Attachment-Focused Family Play Therapy

An Intervention for Children and Adolescents after Trauma

Cathi Spooner

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781317374374
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Attachment-Focused Family Play Therapy presents an essential roadmap for therapists working with traumatized youth.

Exploring trauma and attachment through a neurobiological focus, the book lays out a flexible framework for practitioners treating young clients within the context of their family relationships. Chapters demonstrate how techniques of play and expressive therapy can be integrated into work with different developmental stages, while providing the tools needed to fully incorporate the family into the healing process. The book also provides clinical examples and guidance on the ethical decision-making needed to effectively implement attachment work and facilitate positive change.

Written in an accessible style, Attachment-Focused Family Play Therapy is an important resource for mental health professionals who work with traumatized children, adolescents, and adults.

Part I

Neurobiology of Trauma, Attachment, Behaviors, and Emotion Regulation

1

Rationale for an Attachment-based Family Play Therapy Approach Integrating Play and Expressive Arts

This chapter will provide an overview of research and clinical practice with trauma, attachment, and treatment with families. An introduction to the rationale for an attachment focus when working with families will be discussed, as well as the effectiveness of play therapy and the integration of play and expressive arts. Over the last two decades, mental health professionals have increased their knowledge of the neurobiology of relationships and trauma. The increase in the understanding of how our brain plays a role in our behavior and in our relationships has helped therapists become more grounded in research when developing and implementing treatment models with their clients, especially traumatized clients. Play therapy has been utilized by therapists for decades and has been shown to be an effective modality to help children resolve their mental health problems. Integrating parents as well as other family members into the treatment process has been shown to improve outcomes. Attachment therapists have used neurobiology to help guide their work with traumatized and attachment disordered clients. A brief overview of the treatment model for working with traumatized children and their families will be presented to introduce the basic structure and rationale for integrating play therapy and expressive arts―with a focus on neurobiology.

Three Decades of Research on Trauma and Attachment Neurobiology: An Overview

The last three decades of research have given mental health professionals a greater understanding of how the brain is impacted by trauma and attachment. Professionals with a foundational understanding of the neurobiology of trauma and attachment are able to understand the complex nature of the behavior manifested by traumatized youth within their relationships and daily activities. Our brain wiring begins its development in utero and continues on up into our late twenties and early thirties. It develops sequentially and hierarchically from the least complex functions in our brain stem to the most complex functions in our prefrontal cortex (Perry, Pollard, Blakely, Baker, & Vigilante, 1995). All of our experiences provide the foundation that influences our individually unique neural wiring with all the nuances of those experiences. We remember each event, each sensory input in our lives—the emotions we felt, what we thought, what we saw, what we heard, what we smelled, and what we physically felt.

These felt experiences are stored in our memories with all of this information attached to it. (Perry et al., 1995; Shapiro, 2012; Siegel & Hartzell, 2003; Steele & Malchiodi, 2012; Steele & Raider, 2001). Marrone (2014) discusses the connection between autobiographical memory, attachment, and one’s current lived experiences. He explains that our memories are integrated into our daily functioning to better understand the connection between our growing up years and our view of the world and ourselves. Memory and trauma will be discussed in more depth in Chapter 3. When working with traumatized children, it’s critical that we understand how children perceive the world and their relationships because those memories become the foundation of their reality and the lens through which they interact with others. I like to use the analogy of eyeglasses with colored lenses to understand how our experiences influence our view of the world and others. Imagine that you are looking at the world around you wearing glasses with blue lenses―and that those are the only glasses you ever wore to see. Obviously, your perception would be that the world is blue because the lenses you are looking through are blue. Your perception forms your reality and therefore your decision-making and actions are based on your experience of seeing the world as blue. On the other hand, if I wore purple lenses and perceived the world as purple, and we were in the same room together looking at the same people and things, I would see the world differently than you in some ways because I would see everything as purple and you would see everything as blue. Our different perspectives would be because of our different realities.

