Attachment Healing Traumatized Caregivers and

Healing Traumatized Caregivers and AttachmentA Workshop Addressing Caregiver’s Unresolved Intergenerational Trauma and Insecure Attachment

1) Welcome to: Healing Traumatized Caregivers and Attachment - A Workshop Addressing Caregiver’s Unresolved Intergenerational Trauma and Insecure Attachment. This workshop will begin with an interactive discussion regarding traumatized parents and attachment. At your table you will find the workshops handouts, today’s outline to give you an overview of what to expect, paper for note-taking/activities we will do throughout our time together and extra pens for note taking. If you have not already done so, please sign in at the front table to ensure you’ve checked in and you will receive a certificate of attendance at the end of the workshop.

2) If you have any questions throughout the workshop, feel free to raise your hand, depending on the time - the presenter may answer your question or may have you hold onto your question toward the end of the workshop.

(Facilitator clicks next slide)

Workshop: Overview

Agenda: Second Half of the Workshop

Second Presenter: Topic - Unresolved Trauma and Role of Clinicians● Unresolved and Intergenerational Trauma ● Transmission of Trauma

⇒ Activity● Trauma and Attachment● Trauma’s impact on child-rearing practices● Developmental Impact of Intergenerational

Trauma ● Role of Clinicians

Complete the workshop evaluation at the end

Agenda: First Half of the Workshop

First Presenter: Topic - Attachment● Welcome ● Introduction to Trauma ● Introduction into Attachment

⇒ Activity● Overview of Attachment Styles ● Attachment Formation ●

Break [12pm-12:15pm]End [4pm]

What to expect from today’s workshop:1) The first presenter will discuss a brief overview of trauma then begin

discussing the topic of attachment including: attachment styles and how attachment forms. The purpose of this is first half of the workshop is to inform clinicians what behaviors or symptoms to notice in a clinical setting between a caregiver-child dyad in order to identify the attachment. There will also be activities for you, as mental health clinicians, to reflect upon your attachment history in which promotes clinical growth and empathy.

2) Then we will have a fifteen-minute break between the first half and the second half.

3) After the break, the second presenter will introduce the topic of unresolved intergenerational trauma that promotes clinicians to examine the effects of intergenerational trauma onto a caregiver’s attachment styles. The workshop will provide an activity to also get you thinking intergenerationally and how a family history relates to their current well-being. The workshop will explore these topics by identifying how caregivers’ unresolved trauma from childhood transpired into the attachment relationship with their children and impedes their child’s development.

4) After attending this workshop, we hope that clinicians will feel more confident in understanding the developmental impact of unresolved, intergenerational trauma on attachment. The encouraging aspect of this workshop is that you as a mental health clinician can help heal caregiver’s past trauma that will then

1) positively contribute to healthier child-rearing practices and promote a secure attachment. To help with this we will discuss how clinicians can assist in breaking the cycle of intergenerational trauma.

2) There will be loving-kindness breaks between the first and second halves as this is a lot of information and possibly a difficult topic for some. Thus brings me to the next slide


(Mort, 2020)

Creating Safety

Figure 1: Find your sense of safety without control. Adapted from “The Unshaming Journey Project” by Usman, 2018, retrieved from https://theunshamingproject.org/blog/find-your-sense-of-safety-without-control/

As clinicians, one of our goals should be to create safety within the therapeutic relationship. Since attachment and trauma are often triggering and a difficult topic:

● I’d want you to feel safe, as a trauma-informed practice meaning an environment that understands trauma and works to heal trauma not retraumatize clients. We want you to feel comfortable in taking a break if you need to, get up and stretch, or do whatever you need to do to ensure to feel safe and grounded.


Welcome: Presenter

Name

Title

Current Place of Employment

Clinical Experience

Contact Information

The workshop facilitator welcomes the first presenter. ● The first presenter introduces himself/herself, clinical title, current place of

employment, clinical experience and if the presenter feels comfortable, his/her contact information for attendees to reach out after the workshop.

(Presenter clicks next slide)

What is trauma?Origin: Greek - meaning wound

“Trauma is a wound… if I cut the flesh, then the healing would include scar tissue forming and if the wound is great enough there would be a big scar there. The scar would be without nerve endings so you wouldn’t feel and it would be much less flexible then the normal flesh. Trauma is when there is a loss of feeling and there’s a reduced flexibility in responding to the world, there’s a hardening that happens.”

- Gabor Maté, Phd

What is trauma?1) Trauma stems from the greek origin: wound2) Trauma is the exposure to a harmful event such as a natural disaster, war, loss,

abuse, violence or anything that causes psychological and/or emotional harm. (SAMHSA, 2014)

3) Gabor Mate, a leading trauma-informed figure, says “Trauma is a wound… if I cut the flesh, then the healing would include scar tissue forming and if the wound is great enough there would be a big scar there. The scar would be without nerve endings so you wouldn’t feel and it would be much less flexible then the normal flesh. Trauma is when there is a loss of feeling and there’s a reduced flexibility in responding to the world, there’s a hardening that happens.”


Prevalence of Trauma

● More than 60% of clients within a mental health care setting have experienced trauma such as childhood maltreatment and neglect

● Nearly one-fourth of the population experiences emotional trauma

● One of every seven children that experience child abuse or neglect develop post-traumatic stress syndrome.

(Pilkay &Combs-Orme, 2020)

Prevalence of Trauma: 1) More than 60% of clients within a mental health care setting have experiences

trauma such as childhood maltreatment and/or neglect2) One-fourth of the population experiences emotional trauma3) One of every seven children that experience child abuse or neglect develops

will post-traumatic stress syndrome.


Raising Hand - Activity

● If you are a clinician that works with children, families or caregivers/parents

● You have personally noticed children’s behaviors resulting from caregiver’s mental health?

● If you assess caregiver’s for trauma history or attachment trauma within your agency?

Let’s do a hand activity - Raise your hand if the following apply to you. ● If you are a clinician that works with children, families or caregivers/parents● You have personally noticed children’s behaviors resulting from caregiver’s

mental health?● If you assess caregiver’s for trauma history or attachment trauma within your

agency?

Thank you, most of us do work in settings with families and caregivers, therefore, hopefully this workshop will be valuable for your clinical knowledge.(Presenter clicks next slide)

Adverse Childhood Experiences (ACE’s)

(Jayne, found on Pexels)

https://www.youtube.com/watch?v=OtXd19s9i8k

(Baptist Memorial Health Care, 2018)

Figure 2: Grayscale photograph of woman crying. Adapted from “Pexels” by Jayne, 2017, retrieved from https://www.pexels.com/photo/adult-alone-anxious-black-and-white-568027/

Adverse Childhood Experiences (ACE’s)1) In a study of nearly 3000 children were surveyed involving the history of

adverse childhood experiences (ACEs), finding nearly one fifth of the children surveyed had a parent who had experienced at least 4 or more ACEs during childhood. In this same study the children with caregivers who had experienced four or more ACE’s scored higher for behavioral and emotional issues (Schickedanz et al., 2018).

Let’s watch this video explaining what ACE’s are:(Presenter - Show video: 3 minutes long) (After video)

1) There is a connection between traumatic experiences and later challenges one may face throughout life. Thus, it seems that not only does trauma experienced by caregivers as children affect the life and relationships of the adult caregiver, but also affects the caregiver’s ability to parent, negatively impacting the development of their children.


https://www.youtube.com/watch?v=OtXd19s9i8k

This table shows the national prevalence of adverse child or family experiences: - 47.9% of national population of children had experienced at least one ACE- Nearly 23% had more than 2 ACE’s- 25.7% low SES- 20% experienced parent’s divorce- 10.7 live with a caregiver that abuses substances- Nearly 9% witness community violence and lived with a caregiver with mental

illness/suicidal- 7.3 witness domestic violence- Nearly 7% had a parent serve in jail- 4% discriminated against due to race/culture- 3% experienced a death of a parent


Activity: What’s your ACE score?

