The interrelation between trauma and symptoms of trauma

such as substance abuse, eating disorders, depression, and anxiety

The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers

Includes: Seeking Safety, DBT, EMDR, narrative exposure therapy, somatic experiencing, stress inoculation training, etc

Trauma-Informed vs Trauma-Specific

Trauma informed care = how care is delivered

and involves management of environment, program, and staff

Realizes the widespread impact of trauma and understands potential paths for recovery

Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

Responds by fully integrating knowledge about trauma into policies, procedures, and practices

AND Seeks to actively resist re-traumatization

Trauma-Informed vs Trauma-Specific

Effective trauma informed care functions like:

The insulation around an electrical cord Noise canceling head-phones lifeguarding on a beach:

talk through guide out throw a flotation device go out and get

It contains and off-sets the negative effects of trauma

Trauma Informed Care

Trauma Informed CareTrauma informed care is about how care is delivered

Services delivered in a manner that supports integration of brain functions

Five principles of Environment and Program Management:1) Safety: Ensuring physical & emotional safety; “do no harm”2) Trustworthiness: Maximizing trustworthiness, making tasks clear, maintaining appropriate boundaries3) Choice: Prioritizing consumer choice & control over recovery4) Collaboration: Maximizing collaboration & sharing of power with consumers5) Empowerment: Identifying what they are able to do for themselves; prioritizing building skills that promote recovery; helping consumer find inner strengths needed to heal

Trauma Informed CareTrauma informed care is about how care is delivered

Effective trauma informed care takes into consideration the “contagion” effect of emotional states…

therefore

…trauma informed care must include care for the other AND care for self

Trauma Informed Care

Intentionally do those things that fill me up in order to stay well ex: gratitude practice, exercise, meditation, safe people, alone time, etc Self-attunement Alignment with values

Intentional boundary management Playground example Not contributing to the chaos around me protects me and clients

Face/address my own feelings/experiences of helplessness Do my own work

Get my emotional and significance needs met apart from work Anything that is unresolved in me will get triggered in this environment If I don’t, I risk working out my own issues at the expense of clients

IPNB Care of Self

It’s all about who you are in the room Eye contact - attunement Listen to the story

ask if they feel heard vs proving you’ve heard It’s not about what’s wrong, it’s about what happened It’s not about the event. It’s about the experience of the event

Consistency Fairness Professional transparency The process IS the product

In creating conditions of safety, the roadblock is often myself…

Interpersonal Care of Other

Ainsworth, Mary. Patterns of Attachment: A Psychological Study of the Strange Situation. Psychology Press. London, England. 1979

Bloom, Sandra. Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care. Oxford Press. 2013.

Bowlby, John. Attachment: Second Edition. Basic Books. New York, NY. 1983. Bowlby, John. Separation: Anxiety and Anger. Basic Books. New York, NY. 1976. Bowlby, John. A Secure Base. Routledge. New York, NY. Re-issue 2005. Bretherton, Inge. The Origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental

Psychology (1992), 28, 759-775. Clark, Carrie. Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care. Routledge

Publishing. 2014. Cloud, Henry. Changes That Heal. Zondervan Publishing. Grand Rapids, MI. 1992. Cozolino, Louis. The Neuroscience of Psychotherapy: Healing the Social Brain. W.W. Norton and Company.

New York, NY. 2010. Evans, Amanda. Trauma-Informed Care: How neuroscience influences practice. Routledge Publishing.

2014. Levine, Peter. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North

Atlantic Books. 2010 Levine, Peter. Waking the Tiger. North Atlantic Books. 1997.

References

Main, Mary. Intergenerational Transmission of Attachment. PBS Series. 1995.

Main, Mary and Hess, Erik. Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies. Journal of the American Psychoanalytic Association, 48:1097-1127. 2000

Scaer, Robert. The Body Bears the Burden. Routledge Publishing. 2014. Siegel, Daniel. Mindsight: The New Science of Personal Transformation.

Random House, NY, NY. 2010. Siegel, Daniel. Pocket Guide to Interpersonal Neurobiology. Norton

Publishing. NY, NY. 2012 Siegel, Daniel. The Neurobiology of "We": How Relationships, the Mind,

and the Brain Interact to Shape Who We Are (Sounds True Audio Learning Course). 2010.

Siegel, Daniel. The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. W.W. Norton and Company. New York, NY.2007.

References

Siegel, Daniel. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. The Guilford Press. New York, NY. 2001.

Siegel, Daniel. The Mindsight Institute Conference on the IPNB of Attachment. UCLA. Los Angeles, CA. 2010

Siegel, Daniel. Toward and Interpersonal Neurobiology of the Developing Mind: Attachment Relationships, Mindsight, and Neural Integration. Infant Mental Health Journal Vol 221 (1-2), 87-94. 2001.

Siegel, Daniel and Hartzell, Mary. Parenting From the Inside Out. Tarcher Press. Los Angeles, CA. 2004

Sutherland, Carol. Inner Relationship Focusing: Strengthening Attachment and Interpersonal Neurobiological Integration. Focus Training. Cape Cod, MA. 2005.

Thompson, Curt. Anatomy of the Soul: Surprising Connections between Neuroscience and Spiritual Practices That Can Transform Your Life and Relationships. SaltRiver Publishing. New York, NW. 2010

Townsend, John and Cloud, Henry. How People Grow. Zondervan Publishing. Grand Rapids, MI. 2004

Van der Kolk, Bessel. The Body Keeps the Score. Viking Publishing. NY, NY. 2014

References

Documents

Interpersonal Neurobiology of Poverty and Trauma Informed Care Trish Thacker, MSW, LICSW Program Director Minneapolis Harbor Light Center For more information