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Nurturing the Hearts and Brains through Treatment and Parenting

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1 Nurturing the Hearts and Brains through Treatment and Parenting
Anne Lange, BSN, MSW, ACSW 1

2 As a result of this course, you will be prepared to:
Course Objectives As a result of this course, you will be prepared to: Identify ways early brain development and brain functioning is related to self-regulation and healthy interpersonal relationships. Describe the relationship between brain function, attachment, empathy and relational connection. Discuss various concrete strategies to assist clients in self regulation and promotion of interpersonal connection and healthy self esteem based on mindfulness principles and the Nurtured Heart Approach model

3 A Child’s Brain Parents dramatically influence the systems in a child’s brain based on the nature of the interaction Early relationship interactions with the infant/child can have lifelong effects, leading to a fulfilling or a painful adulthood Understanding basic brain development, as it relates to relationship can positively inform parenting strategies.

4 Triune Brain

5 The Brain Rational Brain Mammalian Brain Reptilian Brain

6 Triune Brain (Reptilian Brain)
Hunger Digestion Breathing Circulation Temperature Movement, posture, balance Sunderland, 2006

7 Triune Brain (Mammilian Brain)
Rage Fear Separation Distress Caring and Nurturing Social Bonding Playfulness Explorative Urge Lust in Adults Sunderland, 2006

8 Triune Brain (Rational Brain)
Creativity and Imagination Problem- solving Reasoning and reflection Self- awareness Kindness, empathy and concern

9 Triune Brain Brainstem: (Lizzard) respirations, vessel constriction, sleep cycles, some aspects of flight, fight and freeze Limbic region: (Mammalian) amygdala, hippocampus, hypothalamus,interfacing with middle prefrontal region (medial, ventral, orbitofrontal and anterior cignulate) Cerebral Cortex: (Rational) occipital lobe, parietal lobes, temporal lobes, frontal cortex Badenoch p13 handmodel “brain in the palm of your hand” seigel Badenoch, 2008 9

10 Building Blocks of Brain and Nervous System
100 billion Neurons Each neuron has ,000 Synaptic Connections to other neurons 2 million miles of neural highways in brain Communication between neurons is facilitated by Neurotransmitters, increasing (excite) or decreasing (inhibit) electric activity Neurotransmitters dramatically impact, Thought, Mood and Behavior

11 Pruning No wonder adolescence is so turmultous p8 badenoch
Pruning is a process of cell death 3 year old brains have about 1,000 trillion synapses This number declines with age - simplification leads to efficiency 90 percent of the growth of the human brain occurs in the first five years of life Chronic stress can lead to excessive pruning Adolescence leads to burst of overproduction, then a reduction of neurons by 50% No wonder adolescence is so turmultous p8 badenoch Stability by mid 20’s only 100 to 500 trillion synapses 11

12 Genes and Experience Genes direct overall brain organization Experience influences how and when genes become expressed (Seigel, 1999) “What fires together, wires together” REMEMBERING Every act of recall is also potentially an act of modification Ex thinking of grandma warmth in body, loving connection Directing attention to a memory brings present moment to the memory, hence the comforting presence can alter clients painful past experience 12

13 Healing Connection between Adult and Child; Therapist and Client, can create comfort and experience of compassion through; sound of voice, position of body and look on therapists face This can initiate new neural firings that will become connected to painful and frightening childhood events This will reduce the suffering associated with these events New information can help reshape experience from past, adding comfort, understanding and a caring other Pg 9 Badenoch Badenoch, 2008 13

14 Neuroplasticity The ability to change patterns of energy and information in response to new experience The hope of healing lies in the ability both within the mind and between minds to modify wired in painful and frightening experiences Psychotherapy can be a mutual engagement that can change both structure and function of the brain= Neural Integration Sharing this info with client’s brings them hope, parents of children with trauma, this brings them hope! Badenoch, 2008 14

15 Autonomic Nervous System
Sympathetic: acts like accelerator in the car, fight/flight, arousal! (increased HR; increased blood pressure; sweating; tense muscles; increased breathing; decreased appetite Parasympathetic: acts like the brakes of the car, may feel withdrawn=shame, slow, relaxed, calm Badenoch, 2008

16 The greater the early wounding, the stronger the implicit memory has on the present, until there is integrative healing P Badenoch, 2008 16

