The reading group had its first meeting. We discussed the first four chapters of Healing Trauma: attachment,mind, body, and brain edited by Marion Solomon and Daniel Siegel.(W.W. Norton & Co. 2003) It’s a difficult book. Several chapters speak about brain physiology. Several are in "academic speak" in which all sentences must have at least 10 clauses and must be in passive voice. And the content has necessary (though not perfectly written) bases for understanding what is happening in the minds and brains of poorly attached and/or traumatized people and what to do with them.

Dan Siegel’s first chapter is An Interpersonal Neurobiology of Psychotherapy: The Developing Mind and the Resolution of Trauma. Siegel uses complexity theory to define Mental Health as the maximal complexity that the brain and mind can have: maximally stable, adaptive, and flexible. Not too rigid, not too chaotic. Some of his main points are that

  • Experience changes brain structure. A connecting, congruent, responsive parent allows a baby to develop the hardware for self-regulation (including affect tolerance), meaning, and communication on overlapping circuits. Other kinds of parents can get kids to develop blind spots, dissociative responses, or chaotic or ultra-rigid circuitry.
  • Communication inside an attachment relationship is the main experience that regulates and organizes and develps the circuits of the brain that mediate self-regulation and social relatedness. . .We connect by sharing emotional states.
  • Therapy works by letting the therapist be an attachment figure in an interactive relationship the enables the coregulation of internal states. Later the clients (like growing children) can regulate their own emotional states.
  • (p.38) To create a secure attachment you need 1. Contingent (responsive/understanding) communication 2. Reflective dialog on the contensts of mind (feelings, thoughts, memories, beliefs, etc.) 3. Repair (when there’s a rift or miscommunication, it’s acknowledged and the parties make attempts to move forward and reconnect.) 4. Emotional communication that creates an experience of empathy and compassion (positive emotions are amplified, negative ones are soothed) 5. Coherent narratives (when we can speak about something with coherence while feeling, but not being overwhelmed or shut down by emotion, we’re doing o.k. with it.
  • Coherent narratives. See above. An incoherent narrative about childhood events (even in an otherwise articulate parent) predicts disorganized attachment in the person’s children. I’ve known about this work for years, it’s explained in detail in this chapter and in the next.
  • Clinical applications. (p.45) "Patient should be given the sense of safety in which traumatic states are re-experienced, communicated and altered in more adaptive patterns" resulting in better integration of information and energy flow. (p. 47) "Effective therapy is an emotionally engaging and transformative experience that enables . . .integration to occur. He says in bigger words that the normal human emotional response is therapeutic. Staying sane and staying connected to your clients while they work through hard experiences is good therapy.

There was much more in that chapter. It made me think of Dan Siegel’s comment, at the 2004 Attachment Conference. He’d been asked, in front of a thousand of us, what he thought about EMDR. He said that EMDR was a bilateral brain therapy, but not because of the hand waving or other bilateral stimulus. When we set up the protocol, we first stimulate the amygdala and hippocampus, by bringing up the trauma. Then we connect in the left frontal brain, by asking about cognitions, go into the right brain to bring in awareness of feelings, hop to the left brain to name the feelings then back to the right brain to bring up the body map, then to the left brain again to name the place.       

One more Siegel thing. He wrote a lovely book, with Mary Hartzell, for parents: Parenting from the Inside Out. It explains his brain integration ideas, almost in English, and gives clear instructions in using what is known about attachment to do better parenting. (And better psychotherapy, too.)

Eric Hesse, Mary Main, Kelley Yost Abrams, and Anne Rifkin cowrote Unresolved States Regarding Loss or Abuse Can Have "Second Generation" Effects: Disorganization, Role Inversion, and Frightening Ideation in the Offspring of Traumatized, Non-Maltreating Parents. A title and a synopsis all in one! If you can’t figure out why your client, who has pretty nice parents, turned is so dissociative, borderline, full of scary thoughts/anxieties, or incredibly codependent, look to their parent’s histories. If a parent had unresolved grief or trauma that leaked out in little dissociative lapses or sad/scared looks when nothing particularly sad or scary was going on, the kids could have learned to space out, take care of the parent, or become unable to self-regulate. They have a good description of disorganized attachment (beyond the scope of this article!) and how the kids got that way. They back it up with concrete research. It explains a lot of the people I see. They don’t say much about clinical implications. Here are my suggestions for any poorly attached clients:

  Building Attachment Functions

a.      Sit close.

b.      Mirror affect and attention.

i.         Tone

ii.       Intensity

iii.      Backing off, when they do

iv.     Engaging when they do.

c.      Model positive affect: excitement, humor, happiness

d.      Create opportunities of intersubjectivity: knowing that you are in synch, experiencing the same feeling at the same time.

e.      Be a constant object. Be consistent, session-to-session in limits, attention, etc.

f.        Let yourself feel your client inside of you—experience their somatic experience.

g.      Use resource installation (RI) of any past experience of attachment, feeling connected, cared for, loved, and/or understood.

Utilization language Kitchur (99/00)—from M.Erickson:  Use the clients’ metaphors, belief systems, and experience when explaining, encouraging, etc. 

I’ll write more later.