Figure 3:Three types of ACE’s. Adapted from “Centers of Disease Control and Prevention” “by Robert Wood Johnson Foundation, 2014, retrieved from https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

In your packet of information, you’ll see the ACE’s questionnaire, please take the next 5 minutes to complete the questionnaire. Presenter: Allow 5 minutes for attendees to complete their ACE’s - refer to Handout A in the appendix (pg. 156)

(After five minutes presenter clicks next slide)

https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

Discussion

Raise your hand if scored less than 4 ACE’s?

Raised your hand if scored more than 4 ACE’s?

What came up for you completing the ACE handout?

How have you seen the impact of your ACE’s onto your development as a child?

Presenter - Allow 10-15 minutes to discuss the attendees experience completing the ACE’s.Ask the following questions:

● Raise your hand if scored less than 4 ACE’s?● Raised your hand if scored more than 4 ACE’s?● What came up for you completing the ACE handout?● How have you seen the impact of your ACE’s onto your development as a

child?

(Presenter clicks next slide after 10-15 minutes)

“Self-compassion is key because when we’re able to be gentle with ourselves in the midst of shame, we’re more likely to reach out, connect, and experience empathy”

- Brené Brown

Loving Kindness Break

5 Minutes

As mentioned, there are scheduled breaks to instill a trauma-informed practice of safety and acceptance. Please take five minutes for a loving kindness break.Once we return we will begin discussing attachment

(Presenter leaves it on this slide for 5 minutes)

AttachmentBowlby’s Attachment Theory

Caregiver responsiveness to a developing child

Attachment 1) From the moment they arrive, babies begin to develop emotional bonds with

the adults in their lives. A newborn communicates with adults through signals (verbal or non-verbal). These signals let the adult know that the infant needs them. Over time, the infant develops new strategies to keep their caregivers nearby, such as: smiling, reaching, cooing, laughing, and crawling. These behaviors help caregivers develop a deep emotional bond with their infants.

2) The special bond built between a child and the primary caregiver is called attachment. Attachment is usually in place by the end of a baby’s first year of life. Infants’ brains are “wired” to develop an attachment to others. The quality of this attachment depends on the caregiver, the child, and family factors.

3) We will begin to examine attachment: the research that fuels the mental health field understanding of attachment, the characteristics define the attachment bond, how attachment develops and changes over time, and how the attachment trauma impacting a caregivers’ relationship to the child and the child’s psychological development.


Caregiver Responsiveness

AttunementReading CuesMeeting the Need

Child’s Needs

SafetyLoveTrustSecurityBasic Survival Needs(Sleep, suck, eat, hygiene)

Attachment Building

Secure *Need met consistently

Insecure *Need not Met or Met Inconsistently

Let’s look at the correlation between a caregiver meeting a child’s needs and attachment:

1) Every child is born with needs: safety, love, trust, security and the meeting of their survival needs such as sleeping, sucking, eating, and hygiene. Babies are born fully dependent on their caregivers.

2) The caregiver’s attunement, how the caregiver reads the child’s cues and how the caregiver meets the child’s needs appropriately and consistently then impacts the attachment.

3) A secure attachment building foundation would be the consistent meeting of the child’s needs for that love, sense of safety, trust, security and basic needs.

4) While an insecure attachment develops when a caregiver is unresponsive as shown by not meeting the child’s needs or being inconsistent when meeting the child’s needs.


Internal Working Model

Figure 4: Internal working model. Adapted from “Simply Psychology” by Bowlby, 1969 retrieved from https://www.simplypsychology.org/bowlby.html

Bowlby’s Internal Working Model: 1) Attachment building encompasses an internal working model which Bowlby

claims as the cognitive framework of mental representations for understanding the world, self, and others; which in turn guides interactions with others through past memories and expectations their internal model formed during childhood.

2) Bowlby’s internal working model is rooted in the attachment between caregiver-child where the child develops a sense of self-worth/self-understanding. Through the world of a child’s attachment figure, the child learns and what is acceptable and unacceptable.

3) In order to be securely attached, the child would need to receive adequate mirroring in order to produce a working model which results in the sense that they are deserving of love and that they possess value as a human being.

4) Presenter refers to the diagram: As you can see from the diagram, the child’s internal working model is developed from caregiver interactions and according to Bowlby’s Attachment Theory, depending on those interactions, the child will develop:

● A positive sense of self and feeling loved resulting in a secure attachment

● Unloved/rejected resulting in avoidant or otherwise called anxious attachment or

● Angry and confused resulting in resistant or later called ambivalent

● attachment(Presenter clicks next slide)

Attachment styles

1. Secure

2. Insecure

-Ambivalent

- Avoidant

- Disorganized

- Non-attached

Figure 5: Attachment styles. Adapted from “Verywell” by Olah, 2020 retrieved from https://www.verywellmind.com/attachment-styles-2795344

There are five different styles of attachment formed through parent-child interactions in early development based upon the internal working model.

● Secure● Insecure avoidant● Insecure ambivalent

○ Subtypes of insecure attachment: disorganized attachment and non-attached/other attachment


Secure Attachment

● Seen● Safe● Trust● Loved

Figure 6: Crop person touch palms with newborn baby on gray backdrop. Adapted from “Pexels” by Shevts, 2020, retrieved from https://www.pexels.com/photo/crop-person-touch-palms-with-newborn-baby-on-gray-backdrop-3845458/

Secure attachment:1) The ideal attachment is secure attachment. 2) Children with secure attachment have a strong preference for their primary

caregiver over others interactions of the caregiver are attuned to the child’s needs

3) Here, the caregiver actively responds to the child's attempts to communicate and fulfills the child’s needs which promotes the child to gain a sense of independence and security. Essentially, the caregiver demonstrates availability in supporting the child.

4) When the child develops the sense of trust through consistent interactions with his caregiver, the child will feel comfortable exploring his environment knowing that his caregiver is there for him when he needs his caregiver. The child will feel seen, safe, trusting of his caregiver and loved.


Insecure Attachment: Avoidant

● Dismissed● Rejected● Unloved

Figure 7: Boy facing camera selective focus photography. Adapted from “Pexels” by Mohamadi, 2018, retrieved from https://www.pexels.com/photo/boy-facing-camera-selective-focus-photography-1427288/

Insecure attachment, avoidant:1) A child with avoidant attachment style displays little interest in the caregiver. 2) This attachment style appears when the parent dismisses the child's needs, and

therefore, the child learns to minimize the need for attachment to avoid feeling rejected. For an avoidant child, his defense mechanism of withdrawal protects himself by developing an internal message that he does not care that the caregiver was unavailable to him

3) The child does not display distress upon separating from his caregiver and ignores or avoids caregiver when the caregiver returns to the child.

4) An avoidant child does not discriminate against caregivers versus other people, including strangers.

5) The child with this attachment will feel emotionally/physically dismissed, rejected and unloved.


