Blog

Posted in Neuroscience of Attachment

Conceptualizing Play Therapy Treatment … A Standard for Excellence

you need to be a good psychotherapy super sleuth because if you conceptualize the presenting symptoms erroneously then your treatment approach may take you and your client in the wrong direction. Being a good mental health super sleuth is the difference between being a mediocre (at best) and excellent therapist.

 

Written by Cathi Spooner, LCSW, RPR-S

Image by Tumisu from Pixabay 

 

Any really great therapist will tell you that one of the foundational elements of providing excellent psychotherapy to clients is …

 

… Clinical Case Conceptualization.  

 

Are you having flashbacks to graduate school and rolling your eyes at me as you read this?  Well, hang in there with me for a minute.  I LOVE, LOVE, LOVE , LOVE clinical case conceptualization.  It’s like being a psychotherapy detective aka – super sleuth. Yes, that’s my guilty pleasure – watching detective shows. I love a good “who dunnit.” As a psychotherapy super sleuth, you begin an “investigation” to figure out what is going on underneath those symptoms and how to help your clients get better.

 

Here’s why case conceptualization is the backbone… (full disclosure – I’m passionate about this because I see it go wrong so often) … 

 

…it’s the way in which you conceptualize what’s going on with your clients and then formulate a plan to help your clients overcome the problem they were seeking you to help them resolve.  The same is true for play therapy and expressive arts.  How you conceptualize the presenting problem determines how you plan to help your client overcome it. So, you need to be a good psychotherapy super sleuth because if you conceptualize the presenting symptoms erroneously then your treatment approach may take you and your client in the wrong direction. Being a good mental health super sleuth is the difference between being a mediocre (at best) and an excellent therapist.

 

 

What is clinical case conceptualization?

It’s the way in which you conceptualize what the presenting symptoms mean and how you’ll treat those symptoms.  Clinical case conceptualization helps you figure out your “road map” for treatment – aka your treatment plan.   Your clinical case conceptualization is based on collecting information about the frequency, duration, and intensity of the presenting symptoms in order to identify a diagnosis (even a non-DSM diagnosis of the problem) which helps you identify what treatment modality to use and what type of interventions are needed. The way in which you conceptualize the presenting issues also helps you determine how you will pace the sessions, aka – the frequency of sessions.  You’ll also identify who needs to participate in treatment and what you’ll address with parents/family members.

 

Tips for developing your clinical conceptualization

Gathering a thorough history using a psychosocial assessment as well as a genogram model provides the information needed to fully understand what are the factors contributing to the presenting issue as well as the extent of the problem.  For example, is there a family history of trauma, attachment, addiction, and/or mental health problems?  The longer the problems have existed typically means the issue is more entrenched systemically.  Since child and adolescent therapists work with children it’s important to understand them within the context of family, school, social network, and culture.  When you’re gathering information from parents/guardians, and when appropriate the child/adolescent, it’s important to gather information about the presenting symptoms frequency, duration, and severity. How often do the symptoms occur, how long does the problematic behavior last, and how severe are the symptoms? I often ask clients to rate the severity of the symptom using a Likert scale of 0- 10 with “0” meaning no problem to “10” as the most severe. Having my clients rate the severity of their problem gives me information to see the problem through their eyes to get a better sense of how parents/caregivers and the child experience the problem. These are the “clues” I need for my “detective lens” that helps me better identify what’s going on with my client.

 

It’s also very important to ask about the child’s developmental and school history because this information gives clues to help me identify a potential learning problem or other developmental delays that may be impacting symptoms.  It also helps me to get a sense of my client’s ability to manage stressors during significant transitions, such as the transition to school for kindergarten, middle school, and high school. These are big transition periods and it’s important to get a sense of how your young clients adjust to changes in their life. For example, the transition from elementary school to middle and middle school to high school can be problematic, and gathering this information may provide clues as to when problems began to get worse.  I typically ask parents/caregivers if their child’s behavior began to gradually and steadily get worse or if there was an event that seemed to have activated the problematic behavior.  

 

Frequency, duration, and severity of symptoms

 

Using a really good genogram focus to gather information about family history and family relationships provides a framework for collecting information about the broader context of the presenting symptoms and identifying resiliency resources.  This provides information about potential genetic predispositions such as ADHD, learning problems, depression, anxiety, trauma, addiction, and other significant mental health challenges like bipolar disorder.  It’s important to also identify potential resources to support positive growth and resiliency. Gathering information about the quality of family relationship patterns helps provide clues about parenting abilities and attachment patterns.  As child/adolescent therapists, part of our treatment focus is to help parents/caregivers develop skills for supporting their child long after treatment ends.  We need to build therapeutic rapport with parents/caregivers.  Gathering information about family history and relationship patterns gives me clues about the acuity level of the family system in which my young client lives.  All of this information provides clues to help me identify the “roots” of the presenting symptoms and conceptualize the treatment plan needed to help my client overcome their challenges.

 

What happens if you miss key components because you are not gathering “clues”?

Your “roadmap” will likely go to the wrong “destination” or you may get lost in treatment if you don’t have enough information to fully understand what is underneath (roots) your client’s presenting problems.  For example, if you don’t gather information about school performance and school transitions, then you may miss a potential learning disability that warrants further evaluation by a clinical psychologist.  Undiagnosed learning problems can often manifest as defiance, depression, anxiety, and poor self-esteem that may later contribute to substance misuse and/or dropping out of school.  Perhaps you’ve gathered information about a traumatic event your client experienced but you didn’t gather a thorough family history and/or information about generational family attachment patterns.  Children heal best within the context of their relationships because they need their parents/caregivers to help them navigate their world and their emotions. So, why would we leave parents out of the treatment process since they’re a significant part of the solution? Gathering information about family history and family relationship patterns provides information about parent/caregiver capacity to be the support their child needs them to be, and what type of support and interventions are needed to help parents provide healthy support.  It helps us to figure out if a parent/caregiver has the ability and capacity to be a healthy part of the child’s healing process. If we fail to accurately identify the “roots” of the problem and positive resources available, the interventions you choose may not be effective because you didn’t identify what are the potential “roots” of the problem and how to effectively address those “roots.”  

 

Here’s the thing … we don’t always get it “right” in the beginning because our clients are complex and it may take time to fully understand what are the factors contributing to the presenting problems.  However, we do need to make sure we have a mindset of “mental health super sleuth” so that we are regularly looking for clues to the problem so that we can use that information for our clinical decision-making process and adjust the treatment approach as needed throughout the treatment process.  This is critical to effectively help our clients and their families overcome their challenges. 

 

 

Here’s a recap:

·       Clinical case conceptualization is the way in which you identify what are the roots of the symptoms and conceptualize what treatment approach is needed. It forms the basis for your treatment “roadmap.”

·       Gathering a thorough psychosocial assessment helps you identify the “roots” of the symptom frequency, duration, and intensity as well as identifying the severity of the problem within the context of the child’s life.

·       If you miss key components you’ll be trying to figure out why your client may not be making progress and your roadmap will miss the mark for its effectiveness.  

·       We don’t always get it “right” and we may need time to gather enough information as well get to know our clients and their family.  The key is that we need to ensure we are using our mental health super sleuth “lens” so we can accurately identify the “roots” of the problem and figure out how we’re going to integrate parents/caregivers into the treatment process.

 

Posted in Sand Tray Therapy

Tips for Using Sand Tray Therapy with Children and Teens Effectively and Ethically

Written by Cathi Spooner, LCSW, RPT-S

Image by Patrik Houštecký from Pixabay 

 

Using sand tray in the treatment process with children and teens requires child/adolescent therapists to have a good understanding of the common themes and patterns of your young clients because of their unique developmental processes and needs using this expressive arts modality.  Having a clinical framework helps you understand and process your client’s sand tray which requires child/adolescent therapists to have a solid grounding in a theory model because theory drives the application. This blog post discusses what you need to develop proficiency using sand tray confidently, ethically, and effectively with your child and adolescent clients in the treatment process.

 

Sand tray therapy is an expressive arts modality which means it’s projective in nature. Since it’s projective in nature, training and consultation are key to use it ethically and effectively within a grounded framework – theory drives application when you’re using an integrated approach.  There are some basic principles that apply across the board when using expressive arts modalities and how you “clinically interpret” meaning. This requires you to have a foundational idea of how to understand the developmental aspects of using sand tray therapy with children so you know what is typical and what may represent that your client is “stuck” in an earlier social-emotional stage/issue. Recognizing where clients are socially and emotionally stuck provides so much helpful clinical information and informs your clinical decision-making process. When using sand tray therapy, child/adolescent therapists need to know how to recognize common patterns seen in sand trays created by children so you know what is typical and what is not as well as helping you to recognize clinically relevant themes in your young client’s sand trays.  Children and adolescents engage differently in the sand tray therapy process which makes sense when you think about their developmental differences, so child/adolescent therapists need to know how to introduce and process your client’s sand trays based on these developmental differences. Child/adolescent therapists need to know how to identify clinically relevant themes in the sand tray and then know what to do with that information, which requires a framework. 

 

Since it’s projective in nature, training and consultation are key to use it ethically and effectively within a grounded framework – theory drives application when you’re using an integrated approach.

