Residential Child Care Workers Talk About the Impact of a Relational way of Working with Young People
In the spring of 2019, Scottish Attachment in Action met with a group of residential child care workers in Aberdeen. They enthusiastically shared how training in PACE (playfulness, acceptance, curiosity and empathy) and DDP (Dyadic Developmental Practice, Psychotherapy and Parenting) had transformed their relationships with young people. Staff members also talked about how they supported one another in order to stay connected with young people who sometimes presented very distressed behaviours.
What is DDP?
Dyadic Developmental Practice, Psychotherapy and Parenting (DDP)was developed by Dan Hughes as a therapeutic intervention for families who have fostered or adopted children with significant developmental trauma. These are children who have experienced maltreatment and disrupted attachments early in life. They often don’t feel safe with parents, struggle to form secure attachments, and may actively try to prevent their new carers becoming close to them.
DDP was originally developed as a therapy, however, it now has a much broader application providing a set of principles and practices that can support networks, inform and enrich parenting, and support the
child outside of the home, for example, in residential settings and school.
What is PACE?
PACE (Playfulness, Acceptance, Curiosity and Empathy) is the core attitude of DDP. It is a way of thinking, feeling, communicating, and behaving that aims to help the child feel safe, learn to trust the care of adults, and to accept comfort and joy from parenting figures.
Having a PACE-ful attitude can reduce the level of conflict, defensiveness and withdrawal that can be ever present in the lives of troubled children.
Being PACE-ful enables the adult to see the needs and strengths that underlie distressed and challenging behaviour. It offers hope to child and adult alike.
Why do I need the training? DDP helps a social worker repair a relationship with a young person
“I did DDP level one training. It was four days and it was really good. I liked the way it was delivered by Fiona (SAIA Development Coordinator) and Edwina (Certified DDP Trainer). They offered real examples of how DDP can be implemented, and there were opportunities to think about our own practice.”
“As a social worker, sometimes dealing with a young person in distress, I can fall into saviour mode. I want to do things for people rather than just sitting with them and holding that emotion with them.”
“The training also allowed me to think about repairing relationships. For example, I was given the task of finding out about one young person’s experience of being in care. I was hopeful that I would get my task completed efficiently. As soon as he came down the stairs, I started speaking to him about his experiences in care. I forgot he doesn’t like being stigmatised or being looked after. It was first thing in the morning and all he wanted was to be left in peace. I was met with some resistance. I came away from that and thought about what the experience had been like for him. Later, I offered him a lift somewhere he needed to get to. I said I was sorry and I should have known that in the morning he was not keen on chatting to people. I acknowledged that his experience of being in care was unique. The discussion in the car continued, and he was much more open and engaged.”
“Prior to the DDP training, I had read one of Dan Hughes’ books. Before the training, I was kind of doing it (his method) but never had the terms to name what I was doing. The training gave me a frame of reference, and I feel a lot more confident now. It has allowed me to support other staff members with their practice by helping them to explore the meaning behind those emotions rather than just giving factual responses or going into saviour mode.”
DDP helps team members identify when they are struggling with blocked care 1
“As a staff team, we check in with each other to make sure we are as well as we can be. We were talking about how the children’s distressing behaviours can have an impact on us. If we are not taking care of ourselves and each other, this can impact on the way that we interact.”
“Prior to having an understanding of DDP, there wasn’t a clear understanding of blocked care. It is a very hard job we do and we love it, but it is very difficult at the same time. When you find yourself in the position that you’re not enjoying that relationship anymore, it can be very disheartening.
DDP has allowed us to gain an understanding of what is happening especially within your brain, the hormones, and the impact that has on your ability to care. We want to re-ignite the passion again for the young people that we care for. That is not easy because we don’t have those positive experiences of looking after the children when they were little. They have come to us after they have suffered traumatic early childhood experiences and their behaviours display that. We try to understand where they have come from, what this is actually telling us, and how we can work the best to support them and ourselves.”
