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
A young woman recently sent us this poem about growing up in a children’s house. She is passionate about telling others about her experience. I think the poem also expresses that kind of second chance that young people get when they find someone who loves them.
David Woodier, SAIA Chief Blogger
I am a 19-year-old girl, who has been looked after from the age of four months. I have experienced many different care settings but this poem reflects my first placement in a children's house.
Writing has always been a release for me, expressing myself on paper is a way to dilute the intensity of the emotions going through me. And also a way to understand myself more. The small number of care experienced young people, CEYP, who have read my poem, have told me it has really resonated with them, so if I touches anyone either living or working in the system and makes them think, then that's more than I could have ever hoped for.
I currently study social care with an aspiration of becoming a social worker to help other young people. I am actively involved in evoking positive change for CEYP, I am a founding member of my locality's champions board, I'm on the corporate parent sub group, and I am involved in the Children's hearing system on a national scale.
First published as ‘Family Isn't Always Blood’ www.saia.org.uk/blog 2017
© 2017 Beth. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.
Me-Food-Now - responding with relationship to 'acting out' from ambivalent-style attachment in children, teens, and presidents.
This month sees what we hope will be first of international contributions to our news bulletins. Robert Spottswood is the author of the ‘The Bean Seed’ and of ‘The Refrigerator List’ (on our website), also a DDP Therapist, Consultant Trainer. Robert lives in Vermont in USA and has been a friend and supporter of SAIA for many years.
As you will see from the article, Robert and I were ‘chatting’ on email, talking about the universality of attachment theory to all relationships – personal, community and political. I asked Robert if he would write an article for SAIA and he very generously has…… we hope you will find it thought provoking and enjoyable….read on…. Edwina Grant
Me-Food-Now - responding with relationship to 'acting out' from ambivalent-style attachment in children, teens, and presidents.
-- by R. Spottswood, Vermont
Thinking about the families I have had the privilege to work with, while preparing this article, I was struck yet again: what a universal experience is attachment!
Thanks to each of us being born with an attachment system, as Bowlby pointed out, we seek connection with a caring adult as if our lives depended on it. And as we grow, the manner in which we relate to ourselves and the world suggests cues and clues as to how our early search for attachment was responded to. (How 'The Refrigerator List' was generated.)
“How universal!” I exclaimed over email to my Scottish colleague, Edwina Grant. When strangers meet, they routinely go back to preverbal attachment connection behaviours: eye contact, smiles, welcoming tone of voice, and comforting touch -- a handshake.
Relevant here is the Guardian newspaper’s short clip showing the violent, controlling handshake developed by the new U.S. president. Here we see, in my view, a tradition rooted in emotional connection twisted to physically and emotionally dominate each friend from the moment of greeting. Must be seen to be believed:
Attachment also helps explain, as Sue Johnson points out with Emotionally Focused Couples Therapy, how any wound to relationship trust can trigger irritation, 'angry poking', distancing and finally 'abandonment protests' (such as big fights) in desperation to hold onto attachment connection with an adult partner. Again, in the context of couples, I think our attachment system explains why 'open marriage' tends to prove so unstable -- Am I special to him/her? Am I in his thoughts? With a third intimate person, the best I can do to feel secure is to constantly try not to think about it...
Finally, attachment helps me understand at last the riddle of violence in institutions and society. Growing up reading concurrent news from the horrific war on Vietnam, I find answers to the riddle of violence in the attachment-failure of social systems which give the wink to viewing our neighbors as objects – permitting a range of objectifying behaviors, from falsehoods to manipulation to hatred to harassment to stalking to bullying to military planning to torture. For my own personal awareness, every August 9 I stand downtown for an hour with my large homemade sign silently reminding Americans of the results of dropping 13 pounds of plutonium on a city of civilians; and that we have never apologized.
DDP (Dyadic Developmental Psychotherapy) suggests to me an important way out of this closed loop of recurrent dysregulation: connected relationship. Dan Hughes once put it, “If we come to a (therapy) session with an agenda, the kid will quickly sense our agenda and run the other way. My only agenda is to have a relationship with the kid – and they don't even have to talk. I can have a dialogue and I can be both sides of the dialogue”
A chronically angry parent – a great improvement over the brutal grandparents – once demanded of me “How would you respond to the school principal if he ambushed you like he did me, in front of everybody at a school meeting!”