 

As a child/adolescent therapist you need to know how to clinically “hold” sand trays without “stepping all over” their projective content in the sand tray, which will bring the therapeutic process to a screeching halt, not to mention ruining the ability to maintain a safe therapeutic space for your client. Even if you’re using directive prompts within an integrative approach with your child and adolescent clients, you still need to have a framework for “holding” and “processing” the sand tray. I LOVE a good framework because it helps me to navigate the clinical decision-making process that’s necessary to help my clients successfully resolve their challenges – those issues bringing them to my office for therapy in the first place. It’s like have GPS for therapy. If I get stuck or there’s “an accident” halting movement, then my framework, or clinical GPS, helps me figure out another way to get to the same place, or maybe we just need to “stay where we are in traffic” and wait for the “lane to open back up.”

 

I LOVE a good framework because it helps me to navigate the clinical decision-making process that’s necessary to help my clients successfully resolve their challenges – those issues bringing them to my office for therapy in the first place. It’s like have GPS for therapy.

 

Using sand tray therapy without getting training and supervision can be detrimental because you need to have a framework for using it ethically, and that takes an investment in your time and money. The benefit making that investment of time and money is that you know you’re using sand tray therapy ethically as well as knowing how to use it confidently and effectively. There’s nothing worse than getting “lost” in the treatment process and having no clue what’s going on for your client. As mental health professionals, we need to be lifelong learners because the more we learn the more we realize there is more to learn. So, if you’re brand new to sand tray therapy or just starting your journey using sand tray, here’s my advice to getting the right kind of training to get you started with a solid foundation from which you can continue to build your skills:

  • Training needs to include experience creating your own sand trays so you understand the power of this projective modality
  • Training needs to ground you in a theoretical model to guide how you apply the principles of sand tray, including when you are using an integrated approach to play therapy and expressive arts
  • Invest in ongoing consultation to help you identify clinically relevant themes and case conceptualization using sand tray therapy to help with your clinical decision-making process for each client.

 

Here’s a recap:

  • Sand tray therapy is a projective modality (like any other expressive arts modality) and there are fundamental principles of sand tray therapy that are important to know at the very least to ground you in this projective modality.
  • Being grounded in a clinical framework and a theoretical model ensures sand tray therapy application is effective, ethical, and appropriate.
  • The basic principles of sand tray therapy (and other expressive arts modalities) are:
    • understanding the developmental aspects of using sand tray therapy with children so you know what is typical and what may represent that’s your client is “stuck” in an earlier social emotional stage/issue
    • recognizing common patterns seen in sand trays created by children
    • knowing how to engage children and adolescents because they engage differently
    • identifing clinically relevant themes in the sand tray and then knowing what to do with that information
    • “holding” sand trays without “stepping all over” their projective content in the sand tray

 

If you’re interested in learning how to use sand tray therapy with your child and adolescent clients in the treatment process, contact me.

Posted in Neuroscience of Attachment

The Hero’s Journey: Regulating Emotions with Breathing and Mindfulness

Written by Cathi Spooner, LCSW, RPT-S

 

If you’re a mental health professional working with children, youth, and families, chances are you’ve worked with children who struggle with regulating their strong emotions.  Parents of these children are often overwhelmed and unsure how to help their child and are looking to you as the “expert” to know what to do and how to help their child. Emotion dysregulation wreaks havoc on self-esteem and relationships for children so the impact can be experienced throughout their lives if not addressed early.  So how do we help our young clients and reassure their parents that everything will be okay? How do we make sure they have effective skills that will actually help? These are the questions we need to ask ourselves when working with children who experience regular emotion dysregulation and their families. 

 

First, a short review of the mind-body connection to help guide our treatment strategies

From birth children are creating the neural circuitry that will allow them to regulate their emotions, so it’s important to identify treatment strategies that will support this important developmental process. The goal for treatment is helping our young clients develop the ability for long-term emotion regulation skills that will help them to internally regulate their emotions. It’s important for mental health professionals to understand the mind-body connection so they can accurately target their interventions and recognize the underlying triggers for behavior. Using neuroscience-informed strategies to teach coping and calming skills to children and their caregivers provides an opportunity for children to establish the emotion regulation neural circuitry needed to be successful in their relationships and daily lives.

 

From birth children are creating the neural circuitry that will allow them to regulate their emotions, so it’s important to identify treatment strategies that will support this important developmental process.

 

Polyvagal theory developed by Stephen Porges (2011) provides an understanding the role of the autonomic nervous system and the vagal system to regulate emotions. He discusses the importance of maintaining strong cardiac vagal tone and flexibility via the vagal brake (discussed in the blog article: Calming Strategies for Regulating Strong Emotions). Our goal in the treatment process is to help our young clients struggling with emotion regulation create wide windows of tolerance. Since parents are the co-regulators for their children (discussed in the blog article: Benefits of Co-regulation for Children and Parents in Play Therapy), it’s important to teach coping and calming skills to parents so they can regulate their own emotions while helping their child to regulate their emotions. I like to use the analogy of the roller coaster to help parents understand the importance to remaining emotionally regulated during their child’s “emotional storms.”  In this analogy, the roller coaster rails are the child’s emotions and during an emotional meltdown the child is in the roller coaster car moving along the ups and downs and upside downs of the roller coaster with their emotions. Every roller coaster ride has a platform where people wait their turn to get on the roller coaster ride. In this analogy, parents need to remain “on the platform” while their child “rides the emotional roller coaster” to help remain steady and calm until the child can “disembark” from their emotion dysregulation episode. If parents dysregulate then they essentially get on the roller coaster with their child, and there is no adult to be the calming, steadying force to help the child calm down. So helping parents understand the importance of staying on the “platform” is key to helping their child regulate their strong emotions.

 

What does a roller coaster have to do with breathing and mindfulness, you ask? 

To help children and youth (as well as parents) regulate their emotions (i.e. – get off the emotional roller coaster), mental health professionals can teach the importance of mindfulness and breathing. Remember cardiac vagal tone? The ability to slow down the heart rate will in turn bring our vagal system into a state of homeostasis. Helping clients regain homeostasis within their bodies requires that mental health professionals use strategies to teach their clients how to regain balance within their bodies. This will help clients develop emotion regulation circuitry to tolerate stressors throughout their day and remain within their windows of tolerance. If you’ve read my previous blog articles, I discussed the role of vagal nerve system, emotion regulation and co-regulation, and the importance of understanding the neuroscience underlying behavior to make sure you conceptualize treatment needs for your clients. 

 

Helping clients regain homeostasis within their bodies requires that mental health professionals use strategies to teach their clients how to regain balance within their bodies.

 

Paced breathing helps regulate heart rate which in turns helps to settle down the body and settle down emotions and bring your young clients into a mindful state. Mindfulness is generally defined as paying attention on purpose in the present moment. Regulating our breathing critical for this process. When we’re in a mindful state, we are fully present in the moment and focused on calming our emotions and relaxing our bodies. Teaching breathing strategies, such as Square Breathing, Belly Breathing, and other breathing techniques is a valuable tool for regulating emotions and entering into a mindful state. In this mindful state, we are fully present in the moment, not in the past ruminating about unpleasant events or perseverating on potential negative future events, also known as “future tripping.” I love using paced breathing because it can be used anywhere at any time with no special equipment or supplies. For children and adolescents who struggle throughout the day to manage their strong emotions, taking short breaks throughout the day using paced breathing to practice the skills and get into the habit of using this powerful skill can be useful and help strengthen those emotion regulation circuits. What gets “fired” gets “wired”, right? Integrating the therapeutic powers of play into this process ensures the interventions meet their developmental needs. I love using bubbles to teach breathing skills, plus they’re just fun and absolutely helps to be fully present in the moment. Who doesn’t love bubbles, right?

 

Here are links to two paced breathing videos to use with children and teens:

 

https://www.youtube.com/watch?v=YFdZXwE6fRE

 

https://www.youtube.com/watch?v=AOL3isokmY4

 

 

Are you a mental health professional working with children and families? Here’s a free pdf with five of my favorite mindfulness-based emotion regulation interventions to help children regulate their strong emotions.  (I used the beans, bubbles, and water activities with my own chidlren and they were magical!). Click here for a free copy of my pdf: 5 of My Favorite Mindfulness-based Interventions for Regulating Emotions

 

 

Reference

 

Porges, S. W. (2011). The polyvagal theory: Neourophysiological foundations of emotions, attachment, communication, self-regulation. New York, NY: W. W. Norton.

 

 

Posted in Neuroscience of Attachment

The Hero’s Journey: Calming Strategies for Regulating Strong Emotions

Written by Cathi Spooner, LCSW, RPT-S

Image by jplenio from Pixabay 

 

Recognizing the role of the mind-body connection helps mental health professionals teach calming skills that target the larger goal of helping their young clients develop a strong emotion neural system to create a wide window of tolerance for emotional distress. This blog article focuses on understanding the science of mind-body connection to teach clients how to use simple calming skills to manage their emotions.