Insecure Attachment: Ambivalent/Anxious

● Confused● Angry● Resentful

Figure 8: Man carrying child. Adapted from “Pexels” by Phi, 2018, retrieved from https://www.pexels.com/photo/man-carrying-child-1361766/

Insecure attachment, ambivalent/anxious:1) A child with ambivalent attachment does minimal exploration of their

environment. A child with ambivalent attachment is scared to explore the world because he is uncertain if the caregiver will be there when he needs the caregiver.

2) This pattern emerges when caregivers are inconsistent when meeting the child’s needs and when caregivers lack empathy for the child's emotional experiences. The child may adopt strategies to keep the caregiver around. These strategies may include caring for the caregiver or paying more attention to the caregivers’ needs, but ultimately the child possesses underlying feelings of anger about the unreliability of the caregiver and resentment toward the caregiver.

3) The child is not reassured that the caregiver will meet the child’s need, causing the child to both seek and resist contact from caregiver upon reunion. Caregivers with an anxious child may describe them as “clingy”.

4) The child with this attachment will feel confused, angry and resentful toward his caregiver.


Attachment Style Examples: Secure, Ambivalent, Avoidant

https://www.youtube.com/watch?v=DRejV6f-Y3c(Maire Coppola, 2013)

Let’s watch this video to show examples of these style of attachment (4 minutes long)

Summary after watching the video:1) Clinicians can notice a secure attachment attachment style for a child when the

child displays distress when his caregiver separates from the child’s presence but once the child and caregiver are reunited, the child will take comfort in the caregiver's presence (Ainsworth et al., 1978).

2) Clinicians can notice this attachment style if child does not display distress upon separating from his caregiver and ignores or avoids caregiver when the caregiver returns to the child or if the child child does not seek out physical contact and is often wary around the caregiver.

3) Clinicians can identify this attachment style if the child is preoccupied with his caregiver and becomes distressed upon separation from caregiver and the child’s remains distressed when the caregiver returns.


https://www.youtube.com/watch?v=DRejV6f-Y3c

Insecure Attachment: Disorganized

● Dismissed● Rejected● Unloved

Figure 9: Grayscale photograph of a boy crying. Adapted from “Pexels” by Shevts, 2020, retrieved from https://www.pexels.com/photo/grayscale-photo-of-a-boy-crying-3905731/

● Confused● Angry● Resentful

Insecure attachment, disorganized:1) Disorganized attachment occurs when the child experiences abuse creating a

sense of fear toward the caregiver. 2) For the child with disorganized attachment, the caregiver is not viewed as a

source of comfort or security and therefore the child develops a sense that he has no caregiver that will meet his needs.

3) This attachment occurs when the child has sought comfort from the caregiver and interaction or lack of interaction was perceived as a source of danger and/or fear; the child then becomes internally conflicted with the child’s natural desire to feel safety with his caregiver that he perceives as a threat to his sense of safety.

4) A clinician can identify this attachment by seeing a combination of both ambivalence and avoidant attachment due to caregiver’s inconsistent caretaking along with abusive experiences.

● For instance, the child may seek to be held, but will then avoid being touched or run away from the caregiver.


Example: Inconsistent Responsiveness

https://youtu.be/8BA8CcEUP84?t=16(AboutKidsHealth, 2012)

Let’s look at this example of inconsistent caregiving that may contribute to disorganized attachment. (2 minutes 39 seconds)

(After the video, presenter clicks next slide)

https://youtu.be/8BA8CcEUP84?t=16

Insecure Attachment: Non-attached

● No primary caregiver to provide emotional needs but the basic needs are met (eating, sucking, sleeping, hygiene).

Figure 10: Russia Orphanage. Adapted from “Human Rights Watch” by Mazzarino, 2014, retrieved from https://www.hrw.org/report/2014/09/15/abandoned-state/violence-neglect-and-isolation-children-disabilities-russian

Insecure attachment, non-attached:1) A non-attached child as one who has not had the opportunity to form

attachments during early development. For example, children raised in an institution where the child are fed and clothed but have no opportunities to form personal relationships with a caregiver results in the child developing a secure attachment.

2) Non-attachment may also develop when caregivers are completely emotionally unavailable to the child. The emotionally unavailability limits the socio-emotional connections that are needed to form a secure attachment with the caregiver (Ainsworth, et al., 1978).

3) Children in orphanages were often cared for by many different adults. The adults were not always able to be responsive to children’s needs. This made it difficult for children to become attached to adults. In this photo, this is an image from an investigation of orphanages in Russia, they found children under stimulated and under developed for their ages.


Case Example: Non-Attached

https://www.youtube.com/watch?v=VCeWr8OFuEs(BBC News, 2016)

Let’s watch this clip of non-attachment - I want to inform you that this may be difficult to watch, if you need to leave the room and take a break. (4 minutes)


https://www.youtube.com/watch?v=VCeWr8OFuEs

Questions?

Any questions about attachment styles before we move into discussing the formation of attachment?~10 minutes

(After 10 minutes or depending on timing - presenter clicks next slide)

The Formation of Attachment

Let’s now think about how attachment styles develop.


Figure 11: Phases of attachment development. Adapted from “Institute for Learning and Brain Science” by University of Washington retrieved from https://modules.ilabs.uw.edu/module/development-of-attachment/449-2/

The four phases of attachment building:1) The first phase is called the pre-attachment phase. In this phase, newborns

call caregivers to their side. They will cry or smile, which helps keep people close by. Infants may recognize their caregivers, but they do not show a preference for them over strangers. This phase lasts until about 6 weeks of age.

2) The next phase is called attachment-in-the-making. During this phase, infants show a preference for familiar people. They are more interactive with familiar people and are more easily comforted by them. But infants are still happy to spend some time with strangers.

3) The third phase is called clear-cut attachment. Infants and toddlers show clear attachment to primary caregivers. They begin using their caregivers as a secure base. This means that when their secure base leaves, children become upset. You’ve probably seen a crying toddler cling to her mother during daycare drop off. Separation anxiety is a hallmark of this phase.

4) The final phase is the goal-corrected partnership. Children’s attachment bonds continue to evolve once they form clear attachments. Around age two, there is a change in children’s language and cognitive skills. They are now able to understand why their caregivers have left and that they will return. This understanding helps toddlers’ separation anxiety decline. Children no longer cry to protest their parent’s departure. Toddlers and preschoolers may instead negotiate or persuade parents to stay.


https://modules.ilabs.uw.edu/module/development-of-attachment/449-2/



Pre-Attachment Phase

Newborn - 6 weeks

Learning how to get needs met:

● Crying● Smiling● Makes eye contact ● Studies caregiver’s face

○ Mirroring

Figure 12. Toddler lying on pink fleece pad.. Adapted from “Pexels” by Akram, 2018, retrieved from https://www.pexels.com/photo/toddler-lying-on-pink-fleece-pad-1442005/

Pre-attachment phase:1) This stage occurs between age zero to two months. During the

pre-attachment, infants will find joy in social interactions, especially with human faces and voices due to the biological drive to establish human connection.

2) A newborn baby can easily focus on objects in front of him such as a face of the person who is holding and feeding him, to naturally encourage the baby to have a preference for this caregiver. When the caregiver correspondingly responds to the child’s cues such as smiling, crying, babbling and body movements, the child will begin to understand an interactional process called mirroring.

● Mirroring is the process as one in which the caregiver emotionally and physically responds to the baby’s cues in a consistent and reliable way to meet babies needs which creates a corresponding concept of self and others. For instance, if the baby coos as a bid for the caregiver’s response and the caregiver coo’s back to the baby, the caregiver is promoting the child’s internal sense of respect and trust based on the congruencency of interactions.

