Fostering Kids New Zealand Annual Conference September 28-29, 2017 Christchurch, New Zealand Cour tney Rennicke, Ph.D.

SURPRISE! USING THE BRAIN AS A GUIDE TO HEAL “BLOCKED TRUST”

From Mistrust to Trust: Stages in the Attachment Journey

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THERAPEUTIC PARENTING

STAGE 1: AUTOMATIC PILOT, MISTRUST. “I’m bad.” “You’re mean!”

STAGE 2: GOOD CONFUSION. “Whoa this is weird! You understand why I don’t trust you and you are not angry about it.”

STAGE 3: APPROACH/AVOIDANCE CONFLICT. To trust or not to trust…

STAGE 4: PRACTICING TRUST OVER MISTRUST. Stroopin’

STAGE 5: RESOLVING THE CONFLICT. “I can trust you and I am a good kid!”

Thanks to Jon Baylin, Ph.D. & Julie Hudson, Ph.D.

“The brain is the why and P.A.C.E. is the how…”

-Jon Baylin, Ph.D.

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THEORETICAL BASIS FOR DDP

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EPIGENESIS

GOOD CARE turns ON, wakes up and activates the way genes “behave” in children’s brains to support they development of all systems needed to feel safe and engage in social relationships.

POOR CARE turns OFF, silences the expression of genes that support connections and social relationships. Instead it activates a system that is primed to be defensive and wary of others.

Baylin & Hughes, 2016

5 INTERPERSONAL NEUROBIOLOGY: BRAIN-TO-BRAIN

EMOTIONALLY CHARGED INTERPLAY BETWEEN THE RIGHT BRAIN OF THE PARENT AND THE RIGHT BRAIN OF THE CHILD

14 MILLISECONDS

IMPLICIT “ATTACHMENT MEMORIES”

10 INCHES: THE MAGIC SPACE v FACE v VOICE (PROSODY) v TOUCH

Thanks to Jon Baylin, Ph.D.

EPIGENESIS: WHAT GETS WIRED?

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EPIGENETICS: POOR CARE PROMOTES GENE EXPRESSION FOR STRESS HORMONE

RECEPTORS

SAFE: APPROACH, TRUST, ENGAGE

Good Care Promotes SOCIAL ENGAGEMENT

Poor Care Promotes SELF DEFENSE

= OXYTOCIN = STRESS HORMONE (CRH, corticotropin releasing hormone)

Amygdala

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INSECURE/DISORGANIZED ATTACHMENT: INADEQUATE CARE LACKS BUFFER FOR AMYGDALA

Uncinate Fasciculus (UF)

Thanks to Jon Baylin, Ph.D./Dan Hughes, Ph.D.

Prefrontal Cortex (PFC)

Amygdala

Poor care may result in: •  > Amygdala reactivity •  Accelerated development of

the amygdala •  Premature adult-like

phenotype (e.g. pseudo-independent; Tottenham, 2013)

•  Hypersensitivity of right amygdala to non-verbal social cues (face, voice, gesture, touch)

POOR CARE KEEPS YOU ON HIGH ALERT

PRE-FRONTAL CORTEX – LIMBIC SYSTEM SEE SAW: When one “lights up” the other “turns down”.

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NEUROCEPTION & PORGES’ POLYVAGAL THEORY (2011)

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FEELING SAFE

THREAT!!!

VAGAL BRAKE Low vagal tone (ACT): no inhibition on the pacemaker to the heart and heart rate increases Without a functioning myelinated vagus, social behavior would be compromised, and more primitive defensive strategies, such as fight-flight mobilization and tantrums (mediated by the sympathetic nervous system) and shutdown behaviors (mediated by the unmyelinated vagal system) would be more frequently expressed. ¡  Neglect is kind of like draining your car’s

brake fluid – makes stopping and slowing down/calming down more difficult.

From Porges, 2011

NEUROCEPTION aka Threat Detection

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Eluvathingal, T.J. et al. (2006)

Neglected child

Window of Tolerance for Social Engagement

Window of Tolerance For Social Engagement

Nurtured child

LEFT RIGHT

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BLOCKED TRUST: IMPACT ON UF

Thanks to Jon Baylin, Ph.D.

