abc of ohio presents… attachment-focused interventions: cultivating nurturing environments to...

90
ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent- Child Attachment

Upload: jason-merritt

Post on 20-Jan-2016

225 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

ABC of Ohio presents…

Attachment-Focused Interventions:

Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Page 2: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Part I

Theoretical Rationale:

Developmental Trauma Disorder

(Complex Trauma or Reactive Attachment Disorder)

Page 3: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

DEVELOPMENTAL TRAUMA DISORDER(Cook, Blaustein, Spinazzola and van der Kolk, 2003)

http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf

Definition

Children’s experience of multiple traumatic events that occur within the care giving system Prenatal exposure to drugs/alcohol Neglect/Institutionalization Abuse Abandonment/Multiple Moves Pain/Illness/Hospitalization

Involves simultaneous or sequential occurrences of child maltreatment—that are chronic and begin in early childhood

Page 4: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Areas of Impairment

AttachmentAttachmentAffectAffect RegulationRegulationDissociationDissociationCognitionCognitionBiologyBiologyBehavioralBehavioral ControlControlSelfSelf ConceptConcept

DEVELOPMENTAL TRAUMA DISORDER(Cook, Blaustein, Spinazzola and van der Kolk, 2003)

Page 5: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

5

ATTACHMENT• Attachment is the process by

which an emotional connection develops between an infant and his/her caretaker

• This process organizes the infant physiologically and psychologically

• Attachment becomes the basis for how he/she will relate to the world, learn and form relationships

• In addition to the basic needs such as food, shelter and clothing, the infant needs emotional care which is essential for his/her development

• Attachment grows through daily interactions between caretaker and infant

• Smiles, nurturing touch, eye contact, mutual play build trust and security in the child

• This first relationship becomes the blueprint for all future relationships

• It is also the origin of conscience development, empathy, self-esteem and cause and effect thinking

• Insecure attachment patterns seen in 80% of maltreated children

Page 6: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

6

NEED

TRUST

GRATIFICATION

ANGERHIGH AROUSAL

RAGE

Page 7: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

DISSOCIATION• Difficulty with emotional

self-regulation• Difficulty describing feelings

and internal experience• Problems knowing and

describing internal states• Difficulty communicating

wishes and desires• Predisposed to earlier onset

of affective problems, which is associated with more episodes and poorer outcome

• Distinct alterations in states of consciousness

• Two or more distinct states of consciousness

• Hyperarousal & Dissociative• Begins as a protective

defense mechanism and then is utilized more frequently as trauma continues

AFFECT REGULATION

Page 8: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Problems with…• Irrational cognitions• Sustained curiosity/initiative• Processing new information• Focusing and completing new tasks (hypervigilence vs.

hyperactivity)• Understanding own contribution to what happens to them

(cause-and-effect thinking)• Object constancy• Orientation with time and space• Learning disabilities• Abstract thinking

Cognitive

Page 9: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Biology

Problems with…

• Experiences impact brain development• Lifelong reactivity to stress• Problems with coordination, balance, body tone• Somatization• Analgesia (inability to feel pain)• Hypersensitivity to physical touch• Wide variety of medical problems: pelvic pain,

asthma, skin problems, autoimmune disorders• Sensory Integration Dysfunction

Page 10: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Behavioral Control

• Poor impulse control• Self destructive behavior• Aggression• Self soothing behaviors• Sleep and eating disturbances• Substance abuse• Excessive compliance or oppositional behavior• Reenactment of traumatic past

Page 11: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Self Concept

• Lack of coherent sense of self

• Disturbance of body image

• Low self-esteem• Poor sense of

separateness

Page 12: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

7 Core IssuesThe Adoption Overlay

• Loss• Grief• Self-concept• Identity• Shame and Guilt• Intimacy and Relationships• Control

Page 13: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Part II

Translating Theory into Practice:

A Tool-Box of Techniques

Page 14: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Treatment Principles

Parent-Centered and

Child-Focused

Develop a Coherent Narrative

Page 15: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Treatment Principles

Facilitate Grief

Shock/DenialBargainingDepression/SorrowAngerResolution

Page 16: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Treatment Principles

Encourage Behavioral

Change

Encourage Emotional Regulation

(Decrease Dissociation and Hyperarousal)

Page 17: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Treatment Principles

Facilitate Developmental GainsAttachmentAffect RegulationDissociationCognitiveBehavioral ControlSelf-conceptBiology

Page 18: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Nurture, humor and fun!Eye contact, Touch, Talking, Smells, Food, Motion, Warmth

Treatment Principles

Page 19: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of Techniques

• Timeline• Life Book• Children’s Books• Journaling• Art• Role-plays

• Videos• Music• Theraplay™• Yoga• Massage

Page 20: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The narrative is an emotionally rich story that makes sense of one’s life.

