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Talking about Trauma: A DMM Perspective on Danger, Attachment & Adaptation Patricia M. Crittenden, Ph.D. Family Relations Institute, Miami, FL The plan DMM attachment theory as related to trauma Empirical findings An illustrative case: AAI and rare

video Treatment implications Strengths versus Deficit Approach Exposure to DANGER is an OPPORTUNITY to learn essential information about survival.

Danger versus Psychological Trauma Danger is universal. It is an event. Psychological trauma: a response to danger: Not everyone who is endangered has trauma. pain signals that there is something to learn.

Why do some have trauma and others not? The outcomes psychological trauma are: Theory of Attachment & Adaptation Dynamic-Maturational Model of attachment & adaptation (DMM). DMM: Theory about the effects of danger on self-, partner-, and childprotection.

Danger is a universal part of life. Development enables individuals to learn to manage a wide range of dangers. Information Processing The brain is evolved to give preferential attention to danger (Mather & Sutherland)

Two opposite processing routes: Cerebellar cognitive (temporal order, Skinner) Limbic affective (arousal, Le Doux, van der Kolk) Some information is processed verbally

Multiple Dispositional Representations DMM Self-Protective Strategies This leads to 3 self-protective attachment strategies: Cognitive Type As: avoid the danger Affective Type Cs: fight/struggle with the danger Balanced/Integrative Type Bs: consider & resolve the danger

Attachment Self-Protective Strategies Attachment Figures (parents) Children cannot manage most dangers. Attachment figures protect and comfort children in the childs zone of proximal development (ZPD): They let the child do for himself what he

can do; They help him to learn what he is ready to learn; When Parents Are Not in the ZPD Type A child: Parent expected too much and punished failure & negative feelings Type C child: Parent has intermittently & unpredictably

rewarded immature , negative behavior Danger & Psychological Trauma Danger creates the opportunity to learn to protect & comfort the self. Unprotected and uncomforted children: Use short-cuts that omit incomprehensible information. Tuck too threatening & complex information

away where it can be found later. Maturation creates the opportunity to reorganize DRs, with attachment figures Infancy: Attachment Self-Protective Strategies Preschool: Preschool

Attachment Self-Protective Strategies School-age: School-age Attachment Self-Protective Strategies Adolescence: Adolescence Attachment Self-Protective Strategies

Adulthood: Attachment Self-Protective Strategies Psychological Trauma in Childhood Unprotected & uncomforted danger in childhood Combined with lack of reorganization during development Creates psychological trauma in childhood.

This predisposes adults to PTSD from danger occurring in adulthood. Three Empirical Findings 1. Adults with chronic PTSD had unresolved childhood traumas. 2. Most of the traumas were in a dismissed form:

dismissed effects displaced feelings blocked & denied events delusional repairs. 3. Adult traumas were tied to childhood trauma the mind connected related

information. (Crittenden & Newman; Crittenden & Heller) 12 Types of Unresolved Traumas in AAIs Type A Type C Dismissed Preoccupied Displaced Imagined Vicarious Suggested

Blocked/denied Hinted Delusional repair Delusional revenge Depressed Disorganized Discourse Analysis of the AAI Adult Attachment Interview 1-hour, semi-structured interview About childhood danger, protection, &

comfort. Discourse analysis Yields self-protective ABC attachment strategy Unresolved traumas & type of distortion. Cecilias AAI Cecilia Excerpt 1: Relationship with mother

When I say distant its like she had this boyfriend, Big Bob, who was lovely and he used to go he had kids with another woman. And he used to go and see them every single Sunday. And the way I say mean by distant is that particular one particular Sunday, she decidemy mum decided not to come back, so Big Bob couldnt go to and see his kids cause he wouldnt leave us and he hadnt been with mm my mum that long and my mum decided not to come back, so I sort of mean that by distant,

was the fact that sometimes she just wasnt there. Infancy Continued: And I dont remember it personally in a way its from what I have been told by Big Bob cause he cahe err is friends with my uncle and he came round and he was like, Yeah well, I wouldnt have left your mum, but she didnt come back until the FrThursday err no Tuesday, I went Right she

goes and she had left left you for like three nights or whatever? Cause she went out on the Friday, came back on the Tuesday err, I was like Right she goes- he knew she knew I was meant to be seeing my kids on the Sunday and she never came back when she promised she would err and she had left him apparently with no money and there was hardly any food in the house so. Cecilias AAI with discourse analysis

