1. MELISSA CALDWELL ENGLE, MS, LPC, ATR THE ROSS INSTITUTE Executive Clinical Director 1701 Gateway, Suite 349 Richardson, Texas 75080 Private Practice: 214-498-5493 www.rossinst.com

2. UNRESOLVED ATTACHMENT ISSUES: IDENTIFICATION AND TREATMENT TECHNIQUES Melissa Caldwell Engle, MS, LPC, ATR Texarkana, Texas April 12, 2013 www.rossinst.com

3. Trauma is a developmental obstacle in normal human development.

4. Helping people to overcome childhood trauma and/or single event trauma in adulthood is an integrative process.

5. CORE CLINICAL ASSUMPTIONS 1. Un-integrated sense of self Dissociation between mind and body Black and white thinking Inability to recognize and or tolerate affect Inability to recognize and or tolerate ambivalence Treatment Focus- Integrative techniques focusing on: mind and body connection, education about feelings, affect management, containment and pacing, and desensitization.

6. SPECTRUM OF EMOTIONS Stuck Mind Ungrounded-Past Extreme Fluid Mind/Body Grounded –Present Balanced Stuck Body Ungrounded-Past Extreme NumbAngerRage NumbCautiousParanoia NumbHurtDespair/Hopeless NumbVulnerableHelpless NumbSadDepression NumbHappyMania

7. SPECTRUM OF EMOTIONS Stuck Mind Ungrounded-Past Extreme Fluid Mind/Body Grounded –Present Balanced Stuck Body Ungrounded-Past Extreme NumbAfraid/FearTerror/Panic NumbFrustrationOverwhelmed NumbConcernAnxiety NumbConflictedConfused NumbGuiltShame NumbRejectedAbandoned

8. CORE CLINICAL ASSUMPTIONS 2. “It’s all about avoidance” Dysfunctional affect management/symptom Push feelings into the body/behaviors “What problem does this symptom solve?” – not to feel. Treatment Focus – Integrative techniques focusing on: embracing clients ambivalence, balance between anger and grief, desensitization, challenging treatment objectives and integrative statements.

9. OBJECTIVE – TO FEEL MY FEELINGS AND STAY SAFE LOC/egocentric thinking Suicidal Ideations Homicidal Ideations Self-Mutilation Medication Confusion Memories/Content Eating or Not Sex Flashbacks cognitive emotional Alter Egos Staying in the past VRP Triangle Externalizing WAYS TO AVOID FEELING

10. OBJECTIVE – TO FEEL MY FEELINGS AND STAY SAFE Fantasy internalizing Dissociation Humor Intellectualizing Somatization Anxiety OCD thinking & behaving Depersonalization Numbness Rage Sadness/Depression Isolation Black & White thinking Magical childlike thinking Terminally Unique WAYS TO AVOID FEELING

11. CORE CLINICAL ASSUMPTIONS 3. Locus of control shift It’s function Self blaming/sabotaging/cognitions and or behaviors Damaged or destroyed inner self/lost innocence Issues of autonomy/identification with the aggressor Treatment Focus – Integrative techniques focusing on: reversing the locus of control shift, reframing damaged or destroyed, accepting and feeling vulnerability, helplessness, powerlessness, and grief and separation and individuation.

12. LOCUS OF CONTROL SHIFT - ITS FUNTIONS 1.Age appropriate 2.Maintains attachment 3.Provides power and control 4.Provides hope 5.Explains “why?” 6.Provides identity 7.Avoids feelings of helplessness, vulnerability, and powerlessness

13. CORE CLINICAL ASSUMPTIONS 4. Ambivalent Attachment/Trust Issues Grief work Autonomy Treatment Focus – Integrative techniques focusing on: education about biology of attachment, locus of control shift, balance – anger vs grief, tolerate feelings of helplessness, vulnerability, powerlessness, and grief.

14. As people get in touch with their feelings, expect an increase in urgency to regress cognitively, emotionally, or behaviorally.