1. Interpersonal Neurobiology of Poverty and Trauma Informed Care
Trish Thacker, MSW, LICSW
Program Director
Minneapolis Harbor Light Center
For more information or to schedule a training
please contact: Trish Thacker

2. Introductions Trish Thacker, MSW, LICSW Who’ s here today?
Program Director, Salvation Army Harbor Light Center
Clinician for 17 years
Advanced training in: IPNB, trauma, EMDR, forensics, narrative therapy, addictions
Who’ s here today?
What are you hoping to get out of today’s session?

3. Expectations for today
I encourage you to:
1) Ask questions
write down questions or raise hand and ask…will also have q & a before break and before session ending
2) Take care of yourself…stand etc if needed

4. Complexity Disclaimer
This is a simplified presentation, whittled down to core concepts. What is presented today provides a basic structure. A blueprint. A framework of understanding. This presentation illuminates a process and is merely a place to begin …

5. Hand Model of the Brain

6. Interpersonal Neurobiology Primer DEFINITIONS
Interpersonal: of or relating to relationships or communication between people
Neurobiology: the anatomy and physiology of the nervous system
The Nervous System: The system in the body that controls internal functions of the body and receives, interprets, and responds to stimuli

7. Interpersonal Neurobiology Primer DEFINITIONS
THE MIND:
the emergent, self-organizing process that shapes and directs how energy and information flow across time
shaped by the interaction of experience and gene expression
Represents a complex system
Characteristics of a healthy, complex system:
F - flexible
A - adaptive
C - coherent
E - energized
S - stable
Therefore, an individual with “good” mental health will generally exhibit these characteristics

8. Interpersonal Neurobiology Primer DEFINITIONS
Mirror Neuron system:
fires both when a person acts and when the person observes the same action performed by another
Wiring which allows for attunement, empathy ,and connection
Attunement:
to bring in to harmony; the feeling of being “at one” with another human being
Shared emotional states
Powerfully influences others

9. Interpersonal Neurobiology Primer CONCEPTS
Attachment:
a deep and enduring emotional bond that connects one person to another across time and space …”feeling felt”
Defines and effects how we perceive people and the world
Tends to be determined by the attachment style or strategy of the primary care giver
Every child grows up in a different family
Same parent can have different attachment style with each child

10. Concepts Types of Attachment: Secure – earned secure Insecure
anxious/ambivalent
dismissive/detached
disorganized/traumatic

11. Interpersonal Neurobiology Primer
CONCEPTS
Secure - earned secure attachment
Contingent communication
perceive cues
interpret accurately
respond appropriately
in a timely manner
most of the time
Auxiliary containment – foundation for later integration
When injury occurs, the repair is made

12. Interpersonal Neurobiology Primer
CONCEPTS
Insecure – anxious/ambivalent attachment
Parent with “unfinished business” – past intrudes into present
Available inconsistently
Insecure – dismissive/detached
Relationships as tasks and people as roles – few memories,
Unavailable
Insecure - traumatic/disorganized
Biological conundrum – drive toward and away
Parent is a source of fear or pain

13. Interpersonal Neurobiology Primer CONCEPTS
How does this work??
Mirror neurons
Influences perception and interpretation
Attunement with other
Developing mind
World is good and I’m ok
World is unpredictable and I’m nervous
World is cold/unhelpful and I’m separate
World is scary and I’m unprotected
Attachment style
Integration and containment
Intermittent integration/containment
Rigid/unavailable integration/containment
Fragmented/sparse integration and intrusion/no containment

14. Interpersonal Neurobiology Primer CONCEPTS
We are influenced by, and we influence, people and environments
Our minds will filter/define experience and perception based on our history to date (this is not static)
We will act/react/respond in accordance with our self-defined experience and perception
Our interaction with people and environments will effect which genes are turned on and which are turned off (gene expression)
Our life experiences influence genetic coding and the wiring in our brains and bodies (epigenetics)

15. Interpersonal Neurobiology Primer
Side Bar
Emerging field of Epigenetics
refers to external modifications to DNA that turn genes "on" or "off” without changing the DNA sequence
Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state.
This is especially interesting when we consider intergenerational poverty and the transmission
What epigenetic changes may have occurred that influence the generation that follow?
Ex: childhood abuse and/or neglect leave markers in the hippocampus that remain in the next generation and increase risk for mental illness and suicide
What about chronic stress, poor nutrition, no time for play etc?

