PowerPoint For Email - Attachment and Trauma - DR Brisch - 13-14march2014 PDF

Attachment, attachment disorders and
trauma: Diagnostics, treatment and

prevention in children, adolescents
and caregivers.
Karl Heinz Brisch
Kinderklinik und Poliklinik
im Dr. von Haunerschen Kinderspital
Abteilung Pädiatrische Psychosomatik und Psychotherapie
Ludwig-Maximilians-Universität
München
© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.
Outline
• Introduction to attachment theory
• Trauma
• Attachment disorders
• Attachment-based therapy
• Prevention
• Video-demonstration

Attention please!
• Fotography, audio- or video-recordings are
not allowed due to copyright
• Thank you for your understanding!

Interested in slides of
presentation?
• www.khbrisch.de
• downloads
» Sydney

Part 1
• Introduction into attachment theory:
Development of insecure and secure
attachment qualities (with video-
demonstration)

Motivational Survival Systems
Physiological
Needs
Attachment Exploration
Relationship
Sensory Avoidance of
Stimulation negative stimuli
Self-Efficacy

Attachment Theory (1)
• During the infant‘s first year he/she
develops a specific emotional attachment to
a primary attachment figure.
• The attachment system ensures survival
• The attachment figure is the “secure base”
for the infant (“haven of safety”)
• The attachment system is activated by fear
and separation.
Attachment Theory (2)
• The attachment system is reassured by the
physical proximity of the attachment figure.
• The attachment system is in reciprocity with
the exploration system.
• As soon as the attachment system is
reassured, the infant is ready to explore
his/her environment.

„Attachment – Exploration – Seesaw“
Attachment Exploration
Exploration
activated
Attachment
de-activated
Attachment
activated
Exploration
de-activated

Sensitivity (1)
• The caregiver with the highest sensitivity
during interaction will become the infant‘s
major attachment person.
• A high parental sensitivity will enhance the
development of a secure attachment of the
infant.

Development of secure attachment
• Sensitivity to infants signals

• Gaze
• Verbal interaction
• Rhythm of dialogue
• Touch

Window of Tolerance of Stress-Regulation
Hyper-Arousal Sympathetic Nervous System
Dissociation FREEZE
Panic state
Fear of death,
Activated Attachment System
Hyper-Arousal Parasympathetic Nervous System

Dissociation COLLAPSE
© Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved
© zptn-Lutz-Ulrich Besser
Video-Demonstration of sensitivity
• Mother/Father-infant interactions

Attachment quality
of term infants (1)
• Secure (approx. 60%)
• Insecure
– Avoidant (approx. 15%)
– Ambivalent (approx. 10%)
• Beginning of psychopathology
– Disorganized (approx. 10%)
• Attachment Disorder
– Severe early psychopathology (approx. 5%)

Video-Demonstration
• Attachment quality examined in the Strange
Situation Procedure
• Two short separations of infant from mother
• Evaluation of reunion behavior
• Balance of attachment and exploration
behavior

Attachment and psychic
development
• Secure attachment PROTECTION
• Insecure attachment RISK

Consequences of the
development of attachment (1)
• Secure attachment
– protective factor under stress
– greater coping ability
– ability to seek out help
– more attuned social behavior
– larger numbers of relationships
– greater creativity
– greater flexibility and persistence
– better memory and learning
– better language aquisition
– better empathy for the emotions of others/theory of mind
Consequences of the
development of attachment (2)
• Insecure attachment
– risk factor under stress
– less coping ability
– tendency tendency toward solitary solutions to problems
– Empathy for others not so well developed
– withdrawal from social activities
– fewer relationships
– less flexibility in thinking and acting
– tendency to more aggressive behavior in conflicts
– poorer memory and learning
Attachment representations in adults
• Secure-autonomous
• Insecure
– dismissing
– entangled
– Unresolved versus resolved trauma (additional
pattern)

Intergenerational transmission of
attachment patterns
• Connection between
attachment of the parents and the child
– Secure parents with secure children
• mother-child approximately 75%
• father-child approximately 65%
– Insecure parents with insecure children
• Avoidant parent to avoidant child
• Amivalent parent to ambivalent child

Preconditions for the development
of secure attachment in the child
• Sensitivity of the caregiver
• Emotional availability
• Clearing up misunderstandings
• Recognition of projections
• Clarifying conceptions of the ideal
• Traumatizing experienced resolved

Part 2
• Development of disorganized attachment
and attachment disorders (with video-
demonstration)

