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KEYNOTE HANDOUTS- Dr Margot Sunderland

SETTLING TO LEARN: SUPPORTING PUPILS WHO HAVE SUFFERED RELATIONAL TRAUMA

WHY DO WE NEED TO HELP CHILDREN SUFFERING FROM RELATIONAL TRAUMA? DOESN’T TIME HEAL?

Need to understand trauma to be a better teachers

We have to start not with changing the children but with changing ourselves

All challenging behavior is understandable if looked at in the context of what has happened to the child

Chris Blodgett Director of the Child and Family Research Unit Trauma Center at Washington State University Why should we help traumatised children: won’t they just get over it? After all surely time heals? Without intervention trauma doesn’t heal: It can cause cell death in key parts of the brain to do with social and emotional health, debilitating physical and mental ill- health and early death About trauma Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.” (Levine and Kline 2007:3) “Trauma is anything that has a long lasting effect on the psyche or self” (Shapiro 2005) PTSD is the re-living of a past event (De Zulueta 2003). The trauma keeps them rigidly fixated on the past, making them fight the last battle over and over again (Van der Kolk 1996: 17) With trauma we “Shrink from the world or do battle with it” (John Bowlby) The traumatic past won’t go into the past until it is remembered in the present “No one totally escapes the long reach of trauma’s shadow to some degree, at some time or another, during their lifespan.” (Levine and Kline 2007:3) Research shows that witnessing violence towards a sibling was far worse than witnessing violence towards mother or father. It caused depression, anxiety, physical illness, problems with anger, impulsivity and emotional numbing in ways that makes learning and functioning well very difficult indeed Research: Teacher and Vitaliano 2011 TRAUMA NEGATIVELY IMPACTS MENTAL, PHYSICAL HEALTH AND LONGEVITY THE ACE STUDIES (Adverse childhood experiences) (Over 17,000 people) (Felitti et al 2003) Abuse/neglect, domestic violence/parental separation or divorce/parental mental illness/ parent in prison/emotional abuse leading to:

Academic failure

Addictions to drugs/alcohol

Illness

Smoking

Depression

Troubled relationships

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Teenage pregnancy

Attempted suicides

Early death Population attributable risk associated with early adversity: •50% for drug abuse •54% for current depression •65% for alcoholism •67% for suicide attempts • 78% for IV drug use Dube, S.R., Felitti, V.J., Dong, M., Chapman, D.P., Giles, W.H., and Anda, R.F. (2003) Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 111, 564-572 Trauma and shock get into the child’s body, brain, mind, learning, behaviour and relationships dramatically blighting quality of life TRAUMA NEGATIVELY IMPACTS THE BRAIN Prolonged stress in childhood can result in cell death in key social and emotional intelligence centres in the brain (Martin Teicher 2002 Harvard) Stress and the aging hippocampus. McEwen BS, H and M Milliken Neuroendocrinol. 1999 Jan; 20(1): 49-70. Human higher functions in the frontal lobes (executive functions) developmental delay here Empathic Co-operative, Socially skilled, creative, warm, kind Reflective, stable under stress. Creative problem solving The genetically ingrained emotional systems in the limbic system RAGE, FEAR, DISTRESS PLAY, SEEKING, CARE (attachment) (Jack Panksepp Affective Neuroscience 1998) CALM OR ALARM? They are like muscles… the more we activate the pro-social or primitive alarm systems, the more they become personality traits. Trauma attacks actual brain structures Brain structure abnormalities in early-onset and adolescent-onset conduct disorder. Am J Psychiatry. 2011 Jun; 168(6): 624-33 Faircd G, Passamonti L, Hurford G, Hagan CC, von dem Hagen EA, van Goozen SH, Goodyer IM, Calder AJ. Hurtful words attack brain structures too Hurtful words: association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities.Teicher MH, Samson JA, Sheu YS, Polcari A, McGreenery CE.SourceMcLean Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Am J Psychiatry. 2010 Dec;167(12):1464-71. Epub 2010 Jul When children and young people suffer from relational trauma, it can result in:

Underdeveloped brain systems badly affecting capacity for attention, learning, concentration, creativity, empathy, kindness.

