3!! Presentation1

1eftc congres 2009 Bondingpsychotherapy TC De Sleutel Patrick Vanassche

Once it has to be the first time…

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Bonding psychotherapy Bonding psychotherapy in in

TC De SleutelTC De Sleutel

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If we felt loved by our parents, as a result we feel If we felt loved by our parents, as a result we feel at ease in our body and we love ourselves. Self at ease in our body and we love ourselves. Self worth is set and we can relate with others to worth is set and we can relate with others to

have our needs met.have our needs met.Closeness feels warm and good. Closeness feels warm and good.

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If self worth is low and contacting If self worth is low and contacting others for what we need is difficult, others for what we need is difficult, then we persistently hunt for this then we persistently hunt for this

caring love in vain. caring love in vain.

The only solution is to mount enough The only solution is to mount enough self love. self love.

Which is not easily done Which is not easily done

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The TC has tools to The TC has tools to offer young adults offer young adults the skills for self the skills for self

worth and relation worth and relation ability.ability.

Feeling welcome and Feeling welcome and safe in a warm group safe in a warm group

-family-alike helps for -family-alike helps for working on problems working on problems

of self-worthof self-worth

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Each day, this self help community offers Each day, this self help community offers skills for training with living, on the wayskills for training with living, on the way

In different peer groups it is safe to In different peer groups it is safe to explore and find solutions for conflictsexplore and find solutions for conflicts

The staff offers regularly special groups The staff offers regularly special groups for developing insight ... for developing insight ...

Conflicts come along with an inner Conflicts come along with an inner conflictconflict

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Bonding therapy is one Bonding therapy is one among the 12 insight among the 12 insight groups TC De Sleutel groups TC De Sleutel offers in the program offers in the program

The TC and bonding The TC and bonding therapy stem from the therapy stem from the same roots. same roots.

They go easily They go easily together for together for training in the training in the here here and nowand now, problems , problems coming from coming from there there and thenand then..

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In the bonding group and in TC, human warmth from In the bonding group and in TC, human warmth from a peer group and staff is the only way to a peer group and staff is the only way to facilitate facilitate insightinsight and acceptand accept painful lived experiences from painful lived experiences from the past. the past.

Since avoiding pain is a natural defense mechanism…Since avoiding pain is a natural defense mechanism…

When negative feelings emerge in life, we need an When negative feelings emerge in life, we need an

inner ability to seek closeness, support and care inner ability to seek closeness, support and care

from someone. This inner possibility we call from someone. This inner possibility we call

attachmentattachment..

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If this inner If this inner attachmentattachment is not is not functioning appropriate, we can only functioning appropriate, we can only

try to avoid paintry to avoid pain

Drug addicts developed mainly their Drug addicts developed mainly their social skills to escape emotional pain, social skills to escape emotional pain, they are expertsthey are experts

TC confronts this avoidance which TC confronts this avoidance which become visible in contact, building up become visible in contact, building up new social skills to relate new social skills to relate

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Attachment stylesAttachment styles

SecureSecure

Comfortable with Comfortable with

Intimacy and autonomyIntimacy and autonomy

Ambivalent Ambivalent preoccupiedpreoccupied

Preoccupied with Preoccupied with relationshipsrelationships

acceptoracceptor

Dismissing Dismissing avoidantavoidant

Dismissing of intimacyDismissing of intimacy

rejectorrejector

Fearful avoidantFearful avoidantSocial avoidantSocial avoidant

rejectorrejector

Image of the self

Image

of

the

other

+ -

-

+

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In bonding therapy: focus on emotions In bonding therapy: focus on emotions here and nowhere and now

Find own inner logic of emotionFind own inner logic of emotion

Triggered when expressed with loud Triggered when expressed with loud

voicevoice

Reality of self, accepting by letting go Reality of self, accepting by letting go

Possible when secure contextPossible when secure context

A way to discover warmth and intimacyA way to discover warmth and intimacy

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Intern logic of feelingsIntern logic of feelings

1. When 1. When feelingsfeelings come, associated beliefs come, associated beliefs come upcome up

2. These 2. These attitudesattitudes refer to lovability and trust refer to lovability and trust3. Unconscious 3. Unconscious behaviorbehavior intention, automatic intention, automatic

-This happens in the very moment!--This happens in the very moment!-

Feelings stem from limbic systemFeelings stem from limbic system Motivation function, for staying aliveMotivation function, for staying alive Biological needs Biological needs ‘‘Bonding’ a biological needBonding’ a biological need

+ attachment prerequisite!+ attachment prerequisite!

