Strategies for Understanding and Working with Trauma Survivors
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Attachment forms through attuned interactions between infants and their caregivers. Secure attachment provides children with safety and trust, forming the basis for future relationships, self-worth, resilience to stress, and emotional regulation. Trauma and neglect can disrupt attachment, affecting brain development and increasing risks for mental and physical health issues. Trauma-informed care aims to repair attachment injuries by focusing on safety, connections, and managing emotions through empathic, regulated interactions.
Strategies for Understanding and Working with Trauma Survivors
- 1. Presented by: Tami De Coteau, PhD Licensed Clinical Psychologist DeCoteau Trauma-Informed Care & Practice, PLLC www.decoteaupsychology.com
- 2. What is attachment? Interactive; Nonverbal communication Attachment is a system in the brain that that develops to ensure infant safety and survival The comfort, pleasure, and calm and balanced attuned interaction between the infant and caregiver creates a sense of safety within the infant Secure attachment refers to the mutually attuned bond of trust between the primary caretaker and the child Forms the basis for all future relationships; sense of self-worth; resilience to stress; ability to regulate own emotions; make sense of life; create meaningful connections with others
- 3. How does attachment form? Primary Intersubjectivity – Infant and parents discovery of each other Person-to-Person relationship Secondary Intersubjectivity – Infant’s discovery of the world (people, objects, and events) through experiencing the impact of the world on his parents Person-to-Person-to-Object Intersubjectivity – Awareness of shared perceptions and understandings that provide the foundation for social interaction
- 4. Intersubjectivity & Attunement Shared Emotion Infant feels receptive to and connected to his parent He co-regulates his affective state with his parent’s affective state He learns to regulate his own affective state
- 5. Intersubjectivity & Attunement Shared Attention & Shared Intention Infant begins to reflect on his inner life of thought, affect and intention Infant begins to reflect on the inner lives of his parents He is able to co-create the meaning of the people, objects, and events in his life Joint Attention Joint Intention
- 6. The Still Face Experiment https://youtu.be/apzXGEbZht0
- 7. How is attachment related to development? Interactions with others (positive and negative) stimulates regions of the brain responsible for attachment Communication patterns (verbal and nonverbal) influence the child’s mental process Safe and secure communication is necessary to establish secure attachment Establishes the basis on which the child will form relationships with others; his sense of security about exploring the world; his resilience to stress; his ability to balance his emotions, make sense of his life, and create meaningful interpersonal relationships in the future.
- 8. How does trauma and neglect affect the brain? If the attachment region of the brain is not properly stimulated at the critical period of development, then that region and all other regions below and above it are affected 2005 Bruce Perry
- 10. Brain Development Bottom Up – from primitive to most complex Brain development is sequential. More complex systems are dependent on development of less complex systems. For normal brain development to occur there must be specific patterns of activity at specific times during development = sensitive periods Experiences (positive or negative) during sensitive periods organizes brain systems. Therefore, trauma during early childhood can effect all future functional capabilities!
- 11. Activity Across Brain Regions Brain Region Functions Critical Period Experiences needed Functional Maturity Cortex Thinking, Planning, Reasoning, Creativity, & Sensory Integration 3 - 6 years Complex conversations, social interactions, exploration, safe, fed, secure Adult Limbic Emotion, Attachment Memory, & Sensory Integration 1 - 4 years Complex movement, social experience, narrative Puberty Diencephalon Sensory Motor & Sensory Processing : 6 months - 2 years Complex rhythmic movement, simple narrative, affection Childhood Brain Stem State Regulation & Sensory Processing In utero – 9 months Rhythmic, patterned input, engaged caregiving Infancy
- 12. Trauma Leads to Problems with Attachment Attachment is a system in the brain that that develops to ensure infant safety and survival The comfort, pleasure, and calm and balanced attuned interaction between the infant and caregiver creates a sense of safety within the infant Forms the basis for: all future relationships sense of self-worth resilience to stress ability to regulate own emotions make sense of life create meaningful connections with others
- 13. How does attachment affect neurological state and vice versa? Dysregulated Mother Dysregulated Infant Depressed Anxious Stressed Avoids direct eye contact Tunes out Frustration or anger Up & down/unpredictable emotions Cries Clench fist Rigid body or arches back Eyes shut Shuts down Acceleration of the nervous system Mixed withdrawn, clingy, fearful
- 14. Insecure Attachment Avoidant – Parent is unavailable or rejecting. Child adapts by avoiding closeness and emotional connection Ambivalent – Parents’ communication is inconsistent. The child cannot depend on the parent for attunement. He develops anxiety and feelings of insecurity Disorganized – Child’s needs are ignored and parents behavior is a source of terror and disorientation. Child feels overwhelmed, frightened, and traumatized and attachment becomes disorganized and chaotic. Problems with regulation of emotions, social communication, academic abilities, and severe emotional problems
- 15. How does trauma and neglect affect attachment? Insecure attachments arise from repeated experiences of failed emotional connection Abuse; neglect; trauma; prolonged separation; multiple caregivers; maternal depression and/or substance addiction; lack of harmony between child and parent; inexperience mother with poor parenting skills Insecure attachment is passed on from one generation to the next unless repair occurs
- 16. What is Reactive Attachment Disorder?Mental Health Disorder; Severe Insecure Attachment defiance; manipulative or controlling patterns; little or no conscience; frequent and intense anger outbursts; destructive to self, others, and property; gorging or hoarding food; and preoccupation with fire, blood, or violence The child cannot form positive, lasting relationships Often incorrectly diagnosed as several behavioral disturbance and ADHD DSM 5 “The prevalence of reactive attachment disorder is unknown, but the disorder is seen relatively rarely n clinical settings. The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children.”
