what do you mean i have to work with parents?
TRANSCRIPT
“WHAT DO YOU MEAN I HAVE TO WORK WITH
PARENTS?”
WHAT THEY DID NOT TEACH YOU IN GRADUATE SCHOOL:
AIDING PARENTS IN LIVING WITH THEIR TRAUMATIZED CHILD
PRESENTED BY:
LORI MYERS LCSW, RPT
BRIANNA GRANT LCSW, RPT
NOVEMBER 24, 2014
OBJECTIVES FOR THE PRESENTATION
• PARTICIPANTS WILL INCREASE THEIR
KNOWLEDGE AND UNDERSTANDING OF THE
RATIONALE IN INCLUDING CAREGIVERS IN THE
THERAPEUTIC PROCESS
• PARTICIPANTS WILL IDENTIFY HOW TRAUMA AND
ATTACHMENT AFFECT BRAIN DEVELOPMENT
AND HOW TO IMPART THIS KNOWLEDGE TO
CAREGIVERS
• PARTICIPANTS WILL GAIN KNOWLEDGE OF WAYS
TO ENGAGE AND JOIN WITH DIFFICULT
CAREGIVERS
WORK WITH CAREGIVERS
WHY?
•HOW CAREGIVERS TALK TO AND BEHAVE TOWARD
CHILDREN CAN GREATLY INFLUENCE DEVELOPING
BELIEFS ABOUT SELF, OTHERS AND THE WORLD
•PARENTS’ FEELINGS AND THOUGHTS ABOUT THE
TRAUMA IMPACT THEIR CHILDREN’S BEHAVIORS AND
DEVELOPING BELIEFS
•PROVIDE PARENTS WITH A FORUM TO SHARE THEIR
FEELINGS AND THOUGHTS RELATED TO THE TRAUMA
(EVEN THE SOCIALLY UNDESIRABLE THOUGHTS)
IMPORTANCE OF STRONG THERAPEUTIC SKILLS
THE THERAPEUTIC RELATIONSHIP IS CENTRAL
TO ESTABLISH COLLABORATION WITH CLIENTS
NEED FOR THERAPIST JUDGMENT, SKILL, HUMOR AND CREATIVITY TO
IMPLEMENT THERAPY EFFECTIVELY
NEED A GOOD KNOWLEDGE OF DEVELOPMENT TO IMPLEMENT
TREATMENT EXERCISES THAT ARE DEVELOPMENTALLY APPROPRIATE
KNOWLEDGE OF FAMILY SYSTEMS, PARENTING STRATEGIES AND
ATTACHMENT
WHY CAN PARENTS BE RELUCTANT TO JOIN THE PROCESS?
PARENTS CAN OFTEN ENTER THE THERAPY PROCESS WITH A
FEAR …..
• THAT THE THERAPIST WILL TELL THEM THEY ARE DOING EVERYTHING WRONG
• THAT THE THERAPIST WILL TELL THEM THEIR CHILD IS “MESSED UP” OR A BAD KID
• THAT THE THERAPIST WILL BLAME THEM AND THEY WILL FEEL LIKE THEY ARE A BAD
PARENT
• THAT THE THERAPIST WILL JUDGE THEM FOR EVERYTHING THEY HAVE DONE OR
HAVEN’T DONE AS PERSON OR A PARENT
• THAT THE THERAPIST WILL GIVE THEM MORE THINGS TO DO OR TRY WITH THEIR
CHILD AND THEY ARE EXHAUSTED
• THAT THEY WILL HEAR MORE NEGATIVE COMMENTS ABOUT THEIR CHILD OR THEIR
PARENTING
DISTORTED THINKING
• OVER-THINKING
• BLACK AND WHITE
• MINDREADING
• IF, THEN
• COMPARISON
• CONTROL
• I AM, THEREFORE MY CHILD
• MINIMIZING
• EXPERIENCE
WHAT IS TRAUMA?
“OVERWHELMING, UNCONTROLLABLE EXPERIENCES THAT PSYCHOLOGICALLY IMPACT
VICTIMS BY CREATING IN THEM FEELINGS OF HELPLESSNESS, VULNERABILITY, LOSS OF
SAFETY AND LOSS OF CONTROL”
BEVERLY JAMESTREATING TRAUMATIZED CHILDREN:
NEW INSIGHTS AND CREATIVE INTERVENTIONS
“TRAUMA BY DEFINITION INVOLVES
SPEECHLESS TERROR: PATIENTS
OFTEN ARE SIMPLY UNABLE TO PUT
WHAT THEY FEEL INTO WORDS AND
ARE LEFT WITH INTENSE EMOTIONS
SIMPLY WITHOUT BEING ABLE TO
ARTICULATE WHAT’S GOING ON.”
VAN DER KOLK 2002
THE ATTACHMENT BOND
• BABIES COME OUT OF THE WOMB WIRED FOR
RELATIONSHIP. WHEN BABIES ARE BORN THEN CAN
FOCUS ABOUT 8-10 INCHES AWAY.
