1. Embodied Family Therapy
A Somatic Experiencing Based
Approach to Building Attachment and
Healing Family Conflict
Presented at USABP 2012
By: Dr. Michael Changaris

2. The Pendulum Wave
http://www.youtube.com/watch?v=7_AiV12XBbI Y

3. Development of Limbic System
 Family is the place where the HPA-Axis and limbic system is
developed.
 Interactions between parents and parents and their child changes
the neurobiology of emotions.
 Eye contact and connections with
the parent sets in motion a
neurobiological cascade.
 Brief disruptions in contact with a
mother in early infancy can cause
changes in stress reactivity that is
measurable many years later.

4. Development of Limbic System
 Low cortisol levels, particularly near the peak of the diurnal
rhythm, have been reported in abused, neglected and
deprived children (Gunnar & Quevedo, 2007).
 Parenting structure (organization and consistency) can
predict changes in Cortisol in Adolescents (Ellenbogen &
Hodgins, 2008).
 Infant cortisol related to maternal sensitivity. Maternal
sensitivity displayed lower resting CORT, higher reactivity to
emotional events and higher activation of emotion
regulation regions (Blair, Granger, Willoughby, Kivlighan,
2007).

5. Inner Experience
of Individual
“Felt-Experience”
Sensation
Image
Affect
Meaning
Behavior
Effects of The Human Ecosystem on Families Relationship
Y

6. Developing Family Resilience
 Transactional patterns within the family (e.g., providing emotional support,
decoding emotional reactions, normalizing and validation);
Increasing positive emotions helps build family safety (Broaden and Build
Hypothesis – B. Fredrickson)
Ratios:
 Developing emotional regulation skills, skills to support each other through
difficult emotions and problem solving skills increases family resilience.
 Intrapsychic factors within family members (e.g., emotional regulation skills,
openness).
 Extended family system and friends (e.g. supporting the affected family
members or indirectly affected family members, monetary support, practical
support, problem solving).
 Mesosystemic factors, like churches and schools (e.g., contact with religious
figures, support networks, problem-solving).
Y

7. Intergenerational
Trauma and Families
 A Study Found: “Early experience in female rats
transgenerationally influence their future offspring…
enrichment (of the environment) can reduce the
transgenerational impact.”
 Another study found: “Mother's lifetime posttraumatic stress
symptoms were associated with child's PTSD in dose–
response fashion.”
 First Nations adults who’s parent attended Indian Residential
Schools had increased risk of depression in part due to
parent’s experience of averse childhood experiences, adult
trauma and perception of discrimination.
Y

8. Each Family Member Has an Individual
Pattern of Stress Response
Y

9. Hyperactivation Trauma In The Brain and Body Hypoactivation
1. Hyperactive 1. Down regulation
insula (Body of physical
Information) sensations from
the insula cortex.
2. Under-activated
anterior 2. Hyperactivation
cingulate cortex activation in the
(ACC). anterior cigulet
(Regulation) cortex (ACC).
3. Under- 3. Hyperactivation
activation in the medial
medial prefrontal cortex
prefrontal mPFC.
cortex (mPFC).
(Regulation)
Dr. Lanius fMRI Study Dr. Lanius fMRI Study
Y

10. Trauma and Brain Development
 Functional Changes: Hippocampus, Amygdale, Anterior
Cyngulet Cortex, Medial Prefrontal Cortex.
 Later in Life: Structural changes in hippocampus.
 Developmental Theory:
 The age of the trauma effects the system that is effected by the
developmental needs of the age.
 Systems that require a disrupted system to develop in order for
them to reach maturity are disrupted.
 Experience dependent, Experience Expectant, Experience
Independent Events.
Y

11. SIBAM-R Elements of Consciousness
 Sensation (most under recognize): The information from the body.
Sensation come from the Kinesthetic, Autonomic, Proprioception, and
Vestibular system.
 Image: Any abstracted sense memory (e.g. Audio, visual, tactile,
gustatory, olfactory).
 Behavior: Any observable behavior, including changes in skin tone, breath
rates. (Can be implicit or explicit behavior)
 Affect: Emotion and emotional experiences.
 Meaning: Verbal narrative of self, other, or an event as well as any form of
abstracted relationship.
 Relationship (Interpersonal Neurobiology): Non-verbal narrative of
expectations, physiological reactions and the interaction between two
individual’s psychophysiology.

