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- Here's a dismissing adult who talks

2
00:00:04,272 --> 00:00:06,813
about his mother being loving.

3
00:00:07,624 --> 00:00:11,048
So he's just been asked to
give a specific incident

4
00:00:12,155 --> 00:00:15,684
as far back as he can
remember, and he says,

5
00:00:15,684 --> 00:00:17,816
"I don't remember.

6
00:00:18,435 --> 00:00:22,507
"Well, because she was
caring and supportive."

7
00:00:23,951 --> 00:00:26,092
And the interviewer says,
"Well, this can be difficult

8
00:00:26,092 --> 00:00:28,206
"because a lot of people haven't
thought about these things

9
00:00:28,206 --> 00:00:30,655
"for a long time, but take
a minute and see if you can

10
00:00:30,655 --> 00:00:33,754
"think of an incident or an example."

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00:00:35,493 --> 00:00:37,612
"Well..."

12
00:00:38,476 --> 00:00:42,015
"I guess, like, well, you
know, she was really pretty,

13
00:00:42,015 --> 00:00:44,756
"and she took a lot of
care with her appearance.

14
00:00:44,756 --> 00:00:47,701
"Whenever she drove me
to school, I was always

15
00:00:47,701 --> 00:00:51,619
"proud of that when we
pulled up at the playground."

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00:00:53,086 --> 00:00:56,711
The interviewer, who still
hasn't gotten an example

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00:00:56,711 --> 00:01:00,168
of a loving mother, says, "Thank you,

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00:01:00,168 --> 00:01:03,748
"and I just wonder whether
there might be another example."

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00:01:03,977 --> 00:01:05,936
And the participant says, "No, I think

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00:01:05,936 --> 00:01:08,624
"that pretty much takes care of it."

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So here's someone who
describes how his mother looks

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00:01:13,243 --> 00:01:17,999
instead of describing her
loving behaviors toward him.

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He also has trouble remembering,
because most of these

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00:01:23,084 --> 00:01:26,704
memories probably have been
dismissed from his mind.

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So he's looking at superficial features

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as opposed to a truly loving mother.

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00:01:35,807 --> 00:01:38,879
Now what does a preoccupied
adult look like?

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Participant says, "Yeah,
sort of very loving at times,

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00:01:47,873 --> 00:01:51,006
"like people were in the
old days of my youth.

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"Lot of changes since then.

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"I remember home, and home
was good in that, and loving.

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"That's just like my wife.

33
00:02:04,590 --> 00:02:06,733
"Just like my wife is with my child.

34
00:02:06,733 --> 00:02:09,372
"Taking him out to the movies tonight...

35
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"Special thing he's been
wanting to see all week.

36
00:02:11,925 --> 00:02:14,741
"Actually, it's more like
a month, that turtle movie.

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00:02:14,741 --> 00:02:16,741
"Don't like it too much myself.

38
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"Saw it though, when it was
in, maybe six months ago.

39
00:02:20,432 --> 00:02:23,060
"Yeah, she's very loving with him."

40
00:02:23,614 --> 00:02:26,380
And the interviewer says,
"Okay, well, what things come

41
00:02:26,380 --> 00:02:29,228
"to mind when you describe
your childhood relationship

42
00:02:29,228 --> 00:02:32,548
"with your mother as
very loving at times?"

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00:02:33,199 --> 00:02:35,458
Because obviously the participant here has

44
00:02:35,458 --> 00:02:37,701
gone off on talking
about his wife and child

45
00:02:37,701 --> 00:02:40,632
instead of talking about
his own experience.

46
00:02:40,632 --> 00:02:42,657
And the participant says,
"Really great things.

47
00:02:42,657 --> 00:02:45,570
"Felt really special, really
grateful to her for that.

48
00:02:45,570 --> 00:02:49,014
"My childhood, I remember just
sitting on the porch rocking,

49
00:02:49,014 --> 00:02:52,050
"rocking back and forth,
watching my parents or maybe

50
00:02:52,050 --> 00:02:55,324
"having some lemonade,
this, that, and the other.

51
00:02:55,324 --> 00:02:57,196
"Really special sorts of things,

52
00:02:57,196 --> 00:03:00,120
"just me and her,
grateful for all she did.

53
00:03:00,120 --> 00:03:01,894
"I wasn't easy, my temperament

54
00:03:01,894 --> 00:03:04,209
"was hard on her, kind of hard.

55
00:03:04,209 --> 00:03:06,254
"Nobody like her.

56
00:03:06,254 --> 00:03:09,329
"Me and my cousin from next town

57
00:03:09,329 --> 00:03:12,284
"are going down soon, really big birthday.

58
00:03:12,284 --> 00:03:16,125
"She's gonna be 80, gives my age away."

59
00:03:16,565 --> 00:03:21,118
So here's a person who sort of rambles on,

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00:03:21,118 --> 00:03:25,907
uses examples that aren't
relevant to loving.

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00:03:27,463 --> 00:03:30,627
Talks about his wife and
child instead of his own

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00:03:30,627 --> 00:03:35,326
experience, talks about
sitting near her on the porch

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00:03:35,326 --> 00:03:39,609
and drinking lemonade as an
example of her being loving,

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00:03:41,991 --> 00:03:44,359
and is sort of general in his description.

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00:03:44,359 --> 00:03:46,656
"Grateful for all she did for me."

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00:03:46,805 --> 00:03:48,925
That kind of thing.

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00:03:48,925 --> 00:03:51,475
So that's an example of a person who would

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talk about his mother's loving,

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00:03:53,628 --> 00:03:57,196
but show a preoccupied attachment style.

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00:03:58,663 --> 00:04:02,602
Now you might wonder about
a negative description

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00:04:02,602 --> 00:04:04,738
of an early relationship with a mother.

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00:04:04,738 --> 00:04:08,786
So I'm going to give you three examples of

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00:04:10,110 --> 00:04:14,023
interviews, these are from
the adult attachment...

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00:04:14,023 --> 00:04:16,841
from the Handbook of Attachment, which has

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00:04:16,841 --> 00:04:19,171
a chapter on adult attachment.

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00:04:19,171 --> 00:04:22,529
And these are segments of
interviews that were done...

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00:04:24,195 --> 00:04:26,578
with adults.

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00:04:28,250 --> 00:04:31,605
Here's an example of
three different people

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00:04:31,605 --> 00:04:33,774
who use the word "troublesome"

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00:04:33,774 --> 00:04:36,881
to describe their relationship
with their mother.

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00:04:37,581 --> 00:04:40,668
First I'll give you a secure adult.

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00:04:40,668 --> 00:04:43,476
And the participant says, "Troublesome.

83
00:04:43,476 --> 00:04:45,693
"Well, she was troublesome for me

84
00:04:45,693 --> 00:04:47,589
"when I was young, no question.

85
00:04:47,589 --> 00:04:49,742
"She yelled a lot of the time.

86
00:04:49,742 --> 00:04:52,061
"I remember that, and
she also, she could spank

87
00:04:52,061 --> 00:04:55,028
"really hard and she got angry a lot.

88
00:04:55,420 --> 00:04:59,318
"But like I said, my
father left when I was four

89
00:04:59,318 --> 00:05:01,839
"and she was trying to make
enough of an income to support

90
00:05:01,839 --> 00:05:05,278
"us, and trying hard to keep
us on the straight and narrow

91
00:05:05,278 --> 00:05:09,003
"at the same time that she
was away such long hours.

92
00:05:09,003 --> 00:05:11,443
"I didn't like it, what she did.

93
00:05:11,443 --> 00:05:13,941
"Like one time she slapped
me in the face over something

94
00:05:13,941 --> 00:05:18,611
"my sister had done, but
she never apologized.

95
00:05:18,611 --> 00:05:22,976
"I hated the yelling when my
report card wasn't up to par.

96
00:05:22,976 --> 00:05:26,217
"Yes, troublesome, or
maybe I should have said

97
00:05:26,217 --> 00:05:28,657
"it was a troubled relationship.

98
00:05:28,929 --> 00:05:33,136
"But while I wish it had
been different, it wasn't."

99
00:05:33,612 --> 00:05:38,612
So here's a person describing
very clearly and coherently

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00:05:38,914 --> 00:05:40,989
what was troublesome
about his relationship

101
00:05:40,989 --> 00:05:44,461
with his mother, and what he didn't like.

102
00:05:46,416 --> 00:05:50,843
So we see this as a
secure, as part of a secure

103
00:05:50,843 --> 00:05:53,760
adult attachment interview, even though

104
00:05:53,760 --> 00:05:56,164
he's reporting on negative behaviors.

105
00:05:56,164 --> 00:05:57,993
He's able to reflect on them, think about

106
00:05:57,993 --> 00:06:00,933
their impact on him as a child.

107
00:06:01,538 --> 00:06:04,005
At the end he says, "I wish it had

108
00:06:04,005 --> 00:06:05,857
"been different, but it wasn't."

109
00:06:05,857 --> 00:06:08,704
So he accepts the reality of it,

110
00:06:08,704 --> 00:06:11,739
but obviously has reflected on it.

111
00:06:12,424 --> 00:06:15,263
So what about a dismissing person

112
00:06:15,263 --> 00:06:18,363
who would say his
relationship was troublesome?

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00:06:19,919 --> 00:06:22,239
All right, here's the participant.

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00:06:22,239 --> 00:06:26,997
"Troublesome, weak, cried,
fell apart at funerals."

115
00:06:27,608 --> 00:06:29,858
And the interviewer says,
"I wonder if you have any

116
00:06:29,858 --> 00:06:33,965
"specific memories of times
you found her troublesome."

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00:06:34,256 --> 00:06:37,687
"Sobbed through her aunt's
funeral, embarrassing.

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00:06:37,687 --> 00:06:39,699
"Couldn't wait to get away.

119
00:06:39,699 --> 00:06:41,476
"Next question?"

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00:06:42,339 --> 00:06:44,707
Here's someone who's not
talking about mother being

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00:06:44,707 --> 00:06:49,707
troublesome to him except
embarrassing him, and...

122
00:06:51,317 --> 00:06:53,860
is dismissing, clearly
wanting to move on to the

123
00:06:53,860 --> 00:06:57,458
next question, not wanting
to talk about this,

124
00:06:57,458 --> 00:07:01,185
and is quite dismissing of his mother.

125
00:07:01,185 --> 00:07:05,640
"Weak, cried, fell apart at funerals."

126
00:07:06,437 --> 00:07:10,577
And obviously a mother
could still be very loving

127
00:07:10,577 --> 00:07:13,460
and be a kind of person who
would fall apart at a funeral,

128
00:07:13,460 --> 00:07:18,460
but this person hasn't
reflected on his experience.

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00:07:19,719 --> 00:07:24,321
He just sort of produces
this as a canned response.

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00:07:25,796 --> 00:07:30,478
And what about a preoccupied
adult who uses the word

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00:07:30,478 --> 00:07:34,455
"troublesome" to describe his
relationship with his mother?

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00:07:37,742 --> 00:07:41,870
Participant, "Troublesome,
that was an understatement.

133
00:07:41,870 --> 00:07:43,846
"It was yell, yell, yell.

134
00:07:43,846 --> 00:07:46,326
"'Why didn't you do this,
why didn't you do that?'

135
00:07:46,326 --> 00:07:49,566
"Well, mom, it was because you
were just at me all the time.

136
00:07:49,566 --> 00:07:52,397
"Like last week, you started
yelling at the only grandkid

137
00:07:52,397 --> 00:07:55,769
"you've got when we
had you over to dinner.

138
00:07:56,334 --> 00:07:59,866
"And angry, she's angry at me, she's angry

139
00:07:59,866 --> 00:08:04,367
"at her latest husband,
that's the latest in a series.

140
00:08:04,367 --> 00:08:06,498
"Now she's angry at her
neighbor about a tree that's

141
00:08:06,498 --> 00:08:09,961
"supposed to be blocking her
view, and so on and so on.

142
00:08:09,961 --> 00:08:12,506
"She's more troublesome,
she stirs up little things

143
00:08:12,506 --> 00:08:14,761
"like I was saying last week at dinner..."

144
00:08:14,761 --> 00:08:17,016
And this continues.

145
00:08:17,366 --> 00:08:21,910
So here's someone who has...

146
00:08:22,878 --> 00:08:24,954
switched suddenly in the
middle of the story about

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00:08:24,954 --> 00:08:29,954
his mother in childhood,
to addressing her right now

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00:08:30,819 --> 00:08:34,026
as if she were here in the room today.

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00:08:34,026 --> 00:08:38,285
This is one of the signs of
incoherence in the narrative.

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00:08:39,070 --> 00:08:43,030
He's also going on and on about...

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00:08:44,058 --> 00:08:46,501
about the way she treated
her grandkid, about their

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00:08:46,501 --> 00:08:50,289
neighbors, about her latest
husband, really not staying

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00:08:50,289 --> 00:08:53,851
with the issue of early childhood.

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00:08:53,851 --> 00:08:58,851
This interview goes on
from the part I mentioned,

155
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so it's clear this is sort
of a rambling interview.

156
00:09:02,608 --> 00:09:07,330
That's the way in which
preoccupied adults tend to speak.

157
00:09:08,318 --> 00:09:10,830
In fairly rambling ways, their interviews

158
00:09:10,830 --> 00:09:14,282
tend to be longer, and they are...

159
00:09:16,014 --> 00:09:19,489
they're not clear in their descriptions.

160
00:09:20,326 --> 00:09:24,835
So if you have an adult
who's not an organized,

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00:09:24,835 --> 00:09:29,835
attached adult, who is
unresolved or disorganized,

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00:09:31,517 --> 00:09:35,152
this unresolved category in
adult attachment interviews

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00:09:35,152 --> 00:09:39,853
invariably relates to an
experience of trauma or loss.

164
00:09:42,930 --> 00:09:47,930
Speakers who are
disorganized and unresolved,

165
00:09:49,252 --> 00:09:53,046
as they speak about loss or trauma,

166
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their coherence disappears.

167
00:09:57,569 --> 00:09:59,301
They have what we call "lapses

168
00:09:59,301 --> 00:10:02,825
"in monitoring of their discourse."

169
00:10:02,825 --> 00:10:06,093
They're not in touch with
the fact that they're

170
00:10:06,093 --> 00:10:09,868
talking to someone and trying
to make clear a statement.

171
00:10:13,825 --> 00:10:17,130
And what we've found
is that these parents,

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if a parent prior to the
baby's birth is unresolved

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00:10:21,116 --> 00:10:24,672
in relationship to trauma
or loss, they're likely

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00:10:24,672 --> 00:10:29,672
later to have a disorganized
infant attachment relationship.

175
00:10:32,773 --> 00:10:35,466
I'm going to give you a couple
of examples, three examples,

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of ways in which unresolved trauma or loss

177
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can effect an adult attachment interview.

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00:10:43,972 --> 00:10:47,403
Here's a mother who was talking about

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00:10:47,403 --> 00:10:50,765
the loss, a loss in her childhood.

180
00:10:50,765 --> 00:10:53,279
The question is, "Did
you experience any losses

181
00:10:53,279 --> 00:10:56,369
"of people who were important
to you in your childhood?"

182
00:10:56,685 --> 00:11:00,232
So she was asked about it and she said,

183
00:11:00,232 --> 00:11:05,232
"Yes, there was a little
man," and she began to cry.

184
00:11:06,473 --> 00:11:08,952
It turns out this person
was an elderly workman

185
00:11:08,952 --> 00:11:10,900
who had been employed briefly by her

186
00:11:10,900 --> 00:11:13,956
parents when she was eight years old.

187
00:11:14,312 --> 00:11:17,264
Jokingly, he had asked
her to marry him when she

188
00:11:17,264 --> 00:11:21,615
grew up, and she had
said, "No, you'd be dead."

189
00:11:21,819 --> 00:11:24,059
Not long after this interchange, the man

190
00:11:24,059 --> 00:11:27,791
had died unexpectedly
of a brain hemorrhage.

191
00:11:27,791 --> 00:11:30,279
And this mother went on
to tell the interviewer

192
00:11:30,279 --> 00:11:32,736
that it was she who had killed him.

193
00:11:32,736 --> 00:11:37,345
The way she put it was, "I
killed him with one sentence."

194
00:11:37,902 --> 00:11:42,902
So here's a mother who, in
the midst of an interview,

195
00:11:43,132 --> 00:11:47,423
sort of loses touch with
rationality, and goes back

196
00:11:47,423 --> 00:11:51,598
to the magical thinking
of a child who believed

197
00:11:51,598 --> 00:11:54,237
that by saying, "No, I'm
not going to marry you

198
00:11:54,237 --> 00:11:57,517
"because you'd be dead by
the time I was grown up,"

199
00:11:57,517 --> 00:12:01,347
believed that she had
actually killed this man.

200
00:12:02,235 --> 00:12:06,694
She has not resolved this
loss, because she has not

201
00:12:06,694 --> 00:12:09,701
come to an understanding
that obviously her sentence

202
00:12:09,701 --> 00:12:13,170
was not what was killing this person.

203
00:12:14,502 --> 00:12:18,820
That's the source of
incoherence for that interview.