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The bonding experience feels good The bonding experience feels good for lifetimefor lifetime

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Working with attachment defects in Working with attachment defects in Bonding therapyBonding therapy

Ambulant bonding psychotherapy:Ambulant bonding psychotherapy: Peer groupPeer group Mat workMat work Attitude workAttitude work

TC practice: no mat work TC practice: no mat work Severe trauma, mishandledSevere trauma, mishandled No positive image of careNo positive image of care Associated with sex, too difficult Associated with sex, too difficult

TC: secure structure, holding, protecting TC: secure structure, holding, protecting AuthorityAuthority

= permanent presence of the other= permanent presence of the other

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Bonding practice in TCBonding practice in TCThe place in the structureThe place in the structure

One of the peer groupsOne of the peer groups On Friday, 1/14 days – 4,5 hours On Friday, 1/14 days – 4,5 hours 12-17 clients12-17 clients From 2nd Fase on to end TC programFrom 2nd Fase on to end TC program

2 therapists: BP + clin. coordin. or family 2 therapists: BP + clin. coordin. or family therapisttherapist

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Preparation before Bonding Preparation before Bonding therapytherapy

InterviewInterview

Tests Dr Stauss for introspection Tests Dr Stauss for introspection exercise exercise

‘ ‘group contract’group contract’

The seminars: The seminars: family & clients 1st F.family & clients 1st F.

The clinical boardThe clinical board

The information from primary staff The information from primary staff

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Preparation for bonding Overview Preparation for bonding Overview of the 3 testsof the 3 tests

The help from 3 tests for a therapy plan:The help from 3 tests for a therapy plan: RSQ: (1) How severe is anxietyRSQ: (1) How severe is anxiety

°for abandonment°for abandonment

°for closeness°for closeness

(2) How is it with the trust (2) How is it with the trust SCL90: Shows the symptoms and the SCL90: Shows the symptoms and the

weightweight SASB: Gives a glance at the positive and SASB: Gives a glance at the positive and

negative interjects negative interjects

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Rsq shows fear and trust aspectsRsq shows fear and trust aspectsfearfully avoidant - coming secure fearfully avoidant - coming secure

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Rsq shows fear and trust aspectsRsq shows fear and trust aspectspreoccupied attachment style preoccupied attachment style

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Rsq shows fear and trust aspectsRsq shows fear and trust aspectsdismissing attachment style dismissing attachment style

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Rsq shows fear and trust aspectsRsq shows fear and trust aspectsfearfully avoidant - coming secure fearfully avoidant - coming secure

attach. st.attach. st.

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SCL90 shows the symptom loadSCL90 shows the symptom load

Different aspects of emotional disease Different aspects of emotional disease with a ‘severity’ factorwith a ‘severity’ factor

For many clients at the beginning this For many clients at the beginning this diagram helps them for staying, diagram helps them for staying, confronting the pain sumconfronting the pain sum

After 1st Fase (before bonding) clients After 1st Fase (before bonding) clients feel good with the changement and feel good with the changement and motivated for continuing the programmotivated for continuing the program

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SCL90= symptom burdenSCL90= symptom burden

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SCL90= symptom burdenSCL90= symptom burden

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SASB test shows some introjectsSASB test shows some introjects

The left side of the diagram : ‘difficult The left side of the diagram : ‘difficult to live’ the right side: ‘the healthy to live’ the right side: ‘the healthy aspects’aspects’

The difference from healthy is shown The difference from healthy is shown around the diagramaround the diagram

When shown over time, the program When shown over time, the program shows the affiliation gainshows the affiliation gain

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SASB test shows some introjectsSASB test shows some introjects

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SASB test shows some introjects... SASB test shows some introjects...

““No problems, No problems,

……but 3 months but 3 months later, more later, more insight ”insight ”

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Bonding group in practiceBonding group in practice

Go aroundGo around feelingsfeelings

Attitude workAttitude work

Final go around Final go around HomeworkHomework

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Ongoing Group Ongoing Group

First attention: the climateFirst attention: the climate Life in TC first and PhysicalLife in TC first and Physical

Empathic exploration one by oneEmpathic exploration one by one Accent on feelings and attitude circle workAccent on feelings and attitude circle work A peer suggests you what to doA peer suggests you what to do Homework?Homework?

15’ break15’ break

Therapists look for what is priority, Therapists look for what is priority,

techniquestechniques

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Attitude groupAttitude group

in the middle of the groupin the middle of the group What needed?What needed? Express Express When pain comes up, mirroring When pain comes up, mirroring When in pain, a hug brings release + When in pain, a hug brings release +

moremore Giving time to this closeness!Giving time to this closeness! Body position (!) in positive attitudeBody position (!) in positive attitude

After work: taking in is most important to After work: taking in is most important to learn!learn!