Attachment quality
of term infants - Psychopathology
Beginning of psychopathology
Disorganized attachment
• Normal population (approx. 10-20%)
– Genetic mutation in dopamin system
– Postnatal hypoglycemia
• Infants of parents with unresolved trauma
– (approx. 75-80%)
Severe psychopathology
Attachment disorders
Copyright © Karl Heinz Brisch Munich/Germany 2008
Disorganized attachment
• Trance-like states („Freezing“)
• Attention deficit
• Hyperactivity
• Steretype motor movements
• Incoherent and contradictary behavior in
attachment relevant situations

Disorganized attachment, ADHD
and post-traumatic stress disorder
(PTSD)
• Unresolved trauma of parents
• Similar neuro-hormon changes in dopamin-
system
• Traumatized children
• Hyperarousal
• Decreased stress flexibility (window of
tolerance)
Physiology and attachment
qualities
• Physiology of the infant
– stress reaction with all attachment patterns by
separation from the attachment person
• increase of heart rate
• reduction of skin resistance
• increase of salivary cortisol
– maximum values, retarded decrease after reunion in

case of
• insecure-avoidant attachment
• disorganized attachment
• attachment disorders

Unprocessed parental trauma
• Interactional disorder and disorders of
affective communication with the infant
– prenatal and postnatal
• Fearful behavior by the mother
• Fear-inducing behavior by the mother
• Helpless caregiving by the mother

Strange Situation and attachment
disorganization in child
• Video-Example

Origins of attachment disorders
• Early multiple traumatization of children by
attachment figures
– Severe emotional and physical deprivation and neglect
– Physical violence
– Sexual violence
– Emotional violence
– Verbal violence
– Multiple separation from attachment figures
– Loss of attachment figures without secondary
attachment figure
– Witness of violence between attachment figures

Triggers for re-traumatization
Traumatized parents react to trigger in the
behavior of the infant, child or adolescent
• Atttachment behavior
– search for closeness, clinging, crying, pain, needeness
• Separation / exploration behavior
– Distancing, autonomy,
• Trigger by affective arousal of the child
• Unconcious process!!!
Re-enactment of trauma
• In the interaction with the infant/child
– Avoidance of contact and proximity with child
– Abrupt/intermittend breaks in activity and relationship
– Understimulation vs. overstimulation (sexual-sensory)
– Aggressive behavior/violence
• In the affective communication
– Transference of traumatic affects onto the child
• Hyperarousal, panic, rage, shame, feelings of guilt

Part 3
• Impact of trauma on brain maturation,
attachment development and PTSD
• Diagnosis of attachment disorders

Developmental trauma disorder
(Bessel van der Kolk) – a new
diagnosis?
• Chronic early maltreatment by caregivers
• Threatening living conditions
• Changing care systems
• Loss of caregivers
• Inadaquate care
• Physical and emotional deprivation
• Abuse and violence by caregivers
Symptoms of Developmental
Trauma Disorder
• Disorders in
– Delay in physical growth
– Delay and disorders in neural networking and brain
development
– Attachment
– Affect regulation
– Attention
– Cognitive functioning
– Mentalization and empathy
– Interpersonal relationships with aggression
– Dissociation
What is the basic fault in
developmental trauma disorder?
• No fromation of secure attachment
• Attachment disorder due to early
traumatisation by attachment figures

Changes in the brain after early
traumatization in childhood I
• Studies of Martin Teicher, Harvard Medical
School
• Specific changes in the brain
– Typ of violence
– Age of victim
– Gender effects
• Quelle: Teicher, M. H., S. L. Andersen, A. Polcari, C. M. Anderson & C. P. Navalta (2002): Developmental
neurobiology of childhood stress and trauma. Psychiatric Clinics of North America, 25, 397-426.
• Teicher, M. H. (2000): Wounds that time won't heal: The neurobiology of child abuse. Cerebrum, 4, 50-67.

