Therapist Uncensored Podcast

What if we flipped the script and learned to see our body as a messenger that needs to be heard rather than an obstacle to be conquered when it comes to our relationship with food? When we take physiological perspective, we learn that the body has much to say not only about food but also emotional regulation and our basic human needs for attachment and defense. Using the sensory information, attachment system and working with defenses. Who are our guests on this episode, you ask? Well here ya go, they are pretty bad-ass and they were interviewed by Dr. Ann Kelley: Paula Scatoloni, LCSW, CEDS, SEP Paula is a somatic-based psychotherapist, Certified Eating Disorders Specialist, and Somatic Experiencing™ practitioner in Chapel Hill, NC. She has worked in the field of eating disorders for over two decades. Paula served as the Eating Disorder Coordinator at Duke University CAPS for nine years and has taught extensively on the etiology and treatment of eating disorders through workshops, professional trainings, and conferences. She co-developed the first intensive outpatient program for eating disorders in the U.S with Dr. Anita Johnston. She is the co-founder of the Embodied Recovery model and the Embodied Recovery Institute in Durham, NC. Rachel Lewis-Marlow, MS, EdS, LPC, LMBT Rachel is a somatically integrative psychotherapist, dually licensed in counseling and therapeutic massage and bodywork. She is a Certified Advanced Practitioner in Sensorimotor Psychotherapy and has advanced training and 25+ years of experience in diverse somatic therapies including Craniosacral Therapy, Energetic Osteopathy, Oncology massage and Aromatherapy. Rachel She is the co-founder of the Embodied Recovery model and the Embodied Recovery Institute in Durham, NC. provides ongoing training and supervision to clinical and support staff in the programmatic implementation of the Embodied Recovery model. In her private practice in Chapel Hill, NC, Rachel works with trauma, eating disorders, and dissociative disorders.   TU99 Shownotes (are these not awesome or what? Patrons help us be able to do this, thank you you know who you are.) Typical Treatment Model Bio-Psychosocial model Bio: has been usage of pharmacology, re-feeding, nutritional rehabilitation, and yoga Psycho part has been education about emotion and emotional tolerance, dialectical behavioral therapy, supportive therapies to support emotional processing and cognitive distortions, cognitive behavioral treatment to address the distortions, and then try to change the behaviors by changing the cognitions, Social part: family and dynamics around having a place of belonging and one’s sense of belonging in the world, the culture, & the family Usually a treatment team: dietician, a therapist, family therapist, a psychiatrist, a physician Typical View of Recovery Goal: to get somebody to eat a prescribed amount of nutritional food in order to achieve a range of BMI or body size or shape eat it in what we call a normative style, which is a very relative term Focus is on how behaviors are a response to an attitude towards the body itself What’s Missing? Being curious about what the body is saying and expressing through the eating disorder behaviors Shifting the Perspective: The Embodied Recovery Model The Embodied Recovery Model is Somato–Psycho-Social. It expands the role of the body to include anatomy, physiology, kinesiology, movement, and posture. The 5 Core Principles of the Embodied Recovery Model The 5 Core Principles facilitate the intersection between somatic organization, subjective experience of self, and basic human needs for attachment and defense. Shifting from bio-psycho-social model to somato-psycho-social model. Directly resourcing the body so that it becomes a resource in recovery rather than an obstacle to recovery. Collaborate with the body at the physiological level to support the infrastructures that govern emotional regulation, memory, and sustained healing. Shifting the focus from what people with eating disorders are saying about their bodies to what their bodies are saying about what it means to be alive (defense structures) and what they need to thrive (attachment system). subjective experience meaning it’s not so much what people think about themselves but it’s actually the experience of the body and through the body Redefining recovery as an experience of embodiment rather than the absence or reduction of eating disorder symptoms. the idea that when we’re actually working with our body, and we know how to dialogue with it then, it’s going to support us and our relationship with food. Somatic Scaffolding Distorted body image: what’s happening is that the visual image of the body through the eyes and the interoceptive message (signals from the body inside) don’t match up. the visual information that they’re getting is impacted by the internal sensations they’re having and thoughts attempt to make sense of that really loud internal signals translate

