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

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

3. “ 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

4. 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

5. 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

6. 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….

7. 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

8. 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

9. 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

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

11. 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

12. Connection B4 correction
PACE before instruction
Decrease shame whenever possible

14. Questions…