Cathie O'Brien  

  Gestalt Psychotherapy, Supervision, OD Consultancy, Coaching, and Training 

 An Attachment and Trauma Informed Framework

  A whole service/systems approach to emotion-regulation

 

 

Cathie works as a Gestalt Psychotherapist and Organisational Consultant. Cathie has drawn these skills together to develop an Attachment and Trauma informed framework for organisations working with developmental/interpersonal trauma in adults and young people. This whole service approach is developed through training and reflective practice and is key when working with very distressed individuals. This approach aims to develop team work through a relational approach and here she incorporates Chidiac and Denham-Vaughan's SOS (Self/Other/Situation) Model (2013). There is a focus on experiential learning about attachment, trauma and the neurosciences (self) and reflective practice at an individual (other) and whole service level (situation) so teams can really feel the process of emotion-regulation and self-regulation - from the sensory aspects through to the adaptive function. This helps teams to be able to practice what they speak, from a place of experience, as they understand, embody and know the theory from a much deeper level. This impacts the whole service and enables them, over time, to become an emotion-regulating collective.

Fig 1 Attachment and Trauma Informed Organisational Framework.

Cathie O'Brien  2011     

 

Through training and reflective practice Cathie helps professionals to understand and assess relationship (attachment) styles in the adults and young people they work with and their ability to regulate their emotions/nervous system in relation to others and the environment. This informs professionals about the individuals particular rhythm of relationship and therefore 'how' to be in relationship with them. It also helps the teams to consider interventions that are best suited to the individual's needs. 

Teams also learn about their own relationship style and to monitor their own nervous system in relation to distressed adults and young people who they maybe working with. Teamwork is also important here and reflective practice at a team level is encouraged.

Cathie believes that a whole service approach is key when working with very distressed people and the main emphasis is on developing safety and a secure base for service users and staff, as well as compassionate team work, respect, and developing the professional team into a emotion-regulating collective. There will be little change through individual therapy if the environment (meaning professional teams, families and context) remains the same.  This concept lies in ‘field theory’ and believes that one action has a reaction, causing a knock on effect. For instance, if someone is absent from work the whole service has to adjust itself to accommodate this. With distressed service users, if the system does not work together the system has little impact and often, unintentionally, can create greater chaos and disharmony. If the system works well together it can develop the person’s capacity to regulate emotion and this is a physiological change. This can be measured through practice based evidence i.e. decrease in dangerous behaviours, self-harm etc.

Through affect (emotion) regulation, which is a relational approach, the individual develops their ego strength, their sense of self and their sense of difference. The person can internalise their own sense of home which can help to shift chronic presentations and behaviour strategies developed, learning to self-regulate in a more helpful manner.

Cathie believes that it is not the model of work a practitioner is trained in but their ability to engage very distressed and vulnerable people, in a safe working relationship, as well as having a sound understanding of working with interpersonal trauma and the ability to integrate trauma theory into practice.

Fig 2 and Fig 3 shows the focus of training and reflective practice at a more in depth level.  Fig 2 shows in detail the four stages of contacting/self-regulation in Gestalt Therapy integrated with the process of attachment and separation in Attachment Theory (O'Brien, 2011) and Fig 3 further demonstrates the conditions and interventions that create good contact /integration (O'Brien, 2011/2013) drawing upon the three cornerstones of Gestalt Therapy which are Phenomenology (Self), Dialogue (Other) and Field Theory (The We/Situation).

 

Fig 2 The Gestalt Cycle of Contact integrated with the process of attachment and separation.

 

 

Fig 3 

Self, Other and The We = Integration and new learning

Self, Other and The We = Integration /  Learning

 Self

(Sensory)

 A physiological Approach

Other

(Emotion-Regulation)

A Relational Approach

The We

(Systems/Service)

A Whole Systems / Service approach

= Integration and new learning

Psychological development

AIMS  to help organisations concentrate on the first three aspects shown opposite. This is in order to promote emotion -regulation when working with interpersonal trauma. This places emphasis on developing awareness of  physical sensations  and how people may adapt in response to their sensations,  especially in relation to another or the system/ situation. Teams are also encouraged to learn how to regulate emotion in distressed people, including at a whole service level.

BRAIN TRAINING: Please see leaflet under training tab. This is for individuals, professionals, parents and carers and works in parallel to Self, Other and The We = Learning. Developing a whole service approach and common language between professionals, adults, young people and parents/carers.

Developing awareness of the 5 senses: touch, taste, sound, smell and sight.

This is done through:

Curiosity.

Mindfulness.

Play.

Nurturing.

Fun.

Brain Training.

Learning through play and activities.

Kinaesthetic , multi-sensory and visual, spatial  learning.

Activities that meet the physical, emotional, social, intellectual and cultural needs. 

This helps to build  tolerance around physical sensations, developing  awareness of  sensations and what they may mean. This process can be empowering and individuals can regain a sense  of control of their bodies/ the sensory nervous system


 Emotion (affect) regulation happens between self and other.

Learning how we adapt to sensations and in relation to other / systems /situation.

Concentration on the physiological and the non - verbal cues.

Working at the contact boundary between self and other and within the window of tolerance between hyper- and hypo vigilant states.

Developing Presence.

This can calm, contain and gently exercise the nervous system, which can be activated in relationship to others, developing the individuals capacity to learn and grow psychologically.

 


Team work and team development bringing the whole system together.

Working as a 'WE' develops the whole team into an emotion-regulating collective.

Develops a secure base for staff teams through training and reflective practice.

Develops consistency, predictability, routine and singing from the same hymn sheet as a team ie "WE, as an organisation or multi-agency network, have agreed this or that." rather than the potential for "I didn't agree to that decision, but we have to go along with it." Working as a 'WE' can develop safety in relationship and calm the nervous system, helping to integrate any split psychological states. 

Therapeutic network meetings. These meetings can include families, carer's and multi-agency professionals. Teaching all  how to be in relationship with highly anxious individuals. 

Self-regulation.

Puts feelings into words.

Develops language.

Healthy expression.

Social relationships.

Assimilation.

Developmental.

Improves Self Esteem.

Sense of self.

Relationships.

A sense of safety and security.

Autonomy.

Individual Outcomes relevant to the person.

 

 

'When individuals are distressed, uncomfortable in their own bodies and inside out with their emotions, the only outcome I would hope for is that they find equilibrium and self acceptance - the rest will follow'

 

Develops a common Language and working Ethos.

Sensory awareness is a precursor to starting to be able to name emotions.

Emotion regulation is a precursor to self-regulation.

A whole systems approach with very distressed people can regulate emotion and is a precursor to psychological development.

Integration of mind, body and nervous system.

Cathie O'Brien Copyright 2008 - 2017





The  above gently stimulates yet contains the adaptive function and needs commitment from all professionals, families and carers. The adaptive function means how we adapt in relation to self, other and environment, which has often become fixed and stressed with chronic presentations in distressed individuals. This process can start to enable distressed individuals to manage / regulate emotion while being in an interpersonal relationship and as a result develop psychologically. NB This is not a quick fix intervention, it is a long term process. The mind, body and nervous system is complex and can't be fixed in the same manner as a broken leg, it takes time to develop new neural pathways which is not just a case of mind over matter.

Please see my publications for more information and references.