Dive deeper into this new (to us) model of interpreting attachment science and discover how to apply it into your daily life. Sue Marriott LCSW, CGP and Ann Kelley PhD have fun breaking down the last two episodes where Dr. Patricia Crittenden so generously shared her model called the Dynamic Maturational Model (DMM). Focus is on personal and clinical importance in this last of a 3-part series on the DMM. Before we begin: A’s (Red in the DMM)=Historically referred to as Blue on TU B’s (Blue in the DMM)=Historically referred to as Green on TU C’s (Green in the DMM)=Historically referred to as Red on TU AC’s = Historically referred to Tie Dye on TU **Note: We know the colors may be a bit confusing, but it is important to us that you receive information as Dr Crittenden has published it. It is by happenstance that our colors are the same (with the exception of tie dye), but they represent different thinking and behavioral patterns. When we refer to color in the episodes and in the show notes, we are referring to the colors we have historically used on the TU podcast and the letters and self-protective strategies of the DMM. This is only in order to maintain consistency and make the information more easily understood by our listeners. However, the colors as shown in the slides and as listed above, are the way Dr Crittenden uses them in her fantastic work! Brief Hierarchy of Attachment Theory: There’s a lot of similarity between the more familiar Mary Main et al ABC-D model of attachment and the Patricia Crittenden’s DMM interpretation of attachment, but there are also some very important differences. What’s in A Name? Dynamic Maturational Model (DMM) – potentially intimidating mouthful, BUT let’s break it down What it means: Sue and Ann share their take on Dr Crittenden’s walk through the developmental process that happens in attachment from infancy to adulthood. (Listen to Episode 96 and Episode 97). As we mature into different stages of our life, our needs and self-protective strategies (what the DMM helps us learn) we use change accordingly. The beautiful thing about the DMM is the way it incorporates culture, sexuality, key relationships, and danger/safety into the attachment mix. Speaking of safety…. One key difference between the DMM and traditional attachment models is the emphasis on SAFETY rather than SECURITY. According to the DMM: -attachment is about the dyadic relationship in danger, it does not just live in the person -we take in information from the environment (parent in infancy) and shift this into “behaviors” or self-protective strategies. -these strategies develop to protect us. They are our brain’s way of helping us reduce danger and increase connectedness by creating closeness, proximity, and safety. Information Processing -It’s physiological. There are 3 systems: Somatic: what does our body feel…our heart, our stomach feel Cognitive: how we process the information, how do we make meaning Emotional: what’s coming up Bottom line, we can learn from our body. They are connected but not hierarchical. Security = Integration of all 3 of these info systems (Therapist Uncensored’s model ie. getting to the green) The Attachment Spectrum As you move out on the spectrum, (in the DMM, it’s a circle, which is also really cool) we begin to inhibit or exaggerate information based on the response in our environment/the response of our caregivers. We will tend to lean Blue or Red or Tie Dye (check out episodes 59, 60, 61 for more detailed info on each color). NOTE: These colors are Ann and Sue’s Attachment & Regulation Spectrum, not colors from the DMM. It is NOT conscious and forms in the first 2 years via Neuroception. Neuroception (listen to our episode on Polyvagal Theory for more info) tells us, as infants, that if we cry, our caregiver will react a certain way. We inhibit information according to what will keep us safe and bring us closer to our caregiver. The distortive and inhibitive behaviors that develop are functional adaptations to meet the infant’s needs. It is a way of accessing the parts of the caregiver that are available and also keeping the infant out of disorganization. Think organized chaos – the infant may be highly dysregulated but in an organized way rather than disorganized. Exaggerating, de-emphasizing or dissociating, etc. when there is danger is how we, as infants, learned to keep ourselves sane and intact. Bringing Crittenden’s work out of the research and into real life What we love: -Dr Crittenden’s inclusive approach to applying attachment theory across the lifespan. -Dr Crittenden’s stance that self-protective strategies are functional adaptations to keep us as safe. –The compassionate and understanding perspective of the self-protective behaviors we use every day. To summarize the DMM, Dr. Crittenden’s own words say it best: “My work is about all the things that we do when we’re in danger and how stunningly competent even our infants are at figuring out what you need to d

