- Here's a dismissing adult who talks
about his mother being loving.
So he's just been asked to give a specific incident
as far back as he can remember, and he says,
"I don't remember.
"Well, because she was caring and supportive."
And the interviewer says, "Well, this can be difficult
"because a lot of people haven't thought about these things
"for a long time, but take a minute and see if you can
"think of an incident or an example."
"Well..."
"I guess, like, well, you know, she was really pretty,
"and she took a lot of care with her appearance.
"Whenever she drove me to school, I was always
"proud of that when we pulled up at the playground."
The interviewer, who still hasn't gotten an example
of a loving mother, says, "Thank you,
"and I just wonder whether there might be another example."
And the participant says, "No, I think
"that pretty much takes care of it."
So here's someone who describes how his mother looks
instead of describing her loving behaviors toward him.
He also has trouble remembering, because most of these
memories probably have been dismissed from his mind.
So he's looking at superficial features
as opposed to a truly loving mother.
Now what does a preoccupied adult look like?
Participant says, "Yeah, sort of very loving at times,
"like people were in the old days of my youth.
"Lot of changes since then.
"I remember home, and home was good in that, and loving.
"That's just like my wife.
"Just like my wife is with my child.
"Taking him out to the movies tonight...
"Special thing he's been wanting to see all week.
"Actually, it's more like a month, that turtle movie.
"Don't like it too much myself.
"Saw it though, when it was in, maybe six months ago.
"Yeah, she's very loving with him."
And the interviewer says, "Okay, well, what things come
"to mind when you describe your childhood relationship
"with your mother as very loving at times?"
Because obviously the participant here has
gone off on talking about his wife and child
instead of talking about his own experience.
And the participant says, "Really great things.
"Felt really special, really grateful to her for that.
"My childhood, I remember just sitting on the porch rocking,
"rocking back and forth, watching my parents or maybe
"having some lemonade, this, that, and the other.
"Really special sorts of things,
"just me and her, grateful for all she did.
"I wasn't easy, my temperament
"was hard on her, kind of hard.
"Nobody like her.
"Me and my cousin from next town
"are going down soon, really big birthday.
"She's gonna be 80, gives my age away."
So here's a person who sort of rambles on,
uses examples that aren't relevant to loving.
Talks about his wife and child instead of his own
experience, talks about sitting near her on the porch
and drinking lemonade as an example of her being loving,
and is sort of general in his description.
"Grateful for all she did for me."
That kind of thing.
So that's an example of a person who would
talk about his mother's loving,
but show a preoccupied attachment style.
Now you might wonder about a negative description
of an early relationship with a mother.
So I'm going to give you three examples of
interviews, these are from the adult attachment...
from the Handbook of Attachment, which has
a chapter on adult attachment.
And these are segments of interviews that were done...
with adults.
Here's an example of three different people
who use the word "troublesome"
to describe their relationship with their mother.
First I'll give you a secure adult.
And the participant says, "Troublesome.
"Well, she was troublesome for me
"when I was young, no question.
"She yelled a lot of the time.
"I remember that, and she also, she could spank
"really hard and she got angry a lot.
"But like I said, my father left when I was four
"and she was trying to make enough of an income to support
"us, and trying hard to keep us on the straight and narrow
"at the same time that she was away such long hours.
"I didn't like it, what she did.
"Like one time she slapped me in the face over something
"my sister had done, but she never apologized.
"I hated the yelling when my report card wasn't up to par.
"Yes, troublesome, or maybe I should have said
"it was a troubled relationship.
"But while I wish it had been different, it wasn't."
So here's a person describing very clearly and coherently
what was troublesome about his relationship
with his mother, and what he didn't like.
So we see this as a secure, as part of a secure
adult attachment interview, even though
he's reporting on negative behaviors.
He's able to reflect on them, think about
their impact on him as a child.
At the end he says, "I wish it had
"been different, but it wasn't."
So he accepts the reality of it,
but obviously has reflected on it.
So what about a dismissing person
who would say his relationship was troublesome?
All right, here's the participant.
"Troublesome, weak, cried, fell apart at funerals."
And the interviewer says, "I wonder if you have any
"specific memories of times you found her troublesome."
"Sobbed through her aunt's funeral, embarrassing.
"Couldn't wait to get away.
"Next question?"
Here's someone who's not talking about mother being
troublesome to him except embarrassing him, and...
is dismissing, clearly wanting to move on to the
next question, not wanting to talk about this,
and is quite dismissing of his mother.
"Weak, cried, fell apart at funerals."
And obviously a mother could still be very loving
and be a kind of person who would fall apart at a funeral,
but this person hasn't reflected on his experience.
He just sort of produces this as a canned response.
And what about a preoccupied adult who uses the word
"troublesome" to describe his relationship with his mother?
Participant, "Troublesome, that was an understatement.
"It was yell, yell, yell.
"'Why didn't you do this, why didn't you do that?'
"Well, mom, it was because you were just at me all the time.
"Like last week, you started yelling at the only grandkid
"you've got when we had you over to dinner.
"And angry, she's angry at me, she's angry
"at her latest husband, that's the latest in a series.
"Now she's angry at her neighbor about a tree that's
"supposed to be blocking her view, and so on and so on.
"She's more troublesome, she stirs up little things
"like I was saying last week at dinner..."
And this continues.
So here's someone who has...
switched suddenly in the middle of the story about
his mother in childhood, to addressing her right now
as if she were here in the room today.
This is one of the signs of incoherence in the narrative.
He's also going on and on about...
about the way she treated her grandkid, about their
neighbors, about her latest husband, really not staying
with the issue of early childhood.
This interview goes on from the part I mentioned,
so it's clear this is sort of a rambling interview.
That's the way in which preoccupied adults tend to speak.
In fairly rambling ways, their interviews
tend to be longer, and they are...
they're not clear in their descriptions.
So if you have an adult who's not an organized,
attached adult, who is unresolved or disorganized,
this unresolved category in adult attachment interviews
invariably relates to an experience of trauma or loss.
Speakers who are disorganized and unresolved,
as they speak about loss or trauma,
their coherence disappears.
They have what we call "lapses
"in monitoring of their discourse."
They're not in touch with the fact that they're
talking to someone and trying to make clear a statement.
And what we've found is that these parents,
if a parent prior to the baby's birth is unresolved
in relationship to trauma or loss, they're likely
later to have a disorganized infant attachment relationship.
I'm going to give you a couple of examples, three examples,
of ways in which unresolved trauma or loss
can effect an adult attachment interview.
Here's a mother who was talking about
the loss, a loss in her childhood.
The question is, "Did you experience any losses
"of people who were important to you in your childhood?"
So she was asked about it and she said,
"Yes, there was a little man," and she began to cry.
It turns out this person was an elderly workman
who had been employed briefly by her
parents when she was eight years old.
Jokingly, he had asked her to marry him when she
grew up, and she had said, "No, you'd be dead."
