6.Humor & Creativity: laughter and expression shift brain states
Cortisol vs. Oxytocin – The Battle for Regulation
Cortisol disrupts memory, emotion regulation, and trust
• Oxytocin enhances curiosity, empathy, and relationship repair DBT builds predictable routines that reduce cortisol and increase oxytocin
Neurotransmitters and Regulation
• Cortisol (threat, vigilance, inflammation)
Oxytocin (bonding, co-regulation, safety)
• Dopamine (motivation, reward learning)
Serotonin (mood balance, satisfaction)
Dysregulation: Learned Behavior
How Problematic Self-Regulation is Learned
Oxytocin=Responsive release (calming)
Problem Behaviors=reinforced as a method to regulate emotions
Treatment Targets to Increase
• Hugs
• Sing in a choir
• Give a back rub/foot rub
• Hold a baby
• Stroke a dog or cat
• Perform a generous act
• Pray
• Make positive eye contact
• Breath work
• Listen without judgment
• Positive touch
• Proximity
• Laugh/Dance
Mindfulness as a Neurological Reset
Activates the observing brain and quiets the survival brain
• Restores present-moment awareness interrupted by trauma Reduces automaticity and reactivity
From Neurobiology to Mindfulness: Engaging the Observing Mind
• The prefrontal cortex our "observing brain" is often hijacked under chronic stress or trauma
• When reactivated, it allows us to step out of survival reactivity and into choice
Mindfulness helps us shift from automatic responses to conscious awareness
• This is not about mastering a technique it’s about reclaiming access to higher-order functioning
Observing Mind Practice – Dual Awareness
• Guided Practice: Notice a sound in the room
• Feel the weight of your body on the chair
Name an emotion as if it's weather (e.g., cloudy, bright, shifting)
• Return to the breath as an anchor
Debrief Prompt: What did you notice? What shifted when you observed without judgment?
Practice: Grounding in the Present (Observing Mind)
The prefrontal cortex our "observing brain" is often hijacked under chronic stress or trauma
• When reactivated, it allows us to step out of survival reactivity and into choice
• Mindfulness helps us shift from automatic responses to conscious awareness
This is not about mastering a technique it’s about reclaiming access to higher-order functioning Debrief Prompt:
• What did you notice without effort? What shifted when you stopped naming something as good or bad? How might you guide a client through this type of practice?
What’s Alive in You Now?
1. What insight are you taking away?
2. What would you like to explore deeper?
3. What’s one way you might adjust your lens or pacing with clients?
“Often
Rudyard Kipling
• Differentiate developmental and attachment trauma
• Understand the impact of parenting styles on attachment formation
• Explore how DBT interpersonal skills support attachment repair
• Apply trauma-informed strategies for relational safety and boundaries 4
5
Trauma That Shapes Relationship Blueprints
Long-term effects: affect dysregulation, avoidance, clinginess, control
“AN IN - BORN SYSTEM IN THE BRAIN THAT EVOLVES IN WAYS THAT INFLUENCE AND ORGANIZE MOTIVATIONAL, EMOTIONAL AND MEMORY PROCESSES WITH RESPECT TO SIGNIFICANT CAREGIVING FIGURES.” (BOWLBY)
o
o
o
PARENTING STYLE VIGNETTE 1 BALANCED & BOUNDARIED
A 10-year-old describes their mother as 'firm but fair.' She sets clear expectations for homework and bedtime, but always checks in about how the child is feeling. When conflict arises, she listens and then calmly negotiates a solution. The father plays with the child regularly, holds boundaries when needed, and encourages independence.“
PARENTING STYLE VIGNETTE 2 –HARSH & CONTROLLING
"An 8-year-old reports being yelled at frequently and describes both parents as 'always mad.' They talk about being grounded often without knowing why and say their parents don’t explain rules just enforce them. There is little emotional warmth, and affection is only given when rules are followed perfectly."
Authoritarian Parenting
PARENTING STYLE VIGNETTE 3 –WARM BUT INCONSISTENT
"A 7-year-old says their mom is 'really nice' but sometimes forgets to pick them up from school. They describe their dad as 'fun' but often asleep during the day and too tired to help with schoolwork. They feel special when their parents do things together but often don’t know what to expect."
"A 9-year-old describes their caregivers as 'busy' and 'gone a lot.' They spend most of their time alone or on screens. Meals are often skipped or eaten alone. They cannot recall a recent conversation where a parent asked how they were doing emotionally."
Case Vignette – Complex Attachment & Neurobiology
Client Overview: 42-year-old woman raised in Memphis with two maternal caregivers (biological mother and JC).
Themes: Emotional neglect, inconsistent caregiving, warmth and rupture, hyper-functioning, grief, and embodied trauma.
DBT Relevance: Illustrates cortisol sensitivity, relational trauma, and the long arc of attachment repair.
