Discussion of Twelve Clinical Data Points in the High Road Single-Case ABA Data
C.A. Childress, Psy.D. (2019)
Parent-Child Relationship Rating Scale (PC-RRS)
Affection (Aff): Attachment networks – blue line
Cooperation (Co): Emotional regulation – gold line
Social Involvement (SI): Arousal and mood regulation – silver line
High Road Workshop Data
The PC-RSS data from the two-days of the High Road workshop represent a truly remarkable rocket into a joyful, healthy, and happy child by the end of the 2-day workshop. The exit level data points are in the superior range. The child’s affection is 5.5, his emotional system is 6, and his mood is 6. He is immensely happy.
Of note is that this is a 2-day High Road workshop. Typically, Ms. Pruter’s High Road recovery workshops are 4-days. The actual recovery of the parent-child bond typically occurs sometime during the second day of the workshop, and then there are two additional days of recovery stabilization, structured through the workshop protocol, that takes place following the recovery of the parent-child bond of love and affection.
The data from the workshop reflects a typical half-way point of the workshop; the recovery point. Based on the data from the High Road workshop, the recovery of healthy child development occurs in the context of a very happy child. Affection and attachment bonding networks are glowing wonderfully warm and positive, emotional systems are happy and alive, and mood is wonderful. The child is relaxed and happy during the recovery of healthy authenticity. This data provides a remarkable insight into the recovery process from complex trauma. Seeking additional information from Ms. Pruter about this recovery process and how she accomplishes such relaxed joy in the child is recommended.
In the interpretation of the follow-up clinical care data for this initial ABA with the High Road protocol, it is important to note that the typical High Road workshop is an integrated intervention of 4-days, and the protocol is structured for a 4-day recovery. The additional two days of the High Road recovery workshop are important. That Ms. Pruter conducted the recovery in two-days was a feature of her response to trauma and the needs of the case for immediate response when the child became available for her workshop.
The child’s supremely relaxed happiness reflected in the day-2 recovery data from the High Road workshop is a product of the workshop, it is not the actual set points of the child’s regulation systems. They might become his set points if the child spent enough time with Ms. Pruter, but two days is not likely to alter the regulation set points of his nervous system created by three-years of continual psychological child abuse by his pathologically narcissistic father. Once the workshop is over, the child will (if recovered) return to his established neurological set points for these three regulatory systems (attachment; emotions; arousal-mood).
If the child’s ratings on the PC-RRS from the workshop are merely a product of the workshop, then the child’s functioning will collapse into disorganization and chaos once the recovery workshop ends. The initial data into the clinical care period reflects the stable set-points for the three regulatory networks (attachment systems, emotional systems, arousal-mood systems). She recovered the child’s authenticity.
(1) Set-Point for Social Involvement
It is reasonable to expect a drop in functioning evidenced on the PC-RRS data from the end of the HR workshop to entry into my clinical care a week and a half later as a natural function of his return to his established regulatory set-points, and this expected drop to set-points is reflected in the data. The entry points into my clinical care reflect the set-points for these three regulatory systems of the brain: attachment systems (Aff-3), emotional systems (Co-4), and arousal-mood systems (SI-6).
Of first note is the separation of the SI system from the other two. The SI (arousal-mood) system is two points higher than the next regulatory system, and is in the upper-range of regulation – a 6. This suggests anxiety, and likely sustained anxiety/stress, that has elevated the set-point for this regulatory system. The elevated set point also suggests that the child may use better-than-average social skills as an avenue for acquiring nurture, and as a vehicle for anxiety regulation.
A 6 set-point for SI regulation is too high. The child’s nervous system is in a chronic up-regulated state from the years of trauma exposure. The down regulatory systems of the brain are the sadness emotional networks. The 6 set-point of SI suggests inadequate counter-regulation from the down-regulatory systems of sadness. The child has unprocessed sadness. Sadness is metabolized through the attachment networks. The next clinical focus becomes the attachment system.
