 Why Attachment Matters Across the Lifespan. A summary of the Scottish Attachment in Action Annual Conference, 18th December 2019
Reflecting its vision of promoting attachment relationships throughout life, Scottish Attachment in Action’s 11th Annual Conference held in the Queen Elizabeth University Hospital, Why Attachment Matters Across the Lifespan, brought together an impressive range of speakers who provided a stimulating, reflective and often touching account of this important but perhaps rather overlooked area. Edwina Grant, SAIA’s chair introduced and welcomed each speaker to what is a new venue for SAIA events. Sir Professor Harry Burns, Professor of Global Public Health, University of Strathclyde started off the day by giving a characteristically thought provoking and humorous overview of the importance of consistent parenting. Always thoughtful and engaging and with his renowned firm grounding in science (“unless you have evidence all you have is opinion”), Sir Harry is never afraid to make a powerful social comment. He reminded us that the evidence is clear that the most successful societies are those with strong social bonds, connection and cohesion and gave a comprehensive overview of the evidence which supports this, as well as an insight into the motivation to improving the health of Scotland stemming from his early experience as a surgeon in Glasgow. Citing a range of data and scientific studies as well as the inspirational rectorial address by Jimmy Reid in the early 1970’s on alienation, described by the New York Times as the “the greatest speech since President Lincoln’s Gettysburg Address, Professor Burns provided a compelling and motivating call to the promotion of wellness through meaningful asset based support for and empowerment of families and reminded us that solutions emerge when we ask ‘what matters to you?’ The themes and insights of Sir Professor Harry Burns’ keynote address were echoed throughout this fascinating and inspiring day, with all speakers making links directly and indirectly with Sir Harry’s commentary. Ⓟ [view Sir Professor Harry Burns presentation] Scottish Attachment in Action’s patron Professor Helen Minnis, Child and Adolescent Psychiatry (Mental Health and Wellbeing), University of Glasgow gave us the benefit of her extensive professional and research experience on the topic of Getting a good early start: supporting attachment relationships in young children and stressed parents. Once again, we were treated to a comprehensive and accessible overview of a complex area. The Harvard Centre for the Developing Child was highlighted at the outset of Helen’s talk as a helpful source of information particularly for its use of metaphor such as ‘serve and return’ which will be a familiar term for many who work with infants. We were reminded by Helen that if we look across human populations, we recognise that we are adapted to cope with stress, that not all stress is ‘bad’ and that in fact stress responses are helpful in many situations where we are required to perform. The key to understanding human development lies in the understanding of what makes us resilient and adaptive. If we take an evolutionary perspective the quality of the ‘relationships within the pack’ play a vital role and help us to manage throughout life. Adults are programmed to respond to infants’ attachment behaviours but as we are aware there are sometimes barriers which affect this instinctive parental response and that in those circumstances, we need to address the neurodevelopmental issues of parents. Helen went on to describe the divergent developmental paths related to the interactions of temperament and parenting and reminded us that the range of ‘good enough’ parenting can be very wide and varied indeed. Working together to urgently support stressed parents is key, as are relationship focused interventions to support attachment relationships to remove barriers so that instinctive parenting can emerge. The importance of good formulation and helping the person to understand was emphasised. That deeper understanding, so eloquently described, is potentially very helpful in promoting that good formulation. Ⓟ [View Professor Helen Minnis presentation] Following the break and opportunity for networking, Dr Andrea Williams, Consultant Psychiatrist and Medical Psychotherapist, NHS Greater Glasgow and Clyde gave a very interesting presentation on the topic of Attachment Theory and personality disorder: how theory helps in the chaos. The focus of Andrea’s presentation was the work of the Personality and Homelessness Team which works across traditional boundaries to support a more coherent and attachment informed response to those with a diagnosis of personality disorder who find themselves homeless. The themes emerging from this work had resonance for many working to support particular ‘hard to serve’ groups and provided a compelling insight into the importance (and challenge) of taking a relational approach to the way we offer our services. The relevance of ‘doing with rather than to’ in all our services was amply demonstrated throughout Andrea’s presentation, as was the need to constantly learn and be open to shifts in ideas about what actually does help. The role of mentalising, the capacity to understand the mental state of self or others, was highlighted as an area compromised by high levels of stress arousal for both service users and service providers alike. Mentalising is a key element in social understanding and ability to adapt and is closely related to attachment experiences. An understanding of the activation of the attachment system under stress and the related difficulties of regulation of affect also underpin the approach to support for this often-stigmatised group. A recognition of the struggle for some to engage with supports led the team to reflect on the underlying dynamic of epistemic trust, the willingness to accept new information as trustworthy, relevant and generalisable, and its role in social learning and the capacity for change. The overwhelming experience of homelessness coupled with personality disorder can so readily lead to a loss of trust and deep suspicion of those offering help and support. Engagement is often messy, and the service needs to allow for a long intake period before any therapeutic support is even possible. The subtlety of developing trust and the necessity for ostensive cuing (early communicative cues closely allied to mentalising ability) was emphasised as key to the work of the team in engaging with service users and is a reflection from which many services could benefit. “If trust develops people can internalise knowledge and helpful things and take them into their world”. Following lunch and a further opportunity to network, visit the marketplace and bookstall, Jan Beattie, Executive Lead for People Development, Alzheimer Scotland provided a new and stimulating perspective in her presentation From childhood to later life: childhood experiences in dementia. Continuing the themes of the importance of attachment relationships and the way we deliver our services, Jan began by highlighting the importance of dementia as a global health priority but one in which there is no cure, and unlikely to be one around the corner. Many of us will be touched by dementia one way or another. An understanding of attachment can be very helpful in reframing some of the behaviour, distress and responses which can be part of the experience of dementia. It helps us to make sense of the drive to seek connections and the need to offer support which maintains connections. Secure attachment in childhood may lay a protective foundation which enables more effective coping and can be a protection against cognitive decline. However, 33% of people who receive a diagnosis do not go outside afterwards. This is often about a need to protect but clearly has a huge impact on opportunities for social connectedness. So, at a time of cognitive decline when social connection may be most needed, there is a significant risk of this being lost. The issue of lack of engagement and the ability to accept support also has an impact on the capacity to cope. Person centred planning taking account of what has been important has strong resonance with Sir Harry’s description of the importance of meaning making. Family support is key and family carers the most important resource. Walking alongside people through their experience of dementia and keeping connections until the end of life is what makes a difference. Jan ended with a telling and moving personal example from her own experience which gave real meaning to the significance of early relationships throughout life. Ⓟ [Read Jan Beattie's presentation] This fascinating conference closed with a presentation by Andy Lowndes, Deputy Chair and ‘The Music Detective’, Playlist for Life who took us through the work of The Music Detective, giving insight into the importance of music in connecting with important experiences in life. We all have the experience of connecting particular music with important events and feelings and Andy demonstrated this by involving the delegates in sharing some of this experience. As a former mental health nurse and academic, Andy’s interest in this area was piqued by the experience of Sally Magnusson in caring for her mother and the way in which music seemed to enable a connection with herself and with her family in a way that other senses could not reach. While Andy had seen this during his nursing career, he wanted to carry out some research; and so he did. There is a science base and a growing body of research on brain activity and listening to preferred music. Music is neurologically special, and Andy illustrated this through a series of compelling and touching video clips showing the responses of people affected by dementia when listening to music which had meaning for them. Andy works with families and carers to identify personally meaningful music to generate a soundtrack to the person’s life and generate the Playlist for Life which can help access important memories, feelings and experiences and bring comfort and soothing to those experiencing the losses associated with dementia. He encouraged us all to give developing a personal Playlist for Life some thought! 🌐 [Visit Playlist for Life] This innovative conference embodied Scottish Attachment in Action’s commitment to promoting attachment informed practice at all stages of life and was at the forefront of connecting the importance of relational approaches to service delivery throughout the lifespan. Grounded in science, and threaded through with warmth and humanity, this was a truly inspirational day. Alison MacDonald SAIA Trustee Lead officer for Health and Wellbeing within the Scottish Attainment Challenge in North Lanarkshire Thank you to Alison for this great summary of the day!
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When we talk about putting theory into practice, there is a risk that we think of support as something we do to children. Using our knowledge of how children develop secure attachments can help us learn how to attune to them. Expressing curiosity and empathy can be more effective when we learn how to match their affect. In addition to helping children co-regulate, this way of relating can build a special trust between adult and child that may open a door to learning. The link between trust and learning is often more visible in children and young people who have experienced maltreatment and disrupted attachments. The child who seems to assume the worst about our intentions towards them may also struggle to accept our help or advice. We often experience the young person who seems difficult to motivate or engage in learning as controlling or manipulative. The impression that these children are hard to reach and teach is probably linked to their difficulty feeling secure in relationships.  In the first year of an infant’s life, the parent’s or carer’s capacity to think about what is going on in the mind of the child allows curiosity and empathy about the child’s affect*. The carer provides the child with a kind of mirror image reflected in their parent’s or carer’s face and expression. The child manifests a mood or an emotion to a caregiver, who mirrors it in a display of understood affect. The infant who is crying and distressed sees sadness and distress in his caregiver’s face.