Reawakening compassion begins with understanding trauma
“We have one young person who displays a really high level of emotional need and that’s incredibly draining on the whole staff team. We check in with each other and make sure we have regular discussions. In order to reawaken compassion, we have taken the timeline to team meetings. We go through it and look where a young person has come from and the trauma that they have experienced. We remind ourselves that the young person isn’t doing something because they won’t do it but because they can’t do it. We think about the unmet need within a young person’s developmental trajectory.”
A young person responds to curiosity and empathy
“What we realised is that this young person needs a high level of physical touch. We give her lots of cuddles, bedtime routines, bedtime stories, and washing her hair. There is a lot of time invested in nurturing.” “Also, she responds to us being curious about what has happened. Instead of responding immediately to behaviours, I use wondering aloud 2. If she can’t respond verbally, the young person can give a hand gesture, thumbs up or down.”
“There is also a special place where she goes when she wants to speak to me. We haven’t seen as many of the distressed behaviours that we were seeing initially. There was a lot of physical aggression especially directed towards me and another colleague but that doesn’t exist anymore.”
“I think what we have done is create a safe space for her and there is safety within our relationship as well. When she is very dysregulated, I let her know, ‘If you need this time then I can help you regulate.’ We will sit and hug. I used to struggle with sitting with the really distressed emotion; I would have jumped in and tried to fix it. Now I know I need to sit with it, we need to work through this, and we need to understand this. I think that really helps with her.”
Sharing what works with a school builds a deeper understanding of behaviours
“The school were really struggling with her behaviour and so we used the timeline. We had a meeting with the school, and we spoke about how we worked in a relational way. We took the timeline and spoke about the trauma and the neglect she’d experienced. It gave the people in the room a greater understanding.
You could physically see the body language of the teachers and guidance staff changed in response to what they were hearing. You could almost feel the empathy in the room. Now we have this really good relationship with the school, and they are understanding these distressed behaviours.”
PACE training changes mind-sets
“The three-day PACE training was a really good refresher and a reminder of what I should be doing on a day-to-day basis. You naturally have your own values that you bring to the role, but sometimes you should leave them at the front door. We need to think about things with a PACE attitude, rather than defaulting into our normal view on things.”
“I do outreach work with a young person who is coming up for 19 years old, but chronologically probably operates at a younger level. One of the principal things that I remind myself is the can’t not won’t principle. It is easy to say ,‘He’s nearly 19; he should be able to do x, y and z.’ I have to remind myself that although he’s 19, he can’t do a lot of things very well, like budgeting, managing appointments, and that kind of thing. It is the same with some of our other young people; it’s not that they won’t do things, it’s just that they can’t.”
Seeing how PACE works in practice motivates staff
“I get to see results. One young person, she doesn’t do physical touch a lot, but she asked me for a hug one day. I think she asked me because I work in a fairly open way with her and I have built up a really good relationship. I remember saying to a colleague, ‘That’s one of my best moments ever.’ People take for granted in day-to-day life that it is okay to ask for a hug, but when she asked me for a hug I thought, ‘Wow, that’s a moment!’”
A no blame culture helps adults stay open and engaged
“My supervisor and I reflect a lot on things that have happened; we are curious about things. We will look at how I have handled things, and we talk about how I am feeling. We had a situation last weekend where one of our young people, who had been doing a lot of alcohol and this affected his behaviour. He had gone out saying he was going to hurt himself, and I had to hold him to stop him from hurting himself. It was quite a traumatic event, but my supervisor talked through how I was feeling and how I was going to go forward with this young person. There’s never any blame and that helps me stay more open and engaged with a young person.”
DDP helps staff stay in the moment with young people
“Another thing I remember from the DDP training is the importance of always going with an open mind and not being judgemental. I really try to stay in the moment and think about how to match affect 3.
When young person is feeling heightened, you can match their affect to help them co-regulate.
The old calm down never really worked for them. If you can match their mood to kind of bring them down, I think that is really useful.”
