Neurorelational Framework
Model Case:
Selective Mutism
Jessica Richards, MS, LSW, LCSW
IFECMHS and RFP II
Jessica@hp3ba.com
www.the-nrf.com
Outline
•
•
•
•
•
•
•
Model Case- background, Step 1
Break (about 10:30)
Model Case- Step 2 and 3
Lunch
Applying the NRF to your case
Break
Case presentation-Cathy Pope
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
1
Neurorelational Framework
Integrating Cultural
Competence with the NRF
I would like to know:
What are your Critical Questions that you need to
know in order to proceed with your learning
process through the day?
Lingering thoughts?
Things to be clarified?
Questions #1 & 2
1. Memories are based upon:
a. Recall of the stories we can tell
b. Sensory fragments***
88 to 100%, +12%
2. Procedural enactments are:
a. Verbal narratives
b. Non-verbal narratives***
c. Acting older than one is
d. Acting younger than one is
88 to 82%, -6%
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
2
Neurorelational Framework
Question #3 & 4
3. Young children with traumatic histories most often identify
with the role of the:
a. Victim
b. Perpetrator***
c. Protector
32 to 86%, +54%
4. When one has lost developmental gains:
a. Keep moving forward in order to not waste time
b. If possible, take a break from treatment to reduce stress
c. Recommend returning to the previous conditions
wherein development was progressing***
88 to 95, + 7%
Question #5 to 8
___ 5. Feelings of loss and sadness
Blue Zone 96% 91%
-5%
___ 6. Feelings of being violated
Red Zone
72%
91%
+19%
___ 7. Feelings of safety, joy, and pride
Green Zone
100%
100%
0%
___ 8. Feelings of fear and anxiety
Combo Zone 68% 95% +27%
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
3
Neurorelational Framework
Question #9
One cannot know how to work with a young child unless one
gets a thorough history. T F***
from 28% to 95%, + 67%
Confidentiality Pledge
•  We are honored to share a family’s
struggles
•  We respect the journey
•  We commit to keeping privacy to this day,
in this room, for these families
•  We use the descriptive terms such as “the
baby in the Blue Zone and the toddler in
the Red Zone” to keep a collegial
conversation alive
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
4
Neurorelational Framework
3 key concepts, 3 key steps
3 Key Concepts
•  Toxic stress disrupts early
brain networks
•  Relational “serve and
return” process builds
strong circuits
•  Brain architecture is built
upon lived experiences
3 Key Steps
•  #1 Reduce/eliminate toxic
stress in relationships (roots)
•  #2 Improve the quality of
engagement (trunk)
•  #3 Support individual
differences & remediation of
brain networks (branches)
UCB, C. Lillas, © 2014
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
5
Neurorelational Framework
Dandelion or Orchid?
Four Brain Systems:
Macro & Micro Levels
Early Care &
Education
EXECUTIVE
RELEVANCE
Mental
Health
• Emotions
• Memories
• Meaning-making
Child
Welfare
•  Nutrition
• Sleep/awake cycle
• Stress & Stress
Recovery
REGULATION
• Motor planning
• Plan & sequence
• Theory of mind
• Language
Basic Needs/
Medical
• Sensations
• Processing &
Modulation
• Speech
SENSORY
Developmental
Disabilities
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Lillas & Turnbull, 2009
6
Neurorelational Framework
Brief Family History
•  Began treatment 3/2013 when A was 3.5 yrs.
Currently, 6 y.o.
•  Parents, mid/upper 30’s
•  Father has son from previous marriage 10 years older
than A. Joint custody.
•  Mother is employed doing developmental assessments
for adults. Mother in treatment for anxiety and
depression (hx).
•  Father lost his job during client infancy and has been
unemployed for 5 years.
