Connecting the tots: helping parents with undeveloped attachment connect with their children

1. Jennifer Tabor, LCSW 2013 STATEWIDE CONFERENCE Connecting the tots: helping parents with undeveloped attachment connect with their children Tweet us at #NASWIL

2. CONTACT INFORMATION JENNIFER TABOR, LCSW OFFICE ADDRESS: 5206 W ELM ST, STE 103-105 MCHENRY, IL 60050 PHONE: (815) 363-6080, (815) 529-5933 FAX: (815) 363-6080 EMAIL: jennifer_tabor@ymail.com Tweet us at #NASWIL

3. WORKSHOP OBJECTIVES • PARTICIPANTS WILL DEVELOP AN UNDERSTANDING OF ATTACHMENT THEORY AS IT APPLIES TO PARENTS (BOTH ADULT AND ADOLESCENT). • PARTICIPANTS WILL LEARN WHAT CONSTITUTES A HEALTHY ATTACHMENT RELATIONSHIP. • PARTICIPANTS WILL LEARN 5 SPECIFIC ACTIVITIES AND TOOLS THAT THEY CAN USE WITH THEIR CLIENTS (PARENTS WITH UNDEVELOPED ATTACHMENT) TO IMPROVE THEIR CLIENTS’ ATTACHMENT RELATIONSHIPS WITH THEIR CHILD(REN).

4. OUTLINE OF WORKSHOP • INTRODUCTION • HOW ATTACHMENT DEVELOPS • HOW TO TREAT UNDEVELOPED ATTACHMENT IN THE PARENT-CHILD RELATIONSHIP • INTERVENTIONS THAT PROMOTE ATTACHMENT

5. HOW ATTACHMENT DEVELOPS

6. HOW ATTACHMENT DEVELOPS • Attachment is a learned relationship of trust that is built little by little over time. • Attachment is not an inborn instinct. • We are born NEEDING attachment for our survival, not knowing HOW to form an attachment relationship. • We learn HOW to form an attachment relationship from our primary caregivers. • Attachment patterns can be multigenerational.

7. HOW ATTACHMENT DEVELOPS • Attachment has been identified as playing a vital role in all of the following: • maintaining the bonds of trust • attaining full intellectual potential • acquiring a conscience • developing relationships with others • identity and self-esteem • learning to regulate feelings • language development • development of brain structures • organization of the nervous system

8. PARENTS WITH “UNDEVELOPED ATTACHMENTS” • Parents who experienced insecure attachment patterns with their own parents/caregivers as children. • These parents are capable of forming secure attachment relationships with their children, they just do not posses the knowledge and skills to be able to do so at this time. • These parents CAN “break the cycle” by:

9. PARENTS WITH “UNDEVELOPED ATTACHMENTS” • Facing the things that were painful. • Acknowledging that those things still influence them, especially at times of stress. • Intentionally choosing the things they want to pass on to their child(ren) and the things they want to leave behind – and talking about those things with someone who can help them monitor how it is going between the parent and the child. • Finding resources to help them live out their choices, including good information about child development and positive parenting, as well as a good social support system.

10. TREATMENT PROCESS • RECEIVE REFERRAL – USUALLY THROUGH DCFS • GATHER AND REVIEW BACKGROUND INFORMATION, SOCIAL HISTORY, ETC. FROM REFERRAL SOURCE • MEET INDIVIDUALLY WITH PARENTS FOR AN INTAKE SESSION • ASSESSMENT OF THE ATTACHMENT RELATIONSHIP • DEVELOP GOALS AND A TREATMENT PLAN • INTERVENTIONS THAT PROMOTE ATTACHMENT • REVISIT INDIVIDUAL SESSIONS WITH PARENTS THROUGHOUT TREATMENT PROCESS

11. TREATMENT PROCESS • RECEIVE REFERRAL – USUALLY THROUGH DCFS • GATHER AND REVIEW BACKGROUND INFORMATION, SOCIAL HISTORY, ETC. FROM CASEWORKER OR REFERRAL SOURCE * You will want to triangulate information as some parents may minimize their own history of relational trauma.

12. TREATMENT PROCESS • MEET INDIVIDUALLY WITH PARENT(S) FOR AN INTAKE SESSION • This session is part of the assessment and part of the individual therapy with the parent. • It is important to establish a good working relationship with the parent. • We will use the “therapeutic relationship” to help heal the parent’s childhood wounds and empower them. • Use “Questions for Parental Self-Reflection” from Dr. Daniel Siegel’s book Parenting from the Inside Out .