204
00:12:20,337 --> 00:12:25,337
You can also be classified
as unresolved when you

205
00:12:27,000 --> 00:12:30,002
exhibit an abrupt and distinct change

206
00:12:30,002 --> 00:12:33,411
in what's called the "discourse register."

207
00:12:34,655 --> 00:12:38,682
This can be seen in a move where you pay

208
00:12:38,682 --> 00:12:41,861
extreme attention to
detail that doesn't relate

209
00:12:41,861 --> 00:12:45,178
to the experience that
you're talking about.

210
00:12:45,609 --> 00:12:47,882
So here's an interview where she says,

211
00:12:47,882 --> 00:12:51,158
"We went to the hospital in, let's see,

212
00:12:51,158 --> 00:12:54,479
"I think it was the gray Buick, and I sat

213
00:12:54,479 --> 00:12:58,112
"in the back, to the right of my mother.

214
00:12:58,112 --> 00:13:00,707
"I was wearing jeans and a polo shirt.

215
00:13:00,707 --> 00:13:03,711
"Well, not jeans, but you know, khakis,

216
00:13:03,711 --> 00:13:06,302
"and we turned first down
West Street, and then

217
00:13:06,302 --> 00:13:09,938
"there was a lot of traffic,
so we took another street."

218
00:13:10,311 --> 00:13:12,292
And this interview goes on.

219
00:13:12,292 --> 00:13:16,350
So here's a person who's talking
about a trauma or a loss,

220
00:13:16,350 --> 00:13:19,366
and the information
you're getting is about

221
00:13:19,366 --> 00:13:21,573
what clothes she wore and what street she

222
00:13:21,573 --> 00:13:24,538
drove down and what color the car was.

223
00:13:24,538 --> 00:13:29,353
It indicates a fear of actually
dealing with what happened

224
00:13:29,353 --> 00:13:34,043
at this time, so that the
person is just focused entirely

225
00:13:34,043 --> 00:13:39,043
on these details which are not relevant.

226
00:13:41,481 --> 00:13:45,008
Another way a person may
show incoherence in an adult

227
00:13:45,008 --> 00:13:50,008
attachment interview relating
to trauma or loss is to shift

228
00:13:50,177 --> 00:13:55,177
very abruptly into eulogistic
or funereal speech.

229
00:13:56,984 --> 00:13:59,358
So here's an example of a
person who, in the midst of his

230
00:13:59,358 --> 00:14:04,101
adult attachment interview,
starts talking about a loss.

231
00:14:05,028 --> 00:14:09,298
And he says, "She was
young, she was lovely,

232
00:14:09,298 --> 00:14:11,853
"and she was torn from us by that

233
00:14:11,853 --> 00:14:15,942
"most dreaded of diseases, tuberculosis.

234
00:14:16,195 --> 00:14:20,015
"And then I remember time and time again,

235
00:14:20,015 --> 00:14:23,802
"the sounds of the weeping,
the smells of the flowers,

236
00:14:23,802 --> 00:14:26,403
"the mother torn from where she lay

237
00:14:26,403 --> 00:14:29,991
"weeping upon her daughter's coffin."

238
00:14:31,218 --> 00:14:35,084
So here's someone who's not able to use

239
00:14:35,354 --> 00:14:40,354
typical interpersonal, direct,
person-to-person language

240
00:14:40,528 --> 00:14:45,528
in describing the loss of
what's probably a sibling.

241
00:14:48,050 --> 00:14:52,392
He shifts into this very
artificial sounding language

242
00:14:52,392 --> 00:14:55,816
and describes it as a way
of distancing himself,

243
00:14:55,816 --> 00:14:58,892
it appears, from the actual experience.

244
00:14:59,239 --> 00:15:02,624
These are all examples that come from

245
00:15:02,983 --> 00:15:06,384
an article by Erik Hesse, who
has done a lot of the work

246
00:15:06,384 --> 00:15:11,100
on disorganization in recent
years, with Mary Main.

247
00:15:13,021 --> 00:15:18,021
So now I'm going to talk
more about how we begin

248
00:15:18,126 --> 00:15:21,389
to translate what we
know about attachment,

249
00:15:21,389 --> 00:15:25,635
and to apply it in a
therapeutic situation.

250
00:15:28,711 --> 00:15:33,711
And I think the first thing
you need to think about is,

251
00:15:35,058 --> 00:15:38,370
back to Allan Schore's statement
that a sensitive caregiver

252
00:15:38,370 --> 00:15:41,089
downloads her right brain into the infant

253
00:15:41,089 --> 00:15:43,974
during the first three years of life,

254
00:15:44,565 --> 00:15:46,870
and that enables the infant
to move from a chaotic

255
00:15:46,870 --> 00:15:51,622
lack of regulation of affect
and regulation of attention,

256
00:15:51,622 --> 00:15:56,468
regulation of impulses, and
regulation of bodily states,

257
00:15:56,468 --> 00:15:59,908
to smoothly regulated
ability to handle each new

258
00:15:59,908 --> 00:16:04,087
situation with tools that
are learned from the parent.

259
00:16:04,924 --> 00:16:09,708
So in many ways, this is similar
to what we do in therapy.

260
00:16:09,708 --> 00:16:14,708
We are, in our dyadic
relationship with the client,

261
00:16:15,861 --> 00:16:20,310
helping the client develop
some of these skills,

262
00:16:20,809 --> 00:16:25,119
and we generally move from
therapist led regulation,

263
00:16:25,119 --> 00:16:28,184
to co-regulation with the client,

264
00:16:28,184 --> 00:16:31,680
to co-creation of new meanings

265
00:16:31,680 --> 00:16:35,146
for what the client's experiences are.

266
00:16:35,614 --> 00:16:39,585
Finally, to the development
of competency by the client,

267
00:16:39,585 --> 00:16:42,918
emotional competency and
regulatory competency,

268
00:16:42,918 --> 00:16:46,024
and the ability to fruitfully collaborate

269
00:16:46,024 --> 00:16:49,482
in solving the client's problems.

270
00:16:52,174 --> 00:16:54,990
I know some of you work with
children and some of you work

271
00:16:54,990 --> 00:16:58,594
with adults, so I'm going to
talk a little bit about both.

272
00:16:59,798 --> 00:17:04,798
But I'm going to start
by focusing on the model

273
00:17:05,054 --> 00:17:08,927
of treatment that I've
had the most training in,

274
00:17:08,927 --> 00:17:13,927
which is Dan Hughes' Dyadic
Developmental Psychotherapy.

275
00:17:15,051 --> 00:17:17,692
I'm going to give you
more detail about this,

276
00:17:17,692 --> 00:17:21,160
partly because I know more
about it, partly because

277
00:17:21,160 --> 00:17:25,162
I think it helps to
describe one model in detail

278
00:17:25,162 --> 00:17:28,083
in order to give you a
sense of what the different

279
00:17:28,083 --> 00:17:32,167
aspects are of the way
to work with a child

280
00:17:33,867 --> 00:17:36,415
who's had significant
attachment disruption

281
00:17:36,415 --> 00:17:38,559
and perhaps trauma along the way.

282
00:17:38,559 --> 00:17:42,056
If you think about it, for a baby,

283
00:17:42,677 --> 00:17:45,984
attachment disruption means trauma.

284
00:17:47,604 --> 00:17:50,101
When you think of the
importance of the caregiver,

285
00:17:50,101 --> 00:17:53,651
essentially the caregiver
is the child's world.

286
00:17:53,651 --> 00:17:56,704
So losing a caregiver
means losing the world,

287
00:17:56,704 --> 00:18:01,587
the end of the world, and we can't say,

288
00:18:01,587 --> 00:18:03,423
"Oh, they were so young.

289
00:18:03,423 --> 00:18:06,759
"Oh, but the other caregiver was so nice,"

290
00:18:06,759 --> 00:18:08,947
or anything like that, because...

291
00:18:09,303 --> 00:18:14,303
for this child, that
caregiver was the world, and

292
00:18:14,707 --> 00:18:19,707
it was traumatic to lose the
caregiver, however it happened.

293
00:18:20,584 --> 00:18:24,441
If a child has had experience
of loss, and this doesn't

294
00:18:24,441 --> 00:18:28,154
necessarily mean death, it
may mean the parent leaving,

295
00:18:28,154 --> 00:18:32,946
it may mean the parent is
totally unavailable in relation

296
00:18:32,946 --> 00:18:36,483
to substance use or mental health issues.

297
00:18:38,628 --> 00:18:40,629
It may mean a number of things.

298
00:18:40,629 --> 00:18:42,553
That parent...

299
00:18:43,254 --> 00:18:46,843
is not there for the child,
and the child is experiencing

300
00:18:46,843 --> 00:18:49,896
a lack of safety and security
and all the regulatory

301
00:18:49,896 --> 00:18:52,227
functions that the parents
should be modeling,

302
00:18:52,227 --> 00:18:55,350
should be providing to the child.

303
00:18:55,786 --> 00:19:00,097
I think we tend to underestimate
the level of trauma

304
00:19:00,097 --> 00:19:04,031
children have experienced
when they've had early losses.

305
00:19:04,290 --> 00:19:07,298
I know when I first started working

306
00:19:08,600 --> 00:19:13,004
in a new city before I had
my license, I volunteered for

307
00:19:13,004 --> 00:19:17,508
a while on a pre-adolescent
inpatient unit at a hospital.

308
00:19:18,617 --> 00:19:22,125
One of the things I did
was to read kids' charts.

309
00:19:22,492 --> 00:19:27,257
Usually, if a child, a
pre-adolescent, was hospitalized,

310
00:19:27,257 --> 00:19:31,025
almost inevitably there was
an example in their chart

311
00:19:31,025 --> 00:19:35,111
in the history section
of loss or disruption.

312
00:19:35,194 --> 00:19:37,855
Maybe the child went to
live with grandparents

313
00:19:37,855 --> 00:19:42,855
for a year or two, maybe a
parent disappeared, maybe

314
00:19:44,657 --> 00:19:47,983
kin took over at some
point, maybe a parent

315
00:19:47,983 --> 00:19:51,352
was gone for a period of
time when they were ill.

316
00:19:52,084 --> 00:19:55,039
And almost inevitably these...

317
00:19:55,546 --> 00:19:58,725
to me, profoundly important
experiences the child had

318
00:19:58,725 --> 00:20:03,167
early in life were not
reflected upon in the rest

319
00:20:03,167 --> 00:20:06,606
of the child's chart, and
were not seen as the basis

320
00:20:06,606 --> 00:20:09,899
for a number of the child's problems,

321
00:20:10,411 --> 00:20:14,325
but I believe that they were, usually.

322
00:20:16,494 --> 00:20:20,618
If you're trained by Dan Hughes,

323
00:20:20,618 --> 00:20:24,588
he's a delightful person and
I recommend his trainings,

324
00:20:25,687 --> 00:20:28,983
he says the goal of his model of treatment

325
00:20:28,983 --> 00:20:33,983
"is to restore the joyful
dialogic companionship

326
00:20:34,621 --> 00:20:37,272
"which was more likely to
have been present during

327
00:20:37,272 --> 00:20:42,004
"the early years, to
discover the core reciprocal

328
00:20:42,004 --> 00:20:45,813
"intentions that lie under
the difficulties, to accept

329
00:20:45,813 --> 00:20:49,493
"these intentions, and to
communicate with each other

330
00:20:49,493 --> 00:20:52,258
"in ways that facilitate understanding,

331
00:20:52,258 --> 00:20:55,673
"empathy, and interactive repair."

332
00:21:02,325 --> 00:21:04,533
Let's talk about the
features of this model

333
00:21:04,533 --> 00:21:07,595
of attachment-based treatment.

334
00:21:08,986 --> 00:21:13,188
It's dyadic, and the reason
it's dyadic is that the child's

335
00:21:13,188 --> 00:21:17,695
problems occurred when
the caregiver-infant dyad

336
00:21:17,695 --> 00:21:21,175
was inadequate to support
secure attachment.

337
00:21:21,891 --> 00:21:24,651
Healing also must take place in a dyad,

338
00:21:24,651 --> 00:21:27,452
and I think you understand
by now why that would be.

339
00:21:27,452 --> 00:21:30,011
Because it's in a dyadic relationship that

340
00:21:30,011 --> 00:21:32,598
we learn these important skills.

341
00:21:33,808 --> 00:21:36,245
The focus is on healing the dyad,

342
00:21:36,245 --> 00:21:38,710
the caregiver and the child.

343
00:21:38,710 --> 00:21:42,027
So even if you have a
foster or an adopted parent,

344
00:21:42,027 --> 00:21:45,618
so that the caregiver is not the one who

345
00:21:45,941 --> 00:21:49,319
didn't give the child what they
needed when they were young,

346
00:21:50,074 --> 00:21:52,140
the relationship is
troubled or they wouldn't

347
00:21:52,140 --> 00:21:56,097
be there seeing you, so
you still need to focus

348
00:21:56,097 --> 00:22:00,049
on the caregiver as well as the child.

349
00:22:01,108 --> 00:22:05,657
In order for the caregiver to
provide a secure attachment

350
00:22:05,657 --> 00:22:10,415
for the child, they need a
secure attachment themselves.

351
00:22:11,012 --> 00:22:14,741
And often this will mean that
when you start working with

352
00:22:14,741 --> 00:22:17,547
a child, you'll find that
the caregiver needs their own

353
00:22:17,547 --> 00:22:20,825
treatment to help them
provide the security

354
00:22:20,825 --> 00:22:24,072
that will allow the
child to become secure.

355
00:22:30,269 --> 00:22:33,630
So the focus of therapy is
to help the parent become

356
00:22:33,630 --> 00:22:38,571
a therapeutic agent, who
learns effective techniques

357
00:22:38,571 --> 00:22:41,508
to heal the child's attachment.

358
00:22:44,633 --> 00:22:48,909
So you're really asking a
lot of these caregivers.

359
00:22:53,915 --> 00:22:58,704
It's hard, as a therapist,
to see a caregiver

360
00:22:58,704 --> 00:23:02,985
who can't provide the extra
help that a child needs

361
00:23:02,985 --> 00:23:05,594
to develop this level of security.

362
00:23:05,594 --> 00:23:08,261
And it does take extra help.

363
00:23:08,506 --> 00:23:11,975
A baby is sort of programmed for

364
00:23:11,975 --> 00:23:14,899
their brain to soak up caregiving

365
00:23:16,031 --> 00:23:20,321
relationships and develop the
skills they need to develop.

366
00:23:20,321 --> 00:23:23,323
If you are working with
an older child or an adult

367
00:23:23,323 --> 00:23:27,477
who has developed maybe warped skills

368
00:23:27,477 --> 00:23:30,352
or maybe has never developed skills,

369
00:23:30,352 --> 00:23:34,234
they still have developed
ways of being in the world.

370
00:23:34,471 --> 00:23:37,478
So essentially you're needing to help them

371
00:23:37,478 --> 00:23:41,101
break those down and start with new ones

372
00:23:41,101 --> 00:23:43,360
at a time in their life
when their brain isn't

373
00:23:43,360 --> 00:23:45,878
programmed to be soaking this up.

374
00:23:45,878 --> 00:23:48,462
So it's a particularly difficult project,

375
00:23:48,462 --> 00:23:52,453
and it takes a lot of time to do this,

376
00:23:52,453 --> 00:23:55,104
and that's one reason you're
really training a parent

377
00:23:55,104 --> 00:23:58,461
as a therapeutic agent,
because an hour a week,

378
00:23:58,461 --> 00:24:01,398
even three hours a week,
isn't going to do it.

379
00:24:01,398 --> 00:24:04,304
The parent needs to be
on the ground providing

380
00:24:04,304 --> 00:24:07,192
this security and the regulatory function

381
00:24:07,192 --> 00:24:10,051
on a daily basis, all the time.

382
00:24:11,367 --> 00:24:14,465
This therapy is also
called "developmental"

383
00:24:14,783 --> 00:24:19,221
because the child's social
and emotional development

384
00:24:19,221 --> 00:24:22,725
has been frozen or warped
by poor caregiving.

385
00:24:23,011 --> 00:24:26,276
And the therapy must work
with the child where she

386
00:24:26,276 --> 00:24:30,416
or he is developmentally,
not chronologically.

387
00:24:32,676 --> 00:24:34,739
So it's very important
to know early development

388
00:24:34,739 --> 00:24:37,432
to understand where the child is stuck.

389
00:24:38,507 --> 00:24:41,049
I want to say one word
about this, working with

390
00:24:41,049 --> 00:24:44,727
a child developmentally
and not chronologically.

391
00:24:44,727 --> 00:24:48,330
Some people criticize those
who work in this field

392
00:24:48,330 --> 00:24:51,421
for infantilizing children or doing

393
00:24:51,421 --> 00:24:54,640
regression therapy and so forth.

394
00:24:55,529 --> 00:24:57,692
I don't see it that way at all.

395
00:24:57,692 --> 00:25:02,378
I really think when you have
a 10 year old who's expressing

396
00:25:02,378 --> 00:25:06,773
needs in the way a two year old might,

397
00:25:07,409 --> 00:25:10,429
you really need to deal
with that 10 year old

398
00:25:11,232 --> 00:25:13,609
in a 2 year old way, and
that's going to be sort of

399
00:25:13,609 --> 00:25:15,266
difficult, because 10 year olds don't like

400
00:25:15,266 --> 00:25:17,532
to be treated like two year olds.