When ready, group FB When ready, group FB

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Working with attachment styles in Working with attachment styles in attitudeattitude

Preoccupied attachment stylePreoccupied attachment stylePreoccupied clients: a lot of feelings!Preoccupied clients: a lot of feelings!

Information from outside the groupInformation from outside the group Afraid for conflictsAfraid for conflicts Set too high expectations for themselves and no Set too high expectations for themselves and no

help help Look for confirmation from staffLook for confirmation from staff Good empathy for others, taking the blameGood empathy for others, taking the blame They tend to idealizeThey tend to idealize

Negative attitudesNegative attitudes:: ‘‘I can’t...” “I am not important” “it’s never enough”I can’t...” “I am not important” “it’s never enough”

Most difficult: express anger and feel differentMost difficult: express anger and feel different

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WWorking with attachment styles in orking with attachment styles in attitudeattitude

Preoccupied attachment stylePreoccupied attachment style

Positive attitudesPositive attitudes Where find the anger? Where find the anger?

““I exist” “ I go my way!” “I decide!” “living own life”I exist” “ I go my way!” “I decide!” “living own life” Setting limits and permission sentences for Setting limits and permission sentences for

themselves: themselves: ‘‘I may say No!’, ‘enough!’I may say No!’, ‘enough!’ ““I’m your equal!” “I needed love, not your I’m your equal!” “I needed love, not your

confirmation!” confirmation!”

Quick changes in behavior occurQuick changes in behavior occur Examples for ‘homework’:Examples for ‘homework’:

‘‘I’ll practice ‘no’ when ...; I’ll practice ‘no’ when ...; When I have a different opinion I’ll say it anyway!”; When I have a different opinion I’ll say it anyway!”; ““I’ll confront staff if I feel hurt” I’ll confront staff if I feel hurt” ““I’ll ask for help!”I’ll ask for help!”

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Avoidant, dismissing attachment styleAvoidant, dismissing attachment style

Dismissing clients: at ease alone, avoiding Dismissing clients: at ease alone, avoiding intimacyintimacy

Information from outside the groupInformation from outside the group Frequent manipulation, prolonged Frequent manipulation, prolonged

moodiness!moodiness! Difficult to take a haircut, hard to hurtDifficult to take a haircut, hard to hurt Frequent forced to think about behaviorFrequent forced to think about behavior Difficult to accept own limitationsDifficult to accept own limitations

Frequent sport lesionsFrequent sport lesions Yellow carts for aggression, fear of loosing Yellow carts for aggression, fear of loosing

controlcontrol

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Avoidant, dismissing attachment styleAvoidant, dismissing attachment style

Attitude workAttitude work Have to understand how it works -It took time to Have to understand how it works -It took time to

feel, feel, Poor image of care in the past! Poor image of care in the past!

Attitudes to improve openness and self-care;Attitudes to improve openness and self-care; ““I’ ll take care for myself!” & “I’m Important” I’ ll take care for myself!” & “I’m Important” Temper Tantrum technique may helpTemper Tantrum technique may help

Unfamiliar with affection, little dosesUnfamiliar with affection, little doses

Examples for ‘Examples for ‘homeworkhomework’: ’: ““I’ll talk about unpleasant feelings to peers”I’ll talk about unpleasant feelings to peers” ““Have to learn to check my ideas about others” Have to learn to check my ideas about others”

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Anxious, avoidant attachment styleAnxious, avoidant attachment style

Information from outside the groupInformation from outside the group:: Difficult to trust, misunderstand othersDifficult to trust, misunderstand others InvisibleInvisible They don’t ask for helpThey don’t ask for help

Fear on the foreground, lonelinessFear on the foreground, loneliness Fear of abandonment is greatFear of abandonment is great Low self-confidenceLow self-confidence

It takes time to feel secure and It takes time to feel secure and “understand” feelings“understand” feelings

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Anxious, avoidant attachment styleAnxious, avoidant attachment stylePositive attitudesPositive attitudes Desire but afraid to work with anger Desire but afraid to work with anger

Pain on foregroundPain on foreground First: Attitudes for ego strengthFirst: Attitudes for ego strength

“ “I’m important” “I want to live, no I’m important” “I want to live, no more drugs!”, “My anger is not so bad”more drugs!”, “My anger is not so bad”

Then: more vulnerable feelings of shame Then: more vulnerable feelings of shame can be processed. can be processed.

Not in the middle, in the circleNot in the middle, in the circle + attention and support + attention and support

Working in a little peer groupWorking in a little peer group

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Anxious, avoidant attachment styleAnxious, avoidant attachment style

Usually Confusion: Usually Confusion: difficult to accept tenderness and warmthdifficult to accept tenderness and warmth

If confidence in the peer group: sharing the If confidence in the peer group: sharing the secretsecret

Friendship has to be strong enough to process Friendship has to be strong enough to process the fear from missing warmth for years. the fear from missing warmth for years.