- 17. Secure Vs. Insecure Attachment General Population
- 18. Secure Vs. Insecure Attachment Foster/Adopted Children Secure
- 19. The Indian Boarding School
- 20. How can attachment problems be repaired? Help the child & parent regulate their affect Create safety Focus on intersubjective experiences – shared emotion, shared attention, shared intention. Provide empathy and curiosity Respond to the child’s emotional needs Provide structure and supervision Restore harmony and order
- 21. Therapeutic Attachment Parenting by Daniel Hughes P – Playful A – Accepting C – Curious E -Empathic
- 22. Amygdala “Boss” of the limbic system “Alarm” in response to threat History of relationship trauma causes “alarm” to go off in future relationships In other words, the fear stimuli becomes close relationship/connection with others
- 23. Fight, Flight, or Freeze
- 25. The Adverse Childhood Experiences (ACE) Study ACEs are major risk factors for illness, death and poor quality of life, later in life Some of the worst health and social problems in the USA arise as a consequence of ACEsCDC.org
- 26. Problems of Trauma Survivors Impulsivity Hyperactivity Distractibility & Inattention Dysphoria Emotional Numbing Social Avoidance Dissociation Sleep Problems School/Work Failure Anger Eating Difficulties Relationship Difficulties Aggression/Violence Substance Abuse Rudeness Always expecting the worst Resistance to rules Unable to “go with the flow” Regressed or delayed development
- 27. Trauma-Informed Care Amygdala is overactive in traumatized children Goal of TIC is to de-activate the amygdala when it is over-firing When the amygdala is de-activated, compassion is activated TIC rebuilds the child’s brain!
- 28. Trauma & The Brain
- 29. 3 Pillars of Trauma-Informed Care S A F E T Y C O N N E C T I O N S M A N A G I N G E M O T I O N S
- 30. Trauma-Informed Care The greater the intensity, frequency, and duration of the child’s trauma, then the greater the intensity, frequency and duration of the intervention TIC must have breadth and depth Must include sensory, relational, therapeutic, etc. Strategies Some research shows that 1 month of intensive intervention is required for every year of life
- 31. Trauma-Informed Care Every misbehavior is an attempt to fulfill an unmet childhood need Must look to understand the meaning behind the behavior
- 32. The Meaning Behind The Behavior OBSERVABLE BEHAVIOR FEAR - Loss of Control - Brain Stem Fight Flight Freeze
- 33. Relationship trauma can only be healed by relational interventions In placement decisions the child’s developmental stage and their attachment needs must be taken into consideration. Attachments must be established and/or maintained prior to a transition to a new home. If children are moved without consideration for these, the child’s brain development will be negatively impacted and this will influence ALL other functional capacities.
- 34. Citations De Becker, G. The Gift of Fear. 1997. The Gift of Fear. Random House, New York, NY. Karen, R. 1998. Becoming Attached: First Relationships and How They Shape Our Capacity to Love. Oxford Press, New York, NY. Perry, B. 2009. Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14:240-255. Purvis, K. & Cross, D. 2007. The Connected Child. McGraw Hill. Trevarthen, Colwyn, & Kenneth J. Aitken. 2001. Infant Intersubjectivity: Research, Theory, and Clinical Applications. Journal of Child Psychology and Psychiatry 42, 3 – 48. Van Der Kolk, Bessel. 2014. The Body Keeps the Score. Random House, New York, NY.
Editor's Notes
- #3: Attachment is an interactive process involving non-verbal communication. It is an evolutionary fact that our brains are structured to connect to one another. Attachment is a system…. The comfort….. Secure attachment….. Attuned – make receptive or aware Mutually attuned – receptive or aware of one another Attachment forms the basis for all future relationships…..
- #4: Attachment forms through intersubjective experiences - Intersubjectivity – psychological relation between people; experiences between people (rather than individual experience) eye contact Primary Subjectivity refers to the face-to-face exchanges in a person-to-person relationship• facial expression • tone of voice • speech rhythm and rate • posture • gesture • body movement • timing, intensity and voice modulation Primary – begins at about 2 months. Secondary Intersubjectivity – which begins around 9 mos. Intentional communication with others about object – joint attention. Co-experience. These experienced develops in a child the understanding what the other person sees, knows, thinks, and feels – and provides her foundation for all other relationships!