Changes in the brain after early
traumatization in childhood
II
• Specific effects on the brain
– Decreased integration of right and left
hemisphere of the brain
– Decreased function of the implicit memory
function
• Boys: deprivation and physical violence
• Girls: sexual abuse
• Dose effect of changes
Age of child and sensitive phases I
• Very sensitive phase age 0 - 4.5 years and

11 – 13 years
• Hippocampus
– Memory
• Corpus Callosum
– Integration of both hemispheres of the brain

Age of child and sensitive phases II
• Orbito-frontal cortex
– Attention
– Affect regulation
– Motivation
– Sensitivity for reward
– Personal identity
– Self and non-self distinction
– Empathy and mentalization
– Recognition of social networks in groups
• Visuell cortex
– Recognition of faces,
– Recognition of emotions

Verbal emotional maltreatment by
parents
• Decrease in connectivity between limbic

system and cortex
• Decrease in connectivity between motor
speech area (Brocca) and receptive speech
area (Wernicke)

Child as wittness of domestic
violence
• Decrease of connectivity between visual
cortex and temporal lobe
• Decrease of connectivity between visual
cortex and limbic system

Attachment psychopathology
• Attachment disorders are severe early
psychopathology

Intergenerational transmission of
attachment (2)
• Correspondence between attachment of parents
and child
– Parents with unresolved trauma with disorganized
children
– Attachment disordered traumatizing parents with
attachment disordered children

Neurobiological consequences
• Permanent stimulation of stress hormones
• Decrease in growth hormones
• Destructions of neurons in the brain
• Reduction of brain volume

Consequences of attachment
disorders
• Deficits in right brain development
– Affective attunement
– Affect control
– Theory of mind
– Empathy
– Insightfulness
– Mentalizing
• Deficits in cognitive development

disorders (continued)
• No development of secure emotional base
• No or fragmented inner working model of
attachment
• No feeling of emotional security
• No ability to stay in relationships
• Severe behavior disturbance in attachment
relevant situations
• Desorganisation
• Derealisation
• Depersonalisation
• Dissociation

• Panic attacks
• Anxiety disorders
• Severe depression
• Severe narcissitic disorders

• Somatoform disorders
• Psychosomatic disorders
• Eating disorders
• Addiction

• Chronic Posttraumatic Stress Disorder
(PTSD)
• Aggressive behavior disorder
• Antisocial behavior disorders
• Developmental Trauma Disorder – a new
diagnosis?

Late effects of early traumatization
in childhood into adult health
• Impaired somatic and psychic health in

adulthood
• Dose effect relation to impairment
• The more early experiences of violence of
any form, the more diseases in adulhood
(ACE study)

Diagnosis
• Mother/father-infant observation
• Strange Situation Test (Ainsworth)
• Preschooler Test (Marvin & Cassidy)
• Story stem completion task (Bretherton)
• Child attchment interview (Target)
• Adult attachment interview (Georg; Main)

Part 4
• Types of attachment disorders
• Clinical cases (with video-demonstration)

Types of attachment disorders
• No signs of attachment behavior
• Promiscuous (indifferent) (ICD 10)
• Inhibited (ICD 10)
• Hyper-vigilant
• Aggressive
• Role reversal
• Addiction
• Psychosomatic symptoms
Video-Demonstration
of Attachment Disorders
• Strange Situation Procedure
– Promiscuous (indifferent) attachment disorder
– Inhibited attachment disorder

Reaction to traumatization by the
attachment figure
• Search for an attachment figure
• Attachment dilemma
– Attachment figure is present, but source of great
anxiety
• Pathological attachment to perpetrator
• Activation of archaic reactions
– Fight and flight are not possible
– Freeze, dissociation, submission
– Aggression against non-attachment figures with latency
– Self-harm
Clinical Cases

Part 5
• Types of attachment disorders
• Clinical cases (continued)
• Prinicples of attachment therapy

Clinical Cases (cont.)

Therapy I
• Attachment Based Therapy
– Patient's anxiety "activates" his/her search for
an attachment figure
– Therapist must establich a secure therapeutic
bonding by his/her sensitivity
– New attachment experience of safety in therapy
– Focus on exploration of
• Traumatic experiences of loss, separation,
violence
– Psychotraumatherapy
Therapy II
• Attachment Based Therapy
– Integration of segregated affects into inner
working model
– Mourning
– New experiences in relationships
– Separation from therapist
– Interval-Therapy

Part 6
• Treatment of attachment disorders with
attachment therapy (with video-
demonstration)

„Pediatric Intensive Care Unit of Psychotherapy“
for early disorders of attachment and traumatization
Components of treatment
– Somatic treatment
– Social work
– Milieu therapy
– Individual psychotherapy
– Group-psychotherapy
– Trauma-therapy (EMDR)
– Education
Milieu-therapy
Safty and structure
New attachment figures –
individual attachment nurse
and 2 therapists
Psychodynamic and
attachment-based
understanding
Affect and stress regulation
Developmental support
New group experiences with
peers

Individual Psychotheray
• Psychodynamic –
attachment based play
therapy 4-5x /week
• Emergency therapy
• Traumatherapy
• Parent-
Counselling/Education
• Familiy-Therapy 1x/week
• External individual therapy
for mother/father
Creative Therapy
•Art Therapy
•Musik Theray
•Movement Therapy
• Individual sessions (individual

frequency)
• Group sessions,
3 x /week
B.A.S.E.® - Babywatching
• 1x a week observation of
mother/father – baby –
interaction
• Promotion of sensitivity,
empathy, mentalization
• Decrease of aggression
• Decrease of anxiety

Schooling
• Mon – Fri 8:30 - 12:00 a.m.