Not long after this interchange, the man
had died unexpectedly of a brain hemorrhage.
And this mother went on to tell the interviewer
that it was she who had killed him.
The way she put it was, "I killed him with one sentence."
So here's a mother who, in the midst of an interview,
sort of loses touch with rationality, and goes back
to the magical thinking of a child who believed
that by saying, "No, I'm not going to marry you
"because you'd be dead by the time I was grown up,"
believed that she had actually killed this man.
She has not resolved this loss, because she has not
come to an understanding that obviously her sentence
was not what was killing this person.
That's the source of incoherence for that interview.
You can also be classified as unresolved when you
exhibit an abrupt and distinct change
in what's called the "discourse register."
This can be seen in a move where you pay
extreme attention to detail that doesn't relate
to the experience that you're talking about.
So here's an interview where she says,
"We went to the hospital in, let's see,
"I think it was the gray Buick, and I sat
"in the back, to the right of my mother.
"I was wearing jeans and a polo shirt.
"Well, not jeans, but you know, khakis,
"and we turned first down West Street, and then
"there was a lot of traffic, so we took another street."
And this interview goes on.
So here's a person who's talking about a trauma or a loss,
and the information you're getting is about
what clothes she wore and what street she
drove down and what color the car was.
It indicates a fear of actually dealing with what happened
at this time, so that the person is just focused entirely
on these details which are not relevant.
Another way a person may show incoherence in an adult
attachment interview relating to trauma or loss is to shift
very abruptly into eulogistic or funereal speech.
So here's an example of a person who, in the midst of his
adult attachment interview, starts talking about a loss.
And he says, "She was young, she was lovely,
"and she was torn from us by that
"most dreaded of diseases, tuberculosis.
"And then I remember time and time again,
"the sounds of the weeping, the smells of the flowers,
"the mother torn from where she lay
"weeping upon her daughter's coffin."
So here's someone who's not able to use
typical interpersonal, direct, person-to-person language
in describing the loss of what's probably a sibling.
He shifts into this very artificial sounding language
and describes it as a way of distancing himself,
it appears, from the actual experience.
These are all examples that come from
an article by Erik Hesse, who has done a lot of the work
on disorganization in recent years, with Mary Main.
So now I'm going to talk more about how we begin
to translate what we know about attachment,
and to apply it in a therapeutic situation.
And I think the first thing you need to think about is,
back to Allan Schore's statement that a sensitive caregiver
downloads her right brain into the infant
during the first three years of life,
and that enables the infant to move from a chaotic
lack of regulation of affect and regulation of attention,
regulation of impulses, and regulation of bodily states,
to smoothly regulated ability to handle each new
situation with tools that are learned from the parent.
So in many ways, this is similar to what we do in therapy.
We are, in our dyadic relationship with the client,
helping the client develop some of these skills,
and we generally move from therapist led regulation,
to co-regulation with the client,
to co-creation of new meanings
for what the client's experiences are.
Finally, to the development of competency by the client,
emotional competency and regulatory competency,
and the ability to fruitfully collaborate
in solving the client's problems.
I know some of you work with children and some of you work
with adults, so I'm going to talk a little bit about both.
But I'm going to start by focusing on the model
of treatment that I've had the most training in,
which is Dan Hughes' Dyadic Developmental Psychotherapy.
I'm going to give you more detail about this,
partly because I know more about it, partly because
I think it helps to describe one model in detail
in order to give you a sense of what the different
aspects are of the way to work with a child
who's had significant attachment disruption
and perhaps trauma along the way.
If you think about it, for a baby,
attachment disruption means trauma.
When you think of the importance of the caregiver,
essentially the caregiver is the child's world.
So losing a caregiver means losing the world,
the end of the world, and we can't say,
"Oh, they were so young.
"Oh, but the other caregiver was so nice,"
or anything like that, because...
for this child, that caregiver was the world, and
it was traumatic to lose the caregiver, however it happened.
If a child has had experience of loss, and this doesn't
necessarily mean death, it may mean the parent leaving,
it may mean the parent is totally unavailable in relation
to substance use or mental health issues.
It may mean a number of things.
That parent...
is not there for the child, and the child is experiencing
a lack of safety and security and all the regulatory
functions that the parents should be modeling,
should be providing to the child.
I think we tend to underestimate the level of trauma
children have experienced when they've had early losses.
I know when I first started working
in a new city before I had my license, I volunteered for
a while on a pre-adolescent inpatient unit at a hospital.
One of the things I did was to read kids' charts.
Usually, if a child, a pre-adolescent, was hospitalized,
almost inevitably there was an example in their chart
in the history section of loss or disruption.
Maybe the child went to live with grandparents
for a year or two, maybe a parent disappeared, maybe
kin took over at some point, maybe a parent
was gone for a period of time when they were ill.
And almost inevitably these...
to me, profoundly important experiences the child had
early in life were not reflected upon in the rest
of the child's chart, and were not seen as the basis
for a number of the child's problems,
but I believe that they were, usually.
If you're trained by Dan Hughes,
he's a delightful person and I recommend his trainings,
he says the goal of his model of treatment
"is to restore the joyful dialogic companionship
"which was more likely to have been present during
"the early years, to discover the core reciprocal
"intentions that lie under the difficulties, to accept
"these intentions, and to communicate with each other
"in ways that facilitate understanding,
"empathy, and interactive repair."
Let's talk about the features of this model
of attachment-based treatment.
It's dyadic, and the reason it's dyadic is that the child's
problems occurred when the caregiver-infant dyad
was inadequate to support secure attachment.
Healing also must take place in a dyad,
and I think you understand by now why that would be.
Because it's in a dyadic relationship that
we learn these important skills.
The focus is on healing the dyad,
the caregiver and the child.
So even if you have a foster or an adopted parent,
so that the caregiver is not the one who
didn't give the child what they needed when they were young,
the relationship is troubled or they wouldn't
be there seeing you, so you still need to focus
on the caregiver as well as the child.
In order for the caregiver to provide a secure attachment
for the child, they need a secure attachment themselves.
And often this will mean that when you start working with
a child, you'll find that the caregiver needs their own
treatment to help them provide the security
that will allow the child to become secure.
So the focus of therapy is to help the parent become
a therapeutic agent, who learns effective techniques
to heal the child's attachment.
So you're really asking a lot of these caregivers.
It's hard, as a therapist, to see a caregiver
who can't provide the extra help that a child needs
to develop this level of security.
And it does take extra help.
A baby is sort of programmed for
their brain to soak up caregiving
relationships and develop the skills they need to develop.
If you are working with an older child or an adult
who has developed maybe warped skills
or maybe has never developed skills,
they still have developed ways of being in the world.
So essentially you're needing to help them
break those down and start with new ones
at a time in their life when their brain isn't
programmed to be soaking this up.
