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“WHAT DO YOU MEAN I HAVE TO WORK WITH PARENTS

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1 “WHAT DO YOU MEAN I HAVE TO WORK WITH PARENTS
“WHAT DO YOU MEAN I HAVE TO WORK WITH PARENTS?” What they did not teach you in graduate school: Aiding parents in living with their traumatized child PRESENTED BY: LORI MYERS LCSW, RPT BRIANNA GRANT LCSW, RPT NOVEMBER 24, 2014

2 OBJECTIVES FOR THE PRESENTATION
Participants will increase their knowledge and understanding of the rationale in including caregivers in the therapeutic process Participants will identify how trauma and attachment affect brain development and how to impart this knowledge to caregivers Participants will gain knowledge of ways to engage and join with difficult caregivers Remind participants the objectives for the day Be brief

3 WORK WITH CAREGIVERS WHY?
How caregivers talk to and behave toward children can greatly influence developing beliefs about self, others and the world Parents’ feelings and thoughts about the trauma impact their children’s behaviors and developing beliefs Provide parents with a forum to share their feelings and thoughts related to the trauma (even the socially undesirable thoughts)

4 IMPORTANCE OF STRONG THERAPEUTIC SKILLS
THE THERAPEUTIC RELATIONSHIP IS CENTRAL TO ESTABLISH COLLABORATION WITH CLIENTS NEED FOR THERAPIST JUDGMENT, SKILL, HUMOR AND CREATIVITY TO IMPLEMENT THERAPY EFFECTIVELY NEED A GOOD KNOWLEDGE OF DEVELOPMENT TO IMPLEMENT TREATMENT EXERCISES THAT ARE DEVELOPMENTALLY APPROPRIATE KNOWLEDGE OF FAMILY SYSTEMS, PARENTING STRATEGIES AND ATTACHMENT

5 WHY CAN PARENTS BE RELUCTANT TO JOIN THE PROCESS?
PARENTS CAN OFTEN ENTER THE therapy PROCESS WITH A FEAR ….. THAT THE THERAPIST WILL TELL THEM THEY ARE DOING EVERYTHING WRONG THAT THE THERAPIST WILL TELL THEM THEIR CHILD IS “MESSED UP” OR A BAD KID THAT THE THERAPIST WILL BLAME THEM AND THEY WILL FEEL LIKE THEY ARE A BAD PARENT THAT THE THERAPIST WILL JUDGE THEM FOR EVERYTHING THEY HAVE DONE OR HAVEN’T DONE AS PERSON OR A PARENT THAT THE THERAPIST WILL GIVE THEM MORE THINGS TO DO OR TRY WITH THEIR CHILD AND THEY ARE EXHAUSTED THAT THEY WILL HEAR MORE NEGATIVE COMMENTS ABOUT THEIR CHILD OR THEIR PARENTING

6 DISTORTED THINKING OVER-THINKING BLACK AND WHITE MINDREADING IF, THEN COMPARISON CONTROL I AM, THEREFORE MY CHILD MINIMIZING EXPERIENCE Over-generalizing: ie - If this is happening now, it will happen my child’s entire life Black and White thinking: about the child or themselves as a parent. ie: He is just a bad child or I am a horrible parent Mind reading: ie: My child behaves this way because he enjoys making me mad If, Then thinking: ie: If my child behaves this way, then I am a bad parent or If I don’t yell at my child, they would never do anything Comparison: ie: My child is 3 and he should no better than to hit someone when he is mad or My older child never behaved that way so my younger child shouldnt either Superior/Control: ie: If I give my child an inch he will take a mile or If I apologize then I will seem weak and he will take advantage of that. I AM ______, SO MY CHILD MUST BE ________Child Must: ie: I never stole when I was a child so my child shouldnt steal or I have bipolar so that means my child is also biploar. Minimizing: ie: He has no reason to be upset just because he cant have icecream - He had some yesterday. Get over it, whats the big deal? Experience: ie: I was raised this way (spankings, get all straight A’s, lack of affection) and I turned out fine