Polyvagal Theory in a Nutshell

First, we’ll start with briefly (and I mean briefly here because the theory involves a complex system – us) examining the neuroscience of polyvagal theory to help understand the importance of the mind-body connection for the skills. What is Polyvagal theory in a nutshell?  Stephen Porges (2011) proposes that the vagus nerve system is a bi-directional process of complex interactions within the body connecting the brainstem, heart, lungs, and digestive tract to regulate homeostasis. It’s his premise that our ability to regulate our emotions, engage in prosocial interactions with others, and form healthy attachments with others is greatly influenced by our internal physiological state regulated by the vagus system. 

Why do we need homeostasis and what does it have to do with using calming skills? 

Our internal state is influenced by external factors and our body is constantly in a state of working to achieved homeostasis. To use a medical example, when a virus gains access to our body it activates a variety of responses to fight off this virus and regain homeostasis, aka – we feel good and our internal bodily functions are working well because we don’t experience the symptoms of the cold anymore. It’s the same with our emotional state and emotions. Every day we experience varying degrees of stressors and we need to adjust throughout the day to tolerate the distressing situation and manage our emotions. This requires that we operate within our window of tolerance for emotional distress. When we’re in a state of homeostasis, we’re in a calm state, able to regulate our emotions, interact with others in a patient and respectful manner, our heart rate is operating at a good resting heart rate between 60-100 beats per minute, our breathing is within the normal range of 12-20 breaths per minute, and our digestive tract is functioning normally.

Every day we experience varying degrees of stressors and we need to adjust throughout the day to tolerate the distressing situation and manage our emotions.

Our autonomic nervous system consists of the sympathetic nervous system (SNS) and our parasympathetic nervous system (PNS). The polyvagal theory states the PNS is composed of two vagal nerve systems that activate similar responses (immobilization) for different reasons – one activates social engagement (closeness and intimacy) and the other activates a freeze immobilization state in response to danger (Porges, 2011).


Here’s where understanding the brain-body connection helps mental health professionals identify calming strategies that can target the neural system to regain internal homeostasis resulting in emotion regulation. Children are in the process of developing their neural systems for emotion regulation. Their daily experiences provide opportunities to support the ability to develop effective emotion regulation circuitry. Our goal as mental health professionals is to help our young clients struggling with emotion regulation to learn strategies that will help them develop strong neural circuitry for emotion regulation. This will help them to widen their windows of tolerance to navigate the “ups and downs” of life and build resiliency. Their ability to use their parents for co-regulation is a key factor for children developing emotion regulation skills. It’s important to help parents learn calming skills as well so they can regulate their own emotions and help their children regulate their emotions – co-regulation. 

It’s important to help parents learn calming skills as well so they can regulate their own emotions and help their children regulate their emotions – co-regulation. 

Okay, I’m going to “nerd” out a little more and then tie it all together with some calming strategies. Hang in there. It’s important to understand the neurobiology aspect so that we can understand why we are recommending to our clients that they use these calming strategies – aka what do they need to achieve and how do the strategies help them achieve that goal? Make sense? Okay, here we go.

Let’s examine the concept of cardiac vagal tone. Cardiac vagal tone refers to “the functional relationship between the brainstem and the heart” (Porges, 2011, p. 102). It’s important for the internal regulation of the body’s ability to remain in calm, stable functions. Strengthening the cardiac vagal tone helps to create wider windows of tolerance for emotional distress because it helps to create more internal flexibility regarding the ways in which our vagus system responds to daily stressors throughout the day, every day. According to Porges (2011), “cardiac vagal tone is increased to support homeostatic functions, and cardiac vagal tone is decreased to increase cardiac output to support specific motor behaviors in response to environmental challenge” (p. 104). Think about the cardiac vagal tone as we think about our muscles – strengthening the cardiac vagal “muscle” provides the ability for more flexibility and agility with our heart rate, breathing, and regulating connecting internal systems to help us tolerate stressors throughout the day. Keep in mind that muscles also need to be stretched to improve flexibility. This is also true emotionally. Those emotionally stretching opportunities, such as those emotionally challenging times that cause us to grow if we allow them, generally speaking, can be helpful for developing resiliency depending upon our mindset about the “stretching” experience. This in turn helps us to maintain a wide window of tolerance for emotional distress because we can regulate our internal state to maintain regulated emotions and the ability to stay calm. Here’s how that will look throughout a typical day for a school-aged child, who we’ll call Sam (fictitious child):


Sam wakes up and had a poor night of sleep so he’s slow to wake up and running a little late. Mom comes into his room and tells him if he doesn’t get up then he’ll miss the bus and be late for school. Mom is irritated because she’s running late and doesn’t really have time to drive Sam to school if he misses the bus. Sam is aware of his mom’s irritation which adds to his stress. He experiences an increased heart rate and increased breathing rate as he rushes around his room and worries about missing the bus. His emotions are anxious. Cardiac vagal tone is decreased to allow for increased heart rate and breathing. Mom notices Sam is getting stressed out and she recognizes her irritation is only making him more stressed. She goes to Sam and tells him it’s okay and not to worry. He tells her that he didn’t sleep well and he’s stressed out about missing the bus. Mom uses a calming voice tone and reassuring facial expression to let Sam know that she understands and it will all be okay.  Sam’s heart rate and breathing slow down in response to reassurance which results in calmer emotions. Sam gets to school and realizes he forgot his homework at home and his anxiety begins to increase which results in increased heart rate and breathing as he worries about getting a bad grade and his parents being mad at him. His teacher sees the worried look on his face and asks him if he’s okay. He hesitantly tells her that he forgot his homework at home. His teacher reassures him that he can turn in his homework tomorrow because he’s really good about getting his work done. He may also have time in class to complete his homework before the end of the day if he wants to do that. Sam feels better and his heart rate and breathing begin to relax.


Throughout the day we experience stressors that activate internal bodily responses which are regulated by our vagus system. A strong cardiac vagal tone allows for flexibility to tolerate those stressors and helps our heart, lungs, and digestion to regulate and return to homeostasis, i.e. a calm state.


Porges (2011) believes the quality of the cardiac vagal tone greatly influences social behavior and emotion regulation.  Essentially our ability to regulate heart rate and breathing influences social behavior and our ability to regulate our emotions.  He talks about the notion of a vagal brake which regulates heart rate and breathing and other related functions. Here’s how it works. Think about a bicycle and bicycle brakes.  When we want to slow down the bike to make sure we are not going too fast, we apply the brakes to slow down the rotation of the tires propelling us forward. When the vagal brake is activated its purpose is to slow down the rate of heart rate and breathing in an effort to return to a homeostatic state. Using our bicycle analogy, when we release the brakes it allows the tire rotations to move faster and propel us forward. When the vagal brake is released, it allows our heart rate and breathing capacity to increase. For example, the vagal brake needs to be released if we want to run to flee danger. 


How does all of this help us with calming skills?

Our ability to regulate breathing will then in turn regulate heart rate and work toward homeostasis within the body creating a “rest and repose” state, which allows for optimal functioning.  So… when we are teaching skills for calming and coping, we need to understand the importance of breathing and mindfulness. Breathing will help to apply the vagal brake to bring your body into homeostasis if you’re anxious and overwhelmed, which means your heart rate is beating a little faster and your breathing may be shallower resulting in a tense internal and external state. Breathing will help you get into a mindful state and allow your body to relax. When your body is in a homeostatic state, then you’re able to regulate your emotions and engage in prosocial behaviors. This helps us to widen our window of tolerance to manage stressors and regulate our emotions.


When your body is in a homeostatic state, then you’re able to regulate your emotions and engage in prosocial behaviors. This helps us to widen our window of tolerance to manage stressors and regulate our emotions.

Now that you understand the basic neuroscience for the mind-body connection and regulating emotions, here are some quick and easy calming skills to regulate breathing and heart rate to bring your body into homeostasis. The first one is my new favorite and simple for calming your internal state. I actually LOVE it. Give it a try:

·      Sit in a relaxed state ( or stand or lay down – whichever works for you). Put your right hand to your chest over your heart. Allow yourself to really settle into feeling your hand over your heart and connect to the beat and sensation of your heart. Allow yourself to connect to this experience being fully present in the moment.  How does that feel? 

Here’s another one a colleague friend of mine shared with me.  It’s also amazing. 

·      Bring to mind a time when you were happy. Allow yourself to fully be present at the moment with that memory. Notice how your body feels and allow yourself to fully participate in the mindful state. What do you notice about your heart rate and body – relaxed, tense, disconnected?

In these mind-body exercises, you are connecting to an internal state of mindful presence at the moment which will bring your internal state into homeostasis- relaxed and calm from the inside out. The key is to allow yourself to be present at the moment and connect to the experience. This mindful presence at the moment allows us to settle our internal state. I like the hand over the heart skill because I can physically connect to my heart (well not completely physically since my hand is not physically on my actual heart) and I can feel my heart rate slowing down to a relaxed state which then calms my breathing and the rest is history for me… I’m super chill at that moment and enjoying the experience. 



Recap:

·      Our internal state of homeostasis facilitates the ability to regulate our emotions and engage in positive social interactions.

·      Cardiac vagal tone is a key factor to understand for achieving an internal state of homeostasis. Our cardiac vagal tone influences our body’s ability to be flexible to adjust to the stressor of the day and constantly works toward achieving a state of homeostasis – internal calm.

