Transcript The Pyramid Self

Attachment and the
Secure Base System
Self-Confidence/Exploration
Felt security
Secure Base
Caregiver’s
Signal detection
Perceived Threat
Safe Haven
Attachment System
Signaling
Proximity Seeking
The Effects of Secure Base
 Repeated Secure-base interactions create
internalized models of relationships that are
carried forward to new relationship experience
experiences
 What to expect
 How to behave
Secure Base Effects
 Powerful influence on Neurobiology
 Emotion-Regulation and Sensory Integration
 Language Development
 Executive skills—




Shifting
Monitoring
Labeling
Problem-solving
Healthy Neurobiology
 Three interrelated systems
 Thinking
 Feeling
 Relating/communicating
 Working together in an integrated, goal-directed,
collaborative fashion
Attachment Problems
 Attachment Problems—failures in the secure base
system result:
 Defensive, maladaptive relationship models
 Neurobiological failure
 Neurocognitive deficits—lagging skills in:



Thinking
Feeling
Relating/communicating
Most commonly referral to community mental health centers
Includes:
Attention Deficit Hyperactivity Disorder
Oppositional Defiant Disorder
Conduct Disorder
Copy Right: /Sibcy, 2005
[email protected]
Oppositional Defiant Disorder
 Symptoms
 Temper tantrums
 Arguing with adults
 Questioning rules
 Active defiance and refusal to comply with rule
 Deliberate attempts to annoy
 Touch and easily annoyed
 Anger and resentment
 Mean and hateful when upset
 Spiteful attitude and revenge seeking
Complex Oppositional Defiant
Disorder
 Define the problem:
 Meets criteria for ODD, Plus
 Executive skill dysfunction
 Emotion dysregulation—anger plus other emotions
 Relationship disturbances, which includes attachment
system
 Highly resistant to traditional parenting practices
Severe Mood Dysregulation (SMD)
 Distinguished from Classic Bipolar Disorder in
Children (episodic irritability)
 Abnormal baseline mood: irritable, anger, and/or
sadness, noticeable to others & present most of time
 Hyperarousal: insomnia, physical restlessness,
distractibility, racing thoughts or flight of ideas,
pressured speech, intrusiveness
 Increased reactivity to emotional stimuli (temper
outburst) at least 3x/week
Differences in anger expression
 Hand-grenade –ADHD/ODD combo only
 Hurricane—SMD or BPD
Sameroff’s three R’s of intervention
 Re-education
 Redefine
 Remediate
Re-education
The Pyramid Self-Control
Self
Control
Problem
Solving
Cognitive Flexibility
Language Processing/Mindsight
Social Skills
Emotion Regulation
Redefine
Motivation vs Skills
Motivation
Skills
Motivation
Yes
Yes
Adaptive
Maladaptive
(Family
System)
Maladaptive
SMD/BPD
Maladaptive
Family +
CODD with
SMD
Skills
No
No
Preventing explosions while enhancing secure-base
and neuro-cognitive skill development
Goals:
Take parent concerns seriously
Take child concerns seriously
Reduce Challenging Behaviors, especially Reduce MeltDowns
1.
2.
3.



4.
5.
Destructive child’s nervous system
Conditioned Emotional Responses (CERs)
Reinforces insecure relationship models (attachment)
Work on Neuro-Cognitive Skills—Whole Brain Child
Improve Secure Base
Using the Whole Brain
 Left-Right Hemisphere
 Brain Stem
 Limbic System
 Avoid Amygdala Hijacking
 Septal Rages
 Prefrontal Cortex
Secure Base Effects
 Powerful influence on Neurobiology
 Emotion-Regulation and Sensory Integration
 Language Development
 Executive skills—





Frustration tolerance
Shifting
Monitoring
Labeling
Problem-solving
Three Pathways
Pathway A—forcing concern
Compliance Interaction
Pathway B—Working on
Pyramid
Pathway C—temporarily dropping
concern
Three Pathways Compliance Interactions
 Pathway A—Force Adult Concern


Advantages
Disadvantages
 Pathway B—Collaborative Problem Solving


Advantages
Disadvantages
 Pathway C—Temporarily Dropping Concern


Advantages
Disadvantages
Collaborative Problem Solving:
 E—empathy—
 A—Assert—
 R—Respect—
---------------------------- I—Invite- C—Collaboration—
Empathy & Validation
 Listening and understanding child concerns
 Helping child articulate concerns what the concern
 Taking concerns seriously
 Empathy is a reciprocal process, so you may try to
empathize but if the child does not believe you
understand then you have not empathized
Assert—with limits
 Define Problem, expressing concern or expectation
 Don’t mistake your solutions for concerns or
expectation
 Appeal to rules as important principles to follow
 “You can be angry but you can’t do…”
Regulation—keeping it safe
 Work at monitoring and managing your own emotion




regulation—if too upset, go to pathway C
Non-contingent respect
Never use disrespect as a form of punishment
Avoid global, negative attributions
Remain warm—avoid triggering CER’s
Invite
 asking child to generate possible solutions
 Avoid forcing solutions
 Think out loud
Collaboration
 Working with child to come up with workable





solutions
Help child use foresight and hindsight
Model flexibility
Model regulation
Model respect
Maintain warmth
Qualities of Good Solutions
 Mutually satisfactory
 Do-able
 Durable
Back to the pathways
 When to use A
 When to use C
 Different kinds of C’s, some are better than others
 Two kinds of B’s
 Emergence
 Proactive—timing is everything
Parenting and Mentalization









The use parent-child interaction questionnaire
Describe situation: beginning, middle, end
Describe behavior
Interpretations
Actual outcome
Desired outcome
Question: did you get DO?
Why?
Remediation Phase
Engaging the Repair Cycle
 Turning conflict into learning