401
00:25:17,532 --> 00:25:19,366
So you're going to need a find a way

402
00:25:19,366 --> 00:25:22,139
to meet those two year old needs

403
00:25:23,103 --> 00:25:27,933
without making this 10
year old feel infantilized.

404
00:25:29,327 --> 00:25:31,861
Sometimes they don't
mind being infantilized.

405
00:25:31,861 --> 00:25:34,649
I've worked with lots of
kids who start to feel

406
00:25:34,649 --> 00:25:36,896
some of those early, primitive feelings

407
00:25:36,896 --> 00:25:41,071
and crawl into their parents'
laps almost immediately.

408
00:25:43,259 --> 00:25:46,738
But sometimes you have
to be quite careful about

409
00:25:46,738 --> 00:25:51,391
how you go about providing them the...

410
00:25:55,339 --> 00:25:57,411
the love and the security and the

411
00:25:57,411 --> 00:25:59,846
skill-building that they need.

412
00:26:02,358 --> 00:26:06,633
And you also find that kids
developmentally may change

413
00:26:06,633 --> 00:26:10,781
the age that they are
behaving, so they may

414
00:26:11,040 --> 00:26:12,978
be showing two year
old needs at one point,

415
00:26:12,978 --> 00:26:15,015
four year old needs at another point.

416
00:26:15,015 --> 00:26:18,278
They may be looking
perfectly normally developing

417
00:26:18,278 --> 00:26:21,507
at another point, something
happens, they regress.

418
00:26:21,507 --> 00:26:24,321
They look more two year old again.

419
00:26:24,321 --> 00:26:28,078
So it's sort of a moving
target, and you have to keep

420
00:26:28,078 --> 00:26:31,416
meeting the child where
they are developmentally.

421
00:26:32,825 --> 00:26:37,825
Dan Hughes has what he
calls the "attitude,"

422
00:26:40,121 --> 00:26:43,062
the acronym for which is PACE.

423
00:26:43,718 --> 00:26:47,004
His treatment is always playful,

424
00:26:47,004 --> 00:26:49,970
and there's a need to help parents,

425
00:26:49,970 --> 00:26:52,383
who are often sort of grim and frustrated

426
00:26:52,383 --> 00:26:55,648
when they bring a child
in, find an ability

427
00:26:55,648 --> 00:26:57,963
to playfully engage with their child.

428
00:26:57,963 --> 00:27:00,489
Dan does this by example,
and it's important for

429
00:27:00,489 --> 00:27:03,893
the therapist to provide
that example so that

430
00:27:04,265 --> 00:27:06,631
a lightness can emerge
in the relationship.

431
00:27:06,631 --> 00:27:08,745
Because if you think
about it, with babies,

432
00:27:08,745 --> 00:27:11,472
there's a really lovely lightness and joy

433
00:27:11,472 --> 00:27:14,253
that's occurring, playfulness,

434
00:27:14,866 --> 00:27:19,154
excitement, and children
need that experience,

435
00:27:19,154 --> 00:27:21,744
even if they didn't get it early on.

436
00:27:22,932 --> 00:27:27,932
A is for Accepting, and this is critical.

437
00:27:29,406 --> 00:27:31,956
Dan is very good at making it clear

438
00:27:31,956 --> 00:27:36,172
that he accepts this
child, and even accepts

439
00:27:36,172 --> 00:27:39,521
whatever negative behavior may
be the topic of conversation

440
00:27:39,521 --> 00:27:43,780
as the best way the child knows
to achieve goals at present.

441
00:27:44,495 --> 00:27:46,322
This doesn't mean that he accepts

442
00:27:46,322 --> 00:27:49,510
that this is the way it's
going to be, but that it makes

443
00:27:49,510 --> 00:27:53,426
sense to him why the child
would behave this way.

444
00:27:54,050 --> 00:27:56,374
He makes sense of it, and then he helps

445
00:27:56,374 --> 00:27:59,953
the child find ways to move beyond that.

446
00:28:00,964 --> 00:28:05,127
The C in PACE stands for Curious.

447
00:28:05,127 --> 00:28:08,280
Curious about why this is happening now.

448
00:28:09,452 --> 00:28:13,496
So Dan, when a child says...

449
00:28:15,402 --> 00:28:19,960
"Last night at dinner I threw
the plate at my mother."

450
00:28:21,091 --> 00:28:25,182
Dan will just sit there and be curious.

451
00:28:25,904 --> 00:28:28,173
"I wonder why you did that.

452
00:28:28,173 --> 00:28:30,529
"I would've thought you'd
want to eat that food,

453
00:28:30,529 --> 00:28:33,759
"but you really didn't want
to eat the food I guess,

454
00:28:33,759 --> 00:28:36,305
"or what was going on?"

455
00:28:38,730 --> 00:28:42,039
By that kind of sort of naive curiosity,

456
00:28:42,039 --> 00:28:45,152
he gives the child a chance to explain

457
00:28:45,152 --> 00:28:47,995
what the internal process was.

458
00:28:48,560 --> 00:28:50,335
And as you'll see, that's a really

459
00:28:50,335 --> 00:28:52,721
important part of what he talks about.

460
00:28:53,004 --> 00:28:56,899
The E in PACE stands for Empathic.

461
00:28:56,899 --> 00:29:01,490
So he is infinitely
empathic with this child,

462
00:29:01,490 --> 00:29:04,370
who may be pretty annoying at times.

463
00:29:04,370 --> 00:29:06,110
He's also empathic with the parent

464
00:29:06,110 --> 00:29:08,472
and what the parent's putting up with.

465
00:29:08,472 --> 00:29:13,105
So this attitude is a
very important aspect of

466
00:29:13,105 --> 00:29:16,157
dyadic development in psychotherapy.

467
00:29:19,834 --> 00:29:23,064
Parents in this model are seen

468
00:29:23,064 --> 00:29:26,462
as the agents of therapeutic change,

469
00:29:26,963 --> 00:29:30,266
and the problem is seen as being the child

470
00:29:30,266 --> 00:29:35,266
hasn't learned to use a
relationship to change and grow.

471
00:29:36,616 --> 00:29:39,972
They have to learn this
first with parents.

472
00:29:40,869 --> 00:29:45,749
It's Dan's belief and mine
that you can't learn how

473
00:29:45,749 --> 00:29:50,052
to use an attachment relationship to grow

474
00:29:50,901 --> 00:29:53,515
if you're doing individual
therapy with a person

475
00:29:53,515 --> 00:29:56,328
who's not your attachment figure.

476
00:29:57,059 --> 00:30:00,808
It may be possible for adults,
and even for older teens

477
00:30:00,808 --> 00:30:04,250
to do this, to really see a
therapist as an attachment

478
00:30:04,250 --> 00:30:07,043
figure and to use them that way,

479
00:30:07,043 --> 00:30:11,171
but younger children need more 24/7

480
00:30:11,171 --> 00:30:15,514
contact and ongoing interaction for that.

481
00:30:16,202 --> 00:30:18,798
So most of Dan's therapy is done

482
00:30:18,798 --> 00:30:21,626
with the child and the parent present.

483
00:30:24,293 --> 00:30:27,117
Two of the primary processes
that are taking place

484
00:30:27,117 --> 00:30:30,822
in this therapy model
are the co-regulating

485
00:30:30,822 --> 00:30:33,830
of affect, starting with the parent

486
00:30:33,830 --> 00:30:37,112
or the therapist regulating the child,

487
00:30:37,827 --> 00:30:40,689
and the co-creation of new meanings.

488
00:30:40,914 --> 00:30:45,141
If you think about it,
it's really critical that

489
00:30:45,141 --> 00:30:50,141
when you have experienced
negative experiences early,

490
00:30:51,071 --> 00:30:54,705
that you find a new way
of assigning meaning

491
00:30:54,705 --> 00:30:58,407
to those experiences that enables you

492
00:30:58,407 --> 00:31:02,454
to use it positively and to grow from it.

493
00:31:05,867 --> 00:31:08,537
One of the things Dan
Hughes talks about a lot

494
00:31:08,537 --> 00:31:13,178
is the use of
intersubjectivity in treatment.

495
00:31:14,208 --> 00:31:17,395
Intersubjectivity is a concept that was

496
00:31:17,395 --> 00:31:21,266
I think originated by Colwyn Trevarthen,

497
00:31:21,298 --> 00:31:23,689
and there are two levels of it.

498
00:31:23,689 --> 00:31:27,180
The first level of
intersubjectivity, which is important

499
00:31:27,180 --> 00:31:32,180
to use in therapy, is sharing
a feeling between two people.

500
00:31:35,041 --> 00:31:39,397
I'm happy, you see I'm happy,
you share my happiness.

501
00:31:39,770 --> 00:31:44,549
The secondary intersubjectivity is seen

502
00:31:44,549 --> 00:31:48,052
as sharing attention to an object.

503
00:31:48,052 --> 00:31:53,047
So we're both looking at the
dog over there running around,

504
00:31:53,047 --> 00:31:56,253
and we're sharing our
attention and sharing our

505
00:31:56,253 --> 00:31:59,899
experience of watching the dog run around.

506
00:32:00,479 --> 00:32:04,427
Intersubjectivity is
non-verbal at the core.

507
00:32:07,134 --> 00:32:09,870
The therapist is not neutral because

508
00:32:09,870 --> 00:32:13,657
they're really sharing in
the experience of the client,

509
00:32:14,108 --> 00:32:17,427
and it creates a sense of
safety that this client's

510
00:32:17,427 --> 00:32:19,698
experience is shared,
particularly when these are

511
00:32:19,698 --> 00:32:22,425
difficult experiences we're talking about.

512
00:32:22,729 --> 00:32:25,960
Having them shared feels like someone's

513
00:32:25,960 --> 00:32:28,741
carrying your burden with you.

514
00:32:30,024 --> 00:32:33,041
From within the intersubjective stance,

515
00:32:33,041 --> 00:32:38,041
the therapist can co-regulate
affect more effectively,

516
00:32:38,823 --> 00:32:41,242
and help to co-create new meanings

517
00:32:41,242 --> 00:32:44,061
for the difficult experiences.

518
00:32:44,657 --> 00:32:47,581
This intersubjective
experience also enables

519
00:32:47,581 --> 00:32:52,349
right brain co-regulation,
so it becomes...

520
00:32:52,349 --> 00:32:54,737
essentially it's what a
good caregiver's doing

521
00:32:54,737 --> 00:32:57,420
with an infant, and it enables a therapist

522
00:32:57,420 --> 00:33:01,125
to do this with an older child or adult.

523
00:33:02,320 --> 00:33:05,756
Another important concept in Dan's work,

524
00:33:06,512 --> 00:33:08,581
it's also important in the attachment work

525
00:33:08,581 --> 00:33:11,112
we've talked about, is attunement.

526
00:33:11,812 --> 00:33:15,375
So the therapist is attuned to the child.

527
00:33:16,362 --> 00:33:19,569
At times the child may be feeling

528
00:33:19,569 --> 00:33:23,634
very strong affect, and the therapist

529
00:33:23,634 --> 00:33:27,945
matches the vitality
of that child's affect.

530
00:33:31,189 --> 00:33:34,683
If a child's really yelling,
"I hate you, you're the worst

531
00:33:34,683 --> 00:33:37,962
"therapist in the world,"
whatever's going on,

532
00:33:37,962 --> 00:33:41,073
the therapist needs to
respond with the level

533
00:33:41,073 --> 00:33:43,629
of vitality that the
child is experiencing.

534
00:33:43,629 --> 00:33:47,751
So you can say, "I see that
you are really mad at me.

535
00:33:47,751 --> 00:33:51,643
"I understand that that
really is upsetting to you."

536
00:33:52,985 --> 00:33:54,815
What this means is you're sort of matching

537
00:33:54,815 --> 00:33:57,638
the level of the child's feeling.

538
00:33:57,638 --> 00:34:01,521
It enables you then to help
bring down the feeling,

539
00:34:01,521 --> 00:34:05,462
step by step, and begin to
regulate that affect into

540
00:34:05,462 --> 00:34:09,080
something more manageable that
you can work with together.

541
00:34:10,548 --> 00:34:13,253
The result of this for the
child is that he experiences

542
00:34:13,253 --> 00:34:18,253
himself being experienced
differently, and it enables

543
00:34:18,414 --> 00:34:22,470
new meanings to emerge as
a result of the therapist's

544
00:34:22,470 --> 00:34:26,554
reflective function on
the child's process.

545
00:34:30,496 --> 00:34:32,176
Another concept Dan talks about

546
00:34:32,176 --> 00:34:37,176
a lot is affective slash
reflective dialogue.

547
00:34:39,454 --> 00:34:42,480
The dialogue that occurs
with the therapist

548
00:34:42,480 --> 00:34:46,407
is expressive both
verbally and nonverbally,

549
00:34:46,648 --> 00:34:51,476
and it's integrated as
both implicit and explicit

550
00:34:51,476 --> 00:34:54,548
awareness into the sense of self.

551
00:34:55,502 --> 00:34:59,640
So you are reflecting on
the client's experience,

552
00:34:59,640 --> 00:35:02,234
you're reflecting on
your experience of what's

553
00:35:02,234 --> 00:35:07,234
going on in the room,
and you're enabling that

554
00:35:07,505 --> 00:35:10,047
reflection to become part of the client's

555
00:35:10,047 --> 00:35:13,492
understanding of how things are going.

556
00:35:18,794 --> 00:35:22,924
Often when these kids
present in treatment,

557
00:35:25,725 --> 00:35:28,748
the parents are frustrated,
the parents are upset,

558
00:35:28,748 --> 00:35:32,481
the kid is angry,
doesn't want to be there,

559
00:35:34,691 --> 00:35:38,214
and often if they've
been in treatment before,

560
00:35:38,214 --> 00:35:41,048
they've been given a lot
of behavioral techniques

561
00:35:41,048 --> 00:35:43,836
to help manage the child's behavior,

562
00:35:43,836 --> 00:35:46,816
and often this hasn't been effective.

563
00:35:48,101 --> 00:35:51,967
Because a child who really
wants to be in control

564
00:35:51,967 --> 00:35:56,153
because he doesn't trust
adults for good reasons,

565
00:35:57,327 --> 00:36:02,256
is a very strong child, and he can outwit

566
00:36:02,256 --> 00:36:05,411
almost any behavior plan you come up with,

567
00:36:05,411 --> 00:36:10,371
because his real primary goal
in life is to stay in control.

568
00:36:10,371 --> 00:36:12,689
He's seen adults...

569
00:36:14,113 --> 00:36:16,483
hurt him when they were
in control too many times,

570
00:36:16,483 --> 00:36:19,069
and he's not going to
let that happen again.

571
00:36:19,671 --> 00:36:22,889
So really, the job of
the therapist is to help

572
00:36:22,889 --> 00:36:25,494
the child and the parent
find a way to have

573
00:36:25,494 --> 00:36:28,334
a trusting relationship,
and when the child is

574
00:36:28,334 --> 00:36:32,066
profoundly distrustful,
this is very difficult.

575
00:36:33,271 --> 00:36:37,271
The therapist's job in
this model is to search

576
00:36:37,271 --> 00:36:40,285
under the presenting
symptoms of the child,

577
00:36:40,285 --> 00:36:43,298
the parents, or the
relationship, and to find

578
00:36:43,298 --> 00:36:45,895
new meanings for the symptoms.

579
00:36:46,180 --> 00:36:50,332
So a child who is behaving
destructively, for instance,

580
00:36:50,332 --> 00:36:52,097
and who's been given consequences

581
00:36:52,097 --> 00:36:55,196
and consequences and
consequences for this,

582
00:36:57,063 --> 00:37:02,063
it may be that you'll learn
by talking to this child that

583
00:37:04,474 --> 00:37:07,185
he's feeling devalued,
as a result, he tends

584
00:37:07,185 --> 00:37:09,241
to be destructive toward things.

585
00:37:09,522 --> 00:37:12,753
He's so angry at his own...

586
00:37:15,149 --> 00:37:20,149
devaluation that he devalues
other people and other things

587
00:37:20,207 --> 00:37:23,735
and acts destructively or aggressively.

588
00:37:24,869 --> 00:37:27,285
If you can get to this
point where you understand

589
00:37:27,285 --> 00:37:31,141
how he's essentially expressing outwardly

590
00:37:31,141 --> 00:37:34,110
the feelings that are inside him,

591
00:37:34,547 --> 00:37:38,275
you can start with a real understanding

592
00:37:38,275 --> 00:37:42,144
of why one would feel
like being destructive.

593
00:37:42,771 --> 00:37:46,836
And if you start there and
you talk to him about that,

594
00:37:47,552 --> 00:37:50,383
you may find that it's
possible to learn more about

595
00:37:50,383 --> 00:37:55,383
what is behind that sense, that
there's no point in trying.

596
00:37:57,111 --> 00:37:59,883
Alternatively, you may find a child,

597
00:37:59,883 --> 00:38:02,466
often children who are
being placed in different

598
00:38:02,466 --> 00:38:05,135
homes through the foster care system,

599
00:38:05,135 --> 00:38:06,896
are convinced that they're
going to be kicked out

600
00:38:06,896 --> 00:38:09,126
of this house too, because
they might have lost

601
00:38:09,126 --> 00:38:12,629
all the parents they've
ever had, and they believe

602
00:38:12,629 --> 00:38:16,378
strongly that they're
going to lose this one too.