Smaller brains: less sophisticated neuronal networks

Alarm systems in the brain have a field day

Immune system is compromised OVER- ACTIVE ALARM SYSTEMS IN THE BRAIN People who’ve suffered child abuse have 50 percent higher chance of getting cancer mid- life than someone who wasn’t abused (Childhood abuse -has been associated with abnormal patterns of cortisol production in response to stress in adulthood, (- Hyperactivation of the HPA axis suppresses natural killer (NK)-cell activity and

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suppresses production of key cytokines, which protect against the development of tumors. Even though the abuse long since over, the adults are still showing too high levels of cortisol Making a link between childhood physical abuse and cancer Esme Fuller-Thomson Sarah Brennenstuhl MSW

2Cancer. 2009 Jul 15;115(14)

Stress, depression, the immune system, and cancer. Reiche EM, Nunes SO, Morimoto HK. Lancet Oncol. 2004; 5: 617-625. Trauma triggers hyper arousal in the brain stem - leading to all manner of dysregulated brain and body systems Stressed out children functioning like threatened animals - unable to learn, attend, concentrate, enjoy friendships, play, problem solve. ( Scan - Damasio 2001 in Restak The Secret Life of the Brain) Emergency reactions or assessed reactions to stress Discharge or defence The amygdala and other stress response systems in the brain - The more we keep activating (often unwittingly) the alarm systems in the child’s brain, the more the child is likely to grow up angry, anxious and/ or depressed Minor stressors can elicit full- blown emergency reactions When a child feels threatened and unsafe, their thinking is narrowed down to matters of defence or attack BAD STRESS NEGATIVELY IMPACTING ON LEARNING, BEHAVIOUR, RELATIONSHIPS AT SCHOOL Stress chemicals in the brain and body Adrenaline, Cortisol, Corticotrophin Releasing factor (CRF) When cortisol and CRF injected into animals depression, anxiety, increases in heart rate, disrupted digestion, decreased appetite, disruption of sleep, suppression of exploratory activity startle responses, freezing and fighting behavior Leaving children in high levels of stress for a duration, can programme the brain’s alarm systems as hypersensitive (HPA axis) In trauma thinking is hijacked by emotion. The frontal lobes aren’t able to calm the reptilian response “Unfortunately, in the traumatised person, the cortex is unable to allay the fear response. [ This means] we cannot reason away the fear and are left either to act it out on others with extreme emotion, suffer silently from overwhelming feelings [e.g PTSD, phobias, obsessions, ruminations] , or blank out from the distressing fear-response signals.” ( Levine/Kline 2007:11) Redirection of blood flow away from frontal lobes, digestive, immune systems and into the large motor muscles of flight of fight TRAUMA NEGATIVELY IMPACTS THE BODY Hyper-arousal A state of alarm that you can’t switch off inside your body and your mind OR Hyper-inhibition

Shut down the capacity to feel

Bottling up feelings from the age of one

Weak firings in the amygdala (alarm system)

Low bodily arousal

Low level of cortisol Freeze (dissociation) We are biologically programmed to freeze (or go limp) when flight or fright is either impossible or perceived to be impossible. Then the body can no longer bear the overwhelming feelings, it collapses

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into fearful resignation (Learned helplessness) – which is what any animal does in a situation where active escape from threat is impossible. ( Levine and Kline 2007: 9) TRAUMA CAN DAMAGE RELATIONSHIPS AND HURT THE PEOPLE AROUND THE TRAUMATISED CHILD (re-victimisation)

If they don’t talk about their traumatic experiences they will simply repeat them (as victim or persecutor)

This is why children being cruel is so often trauma based

A thing which has not been understood inevitably reappears; like an unlaid ghost it cannot rest until the mystery has been solved and the spell is broken (Freud 1909)

Re-living of the past as victim or perpetrator but some children/teenagers swing from one to the other

The trauma keeps them rigidly fixated on the past, making them fight the last battle over and over again (Van der Kolk 1996)

Omnipotence defence- particularly teenagers

All that is small /vulnerable/helpless is not who I am I am immortal – even if knifed I would survive

Projection and negative transference

I pass on to you the dehumanisation I have known

IN SCHOOLS, WHAT ARE WE TRYING TO CHANGE THE LIVES OF TRAUMATISED CHILDREN?

