Attachment and the Secure Base System SelfConfidenceExploration Felt
Attachment and the Secure Base System
Self-Confidence/Exploration Felt security Secure Base Caregiver’s Signal detection Safe Haven Perceived Threat Attachment System Signaling Proximity Seeking
The Effects of Secure Base �Repeated Secure-base interactions create internalized models of relationships that are carried forward to new relationship experiences �What to expect �How to behave
Secure Base Effects �Powerful influence on Neurobiology �Emotion-Regulation and Sensory Integration �Language Development �Executive skills— � Shifting � Monitoring � Labeling � Problem-solving
Healthy Neurobiology �Three interrelated systems �Thinking �Feeling �Relating/communicating �Working together in an integrated, goal-directed, collaborative fashion
Attachment Problems �Attachment Problems—failures in the secure base system result: �Defensive, maladaptive relationship models �Neurobiological failure �Neurocognitive deficits—lagging skills in: � Thinking � Feeling � Relating/communicating
Disruptive Behavior Disorders Most commonly referral to community mental health centers Includes: Attention Deficit Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder Copy Right: /Sibcy, 2005 gsibcy@Liberty. edu
Oppositional Defiant Disorder �Symptoms �Temper tantrums �Arguing with adults �Questioning rules �Active defiance and refusal to comply with rule �Deliberate attempts to annoy �Touch and easily annoyed �Anger and resentment �Mean and hateful when upset �Spiteful attitude and revenge seeking
Complex Oppositional Defiant Disorder �Define the problem: �Meets criteria for ODD, Plus �Executive skill dysfunction �Emotion dysregulation—anger plus other emotions �Relationship disturbances, which includes attachment system �Highly resistant to traditional parenting practices
Severe Mood Dysregulation (SMD) �Distinguished from Classic Bipolar Disorder in Children (episodic irritability) �Abnormal baseline mood: irritable, anger, and/or sadness, noticeable to others & present most of time �Hyperarousal: insomnia, physical restlessness, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness �Increased reactivity to emotional stimuli (temper outburst) at least 3 x/week
Differences in anger expression �Hand-grenade –ADHD/ODD combo only �Hurricane—SMD or BPD �Reactive Aggression �Proactive/Aggression �Type I Abusers �Type II Abusers
The Pyramid Self-Control Self Control Problem Solving Cognitive Flexibility Language Processing/Mindsight Social Skills Emotion Regulation
Motivation and Skills Motivation Skills
Motivation Yes Adaptive Maladaptive (Family System) Maladaptive SMD/BPD Maladaptive Family + CODD with SMD// Skills No No
Case Study I �Jackie— 8 y. o. girl �Mother-teacher; father-Engineer. Well resourced family; lots of social support; no significant family dysfunction; younger daughter, high functioning. �Child: ADHD with numerous ODD symptoms �Significant mood dysregulation � Both baseline (especially mornings); tantrums/explosions with cursing, spitting, hitting, property destruction � Room Wrecker
Jackie (continued) �Situation Analysis of meltdown �Mom: We were in the kitchen, finishing breakfast. I told Jackie she needed to go upstairs and brush her teeth before we left for school. She refused, saying “we have to go or we’ll miss the bus. ” I said, “we will just have to miss the bus and catch it at another location, depends on how quickly you get it done. ” She jumped off the stool, dragging her bowel on the floor, then kicked it across the room. I told her she was grounded for the next week. She went stomping up the stairs and locked herself in room—wrecking it (pulling clothes out of drawers), kicking, screaming, and yelling….
Case Study: Jermane �Eight year-old African American female �She and Five year-old brother, adopted by Paternal Grandmother �Father—alcohol, drugs, crime, incarceration �Mother-alcohol, drugs, history of physical and sexual trauma �Family history of likely BPD and PTSD �Child exposed to extreme chaos, neglect, possible sexual abuse, exposed to inappropriate sexual behavior between adults
Jermane (continued) �Symptoms: �Extreme mood dysreguation, including Explosive outburst �Hyper arousal symptoms �Inattention, hyperactivity, impulsivity �Rigidity �Poor frustration tolerance �Poor social skills-adults, peers � Controlling/aggressive/intrusive or withdrawn �Poor use of secure base—likely attachment disorganization
Diagnostic Profile �ADHD �ODD �SMD + PTSD �Significant Attachment Dysfunction
Jermane: continued �Grandmother’s History �Chaotic abuse �Incest: 5 th of 6 children. Her mother 14 at birth, father was her stepfather. Patients step-grandfather was her father. . �Her mother was traumatized and extremely abusive �Patient: numerous PTSD symptoms plus, Extreme affect dysregulation: anger and spending tension reduction behaviors � History cocaine addiction, multiple marriages, current husband is heroine addict, in remission �
Unmet Expectations And Compliance Interactions Preventing explosions while enhancing secure-base and neuro-cognitive skill development
Goals: 1. 2. 3. Take parent concerns seriously Take child concerns seriously Reduce Challenging Behaviors, especially Reduce Melt. Downs � � � 4. 5. Destructive child’s nervous system Conditioned Emotional Responses (CERs) Reinforces insecure relationship models (attachment) Work on Neuro-Cognitive Skills—Whole Brain Child Improve Secure Base
Using the Whole Brain �Left-Right Hemisphere �Brain Stem �Limbic System �Avoid Amygdala Hijacking �Septal Rages �Prefrontal Cortex
Secure Base Effects �Powerful influence on Neurobiology �Emotion-Regulation and Sensory Integration �Language Development �Executive skills— � Frustration tolerance � Shifting � Monitoring � Labeling � Problem-solving
Three Pathways Pathway A Compliance Interaction Pathway B Pathway C
Three Pathways Compliance Interactions �Pathway A—Force Adult Concern � Advantages � Disadvantages �Pathway B—Collaborative Problem Solving � Advantages � Disadvantages �Pathway C—Temporarily Dropping Concern � Advantages � Disadvantages
Collaborative Problem Solving: �E—empathy— �A—Assert— �R—Respect— --------------�I—Invite-�C—Collaboration—
Empathy �Listening and understanding child concerns �Helping child articulate concerns what the concern �Taking concerns seriously �Empathy is a reciprocal process, so you may try to empathize but if the child does not believe you understand then you have not empathized
Assert-�Define Problem, expressing concern or expectation �Don’t mistake your solutions for concerns or expectation �Appeal to rules as important principles to follow
Respect �Work at monitoring and managing your own emotion regulation—if too upset, go to pathway C �Non-contingent respect �Never use disrespect as a form of punishment �Avoid global, negative attributions �Remain warm—avoid triggering CER’s
Invite �asking child to generate possible solutions �Avoid forcing solutions �Think out loud
Collaboration �Working with child to come up with workable solutions �Help child use foresight and hindsight �Model flexibility �Model regulation �Model respect �Maintain warmth
Qualities of Good Solutions �Mutually satisfactory �Do-able �Durable
Back to the pathways �When to use A �When to use C �Different kinds of C’s, some are better than others �Two kinds of B’s �Emergence �Proactive—timing is everything
Parenting and Mentalization �The use parent-child interaction questionnaire �Describe situation: beginning, middle, end �Describe behavior �Interpretations �Actual outcome �Desired outcome �Question: did you get DO? �Remediation Phase
Engaging the Repair Cycle �Turning conflict into learning
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