17 Implicit Memory Lodged in body as well as well as emotions
“Reality Checks” to help reorient person to what is really happening, is not useful The only reality is the one created by the neural firings inside the skull and body

18 Empathetic Attunement
Fosters integration in children Empathy is a potent promoter of neural integration, (rewiring) Children who receive sufficient attunement, have a caring parent within by 8 to 12 months Bruce Perry new book Born for Love why empathy and essential and endangered Badenoch, 2008

19 Infant Attachment Brains are hard wired for attachment
Children seek physical closeness and communication A child’s attachment experience parallel’s that of the primary caregiver 85% of the time Ex p 53 ex parent adapted by not paying attention to emotional life, child learns to do that Pg 53 inner community childs brain encodes internal state of mother and father, the beginning of inner community Badenoch, 2008 19

20 Self Awareness All information passes through the adult/therapist’s “Meaning-Making Amygdala” The amygdala is the home of one’s deepest perceptual biases Without self awareness, past trauma experiences, stress tiredness, etc can result in implicit memory response When we are activated without self awareness we miss the client’s world P55 when therapist is in a mindful state can more readily determine what is mine and what is theirs Badenoch, 2008 20

21 Contingent Communication
“ I see you, I feel you” Receiving nonverbal and verbal signals in a way the infant/child feels understood Mostly nonverbal, below level of consciousness, implicit, right to right hemisphere p57 Badenoch, 2008 21

22 Attachment and Self Regulation
Infant’s immature nervous system in dependent on caring adult to help moderate and organize bodily and emotional states in developing brain Various attachment patterns lead to better or worse states of mental health Schore (2007)suggests quality dyadic regulation, followed by self regulation defines subjective experience of self Badenoch, 2008

23 Crying and Separation P 38 sunderland
Stress from prolonged crying and separation can affect the child’s developing brain Infant is born with a very immature and sensitive brain Amygdala is perfectly online at birth, detector of threat Prolonged crying can lead to an oversensitive stress response throughout life Cortisol levels will remain high with prolonged crying which can damage key structures and systems in developing brain 90 percent of the growth of the human brain occurs in the first five years of life Sunderland, 2006 P 38 sunderland

24 Neuroplasticity The ability to change patterns of energy and information by virtue of new experiences (Seigel, 2006) As adults in a child's world we can recognize and honor the ability of an empathetic and attuned relationship to help heal the brain Dyadic regulation can rewire implicit regulatory patterns through calming attunement Badenoch, 2008

25 Patterns of Attachment
Secure Insecure/Avoidant Insecure Anxious/Ambivalent Disorganized P58 Mary Ainsworth and Mary Main Badenoch, 2008 25

26 Secure Attachment Develop a “knowing” that when things go wrong they will be righted again = resilience In this lovely dance the child’s brain is structured to anticipate respect, empathy and warmth resulting in the capacity for self-regulation P62 63 research approx 55% child securely attached decrease of 10% in last 10 years % of american parents believed picking up a child when crying spoils them Play how can anyone not love you? Badenoch, 2008 Hughes, 2009 26

27 Attachment Security Hughes p10 Physiological and emotional regulation
Self-reliance Resilience Social Competence with peers Empathy for others Symbolic play Problem Solving Intellectual Development Communication and language skills Self-integration and Self- worth Hughes p10 Hughes, 2009 27

28 Inner Community Relational experience shapes the inner world In utero and infancy child’s experience of mother initiates neural firing that encode and strengthen certain states of mind Resonance circuits embed presence of mother Neuroplasticity is supported through empathy Internalization occurs throughout a life time P 77 based on object relations, attachment and interpersonal neurobiology Badenoch, 2008 28

29 Inner Community (cont)
Both wounding and healing occur in the context of relationship Repetition results in supporting synaptic strength and becomes traits of mind or stable aspects of personality (Seigel,1999) Results in implicit assumptions that influence current relationships At the heart of inner community is the process of internalization Badenoch, 2008

30 Research (Field et al.,2006) Newborns nervous system and biochemistry is shaped by mother’s mental status during pregnancy Newborns of depressed mothers show similar biochemistry, i.e.  cortisol, dopamine and serotonin, similar to an adult with major depression p78 Badenoch, 2008 30

