Tuesday, June 24, 2014

The Value of Writing and Storytelling

 I said in my previous blog, that in my first job at the Cotswold Community we were expected to read about our work with traumatized children.

Thinking about this I have realized that our culture also had a big emphasis on reading to the boys. Every night (more or less) we ended the day, with a small supper and everyone would sit in a circle while one of the adults would read a story for 10-15 minutes. As well as the story being enjoyed, the consistency of this routine was also very important. We know that repetition and a reliable routine is one of the most important elements in the work with traumatized children – making the world around them an intelligible, predictable and safe place, and helping with emotional regulation. This can be especially important at the end of day, which is often the most stressful time for traumatized children.

After the story the boys would go to bed, and some of them would ask their carer to read to them while they settled down. Another part of our culture was to provide individual reading times during the education day. Some of the boys had very little vocabulary, couldn’t read very well and may not have experienced being read to before. Research has since shown how important having a rich vocabulary is for a child’s development. Being able to form a narrative is also very important for traumatized children. The story of their trauma is unfinished - it had a beginning that just keeps going relentlessly on, whereas a story has a beginning, middle and end.

It is interesting to think that many of the stories told to infants, by their most trusted carers are often frightening - involving witches, monsters, and grandmothers disguised as wolves to devour the unsuspecting child! There is something satisfying about being told such stories, surviving and being able to move on from it. Children who are traumatized are stuck and not able to move on from their all too real stories of terror.

A story told becomes something between two people, that both can have a role in managing and relating to. Many ‘fairy stories’ are symbolic of primal fears and desires. In a sense the story can be a safe way of the parent bringing a primal issue to the surface and helping manage the feelings associated with it. So the parent or carer, becomes an ally of the child in dealing with these issues, as well as the focus of them!  The stories often represent the dynamics of parent-child relationships.

Of course not all childhood stories are frightening, but there is a reason why stories such as, Hansel and Gretel, Snow White, Little Red Riding Hood are so enduring and intuitively read by parents to their young children. Probably the fact that the story is usually read from a book is of some relief to the child, who might fear that such ideas could come straight out of the parent’s head!


Writing about the educational aspect of learning and stories, Shonkoff and Phillips (2000, p.156) capture the essence of the pleasure that can be involved in being read a story,

“Accordingly, the literature on early learning environments is not about accelerating learning with expensive toys and explicit early instruction. Instead, it focuses on how adults interact with young children and set up relatively ordinary environments to support and foster early learning. While this sounds like a subtle distinction, it captures the difference between a child who is taught to recite the alphabet and a child who is read to every night and becomes interested in letters and words because they are associated with the joy of being in her father’s lap, seeing beautiful pictures, and hearing a wonderful story.”

At the Cotswold Community, as well as being expected to read – we were also expected to write. Our yearly calendar was divided into terms or what we called sessions, each one being 6-8 weeks long. After each session, all staff members were expected to write an ‘end of session report’. The remit was fairly broad – anything relevant to our recent work experience that we wanted to share. It could be short or long – normally between a paragraph and a page. Sometimes people would write about their work with a particular child; or a group of children; their experience in a team; an organizational issue; a concept or idea they were thinking about. Once all the reports were written (usually about 30 of them) they would be typed and distributed for all the staff to read. We would then discuss them in various meetings throughout the Community, picking up on themes and pertinent issues.

This process required a high level of commitment and discipline. I have never come across anything like it since. At the Community it was done without fail for over 15 years. The process of writing required us to be reflective – to think over a period of time and consider what stood out? What questions did we have? What were we learning? What did we feel worth sharing? It also enabled us to realize that by writing about our own experience, we could make a difference and have an influence in the organization. It was a feedback loop from the individual into the system as a whole. Feedback loops like this are vital for the health of a system – they provide essential knowledge of what is going on. We could also write things that might cause a negative reaction – there are always challenges involved in writing and expressing ourselves. Encouraging open communication is central to the task of enabling traumatized children to recover, so it is essential to establish this in the culture.

