Preparing to Attach with Children from Hard Places: A Guide to Loving and Leading Laurie Krull, LCSW

Preparing to Attach with Preparing to Attach with Children from Hard Places: Children from Hard Places:

A Guide to Loving and LeadingA Guide to Loving and Leading

Laurie Krull, LCSWLaurie Krull, LCSW

What is Attachment?What is Attachment?

Attachment is:Attachment is:

Proximity seeking behaviorProximity seeking behavior• Established in the first few years of lifeEstablished in the first few years of life• The exclusive relationship between child The exclusive relationship between child

and caregiver(s). and caregiver(s). • There are different patterns of attachment, There are different patterns of attachment,

which becomes crystalized into a state of which becomes crystalized into a state of mind with respect to attachment around mind with respect to attachment around three to five years of age.three to five years of age.

(c) 2008 Center For Family Development www.Center4FamilyDevelop.com 716-810-0790

How Does Attachment Develop?How Does Attachment Develop?

1. Need

2. Meet Need

3. Gratificationor Relief

4. Trust

EriksonEriksonTrust vs. Trust vs. MistrustMistrust

Necessary Input: (a) Eye Contact (b) Touch (c) Movement (d) Smiles“

LO

VE”

The First YearThe First Year


Attachment Teaches:

Repeated bonding cycles create trust:Trust that the world is safeTrust that the infant’s needs will be

metTrust that the infant can effectively

influence the worldTrust that the parent is reliable and

goodTrust that the child is good.

Trust and the bond created can be transferred to others


Why Is Attachment So Important?Why Is Attachment So Important?

Attachment is essential for the Attachment is essential for the foundation of a healthy personality foundation of a healthy personality and is necessary for:and is necessary for:

– the attainment of full intellectual potential – the ability to think logically– the development of a conscience– the ability to cope with stress & frustration– becoming self-reliant– the development of relationships– the ability to handle fear & worry– the ability to handle any perceived threat to self

But what goes wrong??But what goes wrong??

• Environment

• Neurobiology

• Complex/Developmental Trauma

• Post Traumatic Stress Disorder

• Fetal Alcohol syndrome/fetal alcohol effect

• Sensory Integration Disorder

• Language issues and cognitive impact

‘‘Orphanage’ behavior is Orphanage’ behavior is NOTNOT dysfunctional. dysfunctional.

In fact, it is an adaptive In fact, it is an adaptive response to a dysfunctional response to a dysfunctional

environment.environment.

Dysfunctional or Adaptive??Dysfunctional or Adaptive??

Lack of foodLack of food Lack of stimulationLack of stimulation Lack of nurturingLack of nurturing ‘‘Good’ kids get stuff, ‘bad’ kids get Good’ kids get stuff, ‘bad’ kids get

nothingnothing No mirror or distorted mirrorNo mirror or distorted mirror Caring others are fleetingCaring others are fleeting Submission/dominance modelSubmission/dominance model Kids taking care of kidsKids taking care of kids Correction without relationship - Correction without relationship -

SHAMESHAME

EnvironmentEnvironment

Parent as representativeParent as representative Parent represents all adults/peopleParent represents all adults/people

Parent as mirrorParent as mirror Children define themselves as Children define themselves as

parents doparents do

Parent as windowParent as window Children define the world based on Children define the world based on

interactions with parentinteractions with parent

What makes parents so What makes parents so important??important??