To enable children/teenagers to feel very safe emotionally and physically in our schools so they can thrive academically, socially and emotionally

To bring down the child’s stress hormones from toxic levels, to enable learning

To repair brain damage caused by the trauma, through playful, empathic and reflective adult- child relationships

To help the child to form a coherent narrative about what has happened to them to alleviate negative self- referencing, allowing them to build robust self- esteem

To help the child see themselves, relationships and the world differently, no longer perceived through the lens of threat and danger

Through empathy, containment, soothing, attunement, and by thinking psychologically with the child, to establish stress regulatory patterns in the child’s brain and body (good vagal tone)

To enable the child to move from behaving their trauma to reflecting on their trauma

To provide repeated positive relational experiences in schools which enable children to have the felt knowledge of relationship as nurturing not as threatening

To help the child to move from a fixed position of mistrust to trust, and from self- help to help- seeking

To change the child’s inner world from a harsh desolate place to a warm kind place enabling them to manage far better their home situation and life in general

ADULT- CHILD RELATIONSHIPS IN SCHOOLS ARE THE KEY TOOL TO BRINGING ABOUT POSITIVE CHANGE FOR TRAUMATISED CHILDREN The relationships you have with children in schools are what will heal their trauma. …so first and foremost we need to make sure they are healing relaitonships We need school staff who can think about underlying mental states Intervention A thorough psychological and physical safety audit to be carried out in the school as traumatised children feel chronically unsafe. ‘Every change/ transition in school is potentially dysregulating. Transitions are inherently stressful Chris Blodgett Director of the Child and Family Research Unit Trauma Center at Washington State University Intervention Heal brains by changing brain chemistry through secure attachment relationships in the school (attachment aware schools) Brain chemicals systems (the optimal emotion chemical activation you need to live a deeply fulfilling life Oxytocin, Opioids, Dopamine, Optimal levels of noradrenaline

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GABA Benzodiazepines (brain’s natural valium) (plus others) Secure attachment The whole feel of the world changes when the emotion chemicals (opioids, oxytocin, prolactin) are in dominance in the brain. When opioids and oxytocin are optimally activated in the child’s brain we do not want to fight Brain oxytocin, opioids and prolactic systems appear to be the key participants in these subtle feelings that we humans call acceptance, nurturance and love.warmth’ (Panksepp, 1998 :249 Affective Neuroscience) Research with other mammals shows that when opioids and oxytocin are optimally activated in the child’s brain we do not want to fight (Anti-anxiety/ anti-aggression molecules) ( Panksepp 1998) When relational experiences activate optimal levels of opioids, oxytocin, prolactin, and other anti-anxiety and anti-aggression chemicals …the world will feel warm, fascinating and an amazing adventure Intervention All school staff should be able to think psychologically in order to help the child reflect on their trauma rather than behave their trauma Traumatised children are often extremely poor about thinking about their inner life – we, as school staff, mustn’t be Hauser et al (2006) Out of the Woods- Resilient Teenager studies “The resilient kids observe other people very carefully, and think of relationships –– as if they were greatly important “They were interested in psychological experience, and their ideas about themselves and other people were discerning and thoughtful” The contrast-group kids never accord relationships the scrutiny the resilient kids do. They seldom see themselves as part of the problem; and the process of relationships the way they work – seems not to interest them at all. ( 2006: 17) The one in two 16 years olds who experience family breakdown to talk about their feelings/experience in school group sessions Intervention Some school staff should be skilled at conveying empathy /naming the pain that is triggering the challenging behaviour instead of just asking questions or giving lectures All behaviour is understandable Case Example Jessica and Darren Shift from mistrust to trust and capacity to seek solace (John Baylin and Dan Hughes: Brain Based Parenting 2012 Norton Publishing Stage One – Mindless Mistrust You are mean and I’m Bad Stage Two: Whoa!! ! this is weird you are being so different from the adults I’ve known before Stage Three To trust or not to trust Stage Four Practising Trust over Mistrust Stage Five Resolving Conflict. I can trust and I’m a good kid The Art of therapeutic conversation Teenager who is running away from home since family break up No empathy – can’t you see what you are doing to me I am worried sick

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Empathic response - I am so sorry that home is not a place you want to be, but a place you want to run from. I would so like to hear how you see things, why they feel so wrong for you. Perhaps we could go and have a cup of coffee somewhere now, as I really want to hear your side of things. I guess for you, home is no longer a lovely place but a painful place… will you help me understand that …so together we can think of a way of changing things Girl is howling the grief of missing her foster mum- Susan Adoptive Mum – You are with me now Empathic response: You so miss Susan. It hurts you so much. You miss her so much. I know. I know Intervention School staff offers traumatised children the means to symbolise their feelings so they do not fall back on behaving their feelings The Use of images/art/sandplay/therapeutic stories To change unbearable feelings into thinkable thoughts. Everyday words are only poor representations for a child’s traumatic experience. Empathy conveyed through