Affirms reality Creates meaning, provides closure, reduces need to

ruminate Organizes memories—implicit and explicit— into one

chronological account Enhances cause-and-effect, and decreases anxiety,

insecurity and confusion Reduces disparity between what the child is feeling (fear)

and current reality (safety: with parents and therapist) Reduces isolation, feeling of being unknowable and different Creates the ability to alter the child’s dysfunctional patterns

of interaction Facilitates grief which leads to developmental growth

A Tool-Box of Techniques

Page 21: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Explicit or Declarative Memory We have a conscious ability to retrieve the memory

and state the facts and events. We can recall the event

Implicit or Nondeclarative Memory Implicit memory systems  store emotions, sensory

experiences, and expectations and assumptions about relationships based on prior experiences

Implicit memories form early in life prior to the individual having language

They cannot be recalled but they can be triggered Briere , John and Catherine Scott (2006.) Principles of Trauma Therapy: A Guide to Symptoms, Evaluation and Treatment,

Thousand Oaks: Sage Publications.

A Tool-Box of Techniques

Page 22: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

“When salient experience must be unnoticed, disallowed, unacknowledged, or forgotten, the result is incoherence in the self structure. Interconnections among experiences cannot be made, and the resulting gaps in personal history compromise both the complexity and the integrity of the self”

Ogawa et al, 1997

A Tool-Box of Techniques

Page 23: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

23

Completely truthfuldisclosures help the

child to heal and grow

A Tool-Box of Techniques

Page 24: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

• Start at the beginning• Cases of Limited information• Verbal and concrete methods

• Pace- maintain emotional regulation• Value free – the child decides who to love

• Use adoption language: birth mom, birth dad, etc.• Adjust language according to child’s age:

chronological and developmental• Repeat, repeat, repeat!

A Tool-Box of TechniquesTelling the narrative “story”…

Page 25: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of TechniquesTelling the narrative “story”…

Anticipate questions…Say “I don’t know” as needed

“Why did my birth parents use drugs?”“Do you think my birth mom thinks about me?”“Do you think she is in jail?”“Does she have any more children?”“If they get better, can I go live with them again?”“Why didn’t anyone in my country want me?”“Why didn’t the orphanage ladies take me home?”“Do you think my orphanage friends got adopted?”“Are my birth parents alive?”“Are my siblings safe?”“Do you think my siblings think about me?”“Why did you pick me?”“What would you have done if I had been your baby?”

Page 26: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parental Involvement…

• Parent(s) always present helping

• Parent(s) provide comfort

• Parents learn to speak the truth and not reframe the past

• Timeline and life book are ongoing projects

A Tool-Box of TechniquesTelling the narrative “story”…

Page 27: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The Life Book

A BOOK THAT RECORDS A CHILD’S HISTORY FROM THE BIRTH PARENTS TO THE

PRESENT

A Tool-Box of Techniques

Page 28: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of Techniques

The Timeline

•Allows child to place emotions in the right place

•Provides for concepts of past, present and future

•Helps child understand permanency – “forever”

Page 29: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Music is the Language of the Spirit

A Tool-Box of Techniques

Page 30: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

• Researchers have hypothesized which came first: music or language

• Listening to music is an activity even when it’s background noise.

• Keeping time, postures change to reflect the story, evokes emotion.

• Brings up memories and feelings associated with that time.

A Tool-Box of Techniques

Page 31: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Preverbal Trauma

Challenges…

• Trauma occurring before the development of language.

• Narrative memory has not developed fully.

• Sensory information still filters through the amygdala.

Page 32: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

There’s a lot going on in there!!

