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The Role of Attachment in Trauma February 11, 2011

The Role of Attachment in Trauma February 11, 2011. Presented by Ian Newlin LMFT Child & Adolescent Trauma Services. What is Trauma?. The vast majority of children who experience a trauma don’t develop significant symptoms (Perry). Acute Trauma Likely results in PTSD

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The Role of Attachment in Trauma February 11, 2011

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  1. The Role of Attachment in TraumaFebruary 11, 2011 Presented by Ian Newlin LMFT Child & Adolescent Trauma Services

  2. What is Trauma? • The vast majority of children who experience a trauma don’t develop significant symptoms (Perry). • Acute Trauma • Likely results in PTSD • A “re-experiencing” of the trauma • Likely to have co-occurring disorders like drug abuse, Depression, Oppositional Defiant and Conduct Disorder. • Complex Trauma • Likely results in multiple anxiety disorders such as; • Generalized Anxiety Disorder • Depression • Drug Abuse/Dependency • Hallucinations and Psychosis

  3. What to do • Don’t treat trauma • Treat the symptoms, and allow your treatment to be informed by knowledge of trauma. • Understanding of underlying issues comes naturally with time. • Don’t try to decide if the trauma event was “bad enough” • We don’t make the trauma go away • Need for treatment is measured by the severity of the symptoms, not the details of the initial trauma(s). • Educate about trauma • Most clients don’t understand the broad range of events that can be traumatic. • They have probably spent a great deal of time minimizing their experiences.

  4. What is Attachment? • Associated with the prefrontal cortex, behind the eyes. • In the same region associated with interpreting facial expressions, empathy and facial recognition. • First hypothesized by John Bowlby around 1969. • Thought of as the ability to handle stressful situations by processing them with an “attachment figure.” • Secure – Anxious during stress but recovers easily. • Avoidant – Disconnects during stress. • Resistant – Angry or Ambivalent after stress. • Disorganized – Borderline.

  5. What to do • Educate parents, families and adult clients about attachment. • It isn’t just a matter of “do they like me.” • It is etched in to their neurons. • It can be changed and improved, but not quickly. • Help families be mindful of attachment in how they run their household. • Children shouldn’t be punished by withholding time with parents or by losing basic needs such as food, clothing and shelter.

  6. Attachment and Trauma Combined • An information processing theory of trauma. • People recover from trauma by developing rational cognitions, making helpful meaning of the events, and being aware of how the events have impacted them. • Long term symptoms occur when this natural process doesn’t complete fully. • A victim is far more likely to process the events successfully if; • They have a strong attachment relationship to return to. • That attachment figure is able to respond effectively and empathetically to help them process the events.

  7. Attachment and Trauma Combined • Attachment shows promise of “making sense” of trauma, for victims and for clinicians. • People with insecure attachment don’t usually develop PTSD. • People who experience trauma don’t usually develop PTSD or anxiety. • But among people with insecure attachment AND experience trauma, PTSD and anxiety symptoms are frequent. • Research is ongoing…

  8. Attachment and Trauma Combined • Attachment may predict the likelihood of developing trauma symptoms. • AND, addressing attachment is key to treating and recovering from traumatic stress.

  9. What to do • Be curious about people with unexplained symptoms and insecure attachment. • There is probably a trauma history. • Don’t make promises you can’t keep. • Create routine and structure. • Don’t assume anything, go out of your way to reinforce attachment. • Take Heart! The best parents are only %30 “attuned” (Daniel Stern). • Process all interventions through the “attachment filter.”

  10. Vicarious Trauma • Mental Health Professionals must take care of their own reactions to the stories they hear. • Family Time • Mindfulness Exercises • This is critical for the therapist and for the client. • Therapeutic alliance is a critical predictor of patient outcomes.

  11. Sources and Resources • The Interpersonal World of the Infant, by Daniel Stern • www.childtrauma.org the site by Dr. Bruce Perry, also, his book The Boy Who Was Raised as a Dog • www.nctsnet.org the site for The National Child Traumatic Stress Network • www.tfcbt.musc.edu site for free web training in Trauma Focused CBT, one of three best practices for treatment of trauma. • www.kcchildtrauma.com the site for Child & Adolescent Trauma Services in K.C., KS

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