So it's a particularly difficult project,
and it takes a lot of time to do this,
and that's one reason you're really training a parent
as a therapeutic agent, because an hour a week,
even three hours a week, isn't going to do it.
The parent needs to be on the ground providing
this security and the regulatory function
on a daily basis, all the time.
This therapy is also called "developmental"
because the child's social and emotional development
has been frozen or warped by poor caregiving.
And the therapy must work with the child where she
or he is developmentally, not chronologically.
So it's very important to know early development
to understand where the child is stuck.
I want to say one word about this, working with
a child developmentally and not chronologically.
Some people criticize those who work in this field
for infantilizing children or doing
regression therapy and so forth.
I don't see it that way at all.
I really think when you have a 10 year old who's expressing
needs in the way a two year old might,
you really need to deal with that 10 year old
in a 2 year old way, and that's going to be sort of
difficult, because 10 year olds don't like
to be treated like two year olds.
So you're going to need a find a way
to meet those two year old needs
without making this 10 year old feel infantilized.
Sometimes they don't mind being infantilized.
I've worked with lots of kids who start to feel
some of those early, primitive feelings
and crawl into their parents' laps almost immediately.
But sometimes you have to be quite careful about
how you go about providing them the...
the love and the security and the
skill-building that they need.
And you also find that kids developmentally may change
the age that they are behaving, so they may
be showing two year old needs at one point,
four year old needs at another point.
They may be looking perfectly normally developing
at another point, something happens, they regress.
They look more two year old again.
So it's sort of a moving target, and you have to keep
meeting the child where they are developmentally.
Dan Hughes has what he calls the "attitude,"
the acronym for which is PACE.
His treatment is always playful,
and there's a need to help parents,
who are often sort of grim and frustrated
when they bring a child in, find an ability
to playfully engage with their child.
Dan does this by example, and it's important for
the therapist to provide that example so that
a lightness can emerge in the relationship.
Because if you think about it, with babies,
there's a really lovely lightness and joy
that's occurring, playfulness,
excitement, and children need that experience,
even if they didn't get it early on.
A is for Accepting, and this is critical.
Dan is very good at making it clear
that he accepts this child, and even accepts
whatever negative behavior may be the topic of conversation
as the best way the child knows to achieve goals at present.
This doesn't mean that he accepts
that this is the way it's going to be, but that it makes
sense to him why the child would behave this way.
He makes sense of it, and then he helps
the child find ways to move beyond that.
The C in PACE stands for Curious.
Curious about why this is happening now.
So Dan, when a child says...
"Last night at dinner I threw the plate at my mother."
Dan will just sit there and be curious.
"I wonder why you did that.
"I would've thought you'd want to eat that food,
"but you really didn't want to eat the food I guess,
"or what was going on?"
By that kind of sort of naive curiosity,
he gives the child a chance to explain
what the internal process was.
And as you'll see, that's a really
important part of what he talks about.
The E in PACE stands for Empathic.
So he is infinitely empathic with this child,
who may be pretty annoying at times.
He's also empathic with the parent
and what the parent's putting up with.
So this attitude is a very important aspect of
dyadic development in psychotherapy.
Parents in this model are seen
as the agents of therapeutic change,
and the problem is seen as being the child
hasn't learned to use a relationship to change and grow.
They have to learn this first with parents.
It's Dan's belief and mine that you can't learn how
to use an attachment relationship to grow
if you're doing individual therapy with a person
who's not your attachment figure.
It may be possible for adults, and even for older teens
to do this, to really see a therapist as an attachment
figure and to use them that way,
but younger children need more 24/7
contact and ongoing interaction for that.
So most of Dan's therapy is done
with the child and the parent present.
Two of the primary processes that are taking place
in this therapy model are the co-regulating
of affect, starting with the parent
or the therapist regulating the child,
and the co-creation of new meanings.
If you think about it, it's really critical that
when you have experienced negative experiences early,
that you find a new way of assigning meaning
to those experiences that enables you
to use it positively and to grow from it.
One of the things Dan Hughes talks about a lot
is the use of intersubjectivity in treatment.
Intersubjectivity is a concept that was
I think originated by Colwyn Trevarthen,
and there are two levels of it.
The first level of intersubjectivity, which is important
to use in therapy, is sharing a feeling between two people.
I'm happy, you see I'm happy, you share my happiness.
The secondary intersubjectivity is seen
as sharing attention to an object.
So we're both looking at the dog over there running around,
and we're sharing our attention and sharing our
experience of watching the dog run around.
Intersubjectivity is non-verbal at the core.
The therapist is not neutral because
they're really sharing in the experience of the client,
and it creates a sense of safety that this client's
experience is shared, particularly when these are
difficult experiences we're talking about.
Having them shared feels like someone's
carrying your burden with you.
From within the intersubjective stance,
the therapist can co-regulate affect more effectively,
and help to co-create new meanings
for the difficult experiences.
This intersubjective experience also enables
right brain co-regulation, so it becomes...
essentially it's what a good caregiver's doing
with an infant, and it enables a therapist
to do this with an older child or adult.
Another important concept in Dan's work,
it's also important in the attachment work
we've talked about, is attunement.
So the therapist is attuned to the child.
At times the child may be feeling
very strong affect, and the therapist
matches the vitality of that child's affect.
If a child's really yelling, "I hate you, you're the worst
"therapist in the world," whatever's going on,
the therapist needs to respond with the level
of vitality that the child is experiencing.
So you can say, "I see that you are really mad at me.
"I understand that that really is upsetting to you."
What this means is you're sort of matching
the level of the child's feeling.
It enables you then to help bring down the feeling,
step by step, and begin to regulate that affect into
something more manageable that you can work with together.
The result of this for the child is that he experiences
himself being experienced differently, and it enables
new meanings to emerge as a result of the therapist's
reflective function on the child's process.
Another concept Dan talks about
a lot is affective slash reflective dialogue.
The dialogue that occurs with the therapist
is expressive both verbally and nonverbally,
and it's integrated as both implicit and explicit
awareness into the sense of self.
So you are reflecting on the client's experience,
you're reflecting on your experience of what's
going on in the room, and you're enabling that
reflection to become part of the client's
understanding of how things are going.
Often when these kids present in treatment,
the parents are frustrated, the parents are upset,
the kid is angry, doesn't want to be there,
and often if they've been in treatment before,
they've been given a lot of behavioral techniques
to help manage the child's behavior,
and often this hasn't been effective.
Because a child who really wants to be in control
because he doesn't trust adults for good reasons,
is a very strong child, and he can outwit
almost any behavior plan you come up with,
because his real primary goal in life is to stay in control.
He's seen adults...
hurt him when they were in control too many times,
and he's not going to let that happen again.
So really, the job of the therapist is to help
the child and the parent find a way to have
a trusting relationship, and when the child is
profoundly distrustful, this is very difficult.
The therapist's job in this model is to search
under the presenting symptoms of the child,
the parents, or the relationship, and to find
new meanings for the symptoms.