1) `big empathy drawing 2) speaking as the child ( Dan Hughes) 3) doing is straight

Therapeutic Storytelling Intervention Discipline in schools must be carried out with a calm kind voice to set a boundary but without triggering shame If a child feels he has committed some terrible crime, and meets with [an adult] who does not share his self-appraisal of wicked, but instead meets an adult who is firm yet understanding and compassionate, then the child’s terrible belief of himself is lessened, as there will be a mismatch between the persecuting parent in his head and the actual parent who is far more benign in his external reality. But if he feels wicked, plagued by frightening feelings and fantasies of himself as a monster, and then meets [an adult] who [is contemptuous of what he has done] then he feels this confirms his inner reality. His fantasies about himself as a monster remain and are often strengthened as a result of this ‘crucial exchange.’ (Greenberg and Mitchell, 1983: 34) School staff with traumatised children cannot afford to be spontaneously angry Choices and consequences Parenting through Love and Logic (Foster Cline) Building the Bonds of Attachment (Dan Hughes) How to Talk So Kids Will Listen and Listen So Kids Will Talk (Adele Faber; Elaine Mazlish) How to Talk So Teens Will Listen and Listen So Teens Will Talk )Adele Faber and Elaine Mazlish) Intervention School staff will be adept in responding to the traumatised child’s amygdala triggers with emotional regulation The crisp in the mini- bus example When we attune, validate the child’s meaning of an experience, contain, and soothe a child, then top- down brain pathways…naturally inhibits impulsivity, fight and flight. So attachment figures offer the child emotional regulation which leads to the development of stress regulatory systems in their frontal lobes

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Intervention School staff will have a rich menu of skills in calming the child’s body down Sensory zones, mindfulness, green settings, forest schools Vagal Tone /empathy - Stephen Porges (2003) Children and Teenagers are: Better able to learn, to use life well, to concentrate, to enjoy relationships, to be kind to others. Each positive human interaction can be an important brain developing event Organises actual brain systems/frontal lobe executive functions Increase brain growth new synaptic connections, top -down, left- right brain pathways, Develops pro-social and calming brain systems. Regulates brain and body systems Decreases negative effects of stress on the brain Immune system works far better We need to work with both the physiological and the psychological legacy of trauma To avoid being traumatised, the excess energy evoked in our defence must be used up. When the energy is not fully discharged, it does not simply go away; instead it stays trapped, creating the potential for traumatic symptoms. The likelihood of developing traumatic symptoms is related to the level of undischarged survival energy that was originally mobilized to fight or flee. Children need support to release this highly charged state. (Levine/Kline 2007: 28) FREUD It is of great consequence whether there was an energetic reaction to the affectful experience. By reaction we here understand a whole series of voluntary or involuntary reflexes [e.g. crying/shaking] through which according to experience affects are discharged. If the success of the reaction is of sufficient strength it results in the disappearance of a great part of the affect. Language attests to this fact of daily observation in such expressions as ‘to give vent to one’s feelings’ to be ‘relieved by weeping’ etc. If the reaction is suppressed, the affect remains united with the memory. ( Freud Selected Papers in Hysteria and Other Psychoneurosis 1909 No 4 of the Neurosis and Mental disease Monograph series New York) There is a physiological imperative to complete the incomplete sensory-motor impulses that were activated before the body is able to return to a state of relaxed alertness. ( Levine/Kline 2007:14) Move

Movement

Opera

Singing/drama

Calm the brain stem

Your calming tone of voice. Short phrased sentences

Drumming ( Bruce Perry and Bessel Van der Kolk)

Movement

Massage

Three critical steps in treating PTSD:

1) Safety first

2) Calming the body down / working with releasing physiological arousal

3) Emotional processing.

Studies have shown that those who can stick with this treatment, processing trauma in words and feelings in a safe therapeutic context, have a good chance of overcoming their PTSD.

