Attachment disorders presentation
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  • 1. Attachment Disorders Identifying Symptoms, Challenges, andTreatment of Attachment Disordered Youth
  • 2. Attachment Disorders Jennifer Vernon, MS, LPC – Clinical Manager of Child and Family Services Michelle Anspaugh, MS, LPC – Child and Family Therapist Synergy Services, Inc. How many of you have been to attachment trainings? How many of you currently do attachment work?
  • 3. Attachment Styles of Youth Secure Attachment Avoidant Attachment Anxious Attachment Ambivalent/Disorganized Attachment
  • 4. Secure Attachment Seek primary attachment figure when distressed. Curious and responsive to environment Self-confident and good self-esteem Empathetic, humorous, playful Will try in the face of adversity Can ask for help when needed/balanced with developing independence. In shelters for situation specific (parent lost job) or conflict w/ parent
  • 5. Avoidant Attachment Develops when caregiver is rejecting and unresponsive Moms/parents – often depressed, drugs/alcohol problems Passive and withdrawn behavior – doesn’t express distress Avoids closeness to others Avoids feelings Seldom seeks comfort Passive-aggressive Don’t expect much/minimize expectations Have minimal narrative-facts (explicit memory) vs. emotional memories (implicit memory)
  • 6. Anxious Attachment Develops when caregiver is inconsistent responding to child. Anxiety connected to fear of abandonment Seeks emotional closeness as “valium” to quiet anxiety. Can be charming or whiny/complain Non-stop talking, constantly interrupting, or asking questions Looks like ADHD Uses “impression management”/people pleasers Behavior varies depending on who is present Rarely openly defiant or passive-aggressive Fall in love easily – focus on “other”
  • 7. Ambivalent/Disorganized Attachment Most severe attachment disorders Often develop into personality disorders and sociopaths Root cause is often Betrayal Trauma - occurs when the people or institutions we depend on for survival violate us in some way Child/teen responds with extreme self-reliance Very controlling with others Push-pull style Odd behaviors and unpredictable moods Focus on injustices done to them/consider themselves victims Openly angry, defy rules, high-risk behaviors, superficially charming, lack empathy, delinquent acts, self-harm, suicide attempts, cry to get others to engage, lying, aggression, promiscuity RAD, ODD, CD, Complex/Developmental Trauma
  • 8. Experiences That Lead to Attachment Problems Abuse and neglect Loss of parent Unavailability of parent Premature birth Medical problems (especially before age 2) Chronic pain Poor prenatal care
  • 9. Challenges of Treatment Availability of attachment figure Attachment and trauma hx of attachment figures Time in tx Fears of clients:  Trusting us  Allowing others to help  Being let down (again)  Being hurt  Being vulnerable – dangerous
  • 10. Treatment PACE Connection vs. Correction Create a Coherent Narrative  Connect client’s story to current behaviors/feelings  Trauma work Educate caregivers/ staff about Therapeutic Parenting
  • 11. PACE ATTITUDE Daniel Hughes – Attachment-Focused Family Therapy Playfulness Acceptance Curiosity EmpathyTherapist engages youth with this attitude, helping youth engage relationally in a different way.Therapist helps the parent/caregiver engage in PACE attitude to become emotionally connected to youth.
  • 12. How do we get in? Connnection vs. Correction:  Feels counter-intuitive  Reflect youth’s feelings/inner thoughts before giving consequences/lecture  Changing neural feedback loops of interacting Speaking to Speaking for Speaking about
  • 13. Create A Coherent Narrative Connect youth’s story to thoughts/feelings Trauma Work – Trauma effects attachment. Ask youth to bridge the gap between distressing event and emotions/thoughts/body sensations – between explicit and implicit memory. EMDR, TFCBT, etc.
  • 14. Any Questions?
  • 15. Thank you for attending today
  • 16. References Attach.org Clark, Mindi Higgins Kessler. (2009) Diagnostic and Treatment Features of Reactive Attachment Disorder Emdria.org Forbes, Heather T. and Post, Bryan B. (2009) Beyond Consequences, Logic, and Control: A Love Based Approach to Helping Children With Severe Behaviors Freyd, Jennifer J., What is Betrayal Trauma? What is Betrayal Trauma Theory? http://dynamic.uoregon.edu/~jif/defineBT.html Hughes (2007). Attachment-Focused Family Therapy