31 Internalization Occurs throughout life creating the inner community
As soon as neuro equipment is developed, we are relational beings In infancy our brains cannot, differentiate or filter our encounters In infancy we are most dependent, physically and emotionally and through empathetic relationship we develop a sense of self Badenoch, 2008

32 Rupture and Repair It is estimated that mothers are misattuned to their infants 66% of the time (Tronick, 2003) Quick repair builds resilience in the bodies and brains of infants Disruption and reestablishing warm contact infuses hope and a mental model that things go wrong and are set right (Seigel,1999) P100,101 share story of therapist missing the mark p101 badenoch Badenoch, 2008 32

33 Triangle of Well-Being (Daniel J. Seigel)
P 102 33

34 Six Components of Attachment Mary Ainsworth and John Bowlby
On going, not temporary Directed towards a specific person Significant emotionally Driven to maintaining contact with the other Distress occurs during involuntary separation Designed to seek comfort and security (Hughes, 2009) Hughes p 9 34

35 Attachment Parenting P 13 hughes
Intersubjectivity: A communication process (verbal & nonverbal) between child and parent in which experiences are shared resulting in a deepening, expanded and coherent sense of self for both Parents influence child best when child is able to influence parent Best predictor of child attachment patterns is the attachment patterns of the parents (Hughes, 2009) P 13 hughes P 14 schore infant and parent engage in attuned intersubjective non verbal dialogue brain devls, ie prefrontal responsible for affect regulation socail cognition empathy response flexibility self awareness and fear mdulation (seigel) 35

36 Establishing Safety Habitual presence of attachment figure Maintain predictability Enhance safety with discipline Plan in advance for changes or separations Avoid isolation Be deliberate with surprises (Hughes, 2009) P hughes cared for by as few 2nd attachment fiqures as possible 2. structure routine ritual attuned w child intersubjectively then can respond appropriately for child 3. discipline inc safety and increaed in anxiety, a communicate discipline w open and confident stance clarity b. open to childs perspective so child knows parent confident even with knowing childs wishes c. convey decision w empathy for frustration that will likely occur 4. trying to talk child out of anxiety or over reassurance will likely increase anxiey and resistance concrete or tansitional objects 5. time in with anger rather then time out helps child gain regulation thru parent if parent is dysregulated then time out for parent because not provideing safety 6. surprises and excitement not necessarily good for child 36

37 Repairing the Sense of Safety
Relationship repair Sympathetic to fears Bring vague fears into dialogue (Hughes, 2009) P 25 hughesdo not use relationship withdrawal, generates fear and abandonment 37

38 Obstacles to Maintaining Sense of Safety
Trauma Relationship Problems (Hughes, 2009) P 27 attachment security best protector from trauma response If parent has fears “he will never be the same” likely that is the case stay close w child after acute fear, crying shaking screaming match intensity helps to calm by releasing terror peter levines work Relationship conflict state the obvious the conflicts exist in a matter of fact way decrease anxiety and blame and responsibility for child to fix 38

39 Examples of Trauma P 6 Physical Abuse Sexual Abuse Emotional Abuse
Neglect Depressed Parental Care Prolonged Unmet Needs Domestic violence Medical Trauma Auto accident Pre and Peri-birth Trauma Loss of Caregiver Adoption Foster Care Bullying Surrogacy Frequent Moves P 6 (Forbes, & Post 2010) 39

40 Four Memory States Bruce Perry
Cognitive Emotional Motor State P 6 & 7 bruce perry (Forbes & Post, 2006) 40

41 Stress Model Behavior arises from Stress; In between stress and behavior is a primary emotion: Love or Fear P 8 (Forbes & Post, 2006) 41

42 Love and Fear P 9 forbes post (Forbes & Post, 2006) 42

43 Anger and Fear Depression Anger Sadness Fear
Anger based control, manipulation, defiance, hurting of self or other is based in fear Fear based culture reacts to threatening event with ANGER Depression Anger Sadness Fear (Forbes & Post, 2006)

44 Regulatory System = Stress Response System
Affect regulation is established during our earliest regulatory relationships with our caregivers (Bowlby,& Shore) Blueprint is established in the first three years of life for emotional and social relationships Failure to develop affect regulation can lead to psychiatric disorders P17 attachment and regulation very connected Trauma can result in affect dysregulation= RAD, ODD etc (Forbes & Post, 2006) 44

