How to cope in a world without subtitles. - PowerPoint Presentation

Slide1

How to cope in a world without subtitles.

Deceil L. Moore, LCSW, NADD-CCMischa Staton, MA, NADD-DSP

Attachment Issues AND ID– For DSP’sSlide2

Deceil L. Moore, LCSW, NADD-CC

Mischa Staton, MA, NADD-DSPSlide3

Goals for Today

Understand what Attachment is and how important it is

Understand what Attachment Disorders/ issues are

Understand how Attachment Disorders develop

Understand the implications of unresolved attachment issues

Understand how to respond to persons with attachment issues in order to help them grow and thrive in positive ways

Recommit to those we care for and about and help them to overcome the challenges they face because of attachment issuesSlide4

Remember: Many, many different ways to respond to any one situation. Examples presented are not “recipes” just one set of circumstances under which someone adapted with attachment challenges.Slide5

Attachment Disorder

What Do You Think of when You See Those WordsSlide6

Reactive Attachment Disorder:

Persistent failure to respond to interactions in a developmentally appropriate way

Diffuse attachments (indiscriminate social ability w/ marked inability to exhibit selective attachments

History includes: persistent disregard for child’s emotional needs/physical needs or repeated changes in primary care giver Slide7

Have learned to distrust that the world will provide for them

People With Attachment Issues. . Slide8

And what becomes of a child who becomes an adult without some help with attachment issues?

Possibly traits of:

Dependent Personality Disorder

Borderline Personality DisorderAnti-Social Personality DisorderAnxiety

PTSD

Depression

Narcissistic Personality DisorderSlide9

Kim—frightened, somatic complaints,

frequent talk and some gestures of harming

self, has personal dreams—makes plans does not follow through

Example: Kim:Mild delay, some anxietyFather chronically ill, Mother has some symptoms of mood disorderPattern of one parent or another in the hospital frequently, person left struggled to care for themselves let alone her

When older sibling leaves, “about killed mom”Slide10

Attachment Theory

John Bowlby wrote “Attachment and Loss” in 1969; Mary

Answorth, Cindy Hazan, Phillip Shaver and many othersThe idea that quality of attachment to primary caregivers has long lasting impact on emotions and behavior; impacts behavior in adults as well

Laws/policies have been changed in responseSlide11

What is Attachment?

A reciprocal, enduring, emotional and physical affiliation between a child and a caregiver. It is the psychological connection between people that permits them to have significance to each other.Slide12

Healthy Attachment Cycle

Progress toward Trust (Not)Slide13

Trust vs Mistrust

Attachment comes in cycles—

Think of a baby—one time of being fed not enough but several, leads to calmnessAfter several successful completions of the cycle, the child begins to trust

After several unsuccessful completions of the cycle, child begins to adapt or have difficulty (anxiety, depression)Slide14

When children Learn trust--

They can trust and cope, less likely to act out or panic

If Caregivers are a secure base and a safe havenSupport, welcome, comfort, protect, enjoy

Children—and those with attachment issues can:Safely explore the worldSeek interactions, delay interactionsGive informationAssist in organizing the child’s feelings/reactions

They turn into people who trust. . . . Slide15

Attachment/Trust Cycle Not Successful

*

B

egin to not expect, give up hope about needs being met

*Might begin to figure out ways to meet the needs themselves (ODD)

*Probably have difficulty developing empathy

*Might have difficulty being independent

*Might have difficulty relating to anyone

*Might have difficulty making sense of how they feel/what they need and do

*May have difficulty expressing what they need

*This can lead to more difficulties relating Slide16

Attachments help with

Developing and maintaining trust

Conscience DevelopmentDeveloping

healthy relationship

Developing Identity

and self-esteem

R

egulating feelings

Developing language

Developing brain structures for later use

Organizing the nervous systemSlide17

Caregiver’s Role in Attachment

Be Accessible Be Responsive

See the beautyEnjoy the personBelieve in themSlide18

Challenges to Positive Attachment for Persons with ID

Extended stay in ICULack of reciprocity (sensory integration, cognitive challenges, physical challenges)

Caregiver grief or guiltHigh level of family stressA child with disabilities may have difficulty responding to the caregiver in the attachment

cycle; attachment might be too much at timesFrequent moves and/or change in caregiverSlide19