• Asymmetric differences between the left and

right hemispheres in adults.• This asymmetry is reversed in the fetus and may carry into early childhood. • Injury or trauma introduced at this time

can lead to an overdevelopment of the right side hemisphere.

Page 33: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of Techniques

Interventions

Airplanes

What happens if the airplane crashes? Everyone looks for the black box!

Page 34: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Because the Black Box records EVERYTHING! The talking on the radio, the weather, turns, ups and downs…but it can’t tell the difference among people or ‘now’ and ‘back then.’ It doesn’t really think…it just records information and feelings so we can keep ourselves safe.

A Tool-Box of Techniques

Page 35: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Everyone has a Black Box in their brain.

• It’s how we learn. • It can’t tell the difference between good and bad,

right or wrong, or even moms. • It’s main job is to tell us if it is safe or dangerous. • Maybe there’s a part in your Black Box that

recorded moms are mean and hurt their kids?

• I think I can help you fix it if you want.

A Tool-Box of Techniques

Page 36: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

• Children’s Books• Journaling• Art• Role-plays• Photos• Videos

A Tool-Box of Techniques

Page 37: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of Techniques

NurtureRepeating the “Cycle of Needs”

Page 38: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Eye contact• Staring contest• Play peek-a-boo

• Look at each other and name ways you

match• Candy kiss hunt

• Face painting• “I love you” in soap

on mirror

A Tool-Box of TechniquesNurture

Touch• Styling hair

• Scratching back• Hand on the

shoulder• Hold hands while

walking• Kisses

• Clapping games• Hugs, hugs and

more hugs!

Page 39: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of TechniquesNurture

Talking•Sing together

•Read together

•Talk in the car

•Nursery rhymes

•Trace a word on your child’s

back•Identify faces

What a beautiful baby!

Page 40: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of TechniquesNurture

Smell•Lotion•Candle

•Bake cookies

Warmth•Dry mittens in

the dryer•Hot chocolate

•Pup tent•Special blanket

Page 41: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of TechniquesNurture

Motion•Blow bubbles

•Fly a kite•Rock

•Catch fireflies•Make a snow angel

•Shoot baskets

Page 42: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Tool-Box of TechniquesNurture

Food•Have a banana split for

dinner•Go on a picnic

•Say, “Yes, you may have a cookie after

dinner•Have a tea party

•Eat by candlelight with the kids

•Cut sandwiches into heart shapes

•Sprinkle chocolate chips on pancakes

Nurture with rather than battle over food

Page 43: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Structure• The therapist and parents select and lead

the activities. This helps the child develop self-control.

Engagement• Offers stimulation, variety and a fresh view

of life-the child understands that surprises can be fun!

Nurture• Soothing, quieting, caretaking activities

make the world feel safe, predictable and secure

Challenge• Helps the child take a mild age-appropriate

risk. This promotes feelings of competence and confidence. Stresses cooperation

A Tool-Box of Techniques - Theraplay

Page 44: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Improved flexibility, strength, balance, muscle tone

Increases the individual’s awareness of their breathing, and then teaches way to regulate breathing. This is important for calming down.

Pizer, Ann. Benefits of Yoga. [online].http://yoga.about.com/od/beginningyoga/a/

benefits.htm

A Tool-Box of TechniquesYOGA

Taming the Monkey Mind • This is the mind that jumps

from thought to thought like a monkey jumps from tree to tree.

• Emphasis is on being in the present moment. The mind gains the ability to focus and concentrate.

Stress relief via stretching. • Stress-related tension is

stored in the body, making a person feel tight, and often causing pain.

Page 45: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

• Helps in relieving discomfort from gas, colic, and constipation

• Improves blood circulation • aids in digestion • Improves quality and

amount of sleep• Enhances development of

the nervous system and Stimulates neurological development (brain function and brain development)

• Reduces aggression (Cozolino)

• Increases alertness and heightened awareness

• Reduces stress hormones • Improves immune function • Stimulates oxytocin, the

“nurturing hormone” • Deepens bonding: • Stimulates growth and

healthy development of body, mind and spirit

• Relaxing and soothing

International Association of Infant Massage. What are the Benefits of Infant Massage? http://www.iaim.ws/faqs.html