CHILDREN WITH ATTACHMENT PROBLEMS RELATED TO INSTITUTIONAL EARLY REARING HISTORY:

LEFT UNF REDUCED

PSYCHOPATHS:

RIGHT UNF REDUCED

Thanks to Jon Baylin

BLOCKED TRUST: A-SOCIAL vs. ANTI-SOCIAL

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“A-SOCIAL” vs. § Overactive amygdala

§ Underactive Left UF

ANTISOCIAL

§ Small amygdala

§ Small/reduced Right UF

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BLOCKED TRUST: A-SOCIAL VS. ANTISOCIAL DISTINCTION

Are attachment disordered kids antisocial? This “blocked trust” thing is a nice therapist thing to say, right? No! Its in the BRAIN…Attachment disordered kids are:

Thanks to Jon Baylin

MUTUAL DEFENSE SOCIETY (MUTUAL MISTRUST SOCIETY)

BLOCKED TRUST + BLOCKED CARE

MUTUAL DEFENSE SOCIETY

PAG PAG

NO CHANGE: NO SURPRISES, NO “VIOLATION OF EXPECTATIONS”, NO “NEWS OF A DIFFERENCE” TO TRIGGER “REVERSAL LEARNING”, ETC.

NO “POSITIVE PREDICTION ERRORS” (PPES) TO GET THE DOPAMINE SYSTEM INTERESTED IN LEARNING NEW THINGS ABOUT RELATIONSHIPS

“I don’t trust you!”

“I don’t trust

you!!!!”

CHRONIC MISTRUST

Thanks to Jon Baylin, PhD.

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“The brain is the why and P.A.C.E. is the how…”

-Jon Baylin, Ph.D.

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THERAPEUTIC PARENTING IN DDP

When in doubt…

¡ Playful ¡ Accepting ¡ Curious ¡ Empathic

PACE IT! 16

P.A.C.E.

PLAYFULNESS •  Having a “ l ight

tone” - not about being funny.

•  Build sense of

camaraderie and reciprocal enjoyment.

•  Activate dif ferent

part of the brain than is activated when experiencing shame.

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P.A.C.E.: PLAYFUL

ACCEPTANCE: “While it is easy to accept the behavior of a young child, beyond infancy this changes. As a social species, we evaluate one another’s behaviors with regard to whether or not these are in accord with our group’s values.” (Golding & Hughes, 2012)

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P.A.C.E.: ACCEPTING

¡  Challenge : To simply accept the child’s thoughts feelings, or wishes with regard to the situation, WITHOUT trying to change them.

¡  If I ACCEPT the feeling/behavior then my child will become…MORE selfish? aggressive? rude?

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P.A.C.E.: ACCEPTING

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P.A.C.E.: CURIOUS

¡ Wondering rather than interpreting.

¡ An attitude of not knowing.

¡ Make guesses, but happy to reject them.

¡ Taking the lead in exploring possible thoughts wishes and feelings.

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P.A.C.E.: EMPATHY

EMPATHIC

PLAYFUL

ACCEPTING

CURIOUS

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P.A.C.E.: EMPATHY

EMPATHY is the motivates us to relate to others. It is the “ability to identify what someone else is thinking and feeling and to respond to their thoughts and feelings with an appropriate emotion (Simon Baron-Cohen, 2011).” •  Connects us •  Empathy communicates

P.A.C. •  Non-judgmental •  Feeling WITH vs. for

someone

THERAPEUTIC PARENTING

Thanks to Jon Baylin, Ph.D.

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THERAPEUTIC PARENTING: STROOPIN’

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WHATEVER, B…….

ATTACK!!! (200 MSEC)

WHATEVER, B…

ATTITUDE: PACEFUL!

COMPASSION

CONNECT/ DON’T DEFEND

THERAPEUTIC PARENTING: STROOPIN’

Thanks to Jon Baylin, Ph.D.

