Understanding Attachment and Adoption

1. ATTACHMENT AND ADOPTION Presented By Elsebeth Green, LCSW, RPT-S and Collette Dawson-Loveless, LCSW, RPT

2. Attachment The reciprocal dance between the caregiver and the child that develops over time and becomes a template for future relationships.

3. Arousal/Relaxation Cycle Dr. Vera Fahlberg, Separation and Attachment, 1979 Need s Arousal Need Met (By caregiver) Relaxation safety Secure Attachment &Trust belonging esteem PROXIMITY

5. Regulation of Nervous System Brain = Central Nervous System and entire body Particularly the nerve bundles surrounding the heart and gut Optimal brain activity = optimal bodily arousal Healthy, Calm Brain = Healthy Physiological Functioning

6. The Neurobiology of Attachment Attachment dynamics impact the following areas of brain development: Neurochemical activity Size/development of brain tissue Emotional Regulation Regulation of the nervous system Concepts about self/others/the world Memory

7. Positive Effects of Secure Attachment The development of language Ability to assume the view point of another The development of trust and positive world view The development of self-esteem Anxiety reduction and sense of security Love of physical touch and intimacy Learning through social interactions Ability to play and share mutual enjoyment Healthy, brief shame as vehicle for socialization Self-reliance and reliance on others Organized meaningful emotion Intersubjectivity

8. Primary Intersubjectivity The infant and parents exploration of and discovery of each other and self in relation to the other is two-fold: 1. Eyes, voice, gestures and touch of father and mother to the infant (Im special, interesting, lovable to my parent) 2. Eyes, voice, gestures and touch of infant to parent (Im a good parent) Trevarthen, 2001, Trevarthen & Aiken 2001

9. Secondary Intersubjectivity An infants discovery of the features of the world (people, objects and events) through the impact of the world on themselves and their parents: 1. meaning 2. template for relating to others and the world 3. person-to-person-to- object relationships are established

10. Mindsight

11. When things go wrong

12. ATTACHMENT CYCLE - Anxious - - A New Need Triggered: S AFETY , B ELONGING , E STEEM ESPECIALLY BELONGING Personal reactions: Intense Emotions, bodily sensations, implicit/explicit memories of abandonment Learned Behaviors follow : tends to be clingy, whiney, angry, push-pull, chatty, emotional, insistant, lying, stealing Attachment figure responds: frustration sets in as child continues to act in similar ways, never satisfied, seldom grateful, angry exhausted eyes Outcome: more dysregulation, escalating all reactions and behaviors (in your face) or storming off in hopes you will follow, parent happy to have break. Sees consequences as hate. Achieved: decreased sense of S AFETY , B ELONGING , E STEEM AS Parent feels they are failing and child fears getting sent away DISTRUST

13. ATTACHMENT CYCLE- Avoidant New Need Triggered: S AFETY , B ELONGING , E STEEM BUT USUALLY SAFETY OR ESTEEM Personal reactions: Emotions,(mostly just anger) bodily sensations (wants to run away), implicit memories (feels that nothing affected them and yet cant really remember much) Learned Behaviors follow: often pushes others away, goes away, shows bravado or narcissistic traits, controlling, sneaky behaviors, lying, stealing Attachment figure responds: punishing, demanding to know why, wanting to humble/control child, angry eyes, tightening structure and control Outcome: dysregulation increases as child shuts down or challenges parents right to tell them what to do. If child complies, a sense of hate permeates. Sees consequences as hate Achieved: decreased sense of S AFETY , B ELONGING , E STEEM as child plans to run, dig their heals in and refuse to feel or comply, and parent feels they are failing and really dont like this child. DISTRUST

14. ATTACHMENT CYCLE - Disorganized New Need Triggered: S AFETY , B ELONGING , E STEEM Personal reactions: Emotions, bodily sensations, implicit and explicit memories flood in and child melts down NO Learned Behaviors follow: Toolbox does not exist in any organized way. Often bizarre regressed behaviors including encopresis and hurting others Attachment figure responds: confused and awkward efforts to see and respond to the childs inner self in this animal like presentation. Outcome: complete dysregulation until it just stops on its own or help is called in. Child has no abiltiy to discuss or process; no concept of consequences. Parent feels like a failure or the child is beyond repair Achieved: decreased sense of S AFETY , B ELONGING , E STEEM as child sees self as bad, crazy, disappointing and parent is bewildered and repulsed DISTRUST

