Saturday, December 27, 2014

The Importance and Value of ‘Being’

(Bill Watterson)

For many of us, this time of year (holiday season) is a time for ‘being’ with each other and a temporary stop in our often frenetic lives of doing. It can be a special time of being with those to whom we are closely bonded by family and friendship. However, as this potential opportunity is often at odds with our regular day-to-day life and work experience, we might just replace one kind of frenetic activity with another, such as excessive consumption!

The advent of a new year can be a time of reflection, which again can also be obliterated by hyper-activity under the name of celebration. It seems an appropriate time to write a blog on the subject of the value of being, as opposed to doing. The capacity to reflect has been shown to be hugely beneficial to our health, especially when it is built into daily life. I even read recently that a study claims the regular habit of writing in a reflective way can improve the speed of recovery from some illnesses and injuries. Reflection can reduce stress, which improves the immune system, etc.

Increasingly, we hear about the value of reflection and concepts such as mindfulness are becoming familiar. The principles involved are not new and can be traced back thousands of years and are embraced in many fields, such as Buddhism.  In terms of child development and of healthy adult capacities, the ability to reflect, to think about oneself, and to consider what others might be thinking about oneself is an essential part of being able to relate to others. Some researchers have argued that the ability to reflect on one’s experiences is a greater indicator of health than how much adversity one has experienced. As Kezelman and Stavropoulos (2012) who have created excellent guidelines for trauma-informed services, state,

“It isn’t just what happened to you that determines your future – it’s how you’ve come to make sense of your life that matters most.”

Digesting and making sense of experience requires a degree of allowing ourselves to be, to ‘sit with’ and to feel.  Whereas, busily doing can be a distraction and a way of avoiding feelings and thinking. As a result, the avoided feelings and experiences associated with them, remain unprocessed and therefore unintegrated into our personality.  The feelings are inaccessible as any kind of useful guide or resource for the future. Learning from experience comes to a halt and therefore so does development.

Interestingly, I started a discussion on this subject on my LinkedIn group in January two years ago. I wonder whether the timing of the New Year is coincidental.  The quality of discussion was excellent and I think partly because the theme is so universal and not just relevant to our work with traumatized children. Some of the comments made by members of the group show how much this subject resonated with them,

“Imagine that, listening to understand rather than to just respond (teach/tell/direct) - incredible!” (Ian Nussey - Australia)

“….my role was just to be there listening.” (Lorna Miles - UK)

Ian responded – “The special ingredient Lorna - genuinely being with…..”

“The opportunity for free play, space and being with each other and adults was hugely important.” (Judy Furnival - Scotland)

“……..being new to therapeutic care in a residential environment my strategies are at times very basic in the way that I go in and just be me in a relaxed manner as opposed to some that just need to be completely planned throughout each minute of the day which in my opinion leaves no time for proper self-reflection.” (Aaron Hamill - Australia)

“In today's society, every minute of every hour is organized which leaves very little time for children to be creative. …….Always organizing their free time is not the best thing for helping children develop creativity, self-regulation and imagination.  (Sylvie Demers - Canada)

“I agree that children need time to be rather than do. The problem, as I see it is that some children don't know how to be except within a trauma framework. Their frenetic activity might be a way of avoiding thinking and being.” (Christine Gordon - Scotland)

With a group of young people I worked with, we used to plan our evening activities in a meeting after tea. The usual things offered, would be soccer, cricket, bike rides, walks, card games, crafts, swimming, etc. I decided to offer that I would spend a half hour or so ‘being’ in the living room and those who were interested could ‘be’ with me. Naturally, this aroused curiosity as to what ‘being’ involved. I explained something like, just being together, chatting, playing if people wanted to, maybe listening to music, etc. It was less structured than usual, though still with some boundaries. After a while, being became a popular thing to do – if that isn’t a contradiction! A general feeling of safety is necessary for this kind of possibility to develop. I enjoyed these times and over the years have found that girls are better at this than boys – though I might be generalizing from a little experience.

Being rather than doing can be difficult as it allows time to think and feel. For people who are traumatized thinking and feeling is often frightening. Thoughts and feelings must be kept at bay and one way of doing this is through frenetic activity as Christine described above. The world of these children can become a desolate place without emotion. Being rather than doing, conjures up possibilities. There is a sense of uncertainty and not knowing, a lack of control. To a healthy person this might be challenging but also potentially exciting - to a traumatized person it might be terrifying.  Anyone who is close to a traumatized person is likely to pick up this fear and coupled with their own, can easily be swept into a whirlwind of activity as a form of avoidance. In the world of ‘therapy’, especially psychoanalysis it is stated how important it is for the therapist to tolerate a sense of 'not knowing'.

The concept of Negative Capability coined by the poet John Keats back in 1817 is often referred to. Keats described negative capability as the art of remaining in doubt “without any irritable reaching after fact and reason” and “the willingness to embrace uncertainty, live with mystery, and make peace with ambiguity”.

The British psychoanalyst Wilfred Bion elaborated on this, describing negative capability as the ability to put aside preconceptions and certainties, and tolerate the pain and confusion of not knowing. More recently the child psychotherapist and psychoanalyst Adam Phillips in discussing parenting has said,

".....that the parents, the authorities, are at their most dangerous when they believe too militantly that they know what they are doing."