16. Quick break to: think breathe stand etc

17. Definitions of Poverty
Poverty results when the lack of basic security simultaneously affects several aspects of people’s lives, when it is prolonged, and when it severely compromises people’s chances of regaining their rights and reassuming their responsibilities in the foreseeable future
Poverty describes those who are poor and have little or no mobility.
Chronic poverty occurs when people experience several forms of disadvantage at the same time. These combinations keep them in poverty and block off opportunities for improving their livelihoods.

18. Dynamics of Poverty
Difference between being impoverished and being part of a culture of poverty
Those experiencing poverty often carry a sense of:
Being marginalized
Helplessness
Dependence and resulting powerlessness
Not belonging, separateness, singled out
Reduced sense of history due to survival behaviors

19. Poverty and Attachment
Research indicates:
Poverty and related chronic stress can biochemically dampen maternal motivation and sensitivity
Increased stress due to lack of financial resources, reduced social support, and risky home and neighborhood environments directly affects parenting efficacy
Poverty is associated with an up to 22-fold increase in risk for child abuse and neglect
Chronic and acute stress from the basic lack of security that defines poverty causes increased limbic/amygdala maternal functioning that causes the mother to perceive their child’s need as hostile

20. Poverty and Chronic, Acute Stress
Because the negative effects of deprivation on human development tend to be cumulative, individuals with greater exposure to poverty during childhood are likely to have more difficulty escaping poverty as adults
Chronic stress deposits an epigenetic biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands.
childhood poverty is inversely related to working memory in young adults
The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response

21. The more poverty related stress the individual experiences,
IPNB and Poverty
The more poverty related stress the individual experiences,
the less capable they are to effectively manage stress, which contributes to keeping them in the chronically stressed environment

22. IPNB and Poverty What happens to the brain
when experiencing the conditions associated with poverty?

23. IPNB and Trauma What is trauma?
Individual trauma results from an event, series of events, or set of circumstances that is experienced, or witnessed, by an individual as physically or emotionally harmful or threatening
Trauma overwhelms/surpasses our current ability to cope
Trauma can be singular and/or cumulative
Traumatic reactions occur when action is of no avail

24. IPNB and Trauma
What happens in the brain and body when trauma occurs?

25. IPNB and Trauma
What can we expect from traumatized people and people groups?
Flipped lid - Brown-out/black-out state
Triggered reactions vs considered responses
Can be physically reactive
Can be dissociated “loop” of conversation
Disorganized/chaotic behavior (doesn’t make “sense”)
Elaborate back-story explanations
Learned helplessness

26. IPNB and Trauma
What can we expect from homeless/traumatized people and people groups?
Unaware - ness of other people, ideas, causal relationships
False dichotomies – black and white thinking
Rapid shifts in emotional state
Difficulty making decisions
All manner of presentation of fight-flight-freeze behaviors
The “sprint” mentality (vs marathon) which increases long-term suffering
Exercising control in counterproductive ways (posturing, blame casting, etc)

27. IPNB, Trauma, and Poverty
The acute and chronic stress experienced by those in poverty elicits the same brain response as trauma And People experiencing poverty have fewer physiological and socioeconomic resources available to them to resolve the trauma ….. We are working with a population of people who are in various states of acute and chronic trauma

28. Trauma-Informed vs Trauma-Specific
Trauma Specific Care = the care, the treatment itself
Trauma-specific intervention programs generally recognize the following:
The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery
The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety
The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers
Includes: Seeking Safety, DBT, EMDR, narrative exposure therapy, somatic experiencing, stress inoculation training, etc

29. Trauma-Informed vs Trauma-Specific
Trauma informed care = how care is delivered
and involves management of environment, program, and staff
Realizes the widespread impact of trauma and understands potential paths for recovery
Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
Responds by fully integrating knowledge about trauma into policies, procedures, and practices
AND
Seeks to actively resist re-traumatization

30. Trauma Informed Care Effective trauma informed care functions like:
The insulation around an electrical cord
Noise canceling head-phones
lifeguarding on a beach:
talk through
guide out
throw a flotation device
go out and get
It contains and off-sets the negative effects of trauma

31. Trauma Informed Care Trauma informed care is about how care is delivered
Services delivered in a manner that supports
integration of brain functions