However, what adults usually do without even being aware of it, is mark or differentiate their display. For example, they may alternate a brief period of making a sad looking face with a soft smile, gentle voice, and rocking. This enables the child to recognise that the affect displayed by the caregiver is a representation of the child’s. This secondary representation allows a child to learn to calibrate and regulate his or her response rather than acting it out. 1,2 Many children who have been maltreated or who suffered disrupted attachments have not had enough experience with someone who can attune and connect with their affect. Yet, being able to experience a consistent, sensitive response from a parent or carer plays a vital role in helping children learn to regulate their emotions. How do we help children learn to regulate their emotions when they haven’t had these experiences early in life? How do we help them learn what it is like to have an adult who is trying to understand them and give meaning to their inner life and behaviour? In order to reach out to these children, teachers, parents, and carers have sometimes been encouraged to try matching the affect of the child or young person. This isn’t always straightforward, and I have seen mixed results. One teacher said to me, “I try to match his affect when he is upset, but his voice goes up too high.” Another asked, “How do I match his affect when his expression looks frozen or when he curls up in a ball?” I have also seen teachers amazed at the results when they figure out how to do this. “When I said to him, ‘I understand you must be really upset,’ he got even more angry. But when I said in a more animated voice, ‘I get it! No wonder you are upset if you think you were going to get the wrong answer,’ he calmed right down.” Success seems to depend on the child or young person being able to experience what it is like when an adult tries to understand him or her in a curious and empathetic way. It relies on an adult being able to notice the subtleties of a child’s expression and relate it to some underlying intention or meaning. This reflective capacity, often referred to as mentalizing, allows us to imagine the fears, desires, goals, hopes, and beliefs that underlies our own and others’ behaviours. Someone who is mentalizing is curious, accepts that their assumptions about a child’s behaviour may be wrong but wants to try anyway, is aware of the impact of emotion, and is able to see a humorous side of things. However, mentalizing is also a fragile process. It develops naturally, for example, from the interactions between members of a family, but it can be easily switched off when a child or adult feels threatened or shamed. Similarly, when an adult becomes too rigid in interpreting a child’s intentions, when an adult lacks empathy for a child, or even when an adult has lost joy in relating to a child, it may be very difficult to recover that mentalizing stance. What can we learn from the developmental processes, like mirroring, that can help us learn to match affect? The goal is not to present the child with a facsimile of their expression, but with a copy that is distinctive or marked. By matching the intensity and timing of a child’s affect -- for example, by matching the patterns of stress and intonation in the voice -- the adult demonstrates that understanding of the content of that emotion or mood. At the same time, the adult marks their display; for example, rather than shouting back at an angry child, the adult uses animated gestures. Sadness or disappointment can be matched by the tilt of the head or by an exaggerated sigh. Congruence but with a degree of differentiation allows the child to recognize the displayed affect as their own and not the adult’s. One experienced practitioner explained some of these features in these examples: “So, if a child says to me, angrily, 'I am so stupid!' my verbal response to match affect would be to say in an animated tone: That's so hard for you when you think you are stupid!” I would also match the intensity and pattern in the child’s expression with my body language and facial expression. Likewise, if a child was sad and said: ‘I am so stupid,’ I would say the same words, but my non-verbals would be less animated in intensity in order to match the energy of the child's statement.” The following steps may allow the child to get a sense of “you get me” and “you have understood me.” Although our goal is accurate mentalizing (giving the child the picture in my mind of what it is like to be them), we do not have to do this perfectly. It is important that the child experiences the process we use to correct our understanding.
I was in a meeting at a school and one of the teachers, in a light bulb moment, asked this question: “So you mean our job is to help him learn to relate to others rather than give him an education?” If I could go back and answer that question now, I would say something like, “Actually our job is to learn to relate to him first before we can expect him to relate to us.” Yes, relationships are vital to learning. They go hand in hand. It is just that we are used to teaching kids who have learned before they get to school that the knowledge adults have about the world is valuable. For other children, we need to be intentional about helping them learn to trust by giving them opportunities to experience what it is like to have an adult who mentalizes them. That experience of being understood is a key that unlocks learning. 3,4 This is a true story. Harry (not his real name), ten years old, sits at his desk with his head down. His teacher recognises something is wrong. She knows that the question Harry has been asked may have upset him: “Write about a character in a story who feels rejected.” She gently asks Harry, “Come outside with me.” The teacher has prepared herself for a moment like this. She says to Harry, “I can see that it is not easy for you to tell me what is wrong. I would like to do something a bit different. I am going to talk for you.” The teacher continues as if talking for Harry: “‘If I don’t answer my teacher when she asks me what is wrong, I’ll get in trouble. But I don’t know what’s wrong, and I don’t know how to tell you.’” As the teacher speaks her voice become more animated and she moves her hands in front of her like the two sides of a closed gate. She is trying to communicate the sense of frustration, of not knowing, that she imagines Harry is struggling with. Harry looks up and makes eye contact. Silent tears begin to spill down over his cheeks. The teacher pauses and then begins to talk about a time when she kept getting something wrong and didn’t know how to fix it. She begins to lighten the tone of her voice and Harry smiles. Later the teacher reflects on what happened. Was she able to match Harry’s affect? She can’t be sure, but she feels like there was a moment of recognition when Harry made eye contact with her. She thinks that Harry’s tears may have come from a sense of relief that someone could talk about him without making him feel ashamed. What is Harry learning? He is at the beginning; this is the first of many moments when his teacher can talk for him. Gradually, he will understand more about himself, he will see that the emotions that overwhelm him can be understood by his teacher and don’t overwhelm her. He can learn that it feels okay when another person helps you regulate your emotional response. The barriers and fears that cause him to back away from learning will seem less because he is learning to trust. Relating to young people using skills like matching affect allows us to communicate a deeper kind of understanding that can signal to a child that what I have to share with you is relevant and helpful. “If you can get what is in my mind, then I might be interested in what else is in your mind. Now I am interested in what else you have to say about what might work for people in my world”. 4 Just in case you think that the reference to dogs in the title was simply to get you to read this, some experts say that mentalizing is perhaps the most human of traits, and that the animals closest to being able to mentalize humans are dogs. Dog lovers probably already knew this, but It shows what a powerful advantage dogs gain by being able to notice the subtleties in expression of their human owners. How can dogs do this? Try hanging out with humans for several millennia: mentalizing is a great way to build companionship and have someone throw a stick for you. *Affect is often used as an umbrella term to include inner states that are relatively stable, such as an attitude toward a person and something shorter lived like a mood or an emotional response to a specific situation. It can also refer to something that child is not fully aware of and yet manifests in their expression or body language. If that doesn’t confuse you enough, try reading James Gross’ explanation in, “The future is so bright I gotta to wear shades” Emotion Review 2010: 2(3); 212-216 References: 1. Fonagy, P. What is mentalization? Available from: https://www.youtube.com/watch?v=OHw2QumRPrQ 2. Fonagy P. Gergely G. Jurist E. Target M. Affect regulation, mentalization, and the development of the self. 2002. 3. Fonagy P. Alison E. The role of mentalizing and epistemic trust in the therapeutic relationships. Psychotherapy. 2014: 51 (3): 372-380. 4. Bevington D. Epistemic trust for AMBIT. Available from: https://www.youtube.com/watch?v=ZBeEOkwLToM First published in www.saia.org.uk/blog 2019 © 2019 David Woodier, Inclusion Support Teacher. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact. Illustrations by Tom Donaldson www.etsy.com/shop/tomdonaldsonart Key Adults, Inclusion, and School Trips
Young people who struggle with the effects of insecure attachments, past neglect and abuse tend to be excluded because this seems an easier option than wrestling with the question of what kind of support is needed in order to make something like a school trip work. It is bad enough that these kinds of exclusions are probably discriminatory and unlawful, but my recent experience suggests that we may also miss out on the opportunity to learn important lessons about the kind of support that can benefit young people more generally. I recently heard a foster carer comment that one young person had not been on any school trips in the past four years. His behaviour in school was difficult and the head teacher decided this pupil (we’ll call him Matthew) had not merited the same opportunities as other children. I wondered how this deeply disaffected young person would respond were trips were not used as rewards for good behaviour, and if the school were more focused on giving him the kind of relational support he needed. Mathew’s teacher had consented to him coming on the trip only if I went along with him, but that seemed to be the full extent of any planning. The gym hall was full of anxious parents, hugs, last-minute instructions and excited children. These school children were about to embark on their week-long residential at an outdoor centre in the Highlands. Matthew, however, stood on his own. He lived in a children’s home, so had no parents there to wave him off. As the kids piled onto the bus, I noticed that everyone else had found someone to sit next to, except for Matthew. I wondered why no one had really thought about him. Why hadn’t one of the care workers from the home waited with him? Why hadn’t there been assigned