7 WHAT IS TRAUMA? “OVERWHELMING, UNCONTROLLABLE EXPERIENCES THAT PSYCHOLOGICALLY IMPACT VICTIMS BY CREATING IN THEM FEELINGS OF HELPLESSNESS, VULNERABILITY, LOSS OF SAFETY AND LOSS OF CONTROL” BEVERLY JAMES TREATING TRAUMATIZED CHILDREN: NEW INSIGHTS AND CREATIVE INTERVENTIONS LORI Read quote

8 “TRAUMA BY DEFINITION INVOLVES SPEECHLESS TERROR: PATIENTS OFTEN ARE SIMPLY UNABLE TO PUT WHAT THEY FEEL INTO WORDS AND ARE LEFT WITH INTENSE EMOTIONS SIMPLY WITHOUT BEING ABLE TO ARTICULATE WHAT’S GOING ON.” VAN DER KOLK 2002 RACHEL

9 THE ATTACHMENT BOND Babies come out of the womb wired for relationship. When babies are born then can focus about inches away. Human infants are biologically designed for this physical closeness. This sets the stage for attachment Babies whose needs are met believe their world is a safe place and trust the caregiver to provide safety. Let’s take a moment to look at where children come from, how their brains got wired and why they are “wound up” all the time

10 THE ATTACHMENT BOND Children whose needs were not met learned the world is unsafe and caregivers will not meet their needs. These children stop asking for help or believing that they need help. These children believe: I must control everything at all costs because I can’t trust anyone else to keep me safe and meet my needs. Imagine a baby who … Smiles and coos and is ignored A baby who is wet but no one changes him Is hungry and no one feeds him What would the baby do? 1st baby tries harder then gives up Baby stops trying to get its needs met by others Now imagine a baby who cries and is actively mistreated (hit, shaken, etc.) Imagine a baby who holds up its hands to be held and comforted and is pushed away What would the baby do? How might it feel?

11 CORE ELEMENTS OF POSITIVE BRAIN DEVELOPMENT
RELEVANT (DEVELOPMENTALLY MATCHED) REPETITIVE (PATTERNED) REWARDING (PLEASURABLE) RELATIONAL (SAFE) RHYTHMIC (RESONANT WITH NEURAL PATTERNS) RESPECTFUL (CHILD, FAMILY, CULTURAL) FROM NOTES Core elements – how many of our cts actually had these growing up? Neuroarcheology Core elements of positive developmental process Relevant (developmentally matched) Repetitive (patterned) Rewarding (Pleasurable) Relational (Safe) Rhythmic (resonant with Neural patterns) Respectful (Child, family, cultural) Experiences create ravines (neural pathways) in the brain. As we experience repetitions (myelination of the pathway) it continues to create a deeper and deeper ravine. Unless corrective experiences create a new ravine (neural pathway) and allow repeated exposure (myelination) individuals will continue to follow and fall into the old ravine (pathway)

12 AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC NERVOUS SYSTEM: THE GAS PARASYMPATHETIC NERVOUS SYSTEM: THE BRAKES WINDOWS OF TOLERANCE FIGHT/ FLIGHT/ FREEZE Discuss how the sympathetic nervous system is the gas (distress: fight/flight – if safe: excitement) and the parasympathetic nervous system (distress: freeze – if safe: deep rest) provides the brakes for behavior. Windows of tolerance: amount of intensity a person can hold w/o getting dysregulated – Not type of emotion but intensity of emotion Once danger comes in go to sympathetic system (fight/flight) 2 things happen w/ relational threat Social circuitry turns off Cannot take in new information – fear system activated This starts when a person feels helpless Body believe going to die Dorsal vagal is activated – dissociate Consciousness leaves – endorphins rush in Comfort feeling felt because of endorphins Discuss the handout: Understanding how the brain works WHEN THE AUTONOMIC NERVOUS SYTEM COMES ONLINE – IT IS NOT WILLFUL BEHAVIOR IT IS TRAUMA: there is no brain integration to reflect on whether safe or not – person goes right to f/f/f – not making a choice need a neurobiological change