Therapeutic holding to be considered (Education Act Section 550A) When the child has completely lost it “I will hold you, until you can hold yourself” Whilst she takes him on her lap, she speaks to him, as her calm tone will calm him. She uses more empathy “It’s really hard for you sometimes when I tell you things. I can imagine it might feel like the grown-ups have all the power. If that’s true, I can see how it might make you so cross. I know you are mad at me.” Also Securicare and Open Nest for Secondary schools

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Soothing… ride the emotional storm with the eight year old/fourteen year old…this too shall pass … turbulence….as if you are with a distressed baby Brain wave activity Delta waves- low frequencies - adults under hypnosis - highly suggestible. Very common up to age 6. (Dr Rima Laibow 2002) Quantitative EEG and Neurofeedback Talking about feelings calms stress systems in brain and body “The experience of ‘feeling felt’ by the other ( Siegel) Imagining in to what it must feel like for them, even if it is very different to how you are perceiving things. It calms the ALARM systems in that old reptilian and mammalian parts of our brain Hariri, AR., Bookheimer, SY, Mazziotta, JC. (2000) ‘Modulating emotional responses: effects of a neocortical network on the limbic system’, Neuroreport Jan; 1(17):43-48 Intervention School staff can hold in mind a child’s core feelings of distress terror grief rather than seeing diagnosis as the whole picture Trauma and Diagnosis

Diagnosis is a powerful story

When a child is given a diagnosis, the danger is that people stop thinking

Their challenging behaviour is their language of feeling and the discharge of the physiological arousal from the original trauma

Language of Behaviour management, labels and medication

“This child has ADHD. We will need to put her on Ritalin and give her a behaviour management programme

Language of trauma “The child becomes hyperactive and hypervigilant to deal with terrifying chaos of their inner world” ( Orford 1998: 253) Can’t stop her brain storing auditory, visual, kinaesthetic memories of what she may have experienced as terrifying chaos Child psychiatrists often don’t know how to diagnose underdeveloped or shrunken brains resulting from relational stress and relational poverty. One 11 year old girl diagnosed as having: ADHD, Asperger’s, mood disorder, ODD, soiling, dyspraxia, bedwetting, bipolar, PTSD: All dysregulated/ underdeveloped brain and body systems PTSD children look like ADHD children Intervention Schools will have ‘emotional nurses’ able to help a child suffering from traumatic loss to be able to grieve “For a young child the experience …of losing [his parent’s love] is in very truth bereavement.” (Bowlby 1978:33) Many adults don’t know that separation distress, means the child is in acute emotional pain so “the language of loss is the language of pain “ ( PANKSEPP1998 ) Or in other words, the chemistries of pain in the brain are linked to the chemistries of separation distress Does rejection hurt? Eisenberger N1 et al Science 2003 Oct 10:302( 5643) 237-9

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Zubieta -J-K Regulation of Human Affective Responses by Anterior Cingulate and Limbic and u-opioid neurotransmission. General Psychiatry 2003 Vol 60 Goodall’s chimp who died of the pain of a broken heart…. The yearning teenager who nearly died of a broken heart… Otherwise Loss to violence Children like Charlie age 8 - His father had died, whilst in his car on a mobile phone to his mother… He had become very aggressive in school. The school were thinking about expelling him… Animals who are accustomed to high level of opioids then withdrawal of those opioids become very nasty with each other. 75% of men in prison have suffered a broken attachment in childhood (Nacro) When there is a withdrawal of opioids in the brain (when you are coming off a person or heroin- it has the same effect) then what are known as opponent forces are released in the brain. These opponent forces involve the release of a chemical called acetycholine. After the withdrawal of opiates, acetylcholine very strongly and completely washes over the brain, flooding the upstairs brain. It can make people very angry, hostile, irritated – unless they get help with their grief, from a person who is good at comforting and from whom they accept comfort. The comforting of grief, will release opioids and oxytocin in the brain – these block this toxic chemistry of acetycholine. This is why it is vital for children who are suffering from loss to receive comfort Why is it that once the threat is over we are not free of it? Intervention: Some school staff are capable of ‘therapy thinking’ and so can consider unconscious processes of transference and projection TRANSFERENCE The child transfers onto the adult, unprocessed feelings about another person in their life. PROJECTION The child projects onto the adult and other pupils, unbearable feelings about themselves. Being prepared to be hated So you are seeing me as someone who… So you are experiencing me as someone who…. Containment The previously unmanageable feelings become more manageable. They become less terrifying than before, because another person has actually felt them and has been able to tolerate the experience of those feelings. (Casement 1985:82) Providing the child with new relational experiences which activate the brain’s pro-social systems not the alarm systems

Midnight football

Leon Feinstein - adult led youth clubs

Elephants The Minnesota study of Risk and Adaptation (Sroufe et al 2005) Followed 180 infants born in poverty from age 0 to 30, focusing on risk factors for abuse and neglect. The key factor for non- perpetuation of maltreatment was relationship. - an alternative, nonabusive adult during childhood or the teenage years, and/or to have participated in a therapy experience for at least 6 months during some period, Virtually none of the parents who perpetuated the cycle of abuse had experienced any of these forms of relationship.

