Dr Katy Brett Senior Clinical Lecturer Consultant ... · Dr Katy Brett. Senior Clinical Lecturer....

Dr Katy BrettSenior Clinical LecturerConsultant Psychiatrist

Mothers & Babies ServiceSouth Island Perinatal Mental Health Service

Early trauma affects the brain and the body

Trauma underlies many difficulties in adulthood

What having a baby can bring

Experience of the baby

An event is traumatic if it is:

Extremely upsetting

Overwhelms the individuals internal resources

Produces long lasting psychological symptoms

RepeatedCumulativeUsually within specific relationships

• E.g. Attachment, intimate, familiesOften entrapment & conditioning

Prototype is child abuse

‘Re-victimisation’

Intrusive SymptomsThoughts, flashbacks, nightmares

Avoidance

Negative alterations in cognition and mood

Hyperarousal Symptoms

+/- Dissociative symptoms

PTSD

Affect Dysregulation

Negative Self Concept

Interpersonal Disturbances

Dissociative symptoms

Fear of Abandonment*

Affective instabilityIntense/ Inappropriate angerSuicidal behaviour Impulsivity*

Identity DisturbanceChronic emptinessUnstable sense of self*

Interpersonal relationship -unstable & intense*

Felitti & Ananda 1990s

17000 middle class Americans

10 questions• Physical & Sexual abuse• Physical & Emotional neglect• Family dysfunction SA, FV, prison Mental illness Divorce/ separation

Liver Disease

Brain Stem- Reptilian BrainMid Brain – Mammalian BrainNeocortex – Primate Brain

Brain Stem- Reptilian BrainMid Brain – Mammalian BrainNeocortex – Primate Brain

“The essential task of the first year of life is the co-creation of secure attachment bond of emotional communication between the infant and primary caregiver’’ Allan Schore

Fragility of sense of self as a new mother

You will see me as a bad mother

Creating an alliance with the threat of attack

Relentless Demanding Intimacy Arouses attachment

system Regulation

• self & others Attunement Mentalising Being present Working with

professionals

For a mum with trauma: Fear

• Attachment system• My baby doesn't love

me• I might hurt my baby• Repeating/ re-enacting

Dysregulation Mistrust Envy

Overwhelmed Hopeless Dissociate Unpredictable

• Frightened/ frightening

Focus on own needs Emotional unavailable Fail to focus on baby’s

emotional states Fail to address/

modulate affects

Hypervigilance

Dysregulation

Dissociation

Looking away/

freezing/ not

responding

Approach-avoidance

conflict

I want to be a good mother I love my baby I will be different from my mother I will protect her, as I was not protected.

How do I do this when I hate myself I feel sorry for her that she has me as a mother I don’t trust others to care for me Closeness has been dangerous for me

Observation skills Reflective dialogue Inferential skills

Reflective capacity

Positive intentionality Secure Attachment

Model what to do with the infant Ask questions to clarify Reframe baby’s intentions

Wonder aloud about what is going on for the baby

Attend to the baby’s state Imitate the baby to highlight their cues Label feelings of mother and baby Link mental states with behaviour Speak for the baby

A mother can experience herself as meaningful in the eyes of the therapist; the experience of being held in mind as a coherent, intentional person who is trying to do her best allows a mother to start experiencing herself and her baby in the same way.

LS Sadler et al 2006