A Tool-Box of TechniquesInfant Massage

Page 46: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

“Training for the Brain”

A Tool-Box of TechniquesNeurofeedback

Page 47: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Research

Vineland Adaptive Behavioral Scales

Page 48: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Communication Domain Receptive Expressive Written

Daily Living Skills Domain Personal Domestic Community

Research

Socialization Domain Interpersonal Relationships Play and Leisure Time Coping Skills

Motor Skills Domain Gross Fine

Behavior Internalizing Externalizing

The Vineland Measures Development…

Page 49: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Chronological Age 4 years, 4 months 5 years, 7 monthsCommunication• Receptive 1 year, 3 months 1 year, 6 months• Expressive 2 years, 6 months 3 years, 5 months• Written 4 years, 5 months 4 years, 11 monthsDaily Living Skills• Personal 3 years, 1 month 5 years, 0 months• Domestic 4 years, 6 months 5 years, 6 months• Community 3 years, 1 month 4 years, 5 monthsSocialization• Interpersonal Relationships 1 year, 1 month 2 years, 0 months• Play and Leisure Time 0 years, 4 months 0 years, 8 months• Coping Skills 1 year, 10 months 3 years, 4 monthsMotor Skills Domain• Gross 2 years, 1 month 4 years, 11 months• Fine 3 years, 6 months 4 years, 7 monthsBehavior• Internalizing Clinically Significant Clinically Significant• Externalizing Elevated Elevated

Page 50: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Chronological Age 6 y, 0m 7 y, 0 m 8y, 3mCommunication• Receptive 1 y, 6 m 1 y, 11 m 2y, 2m• Expressive 3 y, 2 m 5 y, 0 m 4y, 6 m• Written 5 y, 2 m 6 y, 9 m 7y, 9 m Daily Living Skills• Personal 4 y, 7 m 6 y, 1 m 6y, 6m• Domestic 4 y, 4 m 3 y, 11 m 7y, 7m• Community 3 y, 7 m 5 y, 5 m 5y, 5mSocialization• Interpersonal Relationships 0 y, 3 m 2 y, 3 m 2y, 5 m • Play and Leisure Time 0 y, 9 m 2 y, 10 m 2y, 10m• Coping Skills 1 y, 6 m 2 y, 3 m 2y, 2mMotor Skills Domain• Gross 4 y, 5 m 5 y, 11 m 6y, 10m• Fine 6 y, 6 m 6 y, 6 m 6y, 10mBehavior• Internalizing CS CS CS• Externalizing CS CS CS

Page 51: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Chronological Age 7 years, 11 months 9 years, 1 monthsCommunication• Receptive 1 year, 11 months 2 years, 11 months• Expressive 6 years, 4 months 6 years, 7 months• Written 9 years, 0 months 10 years, 8 monthsDaily Living Skills• Personal 6 years, 1 month 6 years, 6 months• Domestic 5 years, 5 months 9 years, 6 months• Community 7 years, 6 months 8 years, 7 monthsSocialization• Interpersonal Relationships 1 year, 1 month 1 years, 9 months• Play and Leisure Time 2 years, 9 months 5 years, 3 months• Coping Skills 1 year, 6 months 3 years, 5 monthsMotor Skills Domain• Gross Age Equivalent Age Equivalent• Fine 4 years,11 months 6 years, 10 monthsBehavior• Internalizing Clinically Significant Elevated• Externalizing Clinically Significant Elevated

Page 52: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Chronological Age 11 years, 1 months 12 years, 5 monthsCommunication• Receptive 1 year, 9 months 3 years, 11 months• Expressive 5 years, 11 months 7 years, 7 months• Written 9 years, 2 months 10 years, 10 monthsDaily Living Skills• Personal 5 years, 11 month 11 years, 3 months• Domestic 7 years, 7 months 9 years, 6 months• Community 8 years, 11 months 9 years, 6 monthsSocialization• Interpersonal Relationships 0 year, 11 month 3 years, 7 months• Play and Leisure Time 3 years, 2 months 9 years, 3 months• Coping Skills 2 year, 3 months 5 years, 6 monthsMotor Skills Domain• Gross Age Equivalent Age Equivalent• Fine Age Equivalent Age EquivalentBehavior• Internalizing Clinically Significant Elevated• Externalizing Clinically Significant Elevated

Page 53: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Part III

Parents Need Nurture Too!

