Attachment

1. Attachment

2. Time to Change Seats!

3. Your Experience • How does it feel to have to move to another seat? • How attached were you to first seat? • What can you take from this fairly minor disrupted attachment about the power of attachment in our lives?

4. What adoption issues have arisen in your practice since our last class?

5. Our Special Thanks We thank Dr. Dan Hughes for his expertise and guidance in the development of this session.

6. Learning Objectives 1. Define “intersubjectivity” and describe the relationship between intersubjectivity and attachment. 2. Describe five components of Dyadic Developmental Psychotherapy (DDP) that are common to the empirically based psychotherapies and the four elements that comprise “PACE”. 3. Demonstrate the ability to find something to like in an adoptive parent even when the parent’s behavior in relation to the child is negative.

7. Learning Objectives 4. Give at least two examples of how a parent’s attachment history may impact his/her parenting of his/her adopted child. 5. Describe the role of adoptive parents in attachment-focused psychotherapy and two ways to prepare adoptive parents for the sessions with their child. 6. Identify at least three skills that the therapist uses in assessing the child in initial sessions.

8. Learning Objectives 7. List at least three principles of DDP. 8. Describe how a therapist uses playfulness and curiosity to engage the child and demonstrate the power of curiosity in therapy. 9. Describe three clinical skills that are essential to the therapeutic work of DDP. 10.Describe at least two other attachment- focused interventions in working with adopted children and youth.

9. Intersubjectivity

10. Key Theme in DDP: Reciprocal interactions between mother and baby

11. What do you see in these photos?

12. Attunement : What Do You See in These Photos?

13. Intersubjectivity and DDP Intersubjectivity holds three aspects of matching between parent and infant: Affect Attention Intention or Cooperation

14. What do you see in these photographs with respect to affect matching?

15. What do you see in this photograph with respect to joint awareness?

16. What do you see in these photos of children with respect to reciprocal intention?

17. When intersubjectivity is present . . . When intersubjectivity is present . . .

18. What do you see in these photos of children?

19. When intersubjectivity is absent . . . When intersubjectivity is absent . . .

20. What do you see in these photos of children?

21. Intersubjectivity In the DDP model, there is express recognition that children who do not experience intersubjectivity with their parents develop behaviors that reflect the lack of the parents’ active presence in their lives.

22. Exercise in Pairs: Still Face

23. Some Points to Consider • Co-creating your story with your partner • The tremendous impact when intersubjectivity disappears • Imagine what is like for a baby

24. Some Points to Consider Now think about how clients might feel when you function as a “still face” therapist

25. For Discussion In your pre-session work, you were asked to answer the question: What does the concept of intersubjectivity contribute to our clinical work with adoptive families? What thoughts did you have on this concept in relation to our clinical work with adoptive families?

26. Introduction to DDP

27. Introduction to DDP

28. A Quick Review of DDP • A treatment approach to trauma, loss, and/or other dysregulating experiences • Based on principles derived from attachment theory and research • Also incorporates aspects of treatment principles that address trauma • Specialized form of Attachment-Focused Family Therapy which is utilized for all families

29. Key Principles of DDP • Creating a safe setting • Ensuring that exploration occurs within an intersubjective context characterized by nonverbal attunement, reflective dialogue, acceptance, curiosity, and empathy. • Creating a coherent life-story which is crucial for attachment security and is a strong protective factor against psychopathology. • Occurs within the joint activities of co-regulating affect and co-creating meaning “Co-Co” therapy: co-regulation of affect and co-creation of meaning.

30. Small Group Work Handout #6.1 Core Components of DDP Together, review the core components in Handout #6.1. Choose two of the components and discuss for each component: Why is this component particularly important when working with children and youth who have inexperienced insecure attachment, trauma and loss? How are you currently incorporating this component in your clinical practice? How might you deepen your practice in this area?

31. Report Out

32. Handout #6.2 DDT Initial Experimental Studies

33. Break Time!

34. Safety, Intersubjectivity, and PACE

35. How is an intersubjective context created? • Empathy • Acceptance • Curiosity • Nonverbal attunement • Reflective dialogue

36. Small Group work Handout #6.3 The foundation of intervention strategies in DDP is that the therapist and the parents/attachment figures have an attitude of PACE. Look at Handout #6.3: DDP and PACE and in your small groups fill in the chart on PACE.

37. Report Out

38. PACE Playful Accepting Curious Empathetic As Dr. Hughes says, “No lectures”.

39. Why is PACE important? • What we are asking of the child is emotionally stressful. • PACE engages the child intersubjectively, while lectures do not. • By maintaining an attitude characterized by PACE, we ensure that the child is not alone while entering that painful experience. • The child has developed significant symptoms and defenses against that pain, most often because he was alone in facing it.

40. Why PACE is important • When we help the child to carry and contain the pain within him, when we co-regulate the affect with him, we are providing him with the safety needed to explore, resolve, and integrate the experience. • We do not facilitate safety when we support a child’s avoidance of the pain, but rather when we remain emotionally present when he is addressing and experiencing the pain.

41. DDP: Initial Meetings with Parents

42. Handout #6.4 Assessment

43. DDP: Initial Meetings with Adoptive Parents A primary goal of the first meeting with the parents is to establish safety with them. What does this mean? Dr.Hughes says that the therapist’s job is to like the parents.

44. DDP: Initial Meetings with Parents (1) They are good people (2) They are doing the best they can (3) They care about their child or want to care about their child

45. Beth and Tom come to see you because, as Beth informs you, their ten year old adopted son, Hank, lies constantly. Beth is furious that she cannot trust him to ever tell the truth. When you begin the interview, she talks constantly, reciting yet another example of what a liar Hank is. Tom sits passively by without saying a word. Beth is brimming over with anger and makes statements such as, “I can’t believe that we adopted this kid and now we have to live with a liar” and “I sometimes really hate this kid.”

46. Small Group Discussion Beth and Tom come to see you because, as Beth informs you, their ten-year-old adopted son, Hank, lies constantly. Beth is furious that she cannot trust him to ever tell the truth. When you begin the interview, she talks constantly, reciting one example after another about what a liar Hank is. Tom sits passively by without saying a word. Beth is brimming over with anger and makes statements such as, “I can’t believe that we adopted this kid and now we have to live with a liar” and “I sometimes really hate this kid.”

47. Small Group Work Discuss together: • How could you find something to like about Beth and Tom? • What specific approaches might you use to develop a sense of “liking” them?

48. Report Out

49. Demonstrated Role Play: Beth

50. A Question for Discussion What skills did you see the therapist using to stop the venting?