Cecilia Excerpt 1: When I say distant its like she had this boyfriend dst, Big Bob, who was lovely ideal and he used to go dysf he had kids with another woman. And he used to go and see them every single emphasis Sunday. And the way I say mean by distant is dysf that particular one particular Sunday she decidedysf ....my mum decided not to come back, so dpl effect Big Bob couldnt go to and see his kids

cause he wouldnt leave us dst and he hadnt been with mm my mum dysf that long and my mum decided not to come back//, so I sort of mean that vague by distant, was the fact dst that sometimes Continued: Infancy And I dont remember it personally in a way dst & vague its from what I have been told by Big Bob

cause he cahe err v dysf is friends with my uncle and he came round and he was like, Yeah, well, I wouldnt have left your mum, but she didnt come back until the FrThursday err no Tuesday v, v, dysf, I went Right Speech she goes present tense and she had left left you for like three nights or whatever dsm? Cause she went out on the Friday, came back on the Tuesday repeat err, I was like Right she goes- he knew confusion of time & person She knew I was meant to be seeing my kids

on the Sunday and she never came back when she promised she would speech, present tense err and she had left him dpl!! apparently with no money and there was hardly any food in the house so. [So I Utr(dpl, ds) Infancy

Excerpt 2: Like my mom and my step dad would argue and fight and we had a dog who was gorgeous and she was very nervous around loud noises and they would start fighting and she would be shaking behind the sofa and I would go Mum, you are scaring the dog and they would go Get her the fuck out of here then! So I would end up having to take the dog for like a 2-hour walk or whatever because they were arguing.

Infancy Excerpt 2: Like my mom and my step dad would argue and fight and we had a dog who was gorgeous Shift to dog! and she was very nervous around loud noises dpl distress to dog and they would start fighting present participle and she would be shaking present participle & displaced to dog behind the sofa and I would go Mum, you are scaring the

dog speech & dpl caregiving to dog and they would go Get her the fuck out of here then! Violent and scatological speech So I would end up having to take the dog for like a 2-hour walk or whatever dsm because they were arguing. Dog functions as means of escape from an almost present tense danger. Utr(dpl)marital fights Cecilias DMM Attachment Strategy

Utr(dpl, ds)abandonment Utr(dpl)marital fights A+ + Unresolved trauma regarding abandonment and martial fighting in an affect-denying compulsive Type A cognitive strategy Cecilias play video with her son A video was shown in which Cecilia

played with her 6 month old son quite normally. She sat beside and slightly behind him. When he raised an arm quickly in the direction of her chin (behind him), she grabbed her chin as if hit, then paused, then kissed her son. He was completely unaware of anything having happened. Although she acted as if hit, she could not have been hurt by her baby son.

Questions Did the baby hit Cecilia aggressively? no Did he hurt her? no Did Cecilia perceive pain? yes Did she expect to be hit? Yes, by males This is a delusion! What consequence did she give her

son? Cecilias history Sibling died of shaken baby syndrome 7 hospitalizations in 1st year of life 29 hospitalizations by age 18 years Multiple abandonments Mothers boyfriends took care of her They also sexually abused her Babys father in prison for partner

violence Risk to Cecilias son Rewarded for unintended aggression Learns aggression is approved of & elicits love Relationships with children in school? Relationships with girls & women? Is Cecilias delusional repair of trauma creating a bully or violent husband or

both? Using Cecilias trauma productively What does Cecilia need to know? Intimacy with males was important for her survival in childhood. Her context with her son is not like that with Big Bob or her boyfriend. Her son needs a different response from her.

How can we help her to discover and use this information? 6 Implications for treatment 1. Safe context for reassembly of information & attribution of new meanings 2. Protective & comforting transitional attachment figure working in clients ZPD 3. Focus on adaptation to past & current

danger 4. Opposite ABC strategies need opposite treatments 5. Choosing techniques: Functional formulation of the symptoms. Treatment techniques suited to ABC type of information (1st do no harm). Person-specific treatment plans. Conclusions

The mind has an amazing capacity to retain information relevant to danger and comfort. To protect the self, the mind: Dis-associates bits of information & tucks them away Over-associates other bits to retain vigilance Frames information in evocative & metaphorical terms that ensure emotional meaning is retained, without explicit awareness. Development, reflection, and treatment offer ways

forward, especially with the help of a protective attachment figure. DMM Attachment Theory AAI Discourse Analysis CCPP Special DMM Issue Journal of Clinical Child Psychology & Psychiatry

Free access until August 31: http://ccp.sagepub.com/content/15/3.t oc Tell all the truth Tell all the truth but tell it slant Success in Circuit lies Too bright for our infirm Delight The Truths superb Surprise

As Lightening to the Children eased With explanation kind The Truth must dazzle gradually Or every man be blind Emily Dickinson Patricia Crittenden [email protected]

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