I knew she would not like my vulnerable answer, but I gave it anyway:
“Being me, I would try to show a little of my sadness while saying, 'I was feeling good about my child's progress here, until I heard this sudden comment, which surprised and saddened me. I don't understand why I wasn't warned, and I'm just feeling so sad right now.'”
The angry parent stopped, handed me a piece of paper and said, “Would you write that down? I never learned to talk like that growing up – it would have been suicide. Thank you.” She was serious.
Perhaps the most surprising DDP session I can recall was back in 2003. A young teen came in with his divorcing father – an emotionally distant accountant – and began running around my small office, banging things just enough alarm the grown-ups and force father's attention.
“Ha-ha, you can't catch me!”
To us DDP clinicians surface behavior makes sense if we are holding in mind the person's attachment history, life situation, and need for emotional safety under the surface. As Dan pointed out long ago, “Context determines the meanings we make.”
Prioritising physical safety (this was 2002), I scooped up my young client and carried him back to the couch and his father, while co-regulating (second priority) with my voice tone and empathic words – he of course screaming bloody murder the whole time. But I was responding without cognitive argument to his double message: Nobody can catch me – and – my folks are divorcing so I have to force someone safe to catch me and help me before I burst with sadness!
Unfortunately the father was not prepared to provide intimate affective co-regulation to his son on the couch, or I suspect anywhere else. We had not had time to prepare. After 30 seconds of helping me gently rock his noisy, dysregulated boy on the couch, the father turned to me and said, “I can't do this.”
“Okay,” I replied, “let go.” There is no point going further in a session than parents are able.
I expected the angry boy would scamper out of the office to lick his wounds....but he did not. He calmly walked across the room, got a desk chair, brought it back and sat down facing his father. He began pleading in a sorrowful voice (I am not making this up) --
“Come on, Dad! Please! You can do it, Dad! I beg you, PLEASE! You can do it!!....”
As my jaw dropped to the floor I realized what it meant to this boy to have felt his father physically pay attention and care enough to finally co-regulate his son's catastrophic feelings.
This is what comes to mind when I sit down to write about responding with relationship to 'acting out' from ambivalent-style attachment in children, teens, and presidents.
For my next article I will focus more on what it means to me to respond with relationship to dysregulating public officials.
Robert Spottswood (name began in town of Spottiswoode, Scotland)
First published in www.saia.org.uk/blog 2017 © 2017 Robert Spottswood
Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact
The Gentle Challenge
For the first two years of primary school, one little girl I know would not talk to her teachers. Even when close friends of the family greeted her, she looked down and said nothing. Although she couldn’t explain what was wrong, her dad sensed her overwhelming anxiety. He needed a way to help her change her behaviour, but more importantly, he needed a way to help her realize that being noticed by people doesn’t have to be scary. One day he had a small brain wave.
“Here’s the deal. People like to see you smile, but you don’t like doing the talking. How about when someone greets you, you do the smiling, and I’ll do the talking?”
“Hi Sarah*. How are you?”
“Hello Mr. Duncan,” Her dad said. He looked down at the little girl and gently squeezed her hand. She flashed just the briefest of smiles.
Mr. Duncan smiled back.
I didn’t know at the time, but this was an example of what Mary Dozier from the University of Delaware calls the gentle challenge. Since then, I have come to realize this is one of the most important goals in building a relationship with a child who has been maltreated. As Dozier says, it is about gently challenging their worldview (1). In terms of attachment, it is a way of helping children revise their internal working model.
Children who have been maltreated often have distorted expectations and beliefs about self and others. Bowlby observed that these models are established in the first few years of life. As children get older, they become increasingly resistant to change. “The necessary revisions of model are not always easy to achieve. Usually they are completed but only slowly, often they are done imperfectly, and sometimes not done at all” (2). In addition, adults are too easily pulled towards responding in a way that confirms their existing worldview.
The gentle challenge can only take place in the context of a trusting relationship. This, in and of itself, is a complicated task and one that challenges the young person’s worldview. It is important that the adult can empathize with the young person and has some ideas of what kinds of beliefs and expectations a young person is communicating through their behaviour. The gentle challenge is often used in response to a young person who is showing some kind of resistance to relating to others.
Harry had been moved to a new high school, but the honeymoon hadn’t lasted long. He was suspended, and as I drove him home, my mind went back over the years to the little, angry boy I first met in primary school. Harry had fixed ideas about himself and others. When his head teacher retired, Harry told me with all sincerity that he had ruined his head teacher’s life. I tried not to smile, but in my imagination I pictured his head teacher sitting in the sun on a cruise ship sipping a glass of something fizzy. Harry was convinced that teachers disliked him, because he believed he was a bad kid.
