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  • CLANCY BLAIR1, DOUGLAS GRANGER2, MICHAEL WILLOUGHBY3, KATIE KIVLIGHAN
  • Acute stress shifts the brain into a state that fosters rapid defense mechanisms. Stress-related neuromodulators are thought to trigger this change by altering properties of large-scale neural populations throughout the brain. We investigated this brain-state shift in humans. During exposure to a fear-related acute stressor, responsiveness and interconnectivity within a network including cortical (frontoinsular, dorsal anterior cingulate, inferotemporal, and temporoparietal) and subcortical (amygdala, thalamus, hypothalamus, and midbrain) regions increased as a function of stress response magnitudes. β-adrenergic receptor blockade, but not cortisol synthesis inhibition, diminished this increase. Thus, our findings reveal that noradrenergic activation during acute stress results in prolonged coupling within a distributed network that integrates information exchange between regions involved in autonomic-neuroendocrine control and vigilant attentional reorienting.
  • http://www.youtube.com/watch?v=U39RMUzCjiU&feature=relatedhttp://www.youtube.com/watch?v=pYPRnxS6uAw&feature=relatedhttp://www.youtube.com/watch?v=TpE7fBTvvswCoupled Pendulum http://www.youtube.com/watch?v=kqOARsCJC-8&feature=endscreen&NR=1
  • Living in a city increased AMY and perigenual anterior cingulate cortex
  • (sandwich difficult emotional or new experiences between here and now focus and mastery experiences).

Embodied family therapy  a somatic experiencing based approach to building attachment and healing family conflict b Embodied family therapy a somatic experiencing based approach to building attachment and healing family conflict b Presentation Transcript

  • Embodied Family Therapy A Somatic Experiencing Based Approach to Building Attachment and Healing Family Conflict Presented at USABP 2012 By: Dr. Michael Changaris
  • The Pendulum Wavehttp://www.youtube.com/watch?v=7_AiV12XBbI Y
  • Development of Limbic System Family is the place where the HPA-Axis and limbic system is developed. Interactions between parents and parents and their child changes the neurobiology of emotions. Eye contact and connections with the parent sets in motion a neurobiological cascade. Brief disruptions in contact with a mother in early infancy can cause changes in stress reactivity that is measurable many years later.
  • Development of Limbic System Low cortisol levels, particularly near the peak of the diurnal rhythm, have been reported in abused, neglected and deprived children (Gunnar & Quevedo, 2007). Parenting structure (organization and consistency) can predict changes in Cortisol in Adolescents (Ellenbogen & Hodgins, 2008). Infant cortisol related to maternal sensitivity. Maternal sensitivity displayed lower resting CORT, higher reactivity to emotional events and higher activation of emotion regulation regions (Blair, Granger, Willoughby, Kivlighan, 2007).
  • Inner Experience of Individual “Felt-Experience” Sensation Image Affect Meaning BehaviorEffects of The Human Ecosystem on Families Relationship Y
  • Developing Family Resilience Transactional patterns within the family (e.g., providing emotional support, decoding emotional reactions, normalizing and validation); Increasing positive emotions helps build family safety (Broaden and Build Hypothesis – B. Fredrickson) Ratios: Developing emotional regulation skills, skills to support each other through difficult emotions and problem solving skills increases family resilience. Intrapsychic factors within family members (e.g., emotional regulation skills, openness). Extended family system and friends (e.g. supporting the affected family members or indirectly affected family members, monetary support, practical support, problem solving). Mesosystemic factors, like churches and schools (e.g., contact with religious figures, support networks, problem-solving). Y
  • Intergenerational Trauma and Families A Study Found: “Early experience in female rats transgenerationally influence their future offspring… enrichment (of the environment) can reduce the transgenerational impact.” Another study found: “Mothers lifetime posttraumatic stress symptoms were associated with childs PTSD in dose– response fashion.” First Nations adults who’s parent attended Indian Residential Schools had increased risk of depression in part due to parent’s experience of averse childhood experiences, adult trauma and perception of discrimination. Y
  • Each Family Member Has an Individual Pattern of Stress Response Y
