1. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. SAFE ATTACHMENT FAMILY EDUCATION ********* SAFE ATTACHMENT FORMATION FOR EDUCATORS SAFE ATTACHMENT FAMILY EDUCATION ********* SAFE ATTACHMENT FORMATION FOR EDUCATORS Mentor training module I SAFE Karl Heinz Brisch University of Munich Pediatric Clinic and Polyclinic Dr von Hauner Children's Hospital Department of Pediatric Psychosomatics and Psychotherapy ®

2. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Overview I Contents and goals of SAFE Attachment development Transmission of parental trauma Psychological phases during pregnancy Parental fantasies Capacities of the maturing child

3. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Overview II Fears The three of us -- parenthood Interaction and its disorders Video sensitivity training Exercises Open questions Outlook

4. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. SAFE Goals –security for the parents –security for the child –fostering security attachment between parent and child –preventing the transmission of parental trauma to the baby

5. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. SAFE Time requirements –4 prenatal seminar days At approximately the 20th, 24th, 28th, and 32nd weeks of pregnancy –6 postnatal seminar days At approximately 1 month, 2 months, 3 months, 6 months, 9 months, 12 months

6. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. SAFE Methods and modules –Module: Parent group Group experience Information General video sensitivity training (prenatal) Individual video sensitivity training (postnatal) –Individual help module / Psychotherapy Fear support / Trauma –Crisis hotline module Telephone and e-mail

7. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Motivational Survival Systems Relationship Attachment Self-Efficacy Avoidance of Negative Stimuli SensoryStimulation PhysiologicalNeeds Exploration 1. 2.3. 4. 5. 6.

8. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The development of attachment according to John Bowlby‘s attachment theory An infant develops a specific emotional attachment to a primary attachment figure during the first year of life The attachment figure represents a „secure emotional haven“ for the infant

9. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attachment theory The attachment system is activated by fear and separation the attachment system is soothed by physical closeness to the attachment figure

10. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attachment theory The attachment system has a reciprocal relationship to the exploratory system When the attachment system is soothed, the infant is free to explore the environment

11. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Sensitivity The caregiver who responds to the infant with the greatest sensitivity will become the infant‘s primary attachment figure A high degree of sensitivity requires the development of secure attachment

12. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Sensitivity The caregiver must –perceive –correctly interpret –react appropriately to –react promptly to the infant‘s signals

13. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The importance of spokenlanguage between the mother/father and child Fosters secure attachment by naming –the infant‘s actions –the “inner emotional world” of the infant –associations and connections

14. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Rhythm in action and speech Fostering secure attachment by –alternating speech and actions between mother and infant –correcting misunderstandings Fostering insecure attachment by –frequent simultaneous speaking and acting –completely unrelated speaking and acting

15. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Videotaped example Mother-child / Father-child interaction –playing and diapering –split screen technique

16. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attachment qualities Secure(approximately 65%) Insecure –avoidant (approximately 25%) –ambivalent (approximately 10%) –Disorganized (additional pattern) normal population (approximately 15-20%) trauma (approximately 75-80%) –parents or infants

17. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Video demonstration Attachment quality of the 14-month-old infant in the “strange situation“ Separation from the mother twice Observation of the separation and greeting reaction Alternation between attachment and exploration

18. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attachment and psychic development Secure attachment PROTECTION Insecure attachment RISK

19. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Consequences of the development of attachment (1) Secure attachment –protective factor under stress –greater coping ability –ability to seek out help –more attuned social behavior –empathy for the emotions of others –larger numbers of relationships –greater creativity –greater flexibility and persistence –better memory and learning

20. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Consequences of the development of attachment (2) Insecure attachment –risk factor under stress –less coping ability –tendency tendency toward solitary solutions to problems –withdrawal from social activities –fewer relationships –less flexibility in thinking and acting –tendency to more aggressive behavior in conflicts –poorer memory and learning

21. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attachment behavior in adults Secure-autonomous Insecure –distanced –entangled –unresolved trauma (additional pattern)

22. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Intergenerational attachment Connection between attachment of the parents and the child –secure parents with secure children mother-child approximately 75% father-child approximately 65% –insecure parents with insecure children –traumatized parents with disorganized children

23. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Preconditions for the development of secure attachment in the child Sensitivity of the caregiver Emotional availability Clearing up misunderstandings Recognition of projections Clarifying conceptions of the ideal

24. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Unprocessed parental trauma Interactional disorder and disorders of affective communication with the infant –prenatal and postnatal Fearful behavior by the mother Fear-inducing behavior by the mother Helpless caregiving by the mother

25. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Triggers of trauma recall in parents Triggers in the behavior of the infant, –crying, sorrow, pain, neediness –desires for attachment, closeness –separation, boundaries Triggers in affective agitation Unconscious processes!!!

26. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The reenactment of trauma In interaction with the infant –rejection of desires for closeness -- avoidance –violence –abrupt breakoff of actions –overstimulation (sexual-sensory) In affective communication –transmission of traumatic affects rage, shame, agitation

27. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Fantasies and pregnancy Fantasies –before pregnancy –during pregnancy – after pregnancy

28. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Fantasy about the child‘s characteristics Temperament Capacities Powers of resistance Threat Effect on one‘s own personality Effect on the parents‘ relationship

29. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Phases of pregnancy Surprise Joy Ambivalent feelings Fear and worry Changes in the marital relationship Responsibility Nest building Joy and fear before birth Joy and fear: The three of us

30. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Development of the child Abilities of the growing child –feeling –hearing –tasting and smelling –learning –soothing –experience of stress –experience of pain

31. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Prenatal attachment Testing Ultrasound Fetal movements Identification with the child Speaking with the child Feeling with the child Fears and stress

32. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Practice Baby - dialogue

33. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Prenatal checklist Desire for security Fears of malformations Uncertainty What if….??? Coming to terms Remembrance of earlier pregnancies Miscarriages and stillbirths In-vitro fertilization

34. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Ideals The ideal mother The ideal father The ideal baby

35. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Me as mother Physical changes Psychological changes –protection –worries and fears Relational changes –to one‘s partner –to one‘s children –to one‘s own parents –to one‘s friends Prenatal attachment

36. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Me as father Physical changes Psychological changes –protection –worries and fears Critical phases and responsibility Relational changes –to one‘s partner –to one‘s children –to one‘s own parents –to one‘s friends Prenatal attachment

37. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mother Father Baby

38. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mother Father

39. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mother Father

40. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mother Father

41. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mother Father

42. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Mutter Vater Baby Mother Father

43. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. The three of us Father Mother Baby

44. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. “Secure place” exercise A place that is –fantasized –completely individual –secret –safe and protected –no dangers or stress –pleasant –good-feeling –helpful helper

45. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Attentiveness and play Video –attuned dialogue –overstimulation –understimulation –breakoff of communication

46. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Crying – the guarantor of survival Causes of crying –hunger –thirst –fear –being alone –overstimulation -- too many stimuli –understimulation -- boredom –pain –heat or cold –parental worries and tension –………………?????????

47. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Soothing the baby Relief and security when the parents are worried and fearful Sensitive satisfaction of physiological needs (hunger, thirst, etc.) Body contact Calming fears Rocking Voice, talking, and song Safety in not being alone

48. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Three-month change Guideline –sensitivity to constant changes At 6-12 weeks, the baby is –awake longer –more receptive to environmental stimuli –more interested in interactions with persons –danger of the overstimulation –danger of understimulation

49. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Videotaped example of crying

50. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Feeding When baby signals hunger – “on-demand” Perceiving subtle signals of –readiness to nurse –desire for a break –break for interaction with mother/father -- eye contact –rhythm: waking, eating, interaction, sleeping –constant changes in times – baby is getting older –parental flexibility –curiosity and adaptability in the parents

51. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Videotaped example of feeding

52. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Sleeping and separation Sleeping alone is not evolutionary Babies can learn to be separated and alone Fear when separated and alone Soothing by the attachment figure when the baby signals fear by crying Observing spirals of arousal Helping the baby before s/he panics Learning –“My attachment person arrives reliably, on time, and is comforting when I am fearful“ Soothing by body contact

53. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Videotaped example of sleeping

54. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Questions and outlook

55. © Copyright Karl Heinz Brisch Munich 2012. All rights reserved. Meetings SAFE Mentor II SAFE Mentor III Practice day