Why is this subject of ‘being’, which allows the space for something unknown to unfold, so important? I think the key reason is that it is central to the process of our development, as individuals, groups, and societies. How we are able to be with ourselves individually and collectively is fundamental to our health. An infant is born into the world with a distinct lack of ability to be with and tolerate different emotional states. Anything that causes distress requires someone else to be with them, and to emotionally contain the distress. As Donald Winnicott said, there is no such thing as a baby, there is a baby and someone.

The critical issue is what that other person does with the difficulties involved. Is she/he able to tolerate the feelings involved and to think about the infant or does he/she also find the distress intolerable and feel the need to only take it away?

The difference for the infant may be between a helpful/thoughtful response, a relieving/thoughtless response and an unrelieving/thoughtless response. The first changes the infant’s experience in a way that might also encourage him to develop his own capacity to think about his feelings and hence find thoughtful solutions to difficulties. The second might relieve the infant of his distressing feelings, but in a way that discourages thinking and encourages dependency on a quick fix. This is about taking away the distress rather than developing the capacity to sit with it and find constructive solutions. The third just makes matters worse for the infant and is likely to lead to the need for defensive protective measures, such as switching off from emotions.

An important question is whether distress or ‘psychic pain’ is perceived as something to be got rid of and/or relieved, or whether it is something primarily to be understood in a way that makes it tolerable. This question is often highlighted as the difference between parents, who are motivated by the desire to relieve their children of pain and those who are more on the side of helping their child learn to manage painful experiences. The same applies in other aspects of life, professional and personal. Do we want to rescue another from pain and difficulty, or be alongside them as they find their own way? These dynamics are well known in our profession in the form of victim/perpetrator/rescuer. The media also portrays Images of leaders as heroic figures coming to the rescue, with the answers to fix a problem rather than as people who work alongside others to find solutions (Ward, 2014). We can all wish for a ‘magic wand’. Sometimes a solution might not be possible and it is more about finding the best way to live with the ‘problem’.

There may also be a cultural tendency to view all depressive feelings as a problem to be got rid of or solved. As one child who had suffered many difficulties that he had the need to feel sad about, said to me, ‘I need cheering down, not cheering up’. Facing real and painful issues rather than avoiding them is how experience can be integrated into our identities in a way that furthers our learning, understanding and development. Difficulty in being able to tolerate any pain or frustration is likely to hinder development.

Whether we are working directly with a child, or in a management or leadership role, resisting the temptation to become the problem solver can be difficult.  Our need to get out of the difficulty and to relieve our own anxiety can be the primary motivating factor, rather than the development of the person(s) we are with. Generally, working something out oneself with the support of another is a more useful outcome than another working it out for one. It is hard to be alongside someone who is struggling, needing time and making mistakes. The external environment where others may hold us responsible for the outcome can add another layer of anxiety. It might be felt that it is too risky to allow a mistake to happen, so the possibility is pre-empted.

The child and adolescent psychotherapist Margot Waddell (1985) has referred to the different ways of responding to human difficulties as one between ‘serving’ and ‘servicing’,

“The difference between the two modes might be made by the mother who serves, by being available by 'thinking' emotionally, as opposed to the mother who services by doing instead of thinking.”

Waddell elaborates that “servicing nearly always implies action, with very particular overtones” whereas serving “may constitute not doing anything”. However as she explains, “not doing anything does not constitute doing nothing”, and, “There is a 'world' of difference between 'standing by' and 'being a bystander'”. 


It can be misguided to consider doing as active and not doing as passive, when often it is not doing that is the harder and most useful option. For example, how long can we or should we tolerate watching and encouraging a child who is struggling to do something? How much satisfaction does the child get when he or she achieves the task and thinks ‘I did that myself!’?

Waddell explains how these same dynamics can be transferred to organizations and societies.  Where on a collective scale becoming ‘mindlessly busy’ is a way of avoiding the real difficulties we are faced with.  Sadly, this also deprives us of the opportunity to understand those difficulties in a way that leads to growth. This tendency has been clearly outlined by social scientists, going back to the 1950s, such as Elliot Jaques and Isabel Menzies Lyth.  These social scientists explained how organizations unconsciously develop defensive systems to protect themselves against the emotional pain involved in the task. For example, as Menzies Lyth so powerfully described, the task of caring for patients in hospitals includes primitive anxieties related to the themes of illness, loss and death. One way of responding to these anxieties, is to avoid them by depersonalizing the patient, and creating systems which don’t allow ‘professionals’ to get emotionally close to the patient.

We may be familiar with the scene of a Doctor talking to his students about the patient in front of him, who is referred to as a number, or such and such case! While this might help reduce emotional pain (for the Doctor and students), unfortunately it does not aid the patient’s recovery. Emotional connection between doctor and patient has even been shown to improve recovery from the common cold (Rakel et al., 2009).  Therefore a helpful solution would seem to be one that enables human connection between Doctor/Nurse and patient. However, an approach that recognizes the pain involved also needs to provide appropriate professional support.

It is often stated that modern lifestyle militates against the capacity to be in a moment without distraction. This is caricatured by the now familiar image of two people sitting supposedly together having a meal, whilst gazing at their mobile phone. I was in a restaurant recently and noticed a mother feeding her baby, moving her focus between a television and 'smart' phone.  A few and increasingly rare owners of bars and restaurants refrain from the introduction of TVs, etc. and promote the idea that a place just to be together might be of value.

A comment made by a boy in the therapeutic community of Finchden Manor (1930-1974) captured the essence of ‘being’.  When asked by a visitor, ‘what do you do all day’ – he replied, ‘I don’t know what we do, but it’s a fine place to be in’ (Harvey, 2006).