• Max. 6 students
• Individual teaching
• Group teaching
• 3 Teachers are team members
• Team-supversion
• Case-supervsion
External supervision and
training
• Team-Supervision (every 2nd week)
• Case-Supervision (3x/week)
– Nurses
– Therapists
– All staff members
• Training and supervision in
psychotraumatology and attachment
Girl „Lena“, 8 years
Consultation-Liaison Service
• Pediatric hopsital, girl, 8 years

• Diagnosis: Failure to thrive, eating disorder
• Questions:
• Mother-child problem?
• No school attendance

Diagnosis
• Failure to thrive and eating disorder

• Migrane
• 2x Anti-reflux-operation at the stomach
(Hemifundoplicatio)
• Botulinum-injection into the anal muscle because of
chronic obstipation
• Percutaneous tube feeding into the stomach (since 8th
month of life!)
Further Symptoms I
• Chronic stomach pain with vomiting and
choking
• Headaches with vomiting
• Chronic obstipation
• Daily tube feeding with high caloric
nutrition
• Gastro-esophagal reflux
Further Symptoms II
• Delay in bone maturation
• Osteoporosis
• Disorder of thyroid functioning

In-patient treatments
1. December 1999: 13 days 11. Januar 2003: 47 days
2. Oktober 2000: 10 days 12. 1. Anti-reflux operation in Munich
Percutaneus Tube feeding 13. December 2003: 10 days
1. April 2001: 8 days
14. Januar 2005: 8 days
2. Oktober 2001: 28 days
5. November 2001: 2 days 15. March 2005: 7 days
6. December 2001: 4 days 16. January 2006: 19 days
7. Februar 2002: 2 days 17. June 2006: 24 days
8. Juli 2002: 15 days
2. Anti-reflux-operation and anal
9. August 2002: 17 days Botulinum-injections in Berlin
11. October 2006: 10 days
Child surgery clinic in Berlin
12. August 2007: 13 days
13. Admission to our ward

Growth /weight charts

Daily medication at admission
• Thyroid hormone
• Vitamin D
• Medication against obstipation
• Tube feeding
• Pain medication

Intensive Psychotherapy Care
Unit
Strange eating behavior
Anxiety to gain weight
Stomach aches and headaches
Demands for pain medication
Pain attacks in her esophagus
No relations in group to peers
Withdrawal and anxieties
High separation anxiety from mother: Attachment disorder
with clinging
Parent-therapy
Parents: separation during infancy
Mother: psychological problems
Eating disorder
Severe traumatization in her childood
Social welfare – money for caring for
the child
Mother not working because of the
child`s disease
Father less involved

Aims for therapy of child
New sensitive attachment experiences
Learning to differentiated feelings, needs,
somatic sensations
Diffentiating body memories
Development of emotional, cognitive and
social skills
Integration into group
Aims of therapy for parents
Sensibilization for the needs of their

daughter
Involvement of father (trinagulation)
Detecting projections: Ghosts in the nursery
Separation – Autonomy of the enmeshed
mother-“infant“/child dyad

Treatment
Normalization of eating behavior
Slowly reduce tube feeding
Weight gain only with oral feeding intake
Reduce somatic complaints
Less pain medication
Reduce medication for obstipation

Removal of feeding tube after 5
months of theray
• Security and clear boundaries on the ward

• Co-operation with the department of gastro-
enterology
• Keep the tube as symbolic important peace of life
• Party

Discharge
Stabile weight gain without special nutrition
Normalisation in eating behavior
Very seldom somatization
Talking about symbolic contents of somatic
messages
Medication: only thyroid hormone

Discharge
Ambivalent attachment (changed from disorganized)
Emotional stabilization
Less depressive
Contacts to peers in the group and at home
Tolerance to conflicts
Mentalization of others perspective
Contacts to both parents
Parents: mother still anxious about health of daughter
Out-patient treatment
Individual and group sessions

Recommendation: therapy for mother!