603
00:38:16,864 --> 00:38:20,755
And you may see them trying to provoke

604
00:38:21,099 --> 00:38:26,099
the rejection before, so
that they're not once again

605
00:38:27,065 --> 00:38:32,065
surprised by the devastating
loss of another parent.

606
00:38:32,425 --> 00:38:36,352
So they may be acting
out almost intentionally

607
00:38:36,352 --> 00:38:39,308
to get kicked out of this home.

608
00:38:41,512 --> 00:38:44,351
They may be acting out
against a sibling in the home

609
00:38:44,351 --> 00:38:47,208
because that sibling seems
to have things or get things

610
00:38:47,208 --> 00:38:50,341
that they don't feel
that they have or get,

611
00:38:50,341 --> 00:38:54,573
so they want to destroy
that sibling's happiness.

612
00:38:55,824 --> 00:38:59,839
Whatever these things are,
they go beyond the complexity

613
00:38:59,839 --> 00:39:02,595
of simply, "Oh, you broke this,
therefore your consequence

614
00:39:02,595 --> 00:39:07,353
"is you must earn the money
to pay back," whatever it is,

615
00:39:09,745 --> 00:39:13,647
which doesn't get at what
is lying under the symptoms.

616
00:39:13,647 --> 00:39:16,723
When you're doing the work
in dyadic developmental

617
00:39:16,723 --> 00:39:19,981
therapy, you're always
looking under the symptoms.

618
00:39:20,847 --> 00:39:22,973
As I will explain in a
minute, that doesn't mean

619
00:39:22,973 --> 00:39:27,513
you're not providing
consequences, but you're trying

620
00:39:27,513 --> 00:39:31,287
to provide a context that
will give new meanings

621
00:39:31,369 --> 00:39:35,044
or help the child find
the meanings for their,

622
00:39:36,807 --> 00:39:39,469
for the behaviors that they're doing.

623
00:39:40,201 --> 00:39:45,201
You start with finding positive
qualities about the child.

624
00:39:49,119 --> 00:39:53,766
And central to the deepening
of the intersubjective

625
00:39:53,766 --> 00:39:57,432
experience is the
therapist's active curiosity

626
00:39:57,432 --> 00:40:00,005
about family members' experiences.

627
00:40:00,005 --> 00:40:03,974
You're always curious, you're
always trying to figure out

628
00:40:03,974 --> 00:40:07,385
what's beneath the symptoms, and children

629
00:40:07,385 --> 00:40:09,945
can be disarmed by this approach and can

630
00:40:09,945 --> 00:40:13,005
end up being more willing to talk.

631
00:40:14,192 --> 00:40:16,293
One of the...

632
00:40:17,634 --> 00:40:20,920
central tenets of Dan's philosophy is that

633
00:40:20,920 --> 00:40:23,776
when children have
experienced attachment loss

634
00:40:23,776 --> 00:40:28,776
and disruption, they live in
a state of fairly toxic shame,

635
00:40:32,057 --> 00:40:34,544
because they feel that they are to blame.

636
00:40:34,544 --> 00:40:37,577
I've never met a child who
lost a parent who didn't

637
00:40:37,577 --> 00:40:41,677
feel that somehow they were
to blame for that loss.

638
00:40:41,817 --> 00:40:45,684
No matter how unreasonable that might be.

639
00:40:46,067 --> 00:40:49,542
And that belief, that "I'm
such a bad person that

640
00:40:49,542 --> 00:40:53,897
"nobody would want to
parent me," is profound

641
00:40:53,897 --> 00:40:57,672
and pervasive in children's development.

642
00:40:58,412 --> 00:41:00,692
And Dan talks a lot about helping children

643
00:41:00,692 --> 00:41:05,692
turn shame into guilt, guilt being seen

644
00:41:05,761 --> 00:41:09,537
as a much more positive emotion.

645
00:41:11,173 --> 00:41:12,385
I'm going to talk a little bit about

646
00:41:12,385 --> 00:41:14,651
the difference between shame and guilt.

647
00:41:15,087 --> 00:41:18,612
Shame has a focus on the self.

648
00:41:18,880 --> 00:41:21,215
It's about me, "I'm bad."

649
00:41:21,215 --> 00:41:24,142
Whereas guilt has a focus on behavior.

650
00:41:24,142 --> 00:41:26,261
"Oh, I did this thing that wasn't right.

651
00:41:26,261 --> 00:41:29,263
"I broke my mother's favorite vase."

652
00:41:32,969 --> 00:41:35,043
If you feel that you're bad, there's no

653
00:41:35,043 --> 00:41:38,257
real remediation that's possible,

654
00:41:38,732 --> 00:41:40,653
whereas if you're feeling guilty about

655
00:41:40,653 --> 00:41:43,353
breaking your mother's favorite vase,

656
00:41:44,092 --> 00:41:46,317
you may find ways to make it up to her.

657
00:41:46,317 --> 00:41:48,763
You may want to do nice things for her.

658
00:41:48,763 --> 00:41:51,584
You may want to buy her a
new vase, you may want...

659
00:41:51,584 --> 00:41:52,892
There are a number of ways that you might

660
00:41:52,892 --> 00:41:56,352
find to remediate your behavior.

661
00:41:59,848 --> 00:42:04,626
Shame is concerned with other
people's evaluation of you,

662
00:42:04,919 --> 00:42:09,175
whereas guilt is concerned with
your effect on other people.

663
00:42:10,391 --> 00:42:14,989
Shame leads to a desire to
hide or to attack others,

664
00:42:14,989 --> 00:42:19,450
because the feeling is
so profoundly negative,

665
00:42:19,956 --> 00:42:23,967
whereas guilt leads to a desire to confess

666
00:42:23,967 --> 00:42:27,033
and repair the relationship.

667
00:42:29,029 --> 00:42:32,221
Shame leads to a sense
of split self between

668
00:42:32,221 --> 00:42:36,819
the observed, devalued self,
and the observing self,

669
00:42:37,767 --> 00:42:40,775
and guilt leads to a
sense of a unified self

670
00:42:40,775 --> 00:42:44,416
that's not devalued,
that has made a mistake

671
00:42:44,416 --> 00:42:47,600
but has done things to make it better,

672
00:42:47,600 --> 00:42:51,311
so one can go on with a clear conscience

673
00:42:51,311 --> 00:42:54,008
and a good feeling about oneself.

674
00:42:55,435 --> 00:43:00,435
Dan talks a lot in his treatments
about breaks and repairs.

675
00:43:02,224 --> 00:43:05,280
If you remember in talking
about attachment development,

676
00:43:05,280 --> 00:43:07,382
we talked about interactive repair,

677
00:43:07,382 --> 00:43:09,643
and the importance of interactive repair

678
00:43:09,643 --> 00:43:14,435
in a toddler's evolving sense
of self and the sense that,

679
00:43:14,435 --> 00:43:18,053
"I'm a good person even though
I do things that are wrong."

680
00:43:19,433 --> 00:43:23,478
Often for these children
who've lost parents

681
00:43:23,478 --> 00:43:26,215
and who've experienced trauma and abuse,

682
00:43:26,364 --> 00:43:29,707
there's an expectation that a break,

683
00:43:30,063 --> 00:43:32,942
they're doing something
bad, means the end,

684
00:43:32,942 --> 00:43:36,137
and there's a sense of lack of safety.

685
00:43:37,561 --> 00:43:39,861
When that happens the
therapist needs to be

686
00:43:39,861 --> 00:43:43,178
noticing subtle signs of the break.

687
00:43:43,773 --> 00:43:48,586
And sometimes these can
be, breaks can occur

688
00:43:48,983 --> 00:43:52,116
when the child or client misinterprets

689
00:43:52,116 --> 00:43:54,931
what a therapist has said, or a therapist

690
00:43:56,844 --> 00:44:00,785
maybe comes on too strong, or is...

691
00:44:01,253 --> 00:44:03,250
starts talking to a child about something

692
00:44:03,250 --> 00:44:07,457
negative that's gone
on, and the child feels,

693
00:44:07,457 --> 00:44:12,457
"Oh, I've lost you, you're
not on my side any more."

694
00:44:14,082 --> 00:44:16,337
It's very important in
treatment to be noticing

695
00:44:16,337 --> 00:44:18,908
the subtle signs of the break,

696
00:44:18,908 --> 00:44:21,936
to comment on it, to accept it.

697
00:44:21,936 --> 00:44:23,786
There was a break.

698
00:44:23,786 --> 00:44:27,114
To use active curiosity to explore it,

699
00:44:27,114 --> 00:44:30,600
and to, in the end, repair.

700
00:44:32,092 --> 00:44:35,288
You may be saying, when a child...

701
00:44:36,738 --> 00:44:39,392
suddenly folds his hands
and turns away from you,

702
00:44:39,392 --> 00:44:43,316
or stomps out of the room, or says,

703
00:44:43,316 --> 00:44:45,534
"Oh, that's just the way
you are all the time,"

704
00:44:45,534 --> 00:44:48,505
or whatever happens that lets you know

705
00:44:48,505 --> 00:44:50,188
this child has just felt that there was

706
00:44:50,188 --> 00:44:52,986
a break in the empathic relationship.

707
00:44:53,332 --> 00:44:57,055
It's really important to
be non-defensively curious.

708
00:44:57,055 --> 00:45:00,553
"Wow, I didn't realize I was saying

709
00:45:00,553 --> 00:45:02,503
"something that would upset you like that.

710
00:45:02,503 --> 00:45:03,932
"Can you explain it to me?

711
00:45:03,932 --> 00:45:05,427
"Can you tell me what happened

712
00:45:05,427 --> 00:45:09,291
"and tell me how that feels to you?"

713
00:45:09,665 --> 00:45:14,245
So by being curious,
by being non-defensive,

714
00:45:14,976 --> 00:45:17,775
you can end up learning things.

715
00:45:17,775 --> 00:45:19,282
There may be an interpretation you would

716
00:45:19,282 --> 00:45:23,255
never have thought of,
of what just happened,

717
00:45:23,255 --> 00:45:25,887
or what the child was
talking about, and that

718
00:45:25,887 --> 00:45:29,778
enables you then to move in and repair it.

719
00:45:29,778 --> 00:45:31,622
"Oh, is that what you were thinking?

720
00:45:31,622 --> 00:45:35,094
"You were thinking I
didn't like you because

721
00:45:35,094 --> 00:45:37,405
"I told you that it wasn't a good thing

722
00:45:37,405 --> 00:45:40,103
"to break your mom's stuff all the time.

723
00:45:40,103 --> 00:45:44,182
"You know what, I like you
all the time, no matter what.

724
00:45:44,182 --> 00:45:48,412
"I just want you to find a
way not to be breaking things

725
00:45:48,412 --> 00:45:50,318
"so that you and your
mom can get along better

726
00:45:50,318 --> 00:45:52,801
"and have a better life together."

727
00:45:56,127 --> 00:45:58,181
You've essentially created a new meaning

728
00:45:58,181 --> 00:46:01,442
for what it is that you've just said

729
00:46:01,442 --> 00:46:04,312
that caused the break in the child's mind.

730
00:46:04,312 --> 00:46:09,312
Or if the child's gotten angry
at you because you insist

731
00:46:09,361 --> 00:46:11,900
on talking about these
negative things or whatever

732
00:46:11,900 --> 00:46:16,900
else it is, you also are given
an opportunity then to say,

733
00:46:17,920 --> 00:46:20,612
"I know this is so hard to talk about,

734
00:46:20,612 --> 00:46:23,636
"but if we don't talk about
it, we can never help you

735
00:46:23,636 --> 00:46:26,132
"find a way to make it
better, and I really want

736
00:46:26,132 --> 00:46:28,593
"to help you find a
way to make it better."

737
00:46:29,155 --> 00:46:31,951
You're given a chance to
say these kinds of things,

738
00:46:31,951 --> 00:46:34,541
which can help bring the child

739
00:46:34,541 --> 00:46:37,329
along in the treatment session.

740
00:46:42,098 --> 00:46:45,132
So as a foundation to
do this kind of work,

741
00:46:45,132 --> 00:46:48,348
both parents and therapists
need to be sensitively

742
00:46:48,348 --> 00:46:53,209
attuned to the child to help
form a secure attachment.

743
00:46:53,910 --> 00:46:56,508
That means you put a lot less emphasis

744
00:46:56,508 --> 00:47:01,508
on talking about behavior and
more on underlying emotions.

745
00:47:03,042 --> 00:47:07,542
I often talk to parents about
Ross Greene's Basket System.

746
00:47:07,542 --> 00:47:11,697
He, in his book "The
Explosive Child," talks about

747
00:47:12,369 --> 00:47:15,650
helping parents learn
to put their concerns

748
00:47:15,650 --> 00:47:17,600
about a child into three baskets.

749
00:47:17,600 --> 00:47:19,923
The "A Basket" are things like

750
00:47:19,923 --> 00:47:24,923
hurting other people or
significantly damaging property.

751
00:47:26,520 --> 00:47:29,510
And those are things that
really have to be addressed.

752
00:47:29,510 --> 00:47:33,912
The "B Basket" may include
things like unkind words,

753
00:47:35,523 --> 00:47:38,214
bad manners, things like that that are

754
00:47:38,214 --> 00:47:42,377
important but not as critical as

755
00:47:43,375 --> 00:47:46,554
hurting people and damaging things.

756
00:47:46,677 --> 00:47:49,490
The "C Basket" may include
all kinds of other stuff

757
00:47:49,490 --> 00:47:53,141
like making your bed in the
morning, cleaning up your room,

758
00:47:54,510 --> 00:47:56,388
making sure you bring home your homework,

759
00:47:56,388 --> 00:47:59,157
all kinds of concerns that parents have

760
00:47:59,157 --> 00:48:01,611
that are very legitimate concerns,

761
00:48:01,611 --> 00:48:06,611
but when we have A Basket
concerns that are really serious,

762
00:48:06,972 --> 00:48:10,006
we may need to let the C
Basket concerns go for awhile.

763
00:48:10,006 --> 00:48:12,995
You keep them in the C Basket,
you plan to get to them,

764
00:48:12,995 --> 00:48:17,824
but you don't address
them all at the same time.

765
00:48:17,824 --> 00:48:20,643
That can be overwhelming
to a child and to a parent,

766
00:48:20,643 --> 00:48:23,584
and it can help parents
a lot to do that kind of

767
00:48:23,584 --> 00:48:27,586
prioritizing of concerns so that

768
00:48:27,586 --> 00:48:31,638
you're not focusing on
every negative behavior.

769
00:48:33,637 --> 00:48:36,650
You're providing comfort,
containment, safety,

770
00:48:36,650 --> 00:48:40,191
and empathy, because these
are necessary to facilitate

771
00:48:40,191 --> 00:48:44,502
the child's ability to
resolve their past traumas.

772
00:48:47,401 --> 00:48:49,759
You believe that the
child has to integrate

773
00:48:49,759 --> 00:48:53,097
their past experiences,
informing a coherent

774
00:48:53,097 --> 00:48:56,674
understanding of self and relationships.

775
00:48:58,073 --> 00:48:59,788
We talked a lot about the coherence

776
00:48:59,788 --> 00:49:02,089
of narrative in an adult attachment

777
00:49:02,089 --> 00:49:05,231
relationship, adult attachment interview.

778
00:49:06,904 --> 00:49:09,621
One of the things I didn't talk about is

779
00:49:09,621 --> 00:49:14,621
those adults who are what we
call "earned secure" as adults.

780
00:49:15,558 --> 00:49:19,098
So these are adults who had
negative experiences as a child

781
00:49:19,098 --> 00:49:23,278
and probably had an insecure
attachment as a child,

782
00:49:23,618 --> 00:49:27,808
but as adults, as a result
of therapy or positive

783
00:49:27,808 --> 00:49:32,029
relationship with a
partner, they have come to

784
00:49:33,737 --> 00:49:36,760
understand what happened
to them, reflect on it,

785
00:49:36,760 --> 00:49:41,194
find new meanings, and
develop a secure attachment

786
00:49:41,194 --> 00:49:45,012
relationship in the current
setting, and a secure attachment

787
00:49:45,012 --> 00:49:49,851
model, which has been earned, as they say.

788
00:49:49,851 --> 00:49:51,826
So that's what you're
trying to help children

789
00:49:51,826 --> 00:49:54,767
do in the Dan Hughes approach.

790
00:49:54,767 --> 00:49:58,033
You're trying to help them
integrate their past experiences

791
00:49:58,447 --> 00:50:00,942
and come up with a coherent story

792
00:50:00,942 --> 00:50:04,127
of their selves and their relationships.

793
00:50:06,901 --> 00:50:09,616
I talked a little bit
about using consequences,

794
00:50:09,616 --> 00:50:12,673
and obviously many of these children do

795
00:50:12,673 --> 00:50:15,535
all kinds of negative behavior.

796
00:50:16,450 --> 00:50:20,720
So thinking through how you
use consequences is important,

797
00:50:21,304 --> 00:50:25,616
but one of the most important
things is not to be punitive,

798
00:50:25,616 --> 00:50:28,848
which is very tough for
parents to do often.

