1. ATTACHMENT AND TRAUMA DR. GENA CASTRO RODRIGUEZ, LMFT
CALIFORNIA CASA ASSOCIATION
MARCH 28, 2014
OAKLAND, CALIFORNIA
© 2014 Gena Castro Rodriguez

2. AGENDA Introductions and Agenda Overview of Attachment Theory
Break- 15 minutes
Overview of Trauma
Lunch- 1 hour
Effect of Trauma on Attachment
Framework for Working with Children and Youth

3. ATTACHMENT DEFINED
“Attachment” is an inborn system in the brain that evolves in ways that influence and organize motivational, emotional, and memory processes with respect to significant caregiving figures. Siegel, 2013

4. HISTORY AND MAJOR THEORISTS
JOHN BOWLBY
MARY AINSWORTH
Bowlby- London- coined turmed attachment Early influences Freud, Klein
After wwii bowlby – psychiatrist and psychoanalyst was asked by UN to write about maternal deprivation
1951 Bowlby sought new understanding from the fields of evolutionary biology, ethology, developmental psychology, cognitive science and control systems theory.
Pre attachment 0-6 months
period of 6mos to 2 years- sensitive responsiveness
Ainsworth- 60s 70s research primarily in Scotland and Uganda
When they learn to crawl and walk they use AF as secure base
Stranger Situation Protocol
ATTACHMENT IN ADULTS- 80s
Later criticisms of attachment theory relate to temperament, the complexity of social relationships, and the limitations of discrete patterns for classifications.
The set-goal of the attachment behavioural system is to maintain a bond with an accessible and available attachment figure.[15] "Alarm" is the term used for activation of the attachment behavioural system caused by fear of danger. "Anxiety" is the anticipation or fear of being cut off from the attachment figure. If the figure is unavailable or unresponsive, separation distress occurs.[16] In infants, physical separation can cause anxiety and anger, followed by sadness and despair. By age three or four, physical separation is no longer such a threat to the child's bond with the attachment figure. Threats to security in older children and adults arise from prolonged absence, breakdowns in communication, emotional unavailability, or signs of rejection or abandonment.[15]

5. BOWLBY- INFANT ATTACHMENT CYCLE

6. CHARACTERISTICS OF ATTACHMENT
Proximity Maintenance - The desire to be near the people we are attached to.
Safe Haven - Returning to the attachment figure for comfort and safety in the face of a fear or threat.
Secure Base - The attachment figure acts as a base of security from which the child can explore the surrounding environment.
Separation Distress - Anxiety that occurs in the absence of the attachment figure.
BOWLBY THEORY

7. ATTUNEMENT A process that includes 2 parts
Ability to connect with another person’s experience/sensations (i.e. empathy)
The communication of that connection to the other person (Erksine, 1998)
Much of attunement may rely on preverbal and/non-verbal communication facial, body movements, attitude, timing (i.e., experientially) (McWilliams, 1994; Stern, 1984; Papousek and Papousek, 1979)
All of which combine to convey that a client’s relational and affective needs are perceived, and have an impact on the therapist
Still Face Study Dr. Edward Tronick
Slide from Dr. John Snyder, SFPRG

8. AINSWORTH & BELL Controlled observation of child’s attachment behavior
Mother leaves child in unfamiliar environment
Child is approached by stranger
Mother returns
Looks at:
Separation protest
Anxiety
Reunion behavior
The Stranger Situation

9. AINSWORTH- ATTACHMENT PATTERNS
SECURE
INSECURE
Ambivilant
Preoccupied
Resistant
Avoidant
Dismissive
DISORGANIZED
Fearful
Disorganized
Reactive
Mary Main at UC Berk defined disorganized children's lack of a coherent coping strategy Children with a disorganized pattern in infancy tend to show markedly disturbed patterns of relationships. Subsequently their relationships with peers can often be characterised by a "fight or flight" pattern of alternate aggression and withdrawal. Affected maltreated children are also more likely to become maltreating parents.
70% SECURE, 15% RESISITANT/INSECURE 15% AVOIDANT/INSECURE
About 80% of maltreated infants are likely to be classified as disorganized

