Mary Jo Barrett www.centerforcontextualchange.org Walking the Delicate Balance: Sexual Abuse in the Family-How did this happen and what can we do to survive Mary Jo Barrett www.centerforcontextualchange.org

Awareness and Attunement The range of what we think and do Is limited by what we fail to notice And because we fail to notice That we fail to notice There is little we can do To Change Until we notice How failing to notice Shapes our thoughts and deeds -R.D.Laing

What’s Already There? Narrative Bias Myth- about incest and about the treatment of incest

Goal of Workshop To take Incest our of the closet. To get therapist out of Trauma Mindstate around incest To stop blaming the victim To Name in the room what it truly is- why do we make it generic It is Taboo Shrouded in shame Treatment is not radically different, it is the energy around it that matters

Four Levels of Stress Reactivity TRAUMATIC STRESS PTSD COMPLEX DEVELOPMENTAL TRAUMA Any demand on the body system. Consequence of exposure to trauma. Interruption to flow Feelings Fear Helplessness Urgency Anxiety Anger Sadness Urges Fight or Flight or Freeze Exposure to events that are experienced as life threatening, intolerable or could cause injury or death. Experience of trauma becomes more intrusive. Avoidance of cues in the six senses (sight, sound, smell, taste, touch, mind) Hyper-arousal to triggers Result of Multiple Traumatic Events and reaction to Event Traumatic events begin in childhood- Complexity Multiple victimization Interacting contextual effects Depression Emotional deregulation Intrusive thoughts and feelings Identity disturbance Efforts to avoid /numb Relational Disturbance Hyper-arousal to both internal and external events

Working Definition of Incest

Working Definition of Incest Any sexual contact Touching, with intention to sexually arouse the victim and/or the perpetrator Kissing in a prolonged manner and with the above intention Fondling of genitals or other body parts in a sexual manner Overt sexual contact, such as oral-genital contact, manual stimulation of genitals or intercourse Any behavior intended to stimulate the victim sexually, or to stimulate the offending adult relative through the use of the child. This could include showing the child erotic material, taking sexual photographs of the victim, or erotic comments. Incestuous behaviors would be initiated by an adult relative or an adolescent or child relative who is more than a few years older than the child. Incestuous behaviors that are not consensual are considered incestuous abuse.

Trauma-Survival Mindstate Unmanageable stress and the freeze response When we are unable to organize our experiences and make meaning of them in a way that makes predictable sense; our development, growth, and learning are impacted. Complex traumatic histories impair affect regulation, ego adaptive capacities, impulse control, and attachment patterns. Difficulty controlling emotions, cognitions, behavior, and relationship

Sexual Abuse/ Incest Interpersonal in nature Style of interaction Disruption in attachment in significant relationships Often various types- of incest Over time- grooming Involving all forms of violations Revictimization through reactions, as well as, actions

Survival Skills of Abuse Survivors-Adults and Children (Avoidance) Mistrust of others Flashbacks Anxiety, terror and panic Shame, guilt, self-hatred Cognitive distortions Depression, passivity Dissociation Disturbed relatedness Difficulty attaching Detachment, numbing or withdrawal Sexual promiscuity or aversion to sex Drug and alcohol abuse Eating disorders Suicide Self-mutilation Anger and aggressive behavior Perfectionism Alienation from their bodies Personality disorders, mental illness

The Effects of Abuse and Complex Trauma I experience myself as powerless Symptoms as attempted solutions I am disconnected from myself, others, and the world around me Interactional Cycle of Survival I experience myself as devalued I am out of control

Vulnerability and Resource Model of Assessment Social/Political Contexts Community Gender Media Economic Religious Cultural Racial Ability Sexual Orientation Age Familial Contexts Hierarchy Communication Patterns Style Rules Roles Adaptability Boundaries Transgenerational Patterns Individual Context Physiological/Biological Patterns Neurological Temperament Victim/Survivor Cycle Coping Mechanisms Impulse Control Addictions Power Control Attachment Value *T. Trepper & M.J. Barrett 1985, 1989

Resources: Where we find energy and possibility Awareness/Realism- honestly looking at self Creativity- in options and meaning Humor Courage/Initiative Flexibility/Adaptability Faith/Trust Social Support

Fundamental Elements of Trauma Powerlessness Disconnection Devaluing Out of Control

Healing, Growth, and Change Healing, change and growth comes from a process of encircling a person/system with a sense of being valued and empowered. This is done by identifying and engaging with them through their own natural resources and their cycles of growth. Co-creating Refuge and Collaboratively gathering resources from within a person, their family and their community

Engaged Mindstate In an engaged mindstate individuals have access to and incorporate tools that regulate; their affect, cognitions, behavior, and relationships. They experience themselves as powerful, in control, valued, and connected to themselves, a support system and to the world around them. They are aware of their strengths, their resources and their vulnerabilities and have developed a skill set to deal with stress. When people are acting from an engaged mindstate, they have self-awareness and other awareness, can engaged in supportive relationships, and have a meaningful vision of the future.