Tom Robinson the British musician-singer-songwriter who spent a number of years at Finchden Manor, claimed that it saved his life. Talking about life at Finchden, he said,


“As to what we did all day…. there was everything and nothing to do……you could just lie in the grass on the field staring at the sun reading a book……time seemed infinite……what Finchden offered you above all, ….it offered you respite, and there was a complete respite from all forms of nagging and pressure.”

Some visitors to Finchden were critical, saying that the staff seemed to do little but ‘watch the boys’. Finchden’s founder, George Lyward responded that watching is one of the hardest things to do in life. He explained that the staff look for when the boys come alive, nurture the boys’ talents and help them shape their future life.

Maybe it would be helpful for us to reflect upon why as Lyward said, this is so difficult – what gets in the way of allowing ourselves and the children we work with, to be? Comments most welcome – in the meantime – Happy New Year

References

Harvey, J. (2006) Valuing and Educating Young People: Stern Love the Lyward Way London and Philadelphia: Jessica Kingsley Publishers

Dr. Kezelman, C. and Dr. Stavropoulos, P. (2012) The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery, Australia: Adults Surviving Child Abuse (ASCA),   http://goo.gl/t9o3lA

Link to the discussion on Therapeutic Residential and Foster Care for Traumatized Children, January 2013, https://goo.gl/0jcw3i

Link to the interview with Tom Robinson about George Lyward and Finchden Manor, on the BBC Radio 4 ‘Great Lives’ series, http://goo.gl/29lJfV

Menzies Lyth, I. (1959, 1961, 1970) The Functioning of Social Systems as a Defence Against Anxiety, in Containing Anxiety in Institutions: Selected Essays (1988) Vol. 1, London: Free Association Books

Menzies Lyth, I. (1979) Staff support systems: task and anti-task in adolescent institutions, in Containing Anxiety in InstitutionsSelected Essays Vol. 1. London: Free Association Books (1988), http://goo.gl/UlwGiL


Rakel, D.P., Hoeft, T.L., Barrett, B.P., et al. (2009) Practitioner Empathy and the Duration of the Common Cold, in Fam Med, 41, p.494-501 

Waddell, M. (1985) Living in Two Worlds : Psychodynamic Theory and Social Work Practice, Free Associations Vol 10,  http://goo.gl/39828H

Ward, A. (2014) Leadership in Residential Child Care: A Relationship-Based Approach, Norwich: Smokehouse Press

Further reading

Blog by the Child Psychotherapist, Graham Music Blog - 'The Lost Joys of Playing and Just Being', http://goo.gl/e9ID8D

An interesting blog on the benefit and difficulty of being still, http://goo.gl/1tnupn

3 Blogs by Maria Popova, 

"Young Delacroix on the Importance of Solitude in Creative Work and How to Resist Social Distractions", http://goo.gl/M7n01X

"Psychoanalyst Adam Phillips on Our Capacity for “Fertile Solitude”, http://goo.gl/i5SVJT

"Kierkegaard on Boredom, Why Cat Listicles Fail to Answer the Soul’s Cry, and the Only True Cure for Existential Emptiness", http://goo.gl/75vByp

Saturday, November 22, 2014

A Taxi Driver’s Timely Comment on Brain Plasticity

Since I started writing blogs a few months ago I have realized that there are some things worth writing about that may just be like a mini blog – of which this is one.
I was recently travelling by taxi to give a talk in Sydney on childhood trauma and recovery from it. I’m never certain exactly how I will start off a talk and usually just see whatever occurs at the time. The taxi driver was a man in his mid-20s from Nepal who had been living in Australia for 3-4 years. During the two weeks I was in Australia – I heard some fascinating stories and interesting views of many taxi drivers, from Pakistan, India, Kazakhstan, Iran, Greece and Turkey among others.  Occasionally we sat in silence for most of a journey, but generally a conversation ensued.

The Nepalese driver and I were talking about different weather climates. How it could be very hot during Sydney summers, cold but not too cold in the winter. He said that Nepal had a moderate climate, warm most of the year round. I mentioned Ireland, maybe unfairly, where I said they have a few warm sunny days a year and it rains a lot of the time. I had recently been told by an Irish friend that it had been raining every day for 2 months! However, I said people get used to what is normal for them and probably don’t mind so much.

Just before I got out of the car the taxi driver said ‘the human being is like rubber’. An excellent and timely observation on the plasticity of the human brain, which I would soon be talking about - in relation to the potential for recovery from trauma. Possibly, it was also a reflection on how immigrants might adjust to their new environments. It also showed me that just by listening and paying attention, we can be provided with insights and gifts when we least expect them! Maybe those are the best kind of gifts. His comment certainly helped get my talk off to a good start.

Monday, November 3, 2014

Why Horses can be so Therapeutic in Work with Traumatized Children and Young People

The first 14 years of my career was in a therapeutic community for boys who were traumatized due to abuse and neglect. The Cotswold Community was situated on a 365 acre farm. I have often wondered how much of the boys’ healing was gained from living on the farm and spending so much time doing activities and being outside.

In more recent years, many research studies have highlighted the benefits of therapies that connect people to the natural world. For example, wilderness therapy, equine therapy and the therapeutic use of pets and animals.  As well as these types of activity contributing to the recovery from trauma we also know that they can be generally helpful in reducing stress and improving other health conditions. I believe many of these approaches are what Bruce Perry (2004) has termed ‘biologically respectful’ because they connect people to their genetic predispositions.