45 Regulation - Dysregulation
Regulation: Ability to experience and maintain a tolerable level of stress, Calm Dysregulation: Experience of stress outside window of tolerance, stressed-out, state of distress Systems theory speaks of homostasis 80 to 90% disease and disorders attributed to Early regulatory interactions with caregivers determine ability to regulate as we age (Forbes & Post, 2006) 45

46 Impact of Stress and Trauma on Social/Emotional Brain
Stress and Trauma play havoc with regulation Trauma can be stored in cells of body if not processed in a healthy way Children/Parents act out negatively from a state of stress and fear Candace Pert” Molecules of Emotion’ if don’t express process understand within context of relationship stored in body impacting person for a life time (Forbes & Post, 2006) 46

47 Impact of Stress and Trauma on Brain
Causes confused and distorted thinking Compromises short term memory Impairs ability to communicate between left thinking brain, and right emotional brain Trauma impairs ability to think clearly during stressful events Stress to traumatized child or adult can feel like life or death Trauma creates a heightened stress receptor within brain resulting in increased anxiety and aggression Ex left/ right disconnect smile at person while anger, child feels tired but blames parent for making go to bed, feel angry but not recognize stress in body, Not crazy, not intentionally pushing buttons “survival place” fine line betwn fear/excitement joy/pain experience originates out of amygdala, memory system is what allows to translate stress into joy and fear (Forbes & Post, 2006) 47

48 Regulation See page 19 diagram (Forbes & Post, 2006) 48

49 Acting Out Behavior Pain communicated through behavior
Pain and Fear must be addressed in order to effectively impact behavior Consequence , Logic and Control will not effectively support change without first addressing pain and fear. (Forbes & Post, 2006)

50 Conditioning/Patterns
Children and Adults are conditioned to behave in both positive and negative ways Patterns of behavior are deeply woven into our cellular network Overcoming negative condition requires positive repetitious conditioning (NHA) P20 Responding to a negative w a positive eventually makes a negative positve NHA (Forbes & Post, 2006) 50

51 Process not Outcome It is important to recognize conditioning is process as opposed to an outcome Adults/Parents “EXPECT TO FAIL” This is an opportunity to learn and grow The focus of and commitment to change is with the Adult/Parent, not the child P21 expect to fail gives permission to not be perfect As parents adults we get to chose our response not (Forbes & Post, 2006) 51

52 Attachment-focused Control
CONTROL: is the Ability to INFLUENCE the behavior of another individual as opposed to overpowering or changing the other’s behavior Need to be in control is often fear driven RESPONSE- ABLE Example p 23 forbes Teenager/party (Forbes & Post, 2006) 52

53 Summary of Stress Model
First response to stress is unconscious at a body level Fear impacts our ability to be responsive, fear sees problem, love sees solutions Fear is the root of child/adult anger, work to see child as scared rather then angry Misbehaving children are seeking external regulation Behavior modification does not address underlying fear and stress (Forbes & Post, 2006)

54 Summary of Stress Model (continued)
Traditional parenting does not help child regulate through parent- child relationship Stress results in confused and distorted thinking Parent’s stress reduces their ability to be open to child’s emotional state Positive repetitious experiences can overcome negative conditioning. IT IS NEVER TOO LATE! (Forbes & Post, 2006)

55 Summary of Stress Model (Continued)
When the child is misbehaving, they are doing their best to survive Stress triggers our unconscious mind to Live out of the past Avoid the present Obsess about the future (Forbes, & Post 2010)

56 Hostility and Anger in Parents and Adults Revenge is a confession of pain - unknown
Child’s emotional intensity can “stir up” parents own past trauma history, of which the parent may have no awareness Trauma is buried in the state memory; which directs all other responses Childhood trauma may not surface until triggered in adulthood Research adoptive mothers 77% SA or Agreed that they experieced most rage and anger ever in life, 14% thoughts of suicide “upset feelings never die, they are buried alive and come back as something uglier” Steven Covey 7 habits of Highly Effective people (Forbes, & Post 2010) 56

57 Parent/Adult Anger & Rage
Anger and Rage function as a mechanism to stay away from state memory trauma Stressed/traumatized child becomes the associational connection to parent’s unresolved trauma Unintentional acting out on child by wounded parent can then occur P 36 (Forbes, & Post 2010) 57