Generally perceive adults Generally perceive adults asas::

Motivated by self interestMotivated by self interest CruelCruel IgnorantIgnorant DisinterestedDisinterested RejectingRejecting

manipulation of wants/needs – manipulation of wants/needs – often will manipulate to get rather often will manipulate to get rather than ask directlythan ask directly

endless questions and/or demandsendless questions and/or demands indiscriminate – all adults equally indiscriminate – all adults equally

desirabledesirable

Parent as representative-Parent as representative-

Children define self as parents doChildren define self as parents do

Fragmented self image – lack of Fragmented self image – lack of cohesive sense of self prevents cohesive sense of self prevents organized and consistent frame for organized and consistent frame for experiences (positive or negative) experiences (positive or negative) which makes planning and which makes planning and character growth difficultcharacter growth difficult

pervasive negative self imagepervasive negative self image overwhelming sense of shame and overwhelming sense of shame and

doubtdoubt imagine self as either imagine self as either

inappropriately powerful or inappropriately powerful or excessively impotentexcessively impotent

assume that others see them as assume that others see them as they see themselvesthey see themselves

Parent as mirror –Parent as mirror –


Shame CycleShame Cycle

Relationship in Sync

Child Transgresses

Parent repairs relationship

Child feels good

EriksonEriksonAutonomy v Autonomy v

ShameShameParent acts sets limit

Child feels Shame

Child makes amends

Child feels Overwhelming shame

Abuse/neglect & No Repair

NegativeWorking Model

Children define the world Children define the world based on parentbased on parent

world perceived as a scary, world perceived as a scary, random placerandom place

hypervigilance and manipulationhypervigilance and manipulation

Parent as window-Parent as window-

Complex/Developmental TraumaComplex/Developmental Trauma

altered altered brain functionbrain function

OverreactionOverreaction to even to even

small triggerssmall triggers

Risk of parentRisk of parentpathologicalpathological

responseresponse

early early Repeated traumaRepeated trauma


What is Complex What is Complex Trauma?Trauma?

Complex Trauma refers to the Complex Trauma refers to the effects of:effects of:

EARLYEARLY CHRONICCHRONIC MALTREATMENT MALTREATMENT IN A CARE-GIVNG RELATIONSHIP IN A CARE-GIVNG RELATIONSHIP


Domains of Domains of ImpairmentImpairment

AttachmentAttachmentBiologyBiologyEmotional RegulationEmotional RegulationDissociationDissociationBehavioral RegulationBehavioral RegulationCognitionCognitionSelf-ConceptSelf-Concept

Sneaking or hoarding food Sneaking or hoarding food LyingLying Proximity issuesProximity issues

avoiding caregivers (flight)avoiding caregivers (flight) clinginessclinginess

Flat affect punctuated by outbursts Flat affect punctuated by outbursts (fight)(fight)

Appear to have little or no remorse for Appear to have little or no remorse for behavior (frightened rabbit syndrome)behavior (frightened rabbit syndrome)

Typical behaviorsTypical behaviors

hypervigilant = controllinghypervigilant = controlling

hyperarousal (parts of the brain involved hyperarousal (parts of the brain involved in flight/fight are always on so child is in flight/fight are always on so child is likely to over respond to stimulus) or likely to over respond to stimulus) or hypoarousal (hyper or lazy)hypoarousal (hyper or lazy)

more open with other kids and more likely more open with other kids and more likely to seek them out when upset (especially to seek them out when upset (especially other adoptees)other adoptees)

Acts overly charming/affectionate with Acts overly charming/affectionate with strangers or acquaintances but….strangers or acquaintances but….

avoids genuine affection with ‘intimate’ othersavoids genuine affection with ‘intimate’ others

bedtime problemsbedtime problems

being an ‘as if’ childbeing an ‘as if’ child

denying real feelings and/or affect does denying real feelings and/or affect does not match either words or situationnot match either words or situation

prefers to be alone (not at bedtime)prefers to be alone (not at bedtime)

carelessness with things (hard on toys, carelessness with things (hard on toys, clothes, furniture, etc.)clothes, furniture, etc.)

tends to minimize real pain but tends to minimize real pain but exaggerate small hurtsexaggerate small hurts

Electrical pathways in the brain are Electrical pathways in the brain are still forming over the first 3 yearsstill forming over the first 3 years

Any pathways that are not used Any pathways that are not used regularly are vulnerable to ‘pruning’regularly are vulnerable to ‘pruning’

Neurobiology of Neurobiology of Attachment: Attachment:

Areas that are over active Areas that are over active (stress, fight/flight) remain (stress, fight/flight) remain with an excess of neuronal with an excess of neuronal activity. activity.