·      Using mindful activities focused on achieving regulating our heart rate and breathing will help us to achieve an internal state of homeostasis to regulate our emotions and engage in positive social behaviors.

Are you a mental health professional working with children, youth, and families? The Be 5 Framework is a neuroscience-informed framework integrating play therapy and expressive arts using intention and clinical decision-making. Download the free pdf here.

Resource:

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York, NY: W. W. Norton.

Posted in Neuroscience of Attachment

The Hero’s Journey: Mirror, Mirror in Our Minds?

Written by Cathi Spooner, LCSW, RPT-S

Image by ssutton77 from Pixabay 

 

How do mirror neurons help with co-regulation? The mind-body connection of our resonance circuitry is central to co-regulation. Understanding the role of mirror neurons in our resonance circuitry provides insight for mental health professionals to help their clients learn to effectively regulate their emotions. This article discusses the role of mirror neurons in our resonance circuitry and how that helps with co-regulation.

As mental health professionals, how many of you have been in sessions with your clients and you can physically and emotionally feel their emotional distress? I can remember sitting with clients in my office pouring out their deepest sorrows to me and finding myself welling up with tears in my eyes as I sat with them. I could feel their emotional pain, and that filled me with empathy and compassion as I understood them on a deeper level. How is that possible? How is it that I can physically feel their emotional pain?  Mirror neurons and resonance circuits. Let’s explore that further.

Let’s first examine mirror neurons.

Mirror neurons were discovered in the early 1990s by researchers seeking to better understand the premotor area of a monkey’s cortex, which led to a surprising discovery. When observing the predictable behavior sequence of one of the researchers not only did the researcher’s neural circuitry become activated, the same neural circuitry in the monkey became activate simply by observing the behavior of the researcher.

Researchers discovered that these mirror neurons are found in the inferior frontal and posterior parietal areas of the brain and are activated by both the observation and execution of predictable, sequenced behavior. This activation sends energy and information via a representation of the behavior to the mirror neurons from the superior temporal cortex (Badenoch, 2008). According to Badenoch (2008), this process creates “a bridge between motor action and the perception of intention” (p. 38).

So, now that we understand mirror neurons, let’s examine resonance circuits.

They help us to understand the intentions of others and to navigate a complex social world.

Siegel (2011) coined the term resonance circuits to describe the neural circuitry involved in resonating mind to mind with another to become attuned with their internal emotional and physiological states. Resonance circuits involve mirror neurons as well as other circuitry in the cortical areas of the brain and the body. They help us to understand the intentions of others and to navigate a complex social world.

Most mammals have the capacity to “read” the internal states of another via advanced limbic circuitry. Mirror neurons connect by way of the insula, which acts as a superhighway of neural circuitry, to the limbic area and then to the body in a bi-directional manner. The flow of energy and information moves from the limbic area down the brainstem to the body. Information received through the body is then transported up through the brainstem to the limbic and cortical areas of the brain – top-down and bottom-up. This is how we can physiologically resonate with another person to the extent that even our breathing, blood pressure, and heart rate become synced. This is an important point to remember when we explore co-regulation.

This is how we can physiologically resonate with another person to the extent that even our breathing, blood pressure, and heart rate become synced.

Additionally, mirror neurons are believed to be crucial for the ability to experience empathy.  This makes sense when you think about it. If my mind and body can experience what you experience, then I’m more likely to understand you and have empathy.

Siegel and Hartzell (2004) state: “the amygdala is crucial in the perception and outward expression of facial responses and it is central in the regulation of emotional states” (p. 75). It’s where emotions are initially assessed to recognize if a threat exists. Resonance circuits are constantly and without our conscious awareness processing cues received from subtle and obvious facial expressions and body language as well as information from our other senses. Information from external sources in our body received through our sensory circuits can cue us to the internal states and intentions of others.

Have you ever been in a session and could detect an emotion or sense something going on with your client and your client was giving you no indication about what was going on? We can sync emotionally as well as physiologically with another. Sensory inputs also mirror the internal states of others that allow us to emotionally resonate and recognize the emotional energy underneath the behavior and predict the next action in the sequence of events. This can help us become more attuned to another person. As therapists, we strive to resonate mind to mind with our clients to help us understand them at a deeper level so that we can help them better understand themselves and overcome their mental health challenges. It’s also important for mental health professionals to help parents resonate with their children to aid in the attunement process and co-regulation.

Priming is the process that involves what happens when we observe behavioral information sent to the superior temporal cortex to create a representation in our mind to predict what is about to happen based on the sequenced and predictable behavior registered in our mirror neurons. This priming process aids us to become in sync with another because we tune in to another and act based on our prediction of their behavior (Badenoch, 2008; Siegel, 2011). Siegel (2011) states this priming process helps us understand culture and the ways our shared experiences bring us together.

Think about the culture within families and creating internal maps of others within our families and the ways in which relationships operate. Family members influence one another including behavior, mindsets, and beliefs. They become in sync with their behaviors. In family systems theory, this would be called the family process. There is a culture within families based on their shared beliefs, relationship patterns, and behaviors.

Siegel (2011) states: “we are hardwired from birth to detect sequences and make maps in our brains of the internal state – the intentional stance – of other people” (p. 61). Our ability to connect via our mirror neurons in one mind resonating with another mind becomes wired into our neural circuitry. Mammals are uniquely preoccupied to focus on the internal states of others, most especially parents with their children.

How does all of this relate to co-regulation?

Co-regulation requires the ability of children to use the emotion regulation circuits of caregivers when they are experiencing emotional distress. This requires their caregivers to remain within their window of tolerance for emotional distress to effectively regulate their own emotions at that moment. As parents are able to engage their resonance circuits to become attuned with their child and regulate their emotions, the mirror neuron circuitry in the child can begin the wiring process for emotion regulation because their internal states are syncing with their parent’s internal states.

Co-regulation requires the ability of children to use the emotion regulation circuits of caregivers when they are experiencing emotional distress.

Emotional contagion is a term that explains what happens when the emotions of others physiologically resonate within us and impact our own state of mind, which can influence our interpretation of unrelated experiences. Our ability to effectively resonate and understand the internal states of another person requires that we recognize we are separate and distinct from the other and that we are accurately aware of our own internal state. Our ability to recognize our own internal states while also being attuned to another and regulating our emotions facilitates co-regulation.

 

Recap:

  • Mirror neurons allow us to recognize and understand the predictable, sequenced behavior of another. They are crucial for empathy.
  • Resonance circuits include mirror neurons as well as cortical and subcortical regions of the brain and the neural connections through the brainstem to the body. The bi-directional processes from brain to body and body to brain facilitate our ability to physiologically and emotionally resonate with another person.
  • Resonance circuits can aid in the co-regulation process as we recognize our own internal states as separate and distinct from our child so that we can internally regulate our emotions and help our child use our regulated state to sync their emotional state.

Are you a mental health professional working with children using play therapy and expressive arts? Check out this free pdf for the Be 5 Framework based on neurobiology and using intention to create a strong therapeutic space for an integrated approach to play therapy and expressive arts.

 

References

Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York, NY: W. W. Norton.

Siegel, D. J., and Hartzell, M. (2004). Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive. New York, NY: Tarcher.

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. New York, NY: Bantam.

Posted in Neuroscience of Attachment

Mentalization and Its Connection to Co-regulation

Written by Cathi Spooner, LCSW, RPT-S

Image by 460273 from Pixabay 

 

What is mentalization? What is its relationship with co-regulation between caregivers and their children? This blog article focuses on understanding the connection between the concept of mentalization and its connection to attachment and co-regulation for children, youth, and families. As mental health professionals working with children, youth, and families, we have an opportunity to give our young clients and their families a gift that “gives” through the generations by helping them to identify the stories activating shame and emotion dysregulation. So, here we go – what is mentalization and why is it so important to understand when we’re discussing co-regulation?

As mental health professionals working with children, youth, and families, we have an opportunity to give our young clients and their families a gift that “gives” through the generations by helping them to identify the stories activating shame and emotion dysregulation.

First, I’m going to “nerd out” a little about one of my favorite authors researching authenticity and shame resiliency – Dr. Brene Brown. She is the author of several best-selling books including Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead (Brown, 2012). As a modern-day guru for understanding shame and developing shame resiliency, she often refers to the “stories” we tell ourselves about self, others, and relationships. It’s my belief that these stories have their roots in the mentalization process, which influences our ability to effectively regulate our emotions. Think about it – if the stories in my head are predominately shame-based, then my ability to tolerate my emotional distress will be hampered because my “alarm systems” will be activated as if to say “bad things are going to happen to you because you’re ‘bad’.” Check out her TedTalk here: Listening to Shame. You will be so glad that you watched it. Then come right back and read the rest of this article or watch is right after reading this article!

 

What is mentalization?

Mentalization (also referred to as reflective functioning) is a concept developed by Fonagy and his colleagues (Fonagy, Steele, Steele, Moran, and Higgitt, 1991) to understand the way in which humans make sense of themselves, others, and relationships. It’s heavily influenced by our attachment relationships. I view the concept of mentalization as similar to Bowlby’s internal working models (Marrone, 2014) in that our primary attachment relationships lay the foundation for the understanding of ourselves, others, and relationships and how to navigate a complex social world. (See my previous blog posts for more information about the role of mentalization in our conceptualization of self, others, and relationships and more information about emotion regulation and co-regulation.) According to Falkenstrom, Solbakken, Moller, Lech, Sandell, and Holmqvist (2014), “the concept of mentalization is defined as the capacity to understand human behavior in terms of underlying mental states; that is, thoughts, feelings, wishes, needs, and so forth” (p. 27).

