Basic Needs and College Counseling Presented By David W Eckert LMHC NCC CRC Overview of workshop Introductions Basic Neurobiological Theory Defining Normal Consistency Theory Four Basic Needs ID: 757534
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Slide1
Attachment Goes to College
Basic Needs and College Counseling
Presented By:
David W. Eckert, LMHC, NCC, CRCSlide2
Overview of workshop
Introductions
Basic Neurobiological Theory: Defining ‘Normal’
Consistency Theory: Four Basic Needs
Attachment Theory and Research
Understanding Trauma
Client Self-understanding and Insight
From Insight to Interventions
Case Examples Slide3
DisclaimerSlide4
Defining ‘Normal’
Smoller
, J. (2012)
The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior
, Harper Collins
Advances in Neuroimaging have led to sophisticated techniques in studying brain structure and function
‘Normal’ exists along a continuum…
French physiologist
Francios
-Joseph-Victor
Broussais
: ”pathology is not different in kind from the normal; ‘nature makes no jumps’ but passes from the normal to the abnormal continuously.”Slide5
Key Themes
3 Key Themes
Darwin and Natural Selection: our neural circuits are shaped by the adaptive challenges of our evolutionary past
Our trajectory through life is influenced by our genetic make-up, our environmental influences, and chance
The biology of ‘normal’: What are the brain’s designed functions and what do they look like when they go awry?Slide6
Normalize Before you Pathologize
The rise of Multiple Personality Disorder and the absence of repressed memories in other cultures
The brain’s response to evolutionary challenges: adaptive, taken too far, becomes problematic: “exaggerated and inappropriate forms of detecting and responding to threats”
Most psychiatric disorders are extremes of normal quantitative traits
Examples: PTSD, OCD, anxiety, depressionSlide7
Biology of Temperament
Continuum from shy and anxious to bold and uninhibited
New born starts with
Built in drives to satisfy immediate needs
Tools to seeks out helpful and avoid harmful aspects of environment
Plasticity: Ability to form new neural pathways based on new experiences; to learn from experience
Temperament: “a set of cognitive, behavioral, and emotional biases that allow us to respond to (our) environment
The amygdala recognizes emotions and scans for threats
Inhibited and traumatized people have stronger amygdala response that uninhibited people
Temperament reflects hard wiring of personality created when genetics interact with environment Slide8
Big 5 Personality Types
Neuroticism
: Experience worry and unstable moods; not calm and emotionally stable
Conscientiousness:
Self disciplined and achievement-oriented; not disorganized and irresponsible
Openness:
Curious and creative; not close-minded and conventional
Extraversion:
Active, enthusiastic, outgoing; not shy and withdrawn
Agreeableness:
Compassionate, empathic, and cooperative; not antagonistic and unfriendlySlide9
TransitionSlide10
SeparationSlide11
How will it go?
Depends on many factors
…
The medical model often falls short as we attempt to understand problems with the transition to college
Symptoms
Barriers
Disorder or condition
Diagnosis
How do we better understand the symptoms? Slide12
Myth of “Chemical Imbalance”
Much research exists on the role of neural activators and chemical transmitters to understand the neurochemical basis of mental disorders.
Overgeneralization of the implications of the medical model have lead to the oversimplification of mental illness as a chemical imbalance, in spite of a lack of descriptors for the pathogenesis of mental disorders (at the molecular level).
Recent research on the medical model approach shows the risk of apoptis (death of neurons) with antidepressant (and many other) medications.
Epigenetic studies have determined the important role of neuroplasticity and the brains dependence on the environment for healing. Slide13
Neural plasticity
The changing of the structure, function, and organization of neurons in response to new experiences.
Strengthening or weakening nerve connections or adding new nerve cells.
Brain has great capacity to rewire itself!Slide14
Resilience
The creation of new neural pathways in the face of challenges is the biological evidence of resilience
Finding alternatives, problem solving, creating solutions, and overcoming obstacles require new thoughts and behaviors
Changing thoughts and behaviors lead to changing emotional states
This is also the central theory behind Cognitive Behavioral Therapy
Supportive relationships often act as catalysts for resilience Slide15
Interpersonal Neurobiology
The study of the ways our internal experience connects us with the internal experience of others
Combines neurobiology with the social sciences to find answers and strategies that improve our health and functioning
Dr. Dan Siegel
Harvard graduate
UCLA School of MedicineSlide16Slide17
Evolution
“We will now discuss in a little more detail the Struggle for Existence”
Theory of Natural Selection:
“More individuals are produced each
generation than can survive. Phenotypic
variation exists among individuals and the
variation is heritable. Those individuals
with traits better suited to the environment
will survive.”Slide18
McClean’s
Triune Brain
Reptilian
: basal ganglia,
mid-brain, brainstem-
Eat, Sleep & Reproduce.