seating on the bus? Surely Matthew wasn’t the only child worried about who would sit next to him? The next day, we put on wet-suits and headed for our first activity. I watched as Matthew, enthralled by his surroundings, listened to the instructor’s directions before we began our walk up the thickly wooded gorge. As we plunged into a very cold stream and climbed up our first small waterfall, I could see that he was thrilled. Matthew thrived on the sense of risk and the physicality of the experience. Afterwards, I thanked our instructor and explained a little more about Matthew’s background. The instructor replied, “This is just the kind of experience we want to give young people like Matthew. He is the kind of child that can benefit from what we have to offer.” The key to making these kinds of experiences work for all young people is to imagine how a child or young person will experience them. In addition, planning and preparation means thinking about the kind of relationships a young person has or lacks. Is there an adult who knows them well, who can spot the early signs that a child is anxious or upset? If the young person is struggling, is there an adult the young person can accept help from? If not, now is the time to think about helping a child experience that kind of relationship. I hear teachers point to lack of resources as a reason for not including some children. Much of what I saw on the trip with Matthew wasn’t about the need for extra resources, however. It was about giving him the support he needed and making better use of the support he already had. In addition, the things that particularly helped Matthew would also have benefited most, if not all, of the other children. On the back of my experiences and reflections, I have written a guide to school trips based on the requirements of the equality legislation, because it throws weight behind what should be good practice. See the ‘resources’ section of this website for a copy of the guide. First published in www.saia.org.uk/blog 2019 © 2019 David Woodier, Inclusion Support Teacher. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact. Why do some children find it more difficult to learn from being sanctioned for their behaviour? Do some children think differently? Is it something as fundamental as not being able to see the link between an action and its consequences, or is it more about misunderstanding other people’s intentions? When children learn early in life that other people’s motives are not always safe or trustworthy, we need a different approach to discipline. There is still a temptation, especially when under stress, that we default to a dogma that children should learn by facing the consequences of their actions. Consider first what happens when we assume children who have suffered abuse and neglect early in life can change their behaviour in response to being sanctioned. David was in a Primary 1 class. The nursery had flagged concerns that his language was delayed, and he found it impossible to listen to his teacher unless he was sitting on her lap. Observing him in class was rather like watching a runaway train. When he needed something, he would sprint across the room, knocking over other children left and right. His teacher explained, “We can’t have David running over other children. Do you think we should make him sit in the thinking chair?” A few weeks later, I met David’s parents. They both had learning difficulties. For the first months of his life, David had been completely neglected. I wondered how he had even survived. Expecting David to reflect on his behaviour while sitting in the thinking chair was unrealistic. What the teacher was expressing was probably her frustration that nothing seemed to get through to David, but what he needed was help at a developmentally fundamental level. In contrast, John was in his fourth year of high school. He had lived with his gran for most of his life but now she was too frail. John’s mother had died of an overdose and his dad was an alcoholic. School reminded John that he was different; he struggled in all his subjects and others made fun of his dishevelled appearance. I persuaded the school to let him try horse-riding.
On the first day of his lessons, I noticed John watching some of the horses as we drove into the farm. Usually full of bravado, he had become very quiet. He said to me, “I’m nay getting on that thing.”
“You need to get on,” was all I could think to say. Two years later, John was still riding each week. Occasionally, I would see the owner of the stables surreptitiously watching him. When John mounted his horse, there was an observable charge of energy flowing between boy and beast. John’s riding was now the only thing in his life that was not failing. The school sent me an email: “Unless John’s behaviours in school improve, we cannot let him go riding.” The teachers had cause to be concerned about John’s behaviours but even when we pleaded with them, they showed him no compassion. Compassion is not about showing pity, neither is it purely sentimentality. It understands that a young person does not always have to get what he deserves. Compassion sees his vulnerability and instead gives him what he needs as an individual. I could tell John knew something was wrong when his foster carer called him into the room. I tried to soften the blow, but John looked crushed when I told him the school’s decision. I’ll never forget his reaction: “I’m nay going back to school.” And he did not. John knew that his behaviour at school was a problem; what he lacked was the motivation to change. He must have felt the whole world was against him. A basic belief in a benevolent world is not the only thing children need in order to be able to learn from the consequences of their behaviour. A lot of complicated developmental stuff has to have happened. Even in the first twelve months, as Jean Piaget observed, infants, by acting on their environment, learn a huge amount about themselves and the world around them. But is there a limit to how much an infant can learn on their own? Imagine an infant who sees his favourite toy and extends his hand and fingers towards it. Can we assume the little chap can learn simply by his actions that he can have an effect on his world? Nearly three hundred years ago, David Hume, philosopher of the Scottish Enlightenment was not so sure, and philosophers are still arguing over his ideas. Much of what is happening around an infant is just coincidence; for example, the cat walks past and knocks over the same toy. Even if babies are really good “statistical inference machines”1,2 and can work out the correlation of two seemingly random events, they still cannot get to what Hume called “necessary connection.” We may have no way of grasping how our actions cause things to happen without the help of another person. As infants, we need an interpreter to help work out the consequences of our actions 3,4,5. Imagine the same infant who observes his mother reaching out for the same toy. He uses himself as a framework for understanding her actions. “Object-directed, grasping movements can be imbued with goal-directedness, because of the child’s own experience with these acts.”6 According to Usha Goswami, Cambridge Professor of Cognitive Developmental Neuroscience, the ‘’like me analogy” opens the door for the young child to learn about his own and other’s intentions. 6 Imagine one more scenario. This time our baby smiles at his mother, sublimely happy that he has found someone to share in his delight. She beams back, her smile not only communicating her own joy but also attributing her child’s smile with joyful, generous intentions. The infant has his first lesson in personal agency: “I can bring happiness to others.”7 As long as that child’s interpreter is reasonably reliable and attuned, he or she becomes the gateway for learning about another person’s mind and intentions. These are invaluable lessons that can serve him well. What kind of intentions will he attribute in the future to the teacher who gives him a detention? However, if he has grown up with a caregiver who has consistently misinterpreted his acts as apparently provocative, attributing the infant behaviours with a hostile bias, there is good evidence that the same child will attribute the neutral behaviours of others with similar hostile intent.7 We quickly see that there is a developmental pathway that can have serious consequences for how a child responds to his teachers. A lot has to happen in order for a child to accurately learn from the consequences of their actions. They need to be able to organise their behaviours around achieving a desired end. They need a sense of their personal agency: “I can bring about something good.” They need to have mastered the idea that other people have feelings like them and also act with similar kinds of intentions. (I am still working on that one.) They need to be able to regulate their emotions. Bessel Van Der Kolk concludes, “Predictability and continuity are critical for a child to develop a good sense of causality… .”8 Keeping it Real Part of the significant context for a young person is how their behaviour impacts you as a parent, carer, or teacher. These things can feel personal; they can elicit strong feelings of frustration, inadequacy, and being wronged. I have to remind myself that there is no short cut in helping a young person. These are lessons that take time and lots of patience. The skilful part is also about how we present opportunities to young people to reflect on their behaviour. Dan Hughes advises using consequences that logically and naturally follow on from a child’s behaviours.9 Teachers also have a critical role in helping, even if we have a hard time giving up our sticker charts. But methods based on rewards and sanctions can be modified. I once observed a teacher use a system of rewarding a boy who could become very anxious and dysregulated. She told him that he would need to earn twenty marbles to go on a class trip, but she added, “You will never lose a marble you have earned”. I had my doubts at first but in the end, I think it worked because she was sending him a strong message of reassurance. One secondary school struggled when a group foster home opened in the catchment area. The head teacher regularly suspended a couple of the young people. I suggested he should visit the house and express an interest in them. Kids who have faced a lifetime of rejection need to be reminded again and again that it is about their behaviour and not a rejection of them as a person. “You can’t fight in class, but this is your school and I want you back.” Young people, like John, are far more likely to learn from the consequences of their behaviours when we reduce their anxiety and compensate or mitigate for any sense of rejection with clear messages of acceptance. We live in a world where behaviours have consequences and young people look to adults to be competent and fair, but sometimes it seems that compassion is in short supply. We might do well to remember Shakespeare’s words that those who administer justice tempered with mercy are twice blessed. References (1) The infant brain. In our time [podcast on the Internet]. London: BBC; 2010 March 4. [cited 2018 March 28]. Available from: http://www.bbc.co.uk/programmes/b00r2cn4. (2) Sobel D, Kirkham N. Bayes nets and babies: infants’ developing statistical reasoning abilities and their representation of causal knowledge. Developmental Science. 2007; 10(3): 298-306. (3) Sobel D. Integrating top-down and bottom-up approaches to children’s causal inference. In: Johnson S, (ed.) Neoconstructivism: The new science of cognitive development. New York: Oxford University Press; 2010. p. 159-179. (4) Sakkalou E, Gattis M. Infants infer intentions from prosody. Cognitive Development. 2012; 27: 1-16. (5) Meltzoff A. Born to learn: what infants learn from watching us. In: Fox N, Leavitt L, Warhol J, (eds.) The role of early experience in infant development. Johnson and Johnson; 1999. p. 145-164. (6) Meltzoff, A. Imitation as a mechanism of social cognition: origins of empathy, theory of mind and the representation of action. In: Goswami E, (ed.) Blackwell Handbook of Childhood Cognitive Development. Oxford, UK: Blackwell; 2002. p. 6-25. (7) Goswami, U. Child psychology: a very short introduction. Oxford: Oxford University Press; 2014. (8) Van der Kolk, B. Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals. 2005; 35 (5) 401-408. (9) Hughes, D. Adopting children with attachment problems. Child welfare. 1999; 78(5) 541-560. First published in www.saia.org.uk/blog 2019 © 2019 David Woodier, Support Teacher. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact. Creating a Child Centred School for Children with Significant Trauma and Attachment Difficulties1/1/2019
