Attachment-based intervention programs to prevent transgenerational trauma: “SAFE® - Safe Attachment Formation for Educators” and “B.A.S.E.® – Babywatching“ Karl Heinz Brisch Dr von Hauner Children's Hospital Department of Pediatric Psychosomatics and Psychotherapy University of Munich/Germany Email: [email protected] www.khbrisch.de Please, pay attention! • No fotos, audio- or video-recordings are permitted due to copyright and data protection rights. • Thank you for your understanding! © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Homepage www.khbrisch.de/en • Downloads – Slides of presentation – Brisch_SAFE_BASE_Amsterdam_210913 © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. SAFE ® A primary Preventive Parenting Program to Promote Secure Parent-Child Attachment Relationships K. H. Brisch Dr von Hauner Children's Hospital Department of Pediatric Psychosomatics and Psychotherapy University of Munich/Germany Overview • • • • Introduction - attachment theory Contents, goals and results of SAFE Preliminary research data Outlook and further perspectives Copyright K. H. Brisch Munich/Germany The development of attachment according to John Bowlby‘s attachment theory • An infant develops a specific emotional attachment to a primary attachment figure during the first year of life • The attachment figure represents a „secure emotional haven – a secure base“ for the infant Copyright K. H. Brisch Munich/Germany Intergenerational transmission of attachment • 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 – Traumatized parents with disorganized children – Children who are maltreated by their traumatized parents during infancy will develop attachment disorders Copyright K. H. Brisch Munich/Germany 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 Copyright K. H. Brisch Munich/Germany Aims of primary prevention • Promotion of healthy psychological development of parents and children • Development of secure quality of attachment • Enhancement of parental sensitivity for the emotional needs of their infants • Enhancement of emotional availability and sensitivity for their infant's signals • Processing and working through of unresolved parental traumata • Breaking of vicious circles or re-enactment of trauma • Stop transmission of violence from generation to generation Copyright K. H. Brisch Munich/Germany The Research Projekt • Randomized controlled prospective longitudinal study • Intervention group (SAFE®) vs. control group (GUSTA) • Multi-method measurement • Five time points of measurement – Before child birth – After child birth – 6, 9 and 12 months of infant‘s age © Copyright Copyright ErhardtErhardt I & Brisch I & Dr. K H, Brisch LMUKH, Munich 2011 LMU Munich Intervention • SAFE® = Safe Attachment Formation for Educators • Attachment based manualized parenting program • Aim – improvement of secure attachment and reduction of disorganized attachment • • • • Beginning: 20th – 28th week of gestation End: 12 months of infant‘s age 10 seminar days on Sundays (4 pre, 6 post) Closed group setting with becoming mothers, fathers and babies • Two trained mentors leading the group © Copyright Erhardt I & Brisch K H, LMU Munich 2011 Participation in SAFE • Pregnant women and their partners – – – – First time mothers Second and more time mothers Single and adolescent mothers Motivation for the emotional development of their infant – High motivation during pregnancy – Ideal wishes for a new healthy start with each baby – Reflection on own childhood and on relationship with own parents Copyright K. H. Brisch Munich/Germany Modules and methods • Module 1: – Parent-groups • Module 2: – Individual trauma-psychotherapy • Module 3: – Video-Feedback sensitivity training • Module 4: – Crisis-Hotline Copyright K. H. Brisch Munich/Germany Modul 1: Prenatal parent-groups • Contents (video-based teaching) – – – – – Fantasies and anxieties of parents Prenatal bonding Competencies of infants and parents Role expectancies and models of parents Parent-infant interaction and general video-based sensitivity training – Relaxation, impuls control and stabilisation techniques Copyright K. H. Brisch Munich/Germany Modul 1: Postnatal parent-groups • Contents (video-based teaching) – – – – – – Processing of birth experience Postpartum Depression Parental competencies Triangulation mother-father-infant Interactional problems (crying, feeding, sleep) Parental bonding, infant attachment and exploration Copyright K. H. Brisch Munich/Germany Modul 2: Individual traumapsychotherapy • Infants and children can trigger parental unresolved traumatic experiences from their past ("ghost in the nursery") • Individual trauma-psychotherapy for mother/father/partner (unresolved trauma!) • Prevention of re-enactment of unresolved trauma with own child Copyright K. H. Brisch Munich/Germany Modul 3: Video-feedback sensitivity training • Enhancement of sensitivity for infants' signals • Before birth: General training with videoclips of unknown parents and infants (crying, feeding, changing napies, playing) • After birth: Individual training with videoclips of their own mother/father-child interaction Copyright K. H. Brisch Munich/Germany Modul 4: Crisis-hotline • Individual guidance and councelling in case of crisis "emergency" (crying through the night) • By telephone, mobile phone, e-mail • Emotional security for parents • Parents know