A mirror neuron is a neuron that fires both when a person acts and when the person observes the same action performed by another You each become the reflection and extension of the other A back and forth energy emerges between you- liken to an electrical energy flow Positive resonance needs certain ingredients to exist-positive energy in each domain which is created in treatment

What is Therapeutic Change A Differentiation of a Trauma/Survival Mindstate and an Engaged Mindstate which is Based on Present Experience Development of Collaborative Based Therapeutic Goals Effort and Strategies to Build New Patterns of Action-Mind and Body to meet the Collaborative Goals

Moving from Chaos to Coherence Aware and Attune Acknowledge and Accept What’s Already There Self-Regulation Reflect and Explore Mindful and Appropriate Interventions Reorganization and Integration

Traumatized people need to have physical & sensory experiences to: Unlock their bodies Activate effective fight/flight Tolerate their sensations Befriend their inner experiences Cultivate new action patterns

Five Essential Ingredients for Healing Attachment and Connection: To build and rebuild relationships where there is a felt sense of belonging, mutual curiosity, compassion, empathy, connecting to a deep set of values to self and other that provide a meaningful vision. Safety and Empowerment: Building a Safe context/boundaries/structure within and between themselves and their relationships- collaboration and predictability Value: Thru Collaboration/Strength based guidance/Understanding and Identifying Vulnerability and Resources/ and Recognizing the universal nature of challenge and change Skills: Learning and Experience -Psycho educational and experiences/cognitive behavioral/neuro-mind-body/communication/mindfulness/self-regulation within and between Hope: Creation of workable realities – experiencing the possibility of change

Enhance client capabilities Improve client motivation for treatment Five Tenets of an Integrated and Comprehensive Treatment Model-Guidelines for Standards of Care Enhance client capabilities Improve client motivation for treatment Structure the environment Generalization to the environment Enhance therapist’s motivation to provide effective treatment

Enhancing client’s capabilities   Skills training- interpersonal and self Interpersonal regulation- in family, social, work Stabilization of sense of self and emotion regulation

Improve the client’s motivation for change   Collaboration: understanding of process of change, designing process and goals-hence engaging in process, and investing in outcome. Interventions that help quickly, that are practical and understandable Clear and Predictable Treatment Plan- Order to putting life in Order

Assure generalization to natural environment   Homework assignments and practice outside of sessions In session Practice of Skills and Experience and Process Family and Relationship Involvement in the Process

Therapist Own Self: Enhance therapist’s capabilities & therapist’s motivation to treat effectively   Therapist Use of Self- understanding therapeutic giving and receiving Mindfulness and Ethical Attunement Therapeutic Fitness Collaboration An Effective Model to build therapist’s confidence and self empowerment

CCM Provides A Structured Environment   Clarity of Model Understanding Attachment Emphasis on Safety Clear Boundaries Predictability Structure of natural cycle of change Clear stategies to teach and practice skills

The Collaborative Change Model is a Fractal Model of Change A fractal is a never-ending pattern. Fractals are infinitely complex patterns that are self-similar across different scales. They are created by repeating a simple process over and over in an ongoing feedback loop Barrett and Stone Fish

What the caterpillar calls the end of the world, the masters call a butterfly. - Richard Bach

Collaborative Change Model- A Concept driven Model for Change Creating a Context for Change- Refuge, Attachment, Assessment, Direction, Acknowledgement Challenging Patterns/Cycles and Expanding Realities- Give us the opportunity to recognize- Vulnerabilities and Resources-Obstacles and Possibilities- Consolidation- Combining experience to make it stronger more solid for next Repetition. Not an ending rather creating the possibility of evolution

Environment for Change Safe- creating refuge; unlikely to be in danger Seen-Heard-Understood Soothe-lack of stress Secure-assured and steadied 31

Being a “neurobiological regulator” Being a neurobiological regulator requires that the therapist stay attuned to both the regulating and dysregulating effects of the therapeutic encounter. Like a “good enough” mother, we must strive to create an optimal level of arousal from moment to moment.

Regulator (cont’d) Effective neurobiological regulating on the part of therapists requires paying more attention to how we are affecting autonomic arousal than we pay to the content of the patient’s communication and with how to maintain an optimal level of arousal in the room. Janina Fisher,

Daniel J. Seigel, MD The Mindful Therapist Knowing ourselves is the first place to start as we try to widen our windows of tolerance for a broad variety of states in ourselves. We need to learn the art of monitoring our internal world so that we can sense when we’re moving inflexibly far from the plane of possibility. Without such a refined awareness on our part, we may project a feeling of impending chaos or rigidity onto our clients, inappropriately try to move them to their safe place in an attempt to keep them in the window, and directly give them the sense that they, too, are unable to tolerate whatever feeling our memory is emerging at the time. This is how our own internal state of distress can influence our clients’ states.

Relationships- Interactional Patterns Restructure where necessary Increase trust Improve communication Increase connection and intimacy Understand sexual dynamics Understand interactional cycles Interruption of interactional cycles Continue to learn, refine and practice skills- mind, body, in context Practice Incest is transactional and happens in the context of attachment and relationship Goal of treatment to move individuals and the family system into engaged mind state from the chaos of traumatic mind state

Mirroring = Attunement To foster a “felt sense” of connection, we mirror the client’s words and body language, hoping to evoke a visceral sense of being joined, a shared space, a sense of the therapist’s interest and ability to get it. Mirroring is not about WHAT we say, but HOW we say it: interest, body language, choice of words, tone. It is also dyadic dancing: as we mirror clients for signs of resonance, we adjust our words and presence to maximize their ability to stay present and socially engaged. Like parents. Our moment to moment adjustments help clients to regulate and keep their frontal lobes online as much or more as any skill we could teach them. Janina Fisher, PhD