So a child who is behaving destructively, for instance,
and who's been given consequences
and consequences and consequences for this,
it may be that you'll learn by talking to this child that
he's feeling devalued, as a result, he tends
to be destructive toward things.
He's so angry at his own...
devaluation that he devalues other people and other things
and acts destructively or aggressively.
If you can get to this point where you understand
how he's essentially expressing outwardly
the feelings that are inside him,
you can start with a real understanding
of why one would feel like being destructive.
And if you start there and you talk to him about that,
you may find that it's possible to learn more about
what is behind that sense, that there's no point in trying.
Alternatively, you may find a child,
often children who are being placed in different
homes through the foster care system,
are convinced that they're going to be kicked out
of this house too, because they might have lost
all the parents they've ever had, and they believe
strongly that they're going to lose this one too.
And you may see them trying to provoke
the rejection before, so that they're not once again
surprised by the devastating loss of another parent.
So they may be acting out almost intentionally
to get kicked out of this home.
They may be acting out against a sibling in the home
because that sibling seems to have things or get things
that they don't feel that they have or get,
so they want to destroy that sibling's happiness.
Whatever these things are, they go beyond the complexity
of simply, "Oh, you broke this, therefore your consequence
"is you must earn the money to pay back," whatever it is,
which doesn't get at what is lying under the symptoms.
When you're doing the work in dyadic developmental
therapy, you're always looking under the symptoms.
As I will explain in a minute, that doesn't mean
you're not providing consequences, but you're trying
to provide a context that will give new meanings
or help the child find the meanings for their,
for the behaviors that they're doing.
You start with finding positive qualities about the child.
And central to the deepening of the intersubjective
experience is the therapist's active curiosity
about family members' experiences.
You're always curious, you're always trying to figure out
what's beneath the symptoms, and children
can be disarmed by this approach and can
end up being more willing to talk.
One of the...
central tenets of Dan's philosophy is that
when children have experienced attachment loss
and disruption, they live in a state of fairly toxic shame,
because they feel that they are to blame.
I've never met a child who lost a parent who didn't
feel that somehow they were to blame for that loss.
No matter how unreasonable that might be.
And that belief, that "I'm such a bad person that
"nobody would want to parent me," is profound
and pervasive in children's development.
And Dan talks a lot about helping children
turn shame into guilt, guilt being seen
as a much more positive emotion.
I'm going to talk a little bit about
the difference between shame and guilt.
Shame has a focus on the self.
It's about me, "I'm bad."
Whereas guilt has a focus on behavior.
"Oh, I did this thing that wasn't right.
"I broke my mother's favorite vase."
If you feel that you're bad, there's no
real remediation that's possible,
whereas if you're feeling guilty about
breaking your mother's favorite vase,
you may find ways to make it up to her.
You may want to do nice things for her.
You may want to buy her a new vase, you may want...
There are a number of ways that you might
find to remediate your behavior.
Shame is concerned with other people's evaluation of you,
whereas guilt is concerned with your effect on other people.
Shame leads to a desire to hide or to attack others,
because the feeling is so profoundly negative,
whereas guilt leads to a desire to confess
and repair the relationship.
Shame leads to a sense of split self between
the observed, devalued self, and the observing self,
and guilt leads to a sense of a unified self
that's not devalued, that has made a mistake
but has done things to make it better,
so one can go on with a clear conscience
and a good feeling about oneself.
Dan talks a lot in his treatments about breaks and repairs.
If you remember in talking about attachment development,
we talked about interactive repair,
and the importance of interactive repair
in a toddler's evolving sense of self and the sense that,
"I'm a good person even though I do things that are wrong."
Often for these children who've lost parents
and who've experienced trauma and abuse,
there's an expectation that a break,
they're doing something bad, means the end,
and there's a sense of lack of safety.
When that happens the therapist needs to be
noticing subtle signs of the break.
And sometimes these can be, breaks can occur
when the child or client misinterprets
what a therapist has said, or a therapist
maybe comes on too strong, or is...
starts talking to a child about something
negative that's gone on, and the child feels,
"Oh, I've lost you, you're not on my side any more."
It's very important in treatment to be noticing
the subtle signs of the break,
to comment on it, to accept it.
There was a break.
To use active curiosity to explore it,
and to, in the end, repair.
You may be saying, when a child...
suddenly folds his hands and turns away from you,
or stomps out of the room, or says,
"Oh, that's just the way you are all the time,"
or whatever happens that lets you know
this child has just felt that there was
a break in the empathic relationship.
It's really important to be non-defensively curious.
"Wow, I didn't realize I was saying
"something that would upset you like that.
"Can you explain it to me?
"Can you tell me what happened
"and tell me how that feels to you?"
So by being curious, by being non-defensive,
you can end up learning things.
There may be an interpretation you would
never have thought of, of what just happened,
or what the child was talking about, and that
enables you then to move in and repair it.
"Oh, is that what you were thinking?
"You were thinking I didn't like you because
"I told you that it wasn't a good thing
"to break your mom's stuff all the time.
"You know what, I like you all the time, no matter what.
"I just want you to find a way not to be breaking things
"so that you and your mom can get along better
"and have a better life together."
You've essentially created a new meaning
for what it is that you've just said
that caused the break in the child's mind.
Or if the child's gotten angry at you because you insist
on talking about these negative things or whatever
else it is, you also are given an opportunity then to say,
"I know this is so hard to talk about,
"but if we don't talk about it, we can never help you
"find a way to make it better, and I really want
"to help you find a way to make it better."
You're given a chance to say these kinds of things,
which can help bring the child
along in the treatment session.
So as a foundation to do this kind of work,
both parents and therapists need to be sensitively
attuned to the child to help form a secure attachment.
That means you put a lot less emphasis
on talking about behavior and more on underlying emotions.
I often talk to parents about Ross Greene's Basket System.
He, in his book "The Explosive Child," talks about
helping parents learn to put their concerns
about a child into three baskets.
The "A Basket" are things like
hurting other people or significantly damaging property.
And those are things that really have to be addressed.
The "B Basket" may include things like unkind words,
bad manners, things like that that are
important but not as critical as
hurting people and damaging things.
The "C Basket" may include all kinds of other stuff
like making your bed in the morning, cleaning up your room,
making sure you bring home your homework,
all kinds of concerns that parents have
that are very legitimate concerns,
but when we have A Basket concerns that are really serious,
we may need to let the C Basket concerns go for awhile.
You keep them in the C Basket, you plan to get to them,
but you don't address them all at the same time.
That can be overwhelming to a child and to a parent,
and it can help parents a lot to do that kind of
prioritizing of concerns so that
you're not focusing on every negative behavior.
You're providing comfort, containment, safety,
and empathy, because these are necessary to facilitate
the child's ability to resolve their past traumas.
You believe that the child has to integrate
their past experiences, informing a coherent
understanding of self and relationships.