799
00:50:31,954 --> 00:50:34,791
Being punitive in a consequence

800
00:50:34,791 --> 00:50:39,488
tends to evoke shame in
the child, and anger,

801
00:50:40,046 --> 00:50:44,360
and when the child's shame is brought up,

802
00:50:44,360 --> 00:50:49,303
they can't constructively
work on their behavior.

803
00:50:50,803 --> 00:50:52,555
It's really critical not to be

804
00:50:52,555 --> 00:50:55,285
punitive toward these children,

805
00:50:55,486 --> 00:50:56,844
and sometimes that takes a lot of work

806
00:50:56,844 --> 00:50:59,613
with parents to help them not do that.

807
00:51:00,112 --> 00:51:02,953
You use consequences to ensure safety

808
00:51:02,953 --> 00:51:07,109
or teach the child better skills,

809
00:51:07,965 --> 00:51:11,599
and when you deliver a consequence,
you do it with empathy.

810
00:51:11,599 --> 00:51:14,052
Very tough to do.

811
00:51:14,355 --> 00:51:19,355
You say, "You know, your
sister's doll that you just

812
00:51:19,587 --> 00:51:23,578
"pulled the head off of
was her favorite doll,

813
00:51:23,578 --> 00:51:27,182
"and she's going to be so
sad that that's broken.

814
00:51:27,411 --> 00:51:31,008
"I think I'm going to need
to help you find a way

815
00:51:31,008 --> 00:51:33,851
"to pay her back so
she can buy a new doll,

816
00:51:33,851 --> 00:51:36,064
"and that's going to mean
doing a lot of chores

817
00:51:36,064 --> 00:51:38,596
"for the next period of
time in order for you

818
00:51:38,596 --> 00:51:41,908
"to earn back some money so that you can

819
00:51:41,908 --> 00:51:44,900
"pay her for the doll that you broke.

820
00:51:44,900 --> 00:51:46,952
"And I know you're not going
to have fun doing that,

821
00:51:46,952 --> 00:51:49,265
"but I'm going to help you do
them, and we'll get them done,

822
00:51:49,265 --> 00:51:52,951
"and you'll be able to help
your sister find a new doll."

823
00:51:53,401 --> 00:51:57,221
That's such a different way
of delivering a consequence

824
00:51:57,221 --> 00:52:02,221
from the, "Oh, that
means you owe me 10 bucks

825
00:52:02,743 --> 00:52:06,334
"and you better start
earning it right now."

826
00:52:08,059 --> 00:52:11,201
The empathy gives the
child confidence that

827
00:52:11,201 --> 00:52:15,349
you're still on his side, even
though he did a bad thing.

828
00:52:15,349 --> 00:52:18,552
You're going to help him figure
out how to make it better,

829
00:52:22,350 --> 00:52:24,354
but he's going to have to do it.

830
00:52:24,354 --> 00:52:28,066
You don't let a kid like this
off when they do something,

831
00:52:28,066 --> 00:52:31,056
when they seriously misbehave.

832
00:52:31,446 --> 00:52:33,917
The other thing I often
teach parents in a situation

833
00:52:33,917 --> 00:52:38,181
like this, because they tend
to get angry so frequently,

834
00:52:38,181 --> 00:52:41,705
is to do what's called 60 second scolding.

835
00:52:42,725 --> 00:52:47,725
A 60 second scolding
is to start with anger.

836
00:52:48,199 --> 00:52:50,788
"I am so mad at you because
you just tore the head

837
00:52:50,788 --> 00:52:53,830
"off your sister's doll, and
you know she loved that doll

838
00:52:53,830 --> 00:52:57,685
"so much, and I know that
that's a very important doll

839
00:52:57,685 --> 00:53:01,150
"to her, too, and I
know that that must also

840
00:53:01,150 --> 00:53:03,200
"make you feel pretty bad inside, that you

841
00:53:03,200 --> 00:53:05,390
"did something like that to your sister.

842
00:53:05,390 --> 00:53:09,935
"And I know that I don't like
to see you feeling so bad.

843
00:53:09,935 --> 00:53:12,524
"The reason I don't like
to see you feeling so bad

844
00:53:12,524 --> 00:53:15,070
"is because I love you so
much, and I really want

845
00:53:15,070 --> 00:53:17,322
"to help you find a way
to have a better life

846
00:53:17,322 --> 00:53:20,168
"without doing mean things like that."

847
00:53:20,168 --> 00:53:24,171
So you move from anger
and maybe a loud voice

848
00:53:25,117 --> 00:53:27,863
and talking about what the provocation is,

849
00:53:27,863 --> 00:53:32,863
to why it matters to
you, and to the child,

850
00:53:33,027 --> 00:53:37,966
to why the child matters to
you, and to a message of love.

851
00:53:37,966 --> 00:53:41,350
That's a big shift in
the course of 60 seconds,

852
00:53:41,350 --> 00:53:45,779
but if you can learn to do
it, it gives a parent a chance

853
00:53:45,779 --> 00:53:49,050
to express their anger, which they have,

854
00:53:49,050 --> 00:53:53,147
but also to end up with empathy and love.

855
00:54:03,856 --> 00:54:08,157
Dan talks about stages
of trauma resolution.

856
00:54:09,605 --> 00:54:11,497
A child's been traumatized, either just by

857
00:54:11,497 --> 00:54:14,175
the loss of a parent, and
I shouldn't say "just,"

858
00:54:14,175 --> 00:54:18,121
but that may be the only
trauma the child's had,

859
00:54:18,860 --> 00:54:23,208
or by a more complex traumatic situation.

860
00:54:24,137 --> 00:54:27,093
It's important to realize
that the adults serve

861
00:54:27,093 --> 00:54:30,153
as the source of attachment security.

862
00:54:31,058 --> 00:54:35,359
As safety emerges in the
relationship, you can start

863
00:54:35,359 --> 00:54:38,151
to talk about mildly stressful themes

864
00:54:38,151 --> 00:54:41,684
for intersubjective exploration.

865
00:54:42,745 --> 00:54:46,046
Once primary intersubjectivity
is established,

866
00:54:46,046 --> 00:54:49,838
the sharing of feelings,
you move to secondary

867
00:54:49,838 --> 00:54:54,700
intersubjectivity, which
is talking about the trauma

868
00:54:55,416 --> 00:54:57,473
together, sharing feelings as you

869
00:54:57,473 --> 00:55:00,243
talk about something different.

870
00:55:01,222 --> 00:55:04,771
Secondary intersubjectivity
allows the child

871
00:55:04,771 --> 00:55:08,044
to re-experience the trauma as experienced

872
00:55:08,044 --> 00:55:12,818
by the therapist, who is
also co-regulating the affect

873
00:55:12,818 --> 00:55:16,132
in the time that you're talking about it.

874
00:55:16,663 --> 00:55:20,275
Since that affect is no
longer dis-regulating,

875
00:55:20,275 --> 00:55:25,050
it's possible to create
a new meaning together.

876
00:55:26,350 --> 00:55:29,377
That new meaning can then be integrated

877
00:55:29,377 --> 00:55:33,601
into a coherent
autobiographical narrative.

878
00:55:34,838 --> 00:55:39,838
I realize I'm covering a very large

879
00:55:40,400 --> 00:55:43,202
amount of material in
a short period of time,

880
00:55:43,202 --> 00:55:45,555
and I would encourage
you to do some training

881
00:55:45,555 --> 00:55:48,971
with Dan Hughes if this
intrigues you, because

882
00:55:50,322 --> 00:55:55,190
learning how to make use of these concepts

883
00:55:55,190 --> 00:55:58,242
is a very rich way to do therapy

884
00:55:58,242 --> 00:56:01,243
with children who have been traumatized.

885
00:56:02,017 --> 00:56:03,753
I'm just going to read you some basic

886
00:56:03,753 --> 00:56:06,799
assumptions from Dan's website,

887
00:56:08,602 --> 00:56:11,644
that are important for
parents to recognize

888
00:56:11,644 --> 00:56:14,294
and important for therapists too.

889
00:56:14,316 --> 00:56:17,369
Your child is doing the best she can.

890
00:56:17,369 --> 00:56:22,369
This is very basic, and
it's not what most parents

891
00:56:23,481 --> 00:56:26,732
think when they bring
a child in for therapy.

892
00:56:29,637 --> 00:56:33,000
Finding a way to make sense
of that statement is often

893
00:56:33,000 --> 00:56:36,595
a big project of therapy with the parent,

894
00:56:36,595 --> 00:56:39,283
that your child is actually
doing the best she can.

895
00:56:39,283 --> 00:56:40,911
What does that mean?

896
00:56:40,911 --> 00:56:43,416
How can you make sense of that?

897
00:56:44,048 --> 00:56:46,460
He wants to improve.

898
00:56:47,056 --> 00:56:51,252
Her life, as it is now, is a living hell,

899
00:56:51,553 --> 00:56:53,831
so he tries to be safe by controlling

900
00:56:53,831 --> 00:56:57,094
everything in his environment.

901
00:56:57,651 --> 00:56:59,651
She tries to be safe by avoiding

902
00:56:59,651 --> 00:57:02,922
everything that is stressful and painful.

903
00:57:04,428 --> 00:57:07,736
His attacks on you, and
his resistance to you,

904
00:57:07,736 --> 00:57:10,276
reflect his fear of your motives,

905
00:57:10,705 --> 00:57:14,496
poor affect regulation,
fragmented thinking,

906
00:57:14,496 --> 00:57:19,496
pervasive shame, inability to
trust, and lack of control.

907
00:57:23,149 --> 00:57:27,139
For her to change, you will
need to accept, comfort,

908
00:57:27,139 --> 00:57:30,604
and teach her, and this means accepting

909
00:57:30,604 --> 00:57:33,931
the child, not always the behavior.

910
00:57:34,981 --> 00:57:37,544
You will need to validate
his sense of self

911
00:57:37,544 --> 00:57:40,397
while teaching him important skills.

912
00:57:40,672 --> 00:57:43,903
You will need to know
her developmental age

913
00:57:43,903 --> 00:57:47,846
and fine-tune your
expectations to match that age,

914
00:57:47,846 --> 00:57:51,552
so that she will have
success, not failure.

915
00:57:52,252 --> 00:57:54,786
Your physical and psychological presence

916
00:57:54,786 --> 00:57:59,136
are the foundation of your
comforting and teaching her.

917
00:58:01,599 --> 00:58:04,917
Under stressful emotional
conditions, he will

918
00:58:04,917 --> 00:58:08,228
regress and revert to his basic, solitary

919
00:58:08,228 --> 00:58:11,808
defenses he learned in his first home.

920
00:58:12,748 --> 00:58:16,719
She will have to work hard
to learn how to live well.

921
00:58:16,719 --> 00:58:20,687
You cannot do the work for
her, nor can you save her.

922
00:58:20,687 --> 00:58:23,577
You can comfort and teach her.

923
00:58:24,757 --> 00:58:27,877
You will need support and consultation.

924
00:58:27,877 --> 00:58:31,093
You will make mistakes,
and you need to face these,

925
00:58:31,093 --> 00:58:34,496
learn from them, and continue.

926
00:58:36,165 --> 00:58:39,428
On his website there's also
a list of what is not done,

927
00:58:39,428 --> 00:58:43,492
and some of these practices
are things that have been done

928
00:58:43,492 --> 00:58:46,342
in the name of attachment
therapy in the past,

929
00:58:46,342 --> 00:58:48,410
and it's important to...

930
00:58:50,049 --> 00:58:51,496
to stay away from them, because

931
00:58:51,496 --> 00:58:53,827
they are very damaging to children.

932
00:58:54,376 --> 00:58:56,397
So these things are not done.

933
00:58:56,397 --> 00:58:59,967
Holding a child and
confronting them with anger

934
00:58:59,967 --> 00:59:03,979
or poking or pushing the
child while holding them.

935
00:59:05,215 --> 00:59:07,240
Covering a child's nose or mouth

936
00:59:07,240 --> 00:59:09,731
or lying on top of the child.

937
00:59:10,281 --> 00:59:12,989
Utilizing shame, sarcasm, or laughing

938
00:59:12,989 --> 00:59:15,363
in a child's treatment.

939
00:59:16,454 --> 00:59:19,378
Laughing at the child, that is.

940
00:59:19,815 --> 00:59:23,212
Any actions based on power, submission,

941
00:59:23,212 --> 00:59:27,359
power and submission,
where the adult asserts

942
00:59:27,359 --> 00:59:30,243
their power and the child is submissive,

943
00:59:30,243 --> 00:59:34,049
done repeatedly until the child complies.

944
00:59:34,933 --> 00:59:37,365
Interpreting the child's
behaviors as meaning that

945
00:59:37,365 --> 00:59:40,066
she or he does not want
to be part of the family,

946
00:59:40,066 --> 00:59:42,873
and giving consequences for that.

947
00:59:45,912 --> 00:59:50,557
So in order to do this kind of
treatment, it's tough to do.

948
00:59:50,557 --> 00:59:52,810
You must have resolved
your own attachment trauma

949
00:59:52,810 --> 00:59:57,810
or insecurity, because you
can't provide a secure base

950
00:59:59,530 --> 01:00:04,530
unless you have a really solid
attachment model yourself.

951
01:00:05,133 --> 01:00:09,243
It's pretty uncanny how
kids with attachment issues

952
01:00:09,243 --> 01:00:13,435
can find the issues that
you have and hang them out

953
01:00:13,435 --> 01:00:17,714
to dry on the line, and make your life...

954
01:00:18,655 --> 01:00:22,676
evoke shame in you, if
that shame is available.

955
01:00:23,467 --> 01:00:26,021
So you need to have resolved
an awful lot of this,

956
01:00:26,021 --> 01:00:29,048
and you need to help parents do it, too.

957
01:00:30,393 --> 01:00:32,603
The therapist must be
comfortable with both adults

958
01:00:32,603 --> 01:00:35,984
and children, because you're
really working with both.

959
01:00:35,984 --> 01:00:39,663
Therapists must be comfortable
not always being liked,

960
01:00:40,448 --> 01:00:42,988
and the therapist must
have a good sense of humor,

961
01:00:42,988 --> 01:00:46,504
because if you can't laugh,
you're going to be in trouble.

962
01:00:47,844 --> 01:00:52,538
That's Dan Hughes' model of
attachment focused therapy.

963
01:00:52,682 --> 01:00:55,304
I'm going to just briefly
review a few other models.

964
01:00:55,304 --> 01:00:58,335
Dan's model has not been
researched extensively.

965
01:00:58,335 --> 01:01:00,334
There have been a couple of small studies

966
01:01:00,334 --> 01:01:03,150
on it that have shown some success,

967
01:01:03,150 --> 01:01:07,466
but other models do have
some empirical basis

968
01:01:07,466 --> 01:01:12,356
and are actually now
being used in trainings

969
01:01:12,829 --> 01:01:16,080
because of that empirical basis.

970
01:01:17,151 --> 01:01:21,180
One of the approaches is called

971
01:01:21,180 --> 01:01:23,625
"Attachment, Regulation, and Competency"

972
01:01:24,809 --> 01:01:28,641
by Margaret Blaustein
and Kristine Kinniburgh.

973
01:01:28,641 --> 01:01:31,423
They have a book...

974
01:01:33,998 --> 01:01:36,954
that you will find in the bibliography,

975
01:01:36,954 --> 01:01:41,702
describing this technique, and although

976
01:01:42,963 --> 01:01:45,961
it's kind of a phase-based treatment,

977
01:01:45,961 --> 01:01:48,208
where attachment, regulation,
and competency are taught

978
01:01:48,208 --> 01:01:51,537
separately, there's an
understanding that in treatment,

979
01:01:51,537 --> 01:01:54,539
the clinician will need
to interweave the three

980
01:01:54,539 --> 01:01:59,539
aspects of treatment,
as treatment goes along.

981
01:02:00,574 --> 01:02:04,461
So attachment, in this model, is addressed

982
01:02:04,461 --> 01:02:07,085
primarily through training caregivers,

983
01:02:07,764 --> 01:02:11,085
including caregiver affect management,

984
01:02:11,085 --> 01:02:13,124
especially when the caregiver's own

985
01:02:13,124 --> 01:02:16,433
attachment history has been challenging.

986
01:02:18,532 --> 01:02:21,010
Helping the caregiver manage affect

987
01:02:21,010 --> 01:02:24,522
in order to help the child
manage affect is critical.

988
01:02:28,010 --> 01:02:30,531
So helping the caregiver
find a way to be attuned

989
01:02:30,531 --> 01:02:32,045
to the child is important, especially when

990
01:02:32,045 --> 01:02:34,622
the child behavior is challenging.

991
01:02:36,748 --> 01:02:38,966
Helping the caregiver provide consistent

992
01:02:38,966 --> 01:02:41,844
responses to the child behavior

993
01:02:41,844 --> 01:02:44,609
establishes felt security, and reduces

994
01:02:44,609 --> 01:02:48,187
the child's perceived need for control.

995
01:02:48,726 --> 01:02:51,791
And helping the caregiver
provide routines and rituals

996
01:02:51,791 --> 01:02:55,577
for the child established
a felt security also,

997
01:02:55,577 --> 01:02:58,858
and build trust and reliability.