  • Hyperactivation Trauma In The Brain and Body Hypoactivation1. Hyperactive 1. Down regulation insula (Body of physical Information) sensations from the insula cortex.2. Under-activated anterior 2. Hyperactivation cingulate cortex activation in the (ACC). anterior cigulet (Regulation) cortex (ACC).3. Under- 3. Hyperactivation activation in the medial medial prefrontal cortex prefrontal mPFC. cortex (mPFC). (Regulation)Dr. Lanius fMRI Study Dr. Lanius fMRI Study Y
  • Trauma and Brain Development Functional Changes: Hippocampus, Amygdale, Anterior Cyngulet Cortex, Medial Prefrontal Cortex. Later in Life: Structural changes in hippocampus. Developmental Theory:  The age of the trauma effects the system that is effected by the developmental needs of the age.  Systems that require a disrupted system to develop in order for them to reach maturity are disrupted.  Experience dependent, Experience Expectant, Experience Independent Events. Y
  • SIBAM-R Elements of Consciousness Sensation (most under recognize): The information from the body. Sensation come from the Kinesthetic, Autonomic, Proprioception, and Vestibular system. Image: Any abstracted sense memory (e.g. Audio, visual, tactile, gustatory, olfactory). Behavior: Any observable behavior, including changes in skin tone, breath rates. (Can be implicit or explicit behavior) Affect: Emotion and emotional experiences. Meaning: Verbal narrative of self, other, or an event as well as any form of abstracted relationship. Relationship (Interpersonal Neurobiology): Non-verbal narrative of expectations, physiological reactions and the interaction between two individual’s psychophysiology.
  • Emergence of RelationshipInternal State Internal StateFelt Experience Body to Body Felt Experience CommunicationSensation SensationImage ImageBehavior BehaviorAffect AffectMeaning MeaningRelationship Relationship Feedback Between Two Psychobiological System Creates Clinical Third AKA “Relationship” Y
  • Y
  • Implicit Dialog Neuroception: Assessment of safety using implicit vs explicit perceptions. Precognitive Emotional Communication: Limbic fast circuit v.s. cognitive emotional appraisal circuit. Children with positive emotional sensitivity from parents have both a higher amount of emotional experience and a engagement of emotional regulation systems. Physical Dialog: Pupils dilate in synchrony, bodies mirror motions, visceral systems match, heart rates attune, vocal tones match. Y
  • Implicit Dialog PTSD makes it difficult to enter this dialog by: 1. Reducing interoceptive cues, 2. Flooding with interoceptive experiences, altering attention, and 3. Stress reactions that are not shared with a wide group of others. Families can learn to develop the attention to this dialog and facilitate it by increasing the states that make it more likely. PTSD: Facial expression  Darwin and facial expression.  Recognition of fear as anger in individuals with PTSD.  Teens and children process emotions first with the Limbic Circuit and do not activate the frontal lobe. Adults display a different pattern. Y
  • Y Emotion Regulation in Family Resilience Family Family StressResiliency Factors Factors Habits When1. Interpersonal Thoughts In Overwhelm Emotions 1. Interpersonal factors: Factors: Low Prosocial Thought Cognitive Self Emotion conflict Behaviors Skills Regulation Skills resolution.2. Ecosystem Implicit Implicit Self Implicit 2. Ecosystem Factors: Thoughts Regulation Emotions factors: Target Financial identity status. Support 3. Intrapsychic3. Intrapsychic Factors: Factors: Number of Number of family Members with members with High Implicit low Implicit Emotional Emotional Regulation Regulation http://www.youtube.com/watch?v=DD7YDyF6dUk
  • Oppression in Family System Microaggression: Brief expression that communicates hostility towards an individual’s target identity.  Microassault: Verbal or non-verbal attack intended to hurt the other.  Microinsult: Demeaning a person’s identity.  Microinvalidation: Communication that nullifies or invalidates the experience of an individual. Resilience: Developing safe places to be heard, understood and validated and to have reality checks on microagressions is vital. Y
  • Oppression in Family System Impact on health: Reasonable lack of trust in health providers, elevated stress increasing the chance of heart disease, diabetes, and other illnesses. Felt-experience of safety and oppression:  Identify Islands of Safety and the felt experience (SIBAM-R).  Identify SIBAM-R reaction to oppression or microaggression. Develop family and individual emotional regulation strategies.  Identify defensive orienting reactions and work on completion of reactions.  Developing the family as a safe zone to work with impacts of oppression.