As with all things in relationships, we all have similar perceptions of shared experiences with others in our lives which influences our beliefs about ourselves, others, and the world. To expand on the eyeglass analogy here, let’s examine the purple lens to increase our understanding of shared perceptions. The color purple is not a primary color. It’s a mixture of blue and red. If you are wearing eyeglasses with blue lenses and I am wearing eyeglasses with purple lenses, then we both have a shared experience of blue hues in our perception of the world. Our perception of the world during relational interactions may overlap through our understanding and beliefs. These shared perceptions and beliefs tend to help us understand one another better. For example, siblings raised in a home with domestic violence will share certain perceptions about family life, while also having slightly different nuances of understanding based on age, temperament, observations, and cognitive abilities. These are important aspects of memory and understanding within family systems that therapists will need to explore to better identify relationship patterns.

The research of Allan Schore (Schore, 2000, 2001; Schore & Schore, 2008) provides an understanding about how early caregiver experiences impact the brain of the developing infant and how the infant responds. These interactions with parents determine the perception of the parents’ ability to care for them and keep them safe. Siegel and Hartzell (2003) state the relational mind

emerges as the flow of energy and information occurs within a brain, or between brains. Studies of infants have long revealed the interpersonal nature of our earliest days: attuned, reciprocal, mutual, collaborative, contingent communication describes the fundamental universal process that links infant to parent.

(p. 95)

It’s important for therapists to understand that those early pre-verbal experiences influence later development in children. Even though the children do not have language for these early felt experiences, these experiences are still wired in to memory in the child’s brain.

Therapists need to recognize that family members may have differing perceptions of a trauma within a family because each family member will have experienced the same trauma event differently. Family members need help in understanding that each member’s lens will result in their experiencing the trauma memory differently, which will influence the healing process for each family member. These concepts will be explored in later chapters in order to provide an understanding of trauma behaviors, support the promotion of healthy regulation of emotions, and help these children and their families create healthy attachments during the healing process.

All behavior is a manifestation of neural transmissions that are triggered by an individual’s experiences, as well as by their inherited genetic make-up. This can help us better understand trauma behavior. Our brain consists of about 100 billion neurons interconnected through neural pathways, adding up to a length of over 100 million miles in length. (Siegel, 2001). These neural pathways connect and develop various neural systems throughout our bodies (Perry et al., 1995; Siegel, 2001, 2011; Siegel & Hartzell, 2003). These systems are activated by information received from our environment through our senses (sight, sound, smell, touch, taste), as well as our internal systems processing information to create a response based on the specific functions they are designed to activate, such as basic life functions (breathing, heart rate) and more complex functions, such as learning and walking. Brain development is impacted by the interplay among inherited genetics and environmental influences. The environmental experiences of a child will influence brain development and neural integration at each stage of a child’s life. For example, the brain development of a 3-year-old child will look different from the brain development of a 10-year-old child because of their experiences and developmental growth.

The impact of trauma varies across a continuum based on a variety of factors, such as age of impact and brain development, inherent resiliency, understanding of the traumatic event, and access to support. The brain of a child experiencing ongoing trauma at 3 years old will develop differently than the brain of a child who has not experienced traumatic events. The brain of a 10-year-old child who has not experienced a traumatic event until that age will be different from a child who has experienced trauma since early childhood. The integration of neural pathways throughout the brain is dependent upon whether or not the child’s experiences stimulate the growth of neural pathways or prune them if they are not stimulated (Fishbane, 2007; Perry, 2006; Siegel, 2001, 2011).

There are complex networks of neural pathways that transmit information throughout our body that will elicit a response to information received and processed in our brain. Our brain is an amazing organism that is designed to keep us alive and will respond in ways that will do so. If a threat is perceived through information received via our senses, the brain will be alerted to the threat, real or perceived, and activate survival responses, such as the fight, flight, or freeze behavior. If I am walking down the street and I see and smell something or someone that looks unsafe, then my fear emotions will be activated and will alert my brain so the threat can be assessed. Stephen Porges (2011) has studied this phenomenon extensively and created what he calls Polyvagal Theory. He coined the term neuroception to explain the neural system that assesses threat and activates or deactivates fight, flight, or freeze behaviors. A traumatic event will activate the neural systems charged with the purpose of survival.