Vignette #1
Client, 42, describes her mother as: loving, strict, warm, anxious, supportive. Her father: calm, distracted, humorous, fair, emotionally distant. When asked for memories, she shares a story about how her mother often became overwhelmed during homework help and would snap but would later apologize and ask to talk it through. She recalls her father forgetting a school pickup once, but says he explained and reassured her when he got there. Her storytelling is emotionally coherent. She reflects on these moments with warmth, noting, “They weren’t perfect, but I always knew they loved me and wanted to do better.”
Vignette #2
Client, 29, describes her mother as: busy, cold, tired, efficient, unavailable. Her father: funny, charming, inconsistent, angry, gone. She struggles to recall consistent care, saying, “I think they did their best.” She quickly deflects with humor and often speaks in generalities. She minimizes painful memories and avoids emotion.
Vignette #3
Client, 36, describes her mother as: loving, mean, unpredictable, confusing, everything. Her father: missing, deadbeat, sorry, sometimes-there, apologetic. She shares contradictory memories and seems distressed while speaking. Her language becomes chaotic, jumping between blame and guilt. She cries and then laughs inappropriately.
Vignette #4
Client, 31, describes her mother as: affectionate, nervous, talkative, critical, overbearing. Her father: absent, silent, serious, stressed, working. When asked for memories, she gives several detailed examples of calling her mother repeatedly at work to be reassured she wasn’t angry. She reports being punished one moment and smothered the next, and says, “I always felt like I had to prove I was good enough.” Her tone is anxious, her narrative is linear but emotionally intense, and she seeks reassurance from the interviewer.
• Validation = emotional visibility
• Boundary-setting = self-trust and clarity
• Conflict navigation = fear of rupture repair
• Assertiveness = reclaiming voice and needs
Validation Practice
I went to the store yesterday and I saw these Red Hot candies. I completely lost it and forgot what I went into the store to get. It reminded me of when I was little and my mom wanted to teach me about waiting. I had asked for some of those candies and she said no, but when she tucked me in that night, she forced me to eat a huge bag until my mouth and eyes burned. I thought I was past that, but I am having urges to cut myself again. I get so angry with myself. I keep myself from eating. If I had any pills, I’d take them…you know, just to numb out.”
Holding Space Without Losing Self
• Trauma survivors fear closeness and isolation simultaneously
• DBT helps build the ‘middle path’ between enmeshment and avoidance
• Interpersonal Effectiveness = boundary work that doesn’t sever connection
Grounding and Release Practice
• Instructions:
• Bring awareness to your breath
• Notice areas of the body holding tension offer permission to soften
• Recall a moment from today that offered clarity or curiosity
• Set an intention for the evening or tomorrow’s learning
Closing Prompt: What does your nervous system need right now? Who do you want to be with this new awareness?
DBT, Trauma & Attachment – Day 3: Trauma's Impact on Brain Development & Emotion Regulation
Charlottetown 5-Day Immersion with Dr. Eboni Webb, PsyD
Day 3 Learning Objectives
Biopsychosocial Model of Trauma
Understand how trauma impacts development through biological, psychological, and social factors that shape a person's responses.
Influence on Emotional Systems
Learn how trauma affects core systems involved in emotional development and influences emotional responses in daily life.
Biphasic Arousal Model Application Apply the Biphasic Arousal Model to better understand and interpret client behaviors shaped by trauma.
DBT Skills and Trauma Regulation Connect DBT emotion regulation skills to managing trauma-based emotional dysregulation by identifying core organizers of experience.
7 The vagus nerve is the largest nerve in the body and controls our body’s ability to detect danger, sense safety, experience rest/relaxation, and connect socially. It is refined through connection from birth and innervation of touch.
The Polyvagal Theory (Porges, 2011)
• In utero assaults
• Delivery difficulties
• Health of both parents during conception
• Mental Illness
• Abandonment via adoption
• Learning difficulties
• Identity disturbances
• Racial issues
• Inside threats
• Sexual assaults
• Divorce
• Prolonged separation from parents and/or siblings
• Frequent moves
• School transitions
• Bullying (Cyber, physical, etc.)
• Accidents (falls, vehicle, etc.)