58 Parent/Adult Anger & Rage
Traditional parenting directs parents to stay out of their anger, this can be humanly impossible when state memory trauma is triggered. Stress Model perspective suggests an overwhelming fear state has been elicited in the adult Parent /Adult must recognize own fear reaction in order to interrupt the negative neurological feedback loop P 37 forbes Bruce Perry “You cannot change parts of the brain which are not activated. In order to change the “state’ you must activate the’ state’!’ (Forbes & Post, 2006) 58

59 Healing the Parent/Adult
Breathing into feelings of anger in order to make connection to past experience Journaling Meditation Exercise/movement Yoga Rhythm (music, drumming)

60 “Whose Anger (fear) are we dealing with Here?”
Parent must courageously open to their own emotional wounds, in order to open up to their child’s wounds Parent’s healing allows for acceptance of child’s pain and a creation of an emotional safe environment (Forbes & Post, 2006)

61 Fear based Stance One sees oneself as a victim
One moves into a survival mode Self protection results = FIGHT, FLIGHT or FREEZE P 38 forbes parent story p 38 & 40 Forbes Discuss childs potential reaction to fight, flight or freeze from abandoment and feedback loops (Forbes & Post, 2006) 61

62 Parent/Adult Anger & Rage Summary
Parental hostility, anger and rage is: An indicator that one is worn down by nerve grinding behavior Typical for parent’s of attachment challenged children Reflects parents “unfinished business “ Serves to protect parent from unhealed wounds Indicates parent is acting from fear and shifting to blame (Forbes & Post, 2006)

63 Parent/Adult Anger& Rage Summary
When parent is feeling angry and hostile, child needs the parent to : Know they are not the victim, but rather both child and adult are in a state of raw & painful fear Take responsibility for internal reactions Open self to wounds that trigger reactions Recognize own reactions is threatening to child and deepens fear (Forbes & Post, 2006)

64 “It is not your fault, it is how the brain works”
(Forbes & Post, 2006)Badenoch pxxi tell story of cl not meant to make excuses but rather the truth about the brain Instead of taking months or years to relieve shame, we get a good start in five minutes Client begins to establish self as caring observer mindfulness Badenoch reports being struck by the efficacy of empathy supported by brain wisdom (Forbes & Post, 2006) 64

65 Attachment Parenting Intersubjectivity
A infant/child prefers and learns best when the adult is active and responsive to his own activity (contingency) Those activities in which the parent accepts and responds will likely increase the behavior (Nurtured Heart Approach) Mirroring: As the parent perceives child as smart, enjoyable, loveable, etc, he will then experience himself that way (Hughes, 2009) P hughes 2009 65

66 Three Features of Intersubjectivity
Sharing the affective state: Attunement Parent and child are focused on the same object or event Same intentions in the present moment (Hughes, 2009) P in sync with degree of intensity verbal and nonverbal do not need to be matched emotionally, acceptance understanding empathy for childs emotion 2. Sharing an experience rather then change the other perception doe not have to be the same! 3. Shared attention helps child devl attention span, and cooperation ex p 43 When parents move into rational teaching lecturing decrease ability to influence child thru shared experience can elicit compliance and passive agreement which does not increase self efficacy 66

67 Reorganizing Attachment Patterns
Partner or best friend relationships can help resolve compromised attachment histories An emotionally connected relationship with a therapist can assist client in healing attachment Partner, friend or therapist can help adult regulate her reactions to child’s behavior (empathic presence, unconditional acceptance) Acceptance, curiosity & empathy= self acceptance, self-awareness & self-empathy Reflective functioning can support autonomous attachment (mindfulness exercises) (Siegel, 2007) (Hughes, 2009) P 59 Hughes village! 67

68 PACE Playfulness, Acceptance, Curiosity, Empathy
An attitude, an interpersonal stance All rights of parents and children are respected and valued Creates a safe sanctuary to be together Parental authority does not mean inner life of parent is more important then the child A child’s sense of safety supports parental influence Fear decreases genuine parental influence long term PACE often decreases in toddlerhood (Hughes, 2009) P69 70 in toddlerhood tend to convey the behavior is wrong 68