•  Couple in tx for martial stress/strife
Four Brain Systems:
Early Care &
Education
EXECUTIVE
Dyadic
Collateral
Couples
Routine
Child pediatrician care
Welfare Loss of father’s
income
Referral to
psychiatrist
Transdisciplinary
Sensory support
REGULATION
Mental
Health
RELEVANCE
Day care at 2, then
preschool at 3
Basic Needs/
Medical
SENSORY
Developmental
Disabilities
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Lillas & Turnbull, 2009
7
Neurorelational Framework
Sleep & Stress Patterns
Sleep Cycles:
A sleeps from 9:30 pm to 7:30/8:00 am sleeps straight
through the night and has been since 14 weeks w/o “training”
at 3 napped 1-2 hours
Total sleep 10-11 hours
Mom sleeps 7-8 hours light sleeper but generally falls back to
sleep
Dad sleeps 7-8 hours
Stress Patterns:
A (weekend) 20% red, 40% combo, 0% blue, 40% green
A (weekday) 20% red, 60% combo, 0% blue, 20% green
Mom 40% combo, 40% green, 10% red 10% blue
Father 40% red, 40% green, 20% combo
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
8
Neurorelational Framework
A Baby’s A Baby’s Flooded State: Lillas & Turnbull, © 2009
Connie Lillas, PhD, MFT, RN © 2010 Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
9
Neurorelational Framework
A Baby’s Shut-­‐Down State Lillas & Turnbull, © 2009
Connie Lillas, PhD, MFT, RN © 2010 A Baby’s Vigilant State: Lillas & Turnbull, © 2009
Connie Lillas, PhD, MFT, RN © 2010 Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
10
Neurorelational Framework
A Baby’s Vigilant State: Lillas & Turnbull, © 2009
Connie Lillas, PhD, FT, RN © 2010 Using States of Arousal with
Is's/he'in'the'“Green”?'
'
Are'you'in'the'“Green”?'
Adapted'by'Jessica'Richards,'LSCW'
Lillas'&'Turnbull,'2009'
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
11
Neurorelational Framework
“Just Right”
Bright, Shiny eyes
Alert
Fussy
Spacey
Tuned out
Upset
In own world
Tantrum
Frozen
Rage/Flooded
Anxious
Fear
Panic
Adapted by Jessica Richards based on
Lillas & Turnbull, 2009
Using States of Arousal with
•  When is the child in the red, blue or combo zone (tendency?) •  When is the child is in the green zone •  The goal is to expand the amount of time the child is in the green zone – this is where learning and social emotional growth occur •  What is the stress response tendency in the parent (triggers)? •  When is the parent in the green zone? •  When are you in the green? Jessica Richards, 2012 Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
12
Neurorelational Framework
“Just
Right”
Fussy
Spacey
Tuned out
Upset
Tantrum
In own world
Rage/Flooded
Frozen
Anxious
Fear
Panic
States of Arousal for ALL!! •  Parallel process – caregiver must be regulated (green zone) to co-­‐regulate child •  Therapist/teacher must also be in the green zone to effectively work with caregivers and kids •  True for them, true for you •  Put your oxygen mask on first! Then, help your clients! Jessica Richards, 2013 Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
13
Neurorelational Framework
Colored Zones are the background
to Emotional Regulation
Physiology
Under Coordination
Child
Green
Parent
Under Stress
Child
Parent
At home, with parents.
Joy
No deadlines.
Zone
Combo
At home. Financially stable.
X
X
Zone
Red
X
X
X
X
X
1
M
F
Anxiety “Zombie”
1
2
Keyed up
Quiet
.
internally
worry
2
2
1
Angry, protest,
Mad,
Mad,
yelling, defiant
confrontati
digs in
onal
heels
Zone
NA
Blue
Zone
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
2
X
X
depressed
X
14
Neurorelational Framework
Heart, Hand, and Head Patterns
Under Coordination
Under Stress
Child
Parent
Child
#1
Heart
Sweet,
M #1
affectionate
Loving,
thoughtful
F3#
considerate
#2
Assertive
Hand
Head
decisive
Plans well
M #2
F #1
M #2
NA
.
F #1
tasks
#3
M 3#
F #2
Appreciates
Seeks a
knowledge/ framework to
info
F #2
Doer, good at
Guided self
reflection
M #1
#1
#2
M #2
Parent
understand
#3
Parallel Process
•  Important information about how this family
impacts my stress levels (step #1)
•  How does this child/parent impact my
relational style?
–  Brings out my Heart/Hand/Head at my best
–  Can stimulate my Heart/Hand/Head at my worst
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
15
Neurorelational Framework
Parallel Process
•  My tendency Combo zone
•  Easy family to engage with largely Green
•  Pulled toward combo if client was SM in
session
•  Family brings out my warm, empathic
heart
•  A’s age and parents’ anxiety and urgency
pulls out my structured hand
•  When client and parents are under stress I
am prone to Combo if I don’t utilize my
toolkit
Heart, Hand, and Head Patterns
Under Coordination
Under Stress
Overly
accommodating
Heart
1s
Hand
2s
Warm
Empathic
Connect
Repair
Functional helper
Share info.
