dr katy brett senior clinical lecturer consultant ... · dr katy brett. senior clinical lecturer....
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Dr Katy BrettSenior Clinical LecturerConsultant Psychiatrist
Mothers & Babies ServiceSouth Island Perinatal Mental Health Service
Early trauma affects the brain and the body
Trauma underlies many difficulties in adulthood
What having a baby can bring
Experience of the baby
An event is traumatic if it is:
Extremely upsetting
Overwhelms the individuals internal resources
Produces long lasting psychological symptoms
RepeatedCumulativeUsually within specific relationships
• E.g. Attachment, intimate, familiesOften entrapment & conditioning
Prototype is child abuse
‘Re-victimisation’
Intrusive SymptomsThoughts, flashbacks, nightmares
Avoidance
Negative alterations in cognition and mood
Hyperarousal Symptoms
+/- Dissociative symptoms
PTSD
Affect Dysregulation
Negative Self Concept
Interpersonal Disturbances
Dissociative symptoms
Fear of Abandonment*
Affective instabilityIntense/ Inappropriate angerSuicidal behaviour Impulsivity*
Identity DisturbanceChronic emptinessUnstable sense of self*
Interpersonal relationship -unstable & intense*
Felitti & Ananda 1990s
17000 middle class Americans
10 questions• Physical & Sexual abuse• Physical & Emotional neglect• Family dysfunction SA, FV, prison Mental illness Divorce/ separation
Liver Disease
Brain Stem- Reptilian BrainMid Brain – Mammalian BrainNeocortex – Primate Brain
Brain Stem- Reptilian BrainMid Brain – Mammalian BrainNeocortex – Primate Brain
“The essential task of the first year of life is the co-creation of secure attachment bond of emotional communication between the infant and primary caregiver’’ Allan Schore
Fragility of sense of self as a new mother
You will see me as a bad mother
Creating an alliance with the threat of attack
Relentless Demanding Intimacy Arouses attachment
system Regulation
• self & others Attunement Mentalising Being present Working with
professionals
For a mum with trauma: Fear
• Attachment system• My baby doesn't love
me• I might hurt my baby• Repeating/ re-enacting
Dysregulation Mistrust Envy
Overwhelmed Hopeless Dissociate Unpredictable
• Frightened/ frightening
Focus on own needs Emotional unavailable Fail to focus on baby’s
emotional states Fail to address/
modulate affects
Hypervigilance
Dysregulation
Dissociation
Looking away/
freezing/ not
responding
Approach-avoidance
conflict
I want to be a good mother I love my baby I will be different from my mother I will protect her, as I was not protected.
How do I do this when I hate myself I feel sorry for her that she has me as a mother I don’t trust others to care for me Closeness has been dangerous for me
Observation skills Reflective dialogue Inferential skills
Reflective capacity
Positive intentionality Secure Attachment
Model what to do with the infant Ask questions to clarify Reframe baby’s intentions
Wonder aloud about what is going on for the baby
Attend to the baby’s state Imitate the baby to highlight their cues Label feelings of mother and baby Link mental states with behaviour Speak for the baby
A mother can experience herself as meaningful in the eyes of the therapist; the experience of being held in mind as a coherent, intentional person who is trying to do her best allows a mother to start experiencing herself and her baby in the same way.
LS Sadler et al 2006