A PACE approach helps staff respond with more sensitivity
“We put the PACE attitude into practice every day. We talk about a trauma-informed model, and PACE is a way to articulate that. I use curiosity with a young person to explore what is going on for them when they are distressed. When I have obviously got something wrong, I can say I am sorry for putting a young person in that position. I see young people being very responsive to that sort of dialogue. You are no longer telling them how they should feel, you’re actually having them tell you how they feel.”
“Young people can better regulate because we are not seen as a threat. You are no longer threatening them with your ideas or your words. You are no longer in the position where a young person is distressed towards you, and they can see that you have not got distressed by their distress. It is an attuned way of responding.”
Young people talk about the issues that are really important to them
“I wanted to improve the lives of young people and do something different in our children’s homes. DDP is was a way to address trauma. It is about healing trauma instead of us just adopting a behaviourist approach, which does not work.”
“It is creating a culture where we really listen to young people. Recently a young person told us, ‘There’s no food in this house!’” She was upset.
“Before the DDP training, we would have responded by pointing out that there was food in the house. This time we thought about what she was really saying and why this young person was so angry. We worked through a process with the young person.”
“About 40 minutes later she was saying, ‘All the staff are rubbish.’”
“All the staff are rubbish! My goodness that must be really difficult for you!” I said to her. “By exploring her perspective and feelings, the young person was able to open up about what was really troubling her. She was blaming herself for something that had happened in her past. Before we would have just dismissed her with, ‘There is food in the cupboard.’”
“It is really important that as a staff team we are able to keep ourselves contained and regulated because that enables us to hold on to and contain that anxiety for the young person. The end result was amazing. It had nothing to do with the food; it turned out it was about her feeling guilt over something that had happened in the past.”
“Young people are getting the message that you get them, you want to understand them, and they are responding with more open communication and more trust.”
“We have used that approach quite a few times with young people. Sometimes, they don’t want to actually speak. One young person used post-its and wrote, ‘Nope’ and held it up. Then we tried something else and he wrote, ‘Maybe.’”
Do the young people know that you are using this new approach?
“I don’t think they know, apart from one young person. She said these words, ‘Are you trying to therapeutic me?’”
“It has been so gradual the kids are just lapping up the connections and the curiosity. Some young people might say they had noticed something was different. They are choosing to stay with us longer. We have less significant incidents, and our staff are not off with stress.”
Residential managers notice the impact of the training
“Members of the team have come back from the training very motivated and excited saying ‘light bulbs were going off in my head all four days.’”
“We have embedded our ethos of care so that it is aligned with the principles of DDP and PACE and updated our policies and procedures so that they are clearly underpinned by relational/attachment-based practice.”
“We now write our daily written records in a way that is respectful and non-judgemental of our young people.”
“The way in which we work with families has changed in a way that helps us understand the family script and how this impacts on the young person. This also allows for direct family work that is trauma informed.”
“Staff are able to de-escalate situations and do not resort to putative measures. However, we are also clear about what is not acceptable, and any risk-taking behaviours result in higher levels of supervision/safer care planning.”
“DDP has given us an evidential baseline that explains our approach to other agencies within a variety of professional’s forums, including Police, Education, and Health Services. Sharing our approach with others encourages a holistic trauma informed understanding of the young person and their needs.”
1. Hughes, D.& Baylin, J. Brain-Based Parenting: The Neuroscience of Caregiving for Healthy Attachment. 2012: New York: Norton & Co.
2. Woodier D. Wondering aloud. Weblog. Available from:
3. Woodier D. Matching affect and why a dog is a man’s best friend. Weblog. Available from www.saia.org.uk/blog/matching-affect-and-why-dogs-are-a-mans-best-friend
Please note that the PACE and DDP trainings were commissioned by Aberdeen City Council and were delivered within a partnership agreement Aberdeen City Council, Scottish Attachment in Action, and Edwina Grant (independent psychologist and certified DDP trainer).