Not enough time in TC!Not enough time in TC!

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Anxious, avoidant attachment styleAnxious, avoidant attachment style With help from family therapist: With help from family therapist: Some finally mourn...Some finally mourn...

When 3F: outside world frightens When 3F: outside world frightens Positive attitudes: learn to expressPositive attitudes: learn to express

““I have fear I have fear ANDAND do I’ll do it for me!” do I’ll do it for me!” Fear for relapse has to be worked on again Fear for relapse has to be worked on again ““I take good care for myself! I take good care for myself! Going for body level! (peers testimony)Going for body level! (peers testimony)

Examples for homework:Examples for homework: importance to improve friendship and pleasureimportance to improve friendship and pleasure

- playing with mates- playing with mates- go for recovery with family + peers- go for recovery with family + peers

Exploring new hobbiesExploring new hobbies

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BP in practice: Final go aroundBP in practice: Final go around

Every client: what was touching, Every client: what was touching, interesting?interesting?

Invitation to share about ‘the inner work’ Invitation to share about ‘the inner work’ mirroringmirroring

Finding ‘homework’:Finding ‘homework’: intentions intentions Link with ‘the floor’ =concrete! Link with ‘the floor’ =concrete!

+ see support of this peer group+ see support of this peer group

This This intentions are transmitted to the staff intentions are transmitted to the staff

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Clients with borderline traitsClients with borderline traits Work first on positive identity, with anger. Work first on positive identity, with anger.

““I’m me”, “I’ll succeed”, “I’m here too!”I’m me”, “I’ll succeed”, “I’m here too!” When more vulnerable feelings open, When more vulnerable feelings open,

Dose the amount of feeling, avoid Dose the amount of feeling, avoid regression. regression.

Staying in the here and now. Staying in the here and now. Reinforcing with positive statements in good Reinforcing with positive statements in good

eye contact. eye contact. This helps giving them a feeling of strength This helps giving them a feeling of strength TCTC

““I’m allowed to have a place here too!” I’m allowed to have a place here too!”

““I deserve respect!” I deserve respect!”

““My feelings are ok’! (with anger)My feelings are ok’! (with anger) Good evolution outside group when Good evolution outside group when

experienced this positive reinforcements experienced this positive reinforcements

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Practice bonding psychotherapy in Practice bonding psychotherapy in TCTC

Note on risk for retraumatisationNote on risk for retraumatisation

Therapy contractTherapy contract Confrontation body contact: fear comes upConfrontation body contact: fear comes up Work on identity, express anger: Work on identity, express anger:

““You must be ashamed!” You must be ashamed!” finding “fear + power” at body levelfinding “fear + power” at body level

Important: stay in here and now, no Important: stay in here and now, no regression! regression! Learn to take in warmth (nurturing position)Learn to take in warmth (nurturing position)

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End of 3th fase, leaving the End of 3th fase, leaving the bonding groupbonding group

Test & interviewTest & interview Discussion about introspectionDiscussion about introspection

What changed in relations with What changed in relations with friends, familyfriends, family

Self care and asking for help = +Self care and asking for help = + Leaving the group: go-around Leaving the group: go-around

+ looking back, FB from peers+ looking back, FB from peers Positive attitude Positive attitude Best trainers for other peers!Best trainers for other peers!

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Some findings from the Some findings from the testingtesting

1. How TC improves secure 1. How TC improves secure attachment, attachment, intimacy and intimacy and openness for warm openness for warm contactscontacts

2. Symptoms relieve after 1F2. Symptoms relieve after 1F

3. Anxiety reduce effect 3. Anxiety reduce effect changechange

4. Effect change in openness 4. Effect change in openness for warmth for warmth

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Some preliminary findings for TCSome preliminary findings for TChuman warmth insighthuman warmth insight

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Some preliminary findings for TCSome preliminary findings for TC Symptoms after 1st F. Symptoms after 1st F.

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Some preliminary findings for TCSome preliminary findings for TCless fear and more trust before half-way houseless fear and more trust before half-way house

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ConclusionConclusion

Thanks to the openness of team: more Thanks to the openness of team: more integrated integrated

TC is opening, …for some the TC is opening, …for some the ‘holding’ not long enough, need to ‘holding’ not long enough, need to search for alternativessearch for alternatives

The therapist has to stay clientThe therapist has to stay client

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50eftc congres 2009 Bondingpsychotherapy TC De Sleutel Patrick Vanassche

Health & Medicine

3!! Presentation1