If trauma is experienced as an ongoing event, the neural adaptation process will continually activate the body’s stress response. Prolonged activation of the body’s stress response creates maladaptive behaviors that will become hard-wired (Perry et al., 1995), so to speak, creating trauma behaviors that are persistent and maladaptive―to include viewing the world through a trauma lens. Trauma forever changes one’s experience of the world and one’s neural system. For the traumatized person, this trauma lens becomes his or her reality, even if the perception of threat is not an actual threat. This faulty reality then influences his perception of the world as continually unsafe and will activate largely maladaptive behaviors. These maladaptive behaviors can become a barrier to forming healthy relationships with others. According to Porges (2011), when the threat system is activated then a healthy social engagement cannot occur. Understanding the areas of the brain impacted most directly by trauma can help to better understand the behavior of traumatized children and help them learn how to develop and engage in healthy relationship behaviors (Perry, 2006; Weber & Reynolds, 2004).

The focus of the treatment framework offered in this book is designed to help traumatized children learn to engage in relationship behaviors that are healthy, to form secure attachments with their family members, and later on form healthy relationships with others―as well as looking to their attachment figures to help them learn to effectively regulate their emotions. Most treatment models for traumatized children use an attachment framework to support children in learning how to develop healthy social bonds with parents. Trauma can impact whole family systems for generations if change does not occur. Addressing trauma within the family provides a much better outcome for children since children do not exist in a vacuum. Family members need to learn how to talk about the trauma to feel safe again, and to process their experiences. Therapists need to help family members understand the different colored lenses of each family member to successfully bring healing. Children who are able to heal within a family that is also healing are more likely to develop and sustain resiliency. For families who have experienced generational trauma, it will be important for the trauma to be addressed within the family context in order to break the cycle of trauma for future generations.

Family Systems Theory and Attachment Theory

Family Systems Theory focuses on understanding the complex interactions between family members and their communication patterns in order to better understand the behaviors of those family members. It is rooted in Systems Theory, which provides a more general understanding of interactions between entities. Family Systems Theory provides a framework for understanding relationship patterns and how family relationships impact behavior, whereas Attachment Theory examines the quality and nuances of the interaction patterns between primary caregiver and child. Family Systems Theory models can either examine relationship patterns over several generations to examine a broader understanding of the child’s behavior and/or examine family relationships within the nuclear family only. The broader view allows therapists to better understand how entrenched certain family patterns are within the child’s family. For example, take the family in which there is a history of three generations of abuse versus the family in which there are generally well-functioning parents and then the child experiences a traumatic event one time. The severity of the impact of trauma will be mitigated by the resiliency factors of a generally well-functioning family system. In families with a history of trauma, including domestic violence and addiction, over several generations will have more entrenched dysfunction which will create challenges in the healing process.

Children who grow up in families with a generational history of trauma often lack the parental social support needed because their parents have also experienced trauma which has altered their neurobiology and ability to effectively parent their child without intervention. Many of my clients over the years who come from families with generational trauma have difficulty distinguishing between perceived and actual threat, which influences their responses to social situations. For example, 14-year-old Jane lives with her maternal grandmother, Linda, because Jane’s mother, Mary, is in jail for drug charges. Mary grew up in a home with domestic violence and was sexually abused by an uncle and one of her cousins. Mary learned to deal with the abuse by disconnecting from her emotions and seeking solace in unhealthy friendships with drinkers and marijuana users. Mary’s mother, Linda, was distracted by her abusive relationship with Mary’s father and unable to provide the needed emotional support for Mary. Linda was sexually abused by her father and also learned to block out the memories by emotionally disconnecting. The generational pattern of relationships in this family system has been that relationships are chaotic, hurtful, and abusive. The ability of family members to recognize threats has been compromised and family members have learned to survive rather than thrive.

When Jane went to live with her grandmother, Linda, after Mary was arrested, she was raped at a party by a boy she liked while they were drinking alcohol and smoking marijuana. Jane reported the rape to a friend who told her own mother who eventually told Linda. This information activated Linda’s memories of her own sexual abuse which she had learned to dissociate from (as a way to manage the trauma and escape the pain) so that made it difficult for her to support Jane. Instead, Linda tried to minimize the impact of the traumatic experience on Jane so instead of being able to provide emotional support and advocacy for Jane, Linda rationalized the need to “forget about the whole event” so that Jane could “move on” with her life. However, in order for Jane to really heal from her trauma, she as well as her family members will need to address their own experiences so that they can develop a new paradigm of relationships and safety that includes healthy relationship patterns. Family Systems Theory provides a framework for understanding how trauma relationship patterns are played out within the family system and for helping family members to change them...