Little relief for care givers, increase pressure on care giver for attachment

Fear of attachment related to repeated surgeries or health concernsUnease/feelings of incompetency with ID/challengesMisunderstanding of appropriate expectations can lead to abuse/neglect

Sometimes or told. . . “he’ll have to but put somewhere”—can affect believe that attachment can/will/should occurSlide20

Years later—less apparent but symptoms give CluesSlide21

Example: Bella

BackgroundSensory challenges—

Some academic challengesBehavioral issues arise (aggression, verbal aggression—seemingly without antecedent) Slide22

Categories of Attachment Challenges

Avoidant/inhibited/unattachedLots of movement not much connection-

Unaware of what is going on for others-Difficulty communicating and with emotions-Self absorbed?No clear connection-

Touch??Slide23

Anxious/disinhibited

Lots of anxiety, especially about being abandoned, left aloneAvoid anxiety triggers (makes excuses)Will connect indiscriminately

-Come here/get awaySlide24

Disorganized

Rapidly shifting emotionsAggressive in response to fears or in response to many thingsDoes not typically show remorse

Example: Bella (behavioral examples)Slide25

But the need does not go away, just because you don’t trust. . . . “I am desperate to be close to you. . . But it scares me to death.”Slide26

Image to help you understand. . . . RADSlide27

When you get close. . . . You see lots of things like this surrounding the water. . . . . .

What Do You Do???Slide28

How

Caregivers often react to Behaviors related to attachment

…Get frustrated! Get scared!

Take it personally and see themselves as a failureGet told by professionals that they are “making it up”Eventually, give up -Placement is lostPerson stays but no attachment develops

Become

dysregulated

–

????????????????????Slide29

The Do’s in Responding. . .

Understand-this is scary

Reduce changes in relationships as much as possible (placements, therapists, etc.)

Find the “place in the room” you can always stand—”I care about you. I want to help. I can’t let you hurt you or anyone else.”Have appropriate boundaries you are willing to enforce

Do LOTS of bonding activitiesSlide30

Don’t Take It Personally. . . .

Individual is working in a world whose assumptions are different from yours. . . .

Often individual get very afraid when they start to feel comfortable with someoneThey often work to chase you away so that they’ve had control of you leaving. . . It is less painful that way. You can help by: Believing that everyone wants to attach – they just might not know how

It also helps to: Be patient. Don’t give up. Don’t personalize.Slide31

Responding to Behaviors

Be firm and clear

Have appropriate boundariesExpress that you careSupport that he/she has a choice is choosing“Join” with them—be disappointed in outcomes with them, be excited about rewards with themTime In as opposed to Time Out

Help them see outcomes as related to choicesSlide32

What Do you Mean?

Situation: (In response to a new caregiver) “No! This is so stupid. I don’t need this! “ Stomps out, later calls saying thinking of killing self

Possible responses:I sometimes don’t like meeting new people either.You sound very upset. I get that. What can I do to help you?You are so strong and have adapted already so much. It does feel unfair. You have choices. I would be willing to talk through those with you.Slide33

Practice. . . . .

1) Talk of robbing banks and killing peoplePanic and go to extremes if mild indication of changes especially in care givers

“You are the only one I can trust.”Gives 2 cars away that is still paying onSlide34

Good News!!

Attachment is not an event—it is a process.

Any time that you are able to participate in an attachment activity together that completes the cycle, you have moved one step closer in helping the child heal.Slide35

Attachment Talk

I want to help. . . . I know that you are smart and can make good choices. I want to help.

I am excited about what it will be like when you. . . Shoot! I’m disappointed that that won’t work out now. What do you think we should do?Slide36

Helpful Attachment ActivitiesSlide37

We can strengthen the therapeutic relationship by doing some of these things together within appropriate boundaries. . .

We can help bring further resolution of issues by helping important people in their lives do some of these things with the individuals with attachment issues

***** red asterisks mean that these can be done in the therapeutic relationshipSlide38

Increasing Eye Contact

Maximizing Touch

Moving With Your ChildNurturing Through FoodEnhance CommunicationGetting Warm and CozyJust Have FunSlide39

Have Fun

Laugh with your adolescent about things that, at first, shouldn’t be funny (teacher fell out of chair but wasn’t hurt)

*Make something durable together

*Cheer for the same team*Tie-dye a shirt for everyone in the family

Color with your child

*

Complete a jigsaw puzzle together as a family project

*

Buy a paper crown. Take turns wearing the crown. When you wear it, no chores for you that day.