3) The daily back-and-forth social interactions that occur between child and caregiver promote a secure attachment where the child feels seen and understood by the caregiver.


Attachment in the Making

6 weeks - 6/8 months

● Begin to develop a sense of trust for primary caregiver when the child knows they can depend on the caregiver to meet their needs.

Figure 13. Woman carrying a baby at beach. Adapted from “Pexels” by Pixab, 2016 retrieved from https://www.pexels.com/photo/woman-carrying-baby-at-beach-during-sunset-51953/

Attachment in the making:1) Babies during this stage, between three to six months, can now discriminate

between different social responses, meaning they are able to display different responses to different people.

2) They respond in a more familiar way to faces they know versus faces with which they are less familiar or unfamiliar.

3) With familiar faces, babies will share an increased attention to the person as demonstrated by smiling and babbling.

4) The familiarity of the caregivers' face allows the caregiver to comfort the child more easily than a stranger might.


Clear-Cut Attachment

6/8 months to 18 months

● Attachment becomes more established, there becomes a stronger preference for one primary caregiver over other caregivers and will have separation anxiety when the caregiver leaves.

Figure 14. Photo of man and woman having fun with their child. Adapted from “Pexels” by Piacquadio, 2020 retrieved from https://www.pexels.com/photo/photo-of-man-and-woman-having-fun-with-their-child-3820065/

Clear-cut attachment: 1) From seven months to three years, this is a time during which the child

actively seeks closeness of caregiver and displays distress when the child notices when caregiver is not around.

2) At this stage, the child is moving around more independently and seeking out his caregivers comfort while also reading the caregiver's social and emotional cues.

3) As the child learns from the caregiver’s verbal or nonverbal prompts, the child develops an attachment style, based on social, emotional and physical experiences with the caregiver.

4) The child during this stage absorbs the environmental and social cues informing the child how to interact with the caregiver or others. It is important to note that a child during this stage also begins to develop an egocentric viewpoint that motivates the child to get the caregiver aligned with the child’s wants and needs

5) The egocentric viewpoint is a staple in the common separation anxiety that occurs when the primary caregiver leaves during this stage.


Goal-Corrected Partnership

18 months <

Able to form emotional bonds with other caregivers besides their primary caregiver, understands that when caregiver leaves, the caregiver will return (sense of safety is established even if caregiver is not physically present).

Figure 15: Cheerful mother and daughter having fun on bed at home. Adapted from “Pexels” by Piacquadio, 2020 retrieved from https://www.pexels.com/photo/cheerful-mother-and-daughter-having-fun-on-bed-at-home-3756036/

Goal-corrected partnership:1) Begins to develop from age three and beyond.2) The child in this stage has the cognitive ability to understand a sense of safety

for the self when the caregiver is not physically present. 3) For instance, if a secure attachment has been formed, the child will feel

comfort in knowing that the caregiver is still available, even if the caregiver is not present.

4) Here, the child is slightly less egocentric and able to understand the caregiver’s point of view and to develop an understanding of the caregiver’s motives, feelings, goals and plans that might influence caregiver actions.

5) This is the stage when the relationship between caregiver and child is considered to be a partnership with a reciprocal sense of balance. By this stage, the developed internal working model that the child has dependent on the caregiver’s responsiveness will be used as a template when relating to or interacting with others in the future. The internal working model (Positive sense of self and feeling loved, Unloved/rejected or Angry and confused) established in early development will continue for the rest of their life.


Figure 16

This concludes the first half of the workshop, please feel free to get up, stretch and take time for yourself.


Questions?

Any questions regarding the formation of attachment before our break? (Presenter: allow 10 minutes for questions, then click the next slide).

Break

15 Minutes

(Workshop facilitator introduces the break) There will be 15 minutes, let's plan to return at 12:25pm

(Should end around with the first half of workshop at 12:10pm- 131 minutes total)(Facilitator leaves this slide on for 15 minutes)

Welcome: Second Presenter

Name

Title

Current Place of Employment

Clinical Experience

Contact Information

(Workshop facilitator welcomes back attendees and welcomes the second speaker)Second speaker introduces himself/herself, clinical title, current place of employment, clinical experience and if the presenter feels comfortable, his/her contact information for attendees to reach out after the workshop.


Unresolved and Intergenerational Trauma

Figure 17: Green tree photo. Adapted from “Pexels” by Miittermeier, 2018. Retrieved from https://www.pexels.com/photo/green-tree-photo-1080401/

Second half of the workshop - unresolved and intergenerational trauma:1) As we go into the second half of the workshop will be discussing unresolved

and intergenerational trauma and its’ correlation to attachment and child development.

2) Unresolved intergenerational trauma positively correlates to having unsafe, neglectful environments along with unstable relationships

3) This tree is a good representation of the intergenerational transmission of trauma on children. Our great great ancestors are the roots leading up the top of the branches the generations stemming from our past ancestors. There is hope that the new budding leaves on the branches will stop the cycle of trauma and the create a new, stronger, more resilient branch.

**I will be using the terms unresolved and intergenerational trauma interchangeably**


Figure 18

1) Anyone here know of completely normal parents without any issues stemming from their family history?

● I didn’t think so - it’s more common to have some level of dysfunction/trauma - that’s why it is important for mental clinician's to conceptualize the impact intergenerational trauma may have on your clients in the clinic.


Transmission of Trauma through the Generations

Figure 19: Intergenerational trauma. Adapted from “The Mind Journal” by Radcliffe, 2020. Retrieved from https://themindsjournal.com/intergenerational-trauma/2/

Trauma passed down from generation to generation:1) Intergenerational trauma is the transfer of a past traumatic event occurring

within a family many years ago that continues to impact the ability to understand, cope with, and recover from past trauma within the family system.

2) Babies are the silent absorption of multiple generations of trauma that continuously get passed down. When caregivers do not resolve past traumatic experiences, whether chronic mourning or failing mourning, there is an unconscious and repeated recreation of the trauma

● Unresolved trauma can represent itself as chronic mourning which is characterized by a continuous and unresolved grief reaction, or failing mourning in which feelings of grief are minimized or pushed away (Bowlby, 1980).


Gabor Maté, Phd. - Intergenerational Trauma

https://www.youtube.com/watch?v=-a13rn8Cduc

(IoPT Norway- Institute for Trauma, 2019)

Brief overview to begin discussion of Intergenerational trauma (2 minutes 30 mins).



Activity: Genogram

Figure 20: Genogram example. Adapted from “Edrawl” by Lynch, 2020, Retrieved from https://www.edrawsoft.com/author/allison/

Activity:1) Understanding trauma also means you understand your history and the

trauma’s you currently have or resolved. 2) I’d like you to draw out your family’s genogram, keeping in mind the adverse

experiences either you or someone in your family has faced. Note who in your family broke any cycles of intergenerational trauma: such as “who carried this?”

3) We will work on this for roughly 15 minutes, don’t worry if you don’t complete it, you can always work on this at a later time. The goal is to help you get an overview of trauma’s impact within your family system.


Genogram Key

Figure 21: Genogram basic symbols.. Adapted from “GenoPro” by GenoPro 2020, Retrieved from www.genopro.com

Here is the genogram key for you to use as you create your genogram.Keep it on this page for participants to use as a guide while drawing their genogram.Allow 15 minutes for attendees to draw out their genogram - refer to Handout B in the appendix (pg. 157)


Genogram: Discussion

● What did you learn within your family’s history?

● What did you notice?

● Who were the women and men that interrupted the cycle?