69 Playfulness Most parents intuitively maintain infants attention through playfulness Vitality affect (Daniel Stern) measured affect by intensity and rhythm, infants preferred synchronized states (attunement) Laughter great antidote to shame and fear Humor helps develop another perspective on events Playfulness has no agenda Admit mistakes, not take ourselves to seriously Keep an open mind Keep it light when possible (Hughes, 2009) P71- 77 69

70 Acceptance Unconditional acceptance of the child
Only behavior is subject to evaluation and guidance, judgment and criticism Feelings are not judged, only destructive behaviors associated with the feelings Acceptance does not mean permissiveness View child beyond behaviors Parent may disagree with choice but accept intention behind the choice Understand meaning of behavior before reacting

71 Obstacles to Acceptance
Reduce anger, giving energy at time of misbehavior is more likely to entrench the behavior Child more likely to test the connection through mis-behavior “Does my parent accept and love me as I am?” If discipline is about behavior sense of safety is maintained, child remains open to influence If discipline is about inner self, child is likely to be oppositional (Hughes, 2009) P 81 71

72 Obstacles to Acceptance (cont)
Avoid negative judgment , limited anger expression to behavior Safeguard the Relationship - withdrawing relationship does not communicate acceptance - withdrawal creates distance in relationship that can be long term Accept the child’s inner life - thoughts, emotions, attitudes, wishes, perceptions, memories, intentions, values and beliefs

73 Discipline Natural Environmental Consequences or no specific consequence at all, are more effective Acts of discipline are best if they do not threaten the relationship or the child’s sense of self –worth (Hughes, 2009)

74 Curiosity Assuming we know the meaning of behavior often results in negative judgment Acts of discipline replace acts of discovery Assumptions of negative motives replace assumption of positive motives Child begins to oppose parent negative view, which can result in feeling like she must choose between self and relationship (Hughes, 2009) p87 74

75 Curiosity (cont) Assume a “not-knowing” stance
Inner life judgment results in shame, resulting in hiding or denying behavior Children will sense difference between genuine curiosity verses attempt at reasoning Curiosity requires a parent be truly open to being influenced by and understand the child’s inner life Curiosity is equally important in focusing on the child’s positive experiences and behaviors (NHA) (Hughes, 2009)

76 Empathy Empathy provides parental presence for the child, which assists the child in regulation Empathy does not mean rescuing or fixing Empathy helps child’s negative emotion get smaller and positive emotion to get bigger A parents own emotional development, results in an increased ability to be present with their child (Hughes, 2009) P 94 76

77 Obstacles to Empathy Parents do not have confidence that empathy will be helpful Parents were not raised with empathy so do not have an intuitive sense of its value Parents trust the power of reason, since that is the guiding principle of many parenting paradigms (reasoning can be effective after comfort, acceptance and understanding is offered) (Hughes, 2009)

78 PACE with Love Love: Commitment, compromising, enjoyment
Withdrawal puts the child at risk, questioning commitment and reducing attachment security Unconditional permanent commitment reduces child’s need to engage in oppositional behavior to test the relationship Enjoyment reinforces the child’s experience of being special and loved

79 Attachment Focused Communication
Engage child in conversations, co-story telling, rather then lecture Reciprocal dialogue, mutual empathy experience Parents help ascribe meaning to nonverbal expressions, assisting child in developing an ability to converse with inner self, (emotional intelligence) Communication that is evaluative, “Good boy”, “Great Job”, decreases sense of safety Describing and recognizing the moment promotes acceptance (NHA) (Hughes, 2009) P 107co story telling results in each having an impact on the inner life of other 79

80 Reciprocal Conversations
If parent is truly listening and child feels understood, this can reduce escalation even when consensus is not met Reflective conversation includes both affect an reflective components (talking and genuine listening) Parents must feel safe to participate in reciprocal conversation i.e. when authority is questioned (Hughes, 2009) P 111 when authority is questioned does parent become angry and insist on compliance 80

81 Conversation Tips Express commitment to relationship, both implicitly and explicitly Demonstrate interest in whole child, inner life and behavior Honor importance of behavior, without lecture and without excuses Communicate inner life understanding Communicate enjoyment and delight of her child Discover strengths and vulnerabilities related to behavior (Hughes, 2009)

82 Conversation Tips (cont)
Communicate to child that you have his best interest at heart Empathize with child’s distress, including that caused by discipline Ensure that discipline does not compromise open communication Ensure that conflict does not impact worth of child or the relationship Work at discovering best response to each situation Discover uniqueness of child and love for child (Hughes, 2009)