- #5: Intersubjectivity has 3 important components. The first is Shared Emotion… When a baby cries what does an attuned parent do?
- #6: Intersubjectivity also involves shared attention and shared intention. Shared attention is focusing on the same thing. Shared intention is doing something together. Through these intersubjective experiences the infant begins to reflect on his inner thought; emotions and intentions, As well as those of his parents Through this experience he is able to apply meaning to his world.
- #8: Interactions with others stimulates…. Without those interactions the brain is not properly stimulated and cannot properly develop. Communication patterns…(actions and words) Safe and secure…. A securely attached child will have the ability to form he will feel safe in his world; he will be resilient to stress; he will be able to balance his emotions; he will be able to make sense of his life; and he will be able to establish and maintain healthy relationships with others Without such secure attachment the child will impaired in his ability to do any of these.
- #13: Attachment is an interactive process involving non-verbal communication. It is an evolutionary fact that our brains are structured to connect to one another. Attachment is a system…. The comfort….. Secure attachment….. Attuned – make receptive or aware Mutually attuned – receptive or aware of one another Attachment forms the basis for all future relationships…..
- #14: If either parent or child is unable to maintain a calm and balanced nervous state, the attachment bond will be compromised. Both infant and caretaker must feel calm and be focused for positive attachment to occur. When an infant is so dis-regulated that all they do is clench their fists, and scream with their eyes tightly closed or the mother is so depressed or caught up in her own needs that she misses her child's cues for engagement and comfort, opportunities for attachment will be missed. example – disorganized attachment in 6 month old infant. 1/3 attuned interaction is necessary for secure attachment to occur.
- #16: Insecure attachment arises from repeated experiences of failed emotional connection between the child and his caregiver. Insecure attachment is…. The assimilation policies of the federal government, particularly the one that involved sending young Indian children to boarding schools, continues to have a tremendous detrimental effect on Indian views and practices about parenting This history has led to a generational pattern of insecure attachment – the trauma perpetuates itself. We all learn to parent from our experience of being parented ourselves
- #20: Broke every connection the Indian had. Relationships, culture, language, God – as they knew him.
- #21: The first step in healing poor attachment is to bring about a calm and focused state in both parties. Attachment is akin to falling in love, but can't begin until both parties feel safe in their bodies and safe with one another. When adults are anxious, mad, tuned out or overwhelmed, they will not be able to make an attuned connection with a child. Focus on intersubjective experiences - The shared positive emotional experiences of joy are as important to the attachment bond as the shared negative emotional experiences of fear, sadness, anger and shame. A strong attachment bond includes the full range of shared emotional experience. In fact, it is usually more important to share a negative state with a child than to problem solve. Sharing enables children to learn to solve problems for themselves. Provide empathy and curiosity – examples….”This is really scary for you”; ”I notice that you don’t look me in the eye very often. I wondering if your having trouble trusting me.” Respond to the child’s emotional needs – rather than their behavior. Rather than – “your not doing your chores!” “I see that your having trouble doing your chores today. Something must be upsetting you.” Structure and supervision. – provides safety and security. Children need routines and limits. Children love repetition. Rupture and repair is a crucial part of secure attachment. No matter how much we love our children, there comes a point where we are not in agreement with them, a point when we have to set limits, and say "no." This is usually a point of conflict in the relationship. Conflict is normal but the rupture in the relationship must be repaired right away.
- #22: Developed by Daniel Hughes – PACE – unconditional love is expressed through playfulness, acceptance, curiosity, and empathy PACE parenting still provides appropriate boundaries and limits, together with warmth and nurture. The connection that PACE creates with our children however means that this parenting is received as fully unconditional. If children feel loved and trusted. They in turn can love and trust others.
- #25: 1967 U.S. psychologist Martin Seligman began foundational experiments Learned Helplessness (LH) is a mental state in which an organism, forced to bear painful stimuli, becomes unable or unwilling to escape LH theory explains why individuals may accept and remain passive in negative situations despite their clear ability to change them Group 1: dog is able to escape Group 2 : do is leashed but learns to push lever to stop shock Group 3: dog is LH leashed but lever does not work and therefore dog is not able to escape the shock. LH developed only when the dog perceived that it had no control over his environment.
- #26: The experience of trauma, whether it be recent personal trauma, or trauma from long ago, causes our bodies to secret large amounts of stress hormones. Over time, the stress hormones wreak havoc on our health and lead to chronic disease. Conducted by CDC and Kaiser Permanente One of the largest studies ever conducted to assess associations between childhood maltreatment and later-life health and well-being.
- #29: We all want to move beyond our trauma, but the part of the brain that ensures our survival, otherwise known as the downstairs brain, is not very good at denial. Long after trauma is over, the downstairs brain still reacts to the slightest hint of danger and secretes massive amounts of stress hormones. These stress hormones are responsible for the unpleasant emotions and intense physical sensations associated with trauma, such fear, panic, racing heart, sweating, paranoia, and feeling as though your outside your body looking in.
- #30: Connections are central – Safety comes from connection; Managing emotions comes from connection Therefore, Healing comes from connections.