  • Family and Morality Development The family is where a child learns how to expect to be treated, how to treat them self and how to treat others. Culture influences the development of morality. The family influences culture. The family develops morality in the members and the members develop the moral system of the family. Morality becomes a center of gravity for behavior. At times destructive and at times helping the family orient to their best self. Ways the Family Develops Morality:  Modeling Behavior.  Behavioral Correction.  Being Understood Builds Understanding.  Verbal dialogs.
  • PTSD and Morality Morality: “A suite of interrelated other-regarding behaviors that cultivate and regulate complex interactions within social groups.” (Bekoff & Pierce) Two Pliers of Morality: Empathy and Reciprocity Default Mode Network self-referential processing, autobiographical memory, prospection and theory of mind significant deficits for those who have early childhood trauma. Cognitive Morality: Ventromedial prefrontal cortex (VMPC) – Stress changes utilitarian responses to moral reasoning tasks. Possibly through disruption of the cognitive system of moral functioning. Interpersonal moral decisions not directly effected. Deficits in children with conduct disorder. Implicit Morality: Temporoparietal junction (TPJ) – Acute Stress alters the functioning of this system. Deficits in children with conduct disorder. Quality of parenting and non-parental relationships effects the development of ToM and Morality. Play deficits in individuals with antisocial personality disorder and psychopathy. Y
  • Effects of PTSD on Morality and Families Reciprocity: Give and take in co-operative action.  Family development: Normal give and take is vital for household functioning, developing social skills and long-term happiness.  Impact of PTSD:  Fight: Privileging self-needs over others. Increased rate and decreased thresh- hold for moralistic aggression. Decreased ability to self-reflect of impact on others. Leads to change in meaning towards a belief that one’s actions are “right.”  Flight: Devaluing of self-needs for family needs. Over giving and resentment. Flight in the family system leads to the a bind between two primal drives escape avoidance of threat and need to maintain relationship for safety.  Freeze: Not being available for reciprocity, avoidance of participating in the give and take of family life. Feeling numb and uninterested in returning favors. Giving up valuable, time or items due to lack of adequate self-protection.
  • Effects of PTSD on Morality and Families Empathy: “The capacity to (a) be affected by and share the emotional state of another, (b) assess the reasons for the others state, and (c) identify with the other, adopting his or her perspective.” - de Waal  Family development: Disruption in empathy undermines, development of ToM, problem solving, conflict resolution, impedes transition to new developmental stage and reduces the ability of a family to tolerate a range of stressors.  Impact of PTSD:  Fight: Evolutionarily fight diminishes the drive to have empathy in order to protect oneself from with in group violence.  Flight: Leads to avoidance and escape behavior and a privileging of self-needs over the needs of others.  Freeze: Reduced ability to enter into the biological synchrony of interpersonal communication. Leading to poor anticipation of another’s need, feeling flat, disconnected and unavailable.
  • Family and Emotion RegulationDevelopment Rupture repair cycle: Uncomfortable feelings, misunderstandings and conflict leads to understanding, recognition and repair of the relationship. Interoceptive Awareness: The ability to be aware of the body’s signals of emotional states and differentiate between one’s own body responses and the body responses triggered by others. Attachment Behaviors: Behaviors that support the felt experience of safety and connection (e.g. Eye to eye contact, body based synchrony, safe touch, tolerance for both closeness and distance in relationship). Problem Solving Difficult Emotions: Families can learn to figure out together how to tolerate and regulate emotions. This requires acceptance and empowerment. Often parents provide the sensitivity to a child that creates self-understanding and emotional problem solving. Structure, Expectations and Support: Children who have solid safe structure with clear expectations and enough support develop emotional regulation capacity. Y
  • Family and Development of ToM Theory of mind is the understanding of ones own mental states and attribute unique mental states to others. There are two major classes of factors that lead to development of ToM Internal factors and Situational factors.  Internal factors increasing the development of ToM are: language abilities and executive functions.  Situational factors increasing the development of ToM are: having siblings, participating in pretend play, reading storybooks with adults, talking about experiences with peers and adults, care providers who talk about thoughts, wishes, and feelings, adults who provide reasons when correcting a child’s behavior. Children with high ToM: are better communicators, can resolve conflicts with peers more effectively, more socially skilled, more popular, and their schoolwork is often more advanced. Y