I invite people who have particularly interesting and innovative perspectives the opportunity to write a guest blog. This is the first guest blog and I am delighted to introduce Debbie Woolfe and her organization Stable Relationships, which is based in Telford, West Midlands, UK. 

Patrick Tomlinson

Stable Relationships is an organisation that has recently been set up to enable more children, young people, staff and carers to have access to emotionally intelligent, therapeutic and training activities involving horses.

All our programmes combine the theories of child development and trauma with the practicalities of equine based experiential learning. Many of our activities are based on the Epona approach (Linda Kohanov, The Tao of Equus, 2001).

Horses are prey animals so their first response is that of fight, flight and freeze. They communicate non-verbally by picking up on the energetic waves of emotion in their herd, in order to stay safe. This makes them hypervigilant and excellent at reading the emotions of anyone they interact with. Our approach is based on the knowledge that we need to be calm in order to build relationships and learn. Horses are most able to complete tasks successfully when the people working with them are able to be emotional leaders. This usually involves the people becoming calm as the first step towards any activity.

Horses respond to their environment and people interacting with them in similar ways to traumatised people, which makes them excellent at helping staff who work with these people.


Through the work with horses, staff are better able to understand the impact they can have and develop new strategies to improve their working practice. For example, we do an activity where a staff member approaches a horse with the goal of it touching them on the back of the hand.  The horse is loose in a space. The person has to become aware of their own feelings of excitement, vulnerability and fear within the challenge, and manage these feelings to become calm.  They also have to notice tiny movements within the horse, such as a flick of the ear or a swish of the tail. When they see these things they understand how sensitive a horse (and the children/young people they work with) can be.  They develop practical strategies for approaching in a way that promotes maximum calm.  Self-awareness is a large part of the course and staff have reported it impacting their personal as well as professional lives.

Part of our young person course involves them setting boundaries with horses. As a horse approaches they notice and rate their feelings as it moves. They are taught how to stop a horse coming closer than they want and are given the opportunity of experiencing and regulating their own arousal levels and emotions as it approaches. For young people who have experienced various types of abuse or who struggle to regulate higher levels of emotion, this experience can be highly empowering.  

We also take horses out to schools to teach emotional intelligence sessions. Children work through various tasks to help them feel calm, observe and become aware of the messages behind their emotions, and learn how it feels to be trusted and trustworthy.  One activity involves leading horses through various obstacles. The horses need to have a high level of trust in the young person to face obstacles, which may feel challenging to the horse. For a young person to achieve the task successfully they need to be calm, take things at the pace of the horse, keep the horse safe, communicate effectively with it and encourage it.

Finally, we offer creative curriculum sessions for young people who may struggle to engage with classroom based types of learning. The outdoor environment with all its noises, smells, space and practical learning opportunities is excellent at engaging young people in learning. Our horses recently helped us teach Macbeth to a group of young people from a special school for children with emotional and behavioural difficulties. After orienteering to find and read parts of the Macbeth story, the horses were painted with Macbeth group symbols, and ridden, once the young people had answered Macbeth quiz questions.

Stable Relationships is in its very early days. However, we have seen the amazing impact our work has. We are lucky enough to regularly see young people work so well with each other and their horse. Often these are young people who are having major difficulties in their relationships due to very challenging behaviour. We are privileged to regularly see young people who won’t walk past a horse, riding one a few weeks later. We are inspired as we see staff and carers who are demoralised and exhausted realising that they are more powerful and effective than they ever imagined. All our horse based work is experiential and due to this, knowledge becomes wisdom at an accelerated rate.

Here are a couple of brief anonymised examples of our experiences,

Ben

We have a young person Ben who has been doing our course for 6 weeks now, so he is halfway through. He attends a special school and his referral form said he has autism and depression. When he started he was very withdrawn and the first week he refused to leave the cabin, to even walk past the horses, never mind work with them.

As the weeks have progressed he has become far more confident with the situation and the horses. He has developed a stronger relationship with his carer and is able to ask her for help when he needs it, which was one of his key objectives. During the early weeks the carer did most of the horse based activities and Ben watched, seemingly not too engaged. However, as the weeks have gone on, he has become much more involved. He now takes the lead with all the horse based activities, asks questions, and speaks to everyone involved about his internal processes and views. His carer has reported that he doesn’t seem depressed any more, and he tells her that visiting us is the best part of his week.

During his last session we were working on rating our own stress levels as we worked with quite a large horse (actually the largest we have). The carer rated herself as having higher levels of stress than Ben. At first I thought he may not have been entirely honest but the horses always know!  His task involved leading the horse around various obstacles that she hadn’t seen before. She is quite a flighty horse, and was much less willing to go with his carer. The carer was trying to stay calm and talk gently to the horse, encouraging her to move with her.  She did go, but was very hesitant and unsure and kept freezing, before continuing on.  When Ben had a turn, she went willingly. She tried new obstacles and was completely engaged and attentive to Ben throughout the whole task. He was so calm and focused, and that impacted on the horse. It demonstrated very clearly that it is a person's internal feelings that have the biggest impact on horses, and people around them.  Ben had been truthful about his levels of calm and it had been clearly shown by the horse’s response. For him and his carer, having experienced that level of calm in a potentially challenging situation was an eye opener. We were able to discuss other potentially challenging situations, away from the horses, where Ben now thought it may be more possible to stay calm.  He just needed to re-create the feeling that he had just experienced. He could recall the experience he had just had, and recapture the feeling of calm. It was also a big breakthrough in terms of his self-esteem. He is well aware of how far he has come, from not wanting to walk past a horse, to leading around the biggest one at the stables.

