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When Love Is Not EnoughVulnerable Families,
Intergenerational Patterns, Addiction & Attachment
Lauren Lindsey Porter, BA, [email protected]
Lyttelton, New ZealandATCA Conference, 18 September 09 Workshop, Canberra
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“Relationship-Diathesis” Model
Recovery from trauma depends on:Nature of trauma (who, when, intensity, etc)Quality of attachment relationships
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Narnia
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Attachment Styles
Secure Insecure-Avoidant Insecure - Resistant/Ambivalent Insecure - Disorganized (1990)Different fearsIn place by 12 months‘Cradle to grave’
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“Attachment is a difference that makes a difference”
Security leaves children happy and free to learn.
It fosters constructive peer relationships.
Security offers children a relationship-based solution to manage fear and distress.
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6
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-! from exploration to attachment needs and back again - children require the support of an emotionally available adult, someone who is:
-! “kind and always bigger, stronger and wiser than themselves. Wherever possible, this person follows the child’s need. Whenever necessary they take charge” (Marvin et al, 2002).
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Avoidant Attachment
DismissingAttachment strategy is to maintain distance and decrease the likelihood of increased emotionInability to tolerate emotion, which leads to rejectionPrice is loss of sensitive care when neededDisavows belief in a secure base/safe havenAvoids closeness, disengagedBowlby: ‘defensive exclusion’ and ‘compulsive self reliance’
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Ambivalent Attachment
PreoccupiedMonitoring, mind reading in an attempt to forestall any potential drifting awayHyperactivationBlurred boundaries, intrusive, enmeshedKnows the secure base is there but is driven nuts by its unpredictabilitySometimes role reversal - becoming indispensable, parentified
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Disorganized Attachment
UnresolvedParent scripting the child into past narrative/dramaInability to establish consistent attachment strategiesAs children age, strategies evolve into either punitive or caretaking
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Dimensions of Attachment
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Strongest Predictor
Parent’s state of mindBiographical input is related to developmental outputBiology is historyTransmission of invisible is potent
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Attunement
Reading and responding to cuesSynchronous and interactiveDyadicMaintains equilibriumCan be taught/learned
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Patch Adams
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Self Regulation
Babies are not born with the ability to self regulateBabies are reliant on a caregiver to interactively regulate internal statesPhysiological-homeostatic regulation forms the core of attachmentIt is the basis of early learning and forms the infrastructure of our identity, value and safety
‘There is no such thing as a baby; there is a baby and someone.’ Donald Winnicot, MD
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Patch Adams
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The Effects of Stress
Definition: Anything that interferes with homeostatis and attunement; creates dysregulationWith the brain, what doesn’t kill you makes you weaker
Positive touch activates brain’s reward chemicals
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Stress Response
Stress CycleHyperarousal: Major stress hormones, hypermetabolic state, short term coping, ‘fight or flight;’ infants can’t fight or flee so they rely on a caregiverDissociation: Helpless/hopeless, endogenous opiates, cortisol, become ‘unseen;’arousal hormones still presentThere is nothing good about dissociation - it is fundamental disconnection and loss - it is toxic
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Stress/Cortisol Research
Chronic stress associated with elevated cortisol levelsBrain impairment, immune suppression, aggression, intellectual deficits, early puberty, depression and other mental illnessSecurely attached babies have lower levelsSurges OKBoyce - ‘dandelions’ and ‘orchids’
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‘Normal’ Stressors - Bathtime
0
0.10
0.20
0.30
0.40
pre2540
Maternal Sensitivity
Albers, E. M., Riksen-Walraven, J. M., Sweep, F. C., & de Weerth, C. (2008). Journal of Child Psychology & Psychiatry, 49, 97-103.
Time Since Last Feed
Pre bath Post 25 Post 40
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Social Synapse
Stress hormones get transmitted across the social synapseHolocaust survivors, children and grandchildren
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Addiction and Attachment
Effects of substances on parents’ emotional availability, attunement and regulating abilities are profound
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Parenting
Via physiology and brain connection, parenting evokes in us everything we haven’t been aware of that is painful to us
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Genetics and Environment
Predisposition to addiction exists geneticallyExpression of the predisposition rests in the early relational lifeRisk vs. resilience
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Reactive Attachment Disorders
DisinhibitedDefinite lack of differentiationclear indication that would readily go off with a strangerdefinite lack of checking back with parent
Inhibitedindicates distress but does not come for comfort
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Old Model
Learned about prenatal impact of AOD use on fetus via
1960’s and Thalidamide1970’s and Fetal Alcohol Syndrome
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Medical Model
Addiction’s impact on children/family: physical aspectsNeurological impairmentSmaller babies/ growth retardationWithdrawalMore illnessIncreased SIDSCognitive delays
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Holistic Understanding
A developmental model with addiction as one risk factor / aspectIntersection with caregiving environment and other risk factors
Abuse/neglect historyPovertyParental traumaParental psychopathologyFamily violence
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Regulation via Illness
Substance abuse can be understood as an attempt to regulate negative emotions, anxiety and depressive feelingsDirectly related to attachment orientations and family’s ability to tolerate negative emotional states, closeness and separation
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Early Trauma
Fear of facesDecreased networks for facial recognitionConclusions therefore based on internal statesTypically biased with shame
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Face Recognition Research
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Taking Another’s Perspective(Theory of Mind)
False Belief Task
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Behavioral & Emotional Problems
Not problems of the child (Rutter, van Ijzendoorn)Are problems of growing up in neglecting/ maltreating family
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Affect Regulation & Early Trauma
Chronic stress leaves person vulnerableInability to use emotions as cues for action
RecognizeNameTolerateLearn from
Absence of internal emotional signalsOpiate receptor changesCauses dysphoria, confusion and eventual sensation seeking
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Regulation & Substances
Early trauma results in maladaptive self-regulatory abilitiesAttempts to alter affective state via extreme arousal such as drug use Affords self soothing, anesthesia from pain, restoration of affective control and, therefore, high likelihood of repetition‘A life of its own’
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Cycle of Panic
Unable to handle strong feelingsResults in fragmentation of selfDesperate search for soothingTo silence shame Avoid pain
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Plasticity
Change in the brain is possible because the brain is ‘plastic’Attention stimulates neural firing which creates synaptic changeNeurons that ‘fire together wire together’Change is easiest at the later developing levels
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Plasticity and GrowthNew nurturing relationships and the experience of psychotherapy are two ways to activate brain plasticityBrain growth is stimulated via face to face interaction, in part due to mirror neuronal networkBecause the first years and experiences establish the basic circuits and patterns of neuronal growth that subsume the brain’s important functions, they remain critical; early negative effects cannot always be repaired
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Resilience
Myth: resilience is not the effect of bouncing back after traumaPeople are inherently adaptive, not resilientResilience is learned Hallmarks include ongoing plasticity, maintenance of relationships, affect regulation, brain integration and flexibility
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Repair
Repair is the central concept in understanding imperfection and suboptimal interactionRepair is the foundation of empathy and mutual understandingRepair is necessary when communication has been misunderstood or poorly responded toRepair achieves reattunement
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‘Shark Music’ and ‘miscues’Saturday, 19 September 2009