12. Emergence of Relationship
Internal State Internal State
Felt Experience Body to Body Felt Experience
Communication
Sensation Sensation
Image Image
Behavior Behavior
Affect Affect
Meaning Meaning
Relationship Relationship
Feedback Between Two Psychobiological
System Creates Clinical Third
AKA “Relationship”
Y

13. Y

14. Implicit Dialog
 Neuroception: Assessment of safety using implicit vs explicit
perceptions.
 Precognitive Emotional Communication: Limbic fast circuit
v.s. cognitive emotional appraisal circuit.
 Children with positive emotional sensitivity from parents have
both a higher amount of emotional experience and a engagement
of emotional regulation systems.
 Physical Dialog: Pupils dilate in synchrony, bodies mirror motions,
visceral systems match, heart rates attune, vocal tones match.
Y

15. Implicit Dialog
 PTSD makes it difficult to enter this dialog by: 1. Reducing
interoceptive cues, 2. Flooding with interoceptive experiences,
altering attention, and 3. Stress reactions that are not shared with a
wide group of others.
 Families can learn to develop the attention to this dialog and
facilitate it by increasing the states that make it more likely.
 PTSD: Facial expression
 Darwin and facial expression.
 Recognition of fear as anger in individuals with PTSD.
 Teens and children process emotions first with the Limbic
Circuit and do not activate the frontal lobe. Adults display a
different pattern. Y

16. Y
Emotion Regulation in
Family Resilience
Family Family Stress
Resiliency Factors Factors
Habits When
1. Interpersonal Thoughts In Overwhelm Emotions
1. Interpersonal
factors: Factors: Low
Prosocial Thought Cognitive Self Emotion conflict
Behaviors Skills Regulation Skills resolution.
2. Ecosystem Implicit Implicit Self Implicit 2. Ecosystem
Factors: Thoughts Regulation Emotions factors: Target
Financial identity status.
Support
3. Intrapsychic
3. Intrapsychic Factors:
Factors: Number of
Number of family
Members with members with
High Implicit low Implicit
Emotional Emotional
Regulation Regulation
http://www.youtube.com/watch?v=DD7YDyF6dUk

17. Oppression in Family System
 Microaggression: Brief expression that communicates hostility
towards an individual’s target identity.
 Microassault: Verbal or non-verbal attack intended to hurt the other.
 Microinsult: Demeaning a person’s identity.
 Microinvalidation: Communication that
nullifies or invalidates the experience of
an individual.
 Resilience: Developing safe places to be
heard, understood and validated and to
have reality checks on microagressions
is vital. Y

18. Oppression in Family System
 Impact on health: Reasonable lack of trust in health
providers, elevated stress increasing the chance of heart
disease, diabetes, and other illnesses.
 Felt-experience of safety and oppression:
 Identify Islands of Safety and the felt experience (SIBAM-R).
 Identify SIBAM-R reaction to oppression or microaggression.
Develop family and individual emotional regulation strategies.
 Identify defensive orienting reactions and work on completion
of reactions.
 Developing the family as a safe zone to work with impacts of
oppression.

19. Family and Morality Development
 The family is where a child learns how to expect to be treated, how to
treat them self and how to treat others.
 Culture influences the development of morality. The family influences
culture. The family develops morality in the members and the
members develop the moral system of the family.
 Morality becomes a center of gravity for behavior. At times destructive
and at times helping the family orient to their best self.
 Ways the Family Develops Morality:
 Modeling Behavior.
 Behavioral Correction.
 Being Understood Builds Understanding.
 Verbal dialogs.

20. PTSD and Morality
 Morality: “A suite of interrelated other-regarding behaviors that cultivate and
regulate complex interactions within social groups.” (Bekoff & Pierce)
 Two Pliers of Morality: Empathy and Reciprocity
 Default Mode Network self-referential processing, autobiographical memory,
prospection and theory of mind significant deficits for those who have early
childhood trauma.
 Cognitive Morality: Ventromedial prefrontal cortex (VMPC) – Stress changes
utilitarian responses to moral reasoning tasks. Possibly through disruption of
the cognitive system of moral functioning. Interpersonal moral decisions not
directly effected. Deficits in children with conduct disorder.
 Implicit Morality: Temporoparietal junction (TPJ) – Acute Stress alters the
functioning of this system. Deficits in children with conduct disorder.
 Quality of parenting and non-parental relationships effects the development of
ToM and Morality. Play deficits in individuals with antisocial personality
disorder and psychopathy. Y