(2) Set-Point for Attachment
The set-point for the attachment networks upon entry into follow-up clinical care is 3. This is in the normal-range, but the Aff ratings also took the largest drop from the second day of High Road recovery to the stabilization. This may reflect the absence of the final two days of the workshop protocol. I have reviewed the protocol, and I understand how it achieves its effectiveness. The final two days are important regulatory stabilization days for the newly activated attachment networks. The 3 as a set-point for the attachment networks likely reflects the absence of the final two days of the workshop.
The entry set-points into follow-up recovery care represent the half-way set-points in these regulatory systems achieved by the High Road workshop, a snap-shot of the regulatory networks set-points at the time recovery of authenticity occurs. Of note in this regard is the higher regulatory set-point for emotional regulation systems (Co:4) than attachment systems (Aff:3). I have some hypotheses as to why this set-point configuration would occur at the mid-way point of the workshop.
Notice in the workshop data how Co (emotional networks) aligns with SI (the anxiety of trauma), in the context of a meteoric rise in affectionate bonding (Aff; attachment networks), I would offer the suggestion that during the recovery process the emotional systems lay on the trauma networks, and the trauma networks receive the elevated glow of attachment bonding (love) from the attachment networks of the child’s brain. It is my professional opinion that we are watching the extraction of complex trauma – not healing – extraction of damage to the neurological networks of the brain.
In healthy child structures, the set-point for attachment networks (Aff) is above the set-point for the protest behavior (Co), and the two systems are entrained. In the entry data into clinical care, the set-point hierarchy is inverted, and the two systems are not entrained. Based on the speed by which clinical intervention achieved both a reversal of attachment and emotional set-points and entrainment of the two systems, it is likely that this early disruption represents the missing two final days of the High Road workshop.
Additional entry data from clinical care following the full 4-day recovery workshop would be extremely helpful in interpreting this 2-day workshop data. The recovery of attachment bonding with the full 4-day workshop protocol is anticipated to be more robust.
(3) Co-2 Tiffy with Sad
My active clinical intervention does not begin until data point (5). At the first Co drop to 2, I had not applied any clinical interventions of note. In my first session I had done some stabilization, but it was mostly entry work. My second session was with the mother (that released the ratings from their High Road stabilization).
One interpretation of entry level stability is that both mother and child were afraid to do anything. The recovery was great and they didn’t want to do anything to mess it up (reflecting the missing two days of the High Road workshop that are designed to address this “deer-in-the-headlights” experience). Once I became involved as a support to mother, she became more comfortable with the recovery, and as she became relaxed the child became relaxed, and this is reflected in the release of ratings. Everybody relaxed.
Follow the Co line once my intervention releases the ratings from their High Road stability. Notice the drop to the Co-2, with a simultaneous drop in Aff to 3 and SI to 4. The drop in Co represents a protest behavior display, something hurt, or there is a growth occurring. The drop in Aff along with the drop in SI indicates sadness (down regulation of SI and lowered affectional warmth; the child is sad). The drop is to a 2 (not a 1), so it’s a tiff of protest behavior rather than a fight of conflict.
This Co-2 drop occurred three days before my next session with the mother and child, and the first active session of my therapy. Given the history of conflict in this relationship, a drop to 2 in Co is of note for recovery stability. I had not yet had time to become an active stabilizing agent for the relationship, I had unlocked the stability of Dorcy’s recovery, and Dorcy only had 2-days of her workshop protocol rather than the structured and standard 4-day recovery protocol. The mother-child bond may be fragile, and a Co-2 may collapse the recovery achieved by the 2-day workshop. I took no direct steps, but I monitored the following day’s ratings to see if my active intervention was required.
The next day, the Co rose two points, to 4. They had resolved their interaction without the need for my intervention. Attachment bonding remained stable at its set-point of 3, and SI took a 2-point hop to its set-point of 6, indicating the absence of sadness. The Co-2 tiffy with sad had been fully and successfully resolved. We discussed the incident in session and it involved miscommunication and he became frustrated (and used inappropriate language). A normal-range parent-child conflict, resolved entirely normally. We developed communication and problems solving skills in our session.
This data point, Co-2 tiffy with sad, represents an important data point in the High Road ABA recovery profile. It is the data point that indicates the degree of stability to the recovery achieved by the High Road workshop. It is entirely stable.
