Category Archives: Therapy

Attachment in Adulthood – Early Bonding Contract

Lendora_Clifford_002Infants are born with a natural instinct to bond.  There is an innate fear that without a loving adult present, they will die.  Separation anxiety grows stronger throughout the first year of life, as the infant becomes more attached and feels even more dependent upon one or two primary attachment figures.  Although an infant does not yet have language, infants are wonderful observers and fast learners.  (Ninety percent of brain development occurs in the first two years of life!)  The infant begins developing a set of rules for himself to keep his parent closer and to ease his anxiety.  The rules are the essence of the “early bonding contract.” (I heard this term first from Bertrand Cramer, M.D., at a presentation at the Menninger’s Clinic in Topeka.)

A healthy bonding contract might include, “If I express my needs, I will get my needs met.  If I smile, I can get my parent to smile back.  I don’t have to worry, someone will always be there for me.”

But an infant in greater distress might hold the following rules: “I must keep quiet to keep my parent nearby,”  “I must blend into the woodwork,” “I must not have needs.”  Or another infant might find that the opposite rules are more effective:  “I must yell, scream, kick, and make myself heard in order to get someone to notice and give me what I need to live.”

Infants and children do what they have to do to survive.  If the bonding contract rules work for the infant, he can keep his anxiety at a low ebb.  If the rules work sometimes and not other times, the infant may stay continuously on high alert.

Later in life, an early bonding contract may become an “unlivable agreement” (a term I heard years ago from Landry Wildwind during an EMDR workshop) that causes problems in adulthood relationships.  If I learned to shut down my feelings and show no vulnerability in order to keep my attachment figures around, my partner or potential partner may find me  hardened and unfeeling.  If I learned to scream and yell to get my attachment figures to meet my needs, my partner or potential partner may find me demanding, dramatic, and overwhelming.  What worked to survive as an infant, may potentially sabotage my relationships in my adult life.

The real problem with the unlivable agreement, in my opinion, is its tenaciousness. Because the early bonding contract consists of rules for survival, and breaking those rules means potential annihilation, breaking the rules at any age sends alarms up through the nervous system.  One adult might say, “Expressing myself when I am supposed to be quiet makes me feel like I will die.”  Another might say, “Keeping calm and trusting that my partner will stay with me feels like a recipe for abandonment.”

I’m a big believer in the power of inner child work to address deep-seated beliefs and fears that are rooted in infancy and toddlerhood.  Creating a safe place for the younger self, providing safety, care, and nurturing through imagery can be a powerful tool for healing.  EMDR is a modality that increases the power by reaching into the limbic system with bilateral stimulation.  Awareness is the first step.  The rest consists of self-nurturing, self-compassion, healing, and intentional changes in small steps.

When I walked into the office this morning…

MiaI conducted a training along with my wonderful colleagues Stefanie Armstrong and Cathy Schweitzer here in Omaha yesterday, and the entire group became involved in a discussion regarding how traumatized children and adults over-read anger on faces.  Even facial expressions that exhibit sadness, boredom, or fatigue can be easily read as anger or disapproval.  Voice tones that are monotone or bored are read the same way.   We teach parents the importance of lifting the eyebrows, using a lighter voice tone, being playful and light, as part of developing stronger bonds with hurt children.

I woke this morning a little dismayed about the idea of going into work after conducting a 3-day training here (still jet-lagged from Hong Kong–plus a couple of inches of new snow on the ground to deal with.)  However, when I walked into the office, I was greeted by the kind of scenario that plays itself out all the time here.  My colleagues Cathy and Bonnie were bantering with all the children and the adults in the waiting room.  There was lots of laughter and chaos.  There was a cute, red-haired kiddo lobbying for a good movie for the DVD player.  The atmosphere of laughter and love that we have here immediately lifted my mood and energized me for the day.  Though our group is made up of 10 women who are extremely skilled professionals, there is no pretense, stuffiness, or arrogance in this group. The tone is light, the atmosphere is one of warmth and acceptance.   No wonder so many kids and adults feel immediately at home here.  I am really grateful for this.

Adoption allows me to experience success as a trauma therapist.