  • Family and Development of ToM ToM is likely an “experience expectant” skill. The mind is waiting to develop this ability. Understanding one’s own inner experience helps to develop this skill. Interactions with in the family can develop this skill. Decoding the experience of a child helps the child develop their own understanding of their inner world and the inner world of others. The felt-experience of “being with” leads to developing the felt- experience of relationship. Y
  • Interaction Patterns: High Road and Low Road Time Behavior Body Narrative Behavior Representation Meaning Of InteractionSight/Sound Affect Generalized Sensation Verbal Narrative Sensation Resonance Sound Sensation Meaning Affect Affect Behavior Behavior Time
  • Internalized Family InteractionsBody NarrativeRepresentation Internalized Of Interaction Generalized FamilyVerbal Narrative Interaction Embodied Family Therapy Develops New Body-Based Narratives and Verbal Narratives Through Changing the Story and the Experience of the Interaction. Y
  • Non-Linier Systems and Resilience Attractor: An attractor is a set (pattern) towards which a variable, moving according to the dictates of a dynamical system, evolves over time. Attractors: The good, the bad and the transformative. In a family the attractors function like a center of gravity pulling the system towards a pattern of behavior. Regulators: Support the family to return to equilibrium.  Behavioral Implicit: Looks, gestures, body language, vocal tone and facial expressions.  Meaning: Narrative about family members, beliefs about emotions thoughts, correct behavior and expectations. Levers of change: Are the tools one has available to effect the functioning of a system.
  • Bifurcation TheoryTrauma and Family Systems
  • Chaos and BackFigenbaum’s Constant: 4.66920
  • Key PointA destructive pattern mayonly be present in certainenergy states… Y
  • State Dependent Family Behaviors Exploratory Orienting  Privileged Behaviors: Joining, Pro-social Interactions, Playfulness, Open body Stance, Curiosity, Playful aggression.  Unprivileged Behaviors: Anxiety, Anger, Yelling, Tension, Dysphoric Mood, Anxiety Fight  Privileged Behaviors: Aggression, Approach Based Problem Solving, Concrete Solutions, Moralistic Aggression, Affirmation of Higherarchy, Physical stances of aggression, Postural rigidity.  Unprivileged Behaviors: Playfulness, curiosity, Pro-social interactions, Social engagement system, Complex problem solving, Reduced tolerance for ambiguity. Flight  Privileged Behaviors: Avoidance based problem solving, Concrete solutions, Tending and befriending, Cowering, Postural tension, Quick transitions to fight, Humor.  Unprivileged Behaviors: Playfulness, Curiosity, Vulnerability, Openness, Self-expression.
  • State Dependent Family Behaviors Freeze  Privileged Behaviors: Shut down, Stone walling, Limp body postures, Co-lapse, Isolation, Poor care for children, Lack of ability to maintain consequences, Shame dynamics, Pore maintenance.  Unprivileged Behaviors: Playfulness, Curiosity, Safety, Problem solving, Ability to tolerate frustration. Main Street  Privileged Behaviors: Planning, problem solving, Conflict resolution, Complex thinking that includes gradations.  Unprivileged Behaviors: Aggression, Anxiety, Yelling, Tension.
  • Families and Activation State Shut Down/Freeze Family Behaviors Outcomes State 1. No communication. 1. Giving up. 1. Dissociated. 2. Avoidance. 2. Deadening and lack 2. Flat affect. 3. Giving up before a of engagement in 3. No synchrony. solution. life. 4. Hopelessness. 4. No feeling of connection. 3. Not caring about impact on others. High Levels of Activation Family Behaviors Outcomes1. Stress patters. 1. Yelling/Threats/Explosions. 1. Disconnection.2. Aggression. 2. Leaving room. 2. Resolution of3. Coping strategies e.g. 3. Black and white thinking. conflict or seeking 4. Using coping. support. humor/escape. 3. Create meaning or family story. Within Regulatory Family Behaviors Outcomes Capacity 1. Laughter. 1. Developed1. Base line family 2. Playfulness. relationship. behaviors. 3. Low muscle 2. More connection.2. Curiosity. tension. 3. Increased3. Safety. 4. Synchrony. resilience. Y
  • Fight and Flight During Conflict Anger is an approach emotion. Increased rates of activation changes rates of communication. Elevated flight response can flip into anger (Flip-Bifurcation) Elevated fight leads to “over-approach” or using only approach solutions. Freeze states are highly activated, tight patterns with intense feelings bound up. This can lead to highly inflexible behaviors, poor problem solving, and avoidance patterns.