21. Effects of PTSD on Morality and Families
 Reciprocity: Give and take in co-operative action.
 Family development: Normal give and take is vital for household
functioning, developing social skills and long-term happiness.
 Impact of PTSD:
 Fight: Privileging self-needs over others. Increased rate and decreased thresh-
hold for moralistic aggression. Decreased ability to self-reflect of impact on
others. Leads to change in meaning towards a belief that one’s actions are
“right.”
 Flight: Devaluing of self-needs for family needs. Over giving and resentment.
Flight in the family system leads to the a bind between two primal drives
escape avoidance of threat and need to maintain relationship for safety.
 Freeze: Not being available for reciprocity, avoidance of participating in the
give and take of family life. Feeling numb and uninterested in returning favors.
Giving up valuable, time or items due to lack of adequate self-protection.

22. Effects of PTSD on Morality and Families
 Empathy: “The capacity to (a) be affected by and share the emotional
state of another, (b) assess the reasons for the other's state, and (c)
identify with the other, adopting his or her perspective.” - de Waal
 Family development: Disruption in empathy undermines, development of
ToM, problem solving, conflict resolution, impedes transition to new
developmental stage and reduces the ability of a family to tolerate a range of
stressors.
 Impact of PTSD:
 Fight: Evolutionarily fight diminishes the drive to have empathy in order to
protect oneself from with in group violence.
 Flight: Leads to avoidance and escape behavior and a privileging of self-needs
over the needs of others.
 Freeze: Reduced ability to enter into the biological synchrony of interpersonal
communication. Leading to poor anticipation of another’s need, feeling flat,
disconnected and unavailable.

23. Family and Emotion Regulation
Development
 Rupture repair cycle: Uncomfortable feelings, misunderstandings and conflict
leads to understanding, recognition and repair of the relationship.
 Interoceptive Awareness: The ability to be aware of the body’s signals of
emotional states and differentiate between one’s own body responses and the
body responses triggered by others.
 Attachment Behaviors: Behaviors that support the felt experience of safety
and connection (e.g. Eye to eye contact, body based synchrony, safe touch,
tolerance for both closeness and distance in relationship).
 Problem Solving Difficult Emotions: Families can learn to figure out together
how to tolerate and regulate emotions. This requires acceptance and
empowerment. Often parents provide the sensitivity to a child that creates
self-understanding and emotional problem solving.
 Structure, Expectations and Support: Children who have solid safe structure
with clear expectations and enough support develop emotional regulation
capacity.
Y

24. Family and Development of ToM
 Theory of mind is the understanding of ones own mental states and
attribute unique mental states to others.
 There are two major classes of factors that lead to development of ToM
Internal factors and Situational factors.
 Internal factors increasing the development of ToM are: language abilities
and executive functions.
 Situational factors increasing the development of ToM are: having siblings,
participating in pretend play, reading storybooks with adults, talking about
experiences with peers and adults, care providers who talk about thoughts,
wishes, and feelings, adults who provide reasons when correcting a child’s
behavior.
 Children with high ToM: are better communicators, can resolve
conflicts with peers more effectively, more socially skilled, more
popular, and their schoolwork is often more advanced.
Y

25. Family and Development of ToM
 ToM is likely an “experience expectant” skill. The mind is waiting to
develop this ability.
 Understanding one’s own inner experience helps to develop this
skill.
 Interactions with in the family can develop this skill.
 Decoding the experience of a child helps the child develop their
own understanding of their inner world and the inner world of
others.
 The felt-experience of “being with” leads to developing the felt-
experience of relationship.
Y

26. Interaction Patterns:
High Road and Low Road
Time
Behavior Body Narrative
Behavior Representation
Meaning Of Interaction
Sight/Sound Affect Generalized
Sensation
Verbal Narrative
Sensation Resonance
Sound Sensation
Meaning
Affect
Affect
Behavior Behavior
Time

27. Internalized Family Interactions
Body Narrative
Representation
Internalized
Of Interaction
Generalized Family
Verbal Narrative
Interaction
Embodied Family Therapy Develops New
Body-Based Narratives and Verbal Narratives
Through Changing the Story and
the Experience of the Interaction. Y