13. INTAKE SESSION WITH PARENT

14. TREATMENT PROCESS • ASSESSMENT OF THE ATTACHMENT RELATIONSHIP (ESTABLISH A BASELINE) Observe the parent and child interaction and make note of the parent’s strengths and needs (opportunities). I use the following assessment tools: • Keys to Interactive Parenting (KIPS) • Marschak Interaction Method (MIM) • Informal checklists

15. ASSESSMENT • KIPS – A structured observation technique with a rating scale; measure 12 key facets of parenting; training available and required; certification required. http://comfortconsults.com • MIM (Theraplay) – A structured observation technique; uses 9 Theraplay activities; videotaped; training available but not required. • Informal Checklists – FREE! http://ocfs.ny.gov/ohrd/toolkits/cfv/16c.pdf

16. ASSESSMENT

17. ASSESSMENT

18. ASSESSMENT

19. TREATMENT PROCESS • DEVELOP GOALS AND A TREATMENT PLAN Start by asking the parent what his/her goals are. Base goals off of the areas of need that you observed. - The KIPS and the MIM assessments provide guidance in developing goals. - KIPS: 12 parenting behaviors - MIM: 4 dimensions Select interventions that will address those needs.

20. TREATMENT PROCESS • INTERVENTIONS THAT PROMOTE ATTACHMENT

21. INTERVENTIONS THAT PROMOTE ATTACHMENT 1. Teach parent about non-verbal behaviors that promote secure attachment and demonstrate. 2. Teach parent about the importance of physical touch and give them ideas for how to increase physical contact with their child. 3. Assist the parent to “know about” their child (helps the child to experience being understood, noticed, special). 4. Guide the parent to develop a “coherent narrative” and “earned secure attachment.” 5. Help parents with setting limits and creating boundaries.

22. 1. NON-VERBAL CUES THAT PROMOTE ATTACHMENT Dan Siegel’s 4 “S”s of Attachment (The Whole Brain Child) Children Need to Be: • Seen: perceiving them deeply and empathically, “getting” them. • Safe: avoiding actions and responses that frighten or hurt them. • Soothed: helping them deal with difficult emotions and situations. • Secure: helping them develop an internalized sense of well-being. Parents can meet these needs through their non-verbal behaviors. Often, we are not aware of our non-verbals. But, children pick up on EVERYTHING.

23. NON-VERBAL CUES THAT PROMOTE ATTACHMENT • Eye contact – eye-to-eye (not avoiding their gaze) • Facial expression – calm and attentive (not distressed, angry, worried, sad, fearful, or distracted) • Tone of voice – tender, interested, calm (not harsh, indifferent or preoccupied) • Body language - sit with a relaxed, open posture, leaning towards your child (not with your arms crossed and your head back) • Pace, timing and intensity - need to be aware of their child’s preferences for pacing and intensity, which are often slower and less forceful than the parent’s.

24. 2. PHYSICAL TOUCH Increasing physical touch helps parents become the source of comfort and calm for their child. “Touch” will look different at each developmental stage/age of child. Examples of activities you can teach parents to do with their children at each developmental stage: Infants/Toddlers: massaging lotion on child Preschoolers: beep-honk Children: create a hand shake Teens: manicures, doing hair

25. PHYSICAL TOUCH Some parents are uncomfortable with physical touch. This intervention can become therapeutic for them as well. Gradually expose them to physical touch to increase their comfort. Examples: • stickers on hurts  lotion on hurts  lotion on arm • therapist makes physical contact with parent during sessions (placing hand on parent’s shoulder)

26. 3. KNOWING THEIR CHILD This is done in conversation with the parent. Ask questions about their child during the intake session and in an ongoing manner as you work with the family. Some question ideas are available at the following website: http://www.radkid.org/know_your_kid.html These questions also make good conversation starters when working with both the child and parent. The therapist can also ask the parent similar questions about themselves during all interactions.

27. KNOWING THEIR CHILD

28. KNOWING THEIR CHILD

29. 4. COHERENT NARRATIVE All parents can have a secure attachment with their child(ren), regardless of what their childhood experiences were like. The key is to have developed a “coherent narrative.” “life narrative”the way we put our story into words to convey it to another person “internal narrative” the story we tell ourselves “coherent narrative”  telling our story in a balanced way (Dr. Daniel Siegel, Parenting from the Inside Out, 2003)

30. COHERENT NARRATIVE Acknowledging both the positive and negative aspects of their family experiences. Connecting their early family experiences to their later development. Giving a coherent account of their past and how they came to be who they are as adults. For our clients, this requires processing in a relationship with someone who is genuinely attuned to them – a relative, a neighbor, a teacher, a counselor…YOU?

