Willis took the time to cover several childhood disorders related to the atypical social-environmental development that included ADHD, autism, aspergers, and FASD. I gained some valuable insight to the neurological and regulatory disturbances associated with these disorders. Among the most interesting I learned many of these disorders (1 in 4) are correlated with toxic prenatal exposures (i.e., alcohol, smoking, pesticides, poor nutrition, obesity, heavy metals) and 40% of these disorders are caused my environmental factors. I’m particularly interested in attachment, so when Willis lectured about autism it was remarkable the learn that many types of insecure attachments are often mistaken for Autism.
Neglect
I was acutely unaware that child neglect is actually more harmful to the psychological and physiological development of a child than trauma or abuse, as well, the extent that neglect interferes with the primary sensory system of a child, and ultimately abnormal development of the child’s brain—particularly the corporeal size of the brain. Subsequently, the child who experiences neglect is more likely to have an undeveloped cortical system and limbic area, meaning the child essentially relies neurologically on the primal midbrain and brainstem.
Trauma
Willis described in vivid detail the acute and long-term responses to trauma. It was interesting to learn about the progressive development of arousal system; specifically, the sequential manner the child experiences vigilance, alarm, fear, and finally terror, and how with support the child enters a baseline of calm more readily than a child who is physiologically/psychologically vulnerable with few or no supports. Willis also expressed that these children, among others, have altered cardiovascular regulation, behavior impulsivity, increased anxiety, an increased startle response, and sleep abnormalities.
How Are Attachment Schemas Related to Trauma?
After this lecture I became more interested in the neurobiology of attachment and how insecure attachments, often resulting from trauma or neglect, affect the brain the subsequent physiological development of the child. Below are some of my findings.
What is Attachment?
Attachment theory, as defined by Bowlby and Ainsworth, asserts that strong early relationships serve as a secure base from which to go confidently out into the world (Bowlby & Ainsworth, 1991). These fundamental relationships are those that individuals form and try to maintain because they are fundamental to feelings of belonging, security and protection from fear (Sable, 2008). The research suggests that a secure, close connection is a source of strength and personality integration (Siegal & Hartzell, 2003).
Research puts forward that healthy development is dependent on secure parental attachment, where in the child or adolescent feels safe enough to explore his or her environment, while knowing his parental figures are accessible and responsive when called upon (Bowlby, 1988). “This secure attachment is associated with the individuals’ ability to connect with others and cope with affective or stressful problems” (Ketterson & Blustein, 1997, p, 14). Siegal and Hartzell (2003) clarify that when children have primary caregivers who are consistent in their behaviors, are emotionally attuned (the inner state of the child is matched with that of the parent), and respond to the child in such a way that accurately matches the child’s signals, the child consequently feels connected to, understood, and protected. In essence, the child is confidant their caregiver will be responsive and available if they encounter adverse situations (Bowlby, 1988).
Attachment and Internal Regulation
We know that early bonding experiences strengthen networks of the social brain, and that these experiences also promote building of the brain as a whole by stimulating metabolic arousal. These face to face interactions trigger the sympathetic nervous system and increase oxygen consumption and energy metabolism in children. This then increases production of norepinephrine, endorphins, and dopamine enhancing the child’s pleasure during positive connection (Bretherton, 1992). Furthermore, these experiences enhance formation of biochemical environment in the brain conducive to regulation, growth, and optimal immunological functioning—it is optimal balance between sympathetic and parasympathetic arousal (Cozolino, 2010).
Insecure attachment, on the other hand, has been correlated with disconnections among streams of processing within the brain. This psychological vulnerability is due in part to an alteration of the brain’s neuroendocrine response to stress (Siegal, 2001). Children who are mistreated, abandoned, neglected, or even abused have brains that become shaped in ways that do not support long term survival. These children “grow to have thoughts, states of mind, emotions, and immunological functioning they are inconsistent with wellbeing, successful procreation, and long-term survival” (Cozolino, 2010, p. 206). In particular, these children are prone to increased neuronal death; impairment in the ability to learn; an increased anxiety, fearfulness, and stress response; greater vulnerability to addiction; avoidance of novelty and exploratory behavior; reduced gene expression; greater cortisol secretion in response to mild stress (decreased cortisol receptors in hippocampus); reduced GABA receptors (inhibitory receptors associated with a reduction in anxiety); right-biased frontal activation that is correlated with higher stress and arousal (Cozolino, 2010); and run a greater risk of expressing interpersonal violence as they mature (Lyons-Ruth, Alpern, Repacholi, 1993; Lyons-Ruth & Jacobwitz, 1999; as cited in Siegal, 2001).