83 Repairing Conversations
Stop the lecture Take a break Use “I” language not “You” Practice curiosity without judgment Rediscover the positive (NHA) (Hughes, 2009) P change tone invite childs perspective 2. notice strong emotion time out return to conversation later 3. I messages re behavior 4. 83

84 The Three “R’s” Relate emotionally *match intensity, but lead with calm amygdala * do not view anger as disrespect, * understand difference between shame and guilt Reflect * parent participates in self reflection with child * accept difference Repair * restoration of relationship promotes safety and is parents responsibility (Hughes, 2009) Ana,s feed back anger viewed as disrespectful leads to shame p127 guilt/shame p130 P 168 obstacles to repair 1. belief it will fade away 2. parent weak if childs behavior caused the break 3. intitiating repair reinforces misbehavior 84

85 Reducing Attachment Resistance
Focus on inner life and home environment * It is never too late! Gentle persistence towards engagement (PACE) * nothing is personal * use the village to support energy, confidence and perspective Provide structure for the day Reduce choices Give gentle supervision P 184 suprvision is a gift not a punishment, present positvely 85

86 Reducing Attachment Resistance (cont)
Have family rituals Facilitate success Give Time-In, not Time-Out Initiate soothing Safeguard sleep Protect against overstimulation Be securely attached yourself P 185 mistakes can be great learning opportunity but not if shame gets in the way,2. honor devl age not just chronological time in to promote calm,3. sometimes adults need time out 4. be proactive w soothing, 5. hypervigilant thru out day exhausting, start sleep ritual early wake up ritual might be important too ex blue light aqarium bubbling sound etc 86

87 The Nurtured Heart Approach
The approach is about how to therapeutically shift intense children to using their intensity in wonderful ways. It’s about having powerful ways of making any moment an opportunity to create success. The approach is almost like playing moments back for the child and sharing what you see as their experience...which ultimately becomes their experience of themselves. The child can record their experience in more than one dimension. The excitement and success in what is happening and the excitementand success in what isn't happening. We dont have to wait for magnaminous experiences to celebrate. Children equate documentation of being seen as evidence of being celebrated. 87

88 Acorn Parenting



91 Nurtured Heart Approach and Contingent Communication

92 The Nurtured Heart Approach/ Contingent Communication and Positive Self Esteem
Children who have a positive view of themselves: handle anger and other emotions better, have healthier relationships, are more successful in school and work, and are happier. The approach is almost like playing moments back for the child and sharing what you see as their experience...which ultimately becomes their experience of themselves. The child can record their experience in more than one dimension. The excitement and success in what is happening and the excitementand success in what isn't happening. We dont have to wait for magnaminous experiences to celebrate. Children equate documentation of being seen as evidence of being celebrated. 92

93 Helping Every Child to Flourish
He's on a mission to create the successes. It's not a question of whether you can or can't, you are He's creating a real experience of success...different from a video. If I watched a video of people exercising, it's less than a first hand experience. Catching the good is too diempowering for the challenging child. You may find a couple of successes per day, but they’re harder to find with the ordinary net. This is a about a quantum leap beyond catching children being good. The Horse Whisperer 93


95 Toys R’ Us Children learn to get a reaction and engage our animation.
When do we give relationship? 95

96 The $100 Bills A child learns to get more energy when things are going wrong. 96

97 The Prize Our emotions, our level of involvement, and our energies are the prize. We can choose what, how, and when we radiate. 97

98 Nurtured Heart Intervention
My “M.O.” as a therapist/trainer is simply to teach an approach that works. Then the parent in effect become the “Therapists/Heroes”.