28. Non-Linier Systems and Resilience
 Attractor: An attractor is a set (pattern) towards which a variable,
moving according to the dictates of a dynamical system, evolves over
time.
 Attractors: The good, the bad and the transformative. In a family the
attractors function like a center of gravity pulling the system towards a
pattern of behavior.
 Regulators: Support the family to return to equilibrium.
 Behavioral Implicit: Looks, gestures, body language, vocal tone and facial
expressions.
 Meaning: Narrative about family members, beliefs about emotions
thoughts, correct behavior and expectations.
 Levers of change: Are the tools one has available to effect the
functioning of a system.

29. Bifurcation Theory
Trauma and Family Systems

30. Chaos and Back
Figenbaum’s Constant: 4.66920

31. Key Point
A destructive pattern may
only be present in certain
energy states…
Y

32. State Dependent Family Behaviors
 Exploratory Orienting
 Privileged Behaviors: Joining, Pro-social Interactions, Playfulness, Open body Stance,
Curiosity, Playful aggression.
 Unprivileged Behaviors: Anxiety, Anger, Yelling, Tension, Dysphoric Mood, Anxiety
 Fight
 Privileged Behaviors: Aggression, Approach Based Problem Solving, Concrete Solutions,
Moralistic Aggression, Affirmation of Higherarchy, Physical stances of aggression, Postural
rigidity.
 Unprivileged Behaviors: Playfulness, curiosity, Pro-social interactions, Social engagement
system, Complex problem solving, Reduced tolerance for ambiguity.
 Flight
 Privileged Behaviors: Avoidance based problem solving, Concrete solutions, Tending and
befriending, Cowering, Postural tension, Quick transitions to fight, Humor.
 Unprivileged Behaviors: Playfulness, Curiosity, Vulnerability, Openness, Self-expression.

33. State Dependent Family Behaviors
 Freeze
 Privileged Behaviors: Shut down, Stone walling, Limp body
postures, Co-lapse, Isolation, Poor care for children, Lack of ability
to maintain consequences, Shame dynamics, Pore maintenance.
 Unprivileged Behaviors: Playfulness, Curiosity, Safety, Problem
solving, Ability to tolerate frustration.
 Main Street
 Privileged Behaviors: Planning, problem solving, Conflict
resolution, Complex thinking that includes gradations.
 Unprivileged Behaviors: Aggression, Anxiety, Yelling, Tension.

34. Families and Activation State
Shut Down/Freeze Family Behaviors Outcomes
State 1. No communication. 1. Giving up.
1. Dissociated. 2. Avoidance. 2. Deadening and lack
2. Flat affect. 3. Giving up before a of engagement in
3. No synchrony. solution. life.
4. Hopelessness. 4. No feeling of connection. 3. Not caring about
impact on others.
High Levels of Activation Family Behaviors Outcomes
1. Stress patters. 1. Yelling/Threats/Explosions. 1. Disconnection.
2. Aggression. 2. Leaving room. 2. Resolution of
3. Coping strategies e.g. 3. Black and white thinking. conflict or seeking
4. Using coping. support.
humor/escape.
3. Create meaning or
family story.
Within Regulatory Family Behaviors Outcomes
Capacity 1. Laughter. 1. Developed
1. Base line family 2. Playfulness. relationship.
behaviors. 3. Low muscle 2. More connection.
2. Curiosity. tension. 3. Increased
3. Safety. 4. Synchrony. resilience.
Y

35. Fight and Flight During Conflict
 Anger is an approach emotion.
 Increased rates of activation changes rates of
communication.
 Elevated flight response can flip into anger (Flip-Bifurcation)
 Elevated fight leads to “over-approach” or using only
approach solutions.
 Freeze states are highly activated, tight patterns with intense
feelings bound up. This can lead to highly inflexible
behaviors, poor problem solving, and avoidance patterns.

36. Experiential Exercise
Tracking The Implicit Dialog
1. Brake up into groups of three
2. One person “Child”
3. One person “Parent”
4. One person “Therapist”
5. Child and parent Dyad: Child tells parent about a stressful
moment in their life (real moment, mildly stressful), Parent will
just talk to the child and listen.
6. Therapist: Watch for indications of implicit dialog. Practice
deepening skills of moment of attunement.