Amie

Another example comes from a school we visited last week. We take the horses to work with groups of up to 8 children for a 2 hour emotional intelligence programme. Amie who is 8 years old has had 4 placement moves since June.  Her teacher reported that she had very challenging behaviour and showed no fear or concern for others. She worked well with horses and was excellent at spotting the emotions in them. When it came to the end of the session she was hugging her horse and didn’t want to leave it. We gave her some time and she gave the horse a carrot as a good ending. However, it seemed to impact her teacher more. She started to cry because she said she had never seen her show feelings for any other being before. We are used to seeing these reactions but it is always a humbling reminder of the power of the horses, and the differences they are able to make just by being themselves.

Debbie Woolfe

For more information please contact: contact@stable-relationships.com
http://www.stable-relationships.com/

This is a book on Equine Therapy that may be of Interest,


And an interesting website

LEAP Equine Facilitated Psychotherapy & Learning, http://www.leapequine.com/

References

Kohanov, L. (2001) The Tao of Equus: A Woman's Journey of Healing and Transformation through the Way of the Horse, California: New World Library, http://goo.gl/OagIZ4

Perry, B.D. (2004) Maltreatment and the Developing Child: How Early Childhood Experience Shapes Child and Culture, Margaret McCain lecture on September 23, 2004, http://goo.gl/ftcCzD

Comments

Jenny Huston, Qualified Therapeutic Foster Carer and Person Centred Counsellor, England

I have horses and many other furies that over the years of fostering have proven to be a gateway for my children and young people to start their journey of trust again. I feel they can teach/show us so many things and provide a great sense of belonging, responsibility and empathy without any words spoken.

Patrick Tomlinson

Here is a further blog by Debbie on her therapeutic work with children and horses

A brief video about Stable Relationships from the UK Channel 5 TV channel, showing horses and children in a school, https://goo.gl/F8xWY4

A Few books recommended by people who read this blog,

Emma Speaks: A Journey into the Soul of an Animal Friend, http://goo.gl/YvMWw7

Horse as Teacher: The Path to Authenticity, http://goo.gl/5y8dvO

The Children of Raquette Lake: One Summer That Helped Change the Course of Treatment for Autism, http://goo.gl/9S2WB5

Tuesday, October 7, 2014

The Meaning of a Child’s Stealing and Other Antisocial Behavior

Of course this is a complex subject and there is a risk of making simplistic generalizations. So the aim is just to give some food for thought that may broaden our perspective. The circumstances for each child and young person are unique as is the potential meaning of their behavior. That in itself is an important starting point – all behavior has meaning, however bizarre and bewildering it may seem.


What prompted me to write a blog on this subject was a comment by a psychologist, who said to me, ‘That while culture has a significant influence on behavior, stealing seems to be a universal theme across cultures, for children who are in care’.  She wondered why? 

Early on in my work as a care worker in a therapeutic community for boys who were severely traumatized by abuse and neglect, I was introduced to Donald Winnicott’s (1984) concepts of the 'Antisocial Tendency' and 'Delinquency as a Sign of Hope'. These concepts were especially helpful then and they still are now.


The children’s behavior in the therapeutic community could be extremely antisocial. The concepts provided a framework within which something comprehensible could be made out of what often seemed incomprehensible. Initially a few simple points helped. Children who have been abused, hurt, rejected and who don’t trust adults will relentlessly test the patience, stability and reliability of anyone who tries to care for them. This can be perceived as a necessary survival mechanism the child uses to hopefully arrive at the point where someone does survive him and becomes trustworthy in his eyes.

Unfortunately, many adults don’t ‘survive’ and either they or the child has to leave, so the pattern of rejection continues. Each time this happens the problem is made worse for the child. So the adult’s survival is essential! This is the case not only for an individual working with the child but also the team. The child will also test the ‘family group’s’ ability to survive together.  Within the context of this difficult and often unpleasant work it can be seen there is a seed of hope. It would be more worrying if the child gave up and became completely withdrawn. Usually if a prolonged period of testing and challenging behavior is survived, the child settles and begins to accept the care he so desperately needs and wants. 

Before beginning work in a therapeutic community I had never seen any specifically unusual behavior in children. Plenty of ‘children being children’, but nothing out of the ordinary.  In the home I began in, much of the behavior was extremely unusual to me. One young person would eat the stuffing out of his bed cushions and had an obsession with the sewerage system. Another used to get out of his bed and sleep in his cupboard. Another ran off one night, found some old tins of paint in a shed and emptied them in a decorative pond. I’m not sure we ever figured out exactly what the meaning of that behavior was! Winnicott (1967) urges caution in expecting such a child to explain his behavior, 

“The aggression is liable to be senseless and quite divorced from logic, and it is no good asking a child who is aggressive in this way why he has broken the window any more than it is useful to ask a child who has stolen why he took money.” 

With the boy, the paint and the pond, maybe it was just a series of random opportunities and impulses. However, the pond was in the center of the community so the fact that the water had turned a whitish color could not be missed in the morning. Ward (2011, p.5) gives a general explanation, 

“In the first place this search for boundaries may be shown in the family, and in the form of stealing, disrupting, or doing other things which will draw attention to himself, giving him some sense (however negative) of agency in the world.” 