Make contact
Cross-sector
communication
Take the lead
Assertive
Confront
Directive,
Stand up
action oriented Notice and share
differences
Overly
controlling
Anxious to fix things
Overly demanding
Blaming the victim
Hostile attack
Blaming the system
Take responsibility Overly detached
Overly dismissive
Learn,
ask,
&
Passive-aggressive
Reflective
notice the impact anger
Denial
Problem-solve Dr. Valerie Batts
Neutral
Head
3s
Dr. Connie Lillas
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Dysfunctional
rescuing
Dr. Connie Lillas
Passive avoidance
Antagonistic
avoidance
Denial of differences
across domains
Dr. Valerie Batts
16
Neurorelational Framework
NRF Guiding Principles
•  During assessment in Step #1, map out the
Duration, Intensity, and Rhythm (DIR) of the
stress zones during the awake cycle. This establishes
your baseline so that you know if you are making any progress or not.
Revisit your baseline parameters at least every three months.
•  Always start at the earliest point in the
breakdown. If sleep is disrupted, begin with addressing this
aspect. If green zone is disrupted, begin with this goal as well. This
principle applies to all three steps. Step #1 is the First Level of
Engagement and the First Brain System, Regulation.
NRF Guiding Principles
•  In the regulation system guiding priorities are
intervention for sleep, feeding, and other
physical health issues that must be addressed
while moving forward.
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
17
Neurorelational Framework
Step #2 Levels of
Engagement
“Serve and Return” on All Levels
Step 2: Levels
of Engagement
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
18
Neurorelational Framework
Case #2
PARENT-CHILD RELATIONSHIP MILESTONES
Child: ______________Caregiver: ___________________ Examiner:_________________ Date: ________Diagnosis: __________________
Place an X in the box that
matches the milestone and
achievement levels
1
Age appropriate
under all
conditions,
including stress,
with a full range
of emotions
2
3
Age appropriate but Has capacity but
vulnerable to stress not at age
and/or constricted
appropriate level
range of emotions
4
Inconsistent/needs
sensorimotor
support and
structure to
function at this
capacity
5
Barely
evidences
capacity even
with support
6
Has not reached
this level
Functional Capacities
BOTTOM-UP
Level 1. Getting Calm (Green
Zone) Together (by 3 months)
These functions are built upon the capacity to be calm together
Level 2. When calm, able to
make eye contact & look at
faces
(by 3 months)
Level 3. When making eye
contact, able to share joy &
fall in love (by 5 months)
Level 4. When sharing joy,
able to create a continuous
back and forth flow of
communication (“circles”)
(by 9 months)
Level 5. When in a flow, able
to expand and read nonverbal emotional & gestural
cues (by 13 to 18 months)
TOP-DOWN
Level 6. When reading cues,
able to share feelings with
others through pretend play
and/or by talking (by 24 to 36
months)
Level 7. When sharing
feelings, able to make-sense
and solve problems together
(by 36 to 48 months)
DIR® Institute adapted from the DMIC, ICDL Press
Original functional levels from ICDL’s FEDL; adapted language & organization by Connie Lillas
Parallel Process
•  Important information about how this family
impacts my levels of engagement (step #2)
–  During collateral sessions, up to level 7
•  How far up the levels of engagement ladder
can you get with the parent? The child?
•  With clt, up to level 6 initially with support
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
19
Neurorelational Framework
Levels of Engagement & Functional Capacities
SOCIAL EMOTIONAL MILESTONES
5
4
5
4
Funtional Cpacities
4
5
0
Levels of Engagement
Information gathered from the “Parent-Child Relationship Milestones”.
Levels of Engagement
Level
Ranking
Description
1. Calm
Highest:
Green together reading books or snuggling
Together
Lowest:
Both red locked in conflict
2. Eye
Highest:
Looking at each other’s face during back and forth flow
contact
Lowest:
A in fixed stare can’t connect to parents
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
20
Neurorelational Framework
Starting Bottom up with Rody
bounce – JOY
Rody licks- quiet and loud
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
21
Neurorelational Framework
Levels of Engagement
Level
Ranking
3. Sharing joy
Highest:
Lowest:
4. Circles of
Highest:
communication Lowest:
Description
Tickling, swinging, physical play with high mutual joy
Angry, upset, yelling
7+ circles in a back and forth flow
No response or can’t close circle
Bouncing on Rody
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
22
Neurorelational Framework
Mommy is Rody
Elephant kissie
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
23
Neurorelational Framework
Levels of Engagement
Level
Ranking
5. Reading
non-verbal
cues
6. Sharing
emotional
themes
Description
Highest:
Socially references, reads escalating body cues
Lowest:
Locked into her know stress response, doesn’t see cues
Highest:
Pretend play with themes of aggressor/protector/victim. Nurturing play themes.
