Defiant Teens Desperate Parents Attachmentbased Strategies for Emotional

Defiant Teens, Desperate Parents: Attachment-based Strategies for Emotional and Behavioral Disorders Dr. Joshua Straub

Objectives Define the characteristics of a parent who is a “safe haven” and “secure base” and describe how the core relational beliefs of kids and teens are developed based on the level of safety and attunement in the home.

Objectives Identify the latest research informing attachment-based strategies for emotional and behavioral disorders in teenagers.

Objectives Implement new (very practical and even fun) parenting strategies into their practice with families to: Enhance intersubjectivity, increase levels of safety in the home, develop cognitive skills in their teens, and foster an overall sense of worth in each individual in the family unit.

Attachment Theory How relationships shape our brains ability to regulate emotion and learn to participate in close, intimate relationships Emotion regulation is the ability to tolerate and manage strong negative emotions and to experience the wide range of positive emotions as well Key question: “Is this world I’m living in a safe or dangerous place?

The Role of Experience Brain wires itself based on experience Asks several questions: Is the world a safe place? Can I count on my caregiver’s to help me in time of need? Can I get the care I need when I need it?

Kinds of Memory Implicit Memory— • Present at birth • Includes behavioral, emotional, perceptual, body • Mental models—states become traits • Conscious attention not required for encoding • No sense of recollection when memories recalled • Does not involve hippocampus—mostly amygdala

Kinds of Memory Explicit Memory Emerges in second year of life Sense of recollection when recalled If autobiographical, sense of self and time present Includes semantic (factual) and episodic (autobiographical) Requires conscious attention Involves hippocampus—converts to context If autobiographical—involves prefrontal cortex

Core “Relationship” Beliefs Self • Am I worthy? • Am I capable? Other • Are you reliable? • Are you accessible? • Are you capable? • Are you willing?

Measuring Attachment Beliefs Negative View High Avoidance OTHER Positive View Low Avoidance Positive View Low Anxiety SEL F Negative View High Anxiety SECURE PREOCCUPIED Comfortable with intimacy and autonomy Preoccupied with relationships and abandonment DISMISSING FEARFUL Downplays intimacy, overly self-reliant Fearful of intimacy, socially avoidant Figure 1. Bartholomew’s model of self and other

Relationship Rules Secure Attachment Self Dimension • I’m worthy of love • I’m capable of getting the love I need Other Dimension • Others are willing and able to love me • I can count on you to be there for me Avoidant Attachment Self Dimension • I’m worthy of love (false pride) • I’m capable of getting love I want and need (false sense of mastery) Other Dimension • Others are incompetent • Others are untrustworthy Ambivalent Attachment Self Dimension • I am not worthy of love (I feel flawed) • I’m not able to get the love I need without being angry or clingy Other Dimension Disorganized Attachment Self Dimension • I’m not worthy of love • I’m unable to get the love I need Other Dimension • Others are unwilling • Others are unable

Attachment and Feelings Secure Attachment ØFull range ØGood control ØSelf-soothes ØShares feelings ØOK with others’ feelings Avoidant Attachment ØRestricted affect ØFocus is on control ØUses things to self soothe ØKeeps feelings buried ØDoesn’t share feelings Ambivalent Attachment ØFull range ØPoor control ØCan’t self soothe ØShares feelings too much ØOverwhelmed by others’ feelings Disorganized Attachment ØFull range, but few positive feelings ØPoor control ØCan’t self-soothe ØCan’t really share with others ØOverwhelmed by others’ feelings ØDissociates

Attachment and Intimacy Secure Attachment ØComfortable with closeness ØShares feelings and dreams ØWilling to commit ØBalances closeness and distance ØParticipates in non-sexual touch Ambivalent Attachment ØDesires closeness, but never seems to have enough ØWants to merge with other ØPreoccupied with abandonment ØClings and criticizes Avoidant Attachment ØNot comfortable with closeness ØWithholds feelings and dreams ØDifficulty with commitment ØDistances Disorganized Attachment ØDesires closeness, but fears and avoids it ØWants to merge, then wants to distance ØTerrified of abandonment ØSabotages closeness ØAttracted to people who victimize

Self-Confidence/Exploration Felt security Secure Base Caregiver’s Signal detection Perceived Threat Safe Haven Attachment System Signaling Proximity Seeking

Secure Base Effects 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, goaldirected, collaborative fashion

The Pyramid Self-Control Self Control Problem Solving Cognitive Flexibility Language Processing/Mindsight Social Skills Emotion Regulation

Disruptive Behavior Disorders Most common referral to community mental health centers include: Attention Deficit Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder Copyright: Gary 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

Motivation and Skills Motivation Skills

Motivation Yes No Adaptive Maladaptive Skills No

Explosive Teens Delinquent kids can be traced back to when kids are as little as 3 years old. They noticed they don’t have fun together. They don’t do stuff as a family or have alone time with parents.

The Coercive Cycle Patterson, Forgatch, and colleagues at Oregon Social Learning Center studied antisocial boys and parenting techniques

The Coercive Cycle 1. The child asks for something, making a demand in a really aversive, highly annoying manner. 2. The parent initially comes down very hard on the aversive request. The parent may threaten the child with very negative consequences.

The Coercive Cycle 3. The child escalates, and keeps escalating, using increasingly irritating and embarrassing behaviors (especially if done in public) 4. The parent gets increasingly upset, threatens and eventually loses control with emotions like anger, criticism, and contempt. The child’s escalation continues to worsen.

The Coercive Cycle 5. The exhausted, frustrated, and embarrassed parent eventually backs down, gives in, and the child gets what he or she wanted in the first place.

Skills Explosive Teens Need to Develop 1. Pausing for a few moments rather than immediately reacting 2. Using words to express emotions rather than acting them out.

Skills Explosive Teens Need to Develop 3. Considering alternative actions and their consequences before choosing one to do. For example, when angry, choosing to walk out of the room, rather than throwing a toy. 4. Focusing and sustaining attention on a single task or conversation

Skills Explosive Teens Need to Develop 5. Being able to shift attention to a different task or conversation.

2 Goals with Explosive Teen For problem solving: 1. To understand what is making the child become explosive 2. To help the child to develop a certain set of skills that will allow them to be more flexible, tolerant of frustration, and better at problem solving, given a difficult situation.

Unmet Expectation and Compliance Interactions Preventing explosions while enhancing securebase and neurocognitive skill development

Goals 1. Take parent concerns seriously 2. Take child concerns seriously 3. Reduce Challenging Behaviors, especially Reduce Melt-Downs Destructive child’s nervous system CER’s Reinforces insecure relationship models 4. Work on Neurocognitive Skills 5. Improve Secure Base

Secure Base Effects Powerful influence on Neurobiology Emotion-Regulation and Sensory Integration Language Development Executive skills— 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 expectation Appeal to rules as important principles to follow or

Respect Work at monitoring and managing your own emotion regulation—if too upset, to pathway C Non-contingent respect Never use disrespect as a form of punishment Avoid global, negative attributions Remain warm—avoid triggering CER’s go

Invite Asking teen 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 Doable Durable

Qualities of Good Solutions 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

Moments of Connection Turning conflict into learning

6 Broad Principles of Attachment-Based Therapy Safety Education Containment Understanding Restructuring Engaging