998
01:03:00,950 --> 01:03:03,611
So attachment is largely done by working

999
01:03:03,611 --> 01:03:06,193
with caregivers in this model.

1000
01:03:06,193 --> 01:03:11,193
Regulation includes identifying affects.

1001
01:03:13,161 --> 01:03:17,462
Often children who've had
insecure attachment history

1002
01:03:17,462 --> 01:03:20,825
or disorganized or traumatic background

1003
01:03:21,194 --> 01:03:24,719
have not learned to even know
what it is they're feeling.

1004
01:03:27,715 --> 01:03:29,677
If you think about it,
the way you learn that

1005
01:03:29,677 --> 01:03:32,291
is in this attachment
relationship, and once again,

1006
01:03:32,291 --> 01:03:34,665
they haven't had someone there say,

1007
01:03:34,665 --> 01:03:38,236
"Oh, you look sad right
now," or, "My goodness,

1008
01:03:38,236 --> 01:03:42,257
"you seem worried about
walking up those stairs,"

1009
01:03:42,257 --> 01:03:46,526
or all kinds of ways in which
we are constantly labeling

1010
01:03:46,526 --> 01:03:51,450
for little children what we're
perceiving their feeling is.

1011
01:03:52,150 --> 01:03:56,166
So children who haven't had
that happen often don't know

1012
01:03:56,166 --> 01:03:59,124
what it is that they're experiencing,

1013
01:03:59,124 --> 01:04:02,561
so they need to find a
way to label that internal

1014
01:04:02,561 --> 01:04:06,479
experience, and that's the
first step of regulation.

1015
01:04:06,753 --> 01:04:11,130
Secondly, we're looking
at affect modulation.

1016
01:04:12,053 --> 01:04:15,845
We're especially learning
to express affect

1017
01:04:15,845 --> 01:04:19,092
within optimal levels of arousal.

1018
01:04:23,092 --> 01:04:28,092
A well-balanced person in
life usually manages affect

1019
01:04:28,442 --> 01:04:31,273
in a way that's fairly smooth-waved.

1020
01:04:31,273 --> 01:04:35,068
So you may become upset, then you usually

1021
01:04:35,068 --> 01:04:38,083
find a way to calm yourself down.

1022
01:04:38,361 --> 01:04:41,411
You may become very excited and happy,

1023
01:04:41,411 --> 01:04:43,711
and gradually that
excitement and happiness

1024
01:04:43,711 --> 01:04:47,015
fades, a new feeling takes over.

1025
01:04:47,348 --> 01:04:50,047
Whereas a child who's been
traumatized tends to be

1026
01:04:50,047 --> 01:04:53,074
sort of way above the line of normal

1027
01:04:53,074 --> 01:04:57,419
affect expression, or totally shut down.

1028
01:04:57,419 --> 01:05:00,863
They don't have the middle
range available to them.

1029
01:05:00,863 --> 01:05:04,521
So helping them learn that is a tough job,

1030
01:05:04,521 --> 01:05:09,521
and it's an important job
for parents and therapists.

1031
01:05:10,275 --> 01:05:13,150
And then helping them find safe

1032
01:05:13,150 --> 01:05:16,688
ways to express their
affect, especially when

1033
01:05:16,688 --> 01:05:20,051
their early experiences
have led to the sense

1034
01:05:20,051 --> 01:05:23,002
that affect expression can lead

1035
01:05:23,002 --> 01:05:27,122
to vulnerability and lack of safety.

1036
01:05:28,831 --> 01:05:32,333
The purpose is to express
affect that promotes

1037
01:05:32,333 --> 01:05:36,138
relationships and it helps
them meet their needs.

1038
01:05:37,944 --> 01:05:42,434
But you can imagine a
kid who's been beaten for

1039
01:05:42,945 --> 01:05:47,945
crying when they were hungry,
is going to be afraid to cry.

1040
01:05:49,213 --> 01:05:50,980
So helping them learn to do that

1041
01:05:50,980 --> 01:05:53,426
in a safe environment is important.

1042
01:05:54,806 --> 01:05:59,806
The third skill in this
model is competency.

1043
01:06:02,627 --> 01:06:05,415
A child who's had early trauma or negative

1044
01:06:05,415 --> 01:06:08,718
attachment experiences
has not had a chance

1045
01:06:08,718 --> 01:06:12,797
to build competency in all
sorts of areas of life.

1046
01:06:14,920 --> 01:06:17,283
The first step of building
competency is building

1047
01:06:17,283 --> 01:06:20,240
those right-brain skills,
those executive function skills

1048
01:06:20,240 --> 01:06:23,730
we talked about, like
learning to plan, anticipating

1049
01:06:23,730 --> 01:06:28,730
consequences, inhibiting
impulses, focusing attention.

1050
01:06:29,156 --> 01:06:34,156
So those skills are necessary
in order to build competency,

1051
01:06:34,680 --> 01:06:38,904
and those are hard to teach,
they take a long time.

1052
01:06:42,579 --> 01:06:46,910
Competency also includes
assisting a development

1053
01:06:46,910 --> 01:06:50,430
of the self and identity so that you have

1054
01:06:50,430 --> 01:06:55,273
a sense of a cohesive and positive self.

1055
01:06:57,071 --> 01:07:01,622
Competency training also
includes identifying and building

1056
01:07:01,622 --> 01:07:04,264
key developmental tasks
that are getting in the way

1057
01:07:04,264 --> 01:07:07,352
of a child being able to
do what he wants to do.

1058
01:07:07,625 --> 01:07:10,390
The book that Blaustein
and Kinniburgh wrote,

1059
01:07:10,390 --> 01:07:13,226
"Treating Traumatic Stress
in Children and Adolescents,"

1060
01:07:13,226 --> 01:07:15,522
has much more detailed
descriptions of each

1061
01:07:15,522 --> 01:07:19,958
of these phases of treatments,
as well as very valuable,

1062
01:07:19,958 --> 01:07:23,049
copyable handouts that
are useful to help teach

1063
01:07:23,049 --> 01:07:25,900
children and caregivers new skills.

1064
01:07:26,130 --> 01:07:30,647
They really give you hands-on tools

1065
01:07:30,647 --> 01:07:33,378
to use as you start trying
to teach these skills,

1066
01:07:33,378 --> 01:07:37,244
because explaining a skill to a child is

1067
01:07:37,244 --> 01:07:39,027
completely inadequate as a way

1068
01:07:39,027 --> 01:07:41,616
of teaching them how to make use of it.

1069
01:07:43,088 --> 01:07:45,329
I think you'll find
this book very valuable

1070
01:07:45,329 --> 01:07:47,444
in working with, if you're
working with children

1071
01:07:47,444 --> 01:07:50,337
who have had these experiences.

1072
01:07:54,724 --> 01:07:57,634
There's several authors who have

1073
01:07:57,634 --> 01:07:59,846
developed ways of working with

1074
01:07:59,846 --> 01:08:03,758
traumatized children using EMDR.

1075
01:08:05,193 --> 01:08:07,506
The names I mention here are Joan Lovett,

1076
01:08:07,506 --> 01:08:11,334
Debra Wesselman, and
Lacher, Nichols, and May.

1077
01:08:12,364 --> 01:08:16,080
There's also newer work
by Ana Gomez and others.

1078
01:08:17,658 --> 01:08:22,351
These models tend to include
focusing on regulation

1079
01:08:23,089 --> 01:08:25,482
by using what's called
"resource installation"

1080
01:08:25,482 --> 01:08:29,405
or "resource development" within EMDR.

1081
01:08:29,480 --> 01:08:32,785
So you can build positive
traits and skills,

1082
01:08:32,785 --> 01:08:37,785
help the child envision,
imagine having better skills

1083
01:08:40,362 --> 01:08:42,680
and help them develop those skills

1084
01:08:42,680 --> 01:08:46,884
by using resource
installation tools in EMDR.

1085
01:08:46,884 --> 01:08:50,371
And then usually the biggest
focus in these models

1086
01:08:50,371 --> 01:08:53,748
is developing a trauma narrative

1087
01:08:53,748 --> 01:08:56,077
that can be created by the child

1088
01:08:56,077 --> 01:08:58,674
or the therapist with the parent.

1089
01:08:59,110 --> 01:09:01,442
A trauma narrative...

1090
01:09:03,094 --> 01:09:06,509
your goal is to help the child move from

1091
01:09:06,509 --> 01:09:11,498
an overwhelming and affectively
negatively charged model

1092
01:09:11,498 --> 01:09:15,460
to one that has a new
meaning for their history,

1093
01:09:15,460 --> 01:09:19,158
and gives them a way to move beyond it.

1094
01:09:19,670 --> 01:09:23,024
EMDR seems to be a good model to use

1095
01:09:23,024 --> 01:09:26,198
for working on serious
trauma, because it often

1096
01:09:26,198 --> 01:09:29,189
allows the child to process
frightening material

1097
01:09:29,189 --> 01:09:34,189
with less abreaction and distress.

1098
01:09:39,201 --> 01:09:43,471
Another model of treatment for children

1099
01:09:43,471 --> 01:09:45,832
who've had negative attachment experiences

1100
01:09:45,832 --> 01:09:50,034
and trauma and loss is
Infant-Parent or Child-Parent

1101
01:09:50,034 --> 01:09:54,362
Psychotherapy by Alicia
Lieberman and Patricia Van Horn.

1102
01:09:55,438 --> 01:09:58,600
They've also written a
book on this topic and

1103
01:09:59,576 --> 01:10:02,404
it's a useful book for
therapists who are working,

1104
01:10:02,404 --> 01:10:04,823
especially with young children.

1105
01:10:04,823 --> 01:10:07,534
Their model is primarily psychodynamic,

1106
01:10:07,534 --> 01:10:10,535
long-term treatment for
young children and parents

1107
01:10:10,535 --> 01:10:14,085
who are at risk or have hurt their child

1108
01:10:14,085 --> 01:10:17,722
or have children who have
been hurt in the past.

1109
01:10:18,011 --> 01:10:21,380
It's been informed largely
by data on intergenerational

1110
01:10:21,380 --> 01:10:24,163
transmission of attachment and trauma

1111
01:10:24,715 --> 01:10:28,005
that we reviewed earlier,
and the focus is on

1112
01:10:28,005 --> 01:10:31,999
the caregiver to provide her the mothering

1113
01:10:32,279 --> 01:10:34,532
and a chance to resolve her own trauma,

1114
01:10:34,532 --> 01:10:39,342
so that she can become the
adequate caregiver for the child.

1115
01:10:39,959 --> 01:10:43,936
Lieberman was influenced
largely by Selma Fraiberg,

1116
01:10:43,936 --> 01:10:46,567
whose studies in infant
mental health are wonderful

1117
01:10:46,567 --> 01:10:49,819
studies to read if you
haven't read them yet,

1118
01:10:51,027 --> 01:10:55,072
about the experience of
providing child-parent

1119
01:10:55,072 --> 01:10:58,706
psychotherapy, and really
Selma Fraiberg began this field

1120
01:10:58,706 --> 01:11:01,645
of infant-parent psychotherapy.

1121
01:11:01,970 --> 01:11:05,291
The focus within this model
is on empathic communication

1122
01:11:05,291 --> 01:11:08,957
skills, such as those
found in secure attachment.

1123
01:11:10,697 --> 01:11:13,965
The final intervention
I want to talk about

1124
01:11:14,842 --> 01:11:19,000
that's attachment-focused is called "ABC."

1125
01:11:21,798 --> 01:11:25,832
The ABC Intervention by
Mary Dozier at Delaware.

1126
01:11:25,832 --> 01:11:30,162
This is a short-term,
in-home intervention.

1127
01:11:30,162 --> 01:11:31,974
It's 10 sessions long for at-risk

1128
01:11:31,974 --> 01:11:34,529
parents and babies or toddlers.

1129
01:11:34,529 --> 01:11:36,569
It's also been used with foster parents

1130
01:11:36,569 --> 01:11:40,458
and toddlers and babies, and it's aim

1131
01:11:40,692 --> 01:11:44,909
is to enhance sensitive,
nurturing care, and to decrease

1132
01:11:44,909 --> 01:11:47,149
frightened or frightening
behavior by mothers

1133
01:11:47,149 --> 01:11:50,462
towards babies, because we know that being

1134
01:11:50,462 --> 01:11:53,073
either frightened or
frightening toward your baby

1135
01:11:53,073 --> 01:11:56,192
is more likely to cause disorganized

1136
01:11:56,192 --> 01:11:58,866
attachment on the part of the baby.

1137
01:12:01,278 --> 01:12:04,261
The impact of this change in maternal care

1138
01:12:04,261 --> 01:12:08,100
is to enhance the child's
attachment organization.

1139
01:12:09,368 --> 01:12:14,368
What the mothers are taught in
this 10-session intervention

1140
01:12:15,984 --> 01:12:18,617
is to provide nurturance, even when

1141
01:12:18,617 --> 01:12:21,790
the child seems to be rejecting it.

1142
01:12:23,038 --> 01:12:28,038
To take delight in following
the child's lead in play,

1143
01:12:28,811 --> 01:12:31,789
and to stop intrusive, frightened,

1144
01:12:31,789 --> 01:12:35,805
or frightening behaviors toward the child.

1145
01:12:38,080 --> 01:12:40,504
It's also to recognize how
parents' own attachment

1146
01:12:40,504 --> 01:12:44,587
histories may interfere with
their doing these behaviors.

1147
01:12:44,939 --> 01:12:48,875
And then consolidate the gains
in the child and the parent.

1148
01:12:49,434 --> 01:12:51,564
What's remarkable about
this intervention is that

1149
01:12:51,564 --> 01:12:56,564
in 10 sessions, it's sort
of a coaching intervention,

1150
01:12:57,368 --> 01:12:59,992
there have been dramatic
results in improving

1151
01:12:59,992 --> 01:13:02,817
mother's sensitivity and responsiveness

1152
01:13:02,817 --> 01:13:07,623
and in changing children's and
mother's attachment patterns.

1153
01:13:10,635 --> 01:13:13,962
So this is a very promising
intervention for young children

1154
01:13:13,962 --> 01:13:18,962
and parents, and one that may help prevent

1155
01:13:19,266 --> 01:13:21,579
a lot of the longer-term consequences

1156
01:13:21,579 --> 01:13:25,981
of attachment-based
trauma in young children.

1157
01:13:31,063 --> 01:13:34,603
The final model I'm going to talk about

1158
01:13:36,046 --> 01:13:39,126
is sort of an integrative model of using

1159
01:13:39,126 --> 01:13:42,909
attachment theory in therapy with adults.

1160
01:13:43,701 --> 01:13:47,749
A number of authors
have talked about using

1161
01:13:47,749 --> 01:13:50,650
knowledge from attachment in their...

1162
01:13:52,810 --> 01:13:55,293
in their work with adults,
and I think probably

1163
01:13:55,293 --> 01:13:59,149
the most useful book I know
of for working with adults

1164
01:13:59,149 --> 01:14:04,149
is by David Wallin, on
the use of attachment

1165
01:14:04,160 --> 01:14:09,160
in therapy, and it's in your bibliography.

1166
01:14:11,518 --> 01:14:15,749
My first slide shows
this quote from Bromberg,

1167
01:14:16,323 --> 01:14:19,793
that sort of evokes Dan Siegel's concept

1168
01:14:19,793 --> 01:14:22,821
of interpersonal neurobiology.

1169
01:14:24,786 --> 01:14:27,924
"The therapist's right
hemisphere allows her

1170
01:14:27,924 --> 01:14:32,368
"to know the patient from the inside out."

1171
01:14:33,013 --> 01:14:35,476
So this is talking about a very profound

1172
01:14:35,476 --> 01:14:39,556
dyadic communication, along the lines

1173
01:14:39,556 --> 01:14:42,629
of this interpersonal neurobiology,

1174
01:14:42,629 --> 01:14:46,744
in which the therapist is able to grasp

1175
01:14:46,744 --> 01:14:50,719
what the patient's inside understanding

1176
01:14:50,719 --> 01:14:54,608
of life and themselves can be.

1177
01:14:59,636 --> 01:15:01,920
So what do you do as a therapist

1178
01:15:01,920 --> 01:15:05,089
who's really trying to make use of...

1179
01:15:07,457 --> 01:15:10,303
attachment theory?

1180
01:15:10,866 --> 01:15:13,100
One important piece of it is to use

1181
01:15:13,100 --> 01:15:15,888
the therapist as a secure base.

1182
01:15:16,440 --> 01:15:18,681
That's one way we talk about parents,

1183
01:15:18,681 --> 01:15:21,552
as a secure base for their child.

1184
01:15:24,766 --> 01:15:27,652
I did talk about the fact
that I really feel that

1185
01:15:27,652 --> 01:15:31,865
in treating children, you need
to help parents be the secure

1186
01:15:31,865 --> 01:15:35,402
base, the attachment
figure for their child.

1187
01:15:35,983 --> 01:15:38,094
When you're working with adults, obviously

1188
01:15:38,094 --> 01:15:42,381
there's not a parent there
who can provide that,

1189
01:15:42,655 --> 01:15:47,652
so you really need to
find a way to provide

1190
01:15:47,652 --> 01:15:50,469
this secure base for your client.

