Trust-Based Relational Intervention
Karyn Purvis Institute of Child Development at TCU
TBRI is an attachment-based, trauma informed intervention designed to meet the complex needs of vulnerable children.
“Fear must be calmed through connection and nurturing before we can address specific behaviors“
At-risk:
Difficult pregnancy/difficult birth, early hospitalization, abuse (physical, sexual, etc.), neglect, trauma (surgery, natural disaster)
Compassion and Insight to Trauma
TBRI is a research based set of principles designed for at-risk children or children from hard places to provide deep healing for the WHOLE child, without force. These children missed having their earliest needs met and the consequences can linger even after a child has left a place of hardship. What has not happened may be as or more important of what has happened - either case, the best way to heal trauma is through healthy relationships and attachment. The goal of TBRI is to empower children to understand what is happening in their own mind and body, rewire and change responses in the future, and ultimately change their belief system by intercepting negative beliefs and replacing them with the truth. TBRI uses empowering, connecting, and correcting principles to create deep and lasting change through felt safety, connection, and self-regulation. Empowering principles set the foundation for success by addressing the physical needs (body), connecting principles let the child know that they are safe through attachment (spirit) and together they make the correcting principles successful (mind/soul). The earlier a child receives intervention, the more opportunity there is for the body and brain to heal, resulting in more impressive behavioral gains. However, the human body is powerful, and the brain can physically create new neural connections over the entire lifespan, demonstrating it’s ongoing flexibility (plasticity) - meaning it is never too late for healing!
TBRI uses eye contact, physical touch, voice control, behavior matching and play to form relationships with children and help regulate them. Eye contact allows us to mirror the preciousness of the child, behavior matching shows them that they belong, and play allows us to safely touch the heart of the vulnerable child. We are the primary regulators for children so mindfulness for ourselves equips us to do the rest of TBRI. An example of this: it is easy to be mindful doing yoga on the beach but we have to practice also being mindful when a kid is screaming and testing limits. Mindfulness means being present but also being aware of what each of us are bringing to the interaction based on history, sensory needs, etc.Attachment is formed by patterns and babies typically have a pattern of attachment pegged by 1-1/2 years old. Babies learn attachment very early as “when I cry, my caregiver will meet my need” and that the best way to bring their caregiver close and to be able to calm down is to cry. A caregiver responding to the cry validates that the baby is so important — that when they cry, it means something. This is the basis for self-regulation and self-esteem and so many children often miss the joy of human companionship and security through attachment.TBRI promotes executive functioning through joyful, playful, active, pervasive, relational, and challenging interactions. Along with healing, this leads to improved focus/attention, working memory, self-regulation, creativity, flexibility, and planning which will in turn positively affect life, school, and peer dynamics. Playfulness signals safety so it is important to use playfulness and positive feedback whenever possible. Assume a teacher role using gentle correcting to allow the child to practice safely without shame until they are able to get it right. The goal is to treat the whole child with all of his or her interrelated needs, not just one small aspect of behavior and these children with multifaceted impairments cannot be effectively healed in a single weekly session but will benefit from continued practice and reinforcement.High structure — high nurture
Draw your child closer to you when addressing bad behavior - isolation encourages a child to go off and disassociate emotionally and to focus on things/objects rather than relationships
Only ask a child to look at you (eye contact) when you can mirror their preciousness
Children need to know consequences but not in a way that engenders fear
When going through a difficult time or period of change - go look at the child while they are sleeping to be reminded of their preciousness
When you don’t know what else to do - play together!
Transitions are inherently stressful - traditions or “rituals“ help manage those transitions as well as signify completion of previous stage and signal what is next
Just because a child is safe doesn’t mean they feel safe
Calmly and firmly interrupt bad behavior - identify the need that drives it and show the child how to appropriately achieve their goal
Adopted and foster children need lots of individualized, focused time with parents in order to catch up developmentally and form close family bonds
At risk children appear to be a certain age physically but inside are playing catch-up emotionally, behaviorally, and developmentally. They are still healing from old wounds that are not visible
Remaining mindful of a child’s history will allow you to
1) admire the strength that allowed this child to survive adversity
2) have compassion for the struggles they face
Accepting feelings doesn’t mean that you automatically accept inappropriate expression of those feelings - reassure your child that everyone has feelings and it’s good to express them as long as its done with respect
A child’s world is more predictable and less stressful when a parent provides consistent structure and authority - remain calm, consistent, and in control
Even in discipline - affirm preciousness, not just absence of badness
Repetitive physical activity brings down the stress hormone cortisol and elevates the feel good neurotransmitter serotonin (but be mindful that the child doesn’t become worn out)
Use motivational (builds emotional connection, demonstrates confidence and their ability to learn) and technical coaching in equal parts
When you are trying to work toward longer-term goals — find a way to break down the big goal into smaller, accessible tasks
Create a memory book - use as a tool for talking about the past and at the same time it is a concrete symbol of how special the child is and how cherished by you they are (timeline of placements, photos, momentos, drawings, etc.)
Sandwich technique during correction - gain compliance while keeping morale up
IDEAL response
-Immediate - respond as quickly as possible
-Direct - engage with eye contact, proximity, physical touch
-Efficient - measured response that is equal intensity to the challenge
-Action-based - opportunity for re-do, practice the right way
-Leveled at the behavior - not the child
Sad children look angry, scared children look and feel crazy (endless energy—endless anxiety)
TBRI Quick Tips:
“The goal is to see the precious child that exists beneath the survival strategies and to let them know that we see them.”
— Karyn Purvis
TBRI References
Website: https://child.tcu.edu/about-us/tbri/
TBRI intro video: https://www.youtube.com/watch?v=7vjVpRffgHQ
The Connected Child: https://www.amazon.com/Connected-Child-healing-adoptive-family/dp/0071475001