DiscoverCounselor Toolbox PodcastComplicated Grief and Attachment
Complicated Grief and Attachment

Complicated Grief and Attachment

Update: 2020-02-022
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460 – Complicated Grief and Attachment


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Complicated Grief and Attachment

Dr. Dawn-Elise Snipes PhD, LPC-MHSP

Podcast Host: Counselor Toolbox and Happiness Isn't Brain Surgery

Objectives

~ Define Complicated Grief

~ Identify how loss of or lack of an attachment relationship may represent a loss that needs to be grieved.

~ Explore the overlap between complicated grief and trauma

~ Identify risk factors for CG

~ Explore tasks for successful grief resolution

Definitions:

~ Loss: Change that includes being without someone or something in this case the primary attachment relationship

~ Secondary loss: Other losses as a result of a primary loss. Example, loss of security when rejected by primary caregiver

~ Grief: Reaction or response to loss; includes physical, social, emotional, cognitive and spiritual dimensions.

~ Trauma: Any situation that causes the individual to experience extreme distress


Attachment

~ Attachment

~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security.

~ The quality of the infant-parent attachment is a powerful predictor of a child's later social and emotional outcome

~ Determined by the caregiver's response to the infant and toddler when the child's attachment system is ‘activated'

Internal Working Model

~ Children's attachment with their primary caregiver leads to the development of an internal working model which guides future interactions with others.

~ 3 main features of the internal working model

~ a model of others as being trustworthy (what is the loss here?)

~ a model of the self as valuable (what is the loss here?)

~ a model of the self as effective when interacting with others. (what is the loss here?)

~ Secure attachments also help children

~ Feel loved and accepted

~ Learn to manage their emotions

~ Address dichotomous thinking and cognitive distortions


Bowlby on Attachment and Grief

~ Attachment Relationships Help Regulate Psychological And Biological Functions Including:

~ Mastery and performance success

~ Learning and performing

~ Relationships with others (and future attachment)

~ Cognitive functioning

~ Coping and problem solving skills

~ Self-esteem

~ Emotion regulation

~ Sleep quality

~ Pain intensity (physical and emotional)


Bowlby

~ Attachment and safety stimulate a desire to learn, grow and explore

~ Caregivers provide support and reassurance (Safe haven)

~ Encouragement and pleasure (secure base)

Feeney J Pers Soc Psych 631 -648 2004


Bowlby

~ Loss of an attachment relationship

~ Disrupts attachment, caregiving and exploratory systems

~ Attachment: Activates separation response and impacts restorative emotional, social and biological processes

~ Exploratory system: Inhibits exploration with a loss of a sense of confidence and agency.

~ Caregiving: Produces a sense of failure and can include self blame and survivor guilt


Trauma

~ Trauma is any event that is distressing or disturbing

~ How do we know what is distressing or disturbing

~ Erodes a sense of safety (Triggers fight or flight)

~ Emotional (including dysregulation)

~ Mental (interpretations and schemas)

~ Physical (object permanence, darkness, pain, prior experiences)

~ Adverse Childhood Experiences that may disrupt primary attachment

~ Immediate family member with a mental health or addiction issue

~ Immediate family member who is incarcerated

~ Divorce

~ Abuse (child or DV)

~ Neglect


How Can Disrupted Attachment ïƒ Trauma

~ The primary attachment figure remains crucial for approximately the first 5 years of life

~ Trust/mistrust (Ages 0-2)

~ Object Permanence

~ Autonomy/shame (Ages 2-7)

~ Egocentrism: children assume that other people see, hear, and feel exactly the same as they do

~ Children's moral sense in this phase of development is rigid and believe that a punishment is invariable, irrespective of the circumstances.

~ They regard bad things that happen as a consequence for misdeeds and a punishment for misbehavior.

http://www.childhealth-explanation.com/cognitive-development.html

Attachment and Discussion

~ What is a child supposed to have from a caregiver?

~ Emotionally

~ What happens when this doesn't occur?

~ How is that traumatic?

~ Cognitively

~ What happens when this doesn't occur?

~ How is that traumatic?

~ Physically

~ What happens when this doesn't occur?

~ How is that traumatic?

~ What is a caregiver supposed to be like?

~ What happens when this doesn't occur?

~ How is that traumatic?

