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3!! Presentation1

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  • This workshop describes the way BP is practiced in TC De Sleutel Some links in the work with the attachment theory will be shown and how we use BP tests for helping the introspection
  • In the different peer groups clients are invite to facilitate exchange personal experience. The participation in different peer groups triggers the openness. Friday every 1/14d: 9:30-12:30 13:30-15:00 -every even Friday - fixed in the structure Fase 2: First months: Fase 1 is the impulse control. In bonding terms: This confrontation and correction to healthy behaviour in a tender atmosphere make underlying feelings and own needs come into conscious.
  • Intake = search for a therapy plan: Ex ploring ‘ emotional pain’ if possible. >The TC work flour, the groups, the phase demands give connections: what is the burden and what is connection to reality now. >personal history and ‘struggle’ with caretakers, loneliness, illness.. >Some have clear wishes and need to be planned, Seminar : 1 Group clients end Fase1 2 For families (every trimester The seminars give a theoretical information and is open for discussion The family is informed about the method. They are mostly surprised for how we sustain empowerment for their children and how we handle guild. Clinical board : information exchange for staff 1/wk -2 hrs We use 3 tests , some examples for illustration how it helps. Briefing before group start with Primary staff (30’)
  • -This is useful to open the eyes for the feeling anxiety as half of the client population don’t ‘know’ this feeling -And it gives a suggestion for the inner conflict in each between intimacy and being on the own feet -Following slides show different attachment styles -The place on the line -between too much an few anxiety can be projected on the hinter ground of normal, ambulant or residential
  • With the ‘difficult to live’ parts: hope for change in the opposite sector!
  • With the ‘difficult to live’ parts: hope for change in the opposite sector!
  • With the ‘difficult to live’ parts: hope for change in the opposite sector!
  • 1 general encounter if needed 2 When we arrive e look for the physical comfort, sleep well? who is missing? teil.? Empathic exploration of clients reality One by one clients talk about the burden they feel, what makes life difficult for the moment Therapist facilitate group dynamic for more FB ` We ask clients to suggest their mate for what is important to work on. By doing this we have more concern and empathy. We explore the suggestion in dialogue until more clarity about the burden For example: “you need to express your anger against your father”, “you have to exercise to say ‘no!’” But even the suggestions are right , what want client self – what is his truth? Homework: is in the rule difficult for clients to remember, example: I should look in the mirror every morning and say that I’m ‘good enough’ -I forgot but I put a photo when I was a child and talk to it...
  • After 15’ break-- before Att: Choosing another chair! In the middle, clt may suggest the foremat.. What do you find important to do , practice? It may be simple: “I’m angry!” 2. Mostly when in the middle comes an hesitation ... We give time to find a theme. (feelings are slow) Others may suggest but the client in the middle has to look for own words or sentences. Few words. Others are supportive, encourage Encourage to go louder and staying in contact 3. Tender support, but not to much... enough to express presence to help further release. A hug from a mate can give support for further release, and this has to be encouraged! (they avoid!) reconstruction in the brain…: to feel the presence + expressing pain Waiting for client to be open for contact after screaming When client is open of contact, a gentle touch is given or a supportive sentence. Cognitive exploration together with group and client for implementation of the closeness... (Therapists follows “What was needed then and there...) After clt’s work: Group members like to show their closeness and concern too at this moment with a hug! When client is ready and on the chair again : we ask for reactions, who was concerned and want to express this?
  • Some are pampered too much. A lot of feelings! Pain and depression on the foreground -no energy Eye contact helps, in front of a good mate if this works better Staying here and now, others and therapists explore with client what there is. The body is very important, focusing and dealing this with others. If resistance is high a mate may join and help in the middle if agreed.
  • Some are pampered too much. Pain and depression on the foreground -no energy Eye contact helps, in front of a good mate if this works better Staying here and now, others and therapists explore with client what there is. The body is very important, focusing and dealing this with others. If resistance is high a mate may join and help in the middle if agreed. Anger has to be found in realizing that demands of others are too high. Exploring how it is… feeling suffocated, no own living, emptiness
  • They feel better than others, so they have to learn to show emotions and learn to accept their vulnarability. They can become sensitive to the climate in the bonding session, they can feel then a missing; and loss in game -kicks
  • They feel better than others: they have to learn to show emotions and learn to accept their vulnerability. They can become sensitive to the climate in the bonding session, they can feel then a missing then they become open Temper tantrum helps for feeling limits and experience care from others
  • group gives them a lot of tension After time they can accept more tension from beeing in the group Egostrenght and be comfortable with own power...
