how you can provide a safe harbor

 

A while back (see "take this test", November 23, 2021) I wrote about the Adverse Childhood Experience survey, something we were never taught about in medical school despite the fact that a growing body of evidence supports the link between childhood trauma and the development of physical disease and mental health disorders later in life. Childhood trauma includes physical, emotional, and sexual abuse, physical, verbal, and emotional neglect, living with a depressed, mentally ill, or addicted parent, witnessing domestic abuse, and losing a parent to separation or divorce...among others. Chronic adversities like these actually change the architecture of the child's brain, altering the expression of genes that control stress hormone output. This triggers an overactive inflammatory response that can lead to adult disease states, notably autoimmune conditions like lupus and rheumatoid arthritis, heart disease, and PTSD-like anxiety and reactivity. These long-term effects should compel all of us to take the problem of childhood trauma seriously. We should do all we can to identify it, prevent it, and mitigate it.

"You can spend a lifetime

trying to forget a few minutes

of your childhood."

~www.HealthyPlace.com~

This week, I came across another interesting issue that I was never taught about. It has to do with attachment disorders that arise in infancy and early childhood and how they affect health in adults, notably the same kind of autoimmune, cardiovascular, and psychological problems that childhood trauma does. Issues related to childhood attachment will be reflected in adult personality traits, behavior patterns, and relationship difficulties. Repression of anger is especially harmful. 

It turns out that there is a method for uncovering some of these issues in our patients. It is called the Adult Attachment Interview, or AAI, a twenty-question survey that is designed to explore how infants become attached to their parents...or not.

This is it:

Adult Attachment Interview (AAI) (George, Kaplan, and Main 1996) 

The AAI Questions:

1. To begin with, could you just help me to get a little bit oriented to your family—for example, who was in your immediate family, and where you lived?

2. Now I’d like you to try to describe your relationship with your parents as a young child, starting as far back as you can remember.

3–4. Could you give me five adjectives or phrases to describe your relationship with your mother/father during childhood? I’ll write them down, and when we have all five, I’ll ask you to tell me what memories or experiences led you to choose each one.

5. To which parent did you feel closer, and why?

6. When you were upset as a child, what did you do, and what would happen? Could you give me some specific incidents when you were upset emotionally? Physically hurt? Ill?

7. Could you describe your first separation from your parents?

8. Did you ever feel rejected as a child? What did you do, and do you think your parents realized they were rejecting you?

9. Were your parents ever threatening toward you—for discipline, or jokingly?

10. How do you think your overall early experiences have affected your adult personality? Are there any aspects you consider a setback to your development?

11. Why do you think your parents behaved as they did during your childhood?

12. Were there other adults who were close to you—like parents—as a child?

13. Did you experience the loss of a parent or other close loved one as a child, or in adulthood?

14. Other than any difficult experiences you've already described, have you had any other experiences which you should regard as potentially traumatic?

15. Were there many changes in your relationship with your parents between childhood and adulthood?

16. What is your relationship with your parents like for you currently?

17. How do you respond now, in terms of feelings, when you separate from your child / children?

18. If you had three wishes for your child twenty years from now, what would they be? I'm thinking partly of the kind of future you would like to see for your child I'll give you a minute or two to think about this one.

19. Is there any particular thing which you feel you learned, above all, from the kind of childhood you had?

20. What would you hope your child (or, your imagined child) might have learned from his/her experiences of being parented by you?

It requires some training to use this interview effectively; the questions require more than a yes or no response. It requires the provider to assess not only what the patient says, but how they express themselves, for example whether they respond fluently or haltingly, in detail or with a paucity of words, consistently or with frequent self-contradiction. 

The interesting thing about it is this: when the interview is conducted even before a person has a child, it can predict the attachment style they will develop as a parent: secure, avoidant, ambivalent, or disorganized. This, in turn, can raise concern for future problems with health and well-being as an adult, possibly paving the way for early intervention.

The point is that, as health care providers, we rarely have the time or expertise to explore these issues with our adult patients, much deal with them in treatment. How, then, can we help them heal?

"Give me your past,

all your pain,

all your anger,

all your guilt.

Release it to me and

I will be a safe harbor for the life

you need to leave behind."

~Jewel E Ann~

jan