~ How might these traumas also represent a loss?—Let's look


Complicated Grief

~ Symptoms

~ Separation distress involving intrusive, distressing preoccupation with the loss

~ Traumatic stress reflecting specific ways the person was traumatized by the loss

~ Avoidance of reminders

~ Intrusive painful thoughts

~ Emotional numbing

~ Irritability

~ Feelings of hopelessness and purposelessness

~ Shattered self identity

Risk Factors for Complicated Grief Related to Attachment

~ Child

~ Age

~ Physical issues

~ Emotional issues (pre-existing)

~ Cognitive understanding

~ Personality and character traits

~ Nature of the loss

~ Number of losses

~ Circumstances of the loss

~ Resources available

~ Nature of the relationship

~ Length/duration

~ Importance

~ Culture/Roles

~ Quality

~ Dependence

~ Hopes and Dreams (retrospectively)

~ Amount of Daily Change (foster care, relative placement)


Emotional Effects of Trauma and Complicated Grief

~ Dysregulation

~ Anxiety

~ Separation anxiety

~ Reactive Attachment

~ Angry/Irritable/Oppositional

~ Depressed

~ Lonely/Isolated

~ Guilty/Regretful

Physical Effects of Trauma and Complicated Grief

~ Appetite (eating) disturbances

~ Energy, fatigue, lethargy

~ Sleep disturbance

~ Anxiety

~ Gastrointestinal disturbance

~ Compromised immune response; increased illness


Intellectual Effects of Trauma and Complicated Grief

~ Confusion; “What is real?

~ Difficulty concentrating; ex. Read the same page several times

~ Short attention span; ex. Can't finish a 30 minute TV program

~ Difficulty learning new material; short term memory loss; ex. Income taxes

~ Difficulty making decisions

~ Lack of a sense of purpose

~ Inability to find meaning in the events and life itself


Social Effects of Trauma and Complicated Grief

~ Withdrawal

~ Isolation

~ Searching

~ Avoidance

~ Self absorption

~ Clinging/dependence

Reconciliation Tasks

~ To help adults or adolescents who never formed that attachment

~ Acknowledge the reality of the loss.

~ Move toward the pain of the loss while being nurtured physically, emotionally, and spiritually.

~ Develop a new self identity based on a life without that relationship.

~ Experience a continued supportive presence in future years

Reconciliation

~ Learn basic trust, which serves as a basis for all future emotional relationships

~ Learn how to develop fulfilling intimate relationships

~ Develop strategies to maintain emotional balance and resiliency

~ Develop the ability to control behavior, which results in effective management of impulses and emotions

~ Enhance confidence and self-esteem

~ Learn how to share feelings and seek support


Reconciliation

~ Create a foundation for the development of identity, which includes a sense of capability, self-worth, and a balance between dependence and independence

~ Establish a core set of beliefs that leads to empathy, compassion, and conscience

~ Begin exploring the environment with feelings of safety and security, which leads to healthy intellectual and social development


AVOIDANCE

~ Recognize the loss

~ Acknowledge the loss of or lack of establishment of the attachment relationship

~ Understand the losses as a result of the lack of attachment


CONFRONTATION

~ React to the realization of the loss

~ Experience the pain

~ Feel, identify, accept, and give some form of expression to all the emotional, cognitive and physical reactions to the lack of or loss of the attachment figure

~ Identify and mourn secondary losses

~ Loss of safety

~ Loss of happiness (distress)

~ Loss of the childhood I should have had

~ Loss of self esteem

~ Loss of success


CONFRONTATION

~ Recollect and re-experience the relationship

~ Review and remember realistically

~ Revive and re-experience the feelings

~ Relinquish the old attachments to the old assumptive world


ACCOMMODATION

~ Readjust to move adaptively into the new world without forgetting the old

~ Revise the assumptive world

~ Develop a new relationship with the self

~ Adopt new ways of being in the world

~ Form a new identity

~ Reinvest


Summary

~ Failure to develop a primary attachment relationship can be viewed as a loss (or something that was needed that was never achieved)

~ When examining the behaviors of adult or adolescent clients whose primary attachment was disrupted, the traumatic impact can be seen.

~ In order to help people reconcile the trauma it is essential to help them

~ Identify and grieve the losses

~ Review and remember realistically what happened (to combat inaccurate schema)

~ Review the assumptive world (if I just…then she will be love me)

~ Develop a new loving relationship with the self

~ Learn how to trust the self and others to form meaningful and supportive relationships

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Complicated Grief and Attachment

Complicated Grief and Attachment

Charles Snipes