37. Principals of SE Family Therapy
 The family has a natural drive to health.
 Working with the health within the family leads to the family
regaining its own health.
 Solution Focused and Practical.
 Alternate between individual work and family work.
 Families can learn the skills to support each other. The
therapist models skills and then supports the family
members to use the skills.
Y

38. Goals of SE Family Therapy
 Change in family structure
 Change in family and individual stress set point.
 Change in regulatory capacity.
 Change in attachment behaviors and play.
 Increased quality of life, vitality and life-space for family members.
Y

39. Stages of Treatment
 Joining (BSFT): Entering with the family into a problem solving
state.
 Assessment (diagnosis BSFT): Identifies areas of resiliency and
challenge.
 Resource and Regulate (Embodied): Start all change with
regulation and resourcing focusing on positive emotions, relaxation
response and mastery experiences.
 Restructure (BSFT): Use the sandwich technique…
Orient to here and now, focus on resource, work with difficulty,
focus on resource and back to hear and now orienting.
 Reassess: Look for stability of change and one change leading to
other positive changes in the family. Incorporate new information
into interventions.
Y

40. Flow of Session
 Opening Ritual: Each member present reports one thing that went well last
week and one challenge talking mostly with therapist. Finish with orienting and
resourcing lead by family member.
 Identify what family would like to work on in this session. (Observe patterns of
interaction, problem solving, levels of activation, provide stabilization for
family members).
 Brief Psychoeducation and Skill Development Addressing Family Problem.
 Establish Organic Enactment or Directive Enactment Use Restructuring or
Integration Tools.
 Closing Ritual: Closing check in feed back about session with therapist.
Resourcing and orienting skill.
 Establish Family Homework.
Y

41. Structural Change Sessions
Vs. Integration Sessions
 Structural Change Sessions: Work through changing family
patterns by working near the regulatory boundaries to increase
capacity and reduce overwhelm.
 Integrative Sessions: Support to integrate a structural change that
is already happened with in an individual or the family.
 Integrative Sessions:
 Stay within current regulatory boundaries.
 Making new meaning about changes.
 Work slowly focused on grounding and settling.
Y

42. Family System Assessment
Brief Strategic SE Embodied
Family Therapy (BSFT) Family Therapy
 Structure  Emotion Regulation
 Developmental Stage  Cultural Factors
 Conflict Resolution  Family Support
 Identified Patient  Felt-Attachment
 Resonance
Y

43. Embodied Family Therapy Assessment
 Assessment allows the clinician to develop a plan to address
challenges a family faces and to support the family to return
to health.
 Goals of Assessment
 Identify missing skills and behaviors.
 Identify patterns that maintain symptoms of trauma or lead to
disruptions in a families innate resilience.
 Identify narratives that maintain destructive patterns.
 Develop a map of resiliency.
 Identify how to tailor interventions to a specific family’s needs.
 To learn about a family and how to join with them.
Y

44. SE Based Embodied Family Therapy
 By re-establishing innate resilience in a family and its
members the family becomes a central agent of healing after
a traumatic event.
 Working with both implicit (body/somatic) and explicit
(cognitive/narrative) systems the family increases emotional
regulation capacity and reduces the amount of time spent in
states vulnerable to behaviors destructive to the family and
individual health.
 Through working with existing strengths the family develops
an increased ability to access and develop social and
relational support systems.
Y

45. PTSD and Family Systems
Structure
 Structure: Is the way a family organizes itself. Structure includes…
Higherarchy/Leadership, Behavior Control, Guidance/Nurturance,
Alliance Between Parents, Executive Subsystem, Sibling Subsystem,
Flow of Communication.
 Fight: Can alter dramatically the structure of the family. It can reduce
nurturance through increased guidance (helicopter parents), disrupt
connection between parents, and lead to poor communication in an
attempt to mitigate the impact on family.
 Flight: Can alter basic felt-experience of safety and trust making
leadership difficult and disrupting communication.
 Freeze: Can effect the ability of a family to keep working through a
problem, lead to flat communication and through lack of felt-experience
of love lead to more control oriented parenting interventions.
Y