SAEF-mentor from SAFE-group • Reinforcement of parental competencies and parental self-confidence Copyright K. H. Brisch Munich/Germany Summary of Research Results SAFE ®-Program 2011-2012 Attachment Representation of Pregnant Women and Postnatal Depression - Methods • Objectives: – How do attachment representations of pregnant women relate to postnatal depression? – How does the intervention SAFE® impact on mothers’ postnatal depression rate compared to the control group? • Participants: – a non-clinical sample – Randomly assigned – N = 41 mothers in SAFE® and N = 23 mothers in control group • Methods: – 3 months prenatal: Adult Attachment Projective Picture System (AAP; George et al. 1997) – Prenatal and 3 months postnatal: Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) (self-report measure) Attachment Representation and Postnatal Depression- Results 1. In this sample 46% (n = 19) have a secure and 73% (n=30) have resolved attachment representation prenatal. no significant difference between the groups in terms of attachment representation categories • their attachment representation is not related (n.s.) to their depression score at baseline in pregnancy (EPDS) 2. Preliminary data show, when looking postnatally only at those with a depression score of ≥ 10 (cutoff for clinically relevant depression) that the number of affected women goes down to 1/6 in the SAFE® group (fig. 2) postnatally there is a marginal significant difference between the groups (p ≤ .10; Fisher‘s Exact Test). Attachment Representation of Pregnant Women and Postnatal Depression Discussion • Conclusion: – Women who show higher levels of depressive symptoms during pregnancy are more likely to report normal EPDS-scores postnatally if they were part of the SAFE® group. • Limitations: – small sample size. – preliminary results • Future prospects: – To investigate, how these findings interact with parental sensitivity and infants´ attachment quality post-intervention Study Attachment representation of becoming mothers and child birth experience Attachment representation of becoming mothers and child birth experience - Methods • Objectives: – Is there an association between prenatal attachment status (unresolved vs. resolved) and stressful birth experience? • Participants: – N = 120 becoming parents (here: mothers only) – Non-clinical sample • Methods: – Randomized controlled trial – Longitudinal study (ongoing study) – 4 measure points in total (in this study: 2 measure points only) • • 1) 3 months prenatal (AAP) 2) 3 months postnatal (IES) Attachment representation of becoming mothers and child birth experience - Instruments • Attachment measure: – Adult Attachment Projective Picture System (AAP; George et al. 1997) Attachment Representation (F, Ds, E, U) – prenatally: start of intervention • Questionnaire: – Impact of Event Scale (IES; Horowitz et al. 1979; dt. Hütter & Fischer 1997) „Avoidance“ scale, „Intrusion“ scale and total score – 3 months after child birth – Event to rate by participants: „child birth“ Attachment representation of becoming mothers and child birth experience - RESULTS • Attachment (AAP) status before childbirth: • N = 36 (62,1 %) „resolved“ (F, Ds, E) • N = 22 (37,9 %) „unresolved“ (U) • Impact of Event Scale (IES) after childbirth: • Unresolved mothers have higher scores for intrusion (M = 8.00; SD = 7.40) than resolved mothers (M = 4.25; SD = 5.39) and • Unresolved mothers have higher scores for avoidance (M = 3.23; SD = 7.28) than resolved mothers (M = 0.89; SD = 1.92). • Statistical analyses were controlled for birth complications Attachment representation of becoming mothers and child birth experience - Discussion • Conclusions: – Mothers with „unresolved“ attachment representation experience giving child birth as more stressful and more intrusive – Relatively high proportion of mothers in the „unresolved“ category for a non-clinical sample • Limitations: – Preliminary data (Study is ongoing) Study Attachment, trauma and stress in pregnant women before childbirth Attachment, trauma and stress in pregnant women before childbirth - Hypotheses 1) Attachment measurements are an eligible stressor of the attachment system and therefore to measure cortisol levels 1) Unresolved trauma as attachment representation as well as the experience of traumatic events are associated with higher cortisol levels indicating physiological stress Attachment, trauma and stress in pregnant women before childbirth- Methods • Attachment measures: – Adult Attachment Interview (AAI; Main et al., 1982) – Adult Attachment Projective (AAP; George et al. 1997) • Trauma Questionnaires (self-report): – Trauma Antecendents Questionnaire (TAQ; v.d. Kolk 1997) – Posttraumatic Stress Diagnostic Scale (PDS; Foa et al. 1995) • Cortisol levels : – AAI and AAP as stressors (pre and post) – Saliva measurements – 4 times in a sequence Copyright Erhardt I & Dr. Brisch KH, LMU Munich Attachment, trauma and stress in pregnant women before childbirth- Results 1. Frequency of attachment representations (measured with AAP) 2. Frequency of attachment representations and experienced traumatic events (AAP and PDS) 3. Mean differences in unresolved vs. resolved subjects in cortisol levels to emotional stressors (AAI and AAP) Attachment, trauma and stress in pregnant women before childbirth- Results (3) • Expectant mothers with an unresolved attachment