 

How is mentalization connected to attachment?

Mentalization develops and changes over time beginning with our earliest caregiver-infant experiences. Children develop an understanding of themselves through their perceptions and how they make sense of the actions of their caregivers toward them, which contributes to their conceptualization of their own actions that are motivated by their mental states, i.e. emotions, thoughts, desires, and wishes. For example, if I’m a small child and I perceive my mother’s behaviors toward me as indicating that I am “bad,” then it will influence how I perceive myself as “bad,” which will, in turn, impact my emotional state.

 

The quality of the attachment relationship influences the quality of the mentalization process and development. A caregiver’s ability to access and use a well-developed and defined reflective self facilitates a secure attachment relationship. These caregivers have a high mentalization capacity, which means they are self-aware, able to self-reflect and recognize they are separate and distinct from their child, and able to be attuned to their child and their child’s needs. This requires caregivers to have a strong reflective capacity to be aware of their own internal mental states. Essentially this attunement helps caregivers to accurately assess and understand the cues of their child and meet the needs of their child. This interaction requires the child to remain connected to his caregiver through his ability to recognize the mental state of his caregiver for providing safety and lovingly attend to his needs. This is a process that develops over time and through many, many attachment experiences.

Initially, caregiver-infant interactions lay the foundation for physiological experiences accessed through their senses – feeling warmth, hearing a soft and gentle voice, seeing smiles from the caregiver.

 

How is mentalization connected to co-regulation and why does it matter for co-regulation?

Initially, caregiver-infant interactions lay the foundation for physiological experiences accessed through their senses – feeling warmth, hearing a soft and gentle voice, seeing smiles from the caregiver. “The development of the capacity for mental representations of the psychological functioning of self and other is closely related to affect and its regulation” (Fonagy, Steele, Steele, Moran, and Higgitt, 1991, p. 206). Mentalizing focuses both on self and others, cognition and affect, and the underlying psychological and neurobiological processes involved with interpreting one’s own mind and the mind of others based on external factors, such as facial expressions, body language, and voice prosody. Infants learn to pay attention to these external factors in their early caregiver experiences. These processes play a crucial role in the neural connections “wired in” with attachment relationships that we are not consciously aware of and influence our arousal states.

 

Luyten and Fonagy (2015) report the research from cognitive and affective science supports their belief that one’s mentalizing capacity is greatly impacted by two interacting factors: stress or arousal and one’s attachment history. Co-regulation experiences of secure attachment enable children to develop the ability to view themselves as capable, loveable, and acceptable which helps to mitigate the experiences of stressors and arousal states. Inconsistent and inadequate co-regulation experiences as seen in insecure attachment relationships interfere with a child’s ability to “lay down” strong emotion regulation neural pathways necessary for tolerating their emotional distress within a wide window of tolerance. This leaves them vulnerable to developing shame messages that will ultimately leave them at the mercy of their strong emotions and dysregulation.

 

How can mental health professionals help our young clients using play therapy and expressive arts?

Mental health professionals can help identify the stories our clients and their parents are telling themselves and then help them re-write these scripts. Human beings heal within the context of safe, caring relationships. Mental health professionals can provide a safe, therapeutic space for healing using the therapeutic powers of play to help children engage in the change process. Using play therapy and expressive arts interventions can help our young clients to access and explore underlying issues impacting their mental health and facilitate change. We can help parents engage in the treatment process to improve the attachment relationship and teach parents how to be the therapeutic agents of change for their child.

 

 

Recap:

  • The concept of mentalization refers to the ways in which we make sense of ourselves, others, and relationships.

 

  • Mentalization develops within the context of attachment relationships and is impacted by the quality of the attachment relationship

 

  • Emotion regulation and co-regulation are impacted by the quality of the attachment relationship, so it’s important to help our young clients and their caregivers identify and change unhealthy understandings of themselves, others, and relationships using the therapeutic powers of play.

 

 

Are you a mental health professional working with children, youth, and families using play therapy and expressive arts? Download this free pdf for the Be 5 Framework for providing an integrated approach to play therapy and expressive arts with children, youth, and families using intention to create a safe therapeutic space and clinical decision-making.

 

 

References

Brown, B. (2012). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. New York, NY: Avery.

Falkenstrom, F., Solbakken, O. A., Moller, C., Lech, B., Sandell, R., and Holmqvist, R. (2014). Reflective functioning, affect consciousness, and mindfulness: Are these different functions? Psychoanalytic Psychotherapy, 31(1), 26-40. doi.10.1037/a0034049

Fonagy, P., Steele, M., Steele, H., Moran, G. S., and Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201-218.

Luyten, P., and Fonagy, P. (2015). The neurobiology of mentalizing. Personality Disorders: Theory, Research, and Treatment, 6(4), 366-379. doi.10.1037/per0000117

Marrone, M. (2014). Attachment and interaction: From Bowlby to current clinical theory and practice (2nd  ed.). London, UK: Jessica Kingsley.

 

Posted in Neuroscience of Attachment

The Hero’s Journey: Understanding Parents’ Role in Their Child’s Conceptualization of Self and Relationships

Written by Cathi Spooner, LCSW, RPT-S

Image by tookapic from Pixabay 

What kind of “Me” maps, “You” maps, and “We” maps are children developing with their parents and families? Daniel Siegel (2011) refers to the neurobiological roots of our conceptualization of self, others, and relationships as “me” maps, “you” maps, and “we” maps. These neurobiological “maps” are based on our early relationship experiences, most importantly our attachment relationships. It’s my belief that our sibling relationship relationships also play an important role in our development of these maps. Initially, our maps are developed via our experiences with parents (caregivers) and then others in our lives as we grow and develop throughout our lives.

One of the fundamental aspects of Siegel’s (2011) mindsight theory involves understanding the mind which is the underpinning of our maps. He refers to the mind as the flow of energy and information. According to Siegel (2011),

“the mind observes information and energy flow and then shapes the characteristics, patterns, and direction of the flow. Each of us has a unique mind: unique thoughts, feelings, perceptions, memories, beliefs, and attitudes, and a unique set of regulatory patterns. These patterns shape the flow of energy and information inside us, and we share them with other minds” (p. 54).

Think about your young clients and their parents – what’s a typical “map” that you see? For example – when working with a child with significant anxiety, the child’s worry is that the world is not safe. If their parents are anxious, a potential map created between parent and child is one that seeks to determine these questions: “Can I be safe?” and “Can I use my parent to keep me safe?”  Children may worry about parents rejecting them. They may believe “I’m bad, and I view my parent as rejecting me so I must be bad.”  Recognizing these maps can help mental health professionals better understand and identify how and where to intervene once we identify them.

Attachment relationhships begin to from the moment of our birth.

This brings us to attachment and its connection with our sense of self, others, and relationships. Attachment relationships begin from the moment of our birth. It can be argued that our attachment relationships begin in utero since the developing child is exposed to a variety of influences in utero, such as stress, substances, peaceful state of the mother, and parents begin forming their bond with the unborn child while the child is in the womb. Physiologically mother and baby are attached. In addition to attachment styles, there are a variety of ways that I examine attachment relationships, such as the interpersonal neurobiology aspect of relationships, the attachment concept of internal working models, and mentalization (also referred to as reflective functioning).

Beware – I’m about to nerd out on you here. Let’s look at three aspects of attachment relationships one at a time and then I’ll tie them all together at the end.

Internal working models is a concept central to attachment theory to provide a way to understand the inner workings of relationships and the way in which each individual develops an understanding of self, others, and relationships. Marrone (2014) states “working models are cognitive maps, representations, schemes, or scripts that an individual has about himself (as a unique bodily and psychic entity) and his environment” (p. 79). These working models help us to navigate a complex social world.

We can have several internal working models that co-exist which makes sense when you think about the complexity of people. We are not one-dimensional beings – all good or all bad so to speak. Our sense of sense and our understanding of others is complex. Marrone (2014) states our co-existing internal working models of ourselves and of others “can remain split off from each other or can be put together through integrative and synthetic processes” (p. 79). Ultimately, our goal is to develop an integrated sense of self and an understanding the people are complex to avoid a “black and white” view of ourselves and others as “all good” or “all bad.”

Throughout our development, we use past conceptualizations to help us make predictions for current and future situations, then adjust them as needed.

As children grow their understanding of themselves, others, and navigating social nuances will evolve as their cognitive, social, emotional, and physical capacities develop. Throughout our development, we use past conceptualizations to help us make predictions for current and future situations, then adjust them as needed. These internal working models of ourselves and others help us on our journey through life. Once working models are formed, they operate out of our conscious awareness. (Marrone, 2014).