We talked a lot about the coherence
of narrative in an adult attachment
relationship, adult attachment interview.
One of the things I didn't talk about is
those adults who are what we call "earned secure" as adults.
So these are adults who had negative experiences as a child
and probably had an insecure attachment as a child,
but as adults, as a result of therapy or positive
relationship with a partner, they have come to
understand what happened to them, reflect on it,
find new meanings, and develop a secure attachment
relationship in the current setting, and a secure attachment
model, which has been earned, as they say.
So that's what you're trying to help children
do in the Dan Hughes approach.
You're trying to help them integrate their past experiences
and come up with a coherent story
of their selves and their relationships.
I talked a little bit about using consequences,
and obviously many of these children do
all kinds of negative behavior.
So thinking through how you use consequences is important,
but one of the most important things is not to be punitive,
which is very tough for parents to do often.
Being punitive in a consequence
tends to evoke shame in the child, and anger,
and when the child's shame is brought up,
they can't constructively work on their behavior.
It's really critical not to be
punitive toward these children,
and sometimes that takes a lot of work
with parents to help them not do that.
You use consequences to ensure safety
or teach the child better skills,
and when you deliver a consequence, you do it with empathy.
Very tough to do.
You say, "You know, your sister's doll that you just
"pulled the head off of was her favorite doll,
"and she's going to be so sad that that's broken.
"I think I'm going to need to help you find a way
"to pay her back so she can buy a new doll,
"and that's going to mean doing a lot of chores
"for the next period of time in order for you
"to earn back some money so that you can
"pay her for the doll that you broke.
"And I know you're not going to have fun doing that,
"but I'm going to help you do them, and we'll get them done,
"and you'll be able to help your sister find a new doll."
That's such a different way of delivering a consequence
from the, "Oh, that means you owe me 10 bucks
"and you better start earning it right now."
The empathy gives the child confidence that
you're still on his side, even though he did a bad thing.
You're going to help him figure out how to make it better,
but he's going to have to do it.
You don't let a kid like this off when they do something,
when they seriously misbehave.
The other thing I often teach parents in a situation
like this, because they tend to get angry so frequently,
is to do what's called 60 second scolding.
A 60 second scolding is to start with anger.
"I am so mad at you because you just tore the head
"off your sister's doll, and you know she loved that doll
"so much, and I know that that's a very important doll
"to her, too, and I know that that must also
"make you feel pretty bad inside, that you
"did something like that to your sister.
"And I know that I don't like to see you feeling so bad.
"The reason I don't like to see you feeling so bad
"is because I love you so much, and I really want
"to help you find a way to have a better life
"without doing mean things like that."
So you move from anger and maybe a loud voice
and talking about what the provocation is,
to why it matters to you, and to the child,
to why the child matters to you, and to a message of love.
That's a big shift in the course of 60 seconds,
but if you can learn to do it, it gives a parent a chance
to express their anger, which they have,
but also to end up with empathy and love.
Dan talks about stages of trauma resolution.
A child's been traumatized, either just by
the loss of a parent, and I shouldn't say "just,"
but that may be the only trauma the child's had,
or by a more complex traumatic situation.
It's important to realize that the adults serve
as the source of attachment security.
As safety emerges in the relationship, you can start
to talk about mildly stressful themes
for intersubjective exploration.
Once primary intersubjectivity is established,
the sharing of feelings, you move to secondary
intersubjectivity, which is talking about the trauma
together, sharing feelings as you
talk about something different.
Secondary intersubjectivity allows the child
to re-experience the trauma as experienced
by the therapist, who is also co-regulating the affect
in the time that you're talking about it.
Since that affect is no longer dis-regulating,
it's possible to create a new meaning together.
That new meaning can then be integrated
into a coherent autobiographical narrative.
I realize I'm covering a very large
amount of material in a short period of time,
and I would encourage you to do some training
with Dan Hughes if this intrigues you, because
learning how to make use of these concepts
is a very rich way to do therapy
with children who have been traumatized.
I'm just going to read you some basic
assumptions from Dan's website,
that are important for parents to recognize
and important for therapists too.
Your child is doing the best she can.
This is very basic, and it's not what most parents
think when they bring a child in for therapy.
Finding a way to make sense of that statement is often
a big project of therapy with the parent,
that your child is actually doing the best she can.
What does that mean?
How can you make sense of that?
He wants to improve.
Her life, as it is now, is a living hell,
so he tries to be safe by controlling
everything in his environment.
She tries to be safe by avoiding
everything that is stressful and painful.
His attacks on you, and his resistance to you,
reflect his fear of your motives,
poor affect regulation, fragmented thinking,
pervasive shame, inability to trust, and lack of control.
For her to change, you will need to accept, comfort,
and teach her, and this means accepting
the child, not always the behavior.
You will need to validate his sense of self
while teaching him important skills.
You will need to know her developmental age
and fine-tune your expectations to match that age,
so that she will have success, not failure.
Your physical and psychological presence
are the foundation of your comforting and teaching her.
Under stressful emotional conditions, he will
regress and revert to his basic, solitary
defenses he learned in his first home.
She will have to work hard to learn how to live well.
You cannot do the work for her, nor can you save her.
You can comfort and teach her.
You will need support and consultation.
You will make mistakes, and you need to face these,
learn from them, and continue.
On his website there's also a list of what is not done,
and some of these practices are things that have been done
in the name of attachment therapy in the past,
and it's important to...
to stay away from them, because
they are very damaging to children.
So these things are not done.
Holding a child and confronting them with anger
or poking or pushing the child while holding them.
Covering a child's nose or mouth
or lying on top of the child.
Utilizing shame, sarcasm, or laughing
in a child's treatment.
Laughing at the child, that is.
Any actions based on power, submission,
power and submission, where the adult asserts
their power and the child is submissive,
done repeatedly until the child complies.
Interpreting the child's behaviors as meaning that
she or he does not want to be part of the family,
and giving consequences for that.
So in order to do this kind of treatment, it's tough to do.
You must have resolved your own attachment trauma
or insecurity, because you can't provide a secure base
unless you have a really solid attachment model yourself.
It's pretty uncanny how kids with attachment issues
can find the issues that you have and hang them out
to dry on the line, and make your life...
evoke shame in you, if that shame is available.
So you need to have resolved an awful lot of this,
and you need to help parents do it, too.
The therapist must be comfortable with both adults
and children, because you're really working with both.
Therapists must be comfortable not always being liked,
and the therapist must have a good sense of humor,
because if you can't laugh, you're going to be in trouble.
That's Dan Hughes' model of attachment focused therapy.
I'm going to just briefly review a few other models.
Dan's model has not been researched extensively.
There have been a couple of small studies
on it that have shown some success,
but other models do have some empirical basis
and are actually now being used in trainings
because of that empirical basis.
One of the approaches is called
"Attachment, Regulation, and Competency"
by Margaret Blaustein and Kristine Kinniburgh.