Attachment - 'a lasting psychological connectedness between human beings.' (John Bowlby)
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Scottish Attachment in Action’s conference this year (2019) demonstrates SAIA’s commitment to informing and promoting why attachment matters throughout the lifespan life – from cradle to grave we all have a fundamental need for human connection and love.
Over the last twenty years understandings from attachment theory have been increasingly influential on the parenting and professional care of young children. It is now widely understood that infants and young children flourish when they have adults who can provide them with reliable comfort and protection and the opportunity for reciprocal joy and delight. These relationships provide a space where children can easily develop essential social and emotional skills such as self-regulation and emotional competence. These ideas have also been incorporated into central and local governmental policies. For older children whose early development has been compromised by the trauma of neglect or abuse the importance of using the therapeutic power and healing potential of new more positive attachment relationships has also become generally recognised. This focus on the importance of attachment relationships in childhood is welcome; in addition it would be Scottish Attachment In Action’s view that attachment theory has much to offer in understanding and improving the human experience more widely. This paper is intended to spark thoughts, raise questions and generate interest in the potential for adopting an attachment informed approach across many more areas of our lives.
The healing power of relationships
The cascading negative impact of adverse childhood experiences throughout life is now widely recognised but we need to avoid a fatalistic pessimism about this. The emerging evidence of the positive effects of using attachment focused parenting and attachment focused therapeutic approaches to support the recovery of traumatised children and young people offers hope for adults who still carry the emotional and social burdens of unbearable childhood pain. Counsellors, therapists, social workers, and health professionals have long understood the importance of the therapeutic relationships they develop however recognising their role as attachment figures may feel less comfortable or even inappropriate. There can be professional anxiety about creating dependence which perhaps fails to recognise that for some people their route to developing the capacity for interdependence may require a dependable experience of safety, predictability and comfort as well as reciprocity that can help repair trust and hope. The following case study illustrates the power of such healing relationships.
Much of my work involves offering long-term therapy to adults with a background of trauma who often have, a background where a secure base was not formed in infancy/childhood; or where that healthy attachment was lost or broken. Central to the therapeutic relationship is making sense of those negative experiences with adult clients and offering the secure base they have been missing.
Adults whose earliest needs have not been met usually come to counselling with a view that I will not or cannot meet their needs. They often have little expectation that I can help them begin to discover and learn how to meet their own needs.
The building of trust between us takes a long time. Consistency in our work is essential. They need to know and learn to trust that I will be there when I say I will -that if I am to provide that secure base, then they are able to leave me (the therapy space) with the knowledge that I will be there when they return.
Neil 1 (23) came to me struggling with being able to maintain romantic relationships. He found himself controlling, terrified of abandonment and loss, unable to trust, with very low self-worth and devastated by endings. His mother left the family home when he was two years old - his primary attachment figure left and did not return to him.
His relationship with Dad suffered on many levels and did not provide the safety and security needed for secure attachment. He was a lonely, sad, confused child abandoned with the experience of no one being able or willing to meet his needs.
Neil’s insecurity meant he desperately sought and clutched love and connection, yet struggled to receive it when it was offered. He also pushed people away with the same intensity with which he needed that love demonstrated to him. As an adult he believed he was unworthy of love, and was confused and distrusting when I showed him kindness or acceptance.
Our therapy work was a long process over years of building up his trust in me and allowing me to be emotionally close to him. He gradually began to rely on me and to ask for my support, which was complemented with boundary setting to ensure he didn’t cling to me in a way which might overwhelm me and/or inhibit his growth in his ability to rely on himself too. Learning personal boundaries is an essential part of secure healthy relationships.
Had he had that secure attachment in infancy, this would have been in place as an adult. This reparative relationship with me modelled to him the importance of being able to set basic guidelines of how you wish to be treated and how to respond to the wishes of people close to him. He often tested my commitment to him, he would say things to try to hurt me or push me away (often unconsciously). He was always desperate to be my “favourite client” – continually looking for me to confirm his worth. As part of our work and my commitment to him I took his story and our relationship to my counselling supervisor. Establishing a trusting attachment relationship with young people or adults who have not had a secure base can be difficult. It can be tricky, frustrating, tiring and at times feel hopeless. It can also tug at parts of your own attachment history which can exacerbate the difficulty in offering it to another. Supervision, self-care, support for yourself is crucial.