Note: This episode is Part 2 of 2. It stands alone, but to start at Part 1 click HERE. “So which strategy in this model is best? Every behavioral strategy is the right strategy for some problem, but no strategy is the best strategy for every problem. We need them all.” – Dr Patricia Crittenden, creator of the Dynamic Maturational Model of Attachment & Adaptation (DMM) using culture and context. LOOKING FOR THE SLIDES? DOWNLOAD THE PDF HERE: Rudiments-of-the-DMM-PDF VERSION OR THE POWERPOINT VERSION HERE: Rudiments of the DMM Powerpoint version Or if you have great eyesight 🙂 you can view them here.   Therapist Uncensored Episode 97 Show Notes: Before we begin: A’s (Red in the DMM)=Historically referred to as Blue on TU B’s (Blue in the DMM)=Historically referred to as Green on TU C’s (Green in the DMM)=Historically referred to as Red on TU AC’s = Historically referred to Tie Dye on TU **Note: We know the colors may be a bit confusing, but it is important to us that you receive information as Dr Crittenden has published it. It is by happenstance that our colors are the same (with the exception of tie dye), but they represent different thinking and behavioral patterns. When we refer to color in the episodes and in the show notes, we are referring to the colors we have historically used on the TU podcast and the letters and self-protective strategies of the DMM. This is only in order to maintain consistency and make the information more easily understood by our listeners. However, the colors as shown in the slides and as listed above, are the way Dr Crittenden uses them in her fantastic work! Let’s Dive In: To understand self-protective strategies, we have to understand the information the brain is using, even in infancy – it’s neurological. A’s, the B’s and the C’s emphasize different sorts of information. Strategies by Age Group and Model Representation:   Infancy DMM Ainsworth ABC+D A-2: Avoidant A1-2 A1-2 B1-2: Reserved B1-4 B1-4 B3: Comfortable C1 C1-2 B4-5: Reactive D-Controlling C1-2: Resistant/Passive   Preschool Preschoolers utilize false positive affect. A’s split their own self from the other, and they focus on the parent. They take the perspective of the powerful person. C’s split their negative affect, showing either the vulnerable or the invulnerable affect. They hide the other from view. DMM Ainsworth ABC+D A1-2: Avoidant A1-2 A3-4: Compulsively Caregiving/Compliant B1-4 B1-2: Reserved C1-2 B3: Comfortable D-Controlling B4-5: Reactive C1-2: Resistant/Passive C3-4: Aggressive/Feigned Helpless School Age DMM Ainsworth ABC+D A1-2: Avoidant A1-2 A3-4: Compulsively Caregiving/Compliant B1-4 B1-2: Reserved C1-2 B3: Comfortable D-Controlling B4-5: Reactive C1-2: Resistant/Passive C3-4: Aggressive/Feigned Helpless C5-6: Punitive/Seductive   Adolescence DMM Ainsworth ABC+D A1-2: Avoidant A1-2 A3-4: Compulsively Caregiving/Compliant B1-4 A5-6: Compulsively Promiscuous/Self-Reliant C1-2 B1-2: Reserved U/Cannot Classify B3: Comfortable B4-5: Reactive C1-2: Resistant/Passive C3-4: Aggressive/Feigned Helpless C5-6: Punitive/Seductive   Adult DMM Ainsworth ABC+D A1-2: Avoidant A1-2 A3-4: Compulsively Caregiving/Comp B1-4 A5-6: Compulsively Promiscuous/Self-Reliant C1-2 A7-8: Delusional Idealization/Externally Assembled Self U/Cannot Classify B1-2: Reserved B3: Comfortable B4-5: Reactive C1-2: Resistant/Passive C3-4: Aggressive/Feigned Helpless C5-6: Punitive/Seductive C7-8: Menacing/Paranoid A/C: Includes Psycopathy (extreme A/C combination)   Description of each group:* The A’s (our blue. red in the DMM) A1-2: The A1-2 strategy uses cognitive prediction in the context of very little real threat. Attachment figures are idealized by over-looking their negative qualities (A1) or the self is put down a bit (A2). Most A1-2s are predictable, responsible people who are just cool and businesslike. Type A strategies all rely on inhibition of feelings and set danger at a psychological distance from the self. This strategy is first used in infancy. A3: Individuals using the A3 strategy (compulsive caregiving, cf., Bowlby, 1973) rely on predictable contingencies, inhibit negative affect and protect themselves by protecting their attachment figure. In childhood, they try to cheer up or care for sad, withdrawn, and vulnerable attachment figures. In adulthood, they often find employment where they rescue or care for others, especially those who appear weak and needy. The precursors of A3 and A4 can be seen in infancy (using the DMM method for the Strange Situation), but the strategy only functions fully in the preschool years and thereafter. A4: Compulsively compliant individuals (Crittenden & DiLalla, 1988) try to prevent danger, inhibit negative affect and protect themselves by doing what attachment figures want them to do, especially angry and threatening figures. They tend to be excessively vigilant, quick to anticipate and meet others’ wishes, and generally agitated and anxious. T

