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Eftc 3


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Eftc 3

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