1 PLACE/HOME IN UNIVERSE Amsterdam 2009 PBSP & Attachment Theory Comparative Exercise S tudy Petra Vrtbovská Ph.D. Natama – Institute for Family Care Development, Prague Project is supported by Teresa Maxova Foundation Prague

2 WHAT WILL BE COVERED? Method: Comparison of some phenomenological issues in AT and PBSP PLACE, our HOME, in our mind and body Attachment Theory Basics & PBSP Circle of Trust & Shape – Counter-shape Early development (0 – 3 - 5), implicit memory and its impact on „place – home“ Attachment disorders in PBSP structures

3 Within two (or more) referential frameworks: Helps to discover phenomenological equivalents and similarities Helps to discover fundamental differences COMPARATIVE APPROACH

4 TWO FRAMEWORKS PBSP focuses on and defines : Developmental needs and importance of interactive fulfillment of them Principle of „interactive need satisfaction“ Consequences of deficits, trauma and holes in roles Special effective therapy, which uses „Ideal Parents“ in order to change the impact of these consequences ATTACHMENT THEORY and derived therapeutic practice focuses on and defines: Importance of primary care giver (parental figure) for healthy development of personality (including neurobiology) Principle of need satisfaction process Disorders caused by neglect, abuse, trauma in early age „Healthy Parenting Model“ as a healing tool for children and adults

5 MAIN FOCUS TODAY ATTACHMENT THEORY: Attachment Circle of Trust, Circle of Shame Attachment disorders & therapy (DDP) PBSP Basic needs – Place Shape – counter-shape PBSP therapy and attachment disorders

6 PLACE/„home“ in UNIVERSE „The uterus is a place, which literally sustains and respects the child inside. Defines its location and identity. On a symbolic level, the place is in the heart of parents or care givers. Then in the stage of autonomy and self-reliance, we have place in our mind and body. We are „at home“ in our own mind and body…“ Albert Pesso „ One can sit in a beautiful garden and feel desperation, fear, sadness, hopelessness…. As well one can feel very content, calm and hopeful in rather deserted places…“ His Holiness Dalajlama

7 SUMARY OF ATTACHMENT THEORY John Bowlby (1907 – 1990) Genetically based importance of a „mother figure“ and relationship between a child and a „mother“ Attachment Secure Base Inner Working Model Mary Ainsworth (1913 – 1999) Strange situation (diagnosis – research)

8 „ ATTACHMENT“ PHENOMENON I

9 „ ATTACHMENT“ PHENOMENON II „ Attachment“ is an in born system in the brain that evolves in ways that influence and organize motivational, emotional, and memory processes with respect to significant caregivers“ „Repeated experiences become encoded in implicit memory (RH) as expectations and mental models…“ (Daniel J. Siegel)

10 ENERGY-ACTION-INTERACTION-MEANING in a circle shape… ENERGY ACTION MEANING INTERACTION

11 „ ATTACHMENT“ PHENOMENON III

12 TWO FRAMEWORKS Pesso Developmental needs have to be fulfilled at the right time, with the right people in a right way… Memory of good experiences Memory of deficits, trauma, holes in roles… Bowlby It is important that (1) the child's needs are satisfied and (2) the way they are satisfied. By attuned, sensitive caregiver, the same loving safe person. It creates a relationship between the carer and the child, this relationship is encoded as healthy „attachment pattern“ - secure base Bad care is then encoded as a distorted relationship - attachment disorders…

The Developing Brain = Embodied Experience of Care

14 Encoding in early age… RH „Self-awareness, empathy, intersubjective processes are largely dependent upon… right hemisphere resources, which are first to develop.“ (Decenty, Chaminade Consciousness and Cognition, 2003) „Unconscious right brain implicit self now described as „ a cohesive active mental structure that continuously appraises life's experiences and responds according to its scheme of interpretation.“ (Alan Schore, 2003) Emotions = Meaning Memory of meaning Implicit memory, implicit „I“ = meaning of self

15 THE TREE METAPHORE

16 SECURE & INSECURE ATTACHMENT Ainsworth: Secure attachment Insecure attachment: 1.Avoidant, anxious 2.Ambivalent Main, Hess: Disorganized- disoriented attachment DSM – IV (USA) Reactive Attachment Disorder (RAD) Boston Group (Bessel van der Kolk…) Complex Developmental Trauma (CDT)

17 ATTACHMENT in ADULTHOOD Child attachment pattern Adult state of mind with respect to attachment SecureSecure/autonomous Coherent, collaborative, valuing of attachment, objective AvoidantDismissing Not coherent, dismissing attachment related experiences, normalizing, generalizing, brief, „emotionless“ AmbivalentPreoccupied Not coherent, preoccupied, angry, passive, fearful, long tangled speech, irrelevant Disorganized- disoriented Unresolved/disorganized Striking lapse in speech, reasoning, discourse Base for serious personality disorders

Insecure attachments - what do we see?

19 SECURE – INSECURE PLACE in UNIVERSE „Children grow up with dominant experiences of separation, distress, fear and rage, then they will go down not just bad psychological pathway but a bad neurological pathway.“ (Watt, 2003) „Sickness, insanity and death were the dark angels standing guard at my cradle and they have followed me throughout my life.“ (Edward Munch)

20 BOTANICAL GARDEN Taking our place with us everywhere…

21 REACTIVE ATTACHMENT DISORDER (RAD) & CDT RAD (is not just a disorder…) It is a psychiatric diagnosis (USA, DSM – IV- R) Marked disturbed and developmentally inappropriate social relatedness starting before 5 years Excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses to people, indiscriminative friendliness History of pathological care

22 CDT - Complex Developmental trauma (Boston Group – Bessel van der Kolk) Refers to the affects of early, chronic maltreatment in care-giving relationship 7 DOMAINS: 1.Attachment (relational boundaries, lack of trust, social isolation, difficulty to attune with others, lack of secure base) 2.Biology 3.Emotional regulation 4.Dissociation 5.Behavioral regulation 6.Cognition 7.Self-Concept

23 Attachment based therapy approach For developmentally traumatized children/ adults: Dyadic developmental Psychotherapy (Daniel A. Hughes) Therapist – parent relationship Healthy parent – child relationship Rehabilitation of attachment relationship with a new safe adult (therapist) via relationship here and now.

24 PBSP – comprehensive framework PBSP describes and shows how parental care works on multidimensional level in all developmental phases Memories of the process of shape – counter- shape and meaning are being stored through the whole childhood The patterns „form“ the whole „model of autonomy“ of the person (PV)

25 Does PBSP touch on attachment? PBSP structure is from the AT point of view an unique „tool“, as Within a structure session, the clients brain opens different phases of development, explicit as well as implicit memories of events, relations to carers and „self“. The healing is done right „then“ with an „ideal attachment figures“. It is working with memory layers (tree skins)

26 HORIZONS & PRACTICE of PBSP with Attachment issues Attachment disorder = overwhelming SHAME Clients with attachment disorders in PBSP Can PBSP heal attachment disorders and complex trauma? PBSP and help for parents – healthy parenting

27 PBSP and AT disorders, RAD, CDT Practical outcomes for future work… Research to evidence effectiveness of PBSP based on established attachment research (AAP – Adult Attachment protocol) PBSP introduced as an effective therapy for AT disorder based psychological problems