The young boy had certainly gained everyone’s attention and maybe that was what he needed. However, an incident like this can easily go wrong, especially if the pond had fish it in it, which it actually did! The consequences of the action can become a bigger nuisance than the child intended. And instead of helping him to be understood which may have been his hope, causes a harsh reaction without understanding. Winnicott (1956, p.309) explains the nature of the difficulty and the hope, 

“The antisocial tendency implies hope. Lack of hope is the basic feature of the deprived child who, of course, is not all the time being antisocial. In the period of hope, the child manifests an antisocial tendency. The understanding that the antisocial tendency is an expression of hope is vital in the treatment of children who show the antisocial tendency. Over and over again one sees the moment wasted, or withered, because of mismanagement or intolerance. This is another way of saying that the treatment of the antisocial tendency is not psychoanalysis but management, a going to meet and match the moment of hope.” 

As Winnicott explained, it can seem ironic that just at the point when things begin to feel hopeful the child’s behavior can appear to get worse. On this occasion we did manage to tolerate the boy’s behavior and work with him in a positive way. Often thinking about why a child did something would offer some useful insight. This kind of thinking about meaning is central to the psychodynamic approach. Comparing this with a cognitive approach and a focus on developing strategies to manage behavior, Schmidt Neven (1997, p.4) says, 

“However, in using a psychodynamic approach, one would view the problem in a different way. First of all, one would postulate that the destructive behaviour is in itself an important communication. It might, in the context of the family, be the only way in which the child is able to communicate something about what he or she feels. So we would ask the question ‘What lies behind the destructive behaviour?’ The other question we would ask is ‘Why does this behaviour emerge at this particular point in time?’ So the questions ‘What does it mean?’ and ‘Why now?’ are all-important.” 

Adrian Ward (2011, p.4) wrote about Winnicott’s concepts and considered them in relation to the riots that took place in England during 2011. In reference to Winnicott he states, 

“The first thing to be clear about is that he sees the antisocial tendency as being universal: in a refreshingly ‘normal’ way he acknowledges that every child has, in effect, both social and antisocial tendencies. At this point I must ask those readers whose own childhood was without blemish to ‘look away now’ – those who never deliberately swore, broke anything, shouted at their dear mother or pushed their sibling off his or her perch from time to time.” 

Interesting that Winnicott, as the psychologist I mentioned, also referred to the antisocial tendency as universal. One of the tasks of being a parent or carer as Ward and Winnicott point out, is providing the child with clear and appropriate boundaries. At the same time it is important to recognize and have empathy for the fact that healthy development requires the child to push against these boundaries. Sometimes the child might need to go over the boundaries to experience what it is like on the other side. The child psychotherapist Adam Phillips (2009), in his paper ‘In praise of difficult children’, explains the paradox this creates, 

“The upshot of all this is that adults who look after adolescents have both to want them to behave badly, and to try and stop them.” 

Antisocial behavior becomes a more worrisome problem when it isn’t responded to and contained within the family or caretaking setting. The child in this instance is then likely to seek boundaries outside of the family home. Still, there may be an underlying hope within the child that his behavior will alert his primary caregivers. Ward explains, 

“It is as if, in Jan Abrams’s words, ‘the individual is searching for an environment that will say no – not in a punitive way, but in a way that will create a sense of security’ (Abrams 1996 p.54). This is largely an unconscious search of course, in which the child is repeatedly driven to seek out something which is instinctively felt to be missing.” (p.5) 

Many parents will have received the occasional cautionary letter from the school principal or even police, and this has been enough to alert the parents to the child’s needs whatever they may be. However, when this type of scenario isn’t responded to well the child’s behavior may worsen. Over time he may become hardened to living in a world where he feels his needs can’t be understood and met. He may then begin to seek ways of gratifying his own needs. The antisocial behavior may take on a secondary gain, such as feeling excitement, power and delinquent status. Dealing with this problem is far more difficult and highlights the importance of noticing and responding to signs of antisocial behavior early on. 

This brings me back to the issue of stealing and why it is often one of the first acts of the antisocial tendency across cultures. One universal fact regarding child development is that a child cannot grow and develop, without something good and nurturing from adult carers. The child has an instinct for this and behaves in such a way as to illicit the positive response of a carer to his needs, normally the mother to begin with. This has been called 'attachment seeking' behavior.  When a child loses something that felt good, however short or fleeting it was – he is deprived and wishes to return to the positive state that has been lost. Adam Phillips (1988, p.17) in his book on Winnicott explains that when a child in this situation steals he is not specifically interested in the ‘thing’ he steals. He is stealing ‘in symbolic form only what once belonged to him by right’ and which has been lost. He is also ‘alerting the environment to this fact’ and testing the environment’s tolerance towards the nuisance value of such behavior (Barton, Gonzalez and Tomlinson, 2011, p.95). This type of stealing can be understood as an unconscious impulse. It is such a primitive instinct that it can be expected to be a universal phenomenon of childhood deprivation. Maybe even the word stealing is not appropriate as it is so easily misunderstood in a negative judgmental way. 