Page 54: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parents Need Nurture Too!

Complex Trauma creates a ComplexFamily System

Most adoptive families are healthy prior to the arrival of a child with a history of complex trauma.

However, the family often appears unhealthy upon entering services.

The state of the family is a response to the challenges involved in parenting a child with complex trauma issues.

Page 55: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Trauma, by definition…

A single experience or an enduring or repeating event or events, which completely overwhelm the individual’s ability to cope—consumption and depletion of coping skills.

There is frequently a violation of the person’s familiar ideas—expectations—about the world, and the person is put in a state of confusion and insecurity—cognitive dissonance.

This is also seen when people or institutions depended on violate or betray the person in some unforeseen way—isolation.

It usually involves a feeling of complete helplessness in the face of a real or subjective threat to one’s life or to that of a loved one’s life, integrity and sanity—losses.

There is also an inability to integrate the emotions—grief and negative emotional climate—involved with the traumatic experience.

Page 56: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The Dynamics of the Complex Family System

ExpectationsCognitive DissonanceThe Consumption and Depletion of

Coping SkillsThe Emotional Roller-CoasterIsolationA Sea of Grief

Page 57: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

I want to help a child in need I am unable to have children I heard an ad on the radio Love will be enough I know what they have been through My spouse or partner wants to adopt I thought a child would strengthen our marriage A relative’s child needs my help I want my children to have more siblings I want to adopt a young child I don’t want to deal with birth parents I didn’t expect to adopt (foster parents)

The Dynamics of the Complex Family SystemExpectations

Page 58: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

I expect …• my partner to support me• parenting to resolve past issues• my faith to remain strong• my extended family and friends to be

supportive• to be supported by professionals• to be supported by society at large

The Dynamics of the Complex Family SystemExpectations – Additional Layers

Page 59: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Typically-Developing Children

“I expect to have a playmate”

The Dynamics of the Complex Family SystemExpectations

Page 60: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The Adoptee

“I think you will abuse me.”

“I think I am moving somewhere else.”

“I think you are another orphanage.”

“I am unlovable.”

The Dynamics of the Complex Family SystemExpectations

Page 61: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The Dynamics of the Complex Family SystemExpectations

Expectations and reality collide

Page 62: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Cognitive Dissonance

is defined as inconsistencies between expectations and experiences. As humans, we do not like inconsistency.

the greater the inconsistency, the more motivation there is to reduce it.

(Festinger, 1957)

The Dynamics of the Complex Family SystemCognitive Dissonance

Page 63: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Perhaps the greatest source of cognitive dissonance is the invisible quality of mental health issues.

“Why can’t anyone see his problems?”

“Why are they always blaming us?”

The Dynamics of the Complex Family SystemCognitive Dissonance

Page 64: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Adjusting Expectations – Achieving Cognitive Consonance

In evaluating expectations and experiences, our goal is to draw conclusions. We must decide:

• which expectations need to change because they have no rational basis

• which expectations have created losses that need to be grieved

• which expectations need to change because they cannot be fulfilled

• which expectations are valid and can be fulfilled

The Dynamics of the Complex Family System

Page 65: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

“Nothing works!”“We’ve tried it all!”

The Dynamics of the Complex Family System

The Consumption and Depletion of Coping Skills

Page 66: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Ineffective Coping Styles - Parental

PunitiveAccommodating – “I give in”Making Extraordinary EffortsEmotionally Withdrawn “Yes, but…”Split

The Dynamics of the Complex Family System

Page 67: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Ineffective Coping Styles – Healthy Kids

WithdrawnSelf-SacrificingActing OutRegressed “I’ll Cover for You”Victim

The Dynamics of the Complex Family System

Page 68: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Ineffective Coping Styles – Repeating the PatternsTrauma Reenactment or Compulsive Repetition

Children who have experienced trauma alter the dynamics of the adoptive family in a manner that causes a repetition of their abandonment, abuse, neglect, deprivation or life with a drug addict. Their trauma is reenacted, albeit on a smaller scale, within the adoptive home.