• HUMAN INFANTS ARE BIOLOGICALLY DESIGNED FOR
THIS PHYSICAL CLOSENESS.
• THIS SETS THE STAGE FOR ATTACHMENT
• BABIES WHOSE NEEDS ARE MET BELIEVE THEIR
WORLD IS A SAFE PLACE AND TRUST THE
CAREGIVER TO PROVIDE SAFETY.
THE ATTACHMENT BOND
• CHILDREN WHOSE NEEDS WERE NOT MET
LEARNED THE WORLD IS UNSAFE AND
CAREGIVERS WILL NOT MEET THEIR NEEDS.
THESE CHILDREN STOP ASKING FOR HELP OR
BELIEVING THAT THEY NEED HELP.
• THESE CHILDREN BELIEVE: I MUST CONTROL
EVERYTHING AT ALL COSTS BECAUSE I CAN’T
TRUST ANYONE ELSE TO KEEP ME SAFE AND
MEET MY NEEDS.
CORE ELEMENTS OF POSITIVE BRAIN DEVELOPMENT
• RELEVANT (DEVELOPMENTALLY MATCHED)
• REPETITIVE (PATTERNED)
• REWARDING (PLEASURABLE)
• RELATIONAL (SAFE)
• RHYTHMIC (RESONANT WITH NEURAL PATTERNS)
• RESPECTFUL (CHILD, FAMILY, CULTURAL)
AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC NERVOUS SYSTEM:
THE GAS
PARASYMPATHETIC NERVOUS SYSTEM:
THE BRAKES
WINDOWS OF TOLERANCE
FIGHT/ FLIGHT/ FREEZE
AMYGDALA TRIGGERS
• CHILDREN WHO HAVE BEEN HURT OR NEGLECTED
HAVE AN ALARM THAT GOES OFF IN THEIR BRAIN
WHENEVER THEY GET STRESSED
• MOST CHILDREN LEARN TO SELF SOOTHE BY BEING
SOOTHED BY A CAREGIVER.
• CHILDREN WHO HAVE BEEN HURT HAVE IMPAIRED
ABILITIES TO SELF REGULATE.
• THEY MAY REACT STRONGLY TO EVERYDAY THINGS
THAT WOULD NOT BOTHER OTHER CHILDREN
AMYGDALA TRIGGERS
• PHYSICALLY ABUSED CHILDREN SEE ANGER
WHERE OTHERS SEE FEAR.
• WHEN CHILDREN ARE EXPERIENCING AN
AMYGDALA ALARM THEY CANNOT THINK
CLEARLY.
• REASONING WITH THEM CAN MAKE THINGS
WORSE.
CALMING THE AMYGDALA WITH PARENTING SKILLS
“IT MEANS RETHINKING WHAT DISCIPLINE REALLY
MEANS, RECLAIMING IT AS A TERM THAT’S NOT ABOUT
PUNISHMENT OR CONTROL, BUT ABOUT TEACHING
SKILL BUILDING – AND DOING SO FROM A PLACE OF
LOVE, RESPECT AND EMOTIONAL CONNECTION.” ~ NO
DRAMA DISCIPLINE
NO DRAMA DISCIPLINE: CONNECT TO REDIRECT
CIRCLE OF SECURITY: CUE/MISCUE
THERAPLAY: ATTUNEMENT
SELF REGULATION IN THE MOMENT
• HAVE THE CAREGIVER NOTICE THEIR
TRIGGERS
• VALIDATE THEIR EXPERIENCE
• AID CAREGIVER IN SELF ASSESSING
• AID CAREGIVER IN TUNING INTO THEIR
PAST EXPERIENCE
• ENCOURAGE SELF CARE AND SUPPORT
AID FAMILIAL SYSTEM TO CREATE SAFETY
• WHEN CHILDREN DO NOT FEEL SAFE THEIR ENERGY
CANNOT GO ANYWHERE
• CHILDREN MAY DEVELOP THE BELIEF THAT THE WORLD IS
A DANGEROUS PLACE AND EXIST IN “SURVIVAL” MODE
• CHILDREN CANNOT MOVE OUT OF “SURVIVAL” MODE
UNLESS THEIR ENVIRONMENT PROVIDES “FELT” SAFETY
• “FELT” SAFETY AIDS CHILDREN IN MOVING FROM LIMBIC
(REACTIONARY) SYSTEM TO THE PREFRONTAL CORTEX
(THE ABILITY TO RESPOND)
THE NEED FOR ATTUNEMENT
• WHAT IS ATTUNEMENT?
• WHY IS IT IMPORTANT?
• HOW DO YOU DO IT?
• CUE/MISCUE
18
ATTUNEMENT SKILLS
1.BE ATTUNED: NOTICE THE FEELINGS/ENERGY. TRY TO
PICK UP CHILD CUES EARLIER AND EARLIER
2.KEEP YOURSELF CENTERED: STAY IN CONTROL OF YOU.
STAY PRESENT AND IN THE MOMENT.