10. CAREGIVERS Secure Avoidant Resistant
Primary Caregiver’s Behavior Towards Child
Child’s ‘Working Model’ of Itself
Positive & Loved
Unloved & Rejected
Angry & Confused
SECURE: Sensetive and Responsive
Insecure/Avoidant-unresponsive
Insecure: Inconsistent
Secure
Avoidant
Resistant

11. ANIMALS AND ATTACHMENT
Harlow’s Monkeys 1958
The behaviorist framework of explanation would suggest that an infant would form an attachment with a carer that provides food (in behaviorist terms, food is the primary reinforcer, the provider of the food is the secondary reinforcer). ;Harlow and Zimmerman (1958) found evidence against this hypothesis using rhesus monkeys.
Harlow Monkeys 1958

12. TRAUMA Traumatic Events Direct Exposure Witnessing in Person
Types
Abuse- Emotional, Physical, Sexual, Neglect
Assault- Physical, Sexual
Domestic Violence
War, Terrorism, Political Violence- Inside/Outside U.S.
Illness, Medical, Injury, Accident
Natural Disaster
Kidnapping, Forced Displacement
Traumatic Loss And Bereavement
Impaired Caregiver
Extreme Personal/Interpersonal Violence- VOC
Community Violence
School Violence
Vicarious Trauma
Traumatic Events
Direct Exposure
Witnessing in Person
Indirect Exposure
Repeated or Extreme Indirect Exposure to Aversive Details of Events
Incidents of Trauma:
Single Incident Trauma:
Multiple Incidents of Trauma
Early Childhood Trauma

13. ATTACHMENT DISORDERS Problems in attachment lead to:
Poor emotional regulation
Decreased feelings of self worth
Difficulty forming and sustaining satisfying relationships
Attachment Disorder: Diagnosis and Treatment

14. TRAUMA AND DISORGANIZED ATTACHMENT
Dr. Siegle on Disorganized Attachment in the Making

15. CYCLE TRAUMA AND DISORGANIZED ATTACHMENT
Perceive
Triggering
Conditions
Everyday Activities  
Provokes Anxiety
Anxiety Suppression and Distancing 
Children with a disorganized pattern in infancy tend to show markedly disturbed patterns of relationships. Subsequently their relationships with peers can often be characterised by a "fight or flight" pattern of alternate aggression and withdrawal. Affected maltreated children are also more likely to become maltreating parents.
Seeks
Closeness
To Partner
Gives Up on Getting Positive Response   
Increases
Insecurity and Anxiety
Partner Responds
Negatively 

16. Internal Working Model for Self (dependence)
Others
Early experiences with caregivers gradually give rise to a system of thoughts, memories, beliefs, expectations, emotions, and behaviours about the self and others. This system, called the "internal working model of social relationships", continues to develop with time and experience.[28] Internal models regulate, interpret, and predict attachment-related behaviour in the self and the attachment figure. As they develop in line with environmental and developmental changes, they incorporate the capacity to reflect and communicate about past and future attachment relationships

17. ADULT ATTACHMENT CHILD CARE GIVER ADULT SECURE AVOIDANT
Uses caregiver as a secure base for exploration. Protests caregiver's departure and seeks proximity and is comforted on return, returning to exploration. May be comforted by the stranger but shows clear preference for the caregiver.
Responds appropriately, promptly and consistently to needs. Caregiver has successfully formed a secure parental attachment bond to the child.
Able to set appropriate boundaries; comfortable in relationships; able to seek support from partners
AVOIDANT
Little affective sharing in play. Little or no distress on departure, little or no visible response to return, ignoring or turning away with no effort to maintain contact if picked up. Treats the stranger similarly to the caregiver. The child feels that there is no attachment; the child is "rebellious" and has a lower self-image and self-esteem.
Little or no response to distressed child. Discourages crying and encourages independence.
Avoids closeness or emotional connection; distant critical; rigid; intolerant; greater sense of autonomy; tend to cut themselves off emotionally from partner