“Harry how long have we known each other?”
“For years, Mr. Woodier.”
“Harry, do you trust me?”
“I need to ask you do something. Can you give some of the trust you have in me to your new teacher? Maybe she doesn’t hate you.”
Harry said nothing, he just looked at me. I wondered if he could accept that there might be more than one teacher in the world that didn’t dislike him.
The gentle challenge is often counterintuitive. Sometimes it means joining with the young person in their resistance. We accept that the behaviour allowed the child to survive and cope in an adverse situation, but once a child is safe, we want them to experience relationships in a different way.
“I know its important for you that I know you are a smart kid. You can keep shouting out the right answers until we work out some other way for you to be sure that I know you are smart.”
“I can see you want to be in control of this. I think you are right. I don’t think you know me well enough yet. When you get to know me better, perhaps you can trust me.”
Children who have been maltreated sometimes give up signalling their needs. Dozier says it is really important that the parent or caregiver find a way to indicate their availability even when the child acts as if he or she does not need it. In a recent email, Dozier stated, “For example, if a child banged his head and sat alone rubbing his head, the parent might say, ‘Oh honey, I’ll bet that hurts’ while she strokes him on the back.”
The gentle challenge is not a clever script; it is a way of building trust and a new way of relating. It often works better when the adult finds a way to do some of the heavy lifting.
“It isn’t easy to say sorry to someone you think is angry with you. What about if I do the talking and you just come along with me?”
“You told me when you are in your class, you need to use that kind of language because you feel threatened. But you are not in class today; you are on holiday, so why not give that kind of language a holiday?”
The gentle challenge often comes as the culmination of months or even years of building a relationship with a child or young person. It is based on an assumption that young people, despite being maltreated, have an underlying need for connectedness and coherence (1). I see it as a gift, a way of affirming a child as a human being. It asks children to re-imagine a world in which they can be loved and bring joy to others.
* The names of children used in this article have been changed.
1. Dozier M, Bates BC. Attachment state of mind and the treatment relationship. In Atkinson L, Goldberg S. (eds.) Attachment issues in psychopatholgy and intervention. London: Lawrence Erlbaum Associates; 2004. P. 167-180.
2. Bowlby J. Attachment and Loss: Volume 1 Attachment. London: PIMLICO; 1997.
First published as ‘The Gentle Challenge’ www.saia.org.uk/blog 2017
© 2017 David Woodier, Support Teacher, Inclusion Base, North Lanarkshire. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.
Understanding Attachment Helps Teachers Build Resilience in Young People
Resilience can be one of those buzz words in education. It is easy to talk about but trying to help vulnerable young people become more resilient can be more difficult than we imagine.
You present a young person with a ‘once in a lifetime’ opportunity, for example, an outward-bound course. However, when the day comes and the bus is ready to leave, he is nowhere to be found.
You worked all year to prepare your class for the transition to high school. One of your pupils, from a difficult home situation, refuses to attend the new school after the first week.
Is it possible that we underestimate the vulnerability of some children because we don’t get how profoundly trauma* impacts young people? In addition, our view of resilience is so culturally conditioned that we think of resilience too much in terms of an individual’s strengths, rather than recognizing the importance of the relationships that surround a young person. A ‘stand on your own two feet,’ individualistic notion of resilience may be very unhelpful.
A recent phone call to a foster parent reminded me that in many cases building resilience in young people does not go to plan. Several years ago, I began a piece of work with a high schooler, David (not his real name). I carefully planned the activities based on what I understood about resilience, but I missed the importance of long term relationships.
David’s teachers in high school were pulling their hair out. He was restless in class, found it difficult to focus, and often acted like a clown. During my first meeting with him, I quickly realized here was a young man who wasn’t going to sit and listen to me. We needed to do something active together. After playing badminton with him several times, I could see another side to him. Behind his constant fidgeting and impish grin, he was kind, gentle, and eager to please. I began to think about how I could use my relationship with him to help him reintegrate in to his school. He needed an opportunity to experience real success in something that he saw as being worthwhile. He needed a challenge; I needed to stop losing at badminton.
Risk, resilience, and attachment
Education can have a positive impact on resiliency. For example, schools provide opportunities for children to achieve a sense of mastery, the feeling that comes from doing something well. Young people also have the opportunity to explore different social roles that can help them build a more pro-social identity (7). However, for young people like David school often reminds them of failure, and they too easily become cast in the role of a trouble-maker.