This excess activity can wear This excess activity can wear out or preoccupy other parts out or preoccupy other parts of the brain which are needed of the brain which are needed for forming new memories for forming new memories and learningand learning

Pathways involved in social perception the same as those that integrate functions such as the creation of meaning, regulation of body states, regulation of emotion, organization of memory and capacity for interpersonal communication and empathy

Therefore, excessive pruning or hyper arousal within these neural pathways significantly disrupts the process of healing and other learning tasks

Right Brain Dominant SkillsRight Brain Dominant Skills

The right brain is dominant during the first The right brain is dominant during the first three years until language develops.three years until language develops.

Right hemisphere is responsible for social Right hemisphere is responsible for social cognition, psychosocial development, cognition, psychosocial development, affective memory and experience and the affective memory and experience and the perception and storage of interpersonally perception and storage of interpersonally related informationrelated information

Right Hemisphere SkillsRight Hemisphere Skills

Reading social cuesReading social cues Regulating feelingsRegulating feelings Controlling impulsesControlling impulses Focusing attentionFocusing attention Understanding causeUnderstanding cause

and effectand effect Learning to planLearning to planAll developed within the attachment relationshipAll developed within the attachment relationship..

Limbic SystemLimbic System

The The limbic system is a set of brain is a set of brain structures located on top of the structures located on top of the brainstem and buried under the and buried under the cortex..

Limbic system structures are involved Limbic system structures are involved in many of our emotions and in many of our emotions and motivations, particularly those that are motivations, particularly those that are related to survival. Such emotions related to survival. Such emotions include fear, anger, and emotions include fear, anger, and emotions

The limbic system is critically important for the organization of new learning and the capacity to adapt to a rapidly changing environment

Two large limbic system structures, the Two large limbic system structures, the amygdala and and hippocampushippocampus play important play important roles in memory. roles in memory.

The The amygdalaamygdala is responsible for determining is responsible for determining what memories are stored and where the what memories are stored and where the memories are stored in the brain. memories are stored in the brain.

The The hippocampushippocampus sends memories out to the sends memories out to the appropriate part of the cerebral hemisphere appropriate part of the cerebral hemisphere for long-term storage and retrieves them for long-term storage and retrieves them when necessary. when necessary.

Stressful experiences that are chronic or traumatic cause persistently high levels of neuroendocrine hormones

High levels of these hormones can cause permanent damage to the hippocampus which is critical for memory

Chronic stress is known to risk damage to the hippocampus –

critical for memory and planning

Limbic system including amygdala is Limbic system including amygdala is significantly involved in the attachment significantly involved in the attachment experienceexperience

Involved in motivation, emotions and goal-directed behaviorInvolved in motivation, emotions and goal-directed behaviorFlight-fight – freeze stress responseFlight-fight – freeze stress response

The amygdala handles stress response The amygdala handles stress response (flight-fight) while the neo cortex is (flight-fight) while the neo cortex is involved in higher cognitive functions involved in higher cognitive functions such as planning, organizing, judgment such as planning, organizing, judgment and related functionsand related functions

The hypothalamus releases important hormones to the amygdala such as oxytocin which is a bonding hormone that is released through touch, warmth and movement

Oxytocin calms the amygdala and it can spur the pre-frontal cortex to grow GABA (an inhibitor) bearing fibers down to the amygdala and quell the fear response This is why hugs make us feel safe and bonded to the person who is helping to release oxytocin in our brains.

Neo cortexNeo cortexIt is involved in higher functions such It is involved in higher functions such as:as:

sensory perception sensory perception

generation of motor commands,generation of motor commands, spatial reasoning, spatial reasoning,

conscious thought and conscious thought and

languagelanguage

An integrated brain requires neuronal An integrated brain requires neuronal connections across the left and right connections across the left and right hemisphere. hemisphere.