15. STYLES OF ATTACHMENT SECURE SENSE OF SAFETY, BELONGING AND ESTEEM 55% ANXIOUS - FEAR OF REJECTION 15% AVOIDANT FEAR OF BEING TRAPPED 20% DISORGANIZED DEEPLY WOUNDED WITH NO DISCERNABLE PATTERN OF RELATING 5%

16. DSMV Diagnosis we commonly use: 309.81 -Post-traumatic Stress Disorder recurrent, involuntary, and intrusive distressing memories of exposure to actual or threatened death, serious injury, or sexual violence. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 995.54 Child Abuse Confirmed 995.53 Child Sexual Abuse - Confirmed 995.52 Child Neglect Confirmed 995.51 Child Psychological Abuse, Confirmed V61.20 Parent-child relational problem 313.89 Reactive Attachment Disorder -Consistent pattern of withdrawn behavior, not seeking, not accepting comfort; minimal social engagement 313.89 Disinhibited Social Engagement Disorder - overly familiar verbal and physical behavior with unfamiliar adult with diminished or absent checking back with main caregiver

17. Traits of Severely Attachment Disordered Children Angry and controlling Mean and hurtful Affectionate/charming when it suits them Lie and steal Create conflict between others to divide them See others as objects to be manipulated Play with behavior plans to get what they want People seem to mean nothing to them except as vehicles to get needs met; servants; do not miss them or feel love Hurt animals and younger children Put up huge resistance to limit setting or consequences Self soothe in various inappropriate ways

18. Discovering your own style . . . What is your own attachment style PAST Background Relationships Separation Discipline Fear/Threat Loss Emotional Communication Safe Harbor (Secure Base) Launching Pad (Safe Haven) PRESENT FUTURE

19. ESTABLISHING PACE Daniel Hughes P layfulness A cceptance C uriosity E mpathy

20. Principals of Treatment 1. Eye contact, voice tone, touch, movement and gestures are only to communicate safety, acceptance, curiosity, playfulness and empathy and are only reciprocal never coerced. 2. Opportunities for enjoyment and laughter, play and fun, are provided daily and unconditionally. 3. Decisions are made for the purpose of providing success not failures. 4. Successes become the basis for the development of age-appropriate skills.

21. 5. The childs symptoms or problems are accepted and contained. The child is shown how these simply reflect his history. They are often associated with shame which must be reduced by the adults response to the behavior. 6. The childs resistance to parenting and treatment interventions is responded to with acceptance, curiosity and empathy. 7. Skills are developed in a patient manner, accepting and celebrating baby-steps as well as developmental plateaus. 8. The adults emotional self-regulation abilities must serve as a model for the child. 9. The child needs to be able to make sense of his/her history and current functioning. The understood reasons are not excuses, but rather they are realities necessary to understand the developing self and current struggles. 10. The adults must constantly strive to have empathy for the child and to never forget that, given his/her history, s/he is doing the best s/he can.

22. 11. The childs avoidance and controlling behaviors are survival skills developed under conditions of overwhelming trauma. They will decrease as a sense of safety increases, and while they may need to be addressed, this is not done with anger, withdrawal of love, or shame.

23. Experience with States Feel Better with Just one Word YouTube

24. Resource List Building the Bonds of Attachment, Daniel Hughes Brainstorm: The Power and Purpose of the Teenage Brain, Daniel J. Siegel The Whole-Brain Child, Daniel J. Siegel Love Sense: The Revolutionary New Science of Romantic Relationships, Sue Johnson Brain-Based Parenting, Daniel Hughes and Jonathan Baylin Parenting the Hurt Child, Keck and Kupecky The Neurobiology of We, Daniel J. Siegel Mindsight, Daniel J. Siegel Removed, http://vimeo.com/73172036 Feel Better with Just One Word, https://www.youtube.com/watch?v=0E82oV_BeLo