Genetic Expression
Genetic information influences how neurons are connected early in childhood, and it postulated that these early encounters can shape specific gene expression; specifically, secure attachments have been linked to the genes responsible for the creation new synaptic connections (Cozolino, 2010), and the proteins necessary to shape the structure of the brain (Kandel, 1998; Nelson & Bloom, 1997; as cited in Siegal, 2001). This same attachment is also associated with in inhibition the expression of those genes responsible for emotional and behavior disorders (Cozolino, 2010). It has also been discovered that insecure attachment, which is linked to the expression of specific genetic information and stressful or absent experiences, can lead to the elimination of synapses or excessive synaptic pruning (Siegal, 2001).
My Work Setting and Clientele: Application
Currently I work as an intern marriage and family therapist for the Portland State Community Counseling clinic. Thus far none of my clients are children; however, I realize that many of my clients come from neglectful or abusive homes, and others suffered from various forms of trauma in their childhood. I believe it’s important to provide a safe therapeutic container for clients to work through these traumas and the aftermath of being raised in toxic homes. I think that the noxious upbringing many clients experienced in childhood subsequently formulated insecure attachments for many. I believe among the many therapeutic interventions it is essential for the therapist to provide a safe and secure environment while being mindful of the neurobiological vulnerabilities these clients’ have acquired.
Therapy as Re-Parenting
Research tells us that secure attachment can indeed change over time due to extensive stress or traumatic events. However, it is has been found to be more resistant to change than insecure attachment. That being said, insecure attachment can be modified as a result of positive social input such as constructive personal relationships, psychotherapy and increased self-awareness (Pilowsky et al., 2008; as cited in Cozolino, 2010).
Cozolino (2010) suggests that the therapist can act as a guide to a secure attachment relationship to assist the client with modulating their sense of homeostasis, increase flexible affect regulation, and repair insecure attachment schemas. The question is how can we best do this in the therapeutic relationship? Siegal (2001) outlines the basic secure relationship involves collaborative communication, reflective dialogue, interactive repair, coherent narrativization, and emotional communication. The therapist can essentially act as secure parent providing these five elements to the client. First, the therapist must engage in collaborative, contingent communication so the client feels seen. The therapist must be attuned to the client’s verbal and non-verbal signals and responds sensitively, accurately, and accordingly. Second, there must be a level of discourse conducive to a level of verbal sharing that focuses on the internal experience of each person in the dyad. This is somewhat limited as a therapist, but nonetheless the therapist can engage in the limited sense. As an attachment the therapist recognizes the signals sent by the client, attempts to make sense of them in their own mind, and then communicates to the client in such a manner that creates “meaning” for them. Third, when there is a rupture in the therapeutic relationship a healthy repair must be made. If these misunderstandings and missed connections can be identified and connection can be created again the client as an opportunity to “make sense of these painful disconnections and create a sense of meaning out of the understanding of one’s own and another’s mind” (Siegal, 2001, p. 79). Fourth, the therapist must provide a context for the client to re-construct an accurate personal narrative. “This connection of the past, present, and future is one of the central processes of the mind in the creation of the autobiographical form of self-awareness” (Siegal, 2001, p. 79). Ideally, this process act will build the platform for bilateral integration. Lastly, the therapist serves as sounding board for emotional communication. Whether it is sharing in the client’s joy or helping the client sit with their uncomfortable emotions, the ultimate goal is for the therapist to remain connected to the client.
References
Ainsworth, M. D. S., & Bowlby, J.(1991). An ethological approach to personality development.
American Psychologist, 46, 331-341.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development.
New York: Basic Books.
Bretherton, I. (1992). The Origins of Attachment Theory: John Bowlby and Mary Ainsworth.
Developmental Psychology, 28 (5), 759-75.
Cozolino, L. J. (2010). The neuroscience of psychotherapy: Healing the social brain. New York:
W.W. Norton & Co.
Ketterson, T. U., & Blustein, D. L. (1997). Attachment relationships and the career exploration
process. Career Development Quarterly, 46, 167-178.
National Scientific COunsil on the Devloping Child (2003). Excessive Stress Disrupts the
Architecture of the Developing Brain: Working Paper #3.
Sable, P. (2008). What is Adult Attachment? Clinical Social Work. 36, 21-30.
Siegal, D. J. (2001). Infant Mental Health Journal 22, 67–94.
Siegel, D. J., & Hartzell, M. (2003). Parenting from the inside out: How a deeper self-
understanding can help you raise children who thrive. New York: J.P. Tarcher/Putnam.