  • Experiential Exercise Tracking The Implicit Dialog1. Brake up into groups of three2. One person “Child”3. One person “Parent”4. One person “Therapist”5. Child and parent Dyad: Child tells parent about a stressful moment in their life (real moment, mildly stressful), Parent will just talk to the child and listen.6. Therapist: Watch for indications of implicit dialog. Practice deepening skills of moment of attunement.
  • Principals of SE Family Therapy The family has a natural drive to health. Working with the health within the family leads to the family regaining its own health. Solution Focused and Practical. Alternate between individual work and family work. Families can learn the skills to support each other. The therapist models skills and then supports the family members to use the skills. Y
  • Goals of SE Family Therapy Change in family structure Change in family and individual stress set point. Change in regulatory capacity. Change in attachment behaviors and play. Increased quality of life, vitality and life-space for family members. Y
  • Stages of Treatment Joining (BSFT): Entering with the family into a problem solving state. Assessment (diagnosis BSFT): Identifies areas of resiliency and challenge. Resource and Regulate (Embodied): Start all change with regulation and resourcing focusing on positive emotions, relaxation response and mastery experiences. Restructure (BSFT): Use the sandwich technique… Orient to here and now, focus on resource, work with difficulty, focus on resource and back to hear and now orienting. Reassess: Look for stability of change and one change leading to other positive changes in the family. Incorporate new information into interventions. Y
  • Flow of Session Opening Ritual: Each member present reports one thing that went well last week and one challenge talking mostly with therapist. Finish with orienting and resourcing lead by family member. Identify what family would like to work on in this session. (Observe patterns of interaction, problem solving, levels of activation, provide stabilization for family members). Brief Psychoeducation and Skill Development Addressing Family Problem. Establish Organic Enactment or Directive Enactment Use Restructuring or Integration Tools. Closing Ritual: Closing check in feed back about session with therapist. Resourcing and orienting skill. Establish Family Homework. Y
  • Structural Change Sessions Vs. Integration Sessions Structural Change Sessions: Work through changing family patterns by working near the regulatory boundaries to increase capacity and reduce overwhelm. Integrative Sessions: Support to integrate a structural change that is already happened with in an individual or the family. Integrative Sessions:  Stay within current regulatory boundaries.  Making new meaning about changes.  Work slowly focused on grounding and settling. Y
  • Family System Assessment Brief Strategic SE Embodied Family Therapy (BSFT) Family Therapy Structure  Emotion Regulation Developmental Stage  Cultural Factors Conflict Resolution  Family Support Identified Patient  Felt-Attachment Resonance Y
  • Embodied Family Therapy Assessment Assessment allows the clinician to develop a plan to address challenges a family faces and to support the family to return to health. Goals of Assessment  Identify missing skills and behaviors.  Identify patterns that maintain symptoms of trauma or lead to disruptions in a families innate resilience.  Identify narratives that maintain destructive patterns.  Develop a map of resiliency.  Identify how to tailor interventions to a specific family’s needs.  To learn about a family and how to join with them. Y
  • SE Based Embodied Family Therapy By re-establishing innate resilience in a family and its members the family becomes a central agent of healing after a traumatic event. Working with both implicit (body/somatic) and explicit (cognitive/narrative) systems the family increases emotional regulation capacity and reduces the amount of time spent in states vulnerable to behaviors destructive to the family and individual health. Through working with existing strengths the family develops an increased ability to access and develop social and relational support systems. Y
  • PTSD and Family Systems Structure Structure: Is the way a family organizes itself. Structure includes… Higherarchy/Leadership, Behavior Control, Guidance/Nurturance, Alliance Between Parents, Executive Subsystem, Sibling Subsystem, Flow of Communication.  Fight: Can alter dramatically the structure of the family. It can reduce nurturance through increased guidance (helicopter parents), disrupt connection between parents, and lead to poor communication in an attempt to mitigate the impact on family.  Flight: Can alter basic felt-experience of safety and trust making leadership difficult and disrupting communication.  Freeze: Can effect the ability of a family to keep working through a problem, lead to flat communication and through lack of felt-experience of love lead to more control oriented parenting interventions. Y