Common Types of Invalidation
Abuse and neglect
Being ignored
Open rejection of thoughts, feelings, and behaviors
Making “normal” responses “abnormal”
Failing to communicate how experience “makes sense”
Expecting behaviors that one cannot perform (e.g., due to developmental level, emotionality, or behavioral deficits
Core Emotional Systems (Panksepp)
• SEEKING – curiosity, vitality
• RAGE – protest, injustice
• FEAR – danger, threat
• PANIC/GRIEF – abandonment, loss
• CARE – nurturance, empathy
• PLAY – social joy, creativity
• LUST – hormonal development
Need Age of Development Healthy Development Unhealthy Development Key Emotions Impacted
Security 2-3 Self in Relationship Diffuse Boundaries Fear, Jealousy, Love
Pleasure 0-3 Body-Self Development Body Shame Shame, Disgust, Envy, Love, Guilt
Affection 4-5 Capacity for love, sense of love and belonging, worthiness Inhibition from autonomous connection Love, Anger, Envy, Jealousy
Esteem 5-6 Recognition, Acknowledgement, Self-Acceptance Lack of trust in self Sadness, Shame, Guilt
Control 3-7 Choice Compulsion, Impulsivity Jealousy, Anger, Fear
Power 7+ Intention Invulnerability Envy, Guilt, Fear
Borderline Personality Disorder
Key Characteristics Attachment Disturbances
Pattern of Impulsivity Instability in interpersonal relationships
Instability in life
Unstable self-image and emotions
Hypersensitive to abandonment
Pattern of undermining success in relationships
The Biosocial Model
Emotional vulnerabilities are characterized by:
- Emotional sensitivity
- Emotional reactivity
- Slow return to emotional baseline
Over time emotions get sensitized, leading to a “kindling” effect
This emotionality (and associated invalidation) is associated with many problems (disorders)
Emotionality leads to escape and avoidance that leads to chronicity
Biphasic Arousal
Biphasic arousal typically involves an initial phase of heightened stimulation, excitement, and alertness, followed by a period of decreased arousal and relaxation. Such a response can be seen pertaining to the utilization of certain substances like caffeine or alcohol, when experiencing emotional reactions, or during physiological processes. This type of arousal often begins with a higher surge of activity that is then followed by a period of calming down and becoming more relaxed.
Core Organizers of Experience
How the Brain Organizes Our Experiences
Case Vignette
A 15 - year- old male named Jordan has been referred for chronic school avoidance, irritability at home, and increasing isolation. His mother reports that he was a "sensitive" child with early separation anxiety. At age 8, he witnessed a violent home invasion in which his father was assaulted. His father left the family shortly after the incident, and Jordan has not seen him since.
Since the event, Jordan has experienced frequent nightmares, a persistent startle response, and episodes of shutting down when overwhelmed. At school, he is often silent or disengaged, and teachers note that he becomes defiant when asked to participate. He spends most of his time in his room playing video games and avoids family activities. His mother describes him as either "exploding or disappearing."
Case Study Debrief – Jordan
• What stood out in your group’s analysis of Jordan’s dominant emotional systems?
• How did your group differentiate between hyper- and hypoarousal in his behaviors?
• What did you notice about the disrupted core organizers (e.g., identity, perception, behavior)?
• What was your group’s first instinct for a DBT intervention or skill introduction?
• If you were to introduce mindfulness to Jordan, what might that look like?
PL.E.A.S.E.D SKILLS
Sensations
Urges
We cannot selectively numb emotions, when we numb the painful emotions, we also numb the positive emotions.
•
•
•
• Emotional vulnerability (high sensitivity + slow return to baseline)
• Break ineffective emotional cycles by acting opposite to behaviors that are mood congruent
• Opposite action may also create a different emotion Often a “gateway” skill
• Examples include activity when depressed, approaching when anxious, and being kind when angry
Let’s Practice!
Recall Recall an event that is/was emotionally-charged for you.
Close Close your eyes and see yourself in the situation with all the emotions and all the details.
Wrap Wrap your arms around yourself, head down and allow whatever emotions you have to flow in until you hear the bell chime.
Sit up and place After you hear the chime, sit up and place your hands palms up on thighs.
Practice Practice holding a half-smile.
Remain Eyes will remain open.
Lift Lift eyebrows and breathe fully.
Continue Continue recalling the emotionally-charged event until you hear the chime again.
Build Positive Experience
Must be planned/scheduled
Must include mindfulness skills
• Address distractions that interfere with BPEs
• Address judgments that interfere with BPEs (e.g., not deserving, etc.)
• Address concerns about expectations
Build Positive Experience
• Short term
• Do pleasant things that are possible now
• Long term Invest in relationships (Attend to Relationships-A2R)
• Invest in your goals
• Build a satisfying life
• Take one step at a time
Build Mastery
• Engage in activities of daily living
• Accomplish tasks that need to be done
• Take steps toward a challenging goal
• Build a sense of control, confidence, and competence Give yourself credit!
Group Reflection + Integration
• What new language or concepts resonated today?
• How might you use this model to explain a client’s symptoms?
• What personal insight did you gain about emotional development?
Restoring Regulation Before We Re-Enter the World
• Guided Prompt:
• Take a few breaths into your belly and place a hand on your chest or core
• Recall one idea or experience from today that touched you
• Ask: "What do I want to carry forward from this session?"
• Ask: "What can I leave behind that does not serve me or my clients?"