Treating Attachment & Self-Protective Strategies “If it protects you, it’s the right strategy.” – Dr Patricia Crittenden, creator of the Dynamic Maturational Model of Attachment & Adaptation (DMM) using culture and context. LOOKING FOR THE SLIDES? DOWNLOAD THE PDF HERE: Rudiments-of-the-DMM-PDF VERSION OR THE POWERPOINT VERSION HERE: Rudiments of the DMM Powerpoint version Or if you have great eyesight 🙂 you can view them here. Are you ready to move from describing injured developmental pathways and symptoms – to addressing how to heal from disrupted development? We are on the case! In this episode co-host Sue Marriott LCSW, CGP discusses exactly that with Dr. Patrica Crittenden, founder of the Dynamic Maturational Model of Attachment & Adaption (DMM) using culture and context to understand, decode and heal early relational injuries. Their conversation was deep and wide, thus will be published in two sections. In today’s episode, TU96, Dr. Crittenden focuses on wide-reaching cultural aspects of development, safety and danger. She uses decades of observations, assessment, research and clinical work to describe her take on what she refers to as the American Attachment researchers and elucidates how her model is similar and where and why it differs. Dr. Crittenden’s focus on applying this rich research clinically aligns perfectly with the mission of this podcast. Whether you are a clinician, foster parent, educator or are interested for your own personal reasons, you will find her perspective fresh and thought-provoking! Please see the PACKED resources and show notes below! Who is Patricia Crittenden and why do want to know her…. Dr. Mary Ainsworth Dr. Crittenden studied under Mary. D. Ainsworth from 1978 until 1983, when she received her Ph.D. as a psychologist in the Social Ecology and Development Program at the University of Virginia. In addition to Mary Ainsworth’s constant guidance and support, her psychology master’s thesis on the CARE-Index, was developed in consultation with John Bowlby and her family systems research, on patterns of family functioning in maltreating families, was accomplished with guidance from E. Mavis Hetherington. John Bowbly Dr. Crittenden has served on the Faculties of Psychology at the Universities of Virginia and Miami and held visiting professorships at the Universities of Helsinki (Finland) and Bologna (Italy) as well as San Diego State University (USA) and Edith Cowan University (Australia). In 1992 she received a Senior Post-doctoral Fellowship, with a focus on child sexual abuse and the development of individual differences in human sexuality, at the Family Research Laboratory, University of New Hampshire. In 1993-4 she was awarded the Beverley Professorship at the Clark Institute of Psychiatry (Canada). In the last two decades, Dr. Patricia Crittenden has worked cross-culturally as a developmental psychopathologist developing the Dynamic-Maturational Model (DMM) of attachment and adaptation, along with a developmentally attuned, life-span set of procedures for assessing self-protective strategies. She has received a career achievement award for “Outstanding Contributions to the Field of Child and Family Development” from the European Family Therapy Association in Berlin. Currently, Dr. Crittenden’s work is focused on preventive and culture- sensitive applications of the DMM to mental health treatment, child protection, and criminal rehabilitation. Before we begin: A’s (Red in the DMM)=Historically referred to as Blue on TU B’s (Blue in the DMM)=Historically referred to as Green on TU C’s (Green in the DMM)=Historically referred to as Red on TU AC’s = Historically referred to Tie Dye on TU **Note: We know the colors may be a bit confusing, but it is important to us that you receive information as Dr Crittenden has published it. It is by happenstance that our colors are the same (with the exception of tie dye), but they represent different thinking and behavioral patterns. When we refer to color in the episodes and in the show notes, we are referring to the colors we have historically used on the TU podcast and the letters and self-protective strategies of the DMM. This is only in order to maintain consistency and make the information more easily understood by our listeners. However, the colors as shown in the slides and as listed above, are the way Dr Crittenden uses them in her fantastic work! Therapist Uncensored Episode 96 Shownotes: “We crave information about danger because we live so safely, and we know there has to be danger out there and our brains are evolved to hunt for it.” – Andrea Claussen, student of Crittenden What patterns are emerging culturally? Life makes sense the way we live in it – the strategy that is dominant in each culture represents the best solution to the problems/for the dangers that are prevalent and have been prevalent historically that these people have experienced Western countries have become safer than that ever were before.