They have a book...
that you will find in the bibliography,
describing this technique, and although
it's kind of a phase-based treatment,
where attachment, regulation, and competency are taught
separately, there's an understanding that in treatment,
the clinician will need to interweave the three
aspects of treatment, as treatment goes along.
So attachment, in this model, is addressed
primarily through training caregivers,
including caregiver affect management,
especially when the caregiver's own
attachment history has been challenging.
Helping the caregiver manage affect
in order to help the child manage affect is critical.
So helping the caregiver find a way to be attuned
to the child is important, especially when
the child behavior is challenging.
Helping the caregiver provide consistent
responses to the child behavior
establishes felt security, and reduces
the child's perceived need for control.
And helping the caregiver provide routines and rituals
for the child established a felt security also,
and build trust and reliability.
So attachment is largely done by working
with caregivers in this model.
Regulation includes identifying affects.
Often children who've had insecure attachment history
or disorganized or traumatic background
have not learned to even know what it is they're feeling.
If you think about it, the way you learn that
is in this attachment relationship, and once again,
they haven't had someone there say,
"Oh, you look sad right now," or, "My goodness,
"you seem worried about walking up those stairs,"
or all kinds of ways in which we are constantly labeling
for little children what we're perceiving their feeling is.
So children who haven't had that happen often don't know
what it is that they're experiencing,
so they need to find a way to label that internal
experience, and that's the first step of regulation.
Secondly, we're looking at affect modulation.
We're especially learning to express affect
within optimal levels of arousal.
A well-balanced person in life usually manages affect
in a way that's fairly smooth-waved.
So you may become upset, then you usually
find a way to calm yourself down.
You may become very excited and happy,
and gradually that excitement and happiness
fades, a new feeling takes over.
Whereas a child who's been traumatized tends to be
sort of way above the line of normal
affect expression, or totally shut down.
They don't have the middle range available to them.
So helping them learn that is a tough job,
and it's an important job for parents and therapists.
And then helping them find safe
ways to express their affect, especially when
their early experiences have led to the sense
that affect expression can lead
to vulnerability and lack of safety.
The purpose is to express affect that promotes
relationships and it helps them meet their needs.
But you can imagine a kid who's been beaten for
crying when they were hungry, is going to be afraid to cry.
So helping them learn to do that
in a safe environment is important.
The third skill in this model is competency.
A child who's had early trauma or negative
attachment experiences has not had a chance
to build competency in all sorts of areas of life.
The first step of building competency is building
those right-brain skills, those executive function skills
we talked about, like learning to plan, anticipating
consequences, inhibiting impulses, focusing attention.
So those skills are necessary in order to build competency,
and those are hard to teach, they take a long time.
Competency also includes assisting a development
of the self and identity so that you have
a sense of a cohesive and positive self.
Competency training also includes identifying and building
key developmental tasks that are getting in the way
of a child being able to do what he wants to do.
The book that Blaustein and Kinniburgh wrote,
"Treating Traumatic Stress in Children and Adolescents,"
has much more detailed descriptions of each
of these phases of treatments, as well as very valuable,
copyable handouts that are useful to help teach
children and caregivers new skills.
They really give you hands-on tools
to use as you start trying to teach these skills,
because explaining a skill to a child is
completely inadequate as a way
of teaching them how to make use of it.
I think you'll find this book very valuable
in working with, if you're working with children
who have had these experiences.
There's several authors who have
developed ways of working with
traumatized children using EMDR.
The names I mention here are Joan Lovett,
Debra Wesselman, and Lacher, Nichols, and May.
There's also newer work by Ana Gomez and others.
These models tend to include focusing on regulation
by using what's called "resource installation"
or "resource development" within EMDR.
So you can build positive traits and skills,
help the child envision, imagine having better skills
and help them develop those skills
by using resource installation tools in EMDR.
And then usually the biggest focus in these models
is developing a trauma narrative
that can be created by the child
or the therapist with the parent.
A trauma narrative...
your goal is to help the child move from
an overwhelming and affectively negatively charged model
to one that has a new meaning for their history,
and gives them a way to move beyond it.
EMDR seems to be a good model to use
for working on serious trauma, because it often
allows the child to process frightening material
with less abreaction and distress.
Another model of treatment for children
who've had negative attachment experiences
and trauma and loss is Infant-Parent or Child-Parent
Psychotherapy by Alicia Lieberman and Patricia Van Horn.
They've also written a book on this topic and
it's a useful book for therapists who are working,
especially with young children.
Their model is primarily psychodynamic,
long-term treatment for young children and parents
who are at risk or have hurt their child
or have children who have been hurt in the past.
It's been informed largely by data on intergenerational
transmission of attachment and trauma
that we reviewed earlier, and the focus is on
the caregiver to provide her the mothering
and a chance to resolve her own trauma,
so that she can become the adequate caregiver for the child.
Lieberman was influenced largely by Selma Fraiberg,
whose studies in infant mental health are wonderful
studies to read if you haven't read them yet,
about the experience of providing child-parent
psychotherapy, and really Selma Fraiberg began this field
of infant-parent psychotherapy.
The focus within this model is on empathic communication
skills, such as those found in secure attachment.
The final intervention I want to talk about
that's attachment-focused is called "ABC."
The ABC Intervention by Mary Dozier at Delaware.
This is a short-term, in-home intervention.
It's 10 sessions long for at-risk
parents and babies or toddlers.
It's also been used with foster parents
and toddlers and babies, and it's aim
is to enhance sensitive, nurturing care, and to decrease
frightened or frightening behavior by mothers
towards babies, because we know that being
either frightened or frightening toward your baby
is more likely to cause disorganized
attachment on the part of the baby.
The impact of this change in maternal care
is to enhance the child's attachment organization.
What the mothers are taught in this 10-session intervention
is to provide nurturance, even when
the child seems to be rejecting it.
To take delight in following the child's lead in play,
and to stop intrusive, frightened,
or frightening behaviors toward the child.
It's also to recognize how parents' own attachment
histories may interfere with their doing these behaviors.
And then consolidate the gains in the child and the parent.
What's remarkable about this intervention is that
in 10 sessions, it's sort of a coaching intervention,
there have been dramatic results in improving
mother's sensitivity and responsiveness
and in changing children's and mother's attachment patterns.
So this is a very promising intervention for young children
and parents, and one that may help prevent
a lot of the longer-term consequences
of attachment-based trauma in young children.
The final model I'm going to talk about
is sort of an integrative model of using
attachment theory in therapy with adults.
A number of authors have talked about using
knowledge from attachment in their...
in their work with adults, and I think probably
the most useful book I know of for working with adults
is by David Wallin, on the use of attachment
in therapy, and it's in your bibliography.
My first slide shows this quote from Bromberg,
that sort of evokes Dan Siegel's concept
of interpersonal neurobiology.
