MELISSA CALDWELL ENGLE, MS, LPC, ATR
THE ROSS INSTITUTE
Executive Clinical Director
1701 Gateway, Suite 349Richardson, Texas 75080
Private Practice: 214-498-5493
www.rossinst.com
UNRESOLVED ATTACHMENT ISSUES:IDENTIFICATION AND TREATMENT
TECHNIQUES
Melissa Caldwell Engle, MS, LPC, ATR
Texarkana, Texas
April 12, 2013
www.rossinst.com
Trauma is a developmental obstacle in normal human
development.
Helping people to overcome childhood trauma and/or single
event trauma in adulthood is an integrative process.
CORE CLINICAL ASSUMPTIONS
• 1. Un-integrated sense of self• Dissociation between mind and body• Black and white thinking• Inability to recognize and or tolerate affect• Inability to recognize and or tolerate ambivalence
• Treatment Focus- Integrative techniques focusing on: mind and body connection, education about feelings, affect management, containment and pacing, and desensitization.
SPECTRUM OF EMOTIONSStuckMind
Ungrounded-PastExtreme
FluidMind/Body
Grounded –PresentBalanced
StuckBody
Ungrounded-PastExtreme
Numb Anger RageNumb Cautious ParanoiaNumb Hurt Despair/HopelessNumb Vulnerable HelplessNumb Sad DepressionNumb Happy Mania
SPECTRUM OF EMOTIONSStuckMind
Ungrounded-PastExtreme
FluidMind/Body
Grounded –PresentBalanced
StuckBody
Ungrounded-PastExtreme
Numb Afraid/Fear Terror/PanicNumb Frustration OverwhelmedNumb Concern AnxietyNumb Conflicted ConfusedNumb Guilt ShameNumb Rejected Abandoned
CORE CLINICAL ASSUMPTIONS
• 2. “It’s all about avoidance”• Dysfunctional affect management/symptom• Push feelings into the body/behaviors• “What problem does this symptom solve?” – not
to feel.• Treatment Focus – Integrative techniques focusing
on: embracing clients ambivalence, balance between anger and grief, desensitization, challenging treatment objectives and integrative statements.
OBJECTIVE – TO FEEL MY FEELINGSAND STAY SAFE
• LOC/egocentric thinking• Suicidal Ideations• Homicidal Ideations• Self-Mutilation• Medication• Confusion• Memories/Content• Eating or Not
• Sex• Flashbacks
•cognitive•emotional
• Alter Egos• Staying in the past• VRP Triangle• Externalizing
WAYS TO AVOID FEELING
OBJECTIVE – TO FEEL MY FEELINGSAND STAY SAFE
• Fantasy• internalizing
• Dissociation• Humor• Intellectualizing• Somatization• Anxiety• OCD thinking & behaving
• Depersonalization• Numbness• Rage• Sadness/Depression• Isolation• Black & White thinking• Magical childlike thinking• Terminally Unique
WAYS TO AVOID FEELING
CORE CLINICAL ASSUMPTIONS• 3. Locus of control shift
• It’s function• Self blaming/sabotaging/cognitions and or behaviors• Damaged or destroyed inner self/lost innocence • Issues of autonomy/identification with the aggressor
• Treatment Focus – Integrative techniques focusing on: reversing the locus of control shift, reframing damaged or destroyed, accepting and feeling vulnerability, helplessness, powerlessness, and grief and separation and individuation.
LOCUS OF CONTROL SHIFT - ITS FUNTIONS
1. Age appropriate2. Maintains attachment3. Provides power and control4. Provides hope5. Explains “why?”6. Provides identity 7. Avoids feelings of helplessness, vulnerability,
and powerlessness
CORE CLINICAL ASSUMPTIONS
• 4. Ambivalent Attachment/Trust Issues• Grief work• Autonomy
• Treatment Focus – Integrative techniques focusing on: education about biology of attachment, locus of control shift, balance – anger vs grief, tolerate feelings of helplessness, vulnerability, powerlessness, and grief.
As people get in touch with their feelings, expect an increase in urgency to regress cognitively, emotionally, or behaviorally.