1191
01:15:50,469 --> 01:15:53,756
And because a client is old enough to

1192
01:15:53,756 --> 01:15:57,163
use the skills of internalizing your

1193
01:15:58,093 --> 01:16:03,093
security as part of their ongoing feelings

1194
01:16:03,605 --> 01:16:06,863
in their life, they can
carry you with them,

1195
01:16:07,755 --> 01:16:09,959
you can actually become a secure base

1196
01:16:09,959 --> 01:16:13,404
for a client, for an adult client.

1197
01:16:20,652 --> 01:16:25,246
And in session, you use
your regulatory ability

1198
01:16:25,246 --> 01:16:27,544
to co-regulate with the client.

1199
01:16:27,544 --> 01:16:29,674
You may need to actually do the regulation

1200
01:16:29,674 --> 01:16:33,139
for them for awhile,
move to co-regulation,

1201
01:16:33,139 --> 01:16:36,381
as you do with a child, and then help them

1202
01:16:36,381 --> 01:16:40,275
internalize that regulation as their own.

1203
01:16:44,854 --> 01:16:47,434
It's important in treatment
where you're thinking

1204
01:16:47,434 --> 01:16:52,202
about attachment to be
aware of what is evoked

1205
01:16:52,202 --> 01:16:57,124
in you by this client, and
how you can make use of it.

1206
01:16:58,096 --> 01:17:01,154
Countertransference is a critical aspect

1207
01:17:01,154 --> 01:17:03,860
of doing this type of therapy.

1208
01:17:05,664 --> 01:17:09,345
When you're attuned to a
client, even when you're

1209
01:17:09,345 --> 01:17:14,046
not attuned often, you receive
projections from the client

1210
01:17:14,046 --> 01:17:16,169
of emotional material that's defensively

1211
01:17:16,169 --> 01:17:18,854
excluded from their consciousness.

1212
01:17:20,948 --> 01:17:25,059
You can use this
information, this material,

1213
01:17:25,059 --> 01:17:30,059
where feelings are evoked in
you that don't belong to you.

1214
01:17:30,823 --> 01:17:33,837
You can use it as information that shapes

1215
01:17:33,837 --> 01:17:37,906
your treatment plan, or at times it can be

1216
01:17:37,906 --> 01:17:40,529
carefully presented as material

1217
01:17:40,529 --> 01:17:44,024
to the client that can now be integrated.

1218
01:17:44,778 --> 01:17:46,866
And in this process,
you're helping the client

1219
01:17:46,866 --> 01:17:51,423
co-create new meanings and
integrate into themselves

1220
01:17:51,423 --> 01:17:56,423
previously excluded aspects
of affect or information.

1221
01:18:00,291 --> 01:18:04,694
You're also helping them by
presenting a positive view

1222
01:18:04,694 --> 01:18:08,931
of material that has
felt so negative to them

1223
01:18:08,931 --> 01:18:12,037
that they couldn't let
it be part of themselves.

1224
01:18:12,037 --> 01:18:14,379
If you can, just as
you would with a child,

1225
01:18:14,379 --> 01:18:17,455
say, "All right, I guess I can understand

1226
01:18:17,455 --> 01:18:20,778
"how that would make you feel so rotten,

1227
01:18:20,778 --> 01:18:25,487
"but on the other hand,
I see it as a perfectly

1228
01:18:25,487 --> 01:18:29,978
"reasonable way to react to
the situation you were in."

1229
01:18:31,059 --> 01:18:34,880
By helping them do this,
by helping them find

1230
01:18:34,880 --> 01:18:37,190
new ways of understanding what their own

1231
01:18:37,190 --> 01:18:41,003
feelings and behaviors are, they can then

1232
01:18:41,003 --> 01:18:43,578
begin to integrate them and develop

1233
01:18:43,578 --> 01:18:46,014
a more coherent sense of themselves.

1234
01:18:46,014 --> 01:18:48,718
They don't have to leave anything out.

1235
01:18:55,302 --> 01:18:56,602
Just to talk a little bit more

1236
01:18:56,602 --> 01:18:59,221
about projective identification.

1237
01:19:02,746 --> 01:19:04,573
We have to be really careful with clients

1238
01:19:04,573 --> 01:19:07,654
who have severe attachment histories

1239
01:19:07,654 --> 01:19:12,654
because it's really easy
to end up acting out

1240
01:19:14,198 --> 01:19:17,297
what the client, in many
ways, expects of us.

1241
01:19:17,297 --> 01:19:22,151
So a client who's rigidly
excluding aspects of themselves

1242
01:19:22,151 --> 01:19:26,052
will often project those
on to the therapist,

1243
01:19:26,052 --> 01:19:29,288
who may unwittingly play out the behavior

1244
01:19:29,288 --> 01:19:31,810
evoked in him or her by the client.

1245
01:19:33,271 --> 01:19:36,289
A client may evoke in you a desire

1246
01:19:36,289 --> 01:19:41,289
to rescue, to reject,
or misunderstand them,

1247
01:19:43,283 --> 01:19:46,973
and if you're not recognizing
that this is coming

1248
01:19:46,973 --> 01:19:51,009
from the client, and you act on it,

1249
01:19:52,311 --> 01:19:57,183
you reinforce their internal working model

1250
01:19:57,183 --> 01:19:59,048
that they're going to be
rejected, or they're going

1251
01:19:59,048 --> 01:20:01,510
to be misunderstood or
whatever, and that's

1252
01:20:01,510 --> 01:20:03,424
going to make their life harder, and

1253
01:20:05,233 --> 01:20:07,772
it's going to stop the
progress of therapy.

1254
01:20:07,772 --> 01:20:10,586
So attention to countertransference,

1255
01:20:10,586 --> 01:20:14,634
and the ability to process
what's going on in that way,

1256
01:20:14,634 --> 01:20:17,054
is required to work
through these situations

1257
01:20:17,054 --> 01:20:22,054
and to provide limits with
empathy as opposed to rejection.

1258
01:20:23,494 --> 01:20:26,638
So if you think of someone
who always comes late,

1259
01:20:26,638 --> 01:20:30,673
who blames you for planned breaks,

1260
01:20:30,673 --> 01:20:34,109
who feels misunderstood at times,

1261
01:20:34,109 --> 01:20:37,380
it's easy to be annoyed
at a client like that.

1262
01:20:37,380 --> 01:20:40,939
It's easy to end up acting in rejecting

1263
01:20:40,939 --> 01:20:45,500
or misunderstanding ways,
and it's really important

1264
01:20:45,500 --> 01:20:49,398
to be exploring this within yourself first

1265
01:20:49,398 --> 01:20:51,670
to understand, "Is this
the client's projective

1266
01:20:51,670 --> 01:20:56,328
"identification, is this some
remnant of my own history

1267
01:20:56,328 --> 01:20:59,583
"that's coming up to cause me trouble?"

1268
01:20:59,886 --> 01:21:02,368
And then it's important
to figure out a way

1269
01:21:02,368 --> 01:21:04,343
to use it in the therapy,
whether or not you

1270
01:21:04,343 --> 01:21:09,343
discuss it with the client,
to find a way to avoid

1271
01:21:09,756 --> 01:21:14,627
enacting what it is that the
client's projecting on to you.

1272
01:21:18,715 --> 01:21:21,506
It's important in work
with adults, just as it is

1273
01:21:21,506 --> 01:21:26,506
with children, to be aware
of shame versus guilt.

1274
01:21:27,891 --> 01:21:30,328
When there's been an
insecure attachment history,

1275
01:21:30,328 --> 01:21:35,313
the client tends to see
themselves as broken or bad,

1276
01:21:36,231 --> 01:21:40,651
which is the result of a
pervasive shame in their history.

1277
01:21:41,949 --> 01:21:45,952
As we talked about earlier,
shame is not reparable.

1278
01:21:45,952 --> 01:21:49,124
If the self is bad, you
either have to cover it up

1279
01:21:49,124 --> 01:21:51,703
or put on a false self, or project out

1280
01:21:51,703 --> 01:21:55,335
that negative picture on to someone else.

1281
01:21:55,873 --> 01:21:58,528
Guilt, on the other hand, is reparable.

1282
01:21:58,528 --> 01:22:00,988
It's possible to acknowledge bad

1283
01:22:00,988 --> 01:22:04,031
behavior and make recompense.

1284
01:22:05,646 --> 01:22:08,380
So in treatment, by the
therapist's insistence

1285
01:22:08,380 --> 01:22:12,433
that what the client did is
not reflective of his badness

1286
01:22:12,433 --> 01:22:15,533
as a person, but only an
understandable response

1287
01:22:15,533 --> 01:22:19,723
to a situation he found
himself in, the client's

1288
01:22:19,723 --> 01:22:23,274
gradually able to
transform shame into guilt,

1289
01:22:23,274 --> 01:22:25,605
and eventually come to the point

1290
01:22:25,605 --> 01:22:28,243
of developing empathy for himself.

1291
01:22:28,243 --> 01:22:32,467
This is a very long
process, when somebody's got

1292
01:22:32,705 --> 01:22:35,862
shame that's really pervasive
as a basis of their identity,

1293
01:22:37,090 --> 01:22:39,723
but it's an important one to work on,

1294
01:22:39,723 --> 01:22:43,393
and I think every time
you realize there's shame

1295
01:22:43,393 --> 01:22:47,703
being experienced, it's
important to address it because

1296
01:22:50,276 --> 01:22:53,623
that move from shame to
guilt is a critical move

1297
01:22:53,623 --> 01:22:56,935
in developing a stronger sense of self.

1298
01:22:58,290 --> 01:23:01,565
So just as with children,
it's important to recognize

1299
01:23:01,565 --> 01:23:04,736
empathic breaks and repair them.

1300
01:23:05,620 --> 01:23:07,399
There will be times when you misunderstand

1301
01:23:07,399 --> 01:23:09,937
what a person's saying,
there may be times when you

1302
01:23:09,937 --> 01:23:13,175
come late to an appointment,
there may be times

1303
01:23:13,175 --> 01:23:17,460
when you don't answer the
phone when a client calls.

1304
01:23:17,761 --> 01:23:22,384
There will be times when
there's a break between you,

1305
01:23:24,243 --> 01:23:28,062
either that's your
fault or not your fault,

1306
01:23:28,062 --> 01:23:31,094
but it's important to
recognize that it's experienced

1307
01:23:31,094 --> 01:23:36,094
as a break, as a loss,
and to provide repair.

1308
01:23:38,410 --> 01:23:42,277
Sometimes you may just
mis-perceive what a person says.

1309
01:23:42,277 --> 01:23:47,277
Sometimes you may have done
something that is harmful.

1310
01:23:47,665 --> 01:23:51,687
In any case, these are very
rich experiences in therapy,

1311
01:23:51,687 --> 01:23:55,612
and just as with a toddler
who needs thousands of times

1312
01:23:55,612 --> 01:24:00,200
to be told, "No," and
then to be provided love

1313
01:24:00,200 --> 01:24:02,746
and understanding and have an explanation

1314
01:24:02,746 --> 01:24:07,498
of why the "No" occurs, so in therapy.

1315
01:24:08,979 --> 01:24:11,638
It's rich material when you can say,

1316
01:24:11,638 --> 01:24:15,559
"Oh my gosh, is that
what you thought I meant?

1317
01:24:16,141 --> 01:24:19,332
"I can see why you were so upset with me."

1318
01:24:20,595 --> 01:24:22,627
And then you can go on to repair it,

1319
01:24:22,627 --> 01:24:27,627
or some clients will
perceive you being away for

1320
01:24:31,061 --> 01:24:35,428
a planned break as an empathic break.

1321
01:24:35,428 --> 01:24:38,788
They may see that as a
rejection or abandonment,

1322
01:24:39,263 --> 01:24:41,839
and helping them understand that

1323
01:24:42,885 --> 01:24:46,339
you can understand from
their history why this would

1324
01:24:46,339 --> 01:24:50,837
feel like an abandonment, but
you also need them to know

1325
01:24:50,837 --> 01:24:54,203
that you still care about
them, and you really

1326
01:24:54,203 --> 01:24:58,123
want to be with them, is important.

1327
01:24:58,164 --> 01:25:01,994
Every time there's a
perceived break of any sort,

1328
01:25:01,994 --> 01:25:05,065
I think it's critical
that you really mine it

1329
01:25:05,065 --> 01:25:07,976
for all you can, because...

1330
01:25:09,381 --> 01:25:12,246
it is one of the most
important ways we have

1331
01:25:12,246 --> 01:25:14,842
to help people shift their understanding

1332
01:25:14,842 --> 01:25:18,774
of how people work in reaction to them,

1333
01:25:18,774 --> 01:25:21,177
because they have such
a negative view from

1334
01:25:21,177 --> 01:25:23,488
the first model they'd formed.

1335
01:25:23,488 --> 01:25:26,530
It also increases the client's

1336
01:25:26,530 --> 01:25:28,904
ability to have reflective function.

1337
01:25:28,904 --> 01:25:32,433
When you keep showing, "Oh, I said this,

1338
01:25:32,433 --> 01:25:34,679
"and you thought I meant that.

1339
01:25:34,679 --> 01:25:38,193
"Oh my goodness, that must
be have been so disturbing.

1340
01:25:38,193 --> 01:25:41,115
"I really will try not
to say it that way again,

1341
01:25:41,115 --> 01:25:42,558
"but I want you to know what I was

1342
01:25:42,558 --> 01:25:45,436
"talking about was really this."

1343
01:25:45,941 --> 01:25:49,026
That's all using your
own reflective function

1344
01:25:49,026 --> 01:25:52,328
to reflect on the process
between you and the client,

1345
01:25:52,328 --> 01:25:55,668
and encourages them to
start doing the same thing.

1346
01:25:59,955 --> 01:26:03,348
So when you see reflective
function in a client

1347
01:26:03,348 --> 01:26:06,779
it's always a wonderful time in therapy

1348
01:26:06,779 --> 01:26:09,863
and it's important to point it out,

1349
01:26:09,863 --> 01:26:12,945
because it means the client's
moved in to the ability

1350
01:26:12,945 --> 01:26:16,248
to start to process material on their own.

1351
01:26:20,942 --> 01:26:25,036
So it's important to notice
it and it's important to help

1352
01:26:25,036 --> 01:26:29,263
clients nurture the ability
to do that kind of reflection,

1353
01:26:29,263 --> 01:26:31,566
and to extend it into therapeutic

1354
01:26:31,566 --> 01:26:34,364
and non-therapeutic interactions.

1355
01:26:40,400 --> 01:26:42,799
I think it's also important
to think about coherence,

1356
01:26:42,799 --> 01:26:45,162
just as we did when we were talking about

1357
01:26:45,162 --> 01:26:47,858
the adult attachment interview.

1358
01:26:50,218 --> 01:26:53,196
When Mary Main was first
developing the adult attachment

1359
01:26:53,196 --> 01:26:57,560
interview, she came upon
this notion of coherence

1360
01:26:57,560 --> 01:27:02,150
which had been described
by a linguist named Grice,

1361
01:27:02,394 --> 01:27:07,394
and he has Grice's Maxims of Coherence.

1362
01:27:07,938 --> 01:27:11,789
The four aspects of language
that you need to look at

1363
01:27:11,789 --> 01:27:16,789
are quality, whether the person
is truthful and has evidence

1364
01:27:17,612 --> 01:27:21,496
for what they say, that's
considered coherence quality.

1365
01:27:22,002 --> 01:27:27,002
Quantity, whether the person
is succinct yet complete.

1366
01:27:28,731 --> 01:27:32,398
I think if you remember a
couple of those interviews

1367
01:27:32,398 --> 01:27:37,398
that I read you sections of,
a dismissing client is often

1368
01:27:38,353 --> 01:27:42,053
too succinct, they just
give you a sentence or two.

1369
01:27:42,053 --> 01:27:44,686
Remember the one person
who said, "Next question,"

1370
01:27:44,686 --> 01:27:47,656
after they'd given a
very brief description.

1371
01:27:47,836 --> 01:27:49,955
So they weren't complete.

1372
01:27:49,955 --> 01:27:52,091
They were succinct, but not complete.

1373
01:27:52,091 --> 01:27:55,489
Or the preoccupied person
who was going on and on

1374
01:27:55,489 --> 01:27:59,763
about his mother and his
wife and other people,

1375
01:27:59,763 --> 01:28:04,763
and that person was not complete
because he wasn't really

1376
01:28:04,833 --> 01:28:09,639
addressing the question, but
he also was not succinct.

1377
01:28:10,936 --> 01:28:15,242
There's also coherence in
relationship to relevance,

1378
01:28:15,242 --> 01:28:20,242
so that the question is
answered by a relevant answer

1379
01:28:20,286 --> 01:28:23,537
and I think you'll remember
from those interviews that

1380
01:28:23,537 --> 01:28:27,703
a couple of the people gave
answers that didn't relate.

1381
01:28:27,703 --> 01:28:30,502
They didn't tell you what
was troublesome about their

1382
01:28:30,502 --> 01:28:32,543
relationship with their
mother when they were young.

1383
01:28:32,543 --> 01:28:35,081
They went off on other tangents, like what

1384
01:28:35,081 --> 01:28:37,870
their wife was like with their kid.