  • PTSD and Family Systems Developmental Stage Developmental Stage: Transitions are key moments of change with in a family. Managing these key moments of change can lead to long- term effective functioning or destructive patterns of interactions.  Fight: Can lead to taxing and reducing family resilience to stress by increasing family conflict at the time when support is most needed. Learning new skills is inherently stressful.  Flight: Can lead to concrete solutions, poor ability to anticipate the emotions of others and increased self-protection behaviors as a means to control feelings of danger.  Freeze: Can arrest a family development and limit the families ability to access its innate ability to work through the challenges of a new developmental stage. Y
  • Family Developmental Stages Stage I: Beginning  Stage V: Families Families. with Adolescents.  Stage VI: Families as Stage II: Childbearing Launching Centers. Families.  Stage VII: Families in Stage III: Families with the Middle Years. Preschool Children.  Stage VIII: Aging Stage IV: Families with Families. School Children.  Stage VIII: Aging Families.
  • PTSD and Family Systems Conflict Resolution Conflict Resolution: Is the ability to have conflicts and to solve them through including the needs of family members. This skill requires a complex blend of emotional regulation, acceptance, generosity towards other family members and problem-solving abilities.  Fight: Can lead to reduced emotional regulation and increased aggression during conflict, reduced acceptance and generosity and concrete problem solving.  Flight: Can lead to over-riding of self needs or protective impulses. Increased activation state that can easily and quickly transition to fight and aggression.  Freeze: Can lead to low frustration tolerance, giving up on problem solving and giving up on the family. Y
  • PTSD and Family Systems: Identified Patient Identified Patient: Often one individual is the “problem individual” holding all the problems for an entire family. As the family can grow the ability to tolerate their own “good and bad” parts and moves from “rigid stress-based thinking” the IP-hood is spread through out the family.  Fight: Leads to concrete thinking, mothering and avoidance of problems.  Flight: Could lead to rigid patterns of blame, escalation of conflicts, and deep feelings of hurt with.  Freeze: Collapsed body, shame patterns, lack of energy and collapse explosion cycle. Y
  • PTSD and Family Systems: Resonance  Resonance: How a family closeness and distance with in a family system e.g. Boundaries. Boundaries are “semi- permeable” membranes letting in good and out unhealthy. They change from moment to moment.  Fight: Over-ride boundaries of family members to protect self. Leads to chronic feelings of embattlement and unsafely.  Flight: Avoidance of intimacy, feelings of insecurity, apprehension and anticipation of threat.  Freeze: No “felt-experience” of connection, poor ability to feel the indicators of boundaries, feeling isolated and hopeless about change. Y
  • PTSD and Family Systems: Emotion Regulation  Emotion Regulation: The ability to tolerate a wide range of emotional states, increase or decrease emotional activation based on needs, ability to tolerate and trust overwhelm states through confidence in one’s righting response.  Fight: Elevated fight leads to ignoring the needs of others, concrete thinking, and boundary violations in the attempt to protect one’s self.  Flight: Elevated flight leads to basic feeling of insecurity and danger, hypervigilence for threat and privileging of possible dangers in the emotional interactions.  Freeze: Lack of ability to learn from emotional interactions, feelings of helplessness, chronic states of anger or anxiety.
  • PTSD and Family Systems: Cultural Factors  Cultural Factors: Culture impacts a family. Culture effects how a child is expected to act, role of elder children in the family and parental roles. Culture effects non- verbal signals and their meanings. A family is impacted by the judgments, prejudices and political history. Culture includes: Age, Disability Status, Religion, Ethnicity, Sexual Orientation, Socioeconomic Status, Indigiounus Heritage, Nation of Origin, and Gender.  Fight: Often the experience of prejudicial treatment leads to a fight response that can not be processed through even normal self-protection. This can have a profound impact on a family.  Flight: The need to escape but having no “safe cultural space” can lead to anxiety, stress and many family challenges.  Freeze: Freeze states can manifest as desperation, feeling like there is no safety and not being able to access the felt-experience of safety within the family.
