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DeCoteau Trauma-informed Care - Relationships Matter


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By Tami DeCoteau...
"I’ve entitled my presentation “Relationships Matter” because I am going to talk to you about the important bond between a child and his caregiver, and how that bond occurs and how it impacts the child at all levels of development."

Published in: Healthcare
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DeCoteau Trauma-informed Care - Relationships Matter

  1. 1. Presented by: Dr. Tami De Coteau, PhD Licensed Clinical Psychologist
  2. 2. Office of Indian Education MN Dept. of Education Unique features of relationships of American Indians parenting
  3. 3. American Indian Parenting Traditions “A woman may give birth to many children. To all she gives food, care, and a place near her. To each she gives a portion of herself; to each she assigns a place in the household….A mother gives equally to all of her children, from first to last, from strong to weak. All are entitled to a place near her... Her gift does not diminish but increases and renews itself.” - Basil Johnston
  4. 4. What is attachment? Interactive; Nonverbal communication Attachment is a system in the brain that that develops to ensure infant safety and survival The comfort, pleasure, and calm and balanced attuned interaction between the infant and caregiver creates a sense of safety within the infant Secure attachment refers to the mutually attuned bond of trust between the primary caretaker and the child Forms the basis for all future relationships; sense of self-worth; resilience to stress; ability to regulate own emotions; make sense of life; create meaningful connections with others
  5. 5. How does attachment form? Primary Intersubjectivity – Infant and parents discovery of each other  Person-to-Person relationship Secondary Intersubjectivity – Infant’s discovery of the world (people, objects, and events) through experiencing the impact of the world on his parents  Person-to-Person-to-Object Intersubjectivity – Awareness of shared perceptions and understandings that provide the foundation for social interaction
  6. 6. Intersubjectivity & Attunement Shared Emotion Infant feels receptive to and connected to his parent He co-regulates his affective state with his parent’s affective state He learns to regulate his own affective state
  7. 7. Intersubjectivity & Attunement Shared Attention & Shared Intention Infant begins to reflect on his inner life of thought, affect and intention Infant begins to reflect on the inner lives of his parents He is able to co-create the meaning of the people, objects, and events in his life Joint Attention Joint Intention
  8. 8. How is attachment related to development? Interactions with others (positive and negative) stimulates regions of the brain responsible for attachment Communication patterns (verbal and nonverbal) influence the child’s mental process Safe and secure communication is necessary to establish secure attachment Establishes the basis on which the child will form relationships with others; his sense of security about exploring the world; his resilience to stress; his ability to balance his emotions, make sense of his life, and create meaningful interpersonal relationships in the future.
  9. 9. How does trauma and neglect affect the brain? If the attachment region of the brain is not properly stimulated at the critical period of development, then that region and all other regions below and above it are affected 2005 Bruce Perry
  10. 10. The Human Brain
  11. 11. Activity Across Brain Regions Brain Region Functions Critical Period Experiences needed Functional Maturity Cortex Thinking, Planning, Reasoning, Creativity, & Sensory Integration 3 - 6 years Complex conversations, social interactions, exploration, safe, fed, secure Adult Limbic Emotion, Attachment Memory, & Sensory Integration 1 - 4 years Complex movement, social experience, narrative Puberty Diencephalon Sensory Motor & Sensory Processing : 6 months - 2 years Complex rhythmic movement, simple narrative, affection Childhood Brain Stem State Regulation & Sensory Processing In utero – 9 months Rhythmic, patterned input, engaged caregiving Infancy
  12. 12. Brain Development  Bottom Up – from primitive to most complex  Brain development is sequential. More complex systems are dependent on development of less complex systems.  For normal brain development to occur there must be specific patterns of activity at specific times during development = sensitive periods  Experiences (positive or negative) during sensitive periods organizes brain systems.  Therefore, trauma during early childhood can effect all future functional capabilities!
  13. 13. How does trauma and neglect affect attachment? Insecure attachments arise from repeated experiences of failed emotional connection  Abuse; neglect; trauma; prolonged separation; multiple caregivers; maternal depression and/or substance addiction; lack of harmony between child and parent; inexperience mother with poor parenting skills Insecure attachment is passed on from one generation to the next unless repair occurs
  14. 14. Insecure Attachment Avoidant – Parent is unavailable or rejecting. Child adapts by avoiding closeness and emotional connection Ambivalent – Parents’ communication is inconsistent. The child cannot depend on the parent for attunement. He develops anxiety and feelings of insecurity Disorganized – Child’s needs are ignored and parents behavior is a source of terror and disorientation. Child feels overwhelmed, frightened, and traumatized and attachment becomes disorganized and chaotic. Problems with regulation of emotions, social communication, academic abilities, and severe emotional problems
  15. 15. How does attachment affect neurological state and vice versa? Dysregulated Mother   Dysregulated Infant Depressed Anxious Stressed Avoids direct eye contact Tunes out Frustration or anger Up & down/unpredictable emotions Cries Clench fist Rigid body or arches back Eyes shut Shuts down Acceleration of the nervous system Mixed withdrawn, clingy, fearful
  16. 16. What is Reactive Attachment Disorder?Mental Health Disorder; Severe Insecure Attachment defiance; manipulative or controlling patterns; little or no conscience; frequent and intense anger outbursts; destructive to self, others, and property; gorging or hoarding food; and preoccupation with fire, blood, or violence The child cannot form positive, lasting relationships Often incorrectly diagnosed as several behavioral disturbance and ADHD DSM 5 “The prevalence of reactive attachment disorder is unknown, but the disorder is seen relatively rarely n clinical settings. The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children.”
  17. 17. How can attachment problems be repaired? Help the child & parent regulate their affect Create safety Focus on intersubjective experiences – shared emotion, shared attention, shared intention. Provide empathy and curiosity Respond to the child’s emotional needs Provide structure and supervision Restore harmony and order
  18. 18. Therapeutic Attachment Parenting by Daniel Hughes P – Playful A – Accepting C – Curious E -Empathic
  19. 19. How can attachment problems be repaired?
  20. 20. Citations Karen, R. 1998. Becoming Attached: First Relationships and How They Shape Our Capacity to Love. Oxford Press, New York, NY. Perry, B. 2009. Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14:240-255. Trevarthen, Colwyn, & Kenneth J. Aitken. 2001. Infant Intersubjectivity: Research, Theory, and Clinical Applications. Journal of Child Psychology and Psychiatry 42, 3 – 48.