Often the most helpful way to respond is to consider that the child may be looking for his needs to be met within the context of a nurturing relationship. In my experience, once this happens the ‘antisocial tendency’ is likely to disappear at least to what is within the realm of ordinary child development. Ward concludes that the concept of the 'Antisocial Tendency' and 'Delinquency as a Sign of Hope', 

“…was and still remains one of Winnicott’s most remarkable and profound insights…” (p.7) 

References 

Abrams, J. (2007) Language of Winnicott: A Dictionary of Winnicott's Use of Words, London: Karnac 

Barton, S., Gonzalez, R. and Tomlinson, P. (2011) Therapeutic Residential Care for Children and Young People: An Attachment and Trauma-informed Model for PracticeLondon and Philadelphia: Jessica Kingsley Publishers 

Phillips, A. (1988) Winnicott, London: Frontier Press Phillips, A. (2009) ‘In Praise of Difficult Children’, in London Review of Books 31, 3, 16 

Schmidt Neven, R. (1997) Emotional Milestones from Birth to Adulthood: A Psychodynamic Approach, London and Pennsylvania: Jessica Kingsley Publishers 

Winnicott, D.W. (1956) The Antisocial Tendency, in D.W. Winnicott (1984) Deprivation and Delinquency, London and New York: Tavistock Publications 

Winnicott, D.W. (1967) Delinquency as a Sign of Hope, A talk given to the Borstal Assistant Governors’ Conference, held at King Alfred’s College, Winchester, April 1967, retrieved from http://goo.gl/oTIlU7 

Winnicott, D.W. (1984) Some psychological aspects of juvenile delinquency, in Deprivation and Delinquency, ed. C. Winnicott, R. Shepherd, M. Davis, London: Tavistock 

Adrian Ward’s free pdf paper can be downloaded here, http://goo.gl/WUwLoq 

I just found this blog below and think it might be those who are interested Winnicott. It does strike me how much some of his concepts still resonate so powerfully. This is on the ‘Good Enough Mother’, which I have often found to be a salvation!   http://goo.gl/nKxO9i 

Comments 

Gulchekhra Nigmadjanova, Advocacy Advisor at SOS Children's Villages, Uzbekistan I opened for myself Winnicott's Good Enough Mother book. CRC says exactly the same about parenting. And this is something many of us parents live with and apply in bringing up. For there is such a devoted mother or someone dear behind many successful children and adults too. How to raise understanding of this parenting, how to empower parents - of own or foster or care givers to treat their children using this attitude and approaches - this is an issue. 


Moses Wangadia, Programs Team Leader at Retrak, Uganda I like the phrase deprivation. Working with street children in a long time I have seen and heard parents complain about their children becoming thieves and hence ending up on the streets. But what I have learn t about this is that it starts with a child being denied food at most because the child doesn't want to work which is the order of the day in most homes where children contribute or participate at home in certain areas. Once this happens, the children are left with no option but to start looking out for where to get food and certainly having no source of income the easiest way out is to start sneaking to get what to eat either from home or around the neighborhood.  Unfortunately in doing this, some learn t that there is an easy way out where you don't work but get what to eat and it becomes a behavior. All this at a certain level has elements of deprivation. However, what I need to figure out is what causes someone to be averse to working or following instructions at home that lead into this deprivation. If it doesn't still lead to deprivation of parental attention.  

Bonnie Murphy, Consultant, Autism / Child Abuse Advocate, USA Excellent article for both clinicians and caretakers (parents/guardians) of children who display antisocial tendencies. My viewpoints are from the parent side, by no means am I professional, except in the way of "school of hard knocks" as I go on a journey with my son who has antisocial tendencies. I agree with you; that stealing is almost always universal among children who have been abused, traumatized, hurt or rejected. Loved how you Referenced Donald Winnicott's (1984) 'Antisocial Tendency and Delinquency as Sign of Hope,' was especially interesting and his concepts appear to hold true 30 years later: Abused, hurt, rejected children tend to not trust adults and will test patience, stability, and reliability of anyone who tries to care for them. When a child steals an item, the item represents something of loss - it's a subconscious impulse.  Another vital concept by Winnicott; A child tests the 'family group's' ability to survive together. Searching for boundaries in the family, form of stealing, disrupting, or doing other things which will draw attention to himself - giving them sense of control. The child may or may not know why he is doing such behaviors only that it is self-soothing in ways that most people cannot understand. Over the years I have concluded that children of trauma, abuse, neglect, abandonment and rejection are only comfortable in chaotic environments - if no chaos, they will create even though it was what they hated when in an actual unsafe chaotic environment. It seems that breaking this pattern is most difficult. My favorite concept Winnicott illustrates is '....the treatment of the antisocial tendency is not psychoanalysis but management....' This supports Jan Abram's words when she wrote about Winnicott's work: '...the individual searches for environment that will say NO - not punitive way, but way that will create sense of security....' Which comes back around to your concept: '.....One universal fact regarding child development is that a child cannot grow and develop, without something good and nurturing from adult caregivers...' The flow of all incites; Winnicott, Abrams, and yours highlight very important concepts that all caregivers should be aware of. Families need access to such information / training when dealing with antisocial behaving child - it is a vital part of the child's success as he learns to trust society. I reiterate; I speak from personal experience, having dealt with these issues with my 12-year-old son for last eight years - we were completely blindsided by all these behaviors and many more. We knew that adopting an older child would have some issues but never in our wildest dreams could we have foreseen what we have gone through as a family. 

Patrick Tomlinson On the subject of the universal nature of anti-social behavior! “I would there were no age between sixteen and twenty-three or that youth would sleep out the rest; for there is nothing in between but getting wenches with child, wronging the ancientry, stealing, fighting.” Shakespeare, A Winter's Tale, 1623


Thursday, August 21, 2014

Models in Therapeutic Work with Traumatized Children Part 2

In my previous blog, I discussed how models develop in childhood as internal ‘templates’. By the time a child becomes an adult, he or she will have a way of relating to others based on their ‘internal working model’. Once a child is born the parents ideally have some clear ideas about what will be good for their baby, and they also have the capacity to provide it.

