“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 SAFETY WHILE ALLOWING THE CHILD A SENSE OF CONTROL

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: LORI.MYERS@NASHVILLECHILDRENSALLIANCE.ORGWEBSITE: WWW.NASHVILLECA.ORG

BRIANNA GRANT, LCSW, RPTPHONE: 615-463-9804 EXT. 5

EMAIL: BRIANNAPLAYTHERAPY@GMAIL.COMWEBSITE: WWW.BRIANNAGRANT.COM

SEE ATTACHED DOCUMENT FOR BIBLIOGRAPHY AND RESOURCE LIST