Day 2 part 2

1. Day 2 part 2 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

2. Self and Identity The Main Idea: Helping children towards an understanding of self and personal identity, including: Helping them notice the positive and unique things about themselves building of coherence across time and experience, helping them to imagine and work towards future possibilities. Self Dev’t & Identity

3. Trauma…….cont • Lack of exploration due to lack of secure attachments.

4. Trauma impacts on sense of positive identity (self esteem) • Negative experiences lead to negative view of self (including broader social messages)

5. Treatment Targets: Aspects of Identity Unique Self Positive Self Cohesive Self Future Self

6. Unique Self: Individuality Goal: Help child identify personal attributes (likes, dislikes, values, talents, opinions, culture etc.) Example Activities: All About Me Books Personal collage (general/specific) Group collage around single theme, with individual child sections Artistic self-expression Bulletin boards with space dedicated to each resident Activities celebrating individual diversity (i.e., culture-specific meals, holiday celebrations, etc.)

7. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

8. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

9. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

10. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

11. My coat of arms…

12. Positive Self: Esteem & Efficacy • Goal: Build internal resources and ability to identify positive aspects of self • Example activities: • Power book • Pride wall • Superhero self • End-of-week awards • Display youth accomplishments—think of the refrigerator display • Tune into moments of success (both relative and absolute); name them; capture them concretely (both individually and in milieu) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

13. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

14. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

15. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

16. Self esteem is a suitcase..

17. Cohesive Self: Self Across Time and Context • Goal: Help child build sense of self which integrates multiple aspects of experience • Behind the scenes: • Pay attention to incorporating/normalizing multiple affective states and reactions • Observe and help child tune into patterns • Example activities: • Life books • Timelines / life narrative • Family tree, including “family” across placements • Aspects of self • Personal Crest, Masks, Ingredients of Me Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

18. Self-Mask Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

19. Future self: Future orientation Goal: Build child’s ability to imagine self in future; build connections between current activities and future outcomes Example activities: Future self drawing 5-10-20 years Life book addendum Goal setting, future-planning: help kids develop goals (i.e., beyond the program, beyond age 18)---help explore possibility Connect it: In conversation, pay attention to how current actions/ experiences connect to future goals

20. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

21. Executive Functions Applying Competency Skills in Service of TEI Self Dev’t & Identity Routines Competency Psychoed Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

22. FLUID PHASIC APPLICATION OF SKILLS In the Moment Goal Intervention Emphasis Caregiver Core Goals Child Core Goals Surviving and Tolerating Present-focused distress tolerance Recognize and support coping with current perceived experience Support caregivers’ tolerance of their own experience as well as youth experience, and engage in strengths Recognizing and Addressing Build a caregiving system that accurately sees and understands youth experience Self / Other Attunement Recognize and build understanding of patterns; understanding triggers and behavioral functions Shifting and transforming Meaning Making and Future Orientation Identify and explore past experiences, expand on self in the present, and engage links to the future Support caregiver’s own meaning-making and expand family identity Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

23. FLUID PHASIC APPLICATION OF SKILLS In the Moment Goal Intervention Emphasis Examples – applications of child goals Surviving and Tolerating Present-focused distress tolerance Recognize and support coping with current perceived experience -Anchor treatment and foundational skills in positive self and identity – engage the whole child -Use caregiver scaffolding to support basic problem solving / executive functions: identifying possibilities -Cultivate agency (executive function) by providing opportunities for choice and control -Ground self-attunement work in self and identity, who you are / were / want to be Recognizing and Addressing Self / Other Attunement Recognize and build understanding of patterns; understanding triggers and behavioral functions Shifting and transforming Meaning Making and Future Orientation Identify and explore past experiences, expand on self in the present, and engage links to the future -Exploration of self and identity; integrating trauma narrative (narrative TEI) into broader story of self; -Engaging executive functions to anticipate and build awareness of challenges Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

24. Check Yourself Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

25. Great match (Very effective) Totally comfortable +10 +5 Terrible match (Not at all effective) 0 Really uncomfortable -5 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

26. Work with children to actively explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance children’s capacity to effectively engage in present life.