46. PTSD and Family Systems
Developmental Stage
 Developmental Stage: Transitions are key moments of change with in
a family. Managing these key moments of change can lead to long-
term effective functioning or destructive patterns of interactions.
 Fight: Can lead to taxing and reducing family resilience to stress by
increasing family conflict at the time when support is most needed.
Learning new skills is inherently stressful.
 Flight: Can lead to concrete solutions, poor ability to anticipate the
emotions of others and increased self-protection behaviors as a means to
control feelings of danger.
 Freeze: Can arrest a family development and limit the families ability to
access its innate ability to work through the challenges of a new
developmental stage.
Y

47. Family Developmental Stages
 Stage I: Beginning  Stage V: Families
Families. with Adolescents.
 Stage VI: Families as
 Stage II: Childbearing
Launching Centers.
Families.
 Stage VII: Families in
 Stage III: Families with the Middle Years.
Preschool Children.
 Stage VIII: Aging
 Stage IV: Families with Families.
School Children.
 Stage VIII: Aging
Families.

48. PTSD and Family Systems
Conflict Resolution
 Conflict Resolution: Is the ability to have conflicts and to solve them
through including the needs of family members. This skill requires a
complex blend of emotional regulation, acceptance, generosity
towards other family members and problem-solving abilities.
 Fight: Can lead to reduced emotional regulation and increased aggression
during conflict, reduced acceptance and generosity and concrete problem
solving.
 Flight: Can lead to over-riding of self needs or protective impulses.
Increased activation state that can easily and quickly transition to fight and
aggression.
 Freeze: Can lead to low frustration tolerance, giving up on problem solving
and giving up on the family.
Y

49. PTSD and Family Systems: Identified Patient
 Identified Patient: Often one individual is the “problem
individual” holding all the problems for an entire family. As the
family can grow the ability to tolerate their own “good and bad”
parts and moves from “rigid stress-based thinking” the IP-hood is
spread through out the family.
 Fight: Leads to concrete thinking, mothering and avoidance of
problems.
 Flight: Could lead to rigid patterns of blame, escalation of conflicts,
and deep feelings of hurt with.
 Freeze: Collapsed body, shame patterns, lack of energy and collapse
explosion cycle.
Y

50. PTSD and Family Systems: Resonance
 Resonance: How a family closeness and distance with in a
family system e.g. Boundaries. Boundaries are “semi-
permeable” membranes letting in good and out unhealthy. They
change from moment to moment.
 Fight: Over-ride boundaries of family members to protect self.
Leads to chronic feelings of embattlement and unsafely.
 Flight: Avoidance of intimacy, feelings of insecurity, apprehension
and anticipation of threat.
 Freeze: No “felt-experience” of connection, poor ability to feel the
indicators of boundaries, feeling isolated and hopeless about
change.
Y

51. PTSD and Family Systems: Emotion Regulation
 Emotion Regulation: The ability to tolerate a wide range of
emotional states, increase or decrease emotional activation based
on needs, ability to tolerate and trust overwhelm states through
confidence in one’s righting response.
 Fight: Elevated fight leads to ignoring the needs of others, concrete
thinking, and boundary violations in the attempt to protect one’s
self.
 Flight: Elevated flight leads to basic feeling of insecurity and
danger, hypervigilence for threat and privileging of possible
dangers in the emotional interactions.
 Freeze: Lack of ability to learn from emotional interactions,
feelings of helplessness, chronic states of anger or anxiety.

52. PTSD and Family Systems: Cultural Factors
 Cultural Factors: Culture impacts a family. Culture effects how a child is expected
to act, role of elder children in the family and parental roles. Culture effects non-
verbal signals and their meanings.
A family is impacted by the judgments, prejudices and political history. Culture
includes: Age, Disability Status, Religion, Ethnicity, Sexual Orientation,
Socioeconomic Status, Indigiounus Heritage, Nation of Origin, and Gender.
 Fight: Often the experience of prejudicial treatment leads to a fight response that
can not be processed through even normal self-protection. This can have a profound
impact on a family.
 Flight: The need to escape but having no “safe cultural space” can lead to anxiety,
stress and many family challenges.
 Freeze: Freeze states can manifest as desperation, feeling like there is no safety
and not being able to access the felt-experience of safety within the family.

