1. Change the Lens: Change the Life The Nurtured Heart Approach and more…
Annie Lange, LMSW, ACSW

2. Why are we here?
Why are we here today???

3. Objectives
Describe relationships between trauma, brain function, attachment, empathy and relational connection between adult and children.
Discuss the neurobiology of the stress response.
Have a working knowledge of the thought cycle and its effects on feelings and behavior.
Discuss concrete strategies to support attachment, self/child regulation and healthy self-esteem, including the Nurtured Heart Approach Model.

4. Change the lives of Children and Adults
Change our Lens
Change the lives of Children and Adults

5. Every child is born with beautiful potential

6. Potential Blocking Accident Natural Disaster Violence Domestic
Community
School
Neglect
Illness
Child Abuse
Sexual
Physical
Emotional
Adversity 6

7. Caregivers can make a difference…7

8. Attachment Care Giving Video

10. Effects of Trauma & Stress
Adaptation vs Pathology (Survival)
Goal:
Build positive developmental pathways and competencies that support current and future resilience.
Blaustein, Kinniburgh 2010 10

11. Core Concepts of Childhood Development
Nurturing & dependable relationships = healthy childhood development
Humans hardwired to connect
Attachment changes the brain
Child development shaped by nature and nurture, biology and experience
Blaustein, Kinniburgh 2010 11

12. Core Concepts of Childhood Development
Self regulation is essential for child development and life-long health
Balance of risk factors and protective factors determines level of healthy development
Orlans, Levy 2006 12

13. Care giver’s developmental health impacts child’s developmental health13

14. The Developing Brain 14

15. The Developing Brain
The brain is a social organ and develops in the context of relationship
Genes provide framework, life experiences directs final construction
“Use it or lose it”
The first three years of life is most critical

16. Triune Brain

17. The Brain
Rational Brain
Mammalian Brain
Reptilian Brain

18. Adverse Childhood Experience Study
Adults who experienced at least four traumatic events in childhood have increased risk of:
Morbid Obesity
Smoking
Depression
Illness
Unwanted Teen Pregnancy
Domestic Violence
Felitt and Anda (2003) 18

19. Trauma and Memory
Explicit Memory: non emergency memory, logical, has words
Implicit Memory: expressed in body as well as emotions, created by neural firing, no time stamp, experienced as if in the “NOW” moment

20. ADHD Disabilities vs. Hyper-Arousal
Inability to be reflective – think before acting
Selectivity: unable to focus and screen out important from the unimportant
Continuity of Attention: inability to sustain attention and complete assignments
Self-awareness and self-regulation: not able to be responsive to positive and negative reinforcement 20

21. 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/care giving 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 21

22. Human Danger Response Step 1: Danger Beliefs “lens of danger”
Step 2: Body and Behavior Responses
“Fight – Flight – Freeze”
Step 3: Compromised Healthy Development
Regulation
Self * Social * Cognitive
Blaustein & Kinniburgh 2010 22

23. Common Childhood Trauma Triggers
Perceived lack of power or control
Unexpected change
Feeling threatened or attacked
Feeling vulnerable or frightened
Feeling shame
Feeling deprivation or need
Intimacy and positive attention
Blaustein, Kinniburgh 2010

24. Attachment Healing Caregiver Management of Affect Attunement
Consistent response
Routine & Rituals
Blaustein & Kinniburgh 2010 24

25. Challenging Child Behavior Triggering Adult
Child’s triggered response
Anger / Opposition/ Blame
Demand for affection
Patterns of approach and rejection
Extreme response to stressors
Reduced sense of efficacy
Guilt/ Shame
Shutting down or contradicting
Over-reactive
Being overly permissive
Blaustein & Kinniburgh 2010 25

26. Affect Management Self-monitoring skills Affect Management Skills
Body ~ Thought ~ Emotion ~ Behavior
Affect Management Skills
Building a Support System
Blaustein & Kinniburgh 2010 26

27. Affect Management Taking Care of Self
Deep Breathing
Muscle Relaxation
Distraction / Movement (Tai Chi)
Self Soothing / Self Care
Thought Cycle
Mindfulness/Thought Surfing
Meditation
QTIP 27

28. Thought Cycle 28

29. Thought Travel

30. Thought-based Principles
First Step: Awareness / Mindfulness / Attention
State of Mind not dependent on what is going on
90% of time it is the thought not the event that determines the experience
Response Ability
Passenger or Driver of the Thought-Train 30