2.
Paleomammalian
: limbic
system (hippocampus,
hypothalamus, amygdala)
Motivation, emotion, social behavior.
3.
Neomammalian:
Neocortex
-
Higher knowledge from sight, sound and touch.Slide19
Your Brain Has a Mind of Its Own!
Much of what happens in the brain happens beyond conscious awareness and the brain is built for multi-tasking
Memory is the method of information storage and creates context for conscious focus
Implicit vs. Explicit Memory
Implicit Memory
- Made beyond conscious awareness; can’t be verbalized
Explicit Memory-
We are aware of and can be verbalized.
Facilitates new learning
Vital to psychotherapy
Engages working memory
Can be pathway to changes in Implicit system (DiSalvo)
Neuroscientist Simon LeVay:
“The mind is just the brain doing its job.” Slide20
Neuropsychotherapy
Dr. Klaus
Grawe
(1942-2005)
Integrated neurobiology with clinical psychology and psychotherapySlide21
Consistency Theory
We are innately driven to get four basic needs met to maintain a sense of mental well-being or consistency:
We are wired to crave a sense of…
Orientation, Control, Coherence
- Safety, certainty & predictability in our environments
Attachment
-
Belonging & community
Pleasure/Avoid Pain
-
Enjoyment; Away from distress
Self-Esteem Enhancement
-
Mastery & self-worth
(
Grawe
) Slide22
Consistency Theory
Behavior is directed by motivational schemas developed to satisfy those needs through
…
Approach Behaviors
- that originate from cortical or Top-Down processes
Often evidence of stability and healthy attachment
Avoidance Behaviors
- that originate from limbic or Bottom-Up processes
Can be evidence of instability and insecure attachmentSlide23
Top-Down vs. Bottom-Up Processing
Bottom-Up Processing:
Driven by the emotionality of the limbic system and the “fight or flight” response of the HPA axis, actions are taken without including the brain’s executive functions.
Top-Down:
Mindful awareness of the present moment and use of the higher executive functions as information flows from sensation to processing.
Reacting vs. Responding
Indicates: Insecure vs. Secure AttachmentSlide24
Evolution and Attachment
Human infants have years of total dependency during which their brains grow, adapt, and are shaped by experience.
Children survive based on the abilities of their caretakers to meet their needs and keep them safe.
“Those that are nurtured best, survive best.” (Cozolino, 2006)
Children that are poorly attached, traumatized, abused and neglected are more likely to experience substance use, mental health, and medical problems.
What doesn’t kill us makes us weaker!Slide25
Need FulfillmentSlide26
Orientation and Control
Grawe
credited Seymour Epstein (1990) as citing orientation and control as fundamental human needs
We want our perceptions of the world to align with our goals and satisfy our needs
We experience a strong sense of control when we have many options available to us
Trauma is the experience of a total loss of control
Loss of control = stress and distress
Poverty is often experienced as a loss of control Slide27
Attachment
Social Synapse: Dr. Louis
Cozolino
https://www.youtube.com/watch?v=MYokFn1nw4Q
“…the brain is structured with an innate capacity to transcend the boundaries of…its own body in integrating itself with…the world of other brains.” –Daniel Siegel
Our reliance on others is one of our most basic and powerful neurobiological and psychological needs
Our early experiences and relationships shape our approach or avoidance schemas for our lifetime
Our attachment styles cause us to react or respond in particular ways Slide28
Pleasure/Avoidance of Pain
We are motivated to attain pleasant experiences and to avoid painful ones
We all define what constitutes ‘good’ and ‘bad’ experiences for ourselves
We are in a maximum state of consistency when our “current perceptions and goals are completely congruent with one another, and the transpiring mental activity is not disturbed by any competing intentions.” (
Grawe
, 2007)
We pre-consciously align our perception of experience with our intentions; the “Great Confabulator” (
Cozolino
, 2008) Slide29
Self-Esteem Enhancement
This need develops on the foundation of our sense of self; further along the developmental timeline
From a neurological point of view, this need reflects the complexity of functions
Similar to Maslow’s highest need, hierarchically
What about those who maintain a low sense of self-esteem?