LISTEN TO THIS INTERVIEW ON YOUTUBE OR VIMEO
Creating a Child Centred School for Children with Significant Trauma and Attachment Difficulties: An interview with Joanna McCreadie, CEO of Seamab In the following interview, Joanna McCreadie, CEO of Seamab, speaks about how schools can support children and young people who have suffered significant relational trauma and disrupted attachments. Themes emerging from the interview may well resonate with those teaching and working with children and young people who have had an adverse start in life. 1. Tell us about what you do and how you got where you are now. I am the chief executive of Seamab with overall responsibility for the workings of the charity. The most important aspect of my job is overseeing the day-to-day work with the children both in education and in care and their recovery from trauma. I started out at the beginning of my career as a volunteer working with children with disabilities and I found out I love working with kids. I began working in residential childcare in both secure and open settings. At the age of 22, I was working with some of the most challenging young people in Scotland. I found that residential care offers a unique opportunity to engage with children and young people and make a difference. By coming alongside, I could become part of their lives. I think it can be a powerful way to change children’s lives for the better. I then became a children and family’s social worker. I also worked as an inspector of social work services and then I came back into residential care. I have been at Seamab for seven years. My previous experiences prepared me for my current role, where I need to think strategically and at the same time be focussed on what makes a difference to children and what helps them recover from some of their horrific experiences. “My previous experiences prepared me for my current role in which I need to think strategically and at the same time be focussed on what makes a difference to children and helps them recover from some of their horrific experiences.” “I found that residential care offers a unique opportunity to engage with children and young people and make a difference. By coming alongside, I could become part of their lives.” 2. What kind of school is Seamab? I think it is a really happy place to be for the children. It is a place where we care about their lives and experiences. It is about being alongside them, nurturing and supporting them to make up for some of those pieces they have missed. We have a school and a care service; they work together so the children get an integrated experience of care and education. We also have a few children that come on day placements. These are children who have really struggled in mainstream and specialist school settings, but are still living at home. In that way, we can support their staying at home. We see ourselves as a charity that understands the impact of trauma and completely accepts what our children present to us on a day-to-day basis. The work is how to help them move forward. We understand it takes a long time to do this work and we recognise that we have to be persistent. “We see ourselves as a charity that understands the impact of trauma and completely accepts what our children present to us on a day-to-day basis. The work is how to help them move forward.” 3. In your role at Seamab what are you most passionate about? I get most joy from seeing the children playing outside, being happy and just being kids. Giving them what every child should have, the opportunity to be calm, safe and in the company of adults who care about them deeply. I am passionate about creating childhood for children who haven’t had it yet. We recognise that for children who have experienced significant trauma you can’t just do something once or twice, you are probably going to have to do it a hundred times and then you are going to have to amp it up a bit after that. “I am passionate about creating childhood for children who haven’t had it yet. We recognise that for children who have experienced significant trauma you can’t just do something once or twice, you are probably going to have to do it a hundred times and then you are going to have to amp it up a bit after that.” 4. You are working with children who have suffered relational trauma, disrupted attachments and separations and losses. These are children who have struggled in mainstream settings. Your staff must have a lot of training. How do you ensure that knowledge transfers into practice? There is research that shows that training doesn’t necessarily change practice. When I started here, the staff already had training, but it hadn’t created a child-centred and trauma-responsive way of working with children. Yes, we provide training, for example on dyadic developmental practice, DDP, but it is more about the engagement of individuals in a reflective process. Everyone who works with children here has to recognise that they are on a learning journey. The reflective work helps people think about the impact, about what has worked that day and hasn’t, and about what they might do differently tomorrow. We need to teach staff to accept that things will go wrong, that’s part of the learning process. When a child comes to us we accept them unconditionally for who are and what they present. Our job is to work out how to support them effectively. It is not that child’s job to tell us, and it is not that child’s job to sort that out. It is our job to reflect on, try things out and see what works and makes a difference. This approach requires practitioners who are able to reflect and prepared to keep trying things. One of the staff compares working here to solving a Rubik’s Cube. You have to turn the colours around a lot of times before you find the combination that works, and the next day you may have to do that differently again. The other way we have ensured that the knowledge gained in training is transferred into practice is by creating a culture that is strongly focused on the needs of children. That means valuing what every child brings and being a bit gritty about that. Many of the children that come to us are very challenging, and they push adults to the brink of their resilience and tolerance. As a team with have to have a grittiness about seeing that through and keeping that going. “When a child comes to us we accept them unconditionally for who are and what they present. Our job is to work out how to support them effectively. It is not that child’s job to tell us, and it is not that child’s job to sort that out. It is our job to reflect, try things out and see what works and makes a difference. This approach requires practitioners who are able to reflect and prepared to keep trying things.” “The other way we have ensured that the knowledge gained in training is transferred into practice is by creating a culture that is strongly focused on the needs of children. That means valuing what every child brings and being a bit gritty about that. Many of the children that come to us are very challenging, and they push adults to the brink of their resilience and tolerance. As a team with have to have a grittiness about seeing that through and keeping that going.” 5. What happens when adults use an attachment-aware and trauma-informed framework in order to understand behaviours? Adults start to see past the behaviour. They don’t see the child who is being challenging or resistant as being awkward and difficult. They see the child as someone who is struggling emotionally, and so you can have a very different response to that child. They can see the behaviour as a symptom of the child’s trauma experience. It is a behaviour that is adapted to some previous trauma; it has worked for them at some point, but it is not terribly effective now. That allows adults to accept that behaviour and begin to work on it in different ways. It allows the adults to be really flexible. You might have a child who says, “I’m not doing that piece of work.” The adult can look differently at this and think, “Maybe it’s not that important that I control this situation. Maybe what’s more important is that I get at what’s behind that behaviour and help the child engage with me. Maybe I need to address issues of trust and help this child feel safer with me and we can come back later and look at the work. I know that if I sit you down at the desk that you are ‘allergic’ to the pencil. What about if I do the maths outside using stones?” Understanding the impact of trauma gives permission to adults to work more creatively and imaginatively. This allows the adult to get over this bit we tend to get stuck in: “I am the adult and I expect you to follow my instructions.” We know that children who have suffered trauma don’t trust in adult instruction and they are naturally resistant to that. That child is much better at seeing that conflict through than you, so it is better if the adult walks around that conflict and works with it in a different way. “They can see the behaviour as a symptom of the child’s trauma experience. It is a behaviour that is adapted to some previous trauma; it has worked for them at some point, but it is not terribly effective now. That allows adults to accept that behaviour and begin to work on it in different ways.” “Understanding the impact of trauma gives permission to adults to work more creatively and imaginatively. This allows the adult to get over this bit we tend to get stuck in: ‘I am the adult and I expect you to follow my instructions.’” 