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!
Back to the Floor
The three visitors looked friendly, but what I thought would be an opportunity to showcase our work left us feeling we had been caught short.
Someone in headquarters decided it would be good for morale if the heads of education, social work, and health met with some of us who work directly with young people. The initiative was called ‘Back to the Floor.’
One of the three, dressed in a grey suit, asked me, “Why should my child’s education suffer because the teacher has to deal with the behaviour of a young person who is in foster care?”
I have heard the same kind of argument in many schools, sometimes expressed in different ways: “We can’t meet Johnny’s needs here.” In other words, Johnny ruins everyone else’s chance at a good education.
I tried to answer the man in the grey suit, “If I could take you to some of my schools, you would see that schools that are the most inclusive are best for all young people.” My words sounded unconvincing. I wasn’t prepared for his question, and I couldn’t back up my view with any evidence.
The inclusion of children who are looked after in mainstream education is often a contentious issue. Sometimes it is characterized by simplistic thinking1. “We can’t meet Johnny’s needs here” may be true, but is there really some magical other place where Johnny can be ‘fixed’?
Inclusion can also define and strengthen important values. When faced with the challenging behaviour of a looked after child in her school, one head teacher said, “I don’t want him to go to a special school. He needs the relationships he has with children here who don’t have attachment difficulties. He won’t have those role models in a special school. I am not going to exclude him.”
Inclusion can also create ambiguity. It can force teachers into an uncomfortable position, one in which we feel we have to chose between contradictory imperatives2:
Is my job to teach my subject or is teaching about helping children develop as individuals?
I am here to make sure the young person who wouldn’t say boo to a goose can learn, but what do I do when that young person is threatened by the child who acts out the effects of the neglect they have suffered at home?
Inclusion requires substantive change3; it challenges us to look at ourselves and to question the commitment to our values.
Can You Give Me One More Chance?
Successfully including young people who are looked after and who may have attachment difficulties in any kind of mainstream setting can be difficult. Paul was fourteen years old and had been signed up by his foster carer to go to summer camp. It soon became apparent that his carer was under a lot of stress. She said, “I told Paul if he gets sent home, the moment he comes through the door, I will put him in respite care. He has been excluded from school, and people have come to the house to say he is causing trouble in the community. His mum doesn’t even want to see him.” Paul probably felt being sent to camp was just another rejection. This looked far from promising.
I met Paul as he stepped off the bus and introduced him to his group. He seemed to take an almost instant liking to his group leader, an easygoing and energetic young man. I noticed after a couple of days they were rarely apart. However, Paul also mercilessly bullied another boy.
The head of the camp wanted to send Paul back home. “It's not fair on others in the group. He is ruining their week,” she said to me.
I pleaded for one more chance.
I took Paul aside. “We are going to do everything we can not to send you home, but you have to stop bullying. You are going to spend the rest of the day with me and help me clean the kitchens.”
After that Paul’s behaviour wasn’t perfect, but he stopped bullying. A couple of days before the end of the camp, I asked him about his birthday. “I see you have a birthday when you get home. Will you do anything special?”
“No one has ever done anything for my birthday,” he replied.
The next day, I was sitting at lunch on the table next to Paul. Without warning, the other young people came into the dinning room and sang “Happy Birthday” to him.
Paul looked like a deer caught in the brightness of a spotlight. I think he wanted to run away, but he couldn’t. About fifty young people surrounded him.
A year later, we had a call from his foster carer. She told us Paul had looked through the camp brochure until he found the same group of leaders and asked her to sign him up. She told us it had been a much better year at home.
Why did it work? It wasn’t just one thing that made a difference. His group leader had worked hard to build a relationship with Paul, and the head of the camp was willing to take a risk and give me one more chance to reach out to him. I believe Paul got the message that he was wanted there.
Paul contacted us again this year. He apologized and said he plans to spend the summer with the Army and cannot come to camp. Two years ago, when I first met Paul, he was an outcast, unclaimed and unwanted. Being included in that camp had transformed his life.