Lowest:
Emotional expression and symbolic world halted during stress
7. Linking
Highest:
cause &
Lowest:
NA
effect
Snake is going to get you
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
24
Neurorelational Framework
Big Yell! Aggressor/victim
Missing Rody
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
25
Neurorelational Framework
Grumpy and disappointed
NRF Guiding Principles
•  When working “bottom-up” for zone (arousal)
regulation begin with finding the child’s
individual sensory preferences and triggers.
•  For treatment, match the sensory preference
with the Duration, Intensity, and Rhythm (DIR)
for the child’s nervous system that promotes
sleep, the green zone, and stress recovery.
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
26
Neurorelational Framework
NRF Guiding Principles
•  Sensory thresholds vary with each child and
with each context. Matching or countering the child’s zones of
arousal are guided over time, with experimentation, and by watching
the effect on the child’s ability to regulate to sleep and to the green
zone.
•  The child’s arousal patterns and procedural history are
your guide, not the particular “treatment” or EBT you are
using. Individual neurodevelopment that is
trauma informed trumps the EBT. Practice
flexibility with stability.
•  Change does not occur in a straight line. Always
leave the door open for a family to return to you.
Matching or Countering the
Sensory Modality
Low Intensity, Slow
Rhythm
High Intensity, Fast
Rhythm
Match
Match
Lower lights and sounds
Lower tone of voice
Slow down vocal rhythm
Slow down facial expression
Slow movement
Increase lights and sounds
High pitched tone of voice
Rapid vocal rhythms
Bright facial expressions
Fast movement
Counter
Counter
Increase lights and sounds
High pitched tone of voice
Rapid vocal rhythms
Bright facial expressions
Fast movement
Lower lights and sounds
Lower tone of voice
Slow down vocal rhythm
Slow down facial expression
Slow movement
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
27
Neurorelational Framework
Four Brain Systems
Vulnerability of 4 Brain Systems
5
5
4.5
# OF RISK FACTORS
4
3.5
3
3
3
2.5
2
2
2
1.5
1
1
1
0.5
0
0
Regulation
Sensory
Relevance
Executive
BRAIN SYSTEM
Mom
Four Brain Systems:
Macro & Micro Levels
Child
Early Care &
Education
EXECUTIVE
RELEVANCE
Mental
Health
• Emotions
• Memories
• Meaning-making
Child
Welfare
•  Nutrition
• Sleep/awake cycle
• Stress & Stress
Recovery
REGULATION
• Motor planning
• Plan & sequence
• Theory of mind
• Language
Basic Needs/
Medical
• Sensations
• Processing &
Modulation
• Speech
SENSORY
Developmental
Disabilities
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Lillas & Turnbull, 2009
28
Neurorelational Framework
Four Brain Systems:
Early Care &
Education
Day care at 2, then
preschool at 3
Excels in academics
Rigid with routines
Custody shift of
Full term
brother at 3 –
Good sleeper
Robust health
loss
Child
Slim but eats range
Moves at 2 and
Welfare
and + nutrition
4
REGULATION
Mental
Health
RELEVANCE
EXECUTIVE
Basic Needs/
Medical
Prenatal Maternal
Auditory sensitivity Stress
Seeks tactile
Fidgeter
Over reactive to pain
Strong verbal skills
SENSORY
Developmental
Disabilities
Lillas & Turnbull, 2009
NRF Guiding Play Principles
•  Always work with developmental age, not the
chronological age
•  When moving up the developmental ladder,
consider procedural enactments as part of the
emergence of emotional memories that are not
always symbolized through symbolic play or
with a verbal narrative
•  “Pretend” play can hold procedural memories
that are not yet verbalized into a “verbal
narrative” yet embody a “body narrative”
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
29
Neurorelational Framework
NRF Guiding Play Principles
•  Procedural memories that are not yet
verbalized can help us understand traumatic
memories that are lodged in the body
•  These are now “sensory fragments” (this is
what memories are) lodged in the “relevance”
system that shape our meaning-making
experiences
•  While useful, one does not always have to
“know” the history of the child to work with
the child. “The brain is a historical organ.” (B
Perry)
NRF Guiding Play Principles
•  While following the child’s lead and their
interests, in general, work with expanding their
emotional range from the constrictions they
have
•  Use the color wheel to see how expansive or how
constricted their emotional range is, linked with
colored zones
•  With trauma link the aggressor with the victim
(old) with a protector (new)