Self-esteem can be jeopardized to
get other needs metSlide30
History of attachment Studies
Harlow’s monkey studies: baby monkeys would rather be comforted than fed
https://www.youtube.com/watch?v=_O60TYAIgC4Slide31
Ainsworth: “Strange situation”
Mary Ainsworth and the “Strange Situation” studies
https://www.youtube.com/watch?v=gIjyEHaD6B
Mother and 12-18 month old toddler in a room with 2 chairs
8 standardized periods lasting 1-3 minutes, child interacts with mother & stranger
For 2 periods, mother leaves
In one, child is with stranger
In one, child is alone
Researchers gauge how child responds to reunions
3 classifications of attachment resulted
Secure Attachment (55-60%)- Use mother as a secure base to explore environment
Insecure Attachment (20%)- Don’t engage with mother when she returns and may even avoid her
Disorganized/Disoriented (15%)- Seemed to lack any coherent strategy to deal with stressSlide32
Attachment Research (cont’d)
Romanian orphanages and the Bucharest Early Intervention Project (BEIP)
2000-2005
Divided 136 babies (age 6-31 months) into 2 randomized groups
Stayed in institutional care
Assigned to foster care (average age 21 months)
Included comparison group of children living with biological parents
Compared cognitive development in 3 groups- Clear Results:
Institutionalized group scored significantly worse than the other 2 groups on IQ, sensorimotor abilities, and language development
The institutionalized group scored in range of borderline developmentally challenged
The foster care group caught up with control group by 3.5 y/o
Developmental Psychologist John Bowlby notes central component of attachment as child’s development of “internal working models” based on what they can predict from mother’s behavior.
Healthy attachment creates an internal and portable sense of security which has lifelong importance. Slide33
Key Developmental Periods
Primary Emotions can be seen in the first month of life: Joy, distress, disgust, fear, and sadness
Secondary Emotions evidenced within the first 3 years of life: embarrassment, envy, and empathy (Feinberg, 2009)
The adolescent brain (12-18y/o) undergoes disorganization and reorganization, losing overall gray matter (neurons) and increasing white matter (myelinated fibers) connecting neural networks
Brainstorm: The Power and the Purpose of the Teenage Brain
http://www.youtube.com/watch?v=kH-BO1rJXbQSlide34
Stress and distress: Attachment is essential
Inconsistent, unempathic, or overly enmeshed parenting can lead to…
Separation stress from poor attachment releases stress hormones as well as oxytocin & opiates to help with coping (addiction?)
Separation/isolation leads to clear neurological impairments & stronger despair reactions when triggered in the future
Positive attachment is associated with the inhibition of aggression
More distress leads to increased symptomatology
(Grawe)
Trauma=Avoidance Attachment=Trust
Slide35
Attachment TypesSlide36
Secure Attachment
“
…
possess a representational model of attachment figure(s) as being available, responsive, and helpful” (
Bowlby
, 1980)
Trust is relatively easy and confortable with dependency
Gives us a portable, internal sense of security that we carry with us for a lifetime; don’t fear abandonment or intimacy
It leaves us more able to manage stress and less vulnerable to trauma
Approach behaviors and a feeling of personal efficacy are the norm
Important to note that attachments are essential throughout life
Secure Personality Style:
Have a positive view of themselves and others Slide37
Insecure/Avoidant attachment
Independent of the attachment figure both physically and emotionally
Uncomfortable being close to others
Difficulty with trust and depending on others
Others want more emotional intimacy than they are comfortable providing
Self-contained and self-protective
Dismissive Personality Style:
Cerebral; emotions are unimportant; respond to stress by distancing themselves from othersSlide38
Ambivalent/Anxious attachment
Inconsistent parenting leads to individuals being appropriate and nurturing sometimes, and intrusive and insensitive at other times
Confusing to be in a relationship with; partners don’t know what to expect
Can go from distrustful to needy and desperate
Can scare people away with unpredictability
Preoccupied Personality Style:
Present as self-critical and insecure. Seek approval but can’t trust positive messages; can be emotionally desperate. Slide39
Disorganized/ Disoriented attachment
Abusive and neglectful parenting leads them to distrust the person they depend upon to get their needs met
The individuals they attach to are seen as the cause of their internal distress
This leads to internal disconnections and detachment from their internal experiences and emotions
Fear of abandonment and feeling of not being loved
Emptiness associated with Borderline Personality Disorder
Want more intimacy than others are comfortable with
Prone to extremes of emotion and behavior
Trauma Bonds:
People who have been victimized can be drawn to victimizers. History of both self-harm and harm from others. Slide40
Promoting InsightSlide41
Dr. Dan Seigel’s and the Adult Attachment Interview (AAI)
“Parents’ expectations and patterns of relating are profoundly influenced by their own attachment history.” (Seigel, 2012)
Security does not guarantee anything and insecurity is not synonymous with dysfunction.