13 AMYGDALA TRIGGERS Children who have been hurt or neglected have an alarm that goes off in their brain whenever they get stressed Most children learn to self soothe by being soothed by a caregiver. Children who have been hurt have impaired abilities to self regulate. They may react strongly to everyday things that would not bother other children Demonstrate Maracas 1st “Hold the maracas low in your lap and shake them very gently while I talk to you about why I like ______. Ok stop shaking the maracas. Were you able to hear and understand most of what I said? Now put the maracas up by your ears and shake them really hard while I talk to you about why I like ______. Ok stop shaking the maracas. Were you able to hear and understand what I was saying? Probably not. The noise by your ears was lauder then my voice.” When children have been triggered they have internal maracas going off and this interferes with their ability to hear, understand or appropriately respond to what you are saying. THOUGHT: if they can see facial expressions and not hear … see study on next slide

14 AMYGDALA TRIGGERS Physically abused children see anger where others see fear. When children are experiencing an amygdala alarm they cannot think clearly. Reasoning with them can make things worse. Study of angry to fear. Researchers took a picture of a woman with an angry face and the same woman with a fearful expression. Then the computer combined the 2 images. Maltreated children and abused children both looked at the pictures on the anger/fear scale. The maltreated children perceived faces as angry much sooner than the control kids. Children are always watching and may misperceive normal frustration as anger and may feel unsafe. And this can lead to an amygdala trigger Organized brain sheet Trauma brain sheet

15 CALMING THE AMYGDALA WITH PARENTING SKILLS
“IT MEANS RETHINKING WHAT DISCIPLINE REALLY MEANS, RECLAIMING IT AS A TERM THAT’S NOT ABOUT PUNISHMENT OR CONTROL, BUT ABOUT TEACHING SKILL BUILDING – AND DOING SO FROM A PLACE OF LOVE, RESPECT AND EMOTIONAL CONNECTION.” ~ NO DRAMA DISCIPLINE NO DRAMA DISCIPLINE: CONNECT TO REDIRECT CIRCLE OF SECURITY: CUE/MISCUE THERAPLAY: ATTUNEMENT

16 Self Regulation in the Moment
Have the caregiver notice their triggers Validate their experience Aid caregiver in self assessing Aid caregiver in tuning into their past experience Encourage self care and support

17 Aid familial System to create safety
When children do not feel safe their energy cannot go anywhere Children may develop the belief that the world is a dangerous place and exist in “survival” mode Children CANNOT move out of “survival” mode unless their environment provides “felt” safety “Felt” safety aids children in moving from limbic (reactionary) system to the prefrontal cortex (the ability to respond)

18 The Need for Attunement
What is attunement? Why is it important? How do you do it? Cue/miscue

19 Attunement Skills Be attuned: notice the feelings/energy. Try to pick up child cues earlier and earlier Keep yourself centered: stay in control of you. Stay present and in the moment. Ask yourself: where is this child’s energy and level? What does this child need to do to release this energy? Reflect what you are seeing: “I see that you are frustrated. You want the tower to not fall over.” – acknowledging the child’s feelings and wants Cue or support child in skills: reinforce skills and where child has control Help child reestablish feelings of control: this is the time for choices and the adult maintaining safety while allowing the child a sense of control

20 TERMINOLOGY ATTACHMENT STRATEGIES CUE/ MISCUE EMOTIONAL REGULATION
SECURE AMBIVALENT AVOIDANT DISORGANIZED CUE/ MISCUE RUPTURE AND REPAIR EMOTIONAL REGULATION EMPATHY INTERNAL WORKING MODEL LEARNED HELPLESSNESS

21 PARENTING SKILLS Caregiver is the main agent for change
Caregiver is the child’s co regulator Imperative caregiver is included in treatment if possible Positive parenting skills, enhance enjoyable parent child interactions To change an interactional/ reactionary pattern it takes 38 repetitions per week for 1 year … how can we do this without a caregiver?

