Humans are social beings. Historically individual humans are weak, at risk from predators and incapable of surviving for long in nature without others. By being part of a family network; a community or some form of functional group i.e. hunter-gatherer societies, was and still is the safest way to survival. This is thought to be why a child with normal emotional and physical development associates the presence of people as comfort and safety. When with people who make us feel safe our heart rates and blood pressure are lower and our stress response systems are quiet.
But how do children who have not been fortunate enough to be provided with the ‘good enough’ (Winnicott, 1958) care needed for normal development find living and being part of a group? A child who have experienced multiple or prolonged spells of trauma will display stress responses such as; increased heart rate and rapid breathing, often consistently throughout the day (Van Der Kolk, 2014). We realise it is important to be part of at least one group to survive but what are the benefits to being part of more than this one crucial group? If we have learnt to steer clear of being part of a group due to traumatic experiences as part of our early years, can we be reintegrated into other groups or is this likely to re-traumatise?
What is trauma?
Winnicott (1986) defined trauma as the breaking of continuity of the lines of an individual’s existence. According to the Concise Corsini (2004) trauma can be conceptualised as both an event and as a reaction, with a traumatic event being one that an individual experiences actual or threatened serious injury or death (American Psychiatric Association, (APA), 2000) e.g. rape or child sexual abuse. Trauma follows the traumatic event, the APA (2000) discusses how an individual’s response to trauma often involves intense emotions such as fear or hopelessness.
Trauma can impact on a child’s body, brain, memory, emotions, relationships, learning and behaviour. (De Thierry, 2015)
As discussed above trauma can have many different impacts and therefore impacts individuals in different ways, a way to understand this is the trauma continuum (Terr, 1991). Terr’s work states that traumatic exposure may be brief in duration, such as an accident, this is known as Type I trauma. Trauma that involves prolonged, repeated exposure (e.g. sexual abuse) is known as Type II. Later Heide and Solomon (1999) added a Type III trauma, this trauma relates to multiple, pervasive or violent events at an early age, which continues over time. The trauma continuum can be used to assist those who work with traumatised children, enabling practitioners to use a common language, providing consistent responses to children’s behaviour and therefore ensuring that these children receive appropriate care.
(De Thierry, 2015)
The Mulberry Bush School
The Mulberry Bush School is a non-maintained residential special school, providing 38 week residential therapeutic care, treatment and education for primary aged boys and girls. This non-profit charity provides and supports the highest quality therapeutic work with vulnerable children and their families. Between 2008 and 2014 there were sixty children who left the school at the end of their placements. Fifteen children were enrolled at the Mulberry Bush School from outside of a suitable Foster care, children’s home, Adoptive or Biological families during this time and upon leaving all of these children were placed in an environment that best suited their needs. Pre-placement thirty children were not accessing full-time education of any form, with five being home-tutored before enrolment at the school and post placement at the Mulberry Bush fifty four were placed within full-time education elsewhere. The remaining six were either home-tutored or information is unknown. This information is gained from the Mulberry Bush Schools unpublished records (Mulberry Bush School, 2015).
Case Study: Cathy
My initial reasoning to explore this area of child development stemmed from an incident with a child I found myself part of over a year ago. At the time I was a teaching assistant at the Mulberry Bush School in a Foundation stage class. Being the Foundation stage this meant we were the point in the school in which the children first re-joined the education system. For some of those children they had been out of an education setting for a considerable amount of time and for many they also found themselves in highly unstable family placements.
To set the scene, I found myself at one end of our classroom with a nine year old girl in extreme distress; any names throughout have been changed to protect the children’s identities. Cathy was attacking adults, attacking herself (pulling her own hair out, biting herself and punching at her own arms) and shouting and screaming expletives and insults to anyone in close proximity. Cathy had arrived a few days previously, having just spent a period of time the days before her arrival giving evidence in court against her father who had sexually abused her – he was later found guilty and sentenced to a twelve year custodial sentence.