Originally developed by Dr. Mary Main in 1982.
The AAI assesses an adult’s “state of mind with respect to attachment” derived from their experiences.
It is a semistructured autobiographical narrative; answers to a series of questions about their childhood.
Main’s Research: In 1978, children’s responses to the Strange Situation test were compared to the parents’ AAI, administered in 1983.
Results: In a field where a 20% correlation is considered significant, the match of the parents’ 1983 AAI security with how securely their babies behaved 5 years earlier was 70%. Subsequent studies in 4 countries have elicited a secure/insecure correlation of 75%. Slide42
Adult Attachment Interview (AAI)
Sample Questions
What was growing up and your relationship with each parent like?
What was the experience of being separated, upset, threatened, or fearful?
Was there an experience of loss and what was the impact on the individual and family?
How did the person’s relationship with her parents change over time?
How have all of these things shaped the development into adulthood of their personality and parenting approach? Slide43
Adult Attachment Interview Scoring
Each parent is scored on perceived ratings of being loving, rejecting, involving/role-reversing, neglecting when present, and pressuring to achieve.
Most critical- the process and the subject’s ways of presenting and evaluating their history.
The AAI rater also examines the transcript for the pattern of communication between the interviewer and the speaker.
How we talk to people reflects our internal “state of mind with respect to attachment.”
Domains include: overall coherence of transcript, idealization of parent, insistence on lack of recall, level of anger, vagueness, fear of loss, dismissing derogation, metacognitive monitoring, and overall coherence of mind.
Goal: Utilize parental insight and empathy to target behavioral change that promotes positive attachment in quantifiable ways
.Slide44
Attachment Explains Future Relaitonships
https://www.youtube.com/watch?v=VNOgXv7zTLA
Aaron Gilbert of Boston Evening TherapySlide45
TraumaSlide46
Adverse Childhood Experiences (ACE) Study
Anda & Felitti, et al: Strong positive correlation between health risk behavior & disease in adulthood to exposure to childhood emotional, physical, or sexual abuse, & household dysfunction
Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4-to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, >50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity.
The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.
The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
(American Journal of Preventative Medicine, Vol 14, #4)Slide47
Adverse Experiences
Emotional abuse; insults & threats
Physical abuse
Sexual abuse
Emotional neglect
Basic neglect
Substance abuse
Divorce
Witness Domestic Violence
Mental Illness
PrisonSlide48
The Effect trauma on the brain
Danger- coping skills are overwhelmed and we experience a complete loss of control
Pre-conscious mind triggers the body to continue to react as if this past trauma is still occurring
Loss of integration of neural networks controlling cognition, sensation, affect, and behavior
Leads to confusion, poor memory, impaired learning, mood swings, and impulsive behavior
“Fight or flight” response and the ‘worried brain’ is on alert
Trauma = Avoidance
Essential needs remain unmetSlide49
Damage caused by distress
When stress reactions are terminated by cognitive, emotional, or behavioral reactions, neural circuits are facilitated leading to a sense of security/mastery/ consistency/control
If stress exceeds ability to cope; glucocortoid release increases, arousal rises, harms hippocampus, can erase previously learned adaptive behaviors, & destabilizes mental functioning
Uncontrolled threats lead from anxiety to depression & repeated violations of need lead to mood disorders
Overloading the stress cycle over time has very lasting and damaging effects on the brain
(Grawe)
Physical disorders associated with stress: diabetes, heart disease, arthritis, fibromyalgia, multiple sclerosis, chronic obstructive pulmonary disease
Slide50
Trauma-informed Therapy
“What happened to you?” and not “What’s wrong with you?”