David was at risk long before he started school. He was probably exposed to alcohol while in his mother’s womb. When we add up all of the risk factors in a young person’s life things may look pretty bleak, but even then we can underestimate a young person’s vulnerability. We don’t realize that risk factors interact in a way that is not just a simple one plus one. A risk factor, such as an insecure attachment, can have a disproportionate influence on how a child is impacted by other traumatic experiences (1, 2).
To some degree, all children are vulnerable; they all need adults that can help restore a sense of safety and control in a sometimes chaotic world. In this way, a secure attachment between child and caregiver mitigates the effects of trauma. However, the opposite is also true. A child who is insecurely attached may be more easily overwhelmed and unable to develop some of the core competencies, such as the capacity to self-regulate emotional states, that will help protect him against future adversity (3).
The cascading effects of a child’s early attachment experiences may explain why some young people are knocked back so hard by the stress, for example, of moving to a new school. They are like the house built on sand.
Resilience can be defined as “reduced vulnerability to environmental risk experiences, the overcoming of stress or adversity, or a relatively good outcome despite risk experiences” (4). However, it is a relative not absolute quality, for some children, like David, even partial recovery of wellbeing and resilience is important (5).
Finally, in planning my work with David I was aware that building resilience is accomplished not by the removal of all risk and stress, but in the careful managing of these within a supportive relationship (6). In addition, the path to resiliency can begin in one small part of a person’s life, even from a single opportunity or turning point.
Building resiliency: David’s story
David looked nervous as we waited outside the office. The door opened and I introduced him to the head teacher of a local primary school. “David is good at sports and he likes children. Could he volunteer once a week in one of your PE classes?”
Over the next couple of months, I watched a slow transformation take place. David was more focused and ready to listen to correction when things were not going so well. I think it was something about how the younger children showed their delight in having David volunteer in class that helped him change. He was doing something that he could see other people appreciated and valued. He wanted it to work. At the end of his 15 weeks, David planned a dance competition for the children.
The turning point
As the day approached, I sensed David’s increasing anxiety. I noticed small changes in his mood and behaviour; he became increasingly restless when meeting with me. On the day of the competition, David disappeared. Finally, I found him sitting at the back of a room in his high school, slouched all the way under the desk, in a class that he wasn’t even enrolled in.
“David, listen to me. I won’t let you fail. If you get up in front of the kids today and you forget what to say. I will be right there and help you.”
This was the “turning point” and success at this moment depended on my ability to reassure him and whether he could trust me. Most children learn when they are very young that adults can be trusted to help them when they are anxious and fearful. They grow up experiencing, not perfect, but good enough, sensitive, attuned caregiving. Many vulnerable young people haven’t developed this basic kind of confidence. As teachers, it is where we can provide what Louise Bomber calls second chance learning (8). If we have done the work of building a relationship, a young person has the opportunity to learn something they missed earlier in their development.
The dance competition was a great success, and the pupils gave David a thank-you card. As he took the card, I watched the expression on his face. He laughed at the drawing the children had made of him, and read each of their names printed on the back of the card.
Later as we talked about his volunteer work, David could see how his decisions had contributed to its success. He found a sense of his own agency; he was able to bring about something positive in his life. His foster carer remarked, “He is taking more responsibility for himself. He was getting excluded and was depressed. He’s happier and is in school full-time.” David went on to apply to a local college to study sport’s coaching.
I wish I could end the story there. A few weeks ago, I spoke to David’s foster mum. She told me that after leaving school, he had gone back to his birth family, and he was now living as a drug addict.
It breaks my heart to think of David, now in his early twenties, alone and struggling with addiction. I prefer to remember him as the energetic 15-year old that wouldn’t sit still and beat me almost every time at badminton.
We must stop thinking about resilience as something we do to fix young people; it is not an event or an activity alone that makes the difference. In addition, the onus should not be on the young person to change but on the school, family, and community. Perhaps we should stop thinking about resilience in terms of the individual. We should be asking how resilient-building is our school? How do the relationships in a family that is fostering or adopting contribute to the child’s resilience?
We are only ever as resilient as we are connected to those who love and nurture us and that is as true for adults as it is for children.
* Relational trauma describes the experience of chronic and prolonged traumatic events, usually of an interpersonal nature, beginning in early childhood. These experiences usually occur within the child’s caregiving system and have profound developmental effects on a child (3). Typically, children feel overwhelmed and powerless, and often remain confused as to the role of adults more generally.