6. Children may be used to adults standing back and reacting when something is wrong. How is the approach different at Seamab? Our approach of coming alongside a child is quite different to that kind of reactive approach that you often see in other settings. The team will try to understand the child, what they like to do and don’t like to do, and what their interests are. We focus on their strengths and think about their future. We hold hope for them in terms of what their lives might mean for them and other people. In coming alongside a child, we try offer things that will be exciting and engaging and focus on developing key support through attachment relationships in school and in the care setting. We know the child needs secure attachment relationships. Once children start to develop those secure attachments, they can have a sense of safety. But that can be quite frightening for children, if they have not had that before. So that can take a lot of working through, persistence and patience. Once children settle into those more secure attachment relationships, we see them start to learn in the classroom and relax in the care setting. We would then be encouraging children to be involved in things in the community like playing American Football or in Cubs. We don’t mind what the activity is, we follow the child’s interest. One of the things people see and comment on when they come to Seamab is all these activities that are going on. A couple of months ago, outside the front of the building, we had a big pile of enormous tyres and a trampette, and we made an obstacle course. The children were out playing on that every day and feeling good about mastering different techniques of going up and down the tyres. There are kids who are able physically and they were taking pride in being able to master a tumble and land on their feet. There were others who were not so confident but were proud of themselves for climbing to the top of the tyre stack and waving down to their trusted adult. It is about creating activities in which the child and adult are together, both participating and enjoying each other. It is almost back to those experiences of very small children and babies where there is joy and pleasure in just being together. We will do these kinds of things routinely here because we see it as an important part of the work. “Our approach of coming alongside a child is quite different to that kind of reactive approach that you often see in other settings.” “In coming alongside a child, we try offer things that will be exciting and engaging and focus on developing key support through attachment relationships in school and in the care setting. We know the child needs secure attachment relationships. Once children start to develop those secure attachments, they can have a sense of safety.” “It is about creating activities in which the child and adult are together, both participating and enjoying each other. It is almost back to those experiences of very small children and babies where there is joy and pleasure in just being together. We will do these kinds of things routinely here because we see it as an important part of the work.” 7. Consistency of approach must be really important. What does that look like? Can you give an example of how you use a shared language when it comes to talking about children’s needs? That is really difficult. We have about 70 adults here, and we all have contact with the children. We will have different approaches as adults. We accept here that consistency doesn’t mean everyone being exactly the same and having the same reaction to a particular behaviour. I think consistency in practice, across care and education, is the stance we take and the approach we have. The children here can be confident that when they are approached by an adult there will be a welcoming smile, and “I’m interested in what you have to say.” Where we try to achieve consistency is in planning for progress. We use ‘Outcomes Star’ when the care and education team come together. We look at what the child has achieved so far and they look at how they plan to make progress towards outcomes for the child. If there have been particular issues or an incident, teams come together and work. It is a challenge to get that agreement and consistency of approach because we have a lot of people with strong opinions that want to get it right for the child. I think that it is quite healthy for the adults to have those debates and then come to a conclusion that allows us to take a consistent approach. For example, if a child requests a mobile phone, we have to agree as a team what are approach is, because it is unhelpful for a child to get inconsistency around that. If a child is telling different adults that they are having a bad day and adults are responding in different ways, that is okay to have slightly different approaches because the child is in different relationships with people. That is how you work out sometimes who the best person is to be with that child at that point. There is tolerance around a certain amount of inconsistency but we try to be consistent around the big issues. “It is a challenge to get that agreement and consistency of approach, because we have a lot of people with strong opinions that want to get it right for the child. I think that it is quite healthy for the adults to have those debates and then come to a conclusion that allows us to take a consistent approach.” “If a child is telling different adults that they are having a bad day and adults are responding in different ways, that is okay to have slightly different approaches because the child is in different relationships with people. There is tolerance around a certain amount of inconsistency but we try to be consistent around the big issues.” 8. It must be difficult to have consensus around how sanctions are used. As a teacher, I would probably rely on rewards and sanctions to help manage behaviour. How would it be different, if I was a teacher at Seamab? For children who have grown up in their families, have secure attachments and are making good developmental progress, reward and sanctions can work for them because they understand that it is about their behaviour it has not been about them. The difficulty for children who have experienced significant trauma is that they carry with them significant shame. It is very easy to trigger children into those powerful feelings that can be very difficult for them to manage. Our children often carry a very strong sense that what has happened in their lives is their fault because they are bad kids and unlovable. The difficulty is that if we say, “We don’t approve of what happened there. You should go and stand outside for ten minutes because you did that,” they are very likely to feel that shame and self-disgust that will undermine the relationship with them that we are trying to develop. We work hard not to use sanctions and not to use rewards for good behaviour. It is all about being in the relationship space with the child and building secure attachments between the child and their teacher or care worker. We want to build that secure attachment base with those key adults around the child. We do that by understanding their behaviour, being with them in the moment and being curious about what is happening for them when they are distressed and doing something we would prefer they wouldn’t. We are really clear about boundaries: ‘Some of the things you want to do are not okay. But we want to work out why that happened and see if we can do it a different way next time.’ In terms in DDP, PACE is critical in our stance as practitioners. In that moment when you might be tempted to as an adult revert back to: “You have been really naughty so what’s going to happen is this,” that has to be set aside so that you can be in the moment with the child in their distress or naughtiness and work through that with them. There are times when we use natural consequences. When a child has damaged something, or made a mess, we would say, ‘There is a big mess here, let’s get that tidied up together and then we can move on to the next thing’. If a child has assaulted an adult, “How are we going to make that okay? You have hurt someone and we want to get that sorted out.” It is not saying to the child, “What are you going to do about that?” Rather, we would ask, “What can we do about that? How can we work it out together?” That can be quite challenging at the end of a difficult day. It is really important to stay emotionally regulated as an adult in order to help the child be emotionally regulated. “We work hard not to use sanctions and not to use rewards for good behaviour. It is all about being in the relationship space with the child and building secure attachments between the child and their teacher or care worker. We do that by understanding their behaviour, being with them in the moment and being curious about what is happening for them when they are distressed and doing something we would prefer they wouldn’t.” “For children who have grown up in their families, have secure attachments and are making good developmental progress, reward and sanctions can work for them because they understand that it is about their behaviour and not about them. The difficulty for children who have experienced trauma is that they carry with them significant shame. Our children often carry a very strong sense that what has happened in their lives is their fault because they are bad kids and unlovable. It is very easy to trigger children into those very powerful feelings that can be very difficult for them to manage.” “We are really clear about boundaries: ‘Some of the things you want to do are not okay, but we want to work out why that happened and see if we can do it a different way next time.’” “There are times when we use natural consequences. When a child has damaged something, or made a mess, we would say, ‘There is a big mess here, let’s get that tidied up together and then we can move on to the next thing’. If a child has assaulted an adult, ‘How are we going to make that okay? You have hurt someone and we want to get that sorted out.’ It is not saying to the child, ‘What are you going to do about that?’ Rather, we would ask, ‘What can we do about that? How can we work it out together?’ That can be quite challenging at the end of a difficult day. It is really important to stay emotionally regulated as an adult in order to help the child be emotionally regulated.“ 9. When children are able to build those secure attachments, what differences do you see in the way they engage in learning? Often when children are referred to Seamab, they are described as uneducable. Sometimes they have not been in education for years. That makes me sad. Once you focus on engaging the child in a trusted and secure relationship, learning can happen. As the adult, you have to be conscious that although you think the trust is there, the child might still be finding that quite difficult. We have seen children going from refusing to do any school work to sitting down and producing lovely pieces of work. We have seen children make rapid progress in literacy and numeracy. We had a child here who had no literacy skills but by the time they left they were fluent readers. We see children enjoying their learning and that is key. Children start to shift their thinking: ‘I can maybe do this and this might be quite fun. It makes my teacher happy when I do this and I like that because I like my teacher a lot.’ When we see children get it in terms of learning, we can calibrate that learning and teaching so that it fits that child’s needs, and we can be focused and flexible around what they are interested in. I have seen children go from spending the whole day being dysregulated, being abusive and violent to six months later they are sitting quite happily in a classroom working away. We sometimes see progress in children’s movement. Children who come here often have difficulty because of trauma with their fine and gross motor skills. We often see progress in the way they move more fluently. They play football confidently. They take on more physical challenges. “I have seen children go from spending the whole day being dysregulated, being abusive and violent to six months later they are sitting quite happily in a classroom working away.” “Once you focus on engaging the child in a trusted and secure relationship, learning can happen. As the adult, you have to be conscious that although you think the trust is there, the child might still be finding that quite difficult.” “We see children enjoy their learning and that is key. Children start to shift their thinking: ‘I can maybe do this and this might be quite fun. It makes my teacher happy when I do this and I like that because I like my teacher a lot.” 10. What does that process of change look like in a school that moves away from relying on rewards and sanctions? What does change look like when a school moves away from control and containment towards a trauma-informed and attachment-sensitive way of working? What were the obstacles in making that change at Seamab? It is really tough because I was asking the team to shift from control and containment to opportunities, relationship and activity. That was an enormous ask, because the team had been trained and managed to work in the control and containment way and they felt they were keeping the children safe. They had built their skills and approaches around that. I came along as the new CEO and said ‘If we are serious about helping children recover from significant trauma we need to do that in a very different way.’ That is challenging for people because they felt they were doing a good job and someone comes along and says something different. There were obstacles in our way: people not seeing that you can do this in any other way, just not getting it and people not having the skill set to work in an attachment-focussed way. A lot of people decided this wasn’t for them and we had a lot of staff leave. That created its own difficulties because we are running a 24/7 service. When we lost significant numbers of staff we went through operational problems. Some of that gave us real opportunity to make that change process happen because we brought in people who were new, people who were willing to work in a relational and attachment-focussed way. That helped shift some of the change in culture. Another obstacle was that the people who were here thought they had it all sorted. think you want a team that is confident but also reflective. And when you go down the road where you think you have it all sorted, you have probably not, because you have lost the bit about your reflection on this particular child who is having a difficult day or you have lost the bit where you have not seen this before or this child needs something totally different or you need to work together differently. When you have lost that reflection piece, it is difficult to work with children in a meaningful way. That was a key challenge: developing reflective ability across the team. A lot of the team had already been trained in DDP but there was not a lot of evidence to support that in practice. We had to redo all the training; we put every single member of staff through the training and we adapted the training so it fit with our context. As a manager, it is quite easy to have your go-to positions, but this has required looking at how things are actually working, understanding them and thinking through what we might try to get it to the next stage. We have had lots of missteps along the way. For example, we did a review of the rota. However, the way we went about making the change was not helpful. If I could do that again I would probably do it in different way. As a manager, you can do things with the best of intentions but when you find out you have not got it right, you need to be prepared to change it again. “It is really tough because I was asking the team to shift from control and containment to opportunities, relationship and activity. That was an enormous ask because the team had been trained and managed to work in the control and containment way. They felt they were keeping the children safe.” “There were obstacles in our way: people not seeing that you can do this in any other way and people not having the skill set to work in an attachment-focussed way. A lot of people decided this wasn’t for them and we had a lot of staff leave.” “When you have lost that reflection piece, it is difficult to work with children in a meaningful way. That was a key challenge: developing that reflective ability across the team.” “We put every single member of staff through the DDP training and we adapted the training so it fit with our context.” “As a manager, you can do things with the best of intentions but when you find out you have not got it right, you need to be prepared to change it again.” 11. Have you seen positive impact from these changes? Have you seen improvement in attainment, attendance and reduced numbers of exclusions? Massive impact. The adults here are much happier and have a much more satisfying and enjoyable experience. That is a critical thing for me because without happy adult role models, how can you tell children there is happiness in their lives. Adults are also quite chilled and relaxed. Seamab is a calm place. People are ready and alert for what might happen but they are also calm and confident about it. That has been a huge shift. It matters for the children because they can feel confident that these are adults who can support them. The change for the children has been phenomenal because they have a really rich experience of life and education at Seamab that we did not offer them before. They come here and do fun things and lots of great activities; they find out things they are talented at and other things they are not so good at but they learn to put up with. They can make progress in all aspects of their lives. We took a group of children to Florida. It was the first time any of those children had been out of Scotland. They had a fabulous time. That is a life-time memory for those children. If I had proposed to the team that was here a few years ago that we would take trip to Florida, they would have looked at me like I was off my head. Whereas the team now said, ‘That’s a good idea and how do we manage that?’ Every year we do a sailing trip for five children with five adults. The first time we planned that there we a lot of concern among the team. It was seen as a high-risk thing to do. I had a sleepless night before the trip. When the five children came back it had been a transformative experience. One of the children came back and said, “I learned to sail a boat, I can do anything.” This is a child who had a really negative view of himself and he came back and was able to see himself in a different way. When I see that kind of impact, I can see the difference that the approach we have now makes for children. “Massive impact. The adults here are much happier and have a much more satisfying and enjoyable experience. That is a critical thing for me because without happy adult role models, how can you tell children there is happiness in their lives.” “People are ready and alert for what might happen but they are also calm and confident about it. That has been a huge shift. It matters for the children because they can feel confident that these are adults who can support them.” “Every year we do a sailing trip for five children. The first time we made this trip, there we a lot of concern among the team. It was seen as a high-risk thing to do. One of the children came back from the trip and said, ‘I learned to sail a boat, I can do anything.’ This is a child who had a really negative view of himself and he came back and was able to see himself in a different way. When I see that kind of impact, I can see the difference that the approach we have now makes for children.” 12. Can you summarise why relationships are important in education? Relationships are often the place where our children have experienced the most hurt and most betrayal. Relationships have got to be the place where people recover. Relationships are where they rediscover themselves as human beings and where they rediscover trust and confidence in others. We know that as you go through life relationships are the most important aspect of everything. Relationships you might have with your partner or with your family or your own children. The capacity to form loving, safe relationships is incredibly important. We have got to build that capacity in children here. We have to got to be able to show them what love feels like and it is safe. We have to give them that experience of being loved and cared for and having an adult who is crazy about them. Relationships build that capacity in the child to have a happy and fulfilling life. If we don’t do that we are failing them. “Relationships are often the place where our children have experienced the most hurt and most betrayal. Relationships have got to be the place where people recover. Relationships are where they rediscover themselves as human beings and where they rediscover trust and confidence in others.” “The capacity to form loving, safe relationships is incredibly important. We have got to build that capacity in children here. We have to got to be able to show them what love feels like and it is safe. We have to give them that experience of being loved and cared for and having an adult who is crazy about them. Relationships build that capacity in the child to have a happy and fulfilling life. If we don’t do that we are failing them.” © 20189 Joanna McCreadie and David Woodier. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.  Is it really a problem of self-esteem? Looking inside may not be the answer to how children can flourish “A sign of health is the ability to enter imaginatively and accurately into the thoughts and feelings and hopes and fears of another person; also to allow the other person to do the same” Donald Winnicott Reminding myself to see children for who they can be When I first meet a young person in school, I like to set myself a challenge. I ask the teacher, “Don’t point her out. Let me observe for a while and see if I can spot who she is.” Usually I can tell by a child’s dishevelled appearance, by an argument between two children, or when I see the child who tries relentlessly to get her teacher’s attention. However, this simple exercise also helps me think about what a child looks like when he or she is settled and happy. I borrow a metaphor from the garden, flourishing, to describe this kind of happiness in children. A quick search on the internet reveals I am not the first to use this term. The idea of human flourishing has been around at least since the time of Aristotle. However, if we think of flourishing simply in terms of boosting a young person’s self-esteem, we may do more harm than good. Notice me! Rather than low self-esteem, attention seeking may be a cry for mutuality Nathan’s teacher made a discovery and she wanted to share it. “I know what it looks like when he is settled. He isn’t looking at me.” She must have recognized my slightly puzzled expression and so she added, “I realized that whenever I look at the class, he is already looking at me, but when he is really into something he isn’t constantly watching me.” Nathan’s teacher had nailed it on the head. (I must have metaphors on the brain.) This little boy was usually in a state of constant vigilance. I