•  Many times young children take on the role of
the aggressor (red zone) as a “one size fits all”
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
30
Neurorelational Framework
“Micro” Level Overview
•  Regula'on: Balance of 24-­‐hour Sleep/Awake Arousal deep sleep, green zone and stress responses •  Sensory: Balance of Processing & ModulaGon of SensaGons •  Relevance: Balance of pos/neg EmoGons, Memories, & Meanings •  Execu've: Balance of iniGaGng and sustaining thoughts, behaviors, & acGons •
•
•
•
•
Prenatal Maternal Stress Frequent Combo Zone Good sleep Strong verbal language Appears easily oversGmulated with people and toys •  OverreacGve to pain •  Resistant to boundaries •  Loss/Longing for brother •  PerfecGonisGc •  Does not speak with new or novel people •  Rigid with rouGnes •  Very slow with transiGons •  Lack willingness to try new things Regula'on System -­‐Triggers Behaviors Observed Frequent combo zone Possible Underlying ExplanaGons •  No procedural memories of green zone in new seUngs •  Biologically “primed” for anxiety •  Cross over with sensory Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
31
Neurorelational Framework
Sensory System -­‐Triggers Behaviors Observed Possible Underlying ExplanaGons Over reacGve to pain SensiGvity to certain vocal qualiGes •
•
•
•
Acute sensiGvity Few soothing resources Gets “stuck” On a sensory level triggers a stress response Relevance System -­‐Triggers Behaviors Observed Possible Underlying ExplanaGons Loss and longing for brother Resistant to boundaries PerfecGonisGc •  Procedural memories of joy fuel longing…brother was a be[er player? Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
•  Limits are a denial/blocked goal but also require fast “shi]ing” to comply (ExecuGve challenge) •  Wants it “right” seeks control, difficulty shi]ing 32
Neurorelational Framework
Execu've System -­‐Triggers Behaviors Observed Possible Underlying ExplanaGons Rigid with rouGnes Lacks willingness to try new things Very slow transiGons •  Challenges with shi]ing, rouGnes decrease anxiety and are comforGng •  Poor or few posiGve procedural memories of new experiences •  Gets “stuck”, current task is familiar/comforGng Regula'on System -­‐Recovery Resources Behaviors Observed Frequent combo zone Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Resources A[empted / Implemented •
•
•
•
•
•
•
Deep breathing Adequate food/snack Adequate sleep Sensorimotor play Giraffe lovie Sensory deep pressure sandwich Jokes/humor 33
Neurorelational Framework
Sensory System -­‐Recovery Resources Behaviors Observed Over reacGve to pain SensiGve to certain vocal qualiGes Resources A[empted / Implemented •
•
•
•
•
Deep pressure Low volume Slow rhythm Subdued affect/intensity Role play (later in treatment) of social scenarios with “trigger” people Relevance System -­‐Recovery Resources Behaviors Observed Loss and longing for brother Resistant to boundaries PerfecGonisGc Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
Resources A[empted / Implemented •  Calendar for brother’s visits •  Pretend play with roles of aggressor/vicGm/
protector •  For every “no” there was at least one “yes” •  Verbal processing of past event •  Board games to build up emoGonally muscle •  CelebraGng successes •  Enhancing emoGonal vocabulary including intensity raGng •  “sloppy” art acGvites 34
Neurorelational Framework
Execu've System -­‐Recovery Resources Behaviors Observed Rigid with rouGnes Lacks willingness to try new things Very slow transiGons Resources A[empted / Implemented •  Encouraging flexibility (playfully) •  Pretend play with playful novelty •  Role play (later in treatment) of new situaGons •  Wrote social stories together in anGcipaGon of new events/acGviGes (i.e. soccer) •  StarGng a game near the end of the session •  TransiGonal warnings Soccer role play with Daddy
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
35
Neurorelational Framework
Linking role play to peers
Prep for mad
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
36
Neurorelational Framework
Parallel Process
•  Important information about how this family
impacts my brain systems (step #3)
–  No specific triggers present
•  What brain systems are you using easily
(automatically) when working with this dyad?
–  Relevance, sensory
•  What brain systems are you using by exerting
conscious control (deliberately) when working
with this dyad?
–  Executive
Connie Lillas, PhD, MFT, RN
infantmentalhealth@earthlink.net
www.the-nrf.com
37