1. Luthar SS, Sawyer JA, Brown PJ. Conceptual issues in studies of resilience: past, present, and future research. Annals of New your Academy of Sciences. 2006;1094: 105-115.
2. Masten AS, Cicchetti D. Developmental cascades. Development and Psychopathology. 2010; 22: 491-495.
3. Van der Kolk BA. Developmental trauma disorder: towards a rational diagnosis for children with complex trauma histories. Available from: http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf [Accessed December 2016].
4. Rutter M. (2006). Implications of resilience concepts for scientific understanding. Annals of New York Academy of Sciences. 2006; 1094: 1-12.
5. Shofield G, Beek M. Risk and resilience in long term foster care. British Journal of Social Work. 2005; 35: 1-19.
6. Woodier D. Building resilience in looked after young people: a moral values approach. British Journal of Guidance and Counseling. 2011; 39; 259-282.
7. Gilligan R. Promoting Resilience: Supporting Children and Young People who are in Care, Adopted or in Need. London: BAAF; 2009.
8. Bomber L. Inside I’m Hurting: Practical Strategies for Supporting Children With Attachment Difficulties in Schools. London: Worth Publishing; 2007.
First published within ‘Understanding attachment helps teachers build resilience in young people’ www.saia.org.uk/blog January 2017
© 2017 David Woodier, Support Teacher, Inclusion Base, North Lanarkshire. Permission granted to reproduce for personal and educational use only. Copyright notice must remain intact.
Over on Twitter we’ve been connecting with @3beesandahoney, an adoptive mummy and blogger at 3beesandahoney.wordpress.com. She has kindly given us permission to reproduce this excerpt from her blog post on October 17th this year.
…That brings me nicely back to the DDP conference (yes, I know I have been waffling again!)
For 2 amazing days, I found myself surrounded by individuals who WANT to support vulnerable children/teens and their families – I should say professionals but from my experience the whole conference environment has an autonomous feel and people would struggle to be able to identify your adopters/carers from your psychologists/social workers/psychodrama therapists, etc., unless your name is in the programme as a speaker for the conference – oh and of course, if you are Dan Hughes!
In truth I cannot tell you if there were any other adopters/carers at the conference (chances are there would have been and quite possibly some of these were also there in a professional capacity), and really I am not sure it is important. That is not to say that I did not know a sole who was attending – Buzz’s therapist was there, as was Jemima (Waxy’s previous DDP therapist and angel in disguise).
We were all there with one goal on our minds. To develop and gain more insight into “The Power of DDP”.
The importance of companionship provided another strong theme throughout the 2-day conference, both in the formal content of Professor Colwyn Trevarthen and Dan Hughes’s presentation but also through the sense of fellowship and camaraderie amongst groups of delegates and the desire to create an environment of safety and understanding in their work with families and children who have/are experiencing the crippling effects of early developmental trauma, helping them move from ‘Mistrust to Trust’ and reducing the risks of ‘blocked care’ occurring (the damage this can cause, I know only too well from personal experience).
I could spend hours writing about the conference. No matter how many times I find myself being drawn into the affect of the content or case studies being presented, and how often it leaves me with an emotional lump in my throat (if I am lucky – usually the hankie has already been deployed by then), as it resonates with my own sons’ struggles and experiences. In the past this would be enough to have me running for the hills and maybe if I had been at a local authority conference or training day, it would have had this exact reaction.
However, at no point did I feel the need to excuse myself and there is one simple reason for this – I knew, if I wobbled, there would be support there if I wanted or needed it.
So while the exhausted, emotionally fragile and jaded side of being an adopter to two vulnerable and traumatised brothers, finds all the National Adoption Week recruitment campaigns difficult when there is a sense of glossing over the realities of adoption. This years’ theme gives myself and many other families the opportunity to try and highlight the need for better adoption support and the lessons that have been learnt and are still to be learnt in order to give our children and families the support they need… No deserve!
With this said, during this week with the help of Buzzbee, I am setting myself the challenge of creating a couple of posts which highlights ‘the good, the bad and the on another planet’ experiences of ‘Adoption Support’.
For more from this blog visit 3beesandahoney.wordpress.com
🔊 Why Attachment Matters [click to listen to audio file of this interview]
In the following interview between Professor Helen Minnis from the University of Glasgow and David Woodier a teacher, adoptive parent and blogger for Scottish Attachment in Action, Helen speaks about 'Why Attachment Matters' to her. Themes emerging from the interview may well resonate with those living and working with children and young people who’ve had an adverse start in life.