Another construct to understand the development of our sense of self, others, and relationships is mentalization, also referred to as reflective functioning. What is mentalization, or reflective functioning? Mentalization is both neurologically-based (think interpersonal neurobiology here) and perceptual and psychological, such as the way in which our mind makes sense of things and their impact in our life. According to Fonagy, Steele, Steele, Moran, and Higgitt (1991), there are two aspects to the self – the pre-reflective self and the reflective self. The pre-reflective self is the self that essentially experiences the events, situations, and interactions of everyday life. The reflective self is the part of ourselves that reflects upon and makes sense of what the self experiences, such as emotions, thoughts, perceptions, reactions, desires, and beliefs. “Mentalizing is the capacity to understand ourselves and others in terms of intentional mental states, such as feelings, desires, wishes, attitudes, and goals” (Luyten and Fonagy, 2015, p. 366). We need these capacities to navigate a complex social world, and they are heavily dependent upon our experiences. You can see the overlap between this construct and the construct of internal working models.

Now, let’s examine the neurobiology of attachment experiences. You’ve probably heard the saying – what fires together wires together. The neural circuitry activated and used over and over becomes strengthened without discrimination about whether or not these neural connections are helpful or not helpful. The neural connections not used will be “pruned” without distinction as to whether or not these neural connections need to be strengthened or pruned. If they’re not used, then they’re pruned.

Perry, Pollard, Blakely, Baker, and Vigilante (1995) describe the process of the way in which states become traits via the pruning process of neural pathways. As we take in information via our sensing circuits, this information becomes the basis for creating

“internal representations of the external world (i.e. information) depends upon the pattern, processing, and storing signals. The more frequently a certain pattern of neural activation occurs, the more indelible the internal representation. Experience thus creates a processing template through which all new input is filtered” (p. 275).

One metaphor to understand the interaction between parents and their children in an attachment relationship is a tennis game, i.e. the “serve” and “return” (also known as “volley”). Here’s how that works in a very simplistic example:

  • Child cries (serve – “come help me!”)
  • Mother goes to child and assesses the need and attempts to soothe the child (return – mother responds to child’s efforts to elicit a response)
  • Mother addresses the need and smiles, comforts, engages with the child (serve – “I’m here for you.” “You’re safe.” “I care about you.”)
  • Child responds by stopping his crying and returns smiles and attention to his mother. (return – “this is good.” “I like this.” He engages mother in the interaction.)

These experiences elicit neurological responses for emotion regulation, homeostasis for bodily functions, and our mind’s way of understanding myself, others, and the world. This is the interpersonal neurobiology aspect of attachment experiences.

So how does all of this influence our formulation of maps?

Family is our “learning labratory” for how the world and relationships work which contribute to the creation of our internal working models

I’ve always viewed family as a “learning laboratory” for how the world and relationships work which contribute to the creation of our internal working models. Interactions between parent and child create the attachment relationship and influence our experiences of authority figures. Interactions between siblings and sibling dynamics can influence our experiences of peers and the ability to form strong peer relationships as well. The sibling dynamics can also influence how we view our parent’s ability to be equitable and maintain safety within the family system. Throughout childhood sibling relationships may change and/or grow because developmentally children are changing. The question I always ask myself when considering sibling relationships is – “how do parents maintain safety and equity within the family system and what are their relationship patterns with each of their children overall?” For example, how do parents account for individual differences in their children – is there a “favorite,” and how does that influence the relationship between the siblings? If there is a sibling who struggles with emotion regulation on a regular basis how do parents address that to maintain a sense of safety in the family for everyone, and how does that influence sibling relationships with that child?

Why does this matter and how is it related to our map-making of ourselves, others, and relationships? The attachment relationship is rooted in interpersonal neurobiology in which Siegel (2011) explains that humans meet mind to mind based on interpersonal neurobiology. This relationship circuitry is rooted in the resonance circuits which are heavily influenced by mirror neurons. As parents are attuned and connected with their child they act as co-regulators to help their child develop their neural circuitry for regulating emotions through the integration of various neural systems throughout the brain and body. Our mirror neurons based within our resonance circuitry also help us to make sense of the intentions of others and are key for developing empathy – the ability to understand others from their point-of-view not how we think they should experience the world. These mirror neurons are the key to helping us to feel “felt” and understood.

We use our resonance circuits to make maps of the intention of others, which influences our maps of relationships. Key in this process is to recognize my own internal states as separate and distinct from others. People with higher mentalization capacity are able to reflect upon their own internal states and experiences and recognize others as separate from their own experiences. People with lower mentalization capacity are less self-aware and able to distinguish their own internal states as separate from others.

Our experiences influence our beliefs about ourselves, others, and relationships influence the “stories” we believe about ourselves, others, and relationships. Am I good or bad or both? This will be heavily influenced by the way in which we interpreted the intention of our parents, as well as our siblings. Are other’s trustworthy and safe? How do relationships work?

What can we do as mental health professionals who work with children, youth, and families to help them become the heroes in their life journey? We are the “wise guides” for our clients and their families to become the heroes in their journey through life. As we establish strong therapeutic rapport with our clients and their families, we can help guide them and teach them important life skills. Using the therapeutic powers of play, we can explore the child’s mentalization about himself, others, and relationships and use the therapy process to adjust any cognitive distortions and increase self-awareness to help the child navigate life more effectively to develop increased windows of distress tolerance and resiliency. We can engage parents in the treatment process to increase the parent’s ability to examine their own mentalization for increased self-awareness and teach them how to more effectively support their child.

Recap:

  • The neurobiology of relationships is rooted in the ways in our minds make sense of other minds and experiences one’s self.
  • Internal working models are based on our early experiences that influence the ways in which we make sense of ourselves, others, and relationships.
  • Mentalization is another way in which I conceptualize internal working models and is heavily influenced by our mirror neuron circuitry.
  • Our resonance circuits are heavily influenced by mirror neurons and help us to make sense of the intentions of others and tune into others both emotionally and physiologically.
  • Our experiences influence our conceptualization of ourselves, others, and relationships. These early experiences are stored away in memory and will influence our responses and capacity for relationships and navigating the social world.
  • Using the therapeutic powers of play can help children develop a positive sense of self and resiliency. Therapists can help parents engage in the treatment process to help their child.

Are you a mental health professional working with children, youth, and families? Download the Be 5 Framework for using intention and therapeutic presence using play therapy based on neuroscience.

References:

Fonagy, P., Steele, M., Steele, H., Moran, G. S., and Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security in attachment. Infant Mental Health Journal, 12(3), 201-218.

Luyten, P., and Fonagy, P. (2015). The neurobiology of mentalizing. Personality Disorders: Theory, Research, and Treatment, 6(4), 366-379. doi.10.1037/per0000117

Marrone, M. (2014). Attachment and interaction: From Bowlby to current clinical theory and practice (2nd ed.). London, UK: Jessica Kingsley.

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. New York, NY: Bantam Books.

Posted in Neuroscience of Attachment

The Hero’s Journey: Understanding the Impact of Poor Emotion Regulation in Children and Adolescents

Written by Cathi Spooner, LCSW, RPT-S 

Image by Александра Туркина from Pixabay

How does emotion dysregulation impact children and adolescents? This blog article focuses on recognizing the importance of helping children to regulate their strong emotions, understanding the concept of windows of tolerance, and using the therapeutic powers of play to help them learn skills for regulating their emotions. As mental health professionals working with children, youth, and families – how many of you are working with kids and teens in your office or program who struggle with regulating their emotions? The answer is probably 100% of you. Emotion dysregulation is one of the most common presenting concerns for parents seeking counseling for their child.

First, what do we mean when we refer to windows of tolerance as it relates to emotion regulation? This is a key concept to understand when working with emotion dysregulation because the goal is to help our young clients regulate their emotions and to do that we need to understand their windows of tolerance for emotional distress.

Each of us has the ability to tolerate emotional distress in varying degrees depending on a variety of neurobiologically-based factors. Our ability to integrate the emotion-processing centers (limbic system) of our brain with the higher-level cognitive functioning areas of our brain (pre-frontal cortex) depends on a lot of biological and experiential information stored away and processed in our minds. Siegel (2011) states: “in general, our windows of tolerance determine how comfortable we feel with specific memories, issues, emotions, and bodily sensations” (p. 137). This will vary from individual to individual. What I might be able to tolerate pretty well, another person may not be able to tolerate as well. And I might be better at tolerating some things better than other things. Our window of tolerance is the range of emotional distress we’re able to tolerate to remain as emotionally regulated as possible and maintain homeostasis. The wider our window of tolerance, the more we’re able to tolerate our distress and remain fairly well regulated for homeostasis. “Within our window of tolerance we remain receptive; outside our window of it we become reactive” (Siegel, 2011, p. 137). 

When we’re stressed and overwhelmed, our brain registers a heightened state of alertness to potential threats as if our mind is saying – “Hey, pay attention here!” All of us get stressed and overwhelmed at times, and our ability to manage our distress will be dependent upon the width of our window of tolerance for emotional distress. Another way to think about it is the range of my ability to tolerate emotional distress. According to Siegel (2011), our windows of tolerance will vary depending on what we are more sensitive to than other things, and our experiences will influence our ability to tolerate circumstances and situations. For example, if a child is raised in a home in which a parent is highly anxious and hyperalert to possible danger, then the child learns to register danger more frequently and can become hyperalert to potential danger easily. Whereas, someone who was not raised in a home with an overanxious parent will likely not be overly sensitive to stressful events and will likely be able to remain within their window of tolerance under normal life circumstances.