"The therapist's right hemisphere allows her
"to know the patient from the inside out."
So this is talking about a very profound
dyadic communication, along the lines
of this interpersonal neurobiology,
in which the therapist is able to grasp
what the patient's inside understanding
of life and themselves can be.
So what do you do as a therapist
who's really trying to make use of...
attachment theory?
One important piece of it is to use
the therapist as a secure base.
That's one way we talk about parents,
as a secure base for their child.
I did talk about the fact that I really feel that
in treating children, you need to help parents be the secure
base, the attachment figure for their child.
When you're working with adults, obviously
there's not a parent there who can provide that,
so you really need to find a way to provide
this secure base for your client.
And because a client is old enough to
use the skills of internalizing your
security as part of their ongoing feelings
in their life, they can carry you with them,
you can actually become a secure base
for a client, for an adult client.
And in session, you use your regulatory ability
to co-regulate with the client.
You may need to actually do the regulation
for them for awhile, move to co-regulation,
as you do with a child, and then help them
internalize that regulation as their own.
It's important in treatment where you're thinking
about attachment to be aware of what is evoked
in you by this client, and how you can make use of it.
Countertransference is a critical aspect
of doing this type of therapy.
When you're attuned to a client, even when you're
not attuned often, you receive projections from the client
of emotional material that's defensively
excluded from their consciousness.
You can use this information, this material,
where feelings are evoked in you that don't belong to you.
You can use it as information that shapes
your treatment plan, or at times it can be
carefully presented as material
to the client that can now be integrated.
And in this process, you're helping the client
co-create new meanings and integrate into themselves
previously excluded aspects of affect or information.
You're also helping them by presenting a positive view
of material that has felt so negative to them
that they couldn't let it be part of themselves.
If you can, just as you would with a child,
say, "All right, I guess I can understand
"how that would make you feel so rotten,
"but on the other hand, I see it as a perfectly
"reasonable way to react to the situation you were in."
By helping them do this, by helping them find
new ways of understanding what their own
feelings and behaviors are, they can then
begin to integrate them and develop
a more coherent sense of themselves.
They don't have to leave anything out.
Just to talk a little bit more
about projective identification.
We have to be really careful with clients
who have severe attachment histories
because it's really easy to end up acting out
what the client, in many ways, expects of us.
So a client who's rigidly excluding aspects of themselves
will often project those on to the therapist,
who may unwittingly play out the behavior
evoked in him or her by the client.
A client may evoke in you a desire
to rescue, to reject, or misunderstand them,
and if you're not recognizing that this is coming
from the client, and you act on it,
you reinforce their internal working model
that they're going to be rejected, or they're going
to be misunderstood or whatever, and that's
going to make their life harder, and
it's going to stop the progress of therapy.
So attention to countertransference,
and the ability to process what's going on in that way,
is required to work through these situations
and to provide limits with empathy as opposed to rejection.
So if you think of someone who always comes late,
who blames you for planned breaks,
who feels misunderstood at times,
it's easy to be annoyed at a client like that.
It's easy to end up acting in rejecting
or misunderstanding ways, and it's really important
to be exploring this within yourself first
to understand, "Is this the client's projective
"identification, is this some remnant of my own history
"that's coming up to cause me trouble?"
And then it's important to figure out a way
to use it in the therapy, whether or not you
discuss it with the client, to find a way to avoid
enacting what it is that the client's projecting on to you.
It's important in work with adults, just as it is
with children, to be aware of shame versus guilt.
When there's been an insecure attachment history,
the client tends to see themselves as broken or bad,
which is the result of a pervasive shame in their history.
As we talked about earlier, shame is not reparable.
If the self is bad, you either have to cover it up
or put on a false self, or project out
that negative picture on to someone else.
Guilt, on the other hand, is reparable.
It's possible to acknowledge bad
behavior and make recompense.
So in treatment, by the therapist's insistence
that what the client did is not reflective of his badness
as a person, but only an understandable response
to a situation he found himself in, the client's
gradually able to transform shame into guilt,
and eventually come to the point
of developing empathy for himself.
This is a very long process, when somebody's got
shame that's really pervasive as a basis of their identity,
but it's an important one to work on,
and I think every time you realize there's shame
being experienced, it's important to address it because
that move from shame to guilt is a critical move
in developing a stronger sense of self.
So just as with children, it's important to recognize
empathic breaks and repair them.
There will be times when you misunderstand
what a person's saying, there may be times when you
come late to an appointment, there may be times
when you don't answer the phone when a client calls.
There will be times when there's a break between you,
either that's your fault or not your fault,
but it's important to recognize that it's experienced
as a break, as a loss, and to provide repair.
Sometimes you may just mis-perceive what a person says.
Sometimes you may have done something that is harmful.
In any case, these are very rich experiences in therapy,
and just as with a toddler who needs thousands of times
to be told, "No," and then to be provided love
and understanding and have an explanation
of why the "No" occurs, so in therapy.
It's rich material when you can say,
"Oh my gosh, is that what you thought I meant?
"I can see why you were so upset with me."
And then you can go on to repair it,
or some clients will perceive you being away for
a planned break as an empathic break.
They may see that as a rejection or abandonment,
and helping them understand that
you can understand from their history why this would
feel like an abandonment, but you also need them to know
that you still care about them, and you really
want to be with them, is important.
Every time there's a perceived break of any sort,
I think it's critical that you really mine it
for all you can, because...
it is one of the most important ways we have
to help people shift their understanding
of how people work in reaction to them,
because they have such a negative view from
the first model they'd formed.
It also increases the client's
ability to have reflective function.
When you keep showing, "Oh, I said this,
"and you thought I meant that.
"Oh my goodness, that must be have been so disturbing.
"I really will try not to say it that way again,
"but I want you to know what I was
"talking about was really this."
That's all using your own reflective function
to reflect on the process between you and the client,
and encourages them to start doing the same thing.
So when you see reflective function in a client
it's always a wonderful time in therapy
and it's important to point it out,
because it means the client's moved in to the ability
to start to process material on their own.
So it's important to notice it and it's important to help
clients nurture the ability to do that kind of reflection,
and to extend it into therapeutic
and non-therapeutic interactions.
I think it's also important to think about coherence,
just as we did when we were talking about
the adult attachment interview.
When Mary Main was first developing the adult attachment
interview, she came upon this notion of coherence
which had been described by a linguist named Grice,
and he has Grice's Maxims of Coherence.
The four aspects of language that you need to look at
are quality, whether the person is truthful and has evidence
for what they say, that's considered coherence quality.
Quantity, whether the person is succinct yet complete.
I think if you remember a couple of those interviews
that I read you sections of, a dismissing client is often
too succinct, they just give you a sentence or two.
Remember the one person who said, "Next question,"
after they'd given a very brief description.
So they weren't complete.
They were succinct, but not complete.