How do we give children the gift of a safe haven?
… I can’t help feel I have been gifted,
Lifted out of darkness,
Carried by angels to a safe place,
A haven with four windows,
And a single door,
The most beautiful place in all the world,
With the most beautiful people to welcome me, … 1
How do we create a world that is safe for children who have suffered abuse and neglect? How do we help them thrive in relationships? The words above are from a poem of a child who was adopted. The question for those of us who live and work with children who have suffered maltreatment is, how to put what we know about attachment into action. In the following interview, Professor Helen Minnis talks about her passion for helping children and young people. She discusses a range of issues, from teenagers to new therapeutic approaches, and from brain development to helping children cope with separation and loss.
When did your interest in attachment begin?
I wanted to do psychiatry, but before I wanted to do psychiatry, I wanted to travel. I spoke to the head of Child and Adolescent Psychiatry at the Maudsley Hospital. I said, “I am going to Guatemala for a year to work in an orphanage. What would you suggest I think about?” He said, “You should think about attachment and attachment disorders,” and he gave me the draft of the psychiatric classification system for attachment disorders. That was where my interest was born. That draft talked about children who had been abused and neglected being indiscriminately friendly on the one hand, and on the other hand, some of them being withdrawn and failing to seek comfort. I arrived at the orphanage and saw that right in front of my face. I was literally covered in children under five. I couldn’t walk forward until I peeled their little hands off. I became passionately interested in attachment.
Is Scotland a nurturing place to grow up? Are children able to build healthy attachments here?
It is all relative. In terms of encouraging the public to think about attachment the Scottish Government is quite far ahead. I remember a few years ago there were billboards, paid for by the Scottish Government, of a big sponge and the words: This is Your Baby’s Brain. I also think we realize we have some really big problems, and one of the big problems is the way we treat our teenagers. I think we ignore them; we don't give them eye contact; and we don’t give them a role in society. There are some major things we could do to make Scotland a more nurturing place, but it is great to live and work in a country where that’s what we are aiming for.
When did you first become involved with the work of Scottish Attachment in Action and why does an organization like Scottish Attachment in Action need to exist?
I was involved from day one. We had the Attachment Reference Group in Glasgow for colleagues from different disciplines to come along and discuss attachment. Edwina Grant heard about what we were doing, and we organized a day when we brainstormed about what Scottish Attachment in Action should look like. It was an incredibly exciting day, because we discovered that although we were from such different disciplines, we were really talking the same language. We realized was there was a need for a common language about attachment particularly across front line services that work with children including police, teachers, and nursery nurses. There was a role for both training and advocacy. I think Scottish Attachment in Action tries to sit in that space. It is always going to be needed, because getting people to think about young children is tricky. It is very hard for adults to put themselves in the mind of a child, because it is a long time since we were children. I think it is something that needs to be a daily struggle.
A number of years ago, you looked at the mental health of a group of adopted children living in Scotland. What effect does nurturing care and a stable family life have on children who were maltreated early in life?
It makes all the difference. Adopted parents have known that. I remember being sharply told off many years ago because I used the term “natural parents” which was an old term people used to use for birth parents, and someone said, “Adopted parents are natural parents, because they have done the nurturing.” That is so true. A child comes into the world with their genetic hand of cards, and what happens to that genetic hand of cards depends so much on the nurturing they receive from their family. From the study of epigenetics, for example, we know that the environment that surrounds the child can modify the DNA. Nurturing from parents is so crucial.
If we were to look inside a child’s brain, that of a child who suffered maltreatment early in life. What are some of differences nurturing care can make?
We don’t know more than we do know. The brain is like an unexplored landscape. One of the reasons I am in child and adolescent mental health is because we know less about the brain than we know about the universe. We know that the frontal temporal lobe of the brain, the sticky-out bit at the forehead, is bigger in humans. That’s because we need more in terms of planning and social interaction. Children who suffered early neglect and maltreatment sometimes have problems with some of the functions particularly associated with that part of the brain. Nurturing care can help children inhibit some of their emotional responses. Learning to plug into other special people by being part of a family and having the world interpreted for you by your parents, older siblings, and gran etc. is really important.
There are some children who seem to resist connecting with that nurturing care. Is there anything to understand about how children build attachments that could help us reach out to these children?
