MELISSA CALDWELL ENGLE, MS, LPC, ATR THE ROSS INSTITUTE Executive Clinical Director 1701 Gateway, Suite 349 Richardson, Texas Private Practice:

UNRESOLVED ATTACHMENT ISSUES: IDENTIFICATION AND TREATMENT TECHNIQUES Melissa Caldwell Engle, MS, LPC, ATR Texarkana, Texas April 12,

Trauma is a developmental obstacle in normal human development.

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

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.

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

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

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.

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

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

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.

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

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.

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