Oxytocin and dogs! Our pet relationships provide a trust and bonding boost, and is the natural love drug our bodies make at key relational moments such as child-birth, nursing, orgasm and falling in love.* In this episode we discuss how to create this moral molecule without even needing complicated human relationships by connecting mutually to our companion pets. What’s not to love about that? The science now is clear – this inter-species relationship is mutually beneficial and potentially life-changing for both of you. Lower cortisol, higher oxytocin, more trust and connection – ba bing! Most of us can relate to having a beloved pet that has been a significant part of our lives. We love them, and the cool thing is, they love us back unconditionally it seems, without regard to our moral failings. In fact, there is now crazy hard science research to back up the power of this connection, particularly regarding dogs. In our last episode, we told you that we’d be talking more about the love drug, oxytocin, and how we can actively induce the release of this hormone in our bodies in order to promote our favorite subject, building security. In this one we get real and walk the walk of vulnerability. So, what do pets, specifically dogs, have to do with oxytocin and building security? Well, security happens through safe connection, and connection both induces the release of oxytocin and is created by it’s presence. This cascade creates a feeling of physiological safety and openness and warmth in our bodies, which helps us to bond and build security. Believe it or not, we can consciously manipulate our body’s release of oxytocin through the bond we create with our beloved pets. And if you’ve been following the podcast, you know this ties into the previous 2 episodes on Polyvagal Theory and our autonomic nervous system. In this episode, join Ann and Sue as they talk about what this experience looks like in real life and how to cultivate the love-drug cross-species. Also hear Sue’s incredibly powerful story of tragic loss, and renewed hope, all related to pets. *Of course we are simplifying a bit – nothing is all good. Oxytocin isn’t always a love-drug, it can cause aggression or feelings of loneliness. For example if the wolves had made eye-contact as the companion dogs did (the wolves made much less eye contact and had no increase in the hormone), it would probably have spiked aggression rather than bonding (an urge to protect their bonded pack rather than attach to the alien human), but we are focusing here on the most major findings of the neuropeptide. Cooper comforting Sue… I know so MANY of you have pets as primaries, it’s a real relationship (scientifically and intuitively) that truly comforts and heals. Episode 95 show notes: Oxytocin – Ann and Sue’s favorite neuropeptide, AKA the cuddle drug, the love drug, the moral molecule. Research shows that the bond we have with our pets is reciprocal. The pleasure center of the brain lights up in us and in our animal partners. Cortisol levels decrease, and oxytocin levels increase in humans and animals when we have high eye contact. The most significant increase (up to almost 300%) is seen with dogs and varies based on breed. It’s an extra boost if we catch our dogs looking at us first. Don’t be embarrassed about your significant other with 4 legs, or less. Hear about bonding with fish, monkey’s picking and humans grooming behavior, and what lice has to do with it all. Dogs and any other beloved pet can be serious attachment figure in our lives, helping us to build a sense of safety and security in the world. It can be a very powerful relationship that is just as strong, and sometimes stronger, than human connections. Granted some people have pets as just animals, an object to guard their home or to rescue or to get dates, but that is totally different from the potential real attachment relationships that in the right circumstances can enhance the lives of the whole family. Sue shares how dogs have been a consistent, benevolent, reliable, caring, protective force in her life. To illustrate this, she shares a vulnerable personal story about her relationships with her dogs, Jackson and Cooper, through some traumatic experiences. Story take-aways: Teenage parenting tip: if you want to get your teen to talk to you, do something active with them so you aren’t staring at them waiting to talk. Engaging in something actively where they don’t have to make direct eye contact is more likely to open up a reluctant talker – like walking dogs, or dribbling balls, or parallel doodling – sneaking up on the conversation is conducive to getting them to open up without stress. Oxytocin is better than crack. Important note: the bond with Jackson and later, Cooper, didn’t replace the relationship with people during these hard experiences. The connection, however, is unique and sometimes better than the connection with people if you come from experiences where people didn’t earn your trust.