  • PTSD and Family Systems: Family Support  Family Support: No family is an island. Families need other families, grandparents, teachers, religious figures etc. After a traumatic event families can begin to isolate, disengage or have a loss of trust in institutions.  Fight: Can lead to damaging external relationships and supports for the family as well as avoidance patterns so that the family does not act in ways that loose relationships.  Flight: Avoidance behaviors, loss of trust, feelings like other people cannot or will not understand the family, isolation.  Freeze: Not accessing resources, not realizing when resources are not helpful.
  • Tracking Family Patterns Explicit Patterns:  Family Narratives  Verbal Burps  Core-beliefs  Verbal and Cognitive Hedonics  Behavior Sequences Implicit Patterns:  SIBAM-R  Behavioral Synchrony  Posture  Vocal Tone  Facial Expression  Tolerance for Misattunement Y
  • Tracking Family Patterns Chain Analysis  Links on a chain that lead to behaviors that damage relationships.  If you brake key links you change the behavior. Chain Analysis (Adapted from DBT)  Step 1 – See the big pattern  Step 2 – SIBAM – R with the family.  Step 3 – Identify states that make the family vulnerable to the difficult interaction.  Step 4 – Identify week links in the pattern.  Step 5 – Use imagery to explore the pattern and more effective solutions to develop new patterns of family interactions. Y
  • Working With a Family Trauma 1. Work with the beginning or end of a T3/-3 family pattern or a trauma first (Highest Intensity at T0). T2/-2 2. Use “resources” in SIBAM to slow down and stabilize affect tolerance and T1/-1 pattern. T0 3. Integrate affect/complete defensive responses.Completion 4. Develop new meaning (a.k.a. Narrative)T T T T T T T-3 -2 -1 0 -1 -2 -3
  • Using Touch In Family Therapy Safe touch can create a felt-experience of being understood. Safe touch increases OT (Oxytocin), Dopamine, Reduces Stress Hormone (Cortisol). Safe touch provided by parent when child is in distress puts on-top of family structure in the role of soothing and provider of safety. Always negotiate the contact. Have parent track how their child’s response changes.
  • Five Major Tools Embodied Family Therapy1. Tools to change family patterns.2. Tools to stabilize new family states.3. Psycho-educational tools and Normalization.4. Family homework5. Developing Family Support Systems
  • Embodied Family Therapy Tools Tools to Change Tools to Change Patterns Patterns Resourcing  Reinforcing “felt attachment” Orienting  Modeling Skills Family Pause  Self-Tracking Repatterning  Uncoupling elements of SIBAM-R from interaction Completion of Defensive pattern. Response  Safe Touch
  • Embodied Family Therapy Tools BSFT Tools to Stabilization Tools Change Structure Decoding.  Main street. Reframing.  Meaning making discussions. Change in Proximity.  Orienting.  Settling.
  • Embodied Family Therapy Tools Psychoeducation and Homework Normalization Understanding Fight/Flight and  Tracking: Give homework to track a Freeze. successful or effective solutions (Safety, Kindness, Success). Understanding Rupture Repair Cycle.  Using Problem Solving Mind. How to support defensive responses.  Respecting Boundaries. Understanding Individual Stress Response.  Family Pause. Understanding thought skills and  Felt-Attachment: See the good, feel body skills. the good, say the good. Orienting to family states.  Family Play.
  • Embodied Family Therapy Tools Developing Support Systems Reaching out to friends and family when things are difficult. Family activities. Physical Exercise and Sports. Increasing Individual Positive Experiences.
  • Closing Thoughts… Family therapy needs to address implicit and explicit systems. In other words the body is a central part of a family system. Developing basic resilience factors for both members of a family and the family supports healing from PTSD symptoms and helps the family be a safe base. The family is the main place a child develops its brain, limbic structures, theory of mind and morality. It is important to help a family develop skills for when they are in a vulnerable emotional state and to move to a more resourced emotional state. The family of today creates the generation of tomorrow. There is a natural drive toward health that clinicians can support a family to have access to.
  • ??? QUESTIONS ???