One of the things we have become more interested in is faulty signaling. This is when neglected children, because of their early experience of neglect, have learned to manage their own world so they habitually don't reach out to parents and carers. They fundamentally don’t understand that parents and carers are there to help you, support you, and comfort you when you are stressed. John Bowlby, who developed attachment theory, described how right across species it is a profound instinct to reach out to your carers when you are, for example, stressed, frightened, or have a tummy ache. It is actually a really small minority of abused and neglected children who don’t reach out. These children are then missing out on huge swathes of normal development. One of the really fantastic things is that in about ninety-nine times out of a hundred if neglected children are placed in loving families early in life that lack of signaling disappears quite quickly. However, there is a tiny minority of children in which it doesn’t melt away. I don’t know if that has something to do with the constitution of the children themselves or whether it has to do with not having the opportunity to be placed in a loving family soon enough. There is a tiny minority of children who, even in teenage years and adulthood, just don’t get that they should be reaching out.
I have noticed that some children with difficult starts in life -- children who don’t seem to respond well to the nurturing care of a foster carer or adoptive parent -- appear to ‘sort things out’ during adolescence. Is there something going on developmentally, a kind of re-wiring of the brain, that allows a young person to see things in a different way?
We know there are two rapid periods of brain development in life, the first few months and years of life and then again in adolescence. In adolescence the axons of the brain -- the long connections between your brain cells -- are being ‘cladded’ with myelin sheaths. It is a bit like cavity wall insulation. This is not something I am an expert on, but I have heard it used to explain why a child who is quite articulate at nine years old seems to almost lose the power of speech when they reach twelve. There is a lot going on in the brain that they are concentrating on. It is recognized that it is a time of opportunity because there is so much plasticity, so much of an opportunity for change and new development in the brain. One of the things that always gives me hope is that we now know you can develop new brain cells even in old age. The brain is different than other organs in the body. When you are born, your heart looks like it looks when you are an adult; it is just a small version of what it will be when you grow up. That is not true of the brain. When you are born and then again in adolescence, the brain has a huge amount of sculpting to be done. It is also worth remembering that some people heal and recover even later than that. I have personal stories of adoptive children who have left home at the age of sixteen and said, “I am never going to darken your door again.” Then they turn up later. I have a family friend whose son came back at his adoptive mum’s seventieth birthday party. He had been in prison and was covered in tattoos from head to toe. Now he is a loved member of the family again. So, although you are right that there are opportunities in teenager years, there are later opportunities as well.
You have been piloting something called the New Orleans Intervention Model in Glasgow. Could you say something about what makes this model different to services-as-usual for children and families?
There are two big differences. One, it is an infant mental health model. The other difference is that it offers treatment to birth families so that it is not just an assessment model. It was developed by Professors Charles Zeanah and Julie Larrieu from Tulane University in New Orleans. For a long time in New Orleans, every child who came into foster care under the age of five was offered this model. It offers standardized, attachment-based assessments in each of their caregiving relationships. They also do interviews and questionnaires with the birth parents about their own experience of attachment and caregiving, and refer the birth parents for help. For example, if they have problems with substance misuse or domestic violence. That process takes about three months, and then there is a period of intensive treatment with the aim of changing the birth family’s relationships so they can get the child home. But if it doesn’t work within a time limit, then the child is recommended for adoption.
Has any aspect of the study surprised you?
We have learned a lot about the nature of our systems here in Glasgow and about the ways in which we inadvertently cause delays for children. I think it has a lot to do with our difficulties as adults in putting ourselves in the mind of a child. There are so many places through a child’s journey where adults from all sorts of professional backgrounds could have thought, ‘This is not right for this child, and we need to move this forward,’ but we don’t. It has been a surprise at what kind of a perennial, entrenched problem that is.
Would there be a benefit in Scotland if we follow the example of some parts of the US where foster carers are also recruited to become prospective adopters?
One of the things we have become interested in through this project is the nature of foster care. Mary Dozier from Delaware has talked about commitment in foster care and whether the commitment comes from the length of a foster placement or from the freedom foster carers are given by their manager to fall in love with the child. In the United States, foster carers usually join the register as adopters. The philosophy behind that is that foster carers are supposed to be totally child centered, to love and commit to the child and potentially be the child’s forever parent. But if the birth parents get their life back on track, then the foster carers will have to relinquish that child. Some people say to me that it must be awful for the foster carer, but can you imagine that is generally what we do to children. The system in the United States allows the adult to take the hit rather than the child, and it seems to work well. Certainly in New Orleans it reduces delays. It means you are also not building in a loss for the child.