(Presenter allows about ~10 minutes for discussion)Look at your genogram and think about the following questions:

● What did you learn within your family’s history?● What did you notice? ● Who were the women and men that interrupted the cycle?

Would anyone like to share what intergenerational patterns they have discovered?


Intergenerational Trauma Correlation with Insecure Attachment

Intergenerational trauma correlation with insecure attachment:1) When studies look at attachment style across the generations while assess

attachment with an assessment tool called the Adult Attachment Interview (AAI) which will be discussed later in this presentation. There was a 75% correlation between the attachment style of the mother and the attachment style of the child. While grandmothers that were identified to have a secure attachment style also had daughters with a secure attachment.


Understanding the Past

https://www.youtube.com/watch?v=JNNT7loaQAo(PsychAlive, 2009)

Caregivers may not want to look at their past but present with concerns of relating to their child currently - usually a child’s behaviors are directly related to attachment.

(Play video, 2 minutes, 28 seconds).

(After video, presenter clicks next slide)

https://www.youtube.com/watch?v=JNNT7loaQAo

Unresolved Trauma’s Impact on Attachment

Attachment Style % of U.S. Population

Secure 55-65%

Avoidant 20-25%

Ambivalent 10-15%

Disorganized 5-15%

Adapted from Mindsight Institution by Daniel Siegel

Unresolved trauma on attachment:1) The normative population has a secure attachment style of 55-65%, avoidant

attachment style of 20-25%, ambivalent attachment style at 10-15% and disorganized attachment comprises 5-15% of the normative population in the United States.

2) Insecure attachment may develop when there is an attachment trauma occurs within the child’s first 5 years of development, such as parental separations, parental mental illness, or any aversive experiences

3) Attachment trauma is linked to negative symptoms including a critical internal working model, decreased stress management skills, poor socio-emotional relatedness and impaired intellectual functioning

4) It’s important to understand the attachment style of our clients to assess any attachment trauma that may be occuring because we often get client’s that present with underlying issues and may not be within this securely attachment population mentioned above.


Intergenerational Trauma: Insecure Attachment of the Caregiver

Figure 22: Postpartum depression and the baby blues. Adapted from “The Help Guide” by Glezer, 2020. Retrieved from https://www.helpguide.org/articles/depression/postpartum-depression-and-the-baby-blues.htm

Unresolved/Intergenerational trauma and the insecure attachment of the caregiver:1) Infants ages four to six weeks and three to five months who had mothers with a

history of childhood abuse, experienced poor parenting with less positive interactions, were provided less attention and found their mother less emotionally available to their needs when compared to those infants whose mothers had not experienced childhood abuse.

2) For children and caregivers with disorganized attachment presents itself in children with caregivers that possess unresolved trauma and loss. 89% correlation between infants with disorganized attachment and a caregiver with unresolved trauma and a disorganized attachment style.

● Disorganized attachment style develops when the caregiver is a direct source of fear. Insecure attachment style of the caregiver influenced by unresolved trauma also corresponds to lapses in reasoning

3) Individuals with anxious or avoidant attachment styles possess dysfunctional relational feelings, thoughts and behaviors, leading to less satisfaction within a relationship and less satisfied partners. Therefore, a caregiver, for example, with anxious attachment does not seek support from key attachment figures but rather from their partners or children, leading to chronic reassurance seeking and insecurities within the a dyad.


Intergenerational Trauma: Stress Management

Figure 23: What is attachment trauma. Adapted from “ BrightQuest Treatment Center” by Bright Quest, 2020 retrieved from https://www.brightquest.com/relational-trauma/what-is-attachment-trauma/

Unresolved/Intergenerational trauma and stress management:1) What trauma response might be happening for the parent here? 2) When most of society talks about parenting, we go to the child’s behaviors and

to break the behaviors - it is important to start with the parent to assess for trauma and find out their perspective to create a narrative for parent to embody the trauma - if trauma is left unresolved, the caregiver has automatic bodily responses to their child’s behaviors if it is triggering their trauma.

3) Caregiver’s psychological distress positively contributes to the development of problem behaviors for children. Multiple studies indicate that a caregiver’s exposure to stress and trauma negatively influences their well-being, with detrimental impacts on the capacity to parent, and ultimately, increasing children’s risk for poor outcomes. This holds true across culturally and socioeconomically diverse samples of caregivers and children and includes a variety of types of trauma including medical accidents, natural disasters, military trauma, abuse, neglect and family and community violence

● The painful feelings associated with past and/or unresolved traumas are often triggered by the stress of being a caregiver, and results in automatic frightening or disorienting behavior on the part of the caregiver, resulting in disorganized attachment for the child.

4) Maternal stress has been linked to harsh parenting, maternal depression, and poor cognitive, socio-emotional, and physical development in children and may have long lasting effects on the well-being of both mother and child.

https://www.brightquest.com/relational-trauma/what-is-attachment-trauma/

Trauma’s Impact on Child Rearing PracticesExposure to trauma in childhood has an unhealthy impact on child rearing practices(George & Solomon, 2008).

Figure 24

Unresolved/Intergenerational trauma and child rearing:1) Deficiencies in early caregiving ranging from: unresponsiveness and

inconsistent behaviors to rejection, deprivation, or abuse and result in a child’s insecure attachment and a negative internal working model, leading to maladaptive behaviors later in life. When a child develops this negative internal working model, the child will often sacrifice their own needs to accommodate for the caregivers or to protect themselves from future harm

2) Therefore, a caregiver’s unresolved trauma implies an emotionally unavailable caregiver that is less likely to cultivate meaningful and thoughtful interactions resulting in a child’s negative internal working model which will impact the child well into adulthood in both personal and relational well-being and ultimately, perhaps in the ability to parent effectively.


Case Example - Joe Frost

https://www.youtube.com/watch?v=Us-qrg92ET4(Supernanny, 2016)

Let’s watch this example of a dysregulated parent attempting to parent effectively but gets taken over by emotions. Disclaimer: this may be difficult to watch, feel free to leave the room if needed.

(Stop video at 2 minutes at 40 seconds)When watching this, what might be triggering for dad making his parenting style ineffective?

(After quick reflection, presenter clicks next slide)

https://www.youtube.com/watch?v=Us-qrg92ET4

Trauma & Child Maltreatment

Figure 25: Defining child maltreatment. Adapted from “ US Department of Health and Human Services” by The National Conference of State Legislatures, 2014 retrieved from https://www.ncsl.org/research/health/preventing-child-maltreatment-defining-the-problem-discussing-solutions.aspx

Trauma’s correlation with child maltreatment:1) Unresolved trauma corresponds to maltreatment during childhood and 27-71%

of adults with a history of abuse display symptoms of dissociation and memory lapses which have been associated with infant attachment disorganization.

2) Of 70 young mothers, 63% of them had an insecure attachment model and mother’s that experienced maltreatment in childhood scored high for having unresolved trauma. The infants of young mothers with unresolved trauma spent more time in infant withdrawal and anger, while mother’s spent less time positively engaging with their infants and more time being intrusive to infants than mothers that had a secure attachment model. Overall, infants with insecure attachment had a more negative relationship with the mother than infants being cared for by mother’s without unresolved trauma (Crugnola et al., 2019).

3) Children that experience maltreatment are linked to insecure attachment and develop traits of manipulation to others, altered psychological responses to stress, behavioral problems and trouble with interpersonal relationships.