Counselling is only one strand through which we as human beings try to form, repair, provide and receive healthy attachment relationships. Without wanting to do myself out of a job, my hope is that those working and living with young people who have not had a fair start in life are able to offer the safety and trust that can help those young people gain a secure base. The truth is, if young people are offered a secure attachment relationship there is less likelihood of them needing counselling and psychological services as adults.
Human beings don’t want to be fixed, they are not broken. Instead, they want to find ways of being able to support themselves and to have an ability and willingness to seek support from others. Offering a secure base to help form a safe, connective relationship with self and others is arguably the greatest gift we can offer another.
Written by Catherine Cooke. Accredited Therapist and Supervisor, and a Trustee of Scottish Attachment in Action
1 Not the client’s real name
Outside the professional arena we also need to recognise the power of normal human love and relationships to reignite the possibility of belonging and reciprocity in people whose early experiences of people have been associated with mistrust or betrayal.
Attachment beyond childhood
Our needs for comfort and protection do not disappear as we reach adulthood. Most of us have special people we turn to at moments of need – friends, partners or family members. Often such relationships are mutually supportive, we are attachment figures for each other. The dominant narrative within the UK, however, privileges the individual over the group and values independence over interdependence. This can leave people lonely and disconnected particularly at times of crisis. Attachment theory can help us recognise the importance of community and connection and the negative consequences for individuals and groups when these are lacking.
Can we create societal and professional systems and structures that support the development of this type of community and connection?
Cultural differences, life events, mental health issues , physical or intellectual difficulties may increase the vulnerability and neediness of any of us and this might make us more dependent on the emotional or physical support of those we trust whether on a permanent or temporary basis. Can we challenge assumptions that seeking help and connection in these circumstances somehow diminishes our worth?
For many of us as we reach old age, increased physical frailty or cognitive decline will shift our relationships with our own children and a reversal of roles can take place where we find ourselves seeking comfort, care and protection from the same individuals we once cradled and soothed as infants. Once again the importance of very basic rhythms of life, consistency of relationship and soothing sensory experiences become key in insuring quality of life. There is a growing body of evidence that demonstrates that attachment-informed practice can have a similar transformational impact on the care of elderly people, whether within families or in professional settings, that it has had on our parenting and professional practice with children.
Attachment in organisations The strongest influences on our children and young people, other than their families, come from the various educational environments they experience. From nursery to further education children are introduced to systems, structures and processes that powerfully affect their everyday lives and development. Educational organisations that recognise that learning is relational – we learn best from people we like and respect - and promote emotional health also support effective learning for all. Indeed for some children school is the safe base when home is not. As children progress through the educational system they move through environments that inevitably become increasingly less attachment-promoting. In nurseries children have their own key workers and within primary schools most of their time is still spent with a single teacher albeit in a much larger group. Once a young person moves to secondary school, however, they are likely to have a timetable that involves multiple changes of teachers, peers and places throughout their school day. In further and higher education most learning takes place either alone through self-study or in large classes Effectively children and young people become progressively less known and recognised as individuals. Many of these structural differences are the inevitable outcome of the different curricular demands at different stages of children’s education. An understanding of attachment theory has, however, allowed many schools to introduce processes, systems and structures that promote the importance of relationships and help teachers notice and recognise distress even when it is expressed through difficult behaviour. Such attachment-promoting schools provide an environment where children who have experienced adversity or trauma can be supported to recover but also where typically developing children are more likely to flourish and enjoy their learning and relationships. What would be necessary to create an educational system where such attachment informed practice would be the norm?