DBT, TRAUMA &ATTACHMENT DAY 4: DBT SKILLS FOR TRAUMA, ATTACHMENT & RELATIONAL DYNAMICS CHARLOTTETOWN 5 - DAY IMMERSION WITH DR. EBONI WEBB, PSYD
Day 4: DBT Skill Objectives
Coping with Trauma
DBT skills help individuals manage trauma and handle complex relational situations, fostering healing and resilience.
Emotional Regulation and Distress Tolerance Enhancing emotional regulation and distress tolerance supports individuals in managing overwhelming feelings during trauma recovery.
DBT for Personality Disorders
Targeted DBT interventions address personality disorders and attachment adaptations for more adaptive functioning.
Mapping DBT to DSM -V Diagnoses DBT strategies are mapped to diagnoses like BPD, PTSD, Anxiety, and ADHD, ensuring tailored support for each condition.
DBT as a Trauma-Responsive System
• Structure builds safety and containment
• Skills provide language for inner and outer experience
• Validation re-patterns shame, helplessness, and isolation
Using DBT for Relational Trauma
• Emotional dysregulation + ruptured attachment = high reactivity
• Trauma often splits our thinking into extremes: safety/danger, good/bad, trust/distrust
• Dialectical thinking helps widen the window of tolerance
• Introduce the concept of holding two truths once
• Skill Spotlight: "Both-And" language, dialectical dilemmas, wise mind
Walking the Middle Path – Trauma & Dialectics
Practice Vignette: “My therapist cares about me… but I also feel abandoned when she doesn’t reply right away.” How could you validate both truths?
• What dialectical phrase might you offer?
• How can you model 'middle path' thinking without minimizing the pain?
WHAT ARE DIALECTICS?
n Opposites, extremes, or polarities (e.g., each thesis has a antithesis)
n Neither position is absolute, and in fact, are interconnected
n Each position has a wisdom or truth
n Movement toward a synthesis is sought
n Movement (and conflict) produces change
“THE CURIOUS PARADOX IS THAT WHEN I ACCEPT MYSELF JUST AS I AM, THEN I CAN CHANGE.”
nMost Fundamental Dialectic in DBT is the fluid movement between Acceptance and Change
nUse Validation to move toward acceptance and CBT techniques to move toward change
nRemember that context will suggest how to balance these strategies
Dialectical Dilemmas
•
DIALECTIC STRATEGIES: ENTERING THE PARADOX
1. Highlighting the contradictions in client’s behavior, therapy, or in reality
2. Refusing “right and wrong;” different perspectives can both be true and answers can be yes and no
3. Key is not to step in with logic to solve the dilemma or struggle; allow the client to make a shift
OTHER DIALECTICAL STRATEGIES
1. Metaphor and Teaching Stories
2. Playing Devil’s Advocate
3. Extending (aikido self-defense) (can be used with resistance)
4. Activating Wise Mind
5. Making Lemonade Out of Lemons
6. Allowing Natural Change
7. Dialectical Abstinence
8. Dialectic Assessment: What’s Missing?
Distress Tolerance in the Context of Trauma
• Trauma often creates a false urgency to act
• TIPP and self-soothing can anchor in the body
• Radical Acceptance can disrupt shame spirals
Goals of Distress Tolerance
• Ability to tolerate painful emotions
Distraction without avoiding Paths to other skills
• Action instead of reaction
Managing crisis without making it worse
Effective Distress Tolerance
• Less emotion-based coping (might work shortterm, but often does not long-term)
• Fewer impulsive behaviors
• Decreased self-injurious urges/behaviors
Decreased suicidal urges/behaviors
• Decreased crisis orientation to life AND
Decreased chronic distress avoidance
Self-Soothe
Distract: Wise Mind ACCEPTS
A Activities
C Contributing
C Comparisons
E Emotions
P Pushing away
T Thoughts
S Sensations
“Acceptance
Stages of Acceptance
(from Kubler-Ross)
• Denial: not wanting to believe its real Anger: feeling that it is unjust and should not have happened or be happening
Bargaining: trying to make a deal to escape the reality
Depression: having reality set in and feeling the impact
Acceptance: acknowledging the reality of what is No matter where you are, you are in the process
1. Willingness is doing what is needed, not sitting on your hands
2. Willingness means dealing with reality, not what you wish it would be
3. The concept contrasts our Western philosophy of “when there ’s a will there s a way
4. Where there is willingness, there is a way is the message
5. What are you willing to do given the situation?
Case Study: Adult with BPD + Attachment Trauma
• Overview: 32-year-old female with a history of abandonment, emotional abuse, and chronic invalidation. Diagnosed with BPD and PTSD. Frequently enters therapy dysregulated, demands reassurance, and panics with perceived therapist distance.
• Discussion Prompts:
• What skill sequences might support her in-session?
• How would you use validation without reinforcing dependency?
• Where might DBT offer containment without control?
