Understanding the Neurobiology of Attachment and Trauma in Clinical Practice
Ripples Allied Health Consultancy
Introduction: Neurobiology of Attachment and Trauma
Attachment is central to a person’s ability to regulate emotions, form secure relationships, and respond to stress. Trauma, particularly in early childhood, can significantly disrupt these processes. Understanding the neurobiological underpinnings of attachment enhances therapeutic interventions, helping both clients and families heal effectively.
Recognising Attachment and Trauma Issues in the Clinic Room
Emotional Dysregulation
01
Signs to Look For
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Sudden mood swings during sessions.
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Overreacting to minor issues or showing little emotional response to significant topics.
Practical Example
Client Scenario: A client becomes extremely anxious when discussing their childhood but remains calm when talking about their current job.
Therapist Scripts
"Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
Strategies to Manage
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Grounding Techniques: Introduce breathing exercises or sensory grounding (e.g., holding a stress ball) when emotional dysregulation is observed.
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Example Script: "Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
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Mindfulness Practices: Encourage clients to focus on their breath or bodily sensations to help regain emotional balance.
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Example Script: "I can see you’re feeling overwhelmed. Let’s take a pause. Close your eyes if you’re comfortable and focus on your breathing. Let’s do it together. Inhale for four counts, hold for two, and exhale slowly."
02
Avoidance and Withdrawal
Signs to Look For
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Reluctance to discuss certain topics.
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Physical distancing (e.g., leaning away, avoiding eye contact).
Practical Example
Client Scenario: A client consistently changes the topic when the conversation approaches their family relationships.
Therapist Scripts
"Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
Strategies to Manage
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Gentle Probing: Use open-ended questions to gently encourage exploration without pressuring the client.
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Example Script: "It seems like you’re finding it difficult to talk about that. What’s coming up for you when we move into that topic? We can explore it slowly, if that feels okay."
Establishing Safety: Reinforce a safe and non-judgmental environment, ensuring the client feels secure to open up at their own pace. -
Example Script: "I want to reassure you that this is a safe space. We will only go as far as you feel comfortable, and you can always tell me if something feels too much."
03
Shut down and Dissociation
Signs to Look For
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Zoning out or appearing disconnected during discussions.
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Difficulty recalling parts of the session.
Practical Example
Client Scenario: A client suddenly becomes quiet and stops responding while discussing a traumatic event.
Therapist Scripts
"Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
Strategies to Manage
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Grounding Exercises: Use techniques such as asking the client to describe their surroundings or to focus on a specific sensory input (e.g., feel the chair beneath them).
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Example Script: "It seems like you’re feeling a bit disconnected right now. Let’s come back to the present. What can you feel with your hands? Maybe the texture of the chair or the temperature of the air?"
Reorienting Statements: Gently guide the client back to the present moment with statements like, "Can you tell me what you’re feeling right now?" -
Example Script: "I notice you seem a bit distant. Can we focus on something in the room together? Maybe tell me three things you can see or describe how your body feels at this moment."
Impact of Attachment and Trauma on Transference and Countertransference
Noting Transference
01
Definition
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In the area of Attachment and Trauma, transference can occur when clients transfer feelings and expectations from past relationships onto the therapist.
Practical Example
Client Scenario: A client begins to see the therapist as a parental figure and reacts with frustration when the therapist sets boundaries.
Therapist Scripts
"Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
Strategies to Manage
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Acknowledge and Explore: Recognise transference and discuss it openly, helping the client understand the origins of these feelings.
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Script for Acknowledging Transference: "It sounds like you might be feeling the way you once felt with someone important in your past. Do you think these feelings are related to our relationship here?"
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Script for Exploring Transference: "You’ve mentioned feeling frustrated with me when I set boundaries. Let’s talk about that—does this remind you of any past experiences or relationships?"
Maintain Boundaries: Clearly maintain professional boundaries while showing empathy and understanding.
02
Noticing Countertransference
Definitions
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In the area of Attachment and Trauma, transference can occur when Therapists project their own emotions and experiences onto the client.
Practical Example
Therapist Scenario: A therapist feels overly protective of a client who reminds them of their own child.
Therapist Scripts
"Let’s take a moment. Can you feel your feet on the ground? Take a deep breath and feel the air fill your lungs. Now, focus on one thing you can hear in the room right now."
Strategies to Manage
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Self-Reflection: Encourage regular self-reflection and supervision to identify and address countertransference.