Early in my career, I learnt that in our work we are also researchers. Though we learn from people who went before us, we were also encouraged to add something to an existing idea or concept, through our own experience. Tom Farrelly (2013) states the two-way process of this,

“However, as well as being consumers of research, practitioners can and should strive to be producers of research.”

Numerous people working at the Community wrote papers or in a few cases, books. This was a little intimidating but also inspiring. The ‘model’ for our work was closely linked to the Psychoanalyst and Pediatrician Donald Winnicott, who also happened to be a prolific writer.

Writing has continued to be a theme in my work. A few examples – when I studied for an MA in Therapeutic Child Care in the 1990’s we were required to keep a reflective journal – simply writing a diary of one’s work, what stood out, what sense we made of it. Writing can be an excellent way of reflecting, which is so important in social work/therapy.  It can also be helpful to one’s development in general.

As Friedrich Nietzsche said, writing can also be a good way of just getting rid of thoughts! He actually said that he had found ‘no other way of getting rid of his thoughts’ (Gane and Chan, 1997, p.39).


If we write we might also find we have a dialogue with ourselves – we may see something we hadn’t noticed before and our ideas can change shape as we write.

After the Cotswold Community I moved on to work at SACCS in the UK, who also work with traumatized children and young people. One of the unique approaches used at SACCS was its Life Story Work. This enabled children to tell their own stories and also work through the feelings and issues involved. They would do this in words, pictures, drawings and symbols that would be made into a life story book.

This process was hugely valuable to many children. For adults as well as children, writing can be a form of working through trauma – putting the story down can bring a sense of closure. Having a coherent narrative is something that a traumatized person often doesn’t have, so developing one that can be integrated as part of one’s identity is a goal of recovery. Bessel van der Kolk and Alexander McFarlane (2007, p.17) state,

“Treatment needs to address the twin issues of helping patients (1) regain a sense of safety in their bodies and (2) complete the unfinished past. It is likely, though not proven, that attention to these two elements of treatment will alle­viate most traumatic stress sequelae.”

Completing the ‘unfinished past’ can be considered as completing the unfinished story, the story of trauma that has a beginning but not an end. On a similar theme, our child psychotherapist consultant Barbara Dockar-Drysdale, used to suggest that if we thought of a nightmare as an unfinished dream, it might help us think with a child about it might be completed. Often this was a helpful perspective.

I also work with the Lighthouse Foundation in Melbourne, Australia – who provide a Therapeutic Family Model of Care for homeless young people. Lighthouse has a strong belief in the value of storytelling - it is built into the culture of the organization. It could be said that our stories define who we are and it is the sharing of them that creates our individual and shared identities. Stories are often told without writing. The verbal tradition of storytelling is powerful and well established – but putting something into the written word, is an essential part of our culture and work.

While writing this blog I was jogged into looking up my old ‘end-of-session reports’ and found that I still have them. Here is my first brief report.

December 85
I joined ‘Springfield’ (one of the homes) for the last five weeks of the session. The session seemed to be quite a steady one though the Christmas week was very busy. I think that I have settled in well and am getting used to the demands of the work. However, I definitely wouldn't describe my experience as a 'Honeymoon'. I have come in for quite a lot of testing out, especially from two of the boys. Quite often I have felt that I should have known more about what is going on and what to do in certain situations. I have realized how important communication within the team is and reading, in helping to overcome this. The weekly training group has also been useful.

My next end-of-session report described how I got my nose broken - it was a steep learning curve!