EMOTION DYSREGULATION: THE “CORE” DEFICIT OF PERSONALITY DISORDERS
Many causes of emotional sensitivity (e.g., attachment problems, loss, trauma, invalidation)
§ Connected to neurochemistry although mediated by psychological factors
High emotional arousal predicts increased susceptibility in the future due to kindling effects
§ Emotion dysregulation leads to escape and avoidance behaviors in BPD and other personality disorders
Personality Disorders & Trauma
Personality Disorders & Trauma
Personality Disorders & Trauma
Mindful Prompt
ATTACHMENT GOAL
SECURE AND AUTHORITATIVE PARENTING PRODUCES
ATTACHMENT RULE
ATTACHMENT IS NOT FIXED OR ABSOLUTE. GROWTH AND CHANGE ARE DRIVEN BY ONE’S SEASON OF LIFE.
DEFINITION:
ATTACHMENT
“AN IN - BORN SYSTEM IN THE BRAIN THAT EVOLVES IN WAYS THAT INFLUENCE AND ORGANIZE MOTIVATIONAL, EMOTIONAL AND MEMORY PROCESSES WITH RESPECT TO SIGNIFICANT CAREGIVING FIGURES.” (BOWLBY)
• Create a safe home environment Emotional Vulnerability
• Model Emotions
Unrelenting Crises
WHAT TO LOOK FOR
Uncontrollable Events
• Crisis -Generating Behavior
• Willfulness, Demandingness • Helplessness Active Passivity
Disconnect between verbal and non -verbal behavior Contextual Competence (mood/situational) Apparent Competence
Unrelenting Crises
• Control the Controllable in the Home
• Practice/Model Delayed Gratification
Cheerlead
• Encourage problem-solving Set Personal Limits Active Passivity
• Highlight effective behaviors observed Lose the assumption of how the loved one “should” behave in all contexts based upon one.
Levels of Validation
(Linehan, 1997)
Level 1: Being acutely attentive
Level 2: Reflecting verbal communication
Level 3: Describing non-verbal communication
• Level 4: Expressing how experience makes sense given history or biology
Level 6: Being in genuine, human contact
Level 5: Expressing how experience makes sense in the present moment and context
VALIDATION PRACTICE
“I went to the store yesterday and I saw these Red Hot candies. I completely lost it and forgot what I went into the store to get. It reminded me of when I was little and my mom wanted to teach me about waiting. I had asked for some of those candies and she said no, but when she tucked me in that night, she forced me to eat a huge bag until my mouth and eyes burned. I thought I was past that, but I am having urges to cut myself again. I get so angry with myself. I keep myself from eating. If I had any pills, I’d take them…you know, just to numb out.”
Levels
of
Validation
(Linehan, 1997)
Level 1: Being acutely attentive
Level 2: Reflecting verbal communication
Level 3: Describing non-verbal communication
Level 4: Expressing how experience makes sense given history or biology
Level 6: Being in genuine, human contact
• Level 5: Expressing how experience makes sense in the present moment and context
Reciprocal Communication
Engaging and responsive, taking clients wants and needs seriously
Being authentic and genuine, not staying in a “therapist” role
Using self-disclosure thoughtfully in the service of therapy
Sharing benign and human examples of skill use and practice
Using examples of how you have approached and solved a problem
Sharing when you would have felt, thought, or responded similarly to how a client reports in a given situation
Sharing your reactions to the client in the moment, providing information that manages relationship contingencies (creating new learning)
Letting the client know about the current state of the relationship, to manage contingencies or address feared reactions
Self-disclosure of Personal Information
Personal information may not relate to client or the therapy; if it is not relevant, do not share it as a rule
Observe and disclose your limits in regard to personal information when needed (ok to explore what personal inquiries mean to the client)
Never share personal problems/issues!
Does it pass the “public” test? In other words, would you share it in front of an audience of your colleagues?
Attachment Styles Case Vignettes – Group Activity
Instructions:
Read each case vignette carefully. As a group or individually, reflect on the attachment style that each vignette best represents. Be prepared to explain your reasoning based on the descriptors, memories, and emotional tone used by the client.
Can I get my own way?
Authoritarian Rule-bound low communication
Deductive discipline
Do you love me? Yes
Vignette 1 –
Permissive lack of boundaries
Authoritative develop. appropriate expectations moderate communication
Inductive discipline
Attachment
Client, 42, describes her mother as: loving, strict, warm, anxious, supportive. Her father: calm, distracted, humorous, fair, emotionally distant. When asked for memories, she shares a story about how her mother often became overwhelmed during homework help and would snap, but would later apologize and ask to talk it through. She recalls her father forgetting a school pickup once, but says he explained and reassured her when he got there. Her storytelling is emotionally coherent. She reflects on these moments with warmth, noting, “They weren’t perfect, but I always knew they loved me and wanted to do better.”