representation (AAP) had significantly (p ≤ 0.05) higher cortisol levels before and after the AAI (1st and 2nd measurement) than those with an resolved attachment representation Mean SD Resolved pre 4.43 1.57 Unresolved pre 5.06 3.68 Resolved post 3.59 1.31 Unresolved post 3.85 2.24 F df p pre AAI 8.7 50 .005 post AAI 4.83 50 .032 Copyright Erhardt I & Dr. Brisch KH, LMU Munich Attachment, trauma and stress in pregnant women before childbirth - Discussion • Unresolved trauma states as attachment representations in pregnant women are associated with increased cortisol levels but not in subjects with a resolved representation (p ≤ 0.05) • But mothers with unresolved status of attachment in respect to trauma did not show a clinical relevant PTSD Copyright Erhardt I & Dr. Brisch KH, LMU Munich Attachment, trauma and stress in pregnant women before childbirth - Conclusions • Attachment assessment may be more sensitive for detecting unresolved trauma in mothers and therefore influence the attachment development of the infant. • Self-assessment measure might not be sensitive enough as denial and resistance to self-disclosure can easiliy be controlled by the subjects Copyright Erhardt I & Dr. Brisch KH, LMU Munich SAFE - Mentor Multiplikatoren - • Training for health professionals • "hands on experiences" with parents and babies – – – – – – – – – Midwifes Pregnancy counsellors Nurses Obstetricians Psychologists Pediatricians Counsellors Child- and adolescent psychotherapists/-psychiatrists And others Copyright K. H. Brisch Munich/Germany Innovation • Early start in pregnancy • Continuation at least till end of first year of infant's life • Effects of group coherence • Combination of advantages of group effects and individual support • Crisis-hotline to prevent acut acting-out • Preventive individual trauma-psychotherapy • No discrimination of high-risk parents • Integration of fathers or partners © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. SAFE-Specials • • • • • • • • • Parents with multiple risks ("high risk parents") Adoptive and foster parents Parents of premature infants Nurses and parents in daycare centres, kindergarten, schools Nurses in mother-infant homes Parents with psychiatric disorders Parents with addiction to drugs Staff and parents in child protective institutions Immigrant parents with their children after experiences of torture and extreme violence © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. SAFE-International • • • • • • • • Austria Switzerland New Zealand Australia Singapore USA Latvia Russia © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Reference Brisch, Karl Heinz (2002/2012) Treating Attachment Disorders. From Theory to Therapy. Second Edition 2012 SAFE-Book Many translations © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. DVD and Homepage • DVD "Embracing Closeness„ (Eng) • DVD "BASE – Babywatching" (Eng) – Kindergarten – School • DVD "Strange Situation„ (Eng) • DVD SAFE (in German only) www.safe-programm.de www.base-babywatching.de © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. B.A.S.E.®-Babywatching A programme to prevent aggressive and anxious behaviour problems and to promote empathy Karl Heinz Brisch Dr. von Hauner Children's Hospital Department of Paediatric Psychosomatic Medicine and Psychotherapy Ludwig-Maximilians-University Munich [email protected] © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. B.A.S.E. ® Babywatching Karl Heinz Brisch Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital Abteilung Pädiatrische Psychosomatik und Psychotherapie Ludwig-Maximilians-Universität München B A S E = Babywatching = Against Aggression and Anxiety = For Sensitivity = For Empathy www.base-babywathing.de www.base-babywatching-frankfurt.de © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Babywatching in Kindergarten and schools Overview • • • • • • • Theoretical background Programme Training by video and life observation Results from research to date Costs Further perspectives Roots of Empathy © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Henri Parens – A Pioneer • Healing from the Holocaust • Autobiographie © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Aggression theory according to Henri Parens I • Types of aggression - Positive healthy aggression as „exploration“ - Negative hostile aggression against others © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Aggression theory according to Henri Parens II • Cause of hostility - Massive rejection and disregard of basic needs of the child by caregivers - Missing empathy in thoughts, feelings and actions of children © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Prevention programme • Goals - Ability for empathy - Preventing hostility • Modules for pupils and teachers - From Kindergarten to grade 12 or 13 - Significant reduction of aggressive behaviour in comparison to control groups © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Kindergarten Programme Baby-watching I • Groups of children watching an infant in interaction with his/her mother/father • Starting shortly after birth till approx. end of first year • Up to autonomous walking and first words © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Kindergarten Programme Baby-watching II • Instruction for baby-watching by educators • One educator leads the group, while another leads the watching • Monitoring of protocol • Frequency - 1 x weekly - Circle of chairs - Duration approx. 