31. COHERENT NARRATIVE Example of a coherent narrative: “My mother was always angry.  She loved us, there was never any doubt about that.  But her parents had really done a number on her.   Her dad worked all the time, and her mother was a closet alcoholic.  Mom was the oldest of six kids, so she always felt like she had to be perfect.  So she bottled everything up, and her emotions just boiled over anytime something went wrong.  My sisters and I usually took the brunt of it, sometimes even physically.  I worry that sometimes I let my kids get away with too much, and I think part of that is because I don’t want them to feel that pressure to be perfect.” The result of developing a coherent narrative is called “earned secure attachment.”

32. 5. SETTING LIMITS AND CREATING BOUNDARIES Limit setting and creating boundaries are an important part of a parent developing a secure attachment with their child. The focus of attachment during the second year of life (or, once the child becomes mobile). This is where they learn to trust that adults can and do keep them safe. They also learn to trust those boundaries.

34. SETTING LIMITS AND CREATING BOUNDARIES “Structure” activities in Theraplay These activities help to regulate and organize the child’s experience. In them, the parent sets limits, defines body boundaries, keeps the child safe, and helps to complete sequences of activities. Examples: bean bag game, pop the bubble, mirroring, peanut butter and jelly, stack of hands, eye signals Booth, Phyllis B. and Jernberg, Ann M. (2010). Theraplay: Helping Parents and Children Build Better Relationships Through Attachment-Based Play (Third Edition). Jossey-Bass Publishers.

35. SETTING LIMITS AND CREATING BOUNDARIES A.C.T. (Child-Parent Relationship Therapy) limit-setting model: 1.    Acknowledge the feeling:
    “I know you would really like to….” or
    “I can see you are feeling very….” 2.    Communicate the limit:
    “….but you may not_______... (because…)” or
    “but your sister is not for hitting” or
    “but the answer is no.” 3.    Target an alternative:
    “You can _______ if you would like” or
    “What you can do is________.”

36. SETTING LIMITS AND CREATING BOUNDARIES Examples of A.C.T. • “I know you would really like to go outside to play, but you may not because it is raining.  You can choose to either complete a puzzle or we can play a game together.” • “I can see you felt very angry / hurt when your sister was making fun of you, but your sister is not for hitting.  When you feel angry you can choose to either hit a pillow or bang on your toy drum.” • “I know you do not like to take your medicine, but whether or not you take medicine is not a choice because it’s something your body needs to get better.  However, you can choose to either take it [with juice or with yogurt] or [through a syringe or a cup].” Landreth, Garry (2012). Play Therapy: The Art of the Relationship (Third Edition). New York: Taylor and Francis Group.

37. TREATMENT PROCESS • REVISIT INDIVIDUAL SESSIONS WITH PARENTS THROUGHOUT TREATMENT PROCESS Remember, you are working with the parent to help them develop a coherent narrative so that they can form a secure attachment with their child(ren). We want to empower them with knowledge and skills. Our relationship with them should model a healthy secure attachment.

38. CONTACT INFORMATION JENNIFER TABOR, LCSW OFFICE ADDRESS: 5206 W ELM ST, STE 103-105 MCHENRY, IL 60050 PHONE: (815) 363-6080, (815) 529-5933 FAX: (815) 363-6080 EMAIL: jennifer_tabor@ymail.com Tweet us at #NASWIL

42. References • Bailey, Becky A. (2000). I Love You Rituals. New York, NY: Harper Collins Publishers, Inc. • Booth, Phyllis B. & Jernberg, Ann M. (2010). Theraplay: Helping Parents and Children Build Better Relationships Through Attachment-Based Play (Third Edition). San Francisco, CA: John Wiley & Sons, Inc. • Landreth, Garry (2005). Child Parent Relationship Therapy (CPRT) Treatment Manual: A 10-Session Filial Therapy Model for Training Parents. New York, NY: Taylor and Francis Group. • Landreth, Garry (2012). Play Therapy: The Art of the Relationship (Third Edition). New York: Taylor and Francis Group. • Nicholson, Barbara & Parker, Lysa (2009). Attached at the Heart: Eight Proven Parenting Principles for Raising Connected and Compassionate Children. Bloomington, IN:iUniverse, Inc. • Siegel, D.J., & Bryson, T.P. (2011).  The Whole-Brain Child:  12 Revolutionary Strategies to Nurture Your Child’s Developing Mind, Survive Everyday Parenting Struggles, and Help Your Family Thrive.  New York, NY: Delacorte. • Siegel, D.J., & Hartzell, M. (2003). Parenting from the Inside Out:  How a Deeper Self-Understanding Can Help You Raise Children Who Thrive.  New York, NY:  Tarcher.