Cathy had had an altercation with another child around the table and had become distressed by this, I escorted her away using a team teach hold as she was causing disruption to the other children and sat on the sofa with her. During this time some of the other children in class were angry about her outburst and started to shout obscenities across the room to her and phrases such as ‘go fuck your dad’ or ‘your dad’s dead’. Cathy had made no attempt to let children know anything about her history other than her place of birth so they were not aware of her recent court appearances. Cathy while in the emotional breakdown described above, begged me to stop them, saying things like ‘they don’t know, why are they saying those things?’ Cathy was unaware that this was the current ‘trend’ of insults the children would use towards each other during unsettled times and saw this as a personal attack. Cathy was later escorted from the building and given space from the other children in the large field area near the residential houses with play equipment to calm and collect herself. I was left feeling confused and for the first time during my employment at the school wondering if Cathy’s placement at the school was re-traumatising, rather than rehabilitating. How much planning and forward thinking was considered when placing a child so soon after a court appearance?
Holding and a Psychologically Informed Planned Environment
Childhood trauma often creates un-integrated, unsociable and emotionally troubled children who are unable to be part of a family network or care group of any form and obtain any educational achievement. Hannon, Wood, and Bazalgette (2010) argued for healthy psychological development, a holding environment needs to be experienced. This holding environment such as the one facilitated at the Mulberry Bush school enables this sense of belonging previously discussed by providing; a secure attachment, “authorative” parenting that provides a combination of responsiveness and demandingness (or warmth and consistent boundaries), and stability. This holding environment aims to facilitate “attunement” to verbal and symbolic forms of communication, as a mother would be attuned to an infant’s pre-verbal and instinctive needs; instead of the mother or in the case of the Mulberry Bush School the therapist takes this role.
This holding is part of a planned environment. According to the Planned Environment Therapy Trust or PET Trust (2015), a planned environment is a way of living and working together, where the environment is carefully planned to benefit those within it. A “psychologically informed planned environment” is able to provide conditions where traumatised children can begin to start to grow emotionally.
The Mulberry Bush School focuses on the importance of relationships within
its planned psychological environment or milieu. Relationships and finding ways to internalise good experiences are at the centre of the therapeutic interventions, by feeling held in mind a child can start to form attachments and find stability in these. This stability and continuity is the secure base any child needs to establish a sense of self and identity. By creating the beginnings of meaningful relationships they school and its staff enables children to grow into functioning adults. This will be discussed further later in relation to education.
Residential Care and Belonging
Baumeister and Leary (1995) argue that a lack of belongingness constitutes to severe deprivation and a cause of a variety of ill effects. They went on to discuss the importance of this belonging;
Human beings have a pervasive drive to form and maintain at least a minimum quantity of lasting, positive, and significant interpersonal relationships. Satisfying this drive involves two criteria: First, there is a need for frequent, affectively pleasant interactions with a few other people, and, second, there interactions must take place in the context of a temporally stable and enduring framework of affective concern for each other’s welfare. [p. 497]
So where does Cathy feel she ‘belongs’? Similarly to many children at the Mulberry Bush School she has a string of broken down foster placements before her attendance at the Mulberry Bush School and since her placement began at the school she has had one more recent change to her foster placement. Foster care remains the preferred option for looked after children, this being the closest care structure to a birth family. But children like Cathy who have experienced early year’s trauma do not have the basic survival skills such as trust to maintain new family like placements, Cathy’s previous foster careers found themselves feeling that they could give the world to Cathy and that this would not be enough for her to maintain the placement without displaying the destructive behaviours we so often see Cathy act out. We must remember that historically, the adults Cathy has felt she could trust have neglected and sexually abused her, therefore, for Cathy the intimacy of a foster family may be just too intolerable.
Residential care as described in the Care Matters White Paper (DfES, 2007) could possibly be a more positive option for many children and young people. Residential care offers a different experience. Diamond, (2015):
Thoughtfully delivered residential care can provide an ethos of professional neutrality, which allows children a safe environment and the conditions in which to explore relationships; if this is backed by a responsible financial commitment, they can do so in their own time. This requires the provision of a relational system that can provide appropriate “emotional distance regulation”. [p. 68]
Abuse and Attachment
I once found it shocking when talking with children at the Mulberry Bush who had been severely abused or neglected by their primary carers (biological parents or extended families) that when asked who they would like to spend time with the most, or return to live with a vast majority were likely to answer the abuser.