(van der Kolk, 1989)

The Dynamics of the Complex Family System

Page 69: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The child who is compulsively repeating his traumatic experience needs the presence of strong attachment figures—adoptive parents

The Dynamics of the Complex Family System

Page 70: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

and Effective Coping Styles

Alter coping and attachment styles&

Provide New Parenting Tools

Page 71: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parenting Pearls…Control, Control, Control

What you want to controlWhat you need to controlWhat you can controlWhat you should not controlWhat you cannot control

Page 72: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

72

Pick and choose carefully

Avoid control battles

Win the ones you take on

Page 73: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parenting Pearls…Developmental Parenting

“Developmental interruptions result in delays that leave the individual developmentally immature”

Page 74: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Developmental Delays

Cause and Effect Thinking

Problem-Solving Skills

Moral Development

Social Skills

Page 75: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

75

Ineffective Parenting Tools

Rewards

Incentives

Removal of Privileges

Time Out

Grounding

IsolationKeck and Kupecky PARENTING THE HURT CHILD

Page 76: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

and Effective Coping Skills

• Natural and Logical Consequences• Paradox

• Joining In• Choices• Time In

• Praise – “Global” vs. “Specific”• Prescribing Symptom

• “Consistent” vs. “Unpredictable”

Page 77: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

No:ThreatsRemindersWarningsBribes

Ineffective Parenting Tools

Less Talk

More Action!

Page 78: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parenting Pearls…

Too much talk causes too little listening

Page 79: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

The Emotional Roller-CoasterThe Impact of Stress on the Adoptive Family

Child arrives with unresolved emotions

Child acts out behaviorally

Parents’ own unresolved issues are triggered.

Child and parent engage in negative emotional interactions.

A Negative Emotional Climate is Created

Page 80: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Triggers are identifiable situations or events that can create emotional upheaval.

The Emotional Roller-CoasterTriggers

Page 81: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

• Mother’s/Father’s Day • Birthdays • Holidays • The anniversary of the

adoption • Anniversary of removal

from birth family• Illness or death of

adoptive parent • Divorce • School-related projects

and classes

The Emotional Roller-CoasterTriggers

• Airplane rides • Visits with birth

siblings • Birth or adoption of a

child• Kindergarten or first

grade • Beginning and end of

each school year• Puberty• Questions/comments

from strangers

Page 82: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Facing Frustrations

Avoid Approaching Storms

Reduce Angry Reactions

Page 83: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Parenting, healing forming strong attachments, etc. are about reactions, not consequences.

The Emotional Roller-Coaster“Reactions” not “Consequences”

Page 84: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Isolation

• Support system shrinks• Marital tension• Time demands• Chaos• Behaviors (socially unacceptable)• Financial strain• Diminished family fun• Lack of services

Clip art

Page 85: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Sea of Grief

Grief—the emotional response to loss—is perhaps the most significant dynamic to develop within the adoptive family parenting a child with mental health issues.

When it comes to the experience of loss, the primary distinction between death and mental illness is that mental illness is not broadly and publicly recognized as a significant loss, when in fact, loss may be the primary trauma for family members during the course of mental illness (Johnson, 1994).

Page 86: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

A Sea of Grief

Although losses abound, there is one central loss. That is, the loss of the person that their adopted son, daughter, brother or sister could have been.

Additionally, in families with persons with serious mental health illness, there is no difference between parents and siblings in their level of grief (Miller, Dworkin, Ward, and Barone, 1990).

Grieving is a chronic—persistent and lasting—process.

Page 87: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Positives - Adoptees

More likely to complete high school or the equivalent

More likely to attend and complete college Less likely to become teen parents Less likely to abuse drugs and alcohol Less likely to have mental health problems Less likely to be arrested and incarcerated More likely to be employed More likely to have adequate incomes More likely to have health insurance

Page 88: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

ParentsTypically-

Developing Children

Positives

Page 89: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Books by the

Attachment and Bonding

Center of Ohio

Page 90: ABC of Ohio presents… Attachment-Focused Interventions: Cultivating Nurturing Environments to Facilitate Parent-Child Attachment

Gregory C. Keck, Ph.D.Attachment and Bonding Center of Ohio

12608 State RoadSuite 1

Cleveland, OH 44133440-230-1960

www.abcofohio.net