Brain activities spanning hemispheres are Brain activities spanning hemispheres are managed by the corpus callosum. managed by the corpus callosum.

Abused and neglected children have smaller Abused and neglected children have smaller corpus callosum than non-abused children corpus callosum than non-abused children

Implications of these Implications of these neurobiologicalneurobiological findingsfindings

The response to trauma comes from The response to trauma comes from deep in the autonomic nervous system deep in the autonomic nervous system which almost instantly accesses survival which almost instantly accesses survival mechanisms before cognitive mechanisms before cognitive interpretation is possible. interpretation is possible.

Therefore, traumatized children often Therefore, traumatized children often react instinctively to the tone of voice, react instinctively to the tone of voice, posture, eyes and speech cadence. posture, eyes and speech cadence.

Attunement is a key to healing

Co-regulation of affect is critical

Attention needs to be paid to the integration of memory and cognitive process with emotion creating a coherent biographical narrative

Assumptions about what is happening within a session or triggering a behavior need to consider neurobiology

What do we do??What do we do??

Focus is not on behavior but Focus is not on behavior but reflects the cooperative, reflects the cooperative, connected sharing of experience connected sharing of experience in the moment and co-creating in the moment and co-creating meaningmeaning

Interactive repairInteractive repair resolves shame resolves shame represents the relationship repair represents the relationship repair

following some relationship breachfollowing some relationship breachReflective dialogueReflective dialogue

verbal expression of internal thought verbal expression of internal thought processes that helps child to begin to processes that helps child to begin to make sense of his/her own inner selfmake sense of his/her own inner self

Contingent collaborative Contingent collaborative communicationcommunication Eye contactEye contact Facial expressionsFacial expressions Tone of voiceTone of voice Body language Body language Timing and intensity of responseTiming and intensity of response


DYADIC DEVELOPMENTAL DYADIC DEVELOPMENTAL PSYCHOTHERAPYPSYCHOTHERAPY

IDENTIFY BEHAVIOR

Using acceptance and curiosity

Using empathy

FINDMEANING

NORMALIZE

Communicate

NEWMEANING

PPlayful

AAccepting

CCurious

EEmpathic

AttunementAttunement caregiver and therapist are in sync caregiver and therapist are in sync

with the child’s inner experience and with the child’s inner experience and provide feedback without judgmentprovide feedback without judgment

Inevitable misattunement and Inevitable misattunement and dysregulation are used as dysregulation are used as opportunities to practice, in the opportunities to practice, in the moment, interactive repair and moment, interactive repair and creation of meaningcreation of meaning

What does DDP look like in real What does DDP look like in real life?life?

Focus is not on behavior but Focus is not on behavior but reflects the cooperative, reflects the cooperative, connected sharing of experience connected sharing of experience in the moment and co-creating in the moment and co-creating meaningmeaning

Interactive repairInteractive repair resolves shame resolves shame represents the relationship repair represents the relationship repair

following some relationship breachfollowing some relationship breach

Caregivers are taught to use Caregivers are taught to use attachment based parentingattachment based parenting Success in these interactions means that Success in these interactions means that

they are consistent with the healing PLACEthey are consistent with the healing PLACE PlayfulPlayful LovingLoving AcceptingAccepting CuriousCurious EmpatheticEmpathetic

Attention is paid to the attachment Attention is paid to the attachment strategies of both the caregiver and strategies of both the caregiver and the therapistthe therapist Both may affect the ability of both to Both may affect the ability of both to

therapeutically interpret the child’s therapeutically interpret the child’s expressions of his/her inner lifeexpressions of his/her inner life

Documents

Preparing to Attach with Children from Hard Places: A Guide to Loving and Leading Laurie Krull, LCSW