References

Farrelly, T. (2013) Evidence Based Practice in Social Care, in Lalor, K. and Share, P. (Eds.) (2013) Applied Social Care: An Introduction for Students in Ireland, Dublin: Gill and Macmillan

Gane, L. and Chan, K. (1997) Introducing Nietzche, Icon Books UK: Totem Books USA

Shonkoff, J.P. and Phillips, D.A. (Eds.) (2000) From Neurons to Neighborhoods: The Science of Early Childhood Development, Committee on Integrating the Science of Early Childhood Development, Board on Children, Youth, and Families - This free PDF is available from the National Academies Press at: http://goo.gl/6N4jWW When it comes to reading, this document is not for the faint hearted! Over 600 pages of research on the science of child development, produced for the USA Government. It does have some excellent information in it.

van der Kolk, B.A. and McFarlane, A.C. (2007) The Black Hole of Trauma, 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

This has just been recommended to me by someone who read the blog.  Frank Cottrell-Boyce: Open the Box of Delights - a video of his talk at this year’s CELSIS conference in Scotland, on the importance of reading to children and storytelling, http://goo.gl/AeXeXE

"When a child is read to, they experience alertness and attention without anxiety. Reading aloud offers children and young people the experience of sharing with peers and carers and joining with the long traditions from which our cultures are built."

One of the points Frank Cottrell-Boyce makes in the video below is that being read to does something special and important to a developing child's brain. It is so powerful, such that Frank says reading to children, purely for pleasure should be a part of daily life.  Just as we did at the Cotswold Community with our bedtime stories and individual reading times. We believed in the value of these experiences, which was focused more on pleasure rather than education. 

Frankie says that reading stories should be provided unconditionally, without expectation of a response at the time. He says that stories are stored in the mind and may be used or come back to a person, when they need them in the future.  He points that out that we get through life by routine and predictability, and stories provide a safe way of experiencing unpredictability - also of imagining ourselves outside of where we are. Frank's views affirm, what I have mentioned about the importance of the daily routine. We also used to provide individual children, reading times during their education day - where they would simply be read to for 15-20 minutes or so.

Reference
Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Postscript
Since writing those blogs I came across this interesting article, Science Shows Something Interesting about People who Love to write, http://goo.gl/y8tgjU

The article refers to research suggesting that writing may have physical as well as mental health benefits. Some of the claims initially sound a little farfetched. However, there is a logic to the idea – reflection, which can be achieved through writing, helps to create a perspective, which can reduce stress, which is likely to impact positively on physical health. Interesting to think how the professional requirement to write, which I refer to in these blogs may have been a more significant antidote than we realized.

And just recently I found that Bessel van der Kolk (2014) has reported the same thing in his book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma.  He refers to an experiment carried out by James Pennebaker at the University of Texas in 1986. 

“He began by asking each student to identify a deeply personal experience that they'd found very stressful or traumatic. He then divided the class into three groups: One would write about what was currently going on in their lives; the second would write about the details of the traumatic or stressful event; and the third would recount the facts of the experience, their feelings and emotions about it, and what impact they thought this event had had on their lives. All of the students wrote continuously for fifteen minutes on four consecutive days while sitting alone in a small cubicle in the psychology building…………………The team then compared the number of visits to the student health cen­ter participants had made during the month prior to the study to the number in the month following it. The group that had written about both the facts and the emotions related to their trauma clearly benefited the most: They had a 50 percent drop in doctor visits compared with the other two groups. Writ­ing about their deepest thoughts and feelings about traumas had improved their mood and resulted in a more optimistic attitude and better physical health.” (p.239-240)

and,

“Writing experiments from around the world, with grade school students, nursing home residents, medical students, maximum security prisoners, arthritis sufferers, new mothers, and rape victims, consistently show that writing about upsetting events improves physical and mental health.” (p.240-241)

Reference


Van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking: New York

Saturday, June 21, 2014

About This Blog

I am writing the blog, because I enjoy writing and I like the idea of creating something, which lasts and can be used in a positive way.    

This blog is primarily for individuals and organizations who provide services for children and young people who have been traumatized – particularly by abuse and neglect, but also from other circumstances.  So on the one hand it may be of interest to a counselor, therapist, foster or residential care worker, but also to those who manage and lead organizations.  It may also be of some interest to people who are more generally involved with trauma work, and also child development and parenting. The blog is aimed to be widely relevant rather than related to specific local issues.