IMG_0037Last week I was in Hong Kong training and consulting for a group of dedicated and talented psychologists, and I discovered that the abused children in their care had an additional obstacle to their healing.  Adoption is not a part of the culture in Hong Kong. Although I don’t have statistics regarding the prevalence of adoption around the world, I know that it is not a part of most cultures the way it is in our country at this time. I have new gratitude for the way families in the U.S. have embraced adoption as a meaningful way of building a family, whether through infant adoption or through U.S. foster care or overseas adoptions.

Children who remain without a family after losing their biological parents due to illness, death, or abuse continue to suffer. Children need the presence of safe attachment figures in order to open up emotionally and heal.  They need to be in the protective care of parents who love them in order to get back on the trajectory for typical emotional, social, and cognitive development.  They need to see themselves reflected through their parents’ loving eyes in order to develop a positive sense of self.

Since my husband and I adopted our middle child from overseas almost thirty years ago, adoption has become an increasingly important part of American culture–so much so that we don’t blink an eye when we see a family that is made up of various skin colors or eye colors.  In this context, even the most traumatized children have a chance for healing and living a productive life.  It is because of the many families who celebrate adoption as a way of life that I can experience real success as a trauma therapist.

“Now that I understand this is dissociation, I’m not mad at him anymore,” said his mother.

file3111258685095Dissociation in children is poorly understood. I have always had mixed feelings about speaking with parents about signs of severe dissociation in their child, because I have been afraid that the discussion would lead the parents to pathologize the child.  Yet, this is a real phenomenon, and when dissociation is not recognized, affected children can end up feeling rejected by their confused and frustrated parents.

Dissociation can be experienced at varying degrees of severity.  We all experience slight dissociation when we are bored, example, and “space out” or “day dream.” Very young children experiencing trauma dissociate or “go away” mentally because they have no other recourse.  They are not big enough to fight or flee. Regular early dissociation wires the brain to life-long dissociation.

The “Structural Dissociation Model” (van der Hart, Nijenhuis, & Steele) posits that severe traumatization leads to little “Emotional Parts” (EPs) of self that are separated off from the front part of self in order to keep memories and their associated emotions at bay.  From a neurological point of view, the EPs are neural networks of unmetabolized stored trauma and emotion in the back of the brain.  When the memory or emotions are triggered, the trauma survivor begins operating out of that EP, and the individual completely or nearly loses access to what I call the “Front Part of Self.”  When the trauma survivor is back in Front Self, his memory for what he was thinking or feeling when dissociated may be confused or even absent.

One mother and father who previously reacted angrily to their child’s sudden switches and seemingly bizarre behaviors have new insight regarding the phenomenon of dissociation.  They report that because of this understanding, they have been able to remain calm and much more effective in keeping their child regulated. I am now convinced that education about dissociation can increase compassion and support for this vulnerable population.  I will write more about dissociation in later blogs.

When feelings are the trigger…

file0001931890417Children (and adults) who experienced inadequate comfort and nurturing as infants and toddlers are frequently unable to manage any sort of emotion – positive or negative – without becoming dysregulated.

Early deprivation leaves inadequate connections in the prefrontal brain.  The prefrontal brain is like Grand Central Station, connecting the higher and lower regions of the brain and also the right and left hemispheres.   The logical regions of the brain are not able to manage the emotional areas.

Another way to understand this is to think about the dependency of infants upon their caregivers to manage their emotions for them – to provide comfort and soothing when they are frightened, in pain, or stressed.  When there is not comforting attachment figure, the infant  learns that feelings are not safe.  The infant learns the only way to cope with feelings is by shutting down.  Feelings of any sort become a source of fear.

Children need their parents’ help to develop integrated brains.  They need assistance to access logical thought – to step back from their emotions a bit and contemplate them – to ride out the feelings, and to find ways to feel better.  It takes time and patience, but it’s an investment parents can make now that will be well worth it in the end.

Adults with a traumatic history need assistance as well, with skilled therapy and development of coping skills.  Traumatized children and adults are a vastly misunderstood population.

Dissociation is a normal and self-protective response.

Dissociation is a normal human response to intense emotions or even to boredom.  Everyone dissociates to some extent, but children who have experienced multiple traumas are high risk for dissociative disorders.  As children or adults, they may regularly shut down or space out, or they may become hyper and extremely silly or behave in other ways that appear strange.  In severe cases of dissociation, traumatized individuals (adults or children) may exhibit fast changes in their emotions and behaviors.  Hollywood has dramatized dissociative disorders with movies like Sybil and The Three Faces of Eve.  I believe these dramatic portrayals have increased the stigma and shame around the problem and prevented many people from seeking and receiving proper treatment.