remember observing him once responding to conversations happening on the other side of the room. It wasn’t just his hypervigilance that worried his teacher. He constantly sought her attention. He interrupted her lessons, and if that didn’t work, he was expert in creating mini-disasters. I have seen water bottles, pencils, and jotters spilled to the floor in a whirl of activity. It would have been easy to think this little boy’s problems were all about attention seeking and low self-esteem. Nathan’s teacher came to me one day quite distressed. “Nathan is telling me he is bad. How do I help him have a better self-esteem?” She paused and then added, “I keep telling him he is not bad and that no one is bad, but he told me again, ‘Miss, I am bad.’” I wondered if Nathan wasn’t trying to communicate a sense of, “Don’t forget me! I can’t bear the thought that you don’t notice me.” Boosting Nathan’s self-esteem wasn’t going to fix this. He needed empathy; someone who would hear how hurt he was and not reject him. I tried to model a response for his teacher. “Oh, Nathan, if you believe you are bad that must be so hard for you.” Rather than attention seeking, a child may be operating from a profound sense of loss, unable to share their grief with others for fear of being abandoned (1). I have been in many meetings in which a teacher talks about a child who is afraid of failure, lacks friends, has poor personal hygiene, seeks attention, or lacks confidence. It is often thought of as a problem of low self-esteem. What concerns me about thinking in terms of self-esteem is that we may miss not only a child’s deeper needs but also become blinded to what true flourishing looks like. Shouldn’t we boost young people’s self-esteem? Not so long ago, the idea of boosting self-esteem was presented as a cure-all for a wide range of social ills such as teenage pregnancy, drug misuse, and other anti-social behaviours (2). I once interviewed a group of African-American boys growing up in the inner city of Chicago. Naively I assumed they would all have low self-esteem. By the end of the interview, I realized that I was the one with a self-esteem problem. My informal survey surprisingly corresponded to the findings of much larger and more scientific studies. Young people’s perceptions of themselves improved significantly during the 1980’s and 90’s. However, according to some even more rigorous studies that tracked young people over several decades, improving self-esteem did not reduce drug misuse or risky sexual behaviours. It seems that Bowlby was right to hold self-esteem ideology in contempt for its simplistic reductionism (2). The wounded self may mask its true needs I don’t want to minimize the depth of harm caused to a child who suffers maltreatment or the devastating impact that neglect and abuse can have on a child’s developing sense of self. An infant’s earliest experience of intimacy with another human being should be one of safety and security. It is in that state of dependence that the infant should be able to experience a sense of rightness and wholeness about themselves. When safety, security, and continuity of care are lacking, a child may suffer a primal, narcissistic wound (1). Put simply, we were not built to flourish as separated beings, so recovery shouldn’t be thought of as boosting self-esteem. Rather, a young person needs to experience relationships in which he or she can be free from a preoccupation with self. Donald Winnicott warned that a child may develop a ‘false self’ as a way of masking their true need for mutuality* (3,4). I think children and young people are happier when they experience the freedom of self-forgetfulness; instead of using a false self to protect themselves, they are able to experience an integrity of self. Again, put simply, they can enjoy other people enjoying being with them.  Not being preoccupied with self allowed him to enjoy being with his classmates
Several years later, in another school and with another teacher, I walked in to Nathan’s classroom and for a moment I couldn’t see him. He was reading a book with two other children. They were peering down at the pages, each with his or her chin cupped in hands. Nathan seemed totally absorbed in the moment. So much so that even his posture was a mirror image of the two other children. I am not being unrealistic; I didn’t think for one moment that Nathan would never struggle again. However, this little glimpse of Nathan being able to relate to others in a way in which he could express his comfort with just being himself helped me think of him not just as an injured, traumatised little boy. Human flourishing as having the freedom to forget self For the past thirty years, I have taken young people to summer camp. This year was no exception. Driving back from a day trip, my car was packed with teenagers. Someone asked to play music from Les Miserables. The young people sang along at the top of their lungs, but one voice stood out to me, not because it was louder but because I had never heard that young person singing before. A young man, one of my pupils, who has lived in fourteen different homes and suffered relentless rejection and loss. He wasn’t trying to draw attention to himself; he was just enjoying being part of the group. For a few moments, I was reminded of what it looks like when young people are flourishing. I find that I never stop needing to be reminded of what that looks like. * Mutuality can be defined as an empathetic exchange between a child and an adult that communicates a sense of being understood. The child’s thoughts and feelings are matched in intensity of involvement and interest (4). Donald Winnicott gave this example: ‘“Settled in for a feed, the baby looks at the mother’s face and his or her hand reaches up so that in play the baby is feeding the mother by means of a finger in the mouth.” The baby whose mother is involved in this intense identification with him benefits from the experience of feeling understood’ (4, p82). Keeping It Real 1. What do we really mean when we say a child has low self-esteem? 2. What other needs might the child be trying to communicate? 3. How do I refresh my vision of what it looks like when children are truly flourishing? References: 1. Newton Verrier, N. The primal wound: understanding the adopted child. CoramBAAF; 2009. 2. Harrison, G. The Big ego trip: finding true significance in a culture of self-esteem. Nottingham: Intervarsity Press; 2013. 3. Phillips, A. Winnicott. London: Fontana Press;1988. 4. V Jordan, Judith. The meaning of mutuality. work in progress. Wellesley Centres for Women; 1986. Available from: https://www.wcwonline.org/vmfiles/23sc.pdf [Accessed 2/10/2017]. 5. Abram, J. The language of Winnicott: a dictionary of Winnicott’s use of words. 2nd edition. London: Karnac; 2007. © 2018 David Woodier. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact. Illustrations by Tom Donaldson https://www.etsy.com/shop/tomdonaldsonart  "I thought ‘e was going to hit me” Children who have been maltreated often find it hard to express who they really are without making themselves more vulnerable. School is a place where they are particularly at risk, but it is also a place where the curriculum may give them opportunities to understand their inner lives and experience the interest and concern of others. I once worked with a boy who was adopted. At the beginning of his first year in high school, he was asked by his teacher to write about his family. He raised his hand and asked, “Which family?” After that he was bullied by some of his classmates. On the other hand, much of children’s literature is rich in themes and characters that can provide opportunities for young people to learn about their inner lives, thoughts, emotions, and motivations (1). Heather Geddes (2) writes that, “The task itself can be a bridge which links the teacher and pupil. Across this bridge the pupil experiences reliable interest and concern without feeling threatened by overwhelming feelings” (p. 74). Using stories as that kind of bridge can be especially beneficial for children with attachment difficulties who are resistant to intimacy in relationships. Harry was ten years old. His mum had died of a drug overdose, and he lived with a family member. He called her “Mum”, but his teachers were concerned that his “mum” leaned on Harry for her emotional needs. Harry had a lot of reasons to be sad and to question if anyone loved him. The only emotion he seemed able to express was anger which was often directed at his teachers. I thought of Harry as being like one of those pre-renaissance paintings. There was very little perspective, very little depth to his self-expression. He seemed to appear only in two dimensions. Like other children who have suffered maltreatment, he was preoccupied with how others evaluated him (3). When I arrived at his school, I found Harry sitting in the head teacher’s office. There had been an altercation during break. As we walked down the corridor I asked, “You were in the head teacher’s office. Was anything wrong?” “No. She was asking me questions about what some other boys were doing.” Harry was very guarded about talking about anything he perceived might make him look bad. Each week I tried to catch him a little off guard, “So how are you doing?” “Good.” Harry always said, “good,” even when things were obviously not going well. Occasionally, children like Harry talk about themselves in a way that opens up a depth of insight and emotion. When this happens in school, it can make them vulnerable, especially when they do this in front of their classmates. We need to be prepared so that we can give them a safe way to express themselves. Harry’s class were reading Goodnight Mister Tom, the story of Willie, a ten-year-old evacuee, who is abused by his mother but finds unconditional love when he moves to live with an older man in the country. Harry and I read sections of dialogue together and recorded them to make an audio book. Harry liked this. He laughed at my attempt at Mister Tom’s accent, and I laughed at his attempt at a London accent. Dialogue seemed to bring us closer together. We listened to the recording, but I was not happy. “There is too much of my voice,” I said. “I would like to begin the recording with you speaking. You could voice Willie’s thoughts as he thinks about his first day with Mister Tom.” Harry replied, “I can’t do that. I don’t know what he would think.” I prompted him, “Do you remember that Willie thought Mister Tom was going to hit him?” Harry began to talk as if he was Willie. He put on his best London accent. “I thought ‘e was going to hit me, but ‘e didn’t. He just picked up that stick to poke the fire.” I began to type. Harry looked at the words and said, “No, he doesn’t sound like that.” “You’re right. I’ll take the ‘h’ off the beginning of the words that begin with ‘h’. How does Mister Tom show he cares for Willie?” I asked Harry. “He bought him clothes. He took care of him when he fainted.” Harry read over the script again, and then, without prompting, he added, “I like this place better than my ‘ouse. I’ve got me own bed. I think Mister Tom is going to ‘elp me. Maybe this is what it’s like to be loved.”  Harry said the words with such feeling, I couldn’t help but think he was speaking from a more personal understanding of Willie’s character. He was no longer trying to present an image of himself; there was something more real and more three-dimensional about him.