Sometimes I wonder about the two different roles of care/therapy and management/leadership.  In my career I have done both, carer/therapist and also manager/leader.  It is tempting to focus on just one, but I think this is an unhelpful approach.  There is often a split in our work between care and management, as if the two are in conflict.  In some societies this problem is described from a business perspective, i.e. carers and other practitioners, don’t care about business and vice-versa.  Politicians are often concerned with the cost of providing care and therapeutic services, and therapeutic service providers bemoan the politicians’ apparent lack of concern about people’s needs. 

There is now undisputed evidence, which shows that attention to the needs of children and young people, and their families, especially those who have been disadvantaged, makes great social, political and economic sense.  This means that people on both the side of care/therapy and also management/business need to collaborate. This can cause discomfort, because people don’t always like to see the two sides of the fence, so the easy option is to keep the two separated and split. 

On this blog I will discuss both.  Sometimes this causes me to feel uncomfortable.  If I see myself at the organizational leadership level, how will people in those roles think of me discussing issues such as: children who need to play; how to communicate with children; meeting the regressed needs of a traumatized child?  How will carers and therapists feel about me talking of management, leadership and outcomes? 

I think my own discomfort is a reflection of the split – so I run the risk of falling out with those on both sides of the fence.  And this is exactly what happens when organizations begin to reflect the traumatizing environments, the young people they work with have come from.  I think the two sides need to be successfully integrated – in recent years this has been called the struggle for congruence in service of the children’s best interests (Anglin, 2004).  You can’t have therapeutic work, which is incongruent with management and leadership practices, and vice-versa.  The organizational consultant, Menzies Lyth (1979) said that it is possible to have management without therapy, but not therapy without management. 

I have experienced leaders and senior executives who understand the importance of the fine detail involved in the therapeutic work, because they have been there themselves.  A highly skilled leader can run an effective organization, without necessarily having a background in that organization’s work.  However, I think in such complex there is something to be said for a leader having experience at every level of the work he/she is in charge of.

The style of the blog, will have a focus on Integration, which I have just realized, is very relevant to the first 14 years of my career at the Cotswold Community – where the task of the work was to help ‘Unintegrated’ children, to become ‘Integrated’ (Winnicott, Dockar-Drysdale).  The term Integration is now also used in neuroscience by people such as, Daniel Siegel.  In this blog I will try to integrate various themes: from many different professional disciplines, such as the psychodynamic approach and neuroscience; the micro and macro levels; the past and the present; and from different cultures. 

I will write at least weekly, and sometimes more.  I want to be practical and will offer links to relevant resources wherever I can.  I would like interaction, and to create a sense of a community, so please: make comments; be constructively critical; ask questions; share anything useful; and also suggest topics for further discussion.  Please also use my email to make suggestions and to talk with me directly.  ptomassociates@gmail.com

Reference
Anglin, J. P. (2004) Creating “Well-Functioning” Residential Care and Defining Its Place in a System of Care, in Child and Youth Care Forum, 33 (3), June 2004, Canada: Human Services Press, Inc.

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

Postscript

Since writing the above over a year ago and reflecting back, a few things stand out.  First of all, my aim to write weekly turned out to be over-ambitious!  It has been more like 3-4 weekly.  I prefer to write something more significant and it takes more thinking over.  I also like to add in links, useful references and resources.  The theme of integration has been consistent and I have enjoyed developing thoughts about this.  The content in this document, includes some of the thoughtful and kind comments made by readers.  I have included those that add something additional to the subject.  I also found on occasions that after I had written a blog, further thoughts developed so in some case I added them afterwards.  I think this shows how writing can be helpful in terms of development – once we get some thoughts out, there is space for new ones to evolve.  