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“Do we heal together or defend together?” ( Jean Magagna Head of Child psychotherapy Great Ormond Street Hospital) Other key references– Hariri, AR., Bookheimer, SY., Mazziotta, JC. (2000) ‘Modulating emotional responses: effects of a neocortical network on the limbic system’, Neuroreport Jan;1(17):43-48 Fairchild G, Passamonti L, Hurford G, Hagan CC, von dem Hagen EA, van Goozen SH, Goodyer IM, Calder AJ. Brain structure abnormalities in early-onset and adolescent-onset conduct disorder. Am J Psychiatry. 2011 Jun;168(6):624-33. Epub 2011 Mar 31. Fairchild et al 2011 Am J Pyshciatry Smaller amgydala volume in conduct disorder vs controls Amygdala involved in fear recognition and learning experience of emotion Volumetric Loss in Emotion Processing Areas – Fairchild G, Stobbe Y, van Goozen SH, Calder AJ, Goodyer IM. Facial expression recognition, fear conditioning, and startle modulation in female subjects with conduct disorder. Biol Psychiatry. 2010 Aug 1;68(3):272-9. Epub 2010 May 5. Levine, P ( 2006) Trauma Through a Child's Eyes: Awakening the Ordinary Miracle of Healing North Atlantic Books,U.S Panksepp, J. (1998) Affective Neuroscience: The Foundations of Human and Animal Emotions, Oxford: Oxford University Press. Teicher MH, Samson JA, Sheu YS, Polcari A, McGreenery CE. Hurtful words: association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities.Am J Psychiatry. 2010 Dec;167(12):1464-71. Epub 2010 Jul 15. Van der Kolk, B. (1989) ‘The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism’, Psychiatric Clinics of North America 12: 389-411. Van der Kolk, BA, Mcfarlane, CA., Weisaeth, L. (Eds.) (1996) Traumatic Stress. NYC: The Guildford Press Van der Kolk, B. (2002) ‘Beyond the talking cure’ (pp. 57-82) .In Shapriro F, editor. EMDR and the new paradigm. New York: APA Van der Kolk, BA. (2003) ‘The neurobiology of childhood trauma and abuse’, Child and adolescent psychiatric clinics of North America 12 293– 317 van der Kolk, BA. (2006) ‘Clinical implications of neuroscience research in PTSD’, Annals of the New York Academy of Sciences Jul;1071:277-93 Van der Kolk, B., Saporta, J. (1991) ‘The Biological Response to Psychic Trauma: Mechanisms and Treatment of Intrusion and Numbing’, Anxiety Research 4: 199-212; For references and a far fuller account: see

What Every Parent Needs to Know Margot Sunderland ( Dorling Kindersley)

Conversations that Matter

For Training days and training courses in child counseling skills/ art therapy skills, the art of therapeutic communication www.childmentalhealthcentre.org and www.artspsychotherapy .org

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Key relational needs for secure attachment

Attunement

Meeting the child’s /teenager’s emotional intensity (positive or negative) on an energetic level, so as to connect with the child in their pain or their joy. Riding the same emotional energy contour (Moments of meeting – Daniel Stern). The child will experience this as a deep enlivening connection with the other.

Empathic Listening

Validating how the child is experiencing the event, even if it’s very different to how you are experiencing it. Not trying to persuade the child out of having the feeling they are having. Rather affirming, understanding and recognising that s/he is feeling what s/he is feeling. Not just empathy, but finding the right words/ language of feeling/tone of voice to convey that empathy

Containment of Feelings

Being able to stay thinking and feeling about a child’s intense feelings (e.g. rage, power plays, terror, distress) without deflecting into action, distraction, getting angry etc. At times this will mean being able to bear their unbearable pain. Also containment through clear structures, boundaries and carried through consequences. Otherwise a “limit deprived child”.

Soothing (emotional regulation)

Soothing and calming the child’s emotionally dysregulated states. Soothing in conjunction with addressing the other relational needs above, can develop actual stress regulating systems in the brain and good vagal tone in the body. These systems are still forming after birth. When the child is not soothed and calmed during intense dysregulated states, they may fail to develop effective stress regulating systems in brain and body. This leaves them vulnerable to developing depressive, anxiety or aggression disorders in later life. They are also far more vulnerable to using alcohol, smoking, or drugs in order to calm themselves down or just to feel normal.

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