Allison Davis Maxon, LMFT allisondavismaxon

1. the Art & Science of AttachmentUnderstanding How Trauma &Neglect Disrupt AttachmentFlorida Coalition for ChildrenJuly 9th 2019 Allison Davis Maxon, LMFT www.allisondavismaxon.com

2. Objectives: • What is the difference between Love and Attachment? • Art of Attachment: Our earliest attachment experiences teach us the ‘dance of attachment’ and create the template for all future interpersonal relationships • Science of Attachment: the ‘primary attachment caregiver’ acts as the ‘external psychobiological regulator of the child’s internal affective states’; the developing child’s brain is experience dependent. Attachment is the key! • Describe Developmental Trauma or Relational Trauma as a way of understanding the complex challenges faced by both children and parents/caregivers • Understand the difference between traditional parenting techniques which utilize Loss, punishment and emotional distance in response to negative behaviors vs therapeutic and attachment-based parenting approaches based on principals of Addition, connection and teaching consequences

3. The Foundation: Attachment Theory, Development & the Brain Every interpersonal skill that is required in order for us to be successful in creating and sustaining relationships – must be LEARNED

4. KINSHIP • Who do I belong to? • Who belongs to me? my kin my clan my connections my tribe my peeps CONNECTIONS

5. My Invisible Strings . . . My Kinship Circle

6. We’re Built for Attachment Early attachment experiences have a profound impact on how we perceive ourselves, others and the world in which we live I am … LOVABLE VALUABLE GOOD

7. Why is Attachment soooo important?Isn’t it the same as Love? • We are social-emotional beings with an innate need to connect and form meaningful relationships • Early attachment experiences have a profound impact on how we perceive ourselves, others and the world in which we live • It’s the primary modality through which all areas of of a child’s developmental potential is maximized - (or minimized!) Meet Derek!

8. The Purpose of Attachment In the animal kingdom, the primary purpose of attachment is to provide safety and protection for the vulnerable. The young animal that ‘seeks proximity’ to its caregiver - is more likely to survive Attachment in humans has many secondary purposes: • the stimulation of the child’s intellectual potential • the development of the child’s socialization skills • the facilitation of Identity Formation • to enable the child to modulate stress & arousal levels (affect modulation) to increase ‘pleasurable states’ and to decrease ‘stressful/painful states’ • the development of a ‘Conscience’ (which requires the ‘Internalization of the Object; ie ‘Attachment Caregiver’)- allows the child to feel empathy • the ability to delay gratification of their needs being met • the ability to attend & focus

9. The Art of Attachment • John Bowlby – The Father of Attachment Theory – Tavistock Clinic The great integrator! Integrating the fields of ethology, behavioral psychology, psychoanalysis, cognitive psychology and child development – with a passion for the scientific method “Forty-four Juvenile Thieves: Their Characters and Home-Life” Bowlby, l944 ‘the infant enters the world w/ an ‘attachment behavioral system’ that allows the biological system (the infant/child) to seek proximity to the parent when threatened, and also allows for exploration behaviors upon activation of the ‘secure base’ Attachment, Separation and Loss by John Bowlby A Secure Base by John Bowlby

11. Attachment and Brain Development • Experience is the architect of the brain – experiences shape and reshape the neural circuitry of the brain • Experience-dependent neural sculpting is accomplished through attunement with the right hemisphere of the parent (Schore, 2000) • Caretakers do more than regulate the present psychobiological state of an infant; they activate the growth of the brain through emotional availability and reciprocal interactions (Emde, l988)

12. The brain on neglect . . . The Child Trauma Academy, Dr. Bruce Perry www.childtrauma.org

13. The Developing Child Substance Abuse Sexual Abuse Poverty Further Traumas Along theWay Multiple Moves & Separations Crime Violence Physical Abuse Neglect The Child Multiple Traumas in Birth Family Genetic Issues

14. Attachment, Development & the Brain The parent/caregiver is the “External Psycho-Biological Regulator of the Child’s Internal Affective States” The two primary tasks are:

15. Arousal Cycle

16. Disrupted Cycle

17. The Attachment Pyramid . Primary attachment relationships Secondary attachment relationships Friendly strangers Primary Attachment Relationships are NOT interchangeable

18. Child Development

19. Normative Child Development “I’ve Missed Critical Steps”

21. Grief, Trauma, Love, Attachment, Joy Our emotional memories are deeply embedded & encoded within the Limbic structures of our brain. Implicit vs. Explicit memory!