4) Caregiver’s that have unresolved trauma negatively affect the caregiver’s ability to foster a safe and secure relationship with the child.


https://www.ncsl.org/research/health/preventing-child-maltreatment-defining-the-problem-discussing-solutions.aspx

https://www.ncsl.org/research/health/preventing-child-maltreatment-defining-the-problem-discussing-solutions.aspx

Trauma’s Impact on Emotional Regulation

Figure 26: Disaster girl by Memegenerator, 2020, retrieved from https://memegenerator.net/instance/54792299/disaster-girl-i-go-0-to-100-real-quick

Unresolved/Intergenerational trauma and caregivers emotional regulation. 1) Emotional regulation is the ability to control our emotions and to stay in a

cognitively, rational place of thinking versus dysregulation which is ruled by our emotions and out brains don’t have access to cognitive functions until the brain feels safe again.

2) The caregiver acts as a co-regulator for one’s child. Therefore, the ability for the caregiver to remain calm and regulated with one’s child impacts the child’s own emotion regulation abilities

3) Early experiences with caregivers impact the development of the attachment system and emotional regulation skills, while caregivers that experience childhood trauma do not possess the adaptive skills in child rearing as evidenced by increased use of hostile actions and lack of emotional affect. Poor regulation abilities in infants is positively linked to neglectful and abusive caregiving resulting in future developmental delays for the child.

4) Unresolved trauma manifests itself through impaired regulation abilities due to the caregiver’s failure to integrate the sense of self with past experiences of trauma and loss.

● This altered sense of self is driven by the survival part of the caregiver’s brain resulting in poor impulse control and less rational decisions. The survival part of the brain dictates the rest of the system and when the caregiver’s unresolved trauma is consistently triggered then the brain is mostly operated in this altered state to survive. When

● the caregiver operates from this altered state of mind the ability to stay calm and regulated is less accessible to the caregiver because the unresolved trauma triggers the natural response for the brain to protect itself.

1) Awareness of those moments are key for the parent to know how to get back to a sense of presence and connection with their child.


Trauma’s Impact on Attunement

Caregiver’s attunement

Survival Mode

Figure 28. The art of attunement. Adapted from “RACQs” by Conarini, 2019, retrieved from https://www.racq.com.au/Living/Articles/The-art-of-attunement

Unresolved/Intergenerational trauma and caregivers attunement:1) Attunement = is a bodily and emotional sensing of others knowing their

rhythm, affect and experience by going beyond empathy to create a two-person experience of unbroken feeling connectedness by providing a reciprocal affect and/or resonating response' (oneness)

2) Which may disrupted by underlying trauma, as we just discussed emotional regulation:

3) Body stores trauma and may revert to the survival mode of responding in a way that signifies a deep trauma, therefore, unresolved past traumas in the caregivers may trigger survival stances of (freeze, fight, flight) if a child does/says something unconsciously attached to that past trauma. Caregivers past trauma is linked to symptoms of dissociation or mentally unavailability resulting in bizarre or inappropriate behavior with the child.

4) When a caregiver dissociaties or is triggered by their children’s attachment needs leading to re-experience of trauma symptoms such as isolation, rejection, and loss; creates an internal sense of fear for the child experiencing the caregiver’s unavailability while the child is watching the caregiver and absorbing the caregivers reactions, parent is modeling a trauma response.


Examples: Attunement https://www.youtube.com/watch?v=7FC4qRD1vn8 (Institute for Learning and Brain Sciences: University of Washington, 2014)

https://www.youtube.com/watch?v=1ij-yplYtMs (Jenny Hughes, 2013)

Here we will see how children beginning at a young age absorb the energy and emotional reactivity to the adults around them.

Play video - (2 minutes 14 seconds).

After video: How did the child change his reaction in response to the emoter?

1) Biologically we possess mirror neurons in the brain that allow us to mirror the behaviors of others but to also understand someone else’s emotional states. Therefore, children learn behaviors and emotional reactions from their environment.

Still face experiment _ example of attunement (two minutes 30 seconds)

Play video (Presenter clicks next slide)

https://www.youtube.com/watch?v=7FC4qRD1vn8

https://www.youtube.com/watch?v=1ij-yplYtMs

Substance Abuse/Addiction

Figure 29: A letter to my alcoholic father. Adapted from “The fix” by Sawyer, 2017 retrieved from https://www.thefix.com/letter-my-alcoholic-father

Unresolved/Intergenerational trauma and substance abuse/addiction:1) Caregivers that abuse substances are more likely to possess an insecure

attachment style stemming from intergenerational trauma, significant losses and low self-esteem.

2) Substance and drug use is linked to continued usage of substances for the following generations

3) In a study with mothers who used medium to high amounts of alcohol prior to pregnancy were more likely to have a disorganized attachment style in comparison to attachment styles of mothers that were absent or light consumers of alcohol.

4) Substances also inhibit parental awareness and presence, therefore, limiting the needing meeting ability for the child with a caregiver that consumes substances. Physically the caregiver may be present but emotionally unavailable, thus impacting the attachment or sense of security for the child.


https://www.thefix.com/letter-my-alcoholic-father

Developmental Impact of Intergenerational Trauma

Now, let’s segway into the developmental impact of intergenerational trauma:1) Caregivers directly influence the child’s representation of others and the

internal working model relating to one’s self presentation. When children adopt a negative self representation, the child becomes more vulnerable to psychopathology.

2) Therefore, caregiver’s insecure attachment positively correlates to psychopathology of caregivers. Mother's unresolved trauma displays frightening behaviors for the children including dissociative states, unusual voice tones, flat affect. When the caregiver’s environment triggers the unresolved trauma, the caregiver responds with fear-related responses that frighten the child.

3) The internal process related to unresolved trauma then impacts the development of the child’s cognitive functioning, mental health and even physical health.


Cognitive Functioning

Figure 30: Trauma and brain development. Adapted from “Ohio state Department” by The Sensory Project, 2020 retrieved from https://www.facebook.com/MarkSmithCounselling/photos/trauma-brain-developmentptsd-trauma-cptsd/1248806621918232/

Cognitive functioning:Explain the figure in the powerpoint (typical development versus exposure to trauma’s impact on development)

● When our brains develop, we first develop the “reptilian brain” or the survival part of the brain shown in orange, then the limbic system develops on top of that responsible for regulation and the social-emotional development shown in green, lastly we develop the neocortex which is the cognition or logical thinking part of the brain shown in purple.

● For a typical child development without exposure to adverse experiences the survival is at the bottom and takes up less congitive resources allowing the child to maintain a sense of regulation and cognitive development. While the opposite is shown for a child with trauma during development where the survival state of the brain is much more prevalent that the logical thinking/cognition part of the brain.

2) A 10 year longitudinal study assessing 85 children ages 7-17, children that had disorganized/insecure attachment had lower scores of self-confidence, IQ, and attention problems resulting in a less optimal cognitive functioning than children with a secure attachment (Jacobsen, Edelstein, & Hoffmann, 1994).

1) Its theorized that children with insecure attachment presented with cognitive challenges due to the children’s internal anxiety and dysregulation.

2) While also the trauma’s impact on emotional regulation impacts a child’s cognitive functioning due to the limited regulation skills and limited access

1) logical thinking related to higher cognitive functioning is limited when the brain routinely operates from the survival state aspect of the brain.


Mental Health

Depression

Anxiety

Dissociation

Figure 31: Depression versus anxiety: How to tell the difference adapted from “Turnaround”, 2020, retrieved from https://www.turnaroundanxiety.com/depression-versus-anxiety-tell-difference/

The transactional process that occurs between caregivers and the mental health problems for their children including anxiety, depression, and dissociation.