The window of tolerance for emotional distress in someone who is usually hyperalert to potential danger will be narrower and their distress may quickly move them outside of their ability to cope with the situation in a calm manner. Their distress will move them outside their window of tolerance. According to Siegel (2011), we tend to have several windows of tolerance that are typically specific to situations and emotional states. When someone is moved outside of their window of tolerance for emotional distress, what does this low distress tolerance “look like?” Siegel (2011) refers to the flow of energy and information in an integrated and coherent manner to help us maintain homeostasis. This homeostasis is what supports physical and emotional well-being. When our homeostasis is disrupted, our body alerts us to potential threats. If our window of tolerance is narrow, then we manifest symptoms of distress more often and sometimes with more intensity depending on the individual. Some people are more prone to be easily emotionally triggered and may have a propensity to go from “zero to 100” with their emotional intensity. These are the children we usually see in our clinical practice because they struggle with regulating their strong emotions that “come hard and fast,” and then they have a long, slow recuperation period after an emotional outburst. It takes their mind and body time to get emotionally regulated and calm again.

Here’s what others may see in these clients with emotion dysregulation difficulties:

  • Children with high anxiety may struggle with emotional “meltdowns” due to irrational fears shutting down rational thinking.
  • Children may struggle with insecurities that leave them feeling stuck and unable to move past their fearfulness about how other people view them or their ability to overcome challenges, such as saying things like, “I can’t …” and/or “My teacher hates me so why try?”
  • Children on the autism spectrum tend to get “stuck” emotionally and then get emotionally overwhelmed due to their rigid thinking and difficulty thinking about things from another perspective for problem-solving.
  • Children with sensory processing problems that overwhelm their sensory systems will likely experience emotion dysregulation because their body and mind are overloaded by the sensory information that overwhelms their ability to tolerate it.
  • Some children may struggle with intense emotions due to underlying neurological “roots” like ADHD, developmental delays, or possible exposure to toxic substances in utero that negatively impact their neurological circuitry.
  • Children who have experienced trauma will likely become dysregulated by their trauma triggers.
  • Children experiencing depression, feelings of hopelessness, and feelings of worthlessness may activate irritability and anger outbursts or cause them to withdraw and become isolated.

How does emotion dysregulation negatively impact children? Children with emotion dysregulation problems are at an increased risk of negative self-concept because they may view themselves as a “bad” kid, “defective,” and/or “unlovable.” They have an increased risk for poor attachment relationships with parents, caregivers, teachers because they may not be able to use the adults in their lives to help them co-regulate and use coping/calming skills when needed. Children with emotion dysregulation problems have an increased risk for poor social competence because of their emotional outbursts, rigid behavior, difficulty taking turns, cheating at games, controlling behavior. These children are often referred to by other children and adults as the “bad kids” or tend to be on the peripheral of the social circles. They may be considered the outcasts and “trouble makers.”

Play therapy can help children struggling with emotion dysregulation learn skills to regulate their emotions and widen their windows of tolerance for emotional distress. Using play therapy with mindful presence and attunement can help them improve self-esteem and teach them coping/calming skills. Mental health professionals can use play therapy to facilitate cognitive restructuring and help with exposure therapy for anxiety-producing stimuli. It can help children and their parents improve their attachment relationships, and help children use their parents for co-regulation. When children are connected with their parents they are more willing to allow their parents to help them use coping skills when they’re struggling emotionally.

The key for mental health professionals working with these children and their parents is to establish a sense of safety and security in the session to invite the child to feel “felt” and “heard,” and understood, which in and of itself is healing. This is where we tap into our resonance circuits as described by Siegel (2011) to become psychobiologically attuned to our clients and mirror to them our sense of calm and empathy.  Siegel (2011) states:

“Here’s the key about relationships: The resonance circuitry not only allows ups to ‘feel felt’ and to connect with one another, but it also helps to regulate our internal state. (It is the middle prefrontal area at the top of the resonance circuitry that shapes our subcortical states)” (p. 138).

The Be 5 Framework is helpful for creating a clinical framework for play therapy and expressive arts interventions. It describes how to create a safe therapeutic space with your young clients using intention and mindful presence within a clinical framework.

Once the therapeutic relationship is established then therapists can introduce the change process and invite parents into the change process to help their child regulate their emotions as needed. When using an integrated approach to play therapy with directive play therapy techniques, it’s usually helpful to start the treatment process by teaching children a language vocabulary and then help them recognize how those emotions are experienced in their bodies and what triggers those emotions. This mind-body connection builds the foundation for learning how to regulate their emotions. Using the therapeutic powers of play is the bridge to help children learn and use coping/calming skills because it is developmentally aligned with their clinical needs.

Recap

  • Children with narrow windows of emotional distress tolerance struggle with emotion dysregulation on a regular basis.
  • Children with emotion dysregulation struggle with a negative self-concept, strained attachment relationships, and poor social relationships.
  • Using the therapeutic powers of play to help children regulate their emotions requires a therapeutic framework that facilitates safety and clinical decision-making and helps them understand the mind-body connections for emotions.

If you’re a mental health professional working with children, youth, and families and you’d like a free copy of the “Be” 5 Framework, click here.

 

Reference:

Siegle, D. J. (2011). Mindsight: The new science of personal transformation. New York, NK: Bantam Books.

Posted in Neuroscience of Attachment

The Hero’s Journey: Using Parents to Create Safety and Emotion Regulation for Children and Teens

Written by Cathi Spooner, LCSW, RPT-S

Image by serrano1004 from Pixabay

How can therapists create a sense of safety within the treatment process for children and teens using parents and the therapeutic powers of play? For me, as a therapist and as a supervisor, this is a critical question that needs to be considered by mental health professionals working with children and adolescents. Children and teens need to use their parents to help them deal with stressful events and situations since challenges are part of life. How children and teens use their parents for emotion regulation support varies depending on the developmental needs of the child and the quality of their attachment relationship with their parents. Different developmental stages require different responses from parents to help their children learn to internalize coping skills and regulate their emotions during stressful events throughout their life journey. Children in higher acuity family systems will typically experience more negative attachment experiences than children in lower acuity family systems. For clarification, the term parents when used in this article refers to any adult who is the caretaker for a child or adolescent, such as a parent, grandparent, aunt or uncle, and foster parent.

This article discusses the importance of helping parents facilitate the activation of their child’s social engagement system to create a sense of safety for effective co-regulation, which means deactivating the neuroception circuits (Porges, 2011) in their child. Neuroception is a term coined by Stephen Porges (2011) as conceptualized in his Polyvagal theory.

First, a little “nerding out” on neurobiology and safety. Hang in there with me. Polyvagal theory helps us understand how our body responds to threat in order to ensure our survival. It’s based on the theory that our autonomic nervous system (ANS) is composed of three structures in an evolutionary hierarchy from primitive to more advanced and only present in mammals. The ANS is involved with the body’s automatic internal regulation of physiology such as the regulation of heart rate, lungs, digestion, and is connected with the cranial nerves involved with hearing, sight, and mouth. The ANS is composed of the sympathetic nervous system (SNS) and the parasympathetic system (PNS). Polyvagal theory postulates that the parasympathetic system, which is responsible for immobilization or slowing down autonomic system functions (aka the ANS “brakes”) is composed of two parts, dorsal and ventral vagal nerve systems (Dana, 2020, Porges, 2011). The most primitive system in the ANS is the dorsal vagal nerve system which is present in reptiles from an evolutionary standpoint. Next in the ANS evolutionary process is the sympathetic system that allows for activation of bodily functions to support the fight-flight response. The most advanced system is unique to mammals and allows for social engagement and connection via the ventral vagus nerve system. The vagus nerve is a system of nerves that are spread throughout the body with two main components, the ventral (most advanced and myelinated) and the dorsal (most primitive and unmyelinated).  

So, what are the neuroception circuits as conceptualized by Stephen Porges (2011) in his Polyvagal theory? Neuroception circuits are the neural systems that are constantly assessing threat without our conscious awareness. They are designed to keep us alive and alert to a potential threat. These neural circuits are designed to assess safety first and foremost, so they need to be deactivated before the neural circuits of the social engagement systems can be activated. Essentially, our mind needs to determine that there is no threat present before we can “let down our guard” and engage in social interaction in a relaxed and trusting manner.  This includes the ability to engage in playful activities. We need to feel safe before we can fully engage in play and be playful. If you’ve ever been around children playing, especially boys (I’m a mother of boys and grew up with two younger brothers), you’ll recognize that fun, playful engagement can instantly change once one of the children perceives the behavior of another child as threatening.  The dynamic can change quickly.