99 The Three-Legged APPROACH
#1: “I will purposefully create success for my child.” 99

100 The Three-Legged APPROACH
“I refuse to be drawn into accidentally energizing and rewarding negativity.” #2: 100

101 The Three-Legged APPROACH
#3: “I will provide TRUE consequence when a rule is broken.” 101

102 Taking a Stand Honest first-hand experiences of success builds a positive portfolio. What is happening right now? t 102

103 Believe in the Miraculous
Genetic and biochemical differences create real propensities. Propensities can be overcome. Weakened pathways can be strengthened. New pathways can be constructed. 103

104 Shamu Lowering the Rope
Creating Success that would not otherwise exist. 104

105 The Toll Booth Man It’s all how you choose to see things. 105

106 And refusing to energize the negative
Energizing Success And refusing to energize the negative 106

107 Techniques for Energizing Successes in Children
Active Recognition – a “snapshot”; noticing and describing what’s going on in this moment. Experiential Recognition – ‘The Big Picture’; Connecting the positive behavior that you notice to values. Proactive Recognition – Noticing when rules are not being broken. Creative Recognition – ‘Creating Success’ where it isn’t ordinarily seen, or doesn’t ordinarily exist. Shamu 107

108 Active Recognition Watch, describe, and document what you see out loud as if for a blind companion. Ordinary moments are windows of opportunity. Notice both actions and emotions. Go with the flow. 108

109 Experiential Recognition: Adding Value
Children often do not know how to evaluate their experiences. They need our help. When do we typically choose to teach the qualities and life skills that we value? How receptive are children to this type of learning? 109

110 Experiential Recognition
Highlight the healthy aspects of the qualities that you wish to enhance. Teaching values is like growing a plant, water the seed, nurture it!! 110

111 Proactive Recognition Noticing and labeling what isn’t happening
When a child is doing ‘nothing’, they are doing many things right. Notice, label and praise the self control. Acknowledge the decision making process of a child as they decide to not act out. 111

112 Good News Relationships with Parents or primary caregivers can change, brain neuropath ways resulting in attachment It is NEVER TOO LATE to create positive change in a child’s life!

113 Attachment and Nurtured Heart Approach
Affective Attunement Contingent Communication Heart to Heart Connection Nurtured Heart Approach Authenticity Truth-telling Recognitions

114 Attachment and Nurtured Heart Approach
Shame Reduction Healthy development shifts shame to guilt Nurtured Heart Approach Recognitions Clear Consequences and “resets” “back in the game”

115 Attachment and Nurtured Heart Approach
Safety Nurtured Heart Approach Consistent Rules Staying Connected Keeping Kids close emotionally

116 In Closing… “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” - Maya Angelou

117 Bibliography Badenoch, Bonnie (2008) Being a Brain-Wise Therapist; A Practical Guide to Interpersonal Neurobiology. New York, W.W. Norton & Company, Inc. Forbes, H. and Post, B. (2006) Beyond Consequences, Logic and Control, Boulder, CO: Beyond Consequences Institute, LCC. Glasser, H., Easley, Jennifer (2008) Transforming the Difficult Child: The Nurtured Heart Approach, Nashville, TN: Vaughan Printing. Glasser, H., and Block, M. (2007) All Children Flourishing, Igniting the Greatness of Our Children. Nashville, TN: Vaughan Printing. Hughes, Daniel A. (2009) Attachment Focused Parenting. New York, NY: W.W. Norton & Co. Inc. Hughes, Daniel A. (2006) Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children. New York, NY: Jason Aronson Pransky, J. (2008) Somebody Should Have Told Us (Simple Truths for Living Well). New York, NY: Strategic Book Publishing. Purvis,Karyn B., Cross, David R. and Sunshine, Wendy Lyons (2007) The Connected Child. New York, NY: McGraw Hill. Siegel, Daniel J. (2003) Parenting from the Inside Out. New York, NY: Penguin Group. Sunderland, Margot. (2006) The Science of Parenting. New York,NY:DK Publishing.

118 To your Greatness!! Annie Lange BSN, LMSW, ACSW Clinical Social Worker
Nurtured Heart Approach Advanced Trainer (517)

119 Enya — Hope Has A Place One look at love and you may see it weaves a web over mystery, all raveled threads can rend apart for hope has a place in the lover's heart. Hope has a place in a lover's heart. Whispering world, a sigh of sighs, The ebb and the flow of the ocean tides. One breath, one word may end or may start a hope in a place of the lover's heart. Hope has a place in a lover's heart. Look to love you may dream, and if it should leave then give it wings. But if such a love is meant to be; Hope is home, and the heart is free Under the heavens we journey far, on roads of life we're the wanderers, So let love rise, so let love depart, Let hope have a place in the lover's heart. Hope has a place in a lover's heart. Look to love and you may dream, and if it should leave then give it wings. But if such a love is meant to be; Hope is home, and the heart is free. Hope is home, and the heart is free.

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