When Love Is Not Enough - Australasian …...When Love Is Not Enough Vulnerable Families,...

When Love Is Not EnoughVulnerable Families,

Intergenerational Patterns, Addiction & Attachment

Lauren Lindsey Porter, BA, [email protected]

Lyttelton, New ZealandATCA Conference, 18 September 09 Workshop, Canberra

Saturday, 19 September 2009

mailto:[email protected]

mailto:[email protected]

“Relationship-Diathesis” Model

Recovery from trauma depends on:Nature of trauma (who, when, intensity, etc)Quality of attachment relationships


Narnia


Attachment Styles

Secure Insecure-Avoidant Insecure - Resistant/Ambivalent Insecure - Disorganized (1990)Different fearsIn place by 12 months‘Cradle to grave’


“Attachment is a difference that makes a difference”

Security leaves children happy and free to learn.

It fosters constructive peer relationships.

Security offers children a relationship-based solution to manage fear and distress.


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-! from exploration to attachment needs and back again - children require the support of an emotionally available adult, someone who is:

-! “kind and always bigger, stronger and wiser than themselves. Wherever possible, this person follows the child’s need. Whenever necessary they take charge” (Marvin et al, 2002).


Avoidant Attachment

DismissingAttachment strategy is to maintain distance and decrease the likelihood of increased emotionInability to tolerate emotion, which leads to rejectionPrice is loss of sensitive care when neededDisavows belief in a secure base/safe havenAvoids closeness, disengagedBowlby: ‘defensive exclusion’ and ‘compulsive self reliance’


Ambivalent Attachment

PreoccupiedMonitoring, mind reading in an attempt to forestall any potential drifting awayHyperactivationBlurred boundaries, intrusive, enmeshedKnows the secure base is there but is driven nuts by its unpredictabilitySometimes role reversal - becoming indispensable, parentified


Disorganized Attachment

UnresolvedParent scripting the child into past narrative/dramaInability to establish consistent attachment strategiesAs children age, strategies evolve into either punitive or caretaking


Dimensions of Attachment


Strongest Predictor

Parent’s state of mindBiographical input is related to developmental outputBiology is historyTransmission of invisible is potent


Attunement

Reading and responding to cuesSynchronous and interactiveDyadicMaintains equilibriumCan be taught/learned


Patch Adams


Self Regulation

Babies are not born with the ability to self regulateBabies are reliant on a caregiver to interactively regulate internal statesPhysiological-homeostatic regulation forms the core of attachmentIt is the basis of early learning and forms the infrastructure of our identity, value and safety

‘There is no such thing as a baby; there is a baby and someone.’ Donald Winnicot, MD


Patch Adams


The Effects of Stress

Definition: Anything that interferes with homeostatis and attunement; creates dysregulationWith the brain, what doesn’t kill you makes you weaker

Positive touch activates brain’s reward chemicals


Stress Response

Stress CycleHyperarousal: Major stress hormones, hypermetabolic state, short term coping, ‘fight or flight;’ infants can’t fight or flee so they rely on a caregiverDissociation: Helpless/hopeless, endogenous opiates, cortisol, become ‘unseen;’arousal hormones still presentThere is nothing good about dissociation - it is fundamental disconnection and loss - it is toxic


Stress/Cortisol Research

Chronic stress associated with elevated cortisol levelsBrain impairment, immune suppression, aggression, intellectual deficits, early puberty, depression and other mental illnessSecurely attached babies have lower levelsSurges OKBoyce - ‘dandelions’ and ‘orchids’


‘Normal’ Stressors - Bathtime

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Maternal Sensitivity

Albers, E. M., Riksen-Walraven, J. M., Sweep, F. C., & de Weerth, C. (2008). Journal of Child Psychology & Psychiatry, 49, 97-103.

Time Since Last Feed

Pre bath Post 25 Post 40


Social Synapse

Stress hormones get transmitted across the social synapseHolocaust survivors, children and grandchildren


Addiction and Attachment

Effects of substances on parents’ emotional availability, attunement and regulating abilities are profound


Parenting

Via physiology and brain connection, parenting evokes in us everything we haven’t been aware of that is painful to us


Genetics and Environment

Predisposition to addiction exists geneticallyExpression of the predisposition rests in the early relational lifeRisk vs. resilience


Reactive Attachment Disorders

DisinhibitedDefinite lack of differentiationclear indication that would readily go off with a strangerdefinite lack of checking back with parent

Inhibitedindicates distress but does not come for comfort


Old Model

Learned about prenatal impact of AOD use on fetus via

1960’s and Thalidamide1970’s and Fetal Alcohol Syndrome


Medical Model

Addiction’s impact on children/family: physical aspectsNeurological impairmentSmaller babies/ growth retardationWithdrawalMore illnessIncreased SIDSCognitive delays


Holistic Understanding

A developmental model with addiction as one risk factor / aspectIntersection with caregiving environment and other risk factors

Abuse/neglect historyPovertyParental traumaParental psychopathologyFamily violence


Regulation via Illness

Substance abuse can be understood as an attempt to regulate negative emotions, anxiety and depressive feelingsDirectly related to attachment orientations and family’s ability to tolerate negative emotional states, closeness and separation


Early Trauma

Fear of facesDecreased networks for facial recognitionConclusions therefore based on internal statesTypically biased with shame


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Face Recognition Research


Taking Another’s Perspective(Theory of Mind)

False Belief Task


Behavioral & Emotional Problems

Not problems of the child (Rutter, van Ijzendoorn)Are problems of growing up in neglecting/ maltreating family


Affect Regulation & Early Trauma

Chronic stress leaves person vulnerableInability to use emotions as cues for action

RecognizeNameTolerateLearn from

Absence of internal emotional signalsOpiate receptor changesCauses dysphoria, confusion and eventual sensation seeking


Regulation & Substances

Early trauma results in maladaptive self-regulatory abilitiesAttempts to alter affective state via extreme arousal such as drug use Affords self soothing, anesthesia from pain, restoration of affective control and, therefore, high likelihood of repetition‘A life of its own’


Cycle of Panic

Unable to handle strong feelingsResults in fragmentation of selfDesperate search for soothingTo silence shame Avoid pain


Plasticity

Change in the brain is possible because the brain is ‘plastic’Attention stimulates neural firing which creates synaptic changeNeurons that ‘fire together wire together’Change is easiest at the later developing levels


Plasticity and GrowthNew nurturing relationships and the experience of psychotherapy are two ways to activate brain plasticityBrain growth is stimulated via face to face interaction, in part due to mirror neuronal networkBecause the first years and experiences establish the basic circuits and patterns of neuronal growth that subsume the brain’s important functions, they remain critical; early negative effects cannot always be repaired


Resilience

Myth: resilience is not the effect of bouncing back after traumaPeople are inherently adaptive, not resilientResilience is learned Hallmarks include ongoing plasticity, maintenance of relationships, affect regulation, brain integration and flexibility


Repair

Repair is the central concept in understanding imperfection and suboptimal interactionRepair is the foundation of empathy and mutual understandingRepair is necessary when communication has been misunderstood or poorly responded toRepair achieves reattunement


‘Shark Music’ and ‘miscues’Saturday, 19 September 2009

When Love Is Not Enough - Australasian …...When Love Is Not Enough Vulnerable Families,...

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