As adults many of us spend a huge proportion of our lives in work settings and recognise that our emotional health and well- being can be profoundly affected by the way our working lives are structured and how well we are managed. Perhaps inevitably, authority structures and colleague relationships can mirror family experiences of rebelling against parents or being nurtured by them, as well as rivalry with siblings or enjoyment of the camaraderie and excitement shared with them. Where the importance of supportive relationships within organisations is recognised this can not only create greater productivity and less absences but also provides an emotionally healthy environment for all. An audit culture, short term or zero hour contracts, punitive targets, reputational anxieties and an increased focus on the digital sphere have all contributed to an environment in which work organisations have become less safe and containing places where relationships can be fractious rather than team-oriented. Where organisations have focused on creating a relational culture with processes and procedures that are congruent with this approach then employees are happier, staff retention improves and the primary task of the organisation is achieved. The basic responsibility of the caring industries is to provide care, support or help for people in some kind of need that is delivered through relationships with others. Yet even in these settings there can be little focus on the needs of workers for consistency, supportive relationships and emotional safety. Is it possible to, as the norm, create organisations that are attachment informed which will have benefits for employers and employees?
Attachment to Place
We tend to think of attachment as only relevant in personal relationships yet there is a growing literature about the importance of attachment to place. Similar factors influence our attachments to places as they do to people. The places we become attached to have been those where we have consistently experienced safety or comfort – this may be a house we have lived in or a school we attended. It may equally, however, be a place in the community where we could retreat when were sad or distressed and find soothing – a religious building, a library, a favourite outdoor space or the gym. Many of these places have the enduring quality of personal attachments – even when we have not visited them for a long time they have meaning. Many of us gain great pleasure from visiting childhood haunts many years later and are outraged if we discover they have disappeared or changed. This attachment to place underpins some of the campaigns to preserve buildings, outdoor places or institutions that are under threat because of new priorities or changing policies. Sometimes such closures can have powerful effects for individuals. Adults who grew up in children’s homes, for example, whose sense of their own narrative is already compromised may find it particularly difficult if their childhood homes have disappeared without trace –some even begin to doubt their own memories and experiences. Creative use of digital archiving and social media can help preserve attachment to place even when original buildings or places have disappeared or changed beyond recognition.
Danger and distortion in attachment
Finally, we maybe need to consider the potentially lethal implications of our collective failure to provide the political, social and emotional environment where individuals, groups and communities can feel included and experience positive attachment relationships. Human beings are social animals with a powerful drive to connect to others and feel a sense of belonging. If these opportunities do not exist within our families or communities and no compensatory or healing experiences are available then the hurt and excluded will find each other and may find their sense of connection or belonging in their shared rage or pain. In many cases this will fuel positive social change and the creation of communities of interest but it may also have destructive consequences. Gangs create strong bonds and give their members an illusory sense of safety and comfort. The genius of the Violence Reduction Unit’s approach to Glasgow’s gangs was that it recognised this function and worked to provide alternative more prosocial ways for young gang members to feel connected and to belong. Using an attachment perspective may help us to understand both the resurgence of terrorism and the poison of racism. Are there implications from an attachment perspective, for example, of adopting a seemingly deliberate policy to create a hostile environment for immigrants?
This paper is by no means an exhaustive account of the way that a better understanding of attachment could enhance professional practice and human relationships more widely. That was never its purpose. At Scottish Attachment in Action we want to encourage exploration, debate and challenge. We hope that our members and any other individuals and organisations interested in attachment will join in this discussion. Let us push at the boundaries! What would an attachment-informed prison system look like? Or an immigration service that recognised the meaning and importance of relationship for individuals, communities and society at large? How would attachment-minded politicians frame policy and law? It is our contention that any service, profession, community or business that involves connection with people would benefit from underpinning their work with an attachment –informed approach. What do you think?
Written by Catherine Cooke and Judy Furnivall, SAIA Trustees, December 2019
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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.
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!
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
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.
(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.
Is it really a problem of self-esteem? Looking inside may not be the answer to how children can flourish.
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?
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?”
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.
• 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.
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.
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
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