Vignette 2 –______________________ Attachment
Client, 29, describes her mother as: busy, cold, tired, efficient, unavailable. Her father: funny, charming, inconsistent, angry, gone. She struggles to recall consistent care, saying, “I think they did their best.” She quickly deflects with humor and often speaks in generalities. She minimizes painful memories and avoids emotion.
Vignette 3 –
Attachment
Client, 36, describes her mother as: loving, mean, unpredictable, confusing, everything. Her father: missing, deadbeat, sorry, sometimes-there, apologetic. She shares contradictory memories and seems distressed while speaking. Her language becomes chaotic, jumping between blame and guilt. She cries and then laughs inappropriately.
Vignette 4
Attachment
Client, 31, describes her mother as: affectionate, nervous, talkative, critical, overbearing. Her father: absent, silent, serious, stressed, working. When asked for memories, she gives several detailed examples of calling her mother repeatedly at work to be reassured she wasn’t angry. She reports being punished one moment and smothered the next, and says, “I always felt like I had to prove I was good enough.” Her tone is anxious, her narrative is linear but emotionally intense, and she seeks reassurance from the interviewer.
Subject's Background
Interviewer: Can you tell me a little about your background?
Subject: Sure. I'm originally from Memphis, born in 1981. Back then, it was a smaller town, you know, the kind where you didn't have to lock your doors. There was a sense of safety and a closeknit neighborhood vibe. I was the middle child in our family, living in a poorer neighborhood. I had an older sister and a younger brother. We were raised by two moms. My biological mom was the main breadwinner of the family. The other mother, whom I'll refer to as JC, presented in a more masculine way and was the more nurturing and engaged one of the two. My biological mother, on the other hand, was quite the opposite. She presented herself in a very feminine manner and made it clear that she was the 'prize' or the 'queen' of the house. We were often reminded, almost as if we were born to be her personal slaves. I remember running to put her shoes on for her. In terms of discipline, it was a bit of a mixed bag. My biological mother was quite permissive, and JC was maybe too nurturing. We didn't get punished a lot. I found myself in a parentified role early on, being the one who always did the right things and was considered the smart one. Things changed when my mother left JC. That's when I really stepped into a parental role. A stepfather was brought into the picture, and our family dynamics became somewhat polyamorous. It was a period marked by a lot of chaos, but I managed to navigate through it pretty well. As for my biological father, there was no real connection there. He came around once when I was about five years old. I didn't even know who he was until after he left. I haven't seen him since then.
Subject's Description of Biological Mother
Interviewer: Can you give me five adjectives to describe your mother in relation to you as a child between the ages of 5-12 years?
Subject:
1. Absent (Valence: ) Age: 7
Story Associated: She was always gone. We would get up in the morning and JC would be there, making a beautiful breakfast spread. I didn’t see my mother until around 6-7pm. By the time she came home, we were already back at the house, getting ready for bed.
2. Threatening (Valence: ) Age: 7-8
Story Associated: I remember watching her get into fights with JC. I would come downstairs to see her throwing plates at JC, yelling, and screaming.
3. Beautiful (Valence: ) Age: 11-12
Story Associated: JC absolutely adored her. JC would write about her, and I would read these descriptions, always portraying her beautifully. When she came home, her uniform was still neatly pressed, she smelled good, and her makeup and hair were perfectly done. She had this long, luxurious “Wave Nouveau.” She was larger than life, like a queen or a godlike figure. We would run to her, take o^ her shoes, and ask about her day.
4. Firm (Valence: )
Age: 6
Story Associated: It was usually JC who would inform us that we had done something wrong and that she would let my mother know. My mother didn’t administer the punishment herself; she would instruct JC to do it. This involved switches, belts, and watching them get beaten down. JC would get us in the plank position for this.
5. Nonchalant (Valence: )
Age: 6
Story Associated: I recall an incident outside where my brother got a green machine, I got a pink big wheel, and my sister got a bike. My sister picked up a piece of plastic with a point on it and hurt me. JC came out when my brother called. When this was told to my mother, she didn’t discipline my sister. It felt like she didn’t defend me. The situation was quite threatening.
Subject's Description of JC
Interviewer: Can you describe JC, who you referred to as your father figure, using five adjectives?
Subject:
1. Creative (Valence: )
Age: 7
Story Associated: We had so much fun together. There are countless memories of good times. We would create songs, making sounds and trying to harmonize. JC taught us all kinds of di^erent songs. It was a really creative environment.
2. Adventurous (Valence: )
Age: 10
Story Associated: JC definitely sparked the adventurous side of me. She had been in the military and traveled abroad, and I loved hearing about her experiences. She encouraged me to explore, leading me to spend a lot of time in the library, befriending librarians and discovering new things. She really ignited those interests in me.
3. Nurturing (Valence: )
Age: 7
Story Associated: JC taught me how to cook. She made homemade biscuits and dumplings and was always cooking. I would watch and learn, and she let me try and fail without any fuss. Another thing - my biological mother wasn't into hugs and kisses, she would push me away. But JC was the opposite; she allowed hugs, kisses, and leaning on her. I've made sure to give my child as much a^ection as she needs, thanks to JC.