20-30 minutes © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Training of empathy • Sensitivity for other people‘s – – – – Thoughts Actions Motivations Feelings and emotions • Selfereflective capacity of mentalizing – „I think that you think that I think…“ – „I feel that you feel that I feel…“ © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. 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. © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Sensitivity (2) • The caregiver has to – perceive the infant’s signals – interpret correctly the infant’s signals – react properly – react promptly to the infant‘s signals © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Gaze • Reciprocal gaze with affect attunement between infant and caregiver promotes secure attachment (intersubjectivity) © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Verbal Interaction • Support of secure attachment by verbalization – of the „inner world“ of affective situations – of the infant‘s action context © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Rhythm of interaction in action and language • Support of secure attachment by – reciprocal change in mother-infant-interaction and communication – correction of mismatches • insecure attachment – via hyper-synchronous interaction and communication – absolutely asynchronous interaction © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Touch • Sensitive touch/massage between infant and caregiver promotes secure attachment • Hormon oxytocin © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Levels of babywatching • • • • • Behavior Motivation Emotion Identification Empathy © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Level of babywatching I • Level of behavior – What does the baby do? – What does the mother/the father do? © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Level of babywatching II • Level of motivation – Why does the baby behave in this way? – Why does the mother/the father behave in this way? © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Level of babywatching III • Level of emotions – How does the baby feel in this situation? – How does the mother/the father feel in this situation? © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Level of babywatching IV • Level of identification with behavior – What would I do in this situation, if I am the baby? – What would I do in this situation, if I am the mother/the father? © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Level of babywatching V • Level of identification with emotions – level of empathy – How would I feel in this situation, if I am the baby? – How would I feel in this situation, if I am the mother/the father? © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Pitfall and failures • • • • • • • No programme of developmental psychology No teaching with blackboard No teacher – caring for baby No student – touching, holding, cudling the baby No focus on baby only and developmental steps BUT always: Focus is on mother/father-infant-interactions © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results Kindergarten I • RTC-Study • Behaviour assessment of the children (N=50, age M=50 months) by - Educators - Parents - Test at start and finish of intervention - Comparison between control group (without intervention) and intervention group © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results II • Improvements in the intervention group - Assessed by educators (CBCL) • Boys - Less aggressive behaviour Less oppositional behaviour Improved alertness Less social withdrawal More emotional reactivity Less „anxious-depressed“ © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results III • Improvements in the intervention group - Assessed by educators (CBCL) • Girls - Fewer physical complaints Improved alertness Less social withdrawal More emotional reactivity Less „anxious-depressed“ © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results IV • Improvements in the intervention group - Assessed by parents (CBCL) • Boys - Less aggressive behaviour Improved alertness Less social withdrawal More emotional reactivity © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results V • Improvements in the intervention group - Assessed by parents (CBCL) • Girls - less sleeping problems Improved alertness Less social withdrawal More emotional reactivity © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results VI • Additional improvements in the intervention group • Assessed by educators - Attachment behaviours - Looking for comfort from caregiver - Applying the method of baby watching and sensitivity of play with one another © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. BASE-School • RCT Studie (Haneder, 2011) • N=250 students, Tyrol/Austria primary schools (N=123 in intervention-groups, N=127 in control-groups) • Strengths and Difficulties Questionnaire • Pre-Post-Intervention • Duration of intervention: 9 month © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Results: Parents and Teachers • Significant improvements in interventiongroups – Emotional problems – Prosocial behavior – Total index of behavior problems © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Improvement Emotional behavior problems • • • • • Anxious-depressive