Severe maltreatment has been defined as;
‘All forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power’. (Butchart, Putney, Furniss and Kahane, 2006, pg 6)
Evidence from research by Radford et al. (2011) shows over 90% of children who have been sexually abused knows of the abuser. They also found that 5% of under 11 year olds and 13.4% of 11-17 year olds have been severely maltreated by a parent or guardian.
These figures are shocking and therefore it is no wonder many children who have experienced this form of trauma lack the base of attachment described by Bowlby (1980). This important emotional link between two people; creates the “safe base” in which a child starts to look outwards and explores the world, returning for comfort when distressed, stressed or for encouragement. A child is born relationally wired with a desire to attach to a caregiver, no matter who that person is, or how they feel about the child.
When an individual has been deprived on the most fundamental part of their emotional development a therapeutic intervention such as the Mulberry Bush may be the least ‘scary’ way to find these attachments as the intensity of relationships is somewhat dissipated due to staff timetables and the number of staff working alongside the children. This also provides the staff with a way to come away and discover their own feelings rather than be immersed completely into the children’s projections and transference. Without this space to reflect there is potential that the adults will react to the children’s behaviours in a negative manner and this would therefore be highly detrimental to the intervention.
Once a child has someone they have attached too they can start to develop their emotional literacy, if this attachment is not secure this emotional literacy may be damaged. This is another area in which a psychologically informed planned environment can help to rebuild damaged areas of a child’s emotional development.
A child needs to have repetitive experiences in early childhood where they can test and challenge the unknown. The ‘unknown’ needs to be met with consistent love, nurture and care from the caregiver for a child to be able to process the unfamiliar and scary emotions brought with it. If a child has missed this part of their development due to lack of suitable attachments or due to trauma they may be unable to reflect upon the emotions felt and will therefore very quickly become immersed in strong, powerful emotions without the skills to respond appropriately to them. An intervention such as the Mulberry Bush breaks this cycle and helps to rebuild pathways in which a child can learn how to cope and develop skills that will lead them into a successful adulthood. This intervention is better placed when the child is younger as the damage may be more repairable due to biological differences to a child’s brain.
Children’s brains have more plasticity during their younger years and therefore are more malleable to change through therapeutic interventions, the younger the invention the more potential it has for success. Neuroscientific research has connected early attachment with the development of neural networks in the prefrontal cortex of the brain. This evidence shows that implications for early childcare are profound and must be addressed (Hobson, 2002). Interventions with traumatised children should not be left, they should be found within days or months and not years and seriously thought about to aid a fuller recovery. While thankfully, society are not faced with many children with such severe trauma as the children in the care of the Mulberry Bush the intervention can be a prevention for crime and imprisonment in adolescence and adult life (Ziegler, ND).
Learning from your peers in a group
Group experience is fundamental when intervening to help people. We spend much of our time in groups in the natural course of our lives, therefore being able to function within a group is crucial to our success, emotionally and financially. Through working with others we develop skills with regards to communication, relationship-building and asserting oneself.
Lindsay and Orton (2012) argue that people with similar life experiences, situations and problems can be a source of support to each other. They discuss people who have experienced particularly damaging and hurtful experiences, who are presently experiencing difficult situations can often feel extremely alone and isolated, this in turn prevents them from joining others who can help them. They discuss a coming together to discuss their experiences, this can aid recovery by showing them they are not alone, can dissipate guilt and cognitive difficulties associated can be overcome. This example is closer related to groups such as Alcoholics Anonymous however, there are instances at the Mulberry Bush that the group work model cultivates deep and meaningful thinking within the child group.