We all know from observing and/or being a parent that there are different versions of how to look after children. Usually, our version is based on our own childhoods, what we have learnt in our families. Most parents want to parent like theirs did, if they have internalized a positive experience of being parented. If they have not and they haven’t been able to acknowledge the difficulties, they may also parent in a similar way and repeat the negative experiences. This is how a cycle of deprivation and abuse continues. Or if they are more in touch with the reality of their own childhood difficulties, they may wish to be different than their parents and bring up their children in a better way. However, even with all the knowledge now available, few first time parents will have received much formal education on parenting.

Add into the equation that both parents will have had different childhood experiences and will have differences and similarities in their views on parenting. Some difference may be positive because it provides their children with a wider range of qualities. However, too much difference on dealing with basic issues could be too contradictory, unpredictable and unhelpful. Sometimes the parents might not be conscious of their differences until: they have a baby; their child reaches certain ages; or particular situations arise. Each stage and event of childhood can have the powerful effect of resurfacing strong feelings in the parents, related to their own childhoods, which they may not have been aware of, or had repressed. On the positive side, how the parents manage their feelings, work together and resolve differences are vital parts of parenting. It provides children a role model on how we can positively cope with difficulties and how difference can be useful rather than negative.

The relevance of parenting, is clear when we think of therapeutic models. Whether we are working in foster care, residential care, therapy or teaching, parent-child dynamics will be involved. The task will require that the foster carer, residential carer, therapist or teacher can reflect upon and untangle what is in the child’s best interests. One child who was living in a residential children’s home complained to me,

‘You can tell how all of the carers were brought up, because they all have different rules and attitudes at mealtimes.’

There is nothing like the way we eat together to highlight differences! In the absence of a clear and agreed model the carers were doing their own thing based on their personal points of view. There could be 8-10 adults in a team, so the potential for confusion is huge. It can be hard for two parents to provide the necessary consistency for a child, so providing it among a large team is challenging.

When there is a team working with a child it is especially helpful to have a model. Traumatized children need predictability and consistency, to help them feel safe and to stabilize their emotions. Only once this achieved can they begin to make use of the experiences they need to recover and develop. Without a clear model, chaos is likely to rein. For many years various reports, investigation’s etc. into ‘looking after children in care’, have found that a clear ethos or philosophy, along with strong leadership are the most consistent factors in positively run organisations that have good outcomes for children and young people. What used to be termed a philosophy of care, is now more frequently referred to as a model of care. Whether we are talking about care, therapy or teaching, having an appropriate model is essential.

A model needs to be based on the best information available for the specific task. For example, if we are teaching an autistic child, the research and theoretical base will be different to that for therapy with a traumatized child. There may be some overlaps but there will also be some differences. I had a steep learning curve, when I began work with traumatized children and another one when I moved and spent some time working with children who were diagnosed with Asperger’s Syndrome.  The model that worked with one didn’t work with the other. It can be said that in working with any child, we need to be adaptive to each child’s personality. For instance, it is now well-known that everyone has different learning styles and therefore different learning needs. But the differences between children with different types of complex needs are especially challenging to adapt to. Bessel van der Kolk et al. (2007) has said that in work with complex trauma a variety of approaches are necessary and,

“Helping people who develop posttraumatic stress disorder (PTSD) in the after­math of a traumatic experience is a complex process that cannot simply be described like a cookbook recipe.”

A model can provide guiding principles, standards, specific techniques, do’s and don’ts. But most importantly it should equip the people doing the work with the ability to think within a framework and work things out together.  A model provides parameters within which things can be tried and monitored. What works can carry on and what doesn’t may need re-thinking or persevering with. Having a benchmark provides a point from which new ideas can be critiqued. If there isn't a benchmark how do we notice how far something is drifting - a bit like walking in the fog, without even a vague marker to keep a sense of direction.

Having a good model on paper is not a guarantee of good outcomes. There are other important factors that will determine success. For example, is the model embedded in the culture, is it understood and do people feel a sense of ownership. It is particularly important that a model is culturally sensitive and takes into account cultural values, language and belief systems.

In work with traumatized children, as I mentioned in the previous blog, every aspect of the environment and how the different parts work together is vital. Different terms like, integration, congruence and joined-up have been used to explain the importance of this. A trauma informed environment is necessary and this includes everyone who is in any way involved – carers, therapists, teachers, managers, senior executives, administrators, etc. Creating this requires a cultural change because how people think about the children, the task and how they relate to each other is all relevant to the model.

Effective leadership and implementation of a model is a challenging task.  To fully establish a strong culture with a clear model can take at least 2-3 years, if not longer. By this I don’t just mean that a model is created on paper, but that it becomes genuinely reflected in the way that individuals and the organisation as a whole works. When a model is fully established, it can be recognized by the positive qualities that run through the organisation, with everyone speaking the same language. It will be reflected in the consistent quality of relationships between adults and children and at all levels of the organization. Ultimately the aim of any model is to achieve the best possible outcomes for children, so continually evaluating, learning and adapting must be part of the culture. As I have said, a model is never finished, it is always evolving.

Reference

Turner, S.W., McFarlane, A.C. and van der Kolk, B.A. (2007) The Therapeutic Environment and New Explorations in the Treatment of Posttraumatic Stress, in van der Kolk, B. A., McFarlane, A.C. and Weisaeth, L. (eds.) Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press

From a great book!