I commented, “You said that just the way I think Willie would have said it.” Harry smiled. I didn’t take the conversation any further. My purpose was not to get Harry to talk about his own experience of neglect or abuse. It was enough that he was able to express something of his true self and he experienced my interest and curiosity without feeling I had intruded on his inner world. “If you want to speak to troubled children you are far more likely to be successful if you do it through ‘their’ language- the language of image, metaphor or story” Margot Sunderland (4). Illustrations by Tom Donaldson www.facebook.com/tomdonaldsonart Keeping it Real: Advice to Parents, Carers, and Teachers Parents and carers: • Talk to your child or young person about how to answer questions their peers may ask or questions that may come up in class: “Who was that lady that picked you up from school?” “Why did you move here?” Help them be discerning about who they talk to and what to disclose to their friends and in public. Teachers: • Be careful about how you introduce activities. Try to anticipate questions that might make a young person vulnerable. Instead of just saying, “Write about your family,” add, “If you are adopted or have lived with more than one family, you might want to write about the family you live with now. Also, if you live some of the time with your mum and some of the time with your dad, you can choose which family to write about.” In that way you can also normalize young people’s experiences by recognizing the variety of family backgrounds. • If you are planning class discussion, speak privately, beforehand to a young person who may be more sensitive and reassure them that you won’t call on them to answer unless they volunteer first. • For the pupil who finds it difficult to even talk about the feelings of characters in a book, allow them to simply listen in to the answers from young people who are more confident. • Where there is a risk that the content of a lesson may resonate with a young person’s traumatic life experience, build time in to the lesson so there is a chance for a young person to regain their equilibrium before they leave your classroom or move on to another activity. References: 1. Killick S, Thomas T. Telling Tales: Storytelling as Emotional Literacy. Blackburn, UK: Educational Printing Services Ltd.; 2007. 2. Geddes H. Attachment in the Classroom: The Links Between Children’s Early Experience, Emotional Well-Being and Performance in School. London: Worth Publishing; 2006. 3. Tangney, J.P, Dearing, R. L. Shame and Guilt. New York: The Guilford Press: 2002. 4. Sunderland M. Using Storytelling as a Therapeutic Tool with Children. Milton Keynes: Speechmark Publishing; 2000. Additional Reading: Golding K. Using Stories to Build Bridges with Traumatized Children: Creative Ideas for Therapy, Life Story Work, Direct Work and Parenting. London: Jessica Kingsley Publishers; 2014. Killick S, Boffey M. Building Relationships Through Storytelling: A Foster Carer’s Guide to Attachment and Stories. The Fostering Network. Available from: https://www.thefosteringnetwork.org.uk/sites/www.fostering.net/files/content/building-relationships-through-storytelling-31-10-12.pdf [Accessed 11-5-17] First published in www.saia.org.uk/blog 2018 © 2018 David Woodier, Support Teacher. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact Handout for teachers I am teaching a young person with attachment difficulties. What do I do? These suggestions are not intended to be a substitute for a more thorough process of assessing a young person’s needs and level of additional support.
© 2017 David Woodier, Support Teacher, Inclusion Base, North Lanarkshire.
Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact. David Woodier is Chief Blogger for Scottish Attachment In Action. www.saia.org.uk/blog A young woman recently sent us this poem about growing up in a children’s house. She is passionate about telling others about her experience. I think the poem also expresses that kind of second chance that young people get when they find someone who loves them. David Woodier, SAIA Chief Blogger I am a 19-year-old girl, who has been looked after from the age of four months. I have experienced many different care settings but this poem reflects my first placement in a children's house. Writing has always been a release for me, expressing myself on paper is a way to dilute the intensity of the emotions going through me. And also a way to understand myself more. The small number of care experienced young people, CEYP, who have read my poem, have told me it has really resonated with them, so if I touches anyone either living or working in the system and makes them think, then that's more than I could have ever hoped for. I currently study social care with an aspiration of becoming a social worker to help other young people. I am actively involved in evoking positive change for CEYP, I am a founding member of my locality's champions board, I'm on the corporate parent sub group, and I am involved in the Children's hearing system on a national scale. Beth  First published as ‘Family Isn't Always Blood’ www.saia.org.uk/blog 2017
© 2017 Beth. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.  This month sees what we hope will be first of international contributions to our news bulletins. Robert Spottswood is the author of the ‘The Bean Seed’ and of ‘The Refrigerator List’ (on our website), also a DDP Therapist, Consultant Trainer. Robert lives in Vermont in USA and has been a friend and supporter of SAIA for many years.
As you will see from the article, Robert and I were ‘chatting’ on email, talking about the universality of attachment theory to all relationships – personal, community and political. I asked Robert if he would write an article for SAIA and he very generously has…… we hope you will find it thought provoking and enjoyable….read on…. Edwina Grant Me-Food-Now - responding with relationship to 'acting out' from ambivalent-style attachment in children, teens, and presidents. -- by R. Spottswood, Vermont Thinking about the families I have had the privilege to work with, while preparing this article, I was struck yet again: what a universal experience is attachment! Thanks to each of us being born with an attachment system, as Bowlby pointed out, we seek connection with a caring adult as if our lives depended on it. And as we grow, the manner in which we relate to ourselves and the world suggests cues and clues as to how our early search for attachment was responded to. (How 'The Refrigerator List' was generated.) “How universal!” I exclaimed over email to my Scottish colleague, Edwina Grant. When strangers meet, they routinely go back to preverbal attachment connection behaviours: eye contact, smiles, welcoming tone of voice, and comforting touch -- a handshake. Relevant here is the Guardian newspaper’s short clip showing the violent, controlling handshake developed by the new U.S. president. Here we see, in my view, a tradition rooted in emotional connection twisted to physically and emotionally dominate each friend from the moment of greeting. Must be seen to be believed: https://www.theguardian.com/us-news/video/2017/feb/14/donald-trumps-strange-handshake-style-and-how-justin-trudeau-beat-it-video-explainer Attachment also helps explain, as Sue Johnson points out with Emotionally Focused Couples Therapy, how any wound to relationship trust can trigger irritation, 'angry poking', distancing and finally 'abandonment protests' (such as big fights) in desperation to hold onto attachment connection with an adult partner. Again, in the context of couples, I think our attachment system explains why 'open marriage' tends to prove so unstable -- Am I special to him/her? Am I in his thoughts? With a third intimate person, the best I can do to feel secure is to constantly try not to think about it... Finally, attachment helps me understand at last the riddle of violence in institutions and society. Growing up reading concurrent news from the horrific war on Vietnam, I find answers to the riddle of violence in the attachment-failure of social systems which give the wink to viewing our neighbors as objects – permitting a range of objectifying behaviors, from falsehoods to manipulation to hatred to harassment to stalking to bullying to military planning to torture. For my own personal awareness, every August 9 I stand downtown for an hour with my large homemade sign silently reminding Americans of the results of dropping 13 pounds of plutonium on a city of civilians; and that we have never apologized. DDP (Dyadic Developmental Psychotherapy) suggests to me an important way out of this closed loop of recurrent dysregulation: connected relationship. Dan Hughes once put it, “If we come to a (therapy) session with an agenda, the kid will quickly sense our agenda and run the other way. My only agenda is to have a relationship with the kid – and they don't even have to talk. I can have a dialogue and I can be both sides of the dialogue” Yes. A chronically angry parent – a great improvement over the brutal grandparents – once demanded of me “How would you respond to the school principal if he ambushed you like he did me, in front of everybody at a school meeting!” I knew she would not like my vulnerable answer, but I gave it anyway: “Being me, I would try to show a little of my sadness while saying, 'I was feeling good about my child's progress here, until I heard this sudden comment, which surprised and saddened me. I don't understand why I wasn't warned, and I'm just feeling so sad right now.'” The angry parent stopped, handed me a piece of paper and said, “Would you write that down? I never learned to talk like that growing up – it would have been suicide. Thank you.” She was serious. Perhaps the most surprising DDP session I can recall was back in 2003. A young teen came in with his divorcing father – an emotionally distant accountant – and began running around my small office, banging things just enough alarm the grown-ups and force father's attention. “Ha-ha, you can't catch me!” To us DDP clinicians surface behavior makes sense if we are holding in mind the person's attachment history, life situation, and need for emotional safety under the surface. As Dan pointed out long ago, “Context determines the meanings we make.” Prioritising physical safety (this was 2002), I scooped up my young client and carried him back to the couch and his father, while co-regulating (second priority) with my voice tone and empathic words – he of course screaming bloody murder the whole time. But I was responding without cognitive argument to his double message: Nobody can catch me – and – my folks are divorcing so I have to force someone safe to catch me and help me before I burst with sadness! Unfortunately the father was not prepared to provide intimate affective co-regulation to his son on the couch, or I suspect anywhere else. We had not had time to prepare. After 30 seconds of helping me gently rock his noisy, dysregulated boy on the couch, the father turned to me and said, “I can't do this.” “Okay,” I replied, “let go.” There is no point going further in a session than parents are able. I expected the angry boy would scamper out of the office to lick his wounds....but he did not. He calmly walked across the room, got a desk chair, brought it back and sat down facing his father. He began pleading in a sorrowful voice (I am not making this up) -- “Come on, Dad! Please! You can do it, Dad! I beg you, PLEASE! You can do it!!....” As my jaw dropped to the floor I realized what it meant to this boy to have felt his father physically pay attention and care enough to finally co-regulate his son's catastrophic feelings. This is what comes to mind when I sit down to write about responding with relationship to 'acting out' from ambivalent-style attachment in children, teens, and presidents. For my next article I will focus more on what it means to me to respond with relationship to dysregulating public officials. Robert Spottswood (name began in town of Spottiswoode, Scotland) Norwich Vermont, USA First published in www.saia.org.uk/blog 2017 © 2017 Robert Spottswood Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact |
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Scottish Attachment in Action is a Scottish Charitable Incorporated Organisation (SCIO) OSCR registered No. SC045708
A: Suite 1, 56 Clydesdale Avenue, Paisley PA3 4JP T: 07471 472703 E: admin@saia.org.uk
[Privacy Policy | Complaints | Contact us]