  • group gives them a lot of tension After time they can accept more tension from beeing in the group Ego strenght and be comfortable with own power... More vulnerable feelings of shame: Important to work through shame and give it back to the offender! “ You must be ashamed!” To take back power over life.
  • group gives them a lot of tension After time they can accept more tension from beeing in the group Ego strenght and be comfortable with own power... More vulnerable feelings of shame: Important to work through shame and give it back to the offender! “ You must be ashamed!” To take back power over life.
  • group gives them a lot of tension After time they can accept more tension from beeing in the group Ego strenght and be comfortable with own power... More vulnerable feelings of shame: Important to work through shame and give it back to the offender! “ You must be ashamed!” To take back power over life. (with help from family therapist)
  • What was touching from others? Express with eyecontact, expressing appreciations What can I do with what happened today?
  • Historic and deeper emotional work is only possible in a safe environment. Therefore care for the (dis)comfort in the group as a whole is important Borderline traits: then…
  • Historic and deeper emotional work is only possible in a safe environment. Therefore care for the (dis)comfort in the group as a whole is important Borderline traits: then…
  • Openness and setting limits always +
  • As dr Stauss stimulates us to do research on the results, we were curious for the outcome for the TC The results are always an effect of the whole program! from 2F > ending TC program (before halfway house)
  • Since 2003 on-going more integrated teamwork, BP is warmer, more is possible! Integrating the different aspects of client is difficult task – the more –the better Limitations finding a good way to work together as therapists, different views… Therapist has to stay client… with the age, being aware of old traps in the self with own feelings and projections
  • Transcript

    • 1. Once it has to be the first time…
    • 2. Bonding psychotherapy in TC De Sleutel
    • 3.
      • If we felt loved by our parents, as a result we feel at ease in our body and we love ourselves. Self worth is set and we can relate with others to have our needs met.
      • Closeness feels warm and good.
    • 4.
      • If self worth is low and contacting others for what we need is difficult, then we persistently hunt for this caring love in vain.
      • The only solution is to mount enough self love.
      • Which is not easily done
    • 5.
      • The TC has tools to offer young adults the skills for self worth and relation ability.
      • Feeling welcome and safe in a warm group
      • -family-alike helps for working on problems of self-worth
    • 6.
      • Each day, this self help community offers skills for training with living, on the way
      • In different peer groups it is safe to explore and find solutions for conflicts
      • The staff offers regularly special groups for developing insight ...
      • Conflicts come along with an inner conflict
    • 7.
      • Bonding therapy is one among the 12 insight groups TC De Sleutel offers in the program
      • The TC and bonding therapy stem from the same roots.
      • They go easily together for training in the here and now , problems coming from there and then .
    • 8.
      • In the bonding group and in TC, human warmth from a peer group and staff is the only way to facilitate insight and accept painful lived experiences from the past.
      • Since avoiding pain is a natural defense mechanism…
      • When negative feelings emerge in life, we need an inner ability to seek closeness, support and care from someone. This inner possibility we call attachment .
    • 9.
      • If this inner attachment is not functioning appropriate, we can only try to avoid pain
      • Drug addicts developed mainly their social skills to escape emotional pain, they are experts
      • TC confronts this avoidance which become visible in contact, building up new social skills to relate
    • 10. Attachment styles Image of the self Image of the other + - - + Fearful avoidant Social avoidant rejector Dismissing avoidant Dismissing of intimacy rejector Ambivalent preoccupied Preoccupied with relationships acceptor Secure Comfortable with Intimacy and autonomy
    • 11.
      • In bonding therapy: focus on emotions here and now
      • Find own inner logic of emotion
      • Triggered when expressed with loud voice
      • Reality of self, accepting by letting go
      • Possible when secure context
      • A way to discover warmth and intimacy
    • 12.
      • Intern logic of feelings
      • 1. When feelings come, associated beliefs come up
      • 2. These attitudes refer to lovability and trust
      • 3. Unconscious behavior intention, automatic
      • -This happens in the very moment!-
      • Feelings stem from limbic system
      • Motivation function, for staying alive
      • Biological needs
      • ‘Bonding’ a biological need
      • + attachment prerequisite!
