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.