22. Attachment and Brain Development Brain Stem – (‘the primitive brain’) the inner core of the brain well functioning at birth, regulating temperature, heart rate, breathing, reflexes Limbic System – (‘the emotional brain’) involved in learning, motivation, memory and emotion the amygdala – (implicit memory) encoding early memory, attachment, fear, emotional memories (-) & (+) the hippocampus – organizes explicit memory in collaboration with the cerebral cortex The Cortex – (‘the executive brain’) primarily shaped through countless positive and negative interactions with our social/physical world - the slow development of the human brain maximizes the impact of environmental influences (increasing chances of survival)

23. The Neurobiology of TraumaThe child’s brain… • Adapts to a hostile environment • Is stuck in survival mode • Is over stimulated by sensory input • Cannot cognitively organize • Is easily triggered into Fight/Flight/Freeze

24. What happens when Attachment is Disrupted? • deep sense of loss and grief • feelings of abandonment and rejection • loss of trust in self and others • behavioral regression • chronic hyper arousal, anxiety and impulsivity • Confusion and poor reality testing • Attachment-deflecting behaviors • Oppositional/defiant behaviors • Isolation & avoidance • Anger & rage • Lying, stealing and manipulating “I am bad . . . therefore I act bad!!”

25. Attachment Patterns Secure Attachment Pattern Insecure Attachment Patterns • Attachment Patterns are identifiable by the 12 month of life • Each pattern has a distinct behavioral repertoire • Disorganized Attachment Pattern is most predictive of long-term mental health problems • Attachment Patterns are malleable

26. Insecure Attachment Patterns Secure Attachment Pattern Disorganized Avoidant Anxious Parentmeetingmost needs Parent meeting minimal needs Pathogenic careTraumaticReactive Parent meeting some needs

27. By Age 5 Each Attachment Pattern reflects a behavioral repertoire Secure A.P. Anxious A.P. Avoidant A.P. Disorganized A.P. Stressed Worried Demanding Blaming Clingy Defiant Isolative Provocative Detached Angry Frozen Bizarre Random Pathological Playful Social Resourceful Enthusiastic

28. Dimensions of Childhood Grief • Apparent lack of feeling; numbing • Physiological stress/somatic symptoms • Regressed behaviors • Disorganization and panic, fear • Explosive Emotions {easily triggered} • Acting-out behaviors {aggression/hyper-arousal} • Guilt and self-blame based on egocentric/ magical thinking • Impulsive, reactive, bullying behaviors • Isolation, withdrawal, emptiness, loneliness

29. Post-Traumatic Stress Disorder VS Developmental Trauma PTSD was introduced into the psychiatric classification system in 1980, originally based on the traumatic symptoms that U.S. veterans experienced returning from the Vietnam War - extensively researched on adult populations In one study of 364 abused children, the most common diagnoses in order of frequency were Separation Anxiety Disorder, Oppositional Defiant Disorder, Phobic Disorders, PTSD, and ADHD. These diagnoses only describe certain symptoms of their current functioning. What is missing is how chronic trauma has impacted the child’s social, emotional, cognitive and neurobiological development. The diagnosis of PTSD is not developmentally sensitive and does not adequately describe the effect of exposure to childhood trauma on the developing child. Because infants and children who experience multiple forms of abuse often experience developmental delays across a broad spectrum, including cognitive, language, motor, and socialization skills, they tend to display very complex disturbances, with a variety of different, often fluctuating, presentations -Bessel van der Kolk, National Child Traumatic Stress Network

