Transcript PowerPoint Presentation - The Attachment Toolbox

Treating the Lingering Effects
of Drug Endangered Children
Utah’s 2nd Annual Drug Endangered Children
Conference
Douglas Goldsmith, Ph.D.
Executive Director
The Children’s Center
Drug Abuse and Psychopathology
• Research reports a significant correlation
between psychopathology and substance
abuse
• Individuals with mental health problems
have a significantly increased likelihood of
abusing drugs (Kessler et al, 1996)
Impact of Psychopathology
• Women diagnosed with schizophrenia or
affective disorder tend to exhibit more
negative and less positive affect, and are
less responsive and involved in caregiving
Impact of Depression
• Depressed mothers show flatter affect and
provide less stimulation and
responsiveness to their infants
• Their infants show less attentiveness and
are more fussy
• Depression + Personality Disorder is
associated with poorest development in
offspring
Addicted Mothers
• Those with higher rates of lifetime
psychiatric diagnoses, including
personality disorders, have more
maladjusted offspring
L. Beckwith et al, 1999
Substance Abusing Mothers
• Show deficits in quality of interactions with
their infants
The Attachment Relationship
• “Almost every infant will develop an
affective tie with a caregiver, and will
endeavor to use that caregiver as a source
of comfort and reassurance in the face of
challenges or threats from the
environment”
Weinfield, Sroufe, Egeland & Carlson, 1999
Individual Differences
• Reflect differences in the child’s history of
care
• Differences cannot be attributed solely to
the infant or to the caregiver but reflect the
patterns of interaction across the history of
care
Weinfield, Sroufe, Egeland & Carlson, 1999
Development of Attachment
• Biological process
• Recognition of the caregiver
• Utilization of the caregiver as
a “haven of safety” and a
“secure base” in order to
explore the environment
Secure Base
• The infant returns to the secure base for
protection and comfort in the light of any
threatening or distressing event
• Bowlby and Ainsworth felt that there is a
delicate balance between exploration and
seeking proximity
Attachment Behaviors
•
•
•
•
•
Approach the caregiver
Crying
Seeking contact
Maintaining the contact
The number of attachment behaviors will
vary with the degree of the perceived
threat in the environment
Weinfield et al (1999)
Secure vs Insecure Attachment
• The classifications “Secure” vs “Insecure”
“Reflect the infant’s apparent perception of
the availability of the caregiver if a need
for comfort or protection should arise, and
the organization of the infant’s responses
to the caregiver in light of those
perceptions of availability.”
Weinfield et al (1999)
Secure Attachment
• The caregiver is perceived as a reliable
source of protection and comfort
Secure Attachment
• When I am close to my loved one I feel good,
when I am far away I am anxious, sad or lonely
• Attachment is mediated by looking, hearing, and
holding
• When I’m held I feel warm, safe, and comforted
• Results in a relaxed state so that one can, again,
begin to explore
•Holmes (1993)
Secure Attachment
• Promote exploration of the environment
• Expand mastery of the environment
• “I can explore with confidence because I
know my caregiver will be available if I
become anxious.”
• The infant gains confidence in his or her
own interactions with the world
Weinfield et al (1999)
Secure Attachment
• Attachment is a reciprocal
relationship
• The parent offers
caregiving behavior that
matches the attachment
behavior of the child
• The child, using social
referencing, checks in
with the mother “looking
for cues that sanction
exploration or withdrawal”
Holmes (1993)
Anxious Attachment
• Lack experience with consistent
availability and comfort
• Attachment behaviors are responded to
with:
– Indifference
– Rebuffs
– Inconsistency
Anxious Attachment
• Anxious about caregiver’s availability
• Afraid that the caregiver will be
unresponsive or ineffective in providing
comfort
• Experience anger about caregivers
unresponsiveness
Anxious Attachment
• Shows overt aggression toward the
inconsistent mother
• “Don’t you dare do that again!” but has to
cling because he knows from experience
that she will.
Holmes (1993)
Anxious Attachment
• Maintain constant low levels of anxiety
about the caregiver’s availability
• Unable to explore the environment without
worry
• Fail to achieve confidence in themselves
and mastery of their environment
Weinfield et al (1999)
Maintaining Proximity
• Secure infants trust in the reliability of the
caregiver’s availability
• Anxious infants make frequent bids for
attention to ensure the availability of the
caregiver just in case a threat in the
environment should occur
Internal Working Model
• “Through a history of responsive care, infants
will evolve expectations of their caregivers’ likely
responses to signs of distress or other signals of
the desire for contact”
• Bowlby believed that, “What infants expect is
what happened before.”
Weinfield et al (1999)
Impact of the Internal
Working Model
The model governs how
children feel toward each
parent and about
themselves, how they
expect to be treated and
how they plan their own
behavior toward their parent
Internal Working Model
• Provides foundation for expectations
concerning the self
• Impacts relationships with caregivers and
noncaregivers
• The IWM teaches children that
“Relationships are a context in which
needs are met.”
Weinfield et al (1999)
Internal Working Model
• The infant anticipates the behavior of the
caregiver in response to the infant’s
signals.