    • 13. The bonding experience feels good for lifetime
    • 14. Working with attachment defects in Bonding therapy
      • Ambulant bonding psychotherapy:
        • Peer group
        • Mat work
        • Attitude work
      • TC practice: no mat work
          • Severe trauma, mishandled
          • No positive image of care
          • Associated with sex, too difficult
        • TC: secure structure, holding, protecting Authority
        • = permanent presence of the other
    • 15. Bonding practice in TC The place in the structure
        • One of the peer groups
            • On Friday, 1/14 days – 4,5 hours
            • 12-17 clients
            • From 2nd Fase on to end TC program
        • 2 therapists: BP + clin. coordin. or family therapist
    • 16. Preparation before Bonding therapy
      • Interview
      • Tests Dr Stauss for introspection exercise
      • ‘ group contract’
      • The seminars: family & clients 1st F.
      • The clinical board
      • The information from primary staff
    • 17. Preparation for bonding Overview of the 3 tests
        • The help from 3 tests for a therapy plan:
        • RSQ: (1) How severe is anxiety
        • °for abandonment
        • °for closeness
        • (2) How is it with the trust
        • SCL90: Shows the symptoms and the weight
        • SASB: Gives a glance at the positive and negative interjects
    • 18. Rsq shows fear and trust aspects fearfully avoidant - coming secure
    • 19. Rsq shows fear and trust aspects preoccupied attachment style
    • 20. Rsq shows fear and trust aspects dismissing attachment style
    • 21. Rsq shows fear and trust aspects fearfully avoidant - coming secure attach. st.
    • 22. SCL90 shows the symptom load
      • Different aspects of emotional disease with a ‘severity’ factor
      • For many clients at the beginning this diagram helps them for staying, confronting the pain sum
      • After 1st Fase (before bonding) clients feel good with the changement and motivated for continuing the program
    • 23. SCL90= symptom burden
    • 24. SCL90= symptom burden
    • 25. SASB test shows some introjects
      • The left side of the diagram : ‘difficult to live’ the right side: ‘the healthy aspects’
      • The difference from healthy is shown around the diagram
      • When shown over time, the program shows the affiliation gain
    • 26. SASB test shows some introjects
    • 27.  
    • 28. SASB test shows some introjects... “ No problems, … but 3 months later, more insight ”
    • 29. Bonding group in practice
      • Go around
        • feelings
      • Attitude work
      • Final go around
        • Homework
    • 30. Ongoing Group
      • First attention: the climate
          • Life in TC first and Physical
      • Empathic exploration one by one
        • Accent on feelings and attitude circle work
        • A peer suggests you what to do
        • Homework?
      • 15’ break
      • Therapists look for what is priority, techniques
    • 31. Attitude group
      • in the middle of the group
        • What needed?
        • Express
        • When pain comes up, mirroring
        • When in pain, a hug brings release + more
          • Giving time to this closeness!
          • Body position (!) in positive attitude
        • After work: taking in is most important to learn!
      • When ready, group FB
    • 32. Working with attachment styles in attitude Preoccupied attachment style
      • Preoccupied clients: a lot of feelings!
      • Information from outside the group
      • Afraid for conflicts
      • Set too high expectations for themselves and no help
      • Look for confirmation from staff
      • Good empathy for others, taking the blame
      • They tend to idealize
      • Negative attitudes :
      • ‘ I can’t...” “I am not important” “it’s never enough”
      • Most difficult: express anger and feel different
    • 33. W orking with attachment styles in attitude Preoccupied attachment style
        • Positive attitudes
      • Where find the anger?
        • “ I exist” “ I go my way!” “I decide!” “living own life”
      • Setting limits and permission sentences for themselves:
        • ‘ I may say No!’, ‘enough!’
        • “ I’m your equal!” “I needed love, not your confirmation!”
      • Quick changes in behavior occur
      • Examples for ‘homework’:
        • ‘ I’ll practice ‘no’ when ...;
        • When I have a different opinion I’ll say it anyway!”;
        • “ I’ll confront staff if I feel hurt”
        • “ I’ll ask for help!”
    • 34. Working with attachment styles in attitude Avoidant, dismissing attachment style
      • Dismissing clients: at ease alone, avoiding intimacy
        • Information from outside the group
        • Frequent manipulation, prolonged moodiness!