...and one year after discharge ?

1 year later...
Normal weight gain and growth
Normal eating behavior
NO visits of phyisians
Rarely somatoform complaints
Group-therapy (3x/week)
Schooling: gymnasium
Peers and friend
Secure attachment
Parents: live together again
Mother working
Part 7
• Treatment of attachment disorders with
attachment therapy (with video-
demonstration)- (continued)
• Supervision of case examples from
delegates (continued)

Attachment traumatization in early
childhood
– „psychic cancer of the brain“
• Extreme damage to the brain, the body, the
psychic and social development
– Physical „death“
– Psychic „death“
– Social „death“
• Chronification
• Is healing possible with a special
„psychotherapeutic intensive care unit“?
„Jonas“, 8 years
History
• Deprivation and extreme phyical maltreatment
during 1st and 2nd year of live by his mother
• Mother drug and alcohol addiction
• With foster parents: 2nd year of live – later
adoption by these foster parents
• Development of extreme selfharm and aggression
against others.
• No admission to kindergarten because of
aggression
• Parents seek ouf for help
Symptoms
• Indifferent attachment disorder
• No affect regulation
• No stress-tolerance
• No schooling
• Communiction with mother by picture cards
• Many food allergies
Intensiv-Psychotherapy Unit
• Nurse and therapists become new attachment
figures
• Milieu-therapy: time-intensive instead of time-out
• NO – medication
• Schooling (from minutes to hours)
• Intensive work wiht adoptive parents (both with

unresolved trauma in AAI)
Video-clip from therapy
„ Attachment and Aggression – Ways out
of the Dilemma“
TV-
Film by Susanne Bauer-Schramm
Bavarian TV
BR Alpha Campus, 19. Januar 2009
• Movement Therapy
• Music therapy

Follow-up
• After discharge:
– Disorganized attachment
– Continuous individual psychotherapy in out-patient department
– Schooling: class for children with special needs with school companion
• After 1 year:
– Ambivalent attachment
– normal school with companion
– Social integration into family, peers at school
• After 2 yerars:
– normal school without companion
• After 3 years:
– Secure attachment

Conclusion
• Treatment should start early
• Intensive treatment
• In-patient with new intensive positive sensitive
attachment experiences
• Affect and impuls control
• Stress regulation
• Social integration
• Healthy bio-psycho-social development
• Prevention is possible
CAMPUS INNENSTADT
KINDERKLINIK UND KINDERPOLIKLINIK
IM DR. V. HAUNERSCHEN KINDERSPITAL
Evaluation of the treamtent model Moses®

Intenvive Care Unit of Psychotherapy
for early traumatized children aged 6-13 years
Evaluation of the treamtent model Moses®
Intenvive Care Unit of Psychotherapy
for early traumatized children aged 6-13 years
„Moses® “ Study
Sample
Children age 6-13 years
Intervention group, waiting control group, healthy control group
Sample size 3 x N = 24 (total sample size N = 72)
Inclusion criteria:
Severe early traumatisation with violence, abuse, neglect by
primary caregivers
Chronification of posttraumatic stress disorder PTSD
Attachment disorder
Exclusion criteria:
Previous inpatient treatment
Severe autism, addiction, mental disability (IQ < 85)
Treatment of 6 children in a group setting
Duration of in-patient treatment: 6 months

Study design
4 points of measurement
T0= 6 months before in-patient treatment (only
waiting group)
T1= Admission to in-patient treatment
T2= Discharge
T3= Follow-up: 6 months after discharge
Methods
Questionnaires and test
Attachment interviews und behavioral observations
(f)MRi
Oxytocin and cortisol in saliva and in blood (1x at T1)
100 05.03.2014 © Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved
Questions and aims 1
Global aim: Evaluation of the treatment programme of the
intensive care unit of psychotheray for early traumatized
children with attachment disorders
What kind of attachment representation do these children
present?
Can we change their attachment respresentation to „earned
secure“?
How does the attachment representation influence the HPA
axis and oxytocin secretion?
Can we develop and optimize ressources like intelligence,
social competence in groups?
Questions and aims 2
Can we influence psychopathology (PTSD symptoms,
dissociation, anxiety, depression)
Can we observe changes in neural structures, function
and connectivity of the brain?