Depression

Irritability and/or anger are more common signs of depression in children and teens.

- Noticeable behavior- physical/ somatic

Figure 32: Child depression. Adapted from Anxiety and Depression Association of America by Bhatia, 2020 retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/childhood-depression

Childhood depression:1) Depression in childhood/adolescence can manifest somewhat differently than it

does in adults. Irritability and/or anger are more common signs of depression in children and teens.

2) Depression for children is likely to develop when the child is unable to form a stable and secure attachment with one’s caregiver or when the caregiver instills an internal message that the child is unlovable/ The child’s felt loss of a relationship with the caregiver turns inward into internalizing feelings of being unworthy of love and a failure to others

3) When depressed, younger children are more likely to have physical or bodily symptoms, such as aches or pains, restlessness, distress during separation from parents, as they may not have the emotional attunement and/or expressive abilities to talk about their emotions.


AnxietyAvoidance

Behavior

- changes in eating, sleeping, energy, or physical complaints of headaches or stomach-aches.

Figure 33: Watch, ask and listen. Adapted from Anxiety and Depression Association of America by Siquelan, 2020 retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/watch-ask-and-listen-how-tell-if-your-child-or

Childhood anxiety:1) Anxiety develops in children due to attachment related anxiety depending upon

the availability of the caregiver. 2) An overprotective parent heightens the child’s sense of anxiety due to the

caregiver’s over-involvement impeding a child’s autonomy and development of the self.

3) While under-involvement or a caregiver’s unavailability in the fulfillment of the child’s needs is linked to childhood symptoms of anxiety.

4) In a study of adolescents that scored high for anxiety, 65% had an anxious attachment style while 35% had ambivalent attachment style to caregivers. Those children diagnosed with generalized anxiety disorder as adults reported feelings of rejection by caregivers, a controlling environment and/or feelings of being unlovable.

5) May notice the child avoiding to do things they once used to love to do or avoid new things - he other signs that parents do often notice are changes in eating, sleeping, energy, or physical complaints of headaches or stomach aches.


Dissociation

Figure 34: Is yelling ever OK? Adapted from K12 by Dennis, 2017 retrieved from https://www.learningliftoff.com/yelling-at-kids/

Child dissociating: 1) Dissociation is a survival mechanism used to protect one’s self and to not be

overwhelmed by traumatic/stressful experiences ( Dozier, Sotvall, & Albus, 1999) .

2) It’s argued that babies will go into a dissociative state when faced with a threat. 3) A child that often feels threatened and goes into this state frequently, their

neural network becomes compromised meaning the child will slip into a dissociative state even under slight stress.

4) Young children with a caregiver that has unresolved trauma are likely to dissociate more (Main & Morgan, 1996).

5) Therefore, when the child seeks protection from the caregiver and is unable to receive it, it predisposes the child to use this survival strategy throughout childhood and into adulthood (Carlson, 1998).


Physical Health

Figure 35:Depression in teenagers. Adapted from RTOR by Silva, 2017 retrieved from https://www.rtor.org/2017/05/09/depression-in-teenagers/

Trauma impacting physical health:1) Children that had an insecure attachment to caregivers, harsh parenting and had

a lack of social support had high blood pressure compared to adults that were raised in a nurturing environment that fostered a secure attachment.

2) Hanson and Chen (2010) studied 87 adult participants in their early 20’s regarding the impact of their childhood family environment on their current social and emotional well-being. They found that the participants that indicated they were from high risk families (family conflict, parental coldness, lack of affection) possessed increased levels of cortisol resulting in increased felt daily stress and lack of sleep.

● Additionally, the participants within these risky families during childhood also reported a lack of parental warmth and nurturance which correlated with less quality of sleep and higher stress levels compared to the participants that had reported little to none childhood adversities (Hanson & Chen, 2010).

3) Overall physical health is negatively impacted by environmental stress, especially when created by caregivers through maltreatment, neglect, or attachment rupturing traumas resulting in lower immune system, obesity, and the associated physical symptoms that may develop when a child develops anxiety or depression.


Figure 38: Attachment and later development.. Adapted from “Institute for Learning and Brain Science” by University of Washington retrieved from https://modules.ilabs.uw.edu/module/development-of-attachment/449-2/

Attachment and later development when looking at secure attachment:We have discussed how attachment can influence children as infants. But how does early attachment affect people later in life?

1) Researchers have found a strong relationship between early attachment and future outcomes. Infants who have a history of secure attachment relationships had much better outcomes than infants who have less secure relationships. For example, infants who have a history of secure relationships go on to have better relationships with teachers and peers. They had a better understanding of emotions. They also grew up to have more confident and complex beliefs about their abilities, traits, and values. They showed less anxiety, depression, and social withdrawal. They had lower aggressive behavior and better social skills. They were also more motivated to achieve in school.

2) Children with a history of secure attachments might have more positive expectations about relationships. That is, they perceive themselves as loved and worthy of that love. Those children tend to grow up knowing they will receive support from others. This helps them adjust to different social situations, and succeed. Also, sensitive caregivers are setting an example for their children. Children are likely to learn how to regulate and express their emotions in an acceptable way. This helps them develop positive relationships and work out conflict in a constructive manner.




Loving Kindness Break

5 Minutes“As children develop, their brains "mirror" their parent's brain. In other words, the parent's own growth and development, or lack of those, impact the child's brain. As parents become more aware and emotionally healthy, their children reap the rewards and move toward health as well.”

― Daniel J. Siegel, M.D.

Please take five minutes for a loving kindness break.Once we return we will begin discussing the role of you as a clinician.

(Presenter leaves it on this slide for 5 minutes, then clicks the next slide)

Role of Clinician

The role you as the clinician plays on resolving trauma and insecure attachment:1) There’s hope to have clinician's conceptualize their clients’ with a

trauma-informed lens to assess and help heal a caregiver’s trauma to improve not only the caregiver’s well-being but as the child’s.

2) There is a need to help caregivers understand how their childhood traumatic experiences impact their children’s well-being, development and attachment, while understanding that the past is not a death sentence, attachment trauma can be healed and just because a caregiver-child dyad presents as an insecure attachment style due to caregiver’s unresolved trauma does not mean the dyad can not change - we as clinicians have the ability to promote healing, break the cycle of intergenerational and increase overall well-being for our clients. Which is an amazing thing!


Bowlby’s Five Tasks for Therapists

1. Provide secure therapeutic relationship

2. Explore the client’s attachment history

3. Explore client therapist relationship

4. Assess past experiences impacting current relationships

5. Determine whether one’s learned internal messages are appropriate for the future.

(Bowlby, 1988)

According to Bowlby (1988), in order to assist clients with attachment issues, there are five tasks a therapist should do:

1) Provide secure therapeutic relationship 2) Explore the client’s attachment history3) Explore client therapist relationship 4) Assess past experiences impacting current relationships5) Determine whether one’s learned internal messages are appropriate for the future.


Trauma Informed Clinician

Figure 36: Infographic. Adapted from “Center for Health Care Strategies, Inc.” by Robert Wood Foundation, 2017 retrieved from https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/

Being a trauma informed clinician:1) Trauma-informed care is a client centered that reflects upon the client’s past

traumatic experiences in a compassionate and reflective manner to connect to their history, empower client healing and utilize client strengths to manage mental health symptoms

2) Presenter instructs attendees to complete a trauma-informed self questionnaire. - Refer to appendix, Handout C pg: (158-162)

(Presenter allows 10 minutes to complete the assessment)

Discussion: Trauma-informed assessment

Turn to your partner and discuss the results of the assessment,

What did you learn about yourself?