Excellent and Inclusive
Camp and school are very different, but some of the issues around inclusion are similar. Will other children suffer because of the behaviour of a child who is looked after? It is relationships that make the difference. Teachers who include children prioritize the importance of relationships in learning, and this benefits all the children in their class. In order to test my hypothesis, I interviewed a group of young people, a teacher, and a teaching assistant.
It had been a steep leading curve for Lewis’ teacher. The impulsive and often angry twelve year old, who had also struggled in his foster care placement was in trouble almost every week.
At the end of the year, I interviewed a group of Lewis’ peers. They all acknowledged their learning had been held back to some extent by their classmate’s challenging behaviours. However, they all had something positive to say about their school: “The work we produce is good and the staff are really friendly.” They also had no difficulty identifying the things they had accomplished. They all rated the relationships in their class as a 4 or 5 out of 5. One of the group commented on how her teacher had handled pupils’ behaviour problems: “She is good at it because she will sit down and have a calm chat with them and calm them down.”
The kinds of skills teachers and teaching assistants learn in order to support a young person with attachment difficulties seem to transfer readily to other children. Another teacher at the end of school year commented:
“I have been teaching for fourteen years. Callum has helped me more than any other child to think about my teaching.
“I have learned to make fewer assumptions about the behaviour of other children in my class. I used to think some behaviours were because a child was spoiled at home. I have learned they may have real issues and need my help.”
“One of my pupils was playing up for another teacher. I used Wondering Aloud, and I gave him some different options for what might be upsetting him. If I hadn’t used this approach, he would never have told me what was wrong.”
“We are rolling out some of these things across the school. Callum has raised the profile of how we handle emotions.”
A teaching assistant from another school wrote:
“I have been able to transfer the skills I have learned to help other children. For example, I noticed a change in another child's behaviour. He was getting upset and walking out of class. I asked the teacher if I could have some time with him. I used Wondering Aloud. I said I had noticed that he was spending a lot of time on his own and that he was distracted easily. I tentatively asked him if the class was too loud or maybe he had a lot on his mind. He said there was too much noise and that it was hard to concentrate. I tried to empathize with him. Later, this child told me he was worried about something happening at home.”
In these classrooms, the behaviour of the children who are looked after had some negative impact on the other children. However, the teachers and teaching assistant were able to use the skills they had learned to identify and respond with sensitivity to children who were struggling. It also seems that the other children in their classes recognize that despite some difficulties, the relationships in their class were very good. They were generally positive about their school and what they had learned.
Inclusion matters because young people who are looked after find the acceptance they need in order to overcome their sense of rejection and shame. And to answer the question from the man in the grey suit, I would be happy to see my own children in a classroom with the kind of teacher who values relationships, who understands young people’s needs, and who finds a way to support the learning of all young people.
* Under the provisions of the Children (Scotland) Act 1995, 'Looked After Children' are defined as those in the care of their local authority.
Features of Inclusive Schools 4
Keeping it Real: Where are you on the inclusion spectrum?
1. Learning Teaching Scotland. Focusing on Inclusion and the Education (Additional Support for Learning Act) (Scotland) Act 2004. Dundee: Learning Teaching Scotland; 2006. Available from: http://www.educationscotland.gov.uk/Images/FocusingOnInclusion_tcm4-342924.pdf [Accessed 16 August 2016].
2. Clark C, Dyson A, Millward A, Robson S. Theories of inclusion, theories of schools: deconstructing and reconstructing the 'inclusive school'. British Educational Research Journal. 1999; 25 (2): 157-177.
3. McLeskey J, Waldron N. Inclusive Schools in Action: Making Differences Ordinary. Alexandria VA: Association for Supervision and Curriculum Development; 2000.
4. Martyn R. The journey to excellence. Available from: http://www.journeytoexcellence.org.uk/videos/martynrouseinclusiveexcellentschools.asp [Accessed 16 August 2016].
First published within ‘Inclusion Makes Better Teachers’ www.saia.org.uk/blog September 2016
© 2016 David Woodier, Support Teacher, Inclusion Base, North Lanarkshire. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.
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