4. Present (Valence: )
Age: 12
Story Associated: JC was always there for me. She was involved in everything I did. Even when I was in magnet schools and she didn't understand the material, she would sit with me, trying to help. She also established structured processes for our activities, ensuring our success.
5. Weak (Valence: ) Age: 7-8
Story Associated: I realized this when I would talk to JC about my feelings and question why she let my mother treat her the way she did. Her response was always about love. That made me question the nature of love and what it meant to be strong in a relationship.
Subject's Experiences
Interviewer: Which parent would you say you were the closest to, and why?
Subject: I was closest to JC. When she left when I was 15, I wanted to go with her but wasn’t allowed. I really clung to the nurture I got from her. The discipline I got from my mother was more like neglect, whereas JC gave me...
Interviewer: Can you tell me about a time when you were emotionally upset as a child, and what happened?
Subject: [Long pause] I think I was emotionally upset when I was 5. There was an incident with a maintenance man who gave my brother and me lollipops through the window into the room where we were taking naps. The lollipops were taken from me, and I was told that I didn’t take care of my brother. I felt shame and guilt. I felt jealous of my brother but not fear as my mother came home. My mother got huge and big and then turned on JC, and JC got blamed. I felt bad for JC. It was not dealt with, and it’s a story where I dropped the ball in defending my brother, and I became the person to defend others and had to forgo my pleasure for others.
Interviewer: Can you tell me about a time when you were physically hurt as a child, and what you did?
Subject: The only thing I can think of is scraped knees, and JC came to my rescue. [foggy memory] I was playing, running, scraped my knee after falling o^ the wall, fell down, scraped both knees, crying, and JC would come for it.
Interviewer: Can you tell me about a time when you were sick as a child?
Subject: When I would get sick, JC would come with Vicks VapoRub, covering our bodies, and blankets to sweat it out. I remember anytime we got sick, this was the first thing we would do. We would get soup and blankets. I don’t remember even being tucked in.
Interviewer: Were your parents a^ectionate with you?
Subject: JC was very a^ectionate. She wouldn’t initiate hugs or kisses, but...
Interviewer: Did you ever feel rejected as a child?
Subject: Oh yes, my mother rejected me all the time. She was always pushing away aggressively.
Interviewer: Tell me about a time you felt frightened as a child?
Subject: I remember feeling frightened when I thought JC might be hurt by glass being thrown at her, and she got cut. I haven’t been specifically frightened...
Interviewer: Tell me about a time you felt threatened as a child?
Subject: Yeah, that’s what I wanted to use before. I think I stepped into this when I was 11-12, and we all would get threatened to be beaten, and I would take ownership...
Interviewer: Were you ever abused as a child?
Subject: Circumstances were neglect, emotional abuse. By whom? My bio mom. E^ects? I'm still working on it even now, not putting myself on the backburner, giving myself rest, not overthinking everyone else, and trying to be a pacemaker for everyone due to a lack of having to figure it all out on my own because I didn’t have guidance. I craved unconditional love with nurture and discipline (nurture, no discipline, only toxicity). I might overdo it with myself and am working on making it healthier.
Interviewer: Did you endure any other type of trauma?
Subject: Ages: 15. Circumstances: JC leaving. E^ects: I knew I would have to do it all, lost support, and I had to be mama. I was called granny in high school. I developed my own inner child that wants to be wild and free.
Subject's Adult Experiences
Interviewer: How is your current relationship with your mother?
Subject: My bio mom lives with my stepfather, who moved in with us when I was 15. I’m embarrassed by her and wouldn’t want anyone to know that I’m related to her. I don’t want to be a part of it. I did a 180, and then I realized that I had to see the qualities that I do share with her.
Interviewer: How is your current relationship with your father/JC?
Subject: I could have gone with her. My mother took me over to her house to have a conversation, and JC told me how we couldn’t be together. There was no communication after that. I wrote to her, and she wrote back, ending the relationship. She told me she is a reminder of a life she no longer has and that she goes to church now and can’t introduce me as her daughter. This has been since I was 19 or 20 years old.
RELATIONSHIP WITH CHILDREN
Interviewer: Do you have children?
Subject: Yes, a daughter, 9 years old.
Interviewer: Why did you choose to adopt or have a child?
Subject: I’ve always wanted her. I wanted a child at 16, but I used to take care of my cousins. I named her before she came along. I was 29 and had her despite having polycystic ovarian syndrome. I named her Acire, which is my name backwards. I wanted her more than I wanted a husband, as I had a husband before. He was praying for her too. I had a child because I’m a mother. I also wanted to be a mother that a child would choose.
Interviewer: Have you ever been separated from your child/children?