P.A.C.E. “JIGGLES” THE KID’S ANTERIOR CINGULATE CORTEX (ACC) INTO ACTION AS SHE EXPERIENCES A CONFLICT BETWEEN HOW SHE EXPECTED YOU TO REACT AND HOW YOU ACTUALLY REACTED, RAMPING UP ATTENTION, ENGENDERING A BRAIN STATE OF “THERAPEUTIC CONFUSION,” AND TRIGGERING PROCESSES OF REVERSAL LEARNING, EXTINCTION, AND “SET SHIFTING”

THERAPEUTIC PARENTING: "YOU'RE WEIRD!”

P.A.C.E. P.A.C.E. P.A.C.E.

Thanks to Jon Baylin, Ph.D.

Positive Prediction Error (PPE): When a parent/caregiver creates surprising moments by using PACE and challenges the child’s expectation of being invalidated, neglected, hurt, feared…

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THERAPEUTIC PARENTING: SURPRISE!

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THERAPEUTIC PARENTING: SURPRISE!

Stay open to the STRUGGLE… The battle between being open and engaging in relationships and self-protection, defensiveness and hypervigilance.

Vs.

DAVID (Safe, Open, Engaged) GOLIATH (Blocked Trust, Defensiveness)

From To The End of June (2013) By: Cris Beam: “Dominique (17 y/o foster daughter) threw up her hands in disgust and looked at the sky. A gurgling sound escaped her throat, and then she sucked her teeth. “Well, I don’t argue with people I don’t love.” Bruce (foster parent) jumped up from the step, a look of glee widening across his face. He bounded down the stairs and out into the street. The other [foster] sisters, who had been gossiping together on the bottom of the step, exchanged embarrassing glances. Bruce was ecstatic . “She loves me, she loves me – Dominique said she loves me!” Bruce was shouting and doing a kind of football touchdown dance in the street. A passing car had to stop and wait for him to finish. “It’s only been 3 months, and she says she loves me!” “NO, I DIDN’T!” Dominique shouted back. “I said I only fight with people I love. I didn’t say I love you.” “Same thing!” Bruce retorted, skipping around.”

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THERAPEUTIC PARENTING: STROOPIN’

CINGULATE

REFLECT

REVISE

REVERSE

REGULATE

PAG

PFC

A C C

SOCIAL BUFFERING: SAFETY MESSAGES TO THE AMYGDALA: FACE, VOICE, TOUCH

OXYTOCIN: SAFE ENOUGH

Very Rapid Ways to Reach the Amygdala and Change Its Firing Patterns: Neurofeedback, Yoga, Brainspotting, Tapping, Music, Dancing…

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Thanks to Jon Baylin, Ph.D.

HIPPOCAMPUS

AMYGDALA

From Mistrust to Trust: Stages in the Attachment Journey

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THERAPEUTIC PARENTING

STAGE 1: AUTOMATIC PILOT, MISTRUST. “I’m bad.” “You’re mean!”

STAGE 2: GOOD CONFUSION. “Whoa this is weird! You understand why I don’t trust you and you are not angry about it.”

STAGE 3: APPROACH/AVOIDANCE CONFLICT. To trust or not to trust…

STAGE 4: PRACTICING TRUST OVER MISTRUST. Stroopin’

STAGE 5: RESOLVING THE CONFLICT. “I can trust you and I am a good kid!”

Thanks to Jon Baylin, Ph.D. & Julie Hudson, Ph.D.

Courtney Rennicke, Ph.D. Dyadic Developmental Psychotherapy Inst i tute B oard Me m be r a t La rg e fo r Un i te d S t a te s & Tre asure r 5 3 0 B roadway, 4 t h F loo r New York , NY 10 01 2 + 1 -21 2 -3 37 -3 5 6 5 Admin : Missy A l lan admin@ddpnetwork .org ddpnetwork .org Adopt ion/Foster Care Therapist Network (AFCTN) P re s ide nt , C o - Fo unde r in fo@ afc t n .o rg h t tp : //a fc tn .o rg •  L i s t s e r v •  Re fe r ra l re s ource •  P ro fe s s io na l t ra in ing s

Rennicke & Associates D i re c to r 5 3 0 B roadway, 4 t h F loo r New York , NY 10 01 2 +1-21 2- 337-3565 CR@rennickeassoc iates .com Admin : Missy A l lan in fo@rennickeassoc iates .com www.renn ickeassoc iates .com

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THANK YOU.