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Hello. Welcome to episode 1 of the “Be A Neff” podcast. Today were going visit this months theme Attachment as it pertains to Expecting Mothers and children birth to 3 years. While we don’t expect to generally work with clients in this age populations except through the parents, we do focus quite a bit on this population during our intake process. It can be especially frustrating as a clinician because this is the part of the intake where we need rich and accurate data but the family or client doesn’t have this information. Or due to shame the information is inaccurate or difficult to discuss. SO what can you do as a clinician when we don’t have the information that we so richly need? We can either attempt to fill in the blanks as we go, or explain to the client how important this information is. I often educate the client or parent from the very first phone call, how important getting a rich history of the clients mother’s pregnancy, list of stressors or drugs exposed to is in understanding the childs stress and behaviors. When the focus is on treating the client, forgiving yourself for the shame a parent may feel, but focus on the child who experienced the trauma, you give yourself the best chance of bringing the truth to light.
SO how do we asses issues that aren’t communicated? What could this look like during intake? A failure of attachment is often where we see trauma behaviors come to life. In our psychosocial stages, within the first 3 years we learn to trust or mistrust the world around us to help us or harm us. Which can present in any matter of ways, such as negative cognitions in any situations that are new or potentially breaking from their current patterns. Can you imagine anything more relevant in psychotherapy today than the phase of life where we learn to trust or distrust the world around us? We invite you to sit back now and imagine your next client is struggling with attachment, either as an expecting parent or early parent who needs help in connecting with their child or adjusting to this phase of life when they too struggle with a healthy attachment.
The concerns the parent may be looking at is the overwhelming stress of having a child and struggling with attachment behaviors either through their own life. Any undue stress at this time should be discouraged, and psycho-education for the mother should be provided that entering into your office is time to do grounding work. Grounding exercises are fundamental as a way to open and close a session, and serve you as a clinician by modeling the importance of staying in a regulated state. The added benefit of creating and forming a opening and closing ritual is that the client feels security in your office as to the purpose of the session and place. Each aspect of your session should be a experience that shows the benefit of structure and builds trust.
Moving forward we may need to get a good idea what Attachment looks like in the office. There are 4 known attachment styles. Anxious, Fearful, Avoidant, and Secure.
Anxious attachment appears in the office as high dependency, a preoccupation with origin relationships in the family and highly emotional over reaction when those relationships are threatened. When working through with anxious attachment in new mothers or fathers, we will see complaints of concern, “am I doing this right? Should I get vaccinated? What happens if I choose the wrong name?” Simple concerns we can advocate for the client to discuss with their doctor and role play that out in session. Alternately, we can also make a list of different concerns and rule out who needs to process them with the new parent, such as the doctor or another family figure who has had children and is good with advice to the couple. I also keep a list of resources available such as parents as teachers for developmental questions, who are available here in my state as a grant funded agency that sends developmental specialists into the home for monthly check ins and to review developmental milestones. A successful parents as teachers coordinator can process these concerns, validate them and tell them whether or not they need to follow up. All things a new parent needs to hear. With my own family, one of the biggest changes was when my husband met our parents as teachers coordinator, he had a poor association with inviting a social worker into the home, and didn’t understand the value. This is a perfect conversation to have because it builds trust in other workers that are only there to assist you in giving your child a strong foundation.
Fearful Attachment is marked by disturbed distress at attempts to engage in a meaningful relationship, marked by early physical abuse, this may present comorbidly or be confused with PTSD. The marked difference may be the age of onset or the amount of time the symptoms have appeared, as Post Traumatic Stress Disorder requires 1 month of symptoms for criteria to have been met, the age of onset for a Reactive Attachment Diagnosis is 9 months of development and under 5 years of age. No age determinations is currently listed for PTSD.
Avoidant Attachment is characterized by a failure to meet the trust versus mistrust stage of development, and learning to be dismissive of attachment. Someone with avoidant attachment characteristics will be strongly independent, refuse any sort of collaboration and likely be noncompliant towards treatment and only there because “some other person” is forcing them. Developing a sense of trust with you, the clinician, will likely elicit a reactive response as it threatens their fear of dependency on another person. Best practice with working with avoidant attachment is to validate them where they are at, and encourage the client to engage on their own efforts.
Secure Attachment is marked by a general sense that needs will be met, a sense of safety and confidence in self, marked by security in relationships. Also noted is a security that basic safety needs for food and home are met. Someone with secure attachement will engage in appropriate adult relationships with boundaries and trust until they have been shown that they cannot trust you. In work with you they will be open and engaged, and will have insight in their relationships and may struggle with their firm boundaries being resisted on in insecure relationships. That being said they may struggle understanding partners that have insecure attachment patterns as “unreliable” or “crazy” since they’ve never had to struggle with these issues on their own.
Breathe App Sesame Street
I appreciate you joining me today and look forward to interacting on instagram and facebook @mytherapies or through the hashtags #topeka #anxiety #therapist and strive to respond to every post. Thank you for joining us. Interested in meeting with us live? This months podcast is sponsored in part by the 2019 KACAP Conference on Poverty. The Kansas Conference on Poverty brings together direct service workers, agency/department management, agency Boards of Directors, volunteers and anti-poverty advocates from Kansas’ non-profit organizations, faith-based agencies and government offices. Join us at the Capital Plaza Hotel in Topeka, Kansas on July 17th and 18th in our live workshops. This year’s conference theme is “Working Towards Prosperity”. I really enjoy this conference, it will be my 3rd year attending and 2nd year speaking. Each year I discover new resources to add to my referral list, and make friends with excellent people doing great things in my state. When you are in the business of solving problems and making change, you sometimes need to recharge your batteries and give back to other workers. We hope to see you live and in real life, and welcome you to our community of change makers!