3.ASK YOURSELF: WHERE IS THIS CHILD’S ENERGY AND
LEVEL? WHAT DOES THIS CHILD NEED TO DO TO RELEASE
THIS ENERGY?
4.REFLECT WHAT YOU ARE SEEING: “I SEE THAT YOU ARE
FRUSTRATED. YOU WANT THE TOWER TO NOT FALL
OVER.” – ACKNOWLEDGING THE CHILD’S FEELINGS AND
WANTS
5.CUE OR SUPPORT CHILD IN SKILLS: REINFORCE SKILLS
AND WHERE CHILD HAS CONTROL
6.HELP CHILD REESTABLISH FEELINGS OF CONTROL: THIS
IS THE TIME FOR CHOICES AND THE ADULT MAINTAINING
TERMINOLOGY
• ATTACHMENT STRATEGIES
• SECURE
• AMBIVALENT
• AVOIDANT
• DISORGANIZED
• CUE/ MISCUE
• RUPTURE AND REPAIR
• EMOTIONAL REGULATION
• EMPATHY
• INTERNAL WORKING MODEL
• LEARNED HELPLESSNESS
PARENTING SKILLS
• CAREGIVER IS THE MAIN AGENT FOR CHANGE
• CAREGIVER IS THE CHILD’S CO REGULATOR
• IMPERATIVE CAREGIVER IS INCLUDED IN TREATMENT
IF POSSIBLE
• POSITIVE PARENTING SKILLS, ENHANCE ENJOYABLE
PARENT CHILD INTERACTIONS
• TO CHANGE AN INTERACTIONAL/ REACTIONARY
PATTERN IT TAKES 38 REPETITIONS PER WEEK FOR 1
YEAR … HOW CAN WE DO THIS WITHOUT A
CAREGIVER?
PARENTING STYLES
• AUTHORITARIAN
• AUTHORITATIVE
• CIRCLE OF SECURITY: “BIGGER STRONGER WISER AND KIND”
PARENTING
• PERMISSIVE
“OTHER” PARENTING STYLES
• BOOT-STRAP PARENT
• DISCONNECTED PARENT
• OVER-ACHIEVING PARENT
• AGREEABLE PARENT
• AVOIDING PARENT
JOINING WITH DIFFICULT CAREGIVERS
ACCEPT AND RESPECT ALL FEELINGS
SHOW THE CAREGIVER YOU ARE LISTENING
MANAGE YOUR AFFECT AND MIRROR NEURONS
REFLECT BACK WHAT YOUR HEAR
NAME THE FEELINGS
NORMALIZE THE FEELINGS
DEPERSONALIZE THE CHILD’S AND CAREGIVERS BEHAVIOR
DISCUSS WHAT CAN BE DONE TO AID CHILD AND FAMILY
THERAPEUTIC SKILLS AND ENGAGING WITH PARENTS
BUILDING CONNECTION WITH PARENTS IS VITAL TO TEACHING SKILLS
HOW DO WE DO THAT? WHERE DO WE START?
• PARENTS COME WITH THEIR OWN ISSUES, PAST EXPERIENCES AND THIS WILL SHOW UP IN THEIR PARENTING
• GET THE KNOW THE PARENT AND COMPLETE A THOROUGH HISTORY• HOW WAS THE PARENT PARENTED?• WHAT DOES THE PARENT WANT TO GAIN FROM THE EXPERIENCE, CHILD
IN TREATMENT?• APPROACH THE PARENT AS A CHILD WHOSE NEEDS MAY NOT HAVE BEEN
MET.
CONCEPTUALIZE PARENTS – WHERE ARE THEY COMING FROM IN THE
EXPERIENCE WITH THEIR CHILD?
• CRUCIAL C’S: COURAGE, CAPABLE, CONNECTION, COUNT• HOW CAN WE VALIDATE AND ENCOURAGE PARENTS?
• MODELING THE SAME SKILLS WE USE WITH ENGAGING CHILDREN AND THEN TEACHING THOSE SKILLS TO THE PARENT (IE: REFLECTION OF FEELINGS, ENCOURAGEMENT, LIMIT SETTING)
REDIRECTNO DRAMA DISCIPLINE
REDUCE WORDS
EMBRACE EMOTIONS
DESCRIBE DON’T PREACH
INVOLVE YOUR CHILD IN THE DISCIPLINE
REFRAME NO INTO A CONDITIONAL YES
EMPHASIZE THE POSITIVE
CREATIVELY APPROACH THE SITUATION
TEACH MINDSIGHT TOOLS
CONTACT INFORMATION:
LORI MYERS, LCSW, RPTPHONE: 615-327-9958 EXT. 2033
EMAIL: [email protected]
WEBSITE: WWW.NASHVILLECA.ORG
BRIANNA GRANT, LCSW, RPT
PHONE: 615-463-9804 EXT. 5
EMAIL: [email protected]
WEBSITE: WWW.BRIANNAGRANT.COM
SEE ATTACHED DOCUMENT FOR BIBLIOGRAPHY AND RESOURCE LIST