53. PTSD and Family Systems: Family Support
 Family Support: No family is an island. Families need other
families, grandparents, teachers, religious figures etc. After a
traumatic event families can begin to isolate, disengage or have a
loss of trust in institutions.
 Fight: Can lead to damaging external relationships and supports for
the family as well as avoidance patterns so that the family does not
act in ways that loose relationships.
 Flight: Avoidance behaviors, loss of trust, feelings like other people
cannot or will not understand the family, isolation.
 Freeze: Not accessing resources, not realizing when resources are
not helpful.

54. Tracking Family Patterns
 Explicit Patterns:
 Family Narratives
 Verbal Burps
 Core-beliefs
 Verbal and Cognitive Hedonics
 Behavior Sequences
 Implicit Patterns:
 SIBAM-R
 Behavioral Synchrony
 Posture
 Vocal Tone
 Facial Expression
 Tolerance for Misattunement
Y

55. Tracking Family Patterns
 Chain Analysis
 Links on a chain that lead to behaviors
that damage relationships.
 If you brake key links you change
the behavior.
 Chain Analysis (Adapted from DBT)
 Step 1 – See the big pattern
 Step 2 – SIBAM – R with the family.
 Step 3 – Identify states that make the
family vulnerable to the difficult
interaction.
 Step 4 – Identify week links in
the pattern.
 Step 5 – Use imagery to explore the
pattern and more effective solutions to
develop new patterns of family interactions.
Y

56. Working With a Family Trauma
1. Work with the beginning or end of a
T3/-3 family pattern or a trauma first
(Highest Intensity at T0).
T2/-2 2. Use “resources” in SIBAM to slow down
and stabilize affect tolerance and
T1/-1
pattern.
T0 3. Integrate affect/complete defensive
responses.
Completion 4. Develop new meaning (a.k.a. Narrative)
T T T T T T T
-3 -2 -1 0 -1 -2 -3

57. Using Touch In Family Therapy
 Safe touch can create a felt-experience of being understood.
 Safe touch increases OT (Oxytocin), Dopamine, Reduces
Stress Hormone (Cortisol).
 Safe touch provided by parent when child is in distress puts
on-top of family structure in the role of soothing and provider
of safety.
 Always negotiate the contact.
 Have parent track how their child’s response changes.

58. Five Major Tools
Embodied Family Therapy
1. Tools to change family patterns.
2. Tools to stabilize new family states.
3. Psycho-educational tools and Normalization.
4. Family homework
5. Developing Family Support Systems

59. Embodied Family Therapy Tools
Tools to Change Tools to Change
Patterns Patterns
 Resourcing  Reinforcing “felt attachment”
 Orienting  Modeling Skills
 Family Pause  Self-Tracking
 Repatterning  Uncoupling elements of
SIBAM-R from interaction
 Completion of Defensive pattern.
Response  Safe Touch

60. Embodied Family Therapy Tools
BSFT Tools to
Stabilization Tools
Change Structure
 Decoding.  Main street.
 Reframing.  Meaning making discussions.
 Change in Proximity.  Orienting.
 Settling.

61. Embodied Family Therapy Tools
Psychoeducation and
Homework
Normalization
 Understanding Fight/Flight and  Tracking: Give homework to track a
Freeze. successful or effective solutions
(Safety, Kindness, Success).
 Understanding Rupture Repair Cycle.
 Using Problem Solving Mind.
 How to support defensive responses.
 Respecting Boundaries.
 Understanding Individual Stress
Response.  Family Pause.
 Understanding thought skills and  Felt-Attachment: See the good, feel
body skills. the good, say the good.
 Orienting to family states.  Family Play.

62. Embodied Family Therapy Tools
Developing Support
Systems
 Reaching out to friends and
family when things are
difficult.
 Family activities.
 Physical Exercise and Sports.
 Increasing Individual Positive
Experiences.

63. Closing Thoughts…
 Family therapy needs to address implicit and explicit systems. In other
words the body is a central part of a family system.
 Developing basic resilience factors for both members of a family and
the family supports healing from PTSD symptoms and helps the family
be a safe base.
 The family is the main place a child develops its brain, limbic structures,
theory of mind and morality.
 It is important to help a family develop skills for when they are in a
vulnerable emotional state and to move to a more resourced emotional
state.
 The family of today creates the generation of tomorrow.
 There is a natural drive toward health that clinicians can support a
family to have access to.

64. ??? QUESTIONS ???