27. Breaking it down… • Actively explore: Engaging in curious reflection • Process: to go beyond observation – moving toward attuned and realistic understanding and meaning-making • Integrate into a coherent and comprehensive understanding of self: Building an age-appropriate understanding of self that incorporates many aspects of experience • Enhancing capacity to engage in present life: Harnessing the above in order to shift from “reaction” mode to thoughtful action and engagement Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

28. How does past meet present? • Historical experiences often interfere with children’s capacity to effectively navigate current life • As described in PTSD Cluster B symptoms, children may be impacted by specific intrusive memories of or thoughts about historical events Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

29. How else does past meet present? Thematic / Fragmented Self-States • In response to chronic stressors, children may develop efficient patterns of response that help them cope with and manage their experience; these patterns may include: • Behaviors (action, stilling) • Thoughts (specific interpretation or meaning) • Emotions (rage, fear) • Body (muscle tension, increase/decreased arousal) • Relational (approach, avoidance) • These patterns may be evoked by specific perceived “themes”, or triggers (i.e., rejection, shame, vulnerability, etc.) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

30. Two types of TEI: • Processing of specific events: • Building a narrative around the emotions, actions/inactions, relational styles, thoughts, physiological states, and models of self/other evoked in relation to past traumatic experiences, and incorporating these into a more coherent, realistic, and broader narrative of self • Integration of fragmented self-states: • Identifying and reflecting upon fragmented aspects of self-functioning, and linking these back to the subjective themes relevant to childhood experiences Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

31. TEI for complex trauma includes, but is not limited, to development of narrative, and involves the sequential development of capacity to first survive and tolerate trauma-driven moments; increasingly be in the moment; reflect upon and make meaning about those moments, and ultimately to shift and transform them. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

32. FLUID PHASIC APPLICATION OF SKILLS: Surviving and Tolerating the Moment In the Moment Goal Intervention Emphasis Caregiver Core Goals Child Core Goals Surviving and Tolerating Present-focused distress tolerance Recognize and support coping with current perceived experience Support caregivers’ tolerance of their own experience as well as youth experience, and engage in strengths Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

33. FLUID PHASIC APPLICATION OF SKILLS: Recognizing and Addressing the Moment In the Moment Goal Intervention Emphasis Caregiver Core Goals Child Core Goals Recognizing and Addressing Self / Other Attunement Recognize and build understanding of patterns; understanding triggers and behavioral functions Build a caregiving system that accurately sees and understands youth experience Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

34. FLUID PHASIC APPLICATION OF SKILLS: Shifting and Transforming the Moment In the Moment Goal Intervention Emphasis Caregiver Core Goals Child Core Goals Shifting and transforming Meaning Making and Future Orientation Identify and explore past experiences, expand on self in the present, and engage links to the future Support caregiver’s own meaning-making and expand family identity Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

35. Surviving the moment- carers Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

36. Setting the Caregiving Foundation….. • Recognising responses, identifying and coping with their own experiences (feelings of anger, helplessness, frustration etc.)Psycho education for carers about the meaning of behaviours and impact of trauma • Structures to support family rhythms, new routines etc. that can be practised in calmer moments

37. Surviving the moment-child Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

38. What helps a child survive a moment? • Attunement by carers/clinician and mirroring, crucial to supporting his experience. • Naming, normalising (affect identification) • Experimenting with range of coping strategies (modulation). • Creating a team to help and support them. • Starting some psychoeducation about the impact of trauma.

39. Recognizing and Understanding the Moment Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

40. Building an attuned caregiving system (what is going on here) • General attunement. Meetings and work with both carers and child • Supporting carers in separate sessions to identify patterns and experiment with responses. • Meetings following “crisis moments” helping to make meaning and exploring problem solving. (exec funct, attunement, modulation, CAM)

41. Starting to engage the child in reflection Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

42. Observe / reflect on patterns, and identify the theme/ trigger Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

43. In-depth exploration of patterns and identifying the function of current behavior Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

44. A - Identification of fragmented self state “Power” State B - Identifying two distinct behavioral / emotional / cognitive patterns C - Identifying specific cues that elicit varying patterns Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

45. Vulnerable State Able to identify self-patterns (behavior, appearance, feeling… Identification of state …but not yet able to identify cues that elicit this state Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

46. And then suddenly you’re back here… Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

48. Shifting and Transforming the Moment Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

49. Ultimately, the goal is for the child to be in the present moment • In-the-moment awareness of distress cues • In-the-moment capacity to engage modulation skills • Growing understanding of links between past, present, and future • Development of life narrative that goes beyond trauma based beliefs of damage, mistrust and danger and moves youth to a broad understanding of self in context that includes vulnerabilities, strengths, resources and challenges. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

50. Intervention considerations • Process may (and generally should) include multi-faceted exploration: narrative / cognitive; affective; physiological; relational • Growing awareness of self-states (by child and/or attachment figure) may be linked to present-oriented strategies (i.e., relational supports, physiological modulation, goal-oriented problem-solving, etc.) • Young child adaptations: • Utilize and support attachment figures in being “curious reflectors” • Anchor in specific experiences, and use terms the child has previously identified in affect identification work (“It sounds like you had a turtle-shell moment today, huh? Mommy told me your teacher got kind of upset today; I wonder if that’s what made your turtle shell come out.”) Help young children and their caregivers start to name / recognize these moments, link them to specific triggers or themes (as possible), and develop coping strategies. • Make it concrete (i.e., puzzle-self, box with different compartments, etc.) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005