Before leaving the High Road stabilization phase of the data to enter my clinical care sessions, the variability in the three systems is notable. The attachment system does not vary with the other two, and there is seeming synchrony of the emotional networks (Co) with the trauma impact (SI; arousal-anxiety), which is not the desired synchrony. The nervous system of the child his healthy, but it is not yet organized.
The focus of my first therapy session was to impact the stability of the attachment recovery. I hoped to raise the set-point on attachment networks to 4 (with rises into 5), I wanted to reverse the set-points for Aff and Co (attachment higher than protest), and I wanted to entrain the emotional system (protest behavior; Co) with the attachment networks (Aff). My intervention in session 1 was on the attachment networks as the ground to organizing the regulatory systems.
(5) Session 1: 7-Spike SI
My first therapy session is indicated by the spike in SI to 7, the arousal system became very active with the material from my first session. Note also the rise in Aff to 4 and the 4-point rise in Co (loss of protest, increased emotional flexibility and cooperation). He liked my session. The rise in Aff and spiking of SI (arousal-mood) suggest he was happy, and the 4-point rise in Co indicates he was relaxed. He liked my first session.
On the following day, Aff continued to rise to 5, SI continued to spike at 7, and Co dropped one point on rebound to 5. He continues to be happy and relaxed, and attachment bonding is increased from my session.
(6) Consolidation V
Two days after my session, his nervous systems consolidate the gains from the intervention, with a rebound (bounce-back) of Aff to 4, Co to 3, and SI to 5. A nice tight synchrony of all three regulatory systems is evidenced, and in a healthy order of set-points, attachment (Aff-4) above protest (Co-3). This V shape of three systems represents the consolidation of the therapy intervention from two days previously. Consolidation occurs on the down-regulatory networks. Then watch what happens.
(7) Integration Triad
The following day, three days after the therapy session, all three regulatory networks converge on a 5 rating, high-normal. This is an integration of the therapy intervention from three days ago. Integration occurs on the up-regulatory networks. The consolidation V to the integration triad is magnificent. Then watch what happens.
(8) Synchrony: Attachment and Protest
Once the three lines converge in integration, where did the blue line go? Attachment (Aff) and emotional regulation (Co) are perfectly synchronized for the next four days, even on a one day bounce they remain synchronized. The correlation of the Aff and Co ratings before the three-line integration point is r=.60, following the three-line integration point the correlation of Aff and Co is r=.94. The two systems achieved synchrony at that three-line integration following the three-line V consolidation, and remained in complete synchrony until the intervention of my second session.
(9) Set-Point Stability
I had introduced organizing disruption followed by consolidation and integration by the intervention of my first session, and the regulatory systems stabilized into new set-points following their consolidation and integration from the therapy intervention. The new stabilization set-point for SI across 3 days was 5, one point lower than it’s entry at 6, and now in the normal-range. The new stabilization set-points for Aff and Co combined appear to be in the 4-5 range, a 1-point increase for attachment regulation from the entry levels. All three regulatory systems are within one point or less of each other.
(10) Session 2: Something to Consider
The stability of synchrony achieved between Aff and Co at the integration point continues for five days following the integration, with my interventions in session 2 becoming the disruptive agent. Session 2 of my therapy produced another immediate spike to 7 in SI, his arousal level was high.
Aff dropped by one point, and Co dropped by two, breaking their synchrony, with Aff settling on a set-point (3) one point higher than Co which dropped in the Co-2 range of “protest behavior.” I had given him something to ponder, not verbally, but in the process of our session, as I wove our session I gave him an issue to consider.
You can see the impact. His stress level went up (SI-7), his emotions became more inflexible, he’s processing something (Co-2), and he didn’t like what he was processing (drop in Aff). What happened?
He figured it out. The next day was a 3-point rise in Aff, to a 6. The last time there was a 6 in Aff was the three-line integration. Now, again, Aff and Co rejoin in synchrony at 6. The only missing component of a three-system integration is that arousal-mood is too high at 7. He’s too happy about what he figured out. That makes me smile.