31. Rule Book (agreements)
What is Stress?
Circumstances +
Thought Story
Rule Book (agreements)
State of Mind 31

32. Understanding Triggers
Trigger: A reminder of a past event that can lead to same set of emotions and behaviors
Blaustein & Kinniburgh 2010 32

33. Blaustein & Kinniburgh 2010
Attachment & Triggers
Avoid or withdraw from Caregiver
Overly clingy and unable to take in support
Freeze
Appear “manipulative” or try to control
Conflict approach / avoidant behavior
Blaustein & Kinniburgh 2010 33

35. Muddy Mind

36. Wheel of Awareness
Siegel, Bryson 2011

37. Viewed through our Lens
Mindfulness
Thoughts
Feelings
Behavior
Something
Happens
Viewed through our Lens 37

38. Mindfulness Awareness on Purpose Of Present Experience With Acceptance38

39. With…
Curiosity
Kindness
Compassion

40. Thought Surfing

41. Thought Surfing Identify Thought
Sit back and watch, don’t act, observe
Note the sensations
Be aware of triggers
Remember it is temporary, transient
Use a helpful mantra “This too shall pass”
Keep practicing
Steven Handel

42. Meditation
Belleruth Naparstek 42

43. Change the Dance, Change the Child: Attunement
“I see you”, “I hear you”
Attunement is a moment to moment, day to day process
Attunement fosters co-regulation 43

44. Consistent Caregiver Response
Active Listening
Self Regulation
Focus on Positive
Consistent behavior management
Blaustein & Kinniburgh 2010 44

45. Care giver Strategies
Star
Q Tip
(Bailey, 2001)

46. The Nurtured Heart Approach
Utilizes the challenges and intensity to create success
Creates first-hand success in the “NOW” moment
Helps create a new portfolio for the Child 46

47. The Nurtured Heart Approach
The approach has three basic aspects:
Super-energizing experiences of success.
Refusing to energize or accidentally reward negativity.
Providing a perfect level of limit-setting and consequences. 47

48. parent*teachers*workers
The adult in a child’s world is the ultimate prize !
parent*teachers*workers
When do we give the $100 bills?

49. The Three Legged Approach
#1 I will purposefully create success for the child
#2 I refuse to be drawn into accidentally
rewarding and energizing the negative
#3 I will provide a true consequence when the rule is broken

50. More than catching kids being good!!!
“Shamu”
“Toll Booth Man”

51. 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 51

52. Blaustein & Kinniburgh 2010
Time Outs
Provides Child space to calm from distressing moment
“RESET”
Used for impulsive or unsafe behavior
Blaustein & Kinniburgh 2010 52

53. Blaustein & Kinniburgh 2010
Trauma & Limit Setting
Reduce need for limits through limited choice
Compromise
Choose your moments (flipped brain)
Be aware of Triggers
Blaustein & Kinniburgh 2010 53

54. Blaustein & Kinniburgh 2010
Limits as Triggers
Fear of abandonment & rejection
Always name rationale for limit linking it to behavior
Moving on (mulligan)
Making adaptations to limits for specific triggers
Blaustein & Kinniburgh 2010 54

55. Blaustein & Kinniburgh 2010
Considerations
Start small and build
Start with reinforcement rather than limit setting
Don’t start with the most difficult behaviors
Blaustein & Kinniburgh 2010 55

56. Build Routine and Rituals56

57. “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

58. To your Greatness!! Annie Lange BSN, LMSW, ACSW Clinical Social Worker
Nurtured Heart Approach Advanced Trainer

59. Change the Lens, Change the Life Bibliography
Badenoch, Bonnie (2008) Being a Brain-Wise Therapist; A Practical Guide to Interpersonal Neurobiology. New York, W.W. Norton & Company, Inc.
Blaustein, M. and Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolsecents, How to Foster Resilience Through Attachment Self-Regulation and Compentency. New York, NY: The Guildford Press.
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.

60. Change the Lens, Change the Life Bibliography
Hendrix, H., and Hunt, H., (1997) Giving the Love that Heals: A Guide for Parents. New York, NY: Pocket Books.
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
Orlans, M., and Levi, T. (2006) Healing Parents: Healing Wounded Children Learn to Trust and Love. Washington, DC: Child Welfare League of America, Inc.
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.
Siegel, Ronald, (2010) The Mindfulness Solution. New York, NY: The Guilford Press