Wednesday, June 18, 2014

The Value of Reading and Writing in Work with Traumatized Children

As this is my first blog it seems fitting to write something about the value of reading and writing in our work with traumatized children. I will also say a little to introduce myself. With all of my blogs, I will just aim to share something that is hopefully useful and thought provoking – I see writing and reading as a way of stimulating a process rather than providing an answer with a full stop/period.

Back in 1985, having finished my degree and a year out, most of which was spent on a Kibbutz in Israel – I needed to get a job and I had decided to work with children who had difficult childhoods. The first job I applied for, through a small newspaper advert was at the Cotswold Community, a therapeutic community in the Cotswolds, England, for ‘emotionally disturbed’ boys. Like a small village on a farm with 4 houses for the boys, 10 in each – and the majority of staff having their own houses on the 350 acre site. The Community had been set up by the Government as an experiment and alternative to the ‘Approved Schools’, which basically were a disaster leading to 85% of residents eventually ending up in prison. The therapeutic approach of the Community was a success, reversing that figure, and became established as an internationally renowned ‘centre of excellence’.

I didn’t understand much of this when I started. Previously I had done a few evenings at a youth club and a module on social psychology on my Social Administration degree. However, it was deemed through the selection process, which included a 3 day visit, that I had a suitable personality for the work.

The boys had suffered extreme levels of abuse and neglect, often beginning from birth. What I saw in my first few weeks was shocking to me. I had no idea that young children could be so developmentally delayed, with such extreme behavior purely as a result of their adverse experiences.

As soon as we began work, each new staff member joined a weekly training group (around 8 of us in a group). We would be given a paper to read in advance and then in a 1 hour meeting, discuss its relevance to our work. We were thrown in at the deep end in many ways – but we had a lot of support around us. We were given papers by well-known people in the field such as Donald Winnicott, Bruno Bettleheim, Isabel Menzies-Lyth, Fritz Redl and David Wineman, and Barbara Dockar-Drysdale. Some of the reading was difficult to understand at the time - and some was so helpful to me in explaining what I was experiencing.


The expectation on us to read, relate what we read to our own work experience and also develop our own thoughts was very significant. The work with the boys was often bewildering, confusing and completely impossible to understand – as well as being very challenging to the point of overwhelming and soul destroying. I now understand this as a reflection of the children’s own experience of the world they grew (or didn't grow) up in. Without the reading, the guidance of the senior people in the organization and the space to think about the work together – there would have been little possibility of making sense of anything.







Our consultant, Barbara Dockar-Drysdale would often begin a meeting by asking what we had been reading.  She would be most concerned if she discovered people weren't reading very much and this was not something you wanted to disappoint her on!

In recent years, I have read some of Dr. Neil Thompson’s work and I like what he has to say about the importance of theory. There can be a tendency in work with children to say ‘it’s common sense’. Neil argues strongly against this notion. Common sense suggests there is a normative way of thinking – it is often a cultural perspective and exclusive to those who belong to that culture and way of thinking. The idea of common sense doesn't encourage critical thinking – if it’s common sense what is the need to analyze, think or debate? So reading can give us a perspective that might be outside of our own experience. This is especially important in work with traumatized children – partly because few of us may have actually experienced what they have. The solutions to what is not a common experience are also often not ‘common’ sense.

The kind of therapeutic approaches that are most helpful in our work are often counter-intuitive. For example, these are a few ideas that I have found very helpful; delinquency can be a sign of hope (Winnicott); getting better can make things worse; depression can be a good thing – as one young boy said to me, ‘I don’t need cheering up, I need cheering down’. Reading helped me learn and 
understand these concepts.

My next blog will continue on this theme. The person who started me off in my career was John Whitwell the Principal at the Cotswold Community back in 1985 – I had the fortune to work with him for the next 14 years. 

For a little more reading, this is his excellent website, which has many papers and resources by people that were involved with the Cotswold Community.  

http://www.johnwhitwell.co.uk/