Laurel Abt’s philosophy of treatment
Traumatized children need help in four main categories:
In order to heal these children, we must understand that all of their reactions are based in fear and shame.
Children with attachment disorder use unhealty tools to feel safe in over-stimulating situations or transition periods.
We need to understand the behaviors before providing consequences.
Attachment Therapy is NOT just for the child. All therapy sessions include the child and one or both parents
The Sequence of Treatment
Attachment therapy is a process. There is no specific timeframe.
Structure/Boundaries (structure creates security)
- The role of the therapist initially is to emphasize rules, expectations and consequences. The child may feel scared because he/she may feel vulnerable. Recognize, the therapeutic relationship will develop as the child tests the boundaries. As therapy progresses, the focus shifts to praising the childs independant achievements.(Terry Levy)
- The purpose of structure: (Dan Hughes)
- Teaches that work is necessary
- Work comes before play
- Teaches that the child can do things even when he/she doesn’t want to
- Teaches the child to communicate respectfully
- Provides security
- Rules for parents:
- Clarify what is expected
- Be consistent and repetitive (instead of controlling and rigid)
- DO NOT offer second chances
- Parents role is to teach not punish
- Provide constant supervision
“An angry parent is not an effective teacher.” – Bryan Post
Healing takes place when a child is surrounded by healthy adults.
“Bonding behaviors decrease when the caregiver is overwhelmed or in distress.” – Dr. Bruce Perry
Affect Regulation – Improve self soothing, and alleviate anxiety & impulsivity
- Bruce Perry’s Neurosequential Model of Therapeutics (NMT)
- Child’s mental template:
1. If the child is calm – he/she has the ability to form healthy attachments
2. Anxious and vulnerable – When a child is over-stimulated their behavior becomes frantic, irritable, and controlling and there is no ability to learn and grow.
- In a state of fear we use the older, more primitive parts of our brain. Chronic stress triggers neural pathways and overdevelops the parts of the brain that manage fear and anxiety. These children tend to focus on survival and responding to threats. RAD brains continue to react even after placement in a safe and healthy family.
- Sensory Integration – Bessel van der Kolk
- Sensory integration activities change the areas of the brain most affected by trauma.
- Goal: To get the sensory integration system in the back of the brain that gets disturbed by trauma to regulate itself.
Traumatized kids are easily hyperaroused; tend to be frozen, and upset.
- “All growth occurs in a state of mindfulness” (If children are NOT regulated NOTHING will happen in the way of treatment or healing).
- “Children with histories of trauma are like deer. Deer flee in an instant when frightened. Deer are hypervigilant – always wary of their environment.” – Arletta James
- Reading and responding to the cues of another.
“When a child is upset, logic often won’t work until we have responded to the right brain’s emotional needs.” This is called, Attunement, which is an emotional connection. Kids need to feel “felt” before we can problem solve. – Dan Siegel, M.D.
“Neglected people tend to not have much motivation, much excitement, or much pleasure, including pleasure in connecting with others.” Van der Kolk
- Whole Brain Parenting (Dan Siegel)
Integrate: Left brain logic, and right brain emotion
- Create Self Awareness: Validate feelings, sensations and thoughts
- Empathy – Recognize that the child is stuck in feelings of shame and truly does NOT believe he/she deserves to be happy or loved.
- Build Bonding Experiences and Trust: Engage, Don’t Enrage
- Therapist and parents project social-emotional cues of acceptance, compassion, caring and safety which calms the child’s stress response.
- Repetition of calming experiences strenghtens the brains neural pathways.
- Address Shame Issues and Build Self Esteem
- Therapist and parents exhibit positive and empathetic responses to the child’s negative behavior which prevents the child’s shameful feelings.
- Provide positive interventions that help the child understand that no matter what, the parent is there for him/her.
- Whole Brain Parenting (Dan Siegel)
- Process Trauma in a safe environmentCognitive Behavioral Therapy