neil w. boris, m.d.dentistry-ipce.sites.olt.ubc.ca/files/2016/08/ey2016plenary-boris.pdf ·...

Neil W. Boris, M.D. 

Clips from a play therapy session ~4 ½ year old boy, his therapist and Grandmother (who is currently caregiver)

What does this clip tell us about this boy’s experiences?

What does this clip tell us about his attachment  needs or struggles?

D. is brought in by GM who says his behavior is “out of control:” Aggressive in Pre‐K (suspended) “doesn’t listen”; “hits and kicks”

At age 2, D. was “kicked across the room” by mother’s then boyfriend Sustained ruptured spleen, lacerated liver‐days in the hospital Removed from Mo’s care to GM…

“As our understanding of the interface of brain development and early psycho‐social experience increases, we see the role of the attachment relationship as far more than being there to protect the human infant. It also fulfills an evolutionary role in ensuring that the brain structures that come to subserve social cognition are appropriately organized and prepared to equip the individual for the collaborative existence with conspecifics for which his or her brain was designed…”

1. Selection of neuronal pathways

2. Emotions—development and regulation

Schore, 1999

Attachment was based on observations Harry Harlow’s monkeys and “Imprinting”

“Bio‐Behavioral System” that is present in many species We are “hard wired” to attach in infancy/early childhood

The system is operative across lifespan Attachment behaviors do change across time! Study of attachment in adults is blossoming…

Before birth…though you can assess attachment reliably starting about 7‐9 months of age…

Initially organized around “protection”—safety under threat…

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me• Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell

Facilitate child’s exploration of physical environment

Emotionally available Physically available

ALLOWING THE CHILD TO GO INTO THE ENVIRONMENT 

TO EXPLORE

Responding sensitively in stressful/alarming situations

Provide reassurance Provide comfort Provide protection

ALLOWING THE CHILD TO COME BACK FOR 

COMFORT/PROTECTION

SECURE BASE SAFE HAVEN

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me• Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell

As each of us has repeated experience (trips around the Circle) with our primary caregivers, we form a set of expectations about relationships

Bowlby called these “Internal Working Models”

1. Selection of neuronal pathways

2. Emotions—development and regulation

Schore, 1999

Relationships are dangerous…I don’t deserve love…I’m so ashamed…what did I do to my son?!

There are monsters everywhere!

[My Mommy left me…Will you  protect me?...Or should I just try to defend myself??]

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me• Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell

CIRCLE OF DISORGANIZATION: Infant To Toddler

© 1999 - Cooper, Hoffman, Marvin & Powell

I need you but you are so frightened or

frightening that I have no one to turn to and I don’t know what

to do.

CIRCLE OFDISORGANIZATION—

PRESCHOOL & OLDER

I need you but you are so frightened or frightening that I have no one to turn to ….BUT NOW I KNOW WHAT TO DO…..

Maternal Depressionand PTSD

Parenting Behavior

Parent-ChildRelationship

FamilyFunctioning

Attachment-Emotion Regulation

ChildDevelopment

Cummings, EM J Child Psychol Psychiatr 35 (1): 73-112, 1994

Family Violence Substance Abuse

“Each individual builds working models of the world and of himself in it, with the aid of which he perceives events, forecasts the future, and constructs his plans. In the working models of the world that anyone builds a key feature is his notion of who his attachment figures are, where they may be found, and how they may be expected to respond. Similarly, in the working model of the self that anyone builds a key feature is his notion of how acceptable or unacceptable he himself is in the eyes of his attachment figures. “ (Bowlby, 1973, p, 203)

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me• Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell

Mutual regulation:

Preschoolers regulate

behavior and emotions

with others

Self-regulation of behavior

and emotions

Behavior and Emotion Regulation Across Development

Trauma May Impair Both Mutual and Self-Regulation

“Little t” trauma:  Parent stepping off the circle This can be DEVASTATING over time (especially if there is no other attachment figure)

“Big T” trauma:  Abuse events Always needs healing…

Historical trauma:  the tearing down of culture‐oppression and its aftermath Often leads to intergenerational effects

Circle of DisorganizationHistorical Trauma

•Displacement•Terror•Cultural oppression

Generations

•Displacement•Terror•Cultural oppression

“Ancestral memory and DNA”…

Identify families with [young] children at risk and engage them in change Do frontline staff really “see” the impacts of trauma on parents and kids?▪ “baby was too young to be affected”

How well to we engage?   What do we have for such families to engage into?

Do we automatically support foster families or others who we know serve traumatized young children?

Child‐Parent Psychotherapy (CPP; Lieberman, et al.)

Attachment and Biobehavioral Catch‐up (ABC; Dozier et al.)

Circle of Security (COS; Cooper, Hoffman, Powell and Marvin)

All are manualized therapies All focus on the dyad and attachment All have a research base  CPP has randomized trials ABC has shown physiologic change in toddlers

All require intensive training (varying levels depending on how “deep” into the treatment you go) Supervision is key to therapist development…

Schore, 1999

Entry Points COS

CPP

ABC

Group (COS) vs. Individual (CPP, ABC) (Each can be applied both ways)

Methods ABC uses “onsite” coaching of interactions COS uses video feedback method CPP is true dyadic/triadic therapy

Therapist characteristics and situation often drives the choice Level of experience/practice environment/ availability of training and supervision

For the case presented today, we used a modified form of Parent‐Child Interaction Therapy …because that’s what Tony was trained in!

Program in FL that has trained foster parents in ABC so they can work with bio parents

Baby Court in FL training therapist in COS to start with groups Those who engage then get CPP individually

“Never doubt that a small group of thoughtful, committed citizens can change the world.  Indeed, it’s the only thing that ever has.”

Margaret Mead

Program Committee Sonya Vellet

Circle of Security  Bert Powell, Glen Cooper and Kent Hoffman

Bob Marvin www.circleofsecurity.net

nboris212@gmail.comfor information on training, speaking, program building and delivery