Subject: Yes, and it’s great. She is with her father every other month. He lives in Knoxville, which is 2 hours away. I’m not big on Christmas but I’m big on birthdays. Before her father was signed up, I was parenting her like JC parented me. She turned into a beast like my mother. We went four months with her being with her father, and now we go back and forth, and it’s been great.
Interviewer: What are your wishes for your child/children?
Subject: I wish for her to be exactly who she sets out to be. I already know that. She is a gift from God. I’m supposed to take care of that gift, but she is not mine.
Interviewer: What did you learn from your own childhood?
Subject: I learned [pause] that balance is so important, and I strive for it every day in my life. I felt so involved in my community and with my family. I belonged. I feel like that is what I am seeking to belong without being too attached. Attached but unattached. There is a faith that it's going to turn out as it's supposed to. So then she can get the overflow.
Case Study Handout – Adult with BPD + Attachment Trauma
Client: A 32-year-old female with a history of abandonment, emotional abuse, and chronic invalidation. Diagnosed with BPD and PTSD. Frequently enters therapy dysregulated, demands reassurance, and panics with perceived therapist distance.
Reflection Prompts
1. What DBT skill sequences might support her in-session?
2. How would you use validation without reinforcing dependency?
3. Where might DBT offer containment without control?
Optional Follow-Up
Sketch a sample treatment plan for the next three sessions using DBT skills that support emotional containment and relationship safety.
Case Vignette Handout – Complex Attachment & Neurobiology
Client: A 42-year-old woman, raised in Memphis, TN, in a family with two caregivers her biological mother and a paternal figure named JC.
From ages 5–12, her experience with her biological mother was marked by emotional inconsistency, neglect, and power imbalances. Descriptions included: "absent," "threatening," "beautiful," "firm," and "nonchalant." While her mother was perceived as physically attractive and commanding, she was emotionally distant and often aggressive. The client described instances of emotional abuse, including being neglected during illness, invalidated during distress, and blamed for sibling conflicts.
In contrast, JC was described with warmth: "nurturing," "creative," "adventurous," and "present." JC was emotionally available, affectionate, and helped the client build a sense of capability and identity through shared activities like cooking, music, and study. However, the client also perceived JC as "weak" for tolerating mistreatment from her mother, creating internal confusion about love and boundaries.
At age 15, JC left the household, a loss the client described as profoundly traumatic. She internalized responsibility, assumed a caregiving role, and earned the nickname “granny” in high school due to her maturity. As an adult, she describes lingering shame and emotional distancing from her biological mother and unresolved grief toward JC, who cut off contact.
The client now has a 12-year-old son. She is conscious of her parenting patterns and strives to balance nurture with structure, often reflecting on her own childhood to inform her parenting choices. She experiences the effects of early trauma in her nervous system, particularly in over-functioning, chronic guilt, and relational hypervigilance.
Group Reflection Prompts
- Which neurotransmitters show up in this client’s story?
- What systems are under- or over-developed?
- What would mindfulness support look like early in this case?
Case Study Breakout – Jordan
Jordan is a 15-year-old male referred for chronic school avoidance, irritability at home, and increasing isolation. His mother reports he was a “sensitive” child with early separation anxiety. At age 8, he witnessed a violent home invasion in which his father was assaulted. His father left the family shortly after the incident, and Jordan has not seen him since.
Since then, Jordan experiences frequent nightmares, a persistent startle response, and episodes of shutting down when overwhelmed. At school, he is often silent or disengaged, becoming defiant when asked to participate. At home, he spends most of his time in his room playing video games and avoids family activities. His mother describes him as either “exploding or disappearing.”
Small Group Discussion Prompts
1. Which emotional systems (Panksepp) appear dominant, suppressed, or dysregulated?
2. What patterns of hyperarousal or hypoarousal do you observe in Jordan?
3. Which core organizers of experience (Ogden) are most impacted?
4. How might you begin to apply DBT emotion regulation skills to support his development?
DBT Triad Practice – Relational Trauma & Skill Integration
This practice invites you to explore how DBT skills function in real-time relational dynamics involving trauma and anxiety.
Triad Roles
- Client A: Presents with relational trauma and anxiety. Consider themes such as fear of abandonment, emotional volatility, or boundary confusion.
- Therapist B: Offers DBT-based support using validation, interpersonal effectiveness, and mindfulness-based responses.
- Observer C: Notes how the therapist paced the conversation, introduced DBT skills, and responded to dysregulation.
Suggested Flow
1. 5-minute roleplay (therapist and client)
2. 2-minute feedback from observer
3. Rotate roles
4. Debrief as a triad
Integration Prompts
• What skill seemed most effective in grounding the interaction?
• How did tone, pacing, and presence affect the therapeutic moment?
• What would you keep, shift, or refine in your next attempt?
Reflection Question
What skill do you tend to lean on in high-stakes relational moments and what new tool do you want to practice more intentionally?