What was your overall score?

What are the areas of improvement?

What are your strengths?

Presenter allows clinicians to discuss amongst themselves for 10 minutes.

(After 10 minutes, presenter clicks the next slide)

Importance of Empathy

Empathy

- rewrite past experiences - Fosters a sense of trust and safety within the relationship to promote change

Empathy activity

1. Pair up - one person (listener) listeners to the (teller) tell a story for 3 minutes.

(Empathy activity: 5-10 minutes).With your same partner or a different partner, select one person to listen to the other for three minutes.

(After 5 to 10 minutes, depending on timing, presenter will click the next slide)

Empathy Discussion

❤🧡

💛

💚💙 ��

🤎

(Allow 10 minutes to discuss the experience)For the tellers, what was it like to have someone listen to you? Did you feel heard, respected, calm?For the listeners, what was it like to be present with another person and maybe learn something new about your partner?

As clinicians, empathy one of our basic tools that we can use to create safety within the therapeutic relationship in which clients feel safe enough to disclose past trauma, allowing them to rewrite the narrative. In order to address the client’s trauma, they need to first trust you, because as we have hopefully learned in this workshop, those in trauma and an insecure attachment have had experiences where the people in their lives were untrustworthy and scary. The presence of empathy is a new experience for those individuals, thus promoting change. (Presenter clicks next slide)

Co-Regulation

Co-Regulation provide children with support and , guidance and modeling they to “understand, , express, and modulate their thoughts, feelings, and behaviors.” - Murray (2015)

Promotes self-regulation and Attachment INHALEEXHALE

Co-regulation:1) While self Regulation- improves impulse control and the ability to resolve

problems, learn new things and recover from difficulty.2) Clinicians can model as a co-regulator to rewrite the caregivers narrative by

being a regulated, empathic, congruent, non-judgemental clinician - going back to the trauma informed assessment - this promotes you to be the co-regulator and modeling for caregivers how to be a co-regulator for their child.

a) You may want to provide psychoeducation of the brain knowing the brain, know where and how they are triggered and what part of their brain are they in and give them the skills to get out of their survival mode through regulation skills and self-reflection.


Connecting to Calm - Dan Siegel

https://www.youtube.com/watch?v=aV3hp_eaoiE&t=8s

(Dalai Lama Center for Peace and Education, 2012)

Here’s Dan siegel again explaining how important it is for the parent to act as the co-regulator within the caregiver-child dyad. (5 minutes)

(After video, presenter clicks next slide).


Clinical Knowledge

● Addressing caregivers trauma promotes a secure attachment uses assessments and measures.

○ Adult Attachment Interview (AAI)

○ Working Model of the Child Interview (WMCI)

● Utilize interventions from the various modalities or talk with your agency about incorporating some assessments into the agency

● Continuing education regarding attachment, trauma, and epigenetics.

Gaining clinical knowledge:1) For mental health clinicians, the knowledge of attachment is foundational to

understanding the couple, parent/child or family dynamic in treatment. For a clinician to effectively understand the relationship dynamics for couples/families seeking treatment, the clinician must take the stance of understanding the past relationship dynamics to conceptualize the dysfunctional patterns. Once the dysfunctional patterns are clear, then the clinician can help guide the couple/family to form healthy relationships through the clinicians knowledge of repairing insecure attachment and trauma.

2) Caregivers find hope in raising their children and desire to raise them differently than they were raised. This hopefulness for a better future for the new generation provides a window of opportunity for a clinician to create meaning within the family system. In order for a clinician to facilitate change, they must provide the right support for caregivers and their children to establish a healing and secure attachment to their child.

3) To provide a secure attachment base, the caregiver must process and work through their past childhood trauma.

● AAI - course have to get certification● WMCI can find online script to gain attachment information from

caregiver.


Epigenetics

Figure 37: Epigenetics. Adapted from “Center on the Developing Mind” by Hayes, 2020 retrieved from https://developingchild.harvard.edu/science/deep-dives/gene-environment-interaction/

Quick look into epigenetics: 1) If young children or pregnant mothers experience toxic stress—as a result of

serious adversity○ such as chronic neglect, abuse, or exposure to violence (ACE’s)

2) The absence of protective relationships and lack of protective factors like we just discussed can create epigenetic change

3) These modifications in DNA have been shown to cause prolonged stress responses and excessive stress changes in brain architecture and chemistry resulting in negative behaviors such as anxiety and depression

4) When you look at this image you can see how the external experiences send neutral signals to the gene proteins which then creates “markers” affecting the biological makeup of an individual.


Increasing Protective Factors

Individual level

○ Sense of purpose ○ Empowerment ○ Self-regulation skills ○ Relational skills ○ Problem-solving skills ○ Involvement in positive activities �

Relationship level

○ Parenting skills ○ Positive peers ○ Parent or caregiver well-being �

Community level

○ Positive school environment ○ Stable living situation ○ Positive community environment

(Presenter reads slide, then clicks to next slide)

https://www.youtube.com/watch?time_continue=164&v=sd5kmUwU6J8&feature=emb_title (Simms/Mann Institute, 2016)

Transforming ghosts in the nursery: Alicia Lieberman

Let’s watch a message of hope in which reiterates the role you play as a clinician.

This video is transforming intergenerational trauma from ghosts in the nursery to angels - (3 minutes)

(After video, presenter clicks next slide)

https://www.youtube.com/watch?time_continue=164&v=sd5kmUwU6J8&feature=emb_title

Figure 39: Mother and child.. Adapted from “Institute for Learning and Brain Science” by University of Washington retrieved from https://modules.ilabs.uw.edu/module/development-of-attachment/449-2/

Creating secure attachment:1) You do not need to have grow up with a secure attachment to be able to

provide secure attachment with your child - History is not a destiny. If able to reflect on our own experiences and family history, the parent is able to make sense of the past and think about the feelings of safety the parent experienced during childhood (Tina Payne Bryson, 2020).

2) Infants’ attachment can have a lasting effect on children’s cognitive, social, and emotional development. A more secure attachment in infancy places a child on a positive path. A less secure attachment can put a child at risk for coping and behavioral problems. Early attachment is just one factor that influences children’s development. Yet, the research suggests that attachment plays an important role in development throughout life.

(Workshop facilitator reminds attendees to use the last few minutes for the workshop evaluation).I’d like for you all to complete the workshop evaluation found in your packet of handouts (Refer to appendix F. pg. 67)

(facilitator clicks next slide)



Questions?

Workshop facilitator: As you complete the evaluation, does anyone have any questions they would like to ask the presenters? (Last 10-15 minutes)

Thank you!

(Facilitator & presenter may insert their information on this slide)

ReferencesAboutKidsHealth (Producer). (2012). Developing attachment: Inconsistent response to a baby’s distress [Video]. Available from

https://www.youtube.com/watch?v=8BA8CcEUP84&feature=youtu.be&t=16

Baptist Memorial Health Care (Producer). 2018. Adverse childhood experiences (ACE) overview

[Video]. Available from https://www.youtube.com/watch?v=OtXd19s9i8k

BBC News (Producer). (2016). Growing up in a Romanian orphanage [Video]. Available from


Child and Adolescent Health Measurement Initiative (2013). Overview of adverse child and family experiences among US children. United States

Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau

(MCHB). Retrieved from www.childhealthdata.org.

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