32. Trauma Informed Care Trauma informed care is about how care is delivered
Five principles of Environment and Program Management:
1) Safety: Ensuring physical & emotional safety; “do no harm”
2) Trustworthiness: Maximizing trustworthiness, making tasks clear, maintaining appropriate boundaries
3) Choice: Prioritizing consumer choice & control over recovery
4) Collaboration: Maximizing collaboration & sharing of power with consumers
5) Empowerment: Identifying what they are able to do for themselves; prioritizing building skills that promote recovery; helping consumer find inner strengths needed to heal

33. Trauma Informed Care
Effective trauma informed care takes into consideration the “contagion” effect of emotional states…
therefore
…trauma informed care must include care for the other AND care for self

34. IPNB Care of Self
Intentionally do those things that fill me up in order to stay well ex: gratitude practice, exercise, meditation, safe people, alone time, etc
Self-attunement
Alignment with values
Intentional boundary management
Playground example
Not contributing to the chaos around me protects me and clients
Face/address my own feelings/experiences of helplessness
Do my own work
Get my emotional and significance needs met apart from work
Anything that is unresolved in me will get triggered in this environment
If I don’t, I risk working out my own issues at the expense of clients

35. Interpersonal Care of Other
It’s all about who you are in the room
Eye contact - attunement
Listen to the story
ask if they feel heard vs proving you’ve heard
It’s not about what’s wrong, it’s about what happened
It’s not about the event. It’s about the experience of the event
Consistency
Fairness
Professional transparency
The process IS the product
In creating conditions of safety, the roadblock is often myself…

36. References
Ainsworth, Mary. Patterns of Attachment: A Psychological Study of the Strange Situation. Psychology Press. London, England. 1979
Bloom, Sandra. Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care. Oxford Press
Bowlby, John. Attachment: Second Edition. Basic Books. New York, NY
Bowlby, John. Separation: Anxiety and Anger. Basic Books. New York, NY
Bowlby, John. A Secure Base. Routledge. New York, NY. Re-issue 2005.
Bretherton, Inge. The Origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology (1992), 28,
Clark, Carrie. Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care. Routledge Publishing
Cloud, Henry. Changes That Heal. Zondervan Publishing. Grand Rapids, MI
Cozolino, Louis. The Neuroscience of Psychotherapy: Healing the Social Brain. W.W. Norton and Company. New York, NY
Evans, Amanda. Trauma-Informed Care: How neuroscience influences practice. Routledge Publishing
Levine, Peter. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books. 2010
Levine, Peter. Waking the Tiger. North Atlantic Books

37. References
Main, Mary. Intergenerational Transmission of Attachment. PBS Series
Main, Mary and Hess, Erik. Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies. Journal of the American Psychoanalytic Association, 48:
Scaer, Robert. The Body Bears the Burden. Routledge Publishing
Siegel, Daniel. Mindsight: The New Science of Personal Transformation. Random House, NY, NY
Siegel, Daniel. Pocket Guide to Interpersonal Neurobiology. Norton Publishing. NY, NY. 2012
Siegel, Daniel. The Neurobiology of "We": How Relationships, the Mind, and the Brain Interact to Shape Who We Are (Sounds True Audio Learning Course)
Siegel, Daniel. The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. W.W. Norton and Company. New York, NY.2007.

38. References
Siegel, Daniel. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. The Guilford Press. New York, NY
Siegel, Daniel. The Mindsight Institute Conference on the IPNB of Attachment. UCLA. Los Angeles, CA. 2010
Siegel, Daniel. Toward and Interpersonal Neurobiology of the Developing Mind: Attachment Relationships, Mindsight, and Neural Integration. Infant Mental Health Journal Vol 221 (1-2),
Siegel, Daniel and Hartzell, Mary. Parenting From the Inside Out. Tarcher Press. Los Angeles, CA. 2004
Sutherland, Carol. Inner Relationship Focusing: Strengthening Attachment and Interpersonal Neurobiological Integration. Focus Training. Cape Cod, MA
Thompson, Curt. Anatomy of the Soul: Surprising Connections between Neuroscience and Spiritual Practices That Can Transform Your Life and Relationships. SaltRiver Publishing. New York, NW. 2010
Townsend, John and Cloud, Henry. How People Grow. Zondervan Publishing. Grand Rapids, MI. 2004
Van der Kolk, Bessel. The Body Keeps the Score. Viking Publishing. NY, NY. 2014