So how is this relevant for children and their parents? Hang in there, I’m going to “nerd out” a bit more – this time about attachment and neurobiology. Children begin forming their conceptualization of relationships from birth based on early experiences with their caregivers.  Bowlby (Marrone, 2014) referred to this understanding of attachment relationships as internal working models. Fonagy and his colleagues (Fonagy, Steele, Steele, Moran, & Higgitt, 1991) refer to the concept of mentalization (also known as reflective functioning) as the way in which our mind makes sense of ourselves, other people, and our relationships with others and is heavily reliant upon early parental experiences. I tend to view internal working models as another way to comprehend mentalization. The neurobiology underlying mentalization, and our internal working models, is heavily influenced by our early experiences and becomes encoded with our early memory and our emotions, perceptions, and experience of events and interactions with others. Mentalization then becomes the foundation for the way in which we form our sense of self, our “place” in the world, and our relationships with others.

Siegel (2011) refers to interpersonal neurobiology as the way in which our mind, through the flow of energy and information via our neural circuitry, creates “maps” for understanding ourselves and others. The mentalization process contributes to the creation of “Me” maps, “You” maps, and “We” maps. These “maps” help us to navigate a complex social world and relationships.

Okay – so now I’m going to bring it all together. Children are reliant upon the adults in their lives to help them survive and grow in the world. Our ability to use the adults in our lives is greatly influenced by our experiences of relationships, especially with early caregivers. Our ability to feel safe within our intimate relationships allows us to use those relationships to manage stressors and navigate challenging situations. Children are heavily reliant upon parents for survival and co-regulation and need to heal within the context of these intimate relationships.

Engaging parents in the play therapy process facilitates the ability for children to use their parents as “safety people.” There are a variety of ways to engage parents in the play therapy process, which will likely depend heavily on the acuity level of the family system and parents. A low acuity family system will have parents who are attuned to their child and the needs of their child. These parents have well-functioning social and emotional capabilities to be adept at the give and take aspects of relationships and the ability to regulate their emotions well overall. Children in these families tend to have an easier time using their parents to help them establish a sense of safety.

Keep in mind that the acuity level operates on a continuum from low to high. Higher acuity families tend to have less attuned parents, family histories of addiction and/or trauma, and significant mental health issues. Therapists need to assess the acuity level of the families to figure out the most effective ways to engage parents in the treatment process, and help their child use their parents as their “safety people.” Helping even higher acuity parents develop the ability to create safety within their parent-child relationship will help children use their parents more effectively to deal with life’s challenges. After all, children will spend the rest of their lives with their family and will be with their therapists for only a short time of their life. It’s imperative as therapists to help parents and their children develop a stronger attachment relationship because the long-term positive treatment outcomes are greatly improved when parents are able to be successfully integrated into the treatment process.

Therapists can use the therapeutic powers of play with children and their parents as an avenue to create that bridge toward safety and healing. Remember, the ability to engage in play requires that the neuroception circuits are deactivated so that the social engagement system can be activated for play to occur. Using the therapeutic powers of play can help to engage children more effectively because the “language” of children is play. Even adolescents, especially socially immature adolescents, can engage in playful exchanges with their parents. They can use the therapeutic powers of play via expressive arts to communicate and explore their self-concept and relationships in a way that is less psychologically threatening to them.

Here’s a recap:

  • Neuroception circuits need to be deactivated before the social engagement system can be activated. We cannot engage in trusting social interactions unless our threat systems are turned off.
  • Children’s experiences with the adults in their lives will influence their understanding of relationships and the ability to use their parents as “safety people.”
  • Helping parents more effectively engage in the treatment process allows the ability for children to use their parents as “safety people” throughout their lifetime.

 

Are you a mental health professional working with children, youth, and families using play therapy and expressive arts? Check out this free pdf for the Be 5 Framework using intention and therapeutic presence within a clinic framework for play therapy.  Click here

 

References

Dana, D. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices. New York, NY: W. W. Norton.

Fonagy, P., Steele, M., Steele, H., Moran, G. S., and Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201-218.

Marrone, M. (2014). Attachment and interaction: From Bowlby to current clinical theory and practice (2nd ed.). London, UK: Jessica Kingsley Publishers.

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York, NY: W. W. Norton.

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. New York, NY: Bantam.

Posted in Neuroscience of Attachment

The Hero’s Journey: Parents and Caregivers as Partners in the Play Therapy Process

Image from Ulrike Mai/Pixaby

Written by Cathi Spooner, LCSW, RPT-S

(*Parents in this article refers to any adult functioning in a parental role for the child)

 

As a mental health professional who works with children, what’s a favorite emotion regulation skill you teach children and how can you integrate parents to help their child generalize that skill into their daily life outside of the therapy office? These are two key questions we need to ask ourselves as mental health professionals when working with children who struggle with emotion regulation. Engaging parents in the treatment process can improve the long-term treatment outcomes for children. This blog post focuses on the benefit of integrating parents into the play therapy process to help children strengthen their neural circuits for emotion regulation and promote resiliency. Children are the next generation of heroes in our communities. Helping children develop resiliency and effective life skills, such as regulating emotions, empowers them to succeed. As mental health professionals, we can support parents in the treatment process because they play a critical role in helping their child successfully navigate the challenges of life.

 

Children need adults to help their emotion regulation neural circuits develop and widen their window of distress tolerance, which promotes resiliency for children. Resiliency is the goal. Resiliency is the ability to navigate the “ups and downs” of life with lots of “bounce back” ability. This means therapists need to help parents become skills coaches for their children and regulate their own emotions. Siegel and Hartzell (2003) propose conceptualizing emotion as an integrative function. They state: “emotion links physiology (body), cognitive (information processing), subjective (internal sensory), and social (interpersonal) processes” (p. 77). The relationship between both the regulatory and regulating aspects of emotions provides a way to understand the connection between the influence of the mind on emotions and influence of emotions on the mind- it’s the chicken and the egg dilemma – which comes first – our beliefs and perspective of events that trigger emotions (mind) and/or how emotions trigger can trigger beliefs and perspectives of events (emotion).

 

Schore and Schore (2008) reframe Attachment Theory as Regulation Theory due to the neurobiology of attachment and its role in co-regulation and the development/strengthening of neural pathways. Mindsight, as developed by Siegel (2011), proposes that integration of complex neural circuitry of the mind is the key to emotional well-being and that our ability to connect with the minds of others, such as with attachment relationships, is also dependent upon the integration of these complex neural systems. The interpersonal mind-to-mind synchronization between parent and child through the resonance circuits is the key to helping children use their parents for co-regulation of their emotions. Resonance circuits refer to the integration of complex neural circuitry identified by Siegel (2011) that are heavily influenced by mirror neurons. These resonance circuits help parents to be attuned, even at the psychobiological level, with their child and play an important role in their child’s ability to accomplish internal integration and self-regulation through co-regulation with a regulated parent (Badenoch, 2008; Siegel, 2011; Siegel & Hartzell, 2003). The goal in treatment is to help children use the regulated state of their parent during “emotional storms” to regulate their internal emotional state over and over until they can eventually self-regulate their internal emotional state.

 

What can therapists do to help parents become skills coaches for their child for emotion regulation? I love including parents in the sessions as we explore and identify how the child experiences emotions physiologically (where and how in the body), developing an emotion vocabulary, and identifying what activates those emotions. Parents and their child can have a conversation about how the child experiences emotions and learn to scale their emotions using the 5-Point Scale (Dunn Buron & Curtis, 2004), and then use that information to create a coping plan. Parent and child can work on those skills over the next week. This is where the magic happens – the child learns to use the skill when they need it most – outside of our therapy office – in their day-to-day functioning. Parents help their child generalize the skills learned in the therapy session to application in their everyday lives. 

 

I like using the 5-Point Scale (Dunn Buron & Curtis, 2004) because it helps conceptualize emotion on a continuum from least severe to severe. The coping skills used when an emotion is less severe will likely differ from coping skills used when an emotion is more severe. For example, deep breathing may help when an emotion is less severe, or even moderately severe, but the child will likely need an adult to help him (or her) co-regulate during an “emotional storm” to eventually regulate themselves. Mental health professionals can help parents and their child identify what that parental help will “look like” during an emotional storm because what may work for one child may not work for another child. It’s important to help parents and their child explore and identify what co-regulation and coping skills are needed to help the child during their emotional storms, which is why it’s important to integrate parents into the play therapy process. 

 

Here’s a recap:

·      Children need their parents to help them create integration for their emotion regulation among complex circuitry in the mind.

·      Emotion has an integrative function and the integration of these vast neural circuity promotes resiliency and emotional well-being

·      Parents and caregivers use their resonance circuits to connect mind-to-mind with their child and help them regulate their emotion circuits

·      Integrating parents and caregivers into the treatment process as skills coaches is important for accomplishing long term emotion regulation and self-regulation

 

Are you a mental health professional working with children, youth, and families using play therapy? Check out this free pdf for the Be 5 framework using intention and therapeutic presence in a clinical framework for play therapy.  Click here

 

References

Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York, NY: W. W. Norton.

Dunn Buron, K., and Curtis, M. (2004). The incredible 5-point scale: Assisting students with autism spectrum disorders in social interactions and controlling their emotional responses. Shawnee Mission, KS: Autism Asperger Publishing Company.

Schore, J. R., and Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36, 9-20. doi.10.1007/s10615-007-0111-7

Siegel, D. J. (2011). Mindsight: The new science of personal transformation. New York, NY: Bantam.

Siegel, D. J., and Hartzell, M. (2003). Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive. New York, NT: Jeremy P. Tarcher/Penguin.