        • Difficult to take a haircut, hard to hurt
        • Frequent forced to think about behavior
        • Difficult to accept own limitations
          • Frequent sport lesions
        • Yellow carts for aggression, fear of loosing control
    • 35. Working with attachment styles in attitude Avoidant, dismissing attachment style
      • Attitude work
      • Have to understand how it works -It took time to feel,
          • Poor image of care in the past!
      • Attitudes to improve openness and self-care;
        • “ I’ ll take care for myself!” & “I’m Important”
        • Temper Tantrum technique may help
      • Unfamiliar with affection, little doses
      • Examples for ‘ homework ’:
        • “ I’ll talk about unpleasant feelings to peers”
        • “ Have to learn to check my ideas about others”
    • 36. Working with attachment styles in attitude Anxious, avoidant attachment style
      • Information from outside the group :
        • Difficult to trust, misunderstand others
        • Invisible
        • They don’t ask for help
        • Fear on the foreground, loneliness
        • Fear of abandonment is great
        • Low self-confidence
      • It takes time to feel secure and “understand” feelings
    • 37. Working with attachment styles in attitude Anxious, avoidant attachment style
      • Positive attitudes
      • Desire but afraid to work with anger
        • Pain on foreground
      • First: Attitudes for ego strength
        • “ I’m important” “I want to live, no more drugs!”, “My anger is not so bad”
      • Then: more vulnerable feelings of shame can be processed.
          • Not in the middle, in the circle
            • + attention and support
          • Working in a little peer group
    • 38. Working with attachment styles in attitude Anxious, avoidant attachment style
      • Usually Confusion:
          • difficult to accept tenderness and warmth
      • If confidence in the peer group: sharing the secret
      • Friendship has to be strong enough to process the fear from missing warmth for years.
          • Not enough time in TC!
    • 39. Working with attachment styles in attitude Anxious, avoidant attachment style
      • With help from family therapist:
        • Some finally mourn...
      • When 3F: outside world frightens
        • Positive attitudes: learn to express
          • “ I have fear AND do I’ll do it for me!”
          • Fear for relapse has to be worked on again
          • “ I take good care for myself!
          • Going for body level! (peers testimony)
      • Examples for homework:
        • importance to improve friendship and pleasure
        • - playing with mates
        • - go for recovery with family + peers
        • Exploring new hobbies
    • 40. BP in practice: Final go around
      • Every client: what was touching, interesting?
        • Invitation to share about ‘the inner work’ mirroring
      • Finding ‘homework’: intentions
        • Link with ‘the floor’ =concrete!
          • + see support of this peer group
      • This intentions are transmitted to the staff
    • 41.
      • Clients with borderline traits
        • Work first on positive identity, with anger.
          • “ I’m me”, “I’ll succeed”, “I’m here too!”
        • When more vulnerable feelings open,
          • Dose the amount of feeling, avoid regression.
          • Staying in the here and now.
        • Reinforcing with positive statements in good eye contact.
          • This helps giving them a feeling of strength
          • TC
        • “ I’m allowed to have a place here too!”
        • “ I deserve respect!”
        • “ My feelings are ok’! (with anger)
        • Good evolution outside group when experienced this positive reinforcements
    • 42. Practice bonding psychotherapy in TC
      • Note on risk for retraumatisation
      • Therapy contract
      • Confrontation body contact: fear comes up
      • Work on identity, express anger:
        • “ You must be ashamed!”
        • finding “fear + power” at body level
      • Important: stay in here and now, no regression!
        • Learn to take in warmth (nurturing position)
    • 43. End of 3th fase, leaving the bonding group
      • Test & interview
      • Discussion about introspection
        • What changed in relations with friends, family
        • Self care and asking for help = +
      • Leaving the group: go-around
        • + looking back, FB from peers
        • Positive attitude
        • Best trainers for other peers!
    • 44. Some findings from the testing 1. How TC improves secure attachment, intimacy and openness for warm contacts 2. Symptoms relieve after 1F 3. Anxiety reduce effect change 4. Effect change in openness for warmth
    • 45. Some preliminary findings for TC human warmth insight
    • 46. Some preliminary findings for TC Symptoms after 1st F.
    • 47. Some preliminary findings for TC less fear and more trust before half-way house
    • 48. Conclusion
      • Thanks to the openness of team: more integrated
      • TC is opening, …for some the ‘holding’ not long enough, need to search for alternatives
      • The therapist has to stay client
    • 49.  
    • 50. www.desleutel.org www.bondingpsychotherapy.org web:

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