Withdrawal Somatoforme complaints Sleep-problems Anxiety disorders © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Improvement Prosocial behavior • Empathy in behavior • Social competence © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Improvement Externalizing behavior • • • • Aggression Attention deficit Oppositional behavior Hyperactivity © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Improvement Global index of behavior problems • • • • Aggression Hyperactivity Emotional problems Problems in interactions with peers © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Summary • Overall positive effects for both boys and girls • Positive changes of externalising and internalising disturbances • Similar positive assessments made by educators and parents © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Summary II • For all involved, an emotionally positive experience • Noticeable generalisation of the mode of baby-watching during play with one another • Preventive intervention at minimal cost © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Outlook • More widespread introduction and testing of programme • Testing in social areas with high risk families • Testing in other age groups • Follow-up programme © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Costs of B.A.S.E.® -Training • BASE-Group-Leader – One day training of kindergarten or school teacher – approx. 50 Euros/person • Supervision by BASE-Mentor – One day training for Group-Leaders – approx.120 Euros/person – Individual prize for supervision • BASE-Trainer – In progress: 2 day training - approx 200 Euros/person © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Costs of running B.A.S.E.® - courses in kindergarten and schools • NONE – For teacher – For institution – For parents • Cost for supervision – Recommendation: Mentoring/supervision by BASE-Mentor –costs depending on contract – Video supervised by mentor • Mother and baby are not paid • Number of children in intervention – As many as one teacher addresses – Each teacher can run more courses © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Training-Grades • BASE-Group-Leader (1day training) – Running BASE-Groups by her/himself in school and kindergarten classes • BASE-Group-Mentor (1-2 day training) – Hands-on experience with group-leading – Supervision of group-leaders • BASE-Group-Trainer (1-2 day training) – Extended hands-on experiences with groups and mentoring – Training of group-leaders – Supervision of group-leaders and mentors © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. B.A.S.E.® -International • • • • • • • • • • Germany Austria Switzerland Belgium Netherlands Italia New Zealand Australia UK In progress: Ukraine, Korea, Latvia, Russia © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Steps towards a BASE-group (1) • • • • • • • Do a BASE-Group-Leader training Find an institutional partner and sponsor Find a kindergarten or school Inform parents and children Do advertising Find a mother/father with a baby Organize cooperation with local partners e. g. obstetrians, midwifes, media • Ask for mentoring/supervision if needed • Do documentation • Do research and evaluation pre-post-intervention e. g. with Strength and Difficulties Questionnaire – SDQ (Goodman) © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Roots of Empathy • • • • • • Canadian Programme – Mary Gordon Infant Development Teaching Book Baby and Mother visit ones a months Handling the baby, touching, cudling Results – research papers – No clear methods, results to doubt • See critical report in the internet • Making money • Benefit not clear from research results © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. DVD • DVD SAFE "Embracing Closeness" • DVD "BASE – Babywatching" • Available for sale after presentation and after workshop or over the internet – s. webpages © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Homepages • www.safe-programm.de/en • www.base-babywatching.de/en • www.khbrisch.de/en © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. John Bowlby (1980) • 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. © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Empathy and Loving Care Author and lecturer Leo Buscaglia once talked about a contest he was asked to judge. The purpose of the contest was to find the most caring child. The winner was: A four-year-old child, whose next door neighbour was an elderly gentleman, who had recently lost his wife. Upon seeing the man cry, the little boy went into the old gentleman's yard, climbed onto his lap, and just sat there. When his mother asked him what he had said to the neighbour, the little boy just said, 'Nothing, I just helped him cry.' © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Reference • Brisch, K. H. (2012) Treating Attachment Disorders (2nd edition) Guilford Press, New York, London © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. International Conference 11. - 13. October 2013 in Munich Attachment and Psychosomatics Information and Programme Email to: [email protected] www.khbrisch.de © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved. Thank you for your attention! www.safe-programm.de www.base-babywatching.de www.khbrisch.de © Copyright K. H. Brisch Munich/Germany 2013. All rights reserved.
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