• Learns to view the world as “good and
responsive” and the “self as deserving
such consideration”.
•
Weinfield et al (1999)
Internal Working Model
• Anxious infants learn to see the world as:
– Unpredictable
– Insensitive
– The self does not deserve better treatment
• These beliefs are carried forward to new
relationships and new experiences
Weinfield et al (1999)
Internal Working Model
• “When the expectation of being hurt,
disappointed, and afraid is carried forward
to new relationships, the anxious infant
becomes an angry, aggressive child.”
Weinfield et al (1999)
Caregiver Responsiveness
• Anxious dyads
– Less sensitive in interactions
– Interfere with children’s behaviors
– Less accessible to bids for contact
• Avoidant dyads
– Averse to physical contact
– Express little emotion during interactions
– Insensitive to timing cues
Weinfield et al (1999)
Emotion Regulation
• “The caregiver’s responses to the infant’s
distress are an external source of emotion
regulation before the infant learns to selfregulate”
Weinfield et al (1999)
Emotion Regulation
• Through observing and interacting with an
attachment figure the infant learns what it
is like to behave in a relationship
• Secure children develop:
– Self-control
– Behavioral reciprocity
– More skilled interactions than anxious
counterparts
Emotion Regulation
• “Consistently providing for infants’ needs
does not condemn them to perpetual
dependency, but in fact serves as the
springboard for self-reliance because it
instills a sense of efficacy concerning the
environment. Being consistently nurtured
and responded to empathically leads not
to a spoiled, self-indulged child, but rather
to an empathic child.”
Weinfield et al (1999)
Attachment Based Interventions
• Secure Base
– Take a careful look at the stressors the family
is experiencing e.g. illness, divorce, deaths,
moves, financial stressors
– Major stressors may need to be carefully
addressed before the family
is emotionally ready to work
on relationship strategies
Attachment Based Interventions
• The parent must have a secure base in
order to provide a secure base!
Attachment Based Interventions
• Secure Base
– Does the family have an extended support
system available? Who is the parent turning
to for support when emotionally drained/
overwhelmed?
– Does the primary caregiver need their own
psychotherapy to address personal issues
around psychiatric problems?
Attachment Based Interventions
• Secure Base
– Prioritize issues around safety such as
exposure to domestic violence, transitions for
parent-time, extreme hostility/ safety concerns
between caregivers who are separating
Attachment Based Interventions
• Secure Base
– May need to address underlying issues
around parental unavailability to the child
• Does the parent find parent-child time enjoyable?
• Is the child’s behavior so out-of-control that the
parent is unable to find enjoyable one-on-one
moments?
– Plan behavioral interventions to increase cooperation to
parental requests
Attachment Based Interventions
• Secure Base
– Decrease oppositional battles around:
• Toileting
– Assist with toilet training or encourage the parent to relax
anxiety around toileting accidents
• Eating
– Stop discussions about quantity of food or insisting that
the child increase their food repertoire
• Sleeping
– Encourage the parent to help the child regulate anxiety
around sleep. Develop a bedtime routine
Attachment Based Interventions
• Secure Base
– Help parent learn to give warnings around
transitions and brief separations
– Increase predictability of the environment
– Increase reliability of parental availability
Attachment Based Interventions
• Secure Base
– Develop nurturing skills
– Help the parent learn to be an “ideal
grandparent”
• Anticipate the child’s needs
• Provide physical comforts
• Plan surprises so the child knows s/he is thought
about even when absent
– Increase sensitivity to cues
Attachment Based Interventions
• Exploration
– Help the parent develop age appropriate
expectations
– Carefully evaluate and develop appropriate
parental supervision
– Assess joint pleasurable activities and
develop a list of pleasant activities
Attachment Based Interventions
• Exploration
– Examine the parent’s ability to “let go”
– Develop plans and support the parent in
managing “conflict free” separations by
waiting until the child is comfortable in a new
environment
Attachment Based Interventions
• Exploration
– Teach the child “checking in” behaviors
• Always keep the caregiver in view
• Use a timer to help the child develop checking-in
skills
Attachment Based Interventions
• Emotional Regulation
– Teach the parent to use “Time-in”
• Remain available during emotional outbursts
• Only move away if child attempts physical attacks
• Constantly reassure child that, “As soon as you
calm down, I’ll help you fix it/ figure it out”
• If attacks persist state, “I’ll be in the next room so I
can stay safe but as soon as I hear you calm I’ll be
right back”
• Develop deep breathing and self-soothing skills
Attachment Based Interventions
• Emotional Regulation
– Work on acceptance of physical contact
• Help child make self-contact rather than other-contact to
soothe self
– Avoid direct “no” and instead fantasize what it would
be like if the child could get all of his/her needs met
– Write down and post the desire to be satisfied at a
later date/ time
– Model self-soothing cognitive strategies
– Teach empathic listening skills
– Use transitional objects
Attachment Based Interventions
• Utilize therapy sessions to model the
safety, empathy, and security of a “holding
environment”.