An illustration of this would be during a community meeting in one of the group living houses. Each meeting a child is asked to chair the discussions; this usually revolves around how the children feel their days have been and what they would like to do during their evening. On this occasion the child chairing asked what the children would most like, this was understood by the adult group as what would the children like to own the most, when arriving at Louis’ turn to speak he said the thing he most wanted in life was for his Great Grandma to be alive again. Louis broke down into tears and the child group while trying to comfort him remained silent for about four minutes in quiet contemplation. The practitioners working remained quiet and allowed the children to work through it together. The next child, Harry, discussed and reflected upon how he would like to be able to spend time with his biological parents and get to know them. Harry is aware that both of his biological parents died when he was a baby. The child group again quietly supported Harry and then moved onto to the next child. This highlights the importance of group work and how therapy cannot simply be done but that the service user must be willing to use the therapy offered to them, in this case the ability to be part of a community and use it to one’s psychological advantage. An individual provision would not have enabled the children to find their own way to this highly emotive thinking and reflection allowing them to find that they are not alone in their struggles.
Individual or one-to-one therapies can leave a client or service user feeling very disempowered and weak in regards to the power equation. Within a group, however, the clients may feel more balanced in power due to greater numbers. Therapeutic experiences have the potential to empower and put clients in touch with the resources available to them and therefore encourage them to take responsibility for their choices and self-improvement. Bringing people together to help and support each other is in itself empowering. Doel and Sawdon (1999) state that increasing feelings of self-worth, a growing ability to feel and use power in constructive ways is empowerment and should be an integral part of the members’ experience of the group. Another argument for a group work model, Rogers (1957) argues that the sense of being accepted as we are is one of the essential conditions for personal growth. He argues that service users who are seen alone can develop a sense of acceptance from interactions with social workers and other professionals however, acceptance and respect (or friendship) of their peers can be much more powerful and greatly increase their feelings of self-worth.
When part of a group you are exposed to different ways to behave. This can be a positive or a negative dependant on the behaviours carried out within the group and the valancy of the individuals within the group. A positive is the potential for normalisation of feelings e.g. a child feeling angry at their biological parents for giving them away, this may be a feeling that many of the children are feeling however, when expressed by another in the group it may empower those too fearful previously to express it.
Button (1997) suggests that while carers can be very kind, loving and patient, groups provide a different form of care, meaning a group can hold ‘big feelings’, such as; shame, fear and terror. A single carer may not be able to hold these feelings for a child and withstand the emotions placed upon them; a group however can share these between them, passing these feelings back to the child in much more manageable pieces over time.
At the Mulberry Bush these ‘big emotions’ are managed and held by the staff group through the use of group reflective spaces, group supervisions and individual supervisions (Thompson and Thompson, 2008). This is a high number of areas left for reflection; nevertheless, it does not stop there.
Trauma isolates those who have experienced it, causing their internal self to shatter. Practitioners working alongside individuals who have this internal shattering will find this experience reflected upon their own internal self (Howard, 2013). We are increasingly aware of the importance of ensuring practitioners are equipped emotionally to help the children.The staff team are asked to work reflectively on a day-to-day basis, thinking allowed and wondering is encouraged to help the children start to pick apart their behaviours. This thinking can be done with the children present and for the more sensitive thoughts and conversations in formal and informal spaces. Without this thinking and securing a sense about who you are as a person you cannot begin to help traumatised children to learn who they are and how they function in day-to-day life.
With regards to the children at the Mulberry Bush, while living and learning alongside their peers the practitioners in the group living and education areas of the school allow the children to regress to a level in which they are enabled to have experiences that they have potentially missed i.e. the foundation stage classes are highly play based, with education almost taking a back seat. This enables children who have had highly negative encounters of education, learning and the classroom environment to re-learn what school is about and all that it entails in a safe, planned environment. The children are introduced gently over time back to the National Curriculum throughout their attendance. Once a child has taken the first steps to being a successful learner they find themselves moved upwards through the school system, at this next level behaviour expectations are higher, alongside higher learning expectations. All expectations, while still working with a group model are differentiated to suit the child’s individual needs, this safeguards their increasing confidence by allowing them to learn at the pace and level that is appropriate for them, while realising that people are all different and that that is ok. Finally, a child reaches the highest level of the school, this classroom attempts to imitate a mainstream classroom within reason, with some class groups managing this better than others. During their time in this class some of the children gain a chance to have weekly visit to a local mainstream primary.
Children are not moved from the education level at any set times during the year but when they gain the ability to move by showing they are emotionally ready for the next step. This being so means that some children will not move from the Foundation stage level throughout their placement or may not reach the top stage, by keeping the children in suitable classrooms rather than moving them at set times allows each child’s placement to be planned and strategically thought about to empower the children to succeed.