Agree to alternate serious talk with “fluff” talk

*

Buy and wear matching t-shirts

Blow bubblies

*Slide40

Get Warm and Cozy

Make or buy a soft, warm blanket to use while watching television, reading,

etc

Put his gloves and scarf in the dryer for a few minutes to make them warm. He’ll go to school with a comfy feeling.Make a safe place for them*

(let them change things in the office)

Tuck a blanket around the child in the car on a cold day.

Pitch a tent in the back yard and get in with the child.

Steam up the bathroom and then everyone draw on the mirror.

Offer tea/coffee/hot chocolate-go and get it form them, remember how they like it

*

Talk about something you have in common for a few minutes

*Slide41

Enhancing Communication

Read the funnies together on the couch

Listen to and learn the individual’s favorite song. Teach him one of yours

Pick a book and read parts of it together every day. (A Safe Place for Caleb)Make a list together (famous rabbits, superheroes, candy bars)*Tell the individual you need help with something and let them participate.

Make a life book with the individual. Let them interview folks and help research for it. Share stories .

*

While waiting for an appointment, make a bet on the color of the professional’s tie or shoes. Celebrate whoever wins

*

Trace a shape on individual’s back with your finger. If he guesses the word, he gets a point.

Really listen

*Slide42

Nuture

Through Food

Serve a banana split for dinner. For no reason. Just because. Just once. Buy a fancy plate at a garage sale. Serve the

ind meals on it.Buy some M&M’s together. Sort them by color. Eat them together. (or talk about what candy you like or games you play with food*)Give and honor choices

*

.

Serve the

ind

something special—i.e. pumpkin spice latte today

*

Have a tea party. Trim the crusts from sandwiches and cut into triangles.

Slide43

Move Together

T

oss a ball or beanbag*

Blow bubbles. Chase them around and pop them.*Fly a kite.*

Catch fireflies, then let them go.

Buy sidewalk chalk and help the

ind

draw a mural.

*

Buy balloons. Blow them up and play a balloon chasing game.

*

Play badminton

*

Make a snow sculpture. Put water in a spray bottle, add food coloring, and spray the sculpture.

Swing together.

*

Go for a ride in the country

Have an Easter egg hunt in the summer

“Chase Rocks” at the oceanSlide44

Maximizing Touch

Share a delightfully smelling lotion on you and have him reciprocate. Talk about what smells you like and what you have in common.

*

Offer appropriate touch (hand hug, side hug, display appropriate hug etiquette, pat on the back, arm touch)*Sit on the same side of the table and put a puzzle together.*

Play tag

*

Sit together and look at a magazine or book together

*Slide45

Increasing Eye Contact

Get a Group photo taken with everyone dressed the same. Hang it prominently in the home and frame one for each child’s room.

Play Peek-a-boo or “I spy” and follow where each other are looking.

*Participate in face painting. Look at each other and name the ways you are alike.*

Put a sticker on your face right between your eyes. Don’t comment on it at all. The

ind

will look at you and laugh—eventually.

*

Talk about applying make up or tying a tie together, demonstrate as you go

*

Really look at the

ind

and appreciate things about him/her

*Slide46

What Helped with BellaSlide47
Slide48
Slide49

Brisch

, K.H. (2002). Treating Attachment Disorders: From Theory to Therapy. New York, NY. The

Guiliford

PressKeck, G.C. & Kupecky, R. (2009). Parenting the Hurt Child. Colorado Springs, CO.: NavPressChara, K.A. & Chara, P.J. (2005). A Safe Place for Caleb. London, NJ: Jessica Kingsley Publishers

Cohen, J.A.;

Mannarino

, A.P;

Deblinger

, E. (2006). Treating Trauma and Traumatic Grief Children and Adolescents. New York, NY. The

Guiliford

Press.

Psychologist World and Partners. (2014). Attachment Theory - Developmental Psychology - Psychologist World. Retrieved from http://www.psychologistworld.com/developmental/attachment-theory.php