Part 8
• Prevention of attachment disorders by the
programs SAFE® and B.A.S.E. ® (with
video-demonstration)
• Final Discussion

Prevention of Attachment Disorders
SAFE ®
„ Secure Attachment Formation for Educators“

• Group-Education in parenting from pregnancy till
end of first year of life
– Children need early attachment
– Recollection of traumata
– Information about re-enactment
– Preventive treatment of traumata even before birth
– Intervall-treatment of parents
Research

• SAFE®-Mentor
Training
in
Munich/Germany
July 14-17, 2014

B.A.S.E.®-Babywatching
A programme to prevent aggressive and anxious
behaviour problems and to promote empathy
®
B.A.S.E.
Babywatching

B.A.S.E.® -UK Training
May 17, 2014 in London
www.base-babywatching-uk.org

B.A.S.E.® - Training
June 13, 2014 in
Edinburgh/Schottland
WAIMH Conference
http://www.aimh.org.uk/
categories/pre-precongress
DVD
• DVD "Embracing Closeness"
• DVD "BASE – Babywatching in
Kindergarten“
• DVD "BASE – Babywatching in School„
• DVD „Strange-Situation-Test“

DVDs available
• Embracing Closeness (Engl)
• BASE-Babywatching in Kindergarten (Engl.)
• BASE-Babywatching in School (German)
• SAFE – Parents (in German)
• SAFE – Therapists (in German)
• Strange-Situation-Procedure High Quality (in
German and English)
Applications of attachment-based
therapy
• Treatment of patients of all ages
• Treatment of all diseases
• Adoption and foster care
• Institutional care
• Day care
• Group therapy
• Family therapy
• Couple therapy
• Prevention of emotional disorders

Summary
• Attachment theory helps to understand
– Human development
– Psychopathology
– Treatment process
– Prevention

John Bowlby (1980)
• Epilogue:
• Intimate attachments to other human beings are the hub
around which a person's life revolves, not only when he is
an infant or a toddler or a schoolchild but throughout his
adolescence and his years of maturity as well, and on into
old age. From these intimate attachments a person draws
his strength and enjoyment of life, and, through what he
contributes, he gives strength and enjoyment to others.
These are matters about which current science and
traditional wisdom are at one.
• We may therefore hope that, despite all its deficiencies, our
present knowledge may be sound enough to guide us in our
efforts to help those already beset by difficulty and above
all to prevent others becoming so.
• In J. Bowlby (1980) Attachment and loss. Vol. III: Loss: Sadness and
depression (pp. 442). New York: Basic Books.
Reference
Brisch, Karl Heinz (2012)
Treating Attachment Disorders.
From Theory to Therapy. 2nd Edition
Guilford Press, New York, London
Gradiva Award Nomination

National Association for the Advancement of
Psychoanalysis
Japanese, Korean, Italian, Slowakian, Russian, Urkainian
translation available!
International Conference
October, 10-12, 2014 in
Munich/Germany
Attachment and Migration

Information and Program
www.khbrisch.de

Reference
Brisch, Karl Heinz (2002)
Treating Attachment Disorders.

From Theory to Therapy.
Guilford Press, New York, London
Japanese, Korean, Italian translation available!

Russian and Ukrainian translation in print

How to contact me?
• [email protected]
Copyright K. H. Brisch Munich. All

rights reserved. 2014
Acknowledgement
I am indebted to all parents and their
children who, with great commitment, gave
their informed consent to present their
videos for teaching and training.
Without their assistance this workshop
presentation would not have been possible.
Copyright K. H. Brisch Munich. All

rights reserved. 2014
Thank you
for your
attention!
• Further information
• www.khbrisch.de
• www.safe-programm.de
• www.base-babywatching.de

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What is attachment theory and how does it relate to child development?

What is attachment theory and how does it relate to child development?

What factors influence the development of secure attachment?

What factors influence the development of secure attachment?

Attachment, attachment disorders and

trauma: Diagnostics, treatment and

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

• Sensitivity to infants signals

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

Activated Attachment System

Hyper-Arousal Parasympathetic Nervous System

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

• Secure attachment PROTECTION

• Insecure attachment RISK

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

Copyright © Karl Heinz Brisch Munich/Germany 2008

– maximum values, retarded decrease after reunion in

Copyright © Karl Heinz Brisch Munich/Germany 2008

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved

© Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved

• Very sensitive phase age 0 - 4.5 years and

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© Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved

• Decrease in connectivity between limbic

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© Copyright K.H. Brisch Munich/Germany 2014. All Rights Reserved

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

• Deficits in cognitive development

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© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

• Impaired somatic and psychic health in

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© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.

© Copyright K. H. Brisch Munich/Germany 2014. All rights reserved.