There are many ways in which teaching staff can improve the teaching environment for the traumatised children in their care at the Mulberry Bush School, however to be able to help you must be able to understand the children in your care. De Thierry (2011) outlined eight areas of understanding in which teaching staff can reduce the stresses of trauma upon a child’s education. These are;
- Making sure the children feel safe. A child who doesn’t feel safe is unable to access their pre-frontal cortex and re-engage in thinking.
- The therapeutic intervention can help develop the broca area of the brain which is responsible for speech and language. Being part of a psychologically informed planned environment can assist this recovery with creative uses of adults, spaces and resources within the school.
- Positive and engaging relationships with adults can help children to learn about how their body and emotions respond to stimuli and how to deal with this in a safe way. They may be unable to explain why they have behaved in the manner they had done so as their cognitive ability will not have been developed fully due to the lack of positive relationships and early attachment.
- Positive experiences form neural pathways which facilitates future positive relational experiences. By strategically basing work at a level a child can manage and succeed at during education at the Mulberry Bush educators are helping to form a positive outlook and experience of education. The aim is to increase self-esteem through supporting a child’s success.
- Modelling self-regulation is necessary for a child to learn the skill themselves. If the adults who live or spend time with the children cannot regulate their own emotions in a way that negative behaviour isn’t displayed, the children in their care have no baseline to go by and cannot learn to regulate themselves.
- Children’s brains have a high degree of plasticity and therefore can change quicker than an adult’s brain. The earlier and more structured the investment the better for the child’s recovery.
- Offering warm, engaging, patient, repetitive, rewarding and relational experiences will eventually change the neural pathways of a traumatised child, enabling them to relate to others and think to the future.
- Shame increases negative behaviour. Avoiding shaming of the children is a must, this includes words to describe and consequences of their behaviour.
While the physical environment and the structure of class groups is planned around the children’s needs the focus still remains upon the child’s experienced trauma and their need for positive adult relationships. It has been highlighted (Perry, 2011) that some traumatised children are unable to develop the capacity to be socially appropriate, empathetic and self-regulating due to their limited experience of positive relational experiences. Teachers and other staff within the education day can facilitate these missed experiences without needing to do plan anything extra to the daily timetable. This is because a simple recognition of a smile, every piece of comfort offered and look of affirmation can help to change the pathological pathways of a child’s brain (De Thierry, 2015).
The combination of group work and a psychologically informed planned environment has evident positives to even the most extreme cases of child trauma. While positive relationships, foundations to a sense of belonging, the ability to learn of our peers and not therapists and a structured education with relationships at the centre are highly effective for many traumatised children, age and other impacting factors such as Autism must be taken into consideration when placing a child within such an organisation.
For children in attendance at the Mulberry Bush School there have been some recent changes to embed this areas of focussed discussed above, these changes have been due to the needs of the current children on role and their own personal difficulties.
First there were some placement changes to the staffing in the education area to increase containment levels in certain classes, these changes enabled a highly unsettled class become contained in a relatively short period of time, due to previously formed relationships and a more functioning staff grouping. This supported the other class groups to be more settled also through less disruptive behaviour outside of their classrooms from the unsettled class. There have been many further positive relationships formed due to these changes.
Secondly, one of the two middle stage classes has been lowered to a foundation level to empower the children in the class to step back and take more time to learn, this has increased their ability to learn through play with lowered expectations and higher staffing levels. Staff have been re-trained to support this.
Due to the change to the class level there is much more scope for those classes to work alongside each other. The staff are now working on changing the culture for the children so that they belong to not only their class, but the foundation level as a whole. This is facilitated by some children swapping classes on certain afternoons for certain lessons. In turn this allows the adults to plan the child groupings dynamically, and to provide spaces where children who are finding it hard to be together can either have a break from each other to reduce stress and anxiety levels or have a safer place to explore their difficult relationships.
All of the above changes are currently providing the necessary psychologically informed planned environments for the children placed at the Mulberry Bush, however, we must not forgot the need to be dynamic and change the structures to the needs of the children.
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