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Script for Self-Reflection on Countertransference: "I notice I’m feeling very protective of you, and I want to be mindful of this as we continue our work. How do you feel about our dynamic? Does it feel helpful?"
Boundaries: Maintain clear professional boundaries and seek peer support when needed.
Ripples Allied Health Consultancy
Therapeutic Processes to Assist Clients with Attachment and Trauma Issues
1. Right-Brain Communication and Attunement
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Technique: Use a warm, soothing tone and maintain gentle eye contact to convey empathy and understanding. Example: "I’m here with you. I see this is hard, and I want to let you know that I’m right here. We can take this at your pace, and we’ll figure it out together."
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Activity: Incorporate non-verbal gestures, such as nodding or appropriate facial expressions, to show attunement. Example: (Using gentle tone and body language) "I understand. It’s okay to feel this way. Let’s just sit with this for a moment before we decide what to do next."
2. Repairing Ruptures
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Scenario: If a session ends abruptly due to a misunderstanding, the next session can start by acknowledging what happened and discussing its emotional impact. Example: "I noticed that last session felt difficult, and it seemed like there was a disconnect. Let’s talk about how that felt for you, and see how we can repair any misunderstandings."
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Technique: Use reflective listening to show the client that their feelings about the rupture are heard and validated. Example: "I want to acknowledge how hard it can be when things don’t feel right between us. What can we do to make you feel safer and more connected in our work together?"
​3. Engaging Clients’ Curiosity and Exploration
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Technique: Encourage clients to explore their feelings. Example "What does this emotion feel like in your body?" or "Can you describe what thoughts come up when you think about this event?"
Activity: Use creative methods such as drawing or journaling to help clients express and explore their emotions. Example: "Let’s imagine that feeling has a shape or a color—what comes to mind? This might give us more insight into what’s happening for you."
​4. Somatic and Body-Based Interventions
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Technique: Guide clients to notice physical sensations during emotional moments, such as tension in the shoulders or a tightening in the chest.
Activity: Introduce simple yoga or stretching exercises to help clients reconnect with their bodies and release stored tension.
5. Integrating the Parts of the Self
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Technique: Use parts work by encouraging clients to dialogue between different parts of themselves (e.g., victim and protector) to foster internal integration.
Activity: Implement guided imagery exercises where clients visualise different parts of themselves interacting in a safe environment.
Ripples Allied Health Consultancy
Follow-Up with Parents or Caregivers
​1. Educating Parents About Attachment
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Parent Sessions: Schedule periodic meetings with parents to discuss their child’s progress and address any concerns. Set up monthly family therapy sessions to monitor improvements and reinforce positive interactions.
Handouts: Provide easy-to-understand handouts explaining attachment styles and their effects on behavior and emotional regulation.
2. Supporting Parental Self-Regulation
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Technique: Teach parents mindfulness and relaxation techniques that they can use to manage their own stress, thereby creating a calmer environment for their child.
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Activity: Encourage parents to practice deep breathing exercises together with their child as a family activity.
3. Building Parent-Child Connection
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Activity: Suggest regular one-on-one time activities, such as reading together, playing games, or engaging in creative projects that foster connection.
Technique: Encourage parents to use positive reinforcement and active listening to strengthen the emotional bond with their child.
4. Helping Parents Repair Ruptures
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Technique: Role-play scenarios with parents on how to apologise and communicate effectively after conflicts or misunderstandings.
Activity: Create a family ritual for discussing and resolving conflicts, promoting open and honest communication.
5. Supporting Parent-Child Interaction
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Technique: Guide parents in recognizing and responding to their child's emotional needs with empathy and consistency.
Activity: Encourage parents to engage in joint activities that promote mutual enjoyment and emotional bonding, such as cooking a meal together or taking a walk.
References
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Buczynski, R., Lanius, R., & Siegel, R. (2023). The Neurobiology of Attachment: TalkBack Session. National Institute for the Clinical Application of Behavioral Medicine.
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Buczynski, R., Schore, A., van der Kolk, B., Siegel, D., Lanius, R., & Ogden, P. (2023). The Neurobiology of Attachment: Main Session. National Institute for the Clinical Application of Behavioral Medicine.
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Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W. W. Norton & Company.
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Schore, A. (2003). Affect Regulation and the Repair of the Self. W. W. Norton & Company.
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Siegel, D. J. (2012). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (2nd ed.). Guilford Press.
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Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
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Sroufe, A., & Siegel, D. J. (2011). The Case for Attachment Theory: The Verdict is In. Psychotherapy Networker.