Safe, caring, warm, nonjudgmental environment
Respectfully allowing the client to lead the process
Provide
psychoeducation
about the effects of trauma
Person-centered and solution-focused approaches increase client’s sense of control
Shift from “victim” to “survivor”
Emphasize that trauma that happened
then
is not happening
now
and is not likely to happen in the
future
Teach mindfulness and distress tolerance to increase top-down processing
Recognize the mind-body connection and promote wellness through healthy sleep, nutrition, and exercise Slide51
Quick Review
Person-centered; “normalizing” approach
Assessing for trauma,
Exploring unmet needs (safety/predictability, attachment, pleasure/distress, and self-esteem)
Understanding client’s basic attachment type,
…
In the context of the “Family/Social History” part of the assessment, including their status as a student
As part of our treatment planning process,
To promote insight and explore alternative thoughts, behaviors, and emotions. Slide52
Therapist’s role
Dr. Dan Siegel: “On Recreating Our Past in our Present”
https://www.youtube.com/watch?v=HzI5vLBrX8ASlide53
Sequencing interventions
Address Distress First
For clients that are coping with trauma…
Down-regulate distress through mindfulness, progressive relaxation, systematic desensitization, deep breathing, meditation, yoga, etc.
Then…
Provide
psychoeducation
about the effects of trauma on the brain
When the client and tolerate emotions related to the trauma, CBT and other cognitive approaches can be effectiveSlide54
Client Example
Client:
Amanda, 22y/o bisexual, Caucasian woman presents as casually dressed in loose jeans and a hooded jumper at times appeared unkempt in her grooming.
Problem:
psychomotor agitation, restlessness, hyper- vigilance, low energy levels, intense eye contact, and flat/depressed affect. Pre-occupied with being criticized or rejected by others and fears having a physical illness in spite of medical reports to the contrary.
Diagnostic Impression
: depression, generalized anxiety, avoidant behaviors, and somatic symptoms. Slide55
Client example
History:
Client reports invalidating, distant, and emotionally abusive relationship with her mother and sister who she describes as “exactly like” her mother. Parents divorced when Amanda was 12y/o related to mother’s affair and this devastated Amanda’s passive-aggressive father who was custodial parent
Coping Technique:
“ I learned to put parts of myself away and to focus on being as perfect as possible.” Avoidance of most social situations and a high level of dependency in her current relationship. Her current significant other told her to “get herself together and learn to trust and relax” because client’s neediness is exhausting.
Slide56
Summary of treatment
Focus on reducing symptoms of anxiety and depression
Identification of concerns related to insecure attachment and fear of abandonment.
Address avoidance and heighten distress tolerance and emotional regulation skills
Distress tolerance skills, mindfulness, systematic desensitization through approach behaviors, CBT focus, and promote wellness (routine, diet, and exercise) Slide57
Response to treatment
Self-harm decreased significantly as therapist developed safety plan and stated clearly priority of keeping client safe
Enhanced insight and recognition of the negative impact of parenting and trauma of divorce
Siegel: “Name it to tame it”
Establishing healthy relationship boundaries; partner included in collateral sessions and relationship issues decreased
Improved sleep habits, nutrition, and exercise routine
Decreased anxiety and depressionSlide58
References
Smoller
, J. (2012)
The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior
, Harper Collins
Cozolino
, L.J. (2006)
The Neuroscience of Human Relationships: Attachment and the Developing Social Brain.
New York, NY: W. W. Norton & Company, Inc.
Siegel, D.J., (2012)
The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are.
New York, NY: The Guilford Press
Feinberg, T.E. (2009)
From Axons to Identity: Neurological Explorations of the Nature of the Self.
New York, NY: W. W. Norton & Company, Inc.
Grawe, K. (2007)
Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy
. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Brandt, K., Perry, B.D., Seligman, S., and Tronick, E. (2014)
Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice. Washington, D.C.:
American Psychiatric Publishing.
Ogden, P., Minton, K., and Pain, C. (2006)
Trauma and the Body: A Sensorimotor Approach to Psychotherapy.
New York, NY: W. W. Norton & Company, Inc.