1385
01:28:38,183 --> 01:28:42,157
So relevance is a critical
part of coherence,

1386
01:28:42,157 --> 01:28:46,664
and manner is the fourth maxim.

1387
01:28:46,664 --> 01:28:50,713
That you should be clear,
brief, and orderly.

1388
01:28:50,713 --> 01:28:54,074
So you should really come
across with a good response

1389
01:28:54,074 --> 01:28:57,990
that makes clear what the
answer is and gives the person

1390
01:28:57,990 --> 01:29:02,921
a good, clear understanding
of what that answer was about.

1391
01:29:06,151 --> 01:29:09,740
One of the most valuable
trainings I did was training

1392
01:29:09,740 --> 01:29:11,857
in rating the adult attachment interview,

1393
01:29:11,857 --> 01:29:15,005
because it caused me to start
paying a lot more attention

1394
01:29:15,005 --> 01:29:17,568
to the language my clients were using.

1395
01:29:18,124 --> 01:29:23,124
When they began to violate one
of these maxims of coherence,

1396
01:29:23,974 --> 01:29:27,254
or particularly when they
started having lapses

1397
01:29:27,254 --> 01:29:29,730
in their discourse so that they were

1398
01:29:29,730 --> 01:29:32,484
showing evidence of disorganization

1399
01:29:32,484 --> 01:29:36,258
or unresolved trauma or
loss, I was much more able

1400
01:29:36,258 --> 01:29:40,276
to pick it up just by the way they talked.

1401
01:29:40,276 --> 01:29:45,276
If you can do that, it
helps you find the places

1402
01:29:45,596 --> 01:29:49,448
where the person is beginning
to feel like they need

1403
01:29:49,448 --> 01:29:53,238
to exclude information from
the therapeutic session

1404
01:29:53,238 --> 01:29:56,042
or even from their own consciousness.

1405
01:29:59,769 --> 01:30:02,987
When you're paying attention
to the narrative of a client,

1406
01:30:03,394 --> 01:30:07,584
you need to look at whether they are

1407
01:30:07,584 --> 01:30:12,584
flexible and complete,
versus rigid and incomplete

1408
01:30:13,067 --> 01:30:15,410
in their description of things.

1409
01:30:15,410 --> 01:30:19,390
Flexibility and completeness are really

1410
01:30:19,390 --> 01:30:24,390
hallmarks of coherence,
and rigidity almost always

1411
01:30:25,315 --> 01:30:29,647
is a reflection of incoherence.

1412
01:30:30,441 --> 01:30:33,762
You should also notice
breaks in narratives.

1413
01:30:34,111 --> 01:30:37,603
When a person pauses,
that may be an indication

1414
01:30:37,603 --> 01:30:42,603
they can't talk about what
has just come into their head.

1415
01:30:43,248 --> 01:30:47,499
You need to look for changes
in tense, person, or tone,

1416
01:30:47,499 --> 01:30:51,143
because those may indicate places where

1417
01:30:51,143 --> 01:30:53,717
someone's just gotten derailed from

1418
01:30:53,717 --> 01:30:57,339
a coherent explanation of what's going on

1419
01:30:57,339 --> 01:31:00,505
by something that's defensively excluded.

1420
01:31:01,507 --> 01:31:03,397
And you need to notice the adequacy

1421
01:31:03,397 --> 01:31:05,614
of the description and what's left out.

1422
01:31:05,614 --> 01:31:10,081
Is it emotional information
or cognitive information?

1423
01:31:11,396 --> 01:31:15,939
When information is
omitted, or when there are

1424
01:31:15,939 --> 01:31:20,188
evoked reactions in the
therapist, those things can

1425
01:31:20,188 --> 01:31:23,288
point to a type of
insecurity that the person

1426
01:31:23,288 --> 01:31:26,423
is feeling, and that can help you know

1427
01:31:26,423 --> 01:31:29,391
how to address what's going on with them.

1428
01:31:30,207 --> 01:31:32,170
If you read David Wallin's book, he has

1429
01:31:32,170 --> 01:31:35,067
extensive descriptions of ways to work

1430
01:31:35,067 --> 01:31:37,789
with avoidant or dismissing clients,

1431
01:31:37,789 --> 01:31:41,663
ways to work with preoccupied
clients, and so forth.

1432
01:31:42,966 --> 01:31:46,440
The other thing you need
to notice in the narrative

1433
01:31:48,041 --> 01:31:53,041
are experiences of dissociation and lapses

1434
01:31:53,541 --> 01:31:57,104
in what's called metacognitive monitoring.

1435
01:31:58,403 --> 01:32:01,580
So dissociation, obviously, is often

1436
01:32:02,258 --> 01:32:05,920
associated with unresolved trauma or loss.

1437
01:32:06,988 --> 01:32:11,246
Similarly, a lapse in
metacognitive monitoring

1438
01:32:11,246 --> 01:32:13,222
is associated with those things.

1439
01:32:13,222 --> 01:32:15,804
What metacognitive monitoring is,

1440
01:32:15,804 --> 01:32:19,198
is the ability to monitor
your own discourse

1441
01:32:19,198 --> 01:32:20,780
for coherence and relevance.

1442
01:32:20,780 --> 01:32:23,296
Most of us, as we talk, we're thinking

1443
01:32:23,296 --> 01:32:25,386
about what we're saying.

1444
01:32:26,174 --> 01:32:28,369
We're thinking about
whether what we've said

1445
01:32:28,369 --> 01:32:31,957
makes clear to the other person

1446
01:32:31,957 --> 01:32:34,618
what we're trying to communicate.

1447
01:32:35,597 --> 01:32:38,690
That means we have an
understanding of the other mind

1448
01:32:38,690 --> 01:32:40,804
with whom we're communicating,
and we'll talk differently

1449
01:32:40,804 --> 01:32:44,138
with a child than we will
with an adult, for instance.

1450
01:32:44,138 --> 01:32:46,049
And we'll talk differently
with some adults than

1451
01:32:46,049 --> 01:32:49,066
with other adults, because
we have an understanding

1452
01:32:49,066 --> 01:32:52,081
of the differences in their minds.

1453
01:32:53,813 --> 01:32:58,373
When you see lapses in
metacognitive monitoring,

1454
01:32:58,373 --> 01:33:03,191
when people sort of lose the
context, or begin to talk

1455
01:33:03,191 --> 01:33:07,773
in ways that don't make sense
in the overall narrative,

1456
01:33:08,730 --> 01:33:10,452
you're more likely to be looking

1457
01:33:10,452 --> 01:33:13,082
at an unresolved attachment pattern.

1458
01:33:13,082 --> 01:33:18,082
And being able to do that
really gives you clues

1459
01:33:18,146 --> 01:33:20,735
to where these patterns
may have originated,

1460
01:33:20,735 --> 01:33:22,813
because you'll find that they come up

1461
01:33:22,813 --> 01:33:25,251
when the person's talking
about an early experience

1462
01:33:25,251 --> 01:33:29,010
or even a later experience that may

1463
01:33:29,799 --> 01:33:33,397
evoke an earlier
experience in their lives.

1464
01:33:36,774 --> 01:33:39,363
You need to pay attention in treatment

1465
01:33:39,363 --> 01:33:43,586
of adults to their arousal level.

1466
01:33:44,542 --> 01:33:47,862
Part of providing regulation
is to keep the client

1467
01:33:47,862 --> 01:33:49,665
in what we call the therapeutic window,

1468
01:33:49,665 --> 01:33:50,710
and this is true whether you're

1469
01:33:50,710 --> 01:33:52,811
working with adults or children.

1470
01:33:53,235 --> 01:33:56,995
The therapeutic window is the space

1471
01:33:56,995 --> 01:34:01,995
in which arousal is high enough
to keep the client engaged,

1472
01:34:02,190 --> 01:34:06,266
so they're not shut down,
but it's not so high

1473
01:34:06,266 --> 01:34:08,883
that cognitive processing is lost.

1474
01:34:08,883 --> 01:34:13,883
So if a person is very aroused, either by

1475
01:34:14,275 --> 01:34:19,275
fear or anger or even
excitement, they're not...

1476
01:34:20,335 --> 01:34:22,811
their cognitive brain, their
left brain, is not functioning

1477
01:34:22,811 --> 01:34:26,684
as well, and when a person is like this,

1478
01:34:26,684 --> 01:34:29,155
they're not learning from you.

1479
01:34:29,732 --> 01:34:32,027
What you need for the
therapeutic window is

1480
01:34:32,027 --> 01:34:34,753
to have this optimal level of arousal,

1481
01:34:34,753 --> 01:34:36,569
that may go up and down some,

1482
01:34:36,569 --> 01:34:38,729
but it doesn't go beyond the window,

1483
01:34:38,729 --> 01:34:42,690
where the person is not
available to learning.

1484
01:34:43,785 --> 01:34:46,161
It's important with adults to help them

1485
01:34:46,161 --> 01:34:48,531
learn to notice their arousal level,

1486
01:34:48,531 --> 01:34:51,130
and to develop skills to calm themselves

1487
01:34:51,130 --> 01:34:53,775
through distraction, breathing,

1488
01:34:53,775 --> 01:34:57,079
relaxation exercises, or meditation.

1489
01:34:58,924 --> 01:35:03,585
And the process of trauma
really needs to proceed slowly,

1490
01:35:03,585 --> 01:35:05,710
staying within the therapeutic window.

1491
01:35:05,710 --> 01:35:10,710
It's critical you start noticing
when a person moves into

1492
01:35:11,017 --> 01:35:15,025
re-experiencing as opposed to re-telling.

1493
01:35:15,300 --> 01:35:18,344
If they're re-experiencing a trauma,

1494
01:35:18,344 --> 01:35:20,997
they're no longer able to process it.

1495
01:35:20,997 --> 01:35:22,706
They're living there.

1496
01:35:22,706 --> 01:35:25,403
You need to help them stay
within the therapeutic window,

1497
01:35:25,403 --> 01:35:28,098
even if that means you do tiny amounts

1498
01:35:28,098 --> 01:35:31,607
of processing at a time, because

1499
01:35:31,607 --> 01:35:34,818
you're essentially losing
them as soon as they

1500
01:35:34,818 --> 01:35:37,657
move out of that therapeutic window.

1501
01:35:44,791 --> 01:35:47,344
So I talked a little bit
about "earned security"

1502
01:35:47,344 --> 01:35:51,145
as adults, in adult attachment.

1503
01:35:52,629 --> 01:35:54,637
What we find in earned secure adults

1504
01:35:54,637 --> 01:35:58,094
is they can tell their story truthfully,

1505
01:35:58,094 --> 01:36:02,775
with a full understanding of
the impact of early experiences

1506
01:36:03,722 --> 01:36:06,075
and an ability to look at the experience

1507
01:36:06,075 --> 01:36:08,207
from the point of view of their caregivers

1508
01:36:08,207 --> 01:36:11,191
as well as their own
point of view at the time.

1509
01:36:12,021 --> 01:36:14,253
They may be sad or angry, but they

1510
01:36:14,253 --> 01:36:17,524
don't get lost in sadness and anger,

1511
01:36:18,041 --> 01:36:19,764
and they're able to describe what they've

1512
01:36:19,764 --> 01:36:23,185
learned from that attachment experiences,

1513
01:36:23,185 --> 01:36:27,415
and how their learning
from those experiences

1514
01:36:27,415 --> 01:36:31,787
has informed their changes in identity

1515
01:36:31,787 --> 01:36:33,805
and their plans for the future.

1516
01:36:33,805 --> 01:36:37,337
They're also able to talk
about how they parent children

1517
01:36:37,337 --> 01:36:41,962
or wish to parent children
as a result of those changes.

1518
01:36:41,991 --> 01:36:44,704
So essentially, a lot
of therapy with adults

1519
01:36:44,704 --> 01:36:47,507
is re-writing their attachment narrative,

1520
01:36:47,507 --> 01:36:51,093
to help them find a new
ending for the story,

1521
01:36:51,093 --> 01:36:54,723
to help them find a way to
make sense of what happened,

1522
01:36:54,723 --> 01:36:57,840
to use what they've learned to build

1523
01:36:57,840 --> 01:37:01,586
new building blocks of the
self, and to develop confidence

1524
01:37:01,586 --> 01:37:06,189
and an ability to move forward,
in a life that they choose.

1525
01:37:08,475 --> 01:37:11,968
Achieving earned security
is a long process,

1526
01:37:12,485 --> 01:37:16,118
and it requires using the
therapist as a secure base.

1527
01:37:16,573 --> 01:37:19,191
Sometimes people can do
this within an intimate

1528
01:37:19,191 --> 01:37:22,534
relationship, a marriage
or some other relationship,

1529
01:37:22,534 --> 01:37:27,534
and it requires coming to
understand transference responses,

1530
01:37:27,656 --> 01:37:30,369
and moving toward empathy for the self

1531
01:37:30,369 --> 01:37:33,317
as well as for one's early caregivers.

1532
01:37:33,317 --> 01:37:35,935
Typically when you hear
an adult who's earned

1533
01:37:35,935 --> 01:37:38,533
secure talk about their early caregiving

1534
01:37:38,533 --> 01:37:41,517
experiences, which were not positive,

1535
01:37:43,693 --> 01:37:47,084
you'll hear them say, "Well,
you know, at the time,

1536
01:37:47,084 --> 01:37:51,096
"the way it felt to me was
she just didn't care about me,

1537
01:37:51,096 --> 01:37:54,156
"but now, when I look
back on it, I can see

1538
01:37:54,156 --> 01:37:57,996
"how complicated her
life was then, and how

1539
01:37:57,996 --> 01:38:02,329
"she had to focus on other
things in order to continue,

1540
01:38:02,329 --> 01:38:05,735
"and I just couldn't be a
priority of hers at the time."

1541
01:38:05,774 --> 01:38:09,873
So this person is reflecting,
using reflective function

1542
01:38:09,873 --> 01:38:12,240
to think back on the experience,

1543
01:38:12,240 --> 01:38:15,406
think back on what their experience was,

1544
01:38:15,406 --> 01:38:20,036
but use their adult mind to understand

1545
01:38:20,036 --> 01:38:22,854
also the mind of their caregiver,

1546
01:38:23,498 --> 01:38:25,806
and make an interpretation
of the caregiver

1547
01:38:25,806 --> 01:38:27,553
that may be different
from the one they made

1548
01:38:27,553 --> 01:38:30,294
at the time they were as a child.

1549
01:38:33,489 --> 01:38:36,575
So in a way that one tends to develop

1550
01:38:36,575 --> 01:38:38,702
empathy for that caregiver as well as

1551
01:38:38,702 --> 01:38:41,452
for the child in that situation.

1552
01:38:42,775 --> 01:38:45,255
That achievement of earned security

1553
01:38:45,255 --> 01:38:47,948
is inherently a dyadic process

1554
01:38:47,948 --> 01:38:52,948
that can only be achieved in relationship.

1555
01:38:55,714 --> 01:38:58,603
And finally, whatever model of attachment

1556
01:38:58,603 --> 01:39:03,603
focused treatment you use,
this is very intense work,

1557
01:39:04,693 --> 01:39:07,200
and you need to think
about self-care even more

1558
01:39:07,200 --> 01:39:12,200
than you do when you're not
doing attachment based therapy,

1559
01:39:12,548 --> 01:39:15,415
when you still need to
think about self care.

1560
01:39:16,461 --> 01:39:19,843
Therapists are only good
at providing regulation,

1561
01:39:19,843 --> 01:39:24,279
attunement, and a secure
base if they themselves

1562
01:39:24,279 --> 01:39:27,618
have achieved a flexible
and fairly complete

1563
01:39:27,618 --> 01:39:30,947
understanding of their
own attachment history.

1564
01:39:32,246 --> 01:39:33,876
This usually means doing some

1565
01:39:33,876 --> 01:39:36,696
significant treatment yourself.

1566
01:39:37,916 --> 01:39:41,774
An ongoing work of this nature is intense.

1567
01:39:42,712 --> 01:39:45,658
It requires access to consultation,

1568
01:39:45,658 --> 01:39:49,653
time away from one's practice
spent in rest, renewal,

1569
01:39:49,653 --> 01:39:54,468
and recharging in one's
own attachment environment.

1570
01:39:55,280 --> 01:39:58,648
All of this enables you to work with

1571
01:39:58,648 --> 01:40:00,822
the transference and countertransference

1572
01:40:00,822 --> 01:40:03,605
processes that are occurring in a way that

1573
01:40:03,605 --> 01:40:07,505
makes sense for you and for your clients.

1574
01:40:08,088 --> 01:40:09,827
So I hope this has been a helpful

1575
01:40:09,827 --> 01:40:11,372
introduction to attachment.

1576
01:40:11,372 --> 01:40:13,568
I don't think you're prepared to go out

1577
01:40:13,568 --> 01:40:15,712
and do attachment-focused treatment now,

1578
01:40:15,712 --> 01:40:18,192
but maybe you've been
intrigued enough to explore it

1579
01:40:18,192 --> 01:40:22,132
some more, and to take on
learning one of these models

1580
01:40:22,132 --> 01:40:25,568
so that you can, in the future,

1581
01:40:25,568 --> 01:40:27,825
be a much more effective therapist.

1582
01:40:27,825 --> 01:40:29,200
Thank you for your time.