22 PARENTING STYLES AUTHORITARIAN AUTHORITATIVE PERMISSIVE
CIRCLE OF SECURITY: “BIGGER STRONGER WISER AND KIND” PARENTING PERMISSIVE

23 “OTHER” PARENTING STYLES
BOOT-STRAP PARENT DISCONNECTED PARENT OVER-ACHIEVING PARENT AGREEABLE PARENT AVOIDING PARENT The unofficial or non-clinical types of parenting styles that we often see in working with parents LORI – NOT SURE IF YOU WANT TO KEEP THIS OR NOT. IT COULD MAKE FOR GOOD CONVERSATION WITH THE AUDIENCE BUT ALSO MAKE IT RELATABLE? Boot-Strap Parent • We don’t really need you, he will get better • I don’t want to coddle him • He’s just being difficult • He just wants attention • He has to get over this • There is something wrong with him. • He’s just trying to manipulate me. • If we just move on- he won’t even remember it Disconnected Parent Quiet, disconnected • Stares, seems disinterested • Possible drugs or unusually straight laced • Everything you say just goes right through them • Odd boundaries, doesn’t seem to see a problem with those or “didn’t know” that was a problem • Sense he/she preps kid before sessions • Never leaves the other parent’s side Over-Achieving Parent Want everything to change right away • Expect a specific time line • May be overly rigid • Child may fall on polar opposite ends of the spectrum – totally checked out (given up) or highly rigid Agreeable Parent Initially seem invested and ideal clients • May shift to just telling you what they think you want to hear • May appear to be on-board but do not follow up • Child may be disorganized and confused AVOIDING Parent Feels like there might be a secret • May not return phone calls, show up late, or not show up for sessions • Returning only when there is a crisis • Child could struggle with a variety of issues

24 JOINING WITH DIFFICULT CAREGIVERS
ACCEPT AND RESPECT ALL FEELINGS SHOW THE CAREGIVER YOU ARE LISTENING MANAGE YOUR AFFECT AND MIRROR NEURONS REFLECT BACK WHAT YOUR HEAR NAME THE FEELINGS NORMALIZE THE FEELINGS DEPERSONALIZE THE CHILD’S AND CAREGIVERS BEHAVIOR DISCUSS WHAT CAN BE DONE TO AID CHILD AND FAMILY Provider be non judgmental Open to, tolerance of and acceptance of caregivers thoughts, feelings, ideas and experience Pg. 56 example Therapist/ caregiver attunement imperative for caregiver to learn attunement with child To be attuned one MUST be regulated Teach parents to see, hear, be here and understand non verbally

25 THERAPEUTIC SKILLS AND ENGAGING WITH PARENTS
BUILDING CONNECTION WITH PARENTS IS VITAL TO TEACHING SKILLS HOW DO WE DO THAT? WHERE DO WE START? Parents come with their own issues, past experiences and this will show up in their parenting Get the know the parent and complete a thorough history How was the parent parented? What does the parent want to gain from the experience, child in treatment? Approach the parent as a child whose needs may not have been met. CONCEPTUALIZE PARENTS – WHERE ARE THEY COMING FROM IN THE EXPERIENCE WITH THEIR CHILD? Crucial C’s: Courage, Capable, Connection, Count How can we validate and encourage parents? Modeling the same skills we use with engaging children and then teaching those skills to the parent (ie: reflection of feelings, encouragement, limit setting)

26 Redirect No Drama Discipline
Reduce Words Embrace Emotions Describe Don’t preach Involve your child in the discipline Reframe No into a conditional yes Emphasize the Positive Creatively approach the situation Teach Mindsight Tools

27 CONTACT INFORMATION: Lori Myers, LCSW, RPT Phone: ext. 2033 Website: Brianna Grant, LCSW, RPT Phone: ext. 5 Website: See attached document for Bibliography and Resource List


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