Notice the nice V drop of entrainment in this “considering” episode, between the attachment system and emotional system (protest behavior system). We want protest contained within the attachment networks. Co-2 drops represent minor breach-and-repair sequences of self-individuation in a social context. The issue is not minor disagreements, it’s how we handle them. If we bring problematic things to the breach, the minor breach can turn into a major one.
Occasional Co-2 drops are healthy individuation, especially in an adolescent-age child. But we want protest behavior contained within the context of healthy attachment bonds. We want the set point for Aff to be higher than for Co, we want them entrained, and we want Aff to always remain in the normal-range or above (3-5, with occasional elevations into 6 and 7).
The entrainment Vs of Aff and Co at data points (6), (10), and (12) all reflect the desired Aff over Co organizational structure (protest behavior guided by and within the context of attachment), with Aff remaining 3 or above (normal and healthy attachment bonding), and no Co-1 (no severely painful breach for the child).
(11) Two-Day 7-Spikes
I find those two-day 7-spikes in SI from my sessions interesting. On the first session they reflect the child’s happiness and relaxation as Aff moves up consistently and Co spikes to 7 and only drops one point to a 6 the following days He felt much more relaxed following my first session of active intervention. The second day of the SI-7 means he continued to be very social with his mother, likely his gregariousness was because he was just a relaxed and happy guy. He’s a great guy.
The second session 7-spikes on the SI scale are different. The first one is an increase in arousal (stress) because of the – thing – I gave him to consider in our session. You can see his Aff drops one and his Co drops two. He’s not happy about that thing I gave him to consider. He’s pondering it, that’s the arousal SI-7. It’s troubling him, that’s the drop in Aff and Co.
He figured it out. The next day, that bounce up for Aff of 3 points and Co 4 points is his figuring it out. That’s an impressive impact. He’s happy and relaxed. Good for him that he’s figuring things out.
The 7-spike in SI on the day following our session is because he’s happy again. The SI scale measures social involvement. He was socializing a lot with his mom. On the day of our therapy, it was his way of managing anxiety and inner stress – that’s his coping style – he has a high-set point for social regulation. So he regulated the stress of day 1 with a 7-spike in SI. Day 2, his Aff took a leap. He is so happy. His Co takes an even bigger leap. He’s relaxed. They both merge spot on at 5. He figured it out. Now, the day-2 7-spike in SI is happiness.
Boy, that session 2 stuff took a lot of processing across a lot of systems. He’s recovering his stability. There’s a down-regulation consolidation of all three systems, a release of 2 points for SI, 2 points for Aff, and 3 points for Co (he’s pooped), into a three-system consolidation V. Look how synchronous those systems are. That is a clean nervous system.
Notice the consolidation V is identical to data point (6), with SI on top, one point higher than Aff, which is one point higher than Co, identical to the consolidation V of data point (6).
This is interesting. At the consolidation V, Aff remained stable at 3, and so did the entrained Co, while SI completed the bounce back of the consolidation V, then Aff and Co completed their bounce back the following day, back into integrated entrainment at 5 (high-normal). That is some hefty consolidation. Two days of Aff-4 and Co-3 synchronized consolidation before an integration at 5. Session 2 gave him some stuff to think about. Whew.
His exit set points leaving this series are: Aff 4-5, Co 3-4, SI 5-6. An entirely healthy and normal-range set of regulatory networks
Conclusion from the Clinical Data Set
The High Road workshop of Dorcy Pruter achieved a remarkable – truly breathtaking – recovery of healthy and normal-range functioning of a wonderful child, in two days, following three years of documented child abuse. The recovery from complex trauma and child abuse is full, it is strong, and robust. She handed into my clinical care, a totally normal-range and wonderful young man. As a clinical psychologist, I am in deep respect for what Ms. Pruter accomplishes on a regular basis.
And if there is any question about how the kids feel about the High Road workshop, for my client it was Aff-5.5, Co-6, SI-6. He loved it.
I’ll bet he did. Because as far as I can tell, the High Road protocol, administered in two days by Dorcy Pruter, achieved a full recovery of the child’s healthy and normal-range development. I’ll bet that did feel pretty good.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857