Individuals with dissociative disorders first learned to dissociate as young children, in order to avoid becoming overwhelmed by intense fear or distress.  This is a response that is self-protective and, in a way, sensible.    When dissociation becomes a hard-wired pattern, it serves to help individuals avoid the distress related to feelings and memories.  Such avoidance is problematic, as it can prevent sufferers from being able to work through and resolve traumatic memories.  Over time, dissociation can become a habitual response to any sort of stress, which can lead to problems in functioning in daily life.

Attachment relationships protect us from the effects of stress and trauma.   Individuals with dissociative disorders almost always struggle with feeling safe and secure in their attachment relationships.   Therapy should always include relationship help.  Parents should be guided in increasing emotional attunement and support.  Dissociative disorders in both children and adults should never be dramatized or pathologized.  The focus should always be on the whole person and not on separateness between parts of self.

Guided visualization can assist in developing a sense of safety for younger parts of self and strengthening the “front part” or “most mature” self.   Any “parts work” or dialoguing with parts of self should take place only after making sure the individual has access to feelings of competence and strength, is grounded in the present, and feeling safe.

Mindfulness is a Lifestyle

Thinking_Of_Fun_by_12055Relaxation and meditation are extremely beneficial for reducing stress, reducing cortisol and inflammation in the brain, and calming reactivity.  But mindfulness involves even more than activities that change consciousness.  Mindfulness involves staying present to all of our experiences, including feelings of sadness, anger, hurt, loneliness, or any other emotions.  The practice of mindfulness includes staying aware of tension or urges.  When we are mindful, we experience our inner state without judgment, no matter what it may be.  We are able to take a step back and think about what we are feeling and thinking without reacting reflexively.  We are able to stay present and introspective.  Without mindfulness, we simply react, and rid ourselves of any uncomfortable feelings as quickly as possible.  We may find ourselves “letting loose” on anyone in our path, “numbing out” with TV, alcohol, or dissociation, or acting impulsively, making a bad situation worse.

Mindfulness may require an entire lifestyle change.  It requires practice, conscious awareness and living with intention on a daily basis.  Mindfulness is acceptance and openness to all the experiences of day-to-day life.  Therapy is a wonderful way to develop greater mindfulness.  So is the practice of meditation, yoga, prayer, or spiritual studies.  There are many routes.  Don’t allow yourself to go through life reacting, hiding, or numbing out.  Live life fully.

I Never Would Have Guessed….

Boy holding onto his motherA child I was working with was having multiple tantrums every day, shortly after her adoption day.  Her mother brought her in, fatigued, defeated, and confused.  The mother said, “I think she is testing us to see if we really love her!”  Certainly, this was a possibility.  But I wondered about grief.  After working with hundreds of adopted children over the years, I have been astounded by the immensity of their grief, and how often grief manifests as anger.   The little girl’s mother was willing to follow my suggestions, and she cradled her daughter and rocked her side-to-side, telling her that all her feelings were normal and OK, and that it was perfectly normal if she was feeling sad.  The little girl’s face crumpled, and she sobbed and sobbed, as her mother stroked her and attuned.  The most important words that little girl heard that day was, “I’m so sorry.”  Finally, her sobs subsided and she relaxed in her adoptive mother’s lap.  By the end of the session we were all making silly faces—she had been able to release the torrent of emotion that had been bottled up inside.  On the way out, her mother turned to me and said, “I never would have guessed she was grieving!”

Adoption is Not the Problem.

Adoption is not the problem.  Adoption is a win-win for adoptive parents, children, and birth parents.  Adoption is not a problem, but early attachment losses and traumas are indeed a problem.  Even preverbal trauma leaves an imprint in the limbic brain of young children and creates entrenched feelings of rejection, abandonment, hurt, mistrust, fear, and worthlessness.  Children wired for rejection will misunderstand normal parenting discipline as attempts to hurt and reject them.  Vulnerable feelings are quickly turned into anger as a method of self-protection.  Mystified parents become angry in return, which triggers children to feel their pain even more intensely.  There is a way out of this – but it’s not easy.  Therapists and parents must work together as a team to assist children in experiencing feelings of love, trust, and closeness on a deep level.