30. Developmental Trauma Developmental Trauma Disorder A new, rational diagnoses for children with complex trauma histories - Bessel A. van der Kolk, MD • Most trauma begins at home; the vast majority of people (80%) responsible for child maltreatment are children’s parents/caregivers • People w/ childhood histories of trauma, abuse and neglect make up almost the entire criminal justice population in the US. • When trauma emanates from within the family, children experience a crisis of loyalty and organize their behavior to survive within their families - fright/terror with no solution!

31. the thing they most NEED is also the thing they most FEAR The Attachment Dilemma Our children often end up in a constant power struggle with their primary caregivers because . . . FEAR will keep me from getting close to you!

32. The Dance of Fear & Shame Fear embeds itself into the body and mind The Attachment Dilemma

33. Repairing Disrupted Attachments Simply put . . . what the child/youth needs most is a secure attachment relationship (a secure base and a safe haven) In order to FEEL DEEPLY Valued, Connected and Loved . . . I need permanent, loving, caring connections

34. The Wheel Of Emotion Learning the Language of Emotion! The family is the Primary Intervention! Re-educating the emotional brain!

35. How Do We Learn the Dance of Attachment?

36. How Do Children Heal? Relational trauma requires relational healing Children need to be claimed! Buckets don’t fill themselves. Parent interventions based on principals of Addition! Experience is the architect of the brain! Maximizing the Developmental Buckets! Physiological Social Emotional Cognitive Conscience

37. Trauma-InformedParents/Professionals Traditional ApproachesParents/Professionals • ‘Add’ teaching consequences • Empathy replaces anger; how can ‘we’ solve this problem • Mistakes are opportunities to learn and re-learn what was missed at earlier stages of development • Reinforces attachment/intimacy; we get our needs met through connection • Reinforces ‘positive internal working model’ • Use Punishment; to inflict pain/harm • Emotional distance and isolation • Mistakes are not OK • Reinforces disrupted cycle; needs not met • Reinforces ‘negative internal working model’ The Limbic Brain must be activated to change; it doesn’t change with words

38. Traditional Therapy vs. Family Attachment Therapy

39. Connection, Connection, Connection Look for the NEED Underneath the behavior! Listen with your heart, you will understand - Pocahontas

40. 10 Things I Need Every Day My words tell you what I want . . . my affect and behavior tell you what I NEED!

41. 10Things: Your Child Needs Every Day Think Buckets!

42. Your Dance of Attachment • Your affect & emotion sets the tone for the dance! • Replenish, Refuel, Create, Play, Sing, DANCE!!! • Your greatest and most powerful tool is _______!!

43. SEVEN CORE ISSUES in ADOPTION & PERMANENCY A Comprehensive Guide to Promoting Understanding and Healing in Adoption, Foster Care, Kinship Families and Third Party Reproduction By Sharon Roszia and Allison Davis Maxon Jessica Kingsley Publishers, July 2019 Contributors include: Dr. Michael Grand, Kris Probasco, Dr. Joe Crumbley, Dr. Abbie Goldberg, Mary McGowan, Kathryn Aytes, Dee Dee Mascarenas, Huyan Freedlander, and others

44. the heart of a child The heart of a child is a scroll, A page that is lovely and white, And to it as fleeting years roll, Come hands with a story to write. Be ever so careful, O hand; Write thou with a sanctified pen; Thy story shall live in the land For years, in the doings of men. It shall echo in circles of light, Or lead to the death of a soul. Give here but a message right, For the heart of a child is a scroll. -Author unknown

45. “Sometimes it is necessary to reteach a thing its loveliness . . . until it flowers again from within.” - Galway Kinnell Thank You Allison Davis Maxon, LMFT www.allisondavismaxon.com allisonmaxon@cox.net