Or the preoccupied person who was going on and on
about his mother and his wife and other people,
and that person was not complete because he wasn't really
addressing the question, but he also was not succinct.
There's also coherence in relationship to relevance,
so that the question is answered by a relevant answer
and I think you'll remember from those interviews that
a couple of the people gave answers that didn't relate.
They didn't tell you what was troublesome about their
relationship with their mother when they were young.
They went off on other tangents, like what
their wife was like with their kid.
So relevance is a critical part of coherence,
and manner is the fourth maxim.
That you should be clear, brief, and orderly.
So you should really come across with a good response
that makes clear what the answer is and gives the person
a good, clear understanding of what that answer was about.
One of the most valuable trainings I did was training
in rating the adult attachment interview,
because it caused me to start paying a lot more attention
to the language my clients were using.
When they began to violate one of these maxims of coherence,
or particularly when they started having lapses
in their discourse so that they were
showing evidence of disorganization
or unresolved trauma or loss, I was much more able
to pick it up just by the way they talked.
If you can do that, it helps you find the places
where the person is beginning to feel like they need
to exclude information from the therapeutic session
or even from their own consciousness.
When you're paying attention to the narrative of a client,
you need to look at whether they are
flexible and complete, versus rigid and incomplete
in their description of things.
Flexibility and completeness are really
hallmarks of coherence, and rigidity almost always
is a reflection of incoherence.
You should also notice breaks in narratives.
When a person pauses, that may be an indication
they can't talk about what has just come into their head.
You need to look for changes in tense, person, or tone,
because those may indicate places where
someone's just gotten derailed from
a coherent explanation of what's going on
by something that's defensively excluded.
And you need to notice the adequacy
of the description and what's left out.
Is it emotional information or cognitive information?
When information is omitted, or when there are
evoked reactions in the therapist, those things can
point to a type of insecurity that the person
is feeling, and that can help you know
how to address what's going on with them.
If you read David Wallin's book, he has
extensive descriptions of ways to work
with avoidant or dismissing clients,
ways to work with preoccupied clients, and so forth.
The other thing you need to notice in the narrative
are experiences of dissociation and lapses
in what's called metacognitive monitoring.
So dissociation, obviously, is often
associated with unresolved trauma or loss.
Similarly, a lapse in metacognitive monitoring
is associated with those things.
What metacognitive monitoring is,
is the ability to monitor your own discourse
for coherence and relevance.
Most of us, as we talk, we're thinking
about what we're saying.
We're thinking about whether what we've said
makes clear to the other person
what we're trying to communicate.
That means we have an understanding of the other mind
with whom we're communicating, and we'll talk differently
with a child than we will with an adult, for instance.
And we'll talk differently with some adults than
with other adults, because we have an understanding
of the differences in their minds.
When you see lapses in metacognitive monitoring,
when people sort of lose the context, or begin to talk
in ways that don't make sense in the overall narrative,
you're more likely to be looking
at an unresolved attachment pattern.
And being able to do that really gives you clues
to where these patterns may have originated,
because you'll find that they come up
when the person's talking about an early experience
or even a later experience that may
evoke an earlier experience in their lives.
You need to pay attention in treatment
of adults to their arousal level.
Part of providing regulation is to keep the client
in what we call the therapeutic window,
and this is true whether you're
working with adults or children.
The therapeutic window is the space
in which arousal is high enough to keep the client engaged,
so they're not shut down, but it's not so high
that cognitive processing is lost.
So if a person is very aroused, either by
fear or anger or even excitement, they're not...
their cognitive brain, their left brain, is not functioning
as well, and when a person is like this,
they're not learning from you.
What you need for the therapeutic window is
to have this optimal level of arousal,
that may go up and down some,
but it doesn't go beyond the window,
where the person is not available to learning.
It's important with adults to help them
learn to notice their arousal level,
and to develop skills to calm themselves
through distraction, breathing,
relaxation exercises, or meditation.
And the process of trauma really needs to proceed slowly,
staying within the therapeutic window.
It's critical you start noticing when a person moves into
re-experiencing as opposed to re-telling.
If they're re-experiencing a trauma,
they're no longer able to process it.
They're living there.
You need to help them stay within the therapeutic window,
even if that means you do tiny amounts
of processing at a time, because
you're essentially losing them as soon as they
move out of that therapeutic window.
So I talked a little bit about "earned security"
as adults, in adult attachment.
What we find in earned secure adults
is they can tell their story truthfully,
with a full understanding of the impact of early experiences
and an ability to look at the experience
from the point of view of their caregivers
as well as their own point of view at the time.
They may be sad or angry, but they
don't get lost in sadness and anger,
and they're able to describe what they've
learned from that attachment experiences,
and how their learning from those experiences
has informed their changes in identity
and their plans for the future.
They're also able to talk about how they parent children
or wish to parent children as a result of those changes.
So essentially, a lot of therapy with adults
is re-writing their attachment narrative,
to help them find a new ending for the story,
to help them find a way to make sense of what happened,
to use what they've learned to build
new building blocks of the self, and to develop confidence
and an ability to move forward, in a life that they choose.
Achieving earned security is a long process,
and it requires using the therapist as a secure base.
Sometimes people can do this within an intimate
relationship, a marriage or some other relationship,
and it requires coming to understand transference responses,
and moving toward empathy for the self
as well as for one's early caregivers.
Typically when you hear an adult who's earned
secure talk about their early caregiving
experiences, which were not positive,
you'll hear them say, "Well, you know, at the time,
"the way it felt to me was she just didn't care about me,
"but now, when I look back on it, I can see
"how complicated her life was then, and how
"she had to focus on other things in order to continue,
"and I just couldn't be a priority of hers at the time."
So this person is reflecting, using reflective function
to think back on the experience,
think back on what their experience was,
but use their adult mind to understand
also the mind of their caregiver,
and make an interpretation of the caregiver
that may be different from the one they made
at the time they were as a child.
So in a way that one tends to develop
empathy for that caregiver as well as
for the child in that situation.
That achievement of earned security
is inherently a dyadic process
that can only be achieved in relationship.
And finally, whatever model of attachment
focused treatment you use, this is very intense work,
and you need to think about self-care even more
than you do when you're not doing attachment based therapy,
when you still need to think about self care.
Therapists are only good at providing regulation,
attunement, and a secure base if they themselves
have achieved a flexible and fairly complete
understanding of their own attachment history.
This usually means doing some
significant treatment yourself.
An ongoing work of this nature is intense.
It requires access to consultation,
time away from one's practice spent in rest, renewal,
and recharging in one's own attachment environment.
All of this enables you to work with
the transference and countertransference
processes that are occurring in a way that
makes sense for you and for your clients.
So I hope this has been a helpful
introduction to attachment.
I don't think you're prepared to go out
and do attachment-focused treatment now,
but maybe you've been intrigued enough to explore it
some more, and to take on learning one of these models
so that you can, in the future,
be a much more effective therapist.
Thank you for your time.