Nurses working with difficult families and vicarious trauma - dealing with their emotional health.” Mandy Seyfang 2014

What do we mean by “difficult families? Emotionally dysregulated families Unable to think/ reflect

“ at times we work with very fragmented, disorganised people for whom I believe the greatest hope is through a therapeutic relationship that can withstand many attacks” Cindy Smith M

Ongoing effects of early trauma Intrusion of traumatic memories Hyperactivity, hyper vigilance Compulsive exposure to dangerous situations- reenactments Dissociation- altered ability to attend and process information Loss of trust in world Poor self perception Extreme difficulty with emotional regulation Split off parts of self M

Aims in relationship Collaborative and safe Sensitive attunement to others affect, needs and anxieties Predictable and consistent- holding environment Awareness and use of transference and counter transference Focus on strengths Working within limits and boundaries Grounded in present to make sense of the past Able to address arousal levels M

Karpman Drama Triangle…. the triangle represents crisis points for us as workers if we are at any one point of traingel Victim… capacities… and also own limitations Rescuer…client is competent Persecutor… be in touch with empathy….

Allan Schore Common factors that support therapuetic change promote affect regulation NOT cognitive insight as was once thought Affect regulation is in the RIGHT brain and is best achieved by another RIGHT brain STOP LOOK LISTEN- need deep emotional involvment on workers part Intimacy is needed to drop defences, dissociation and create safe environment

Workers stance Emotionally sensitive worker- psychobiological attuned Ability to pick up cues that signal a change in state ( NV , behaviour and shift in affect) Empathy- to explicit and implicit experiences and concerns Intuition without conscious reasoning Focus on Affect regulation Flexibility rather than rigid principles Being OPEN to the unfolding experience- loosen control- images rather than thoughts Authentic heartfelt language Suspending LEFT dominance – go more with images, feelings, physical sensations, metaphors, gut feelings, hunches, gist- HOLD Back interpretation Survive the furor- dysregulation to regulation- repair focus

Arousal Continuum- Perry, B (2010) Mental state Calm Alert Alarm Fear Terror Brain area Neo cortex Sub cortex Subcortex Limbic Limbic and midbrain Midbrain and brainstem Brainstem Autonomic Cognition Abstract Concrete Emotional Reactive Reflexive

Mindfulness moments To regulate oneself Internal/ external focus Learn to switch attention Exercise

MISTRUST Social monitoring sensitized Alert to rejection Don’t trust good intentions Controlling behaviour to feel safer Caregivers can feel rejected Develop a shield against shame- Lie Blame Rage

Connection B4 correction PACE before instruction Decrease shame whenever possible

Questions…