18. ADULT ATTACHMENT (CONT)
CHILD
CAREGIVER
ADULT
AMBIVILANT
Unable to use caregiver as a secure base, seeking proximity before separation occurs. Distressed on separation with ambivalence, anger, reluctance to warm to caregiver and return to play on return. Preoccupied with caregiver's availability, seeking contact but resisting angrily when it is achieved. Not easily calmed by stranger. In this relationship, the child always feels anxious because the caregiver's availability is never consistent.
Generally will only respond after increased attachment behavior from the infant.
Anxious and insecure; controlling; blaming; erratic; unpredictable; sometimes charming ; fears rejection from partner; strong desire to maintain closeness
DISORGANIZED
Stereotypes on return such as freezing or rocking. Lack of coherent attachment strategy shown by contradictory, disoriented behaviors such as approaching but with the back turned.
Frightened or frightening behavior, intrusiveness, withdrawal, negativity, role confusion, affective communication errors and maltreatment. Very often associated with many forms of abuse towards the child.
Cannot establish positive relationships; often misdiagnosed

19. ATTACHMENT INVENTORIES
HAZAN AND SHAVER, 1987

20. CORRECTIVE RELATIONAL EXPERIENCES
Attachment Therapy
Relational Therapy
Emotionally Focused Therapy- EFT
The therapeutic relationship becomes the testing ground for emergence of new skills and are the context in which these issues are experienced, explored, shared, understood, and ultimately resolved

21. CONSTRUCTIVIST SELF-DEVELOPMENT THEORY
5 KEY DOMAINS
Safety
Trust
Esteem
Intimacy
Control
Pearlman & Courtois, 2005

22. KEY ELEMENTS IN RELATIONSHIPS
Respect
Information
Connection
Hope
For therapists- integrity, reliability, self-monitoring, supportive connections and self care
Pearlman & Courtois, 2005

23. REFERENCES
Allen, J. & Land, D. (1999) Attachment in Adolescence. In Handbook of Attachment: Theory, Research, and Clinical Applications. The Guilford Press. New York, New York.
 Bain, L. (2009). Examining Attachment Classifications and Trauma History in Violent and Nonviolent Juvenile Offenders. Dissertation. Pacific Graduate School of Psychology.
 Bretherton I. (1992). The Origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology. Vol.28. No.5.pp
 Briere, J. & Shannae, R. (2007). Self-Awareness, Affect Regulation, and Relatedness: Differential Sequels of Childhood Versus Adult Victimization Experiences. The Journal o fNErvous & Mental Disease. Pp  
Cassidy, J; Mohr, J. (2001) Unsolvable Fear, Trauma, and Psychopathology: Theory, Research, and Clinical Considerations related to Disorganized Attachment. Clinical Psychology: Science and Practice; V8, N3, p
Cassidy, J. & Shaver, P. (1999).Handbook of Attachment: Theory, Research, and Clinical Applications. The Guilford Press. New York, New York.
 Ma, K. (2006). Attachment theory in adult psychiatry. Part 1: Conceptualizations, measurement and clinical research findings [Figure]. Advances in Psychiatric Treatment- The royal College of psychiatry. Retrieve from:
Padykula, N. L., & Conklin, P. (2010). The self regulation model of attachment trauma and addiction. Clinical Social Work Journal, 38(4), doi: /s
Pearlman, L & Courtois, Clinical Applications of the Attachment Framework: Relational Treatment of Complex Trauma, Journal of Traumatic Stress, 18(5), doi: /jts.20052
Schore, J. & Schore, A. (2008). Modern Attachment Theory: The Central Role of Affect Regulation in Development and Treatment. Clinical Social Work Journal.vol. 36. Pp
Siegel, D. (2003) Healing Trauma: Attachment, Mind, Body, and Brain, New York: W.W. Norton.
Siegel, D. (2012). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. The Guilford Press. Second Edition.
Siegel, Daniel J. Toward an Interpersonal Neurobiology of the Developing Mind: Attachment, Relationships, “Mindsight”, and Neural Integration.
Silverman, D. K. (2011). A clinical case of an avoidant attachment. Psychoanalytic Psychology, 28(2),
Thorberg, F. A., & Lyvers, M. (2010). Attachment in relation to affect regulation and interpersonal functioning among substance use disorder in patients. Addiction Research & Theory, 18(4),