It is still a reality in the UK and in Scotland that children who are looked after are often moved around. They experience new foster parents, new schools, and new social workers. How do we help children who form multiple attachments? For example, should a child who is adopted visit their previous foster carers? Should a young person who is unexpectedly moved to a new school over the summer holidays have an opportunity to say goodbye to his teacher at his old school?
Those are examples of attachment in action. They are examples of being child centered. In a family where there has not been disruption through abuse and neglect and placement moves, that is what you would do for your child. For various reasons at the age of four, my daughter had to move, and we made a goodbye cake and we visited everyone. That is what you do because you nurture your children’s attachments. It is about nurturing children’s attachments and recognizing that secure attachments can come from surprising places. A child who has had a difficult early start may have a secure attachment with someone like their teacher, and that has got to be recognized.
Some people are concerned that contact, for example, with a previous foster carer, will prolong a child’s sense of loss and that it might make it more difficult for a child to form an attachment to a new family.
Probably the most important thing is to try and tune into the child. Try and understand that a child is likely to be grieving. Children go through bereavement processes in the same way that adults do. Relationships shift for children, and that is not a reason to pretend they don’t exist. Once a child is placed with a forever family, and the child understands that they are in a family who are committing to them for the rest of their lives, contact with a previous foster family can be very positive. This is very different than the situation where you have, for example, quite a damaged birth parent. I am not suggesting all birth parents are damaged. But if, for example, you had a birth parent where the experience for the child visiting the birth parent is really traumatic, then that needs to be thought about in a child-centered way. Difficult decisions have to be made. Children should not be allowed to see people who may have a negative effect on the child’s development.
Children with attachment difficulties often struggle to get the right kind of support in their schools. Can you talk about some of the reasons for this? Is it because children with attachment issues often present a variety of difficulties, and that makes it harder to identify that there may be an underlying attachment issue?
I think there is a lot in that. Identification is a problem. Particularly if they have attachment disorders, children with attachment issues nearly always have other problems. That is confusing, not just for teachers, but also for parents and clinicians as well. We know something we didn’t know fifteen years ago, if children or adolescents have one mental health problem, they are more likely to have others. We used to say, for example, if you have ADHD, then it can’t be anxiety. We know now that wasn’t sensible at all. Children with ADHD are at higher risk, for example, of having problems with autism or vice versa. Children who experienced early neglect and abuse are at higher risk than the general population of having other neurodevelopmental problems. This is some data we have found, and other people have found this, too: children who have had early neglect and abuse and have mental health problems often have complex neurodevelopmental problems. How these problems can be identified in school is really difficult. On the plus side, educational psychologists in Scotland are on the ball with this. I think they have led the way in thinking about attachment in schools and helping teaching staff think about attachment.
We are in the process of trying to develop something called the School Attachment Monitor, SAM. In the last six months, I have been working with Stephen Brewster and Allessandro Vinciarelli from Glasgow University School of Computing Science. SAM will be like a computerized version of the Manchester Child Attachment Story Task. If it works it will be automatically rated which means that it can be used in schools and we can look at the profile of attachment in children in the classroom.
I have heard carers, adoptive parents, and social workers express frustration with the mental health services available for young people in Scotland. Is there a mismatch between the needs of our children and what is offered to families? Is there something we can do about that?
Sometimes it is a problem of not recognizing the complexity of problems children experience when they have been maltreated. I have a lot of sympathy for my colleagues. Many do recognize the complexity, but I think we have all been on a really steep learning curve. We have done some research recently that suggested the direction of travel may not be what we thought it was. We know that a lot of ADHD has genetic causes, but I had always thought another route into ADHD was maltreatment. From some of the data we got recently, it is starting to look as though it might be the other way round. Children with some of these neurodevelopmental problems, in families that are already struggling, might be more likely to be maltreated. Therefore, in a sense, many maltreated children have a double whammy. This is new information for child and adolescent mental health services. In the past, we used to see children who had been maltreated and think that it is no wonder they have conduct problems, problems with behaviour. In fact, we should be thinking we really need to assess these children carefully. They may have genetic loading towards some neurodevelopmental problems that are going to make them more difficult to look after in the first place, not that there is ever an excuse to maltreat a child. The understanding of the complexity of these children hasn’t been there in our profession, but we are getting there. The other big issue is there are not enough of us. There are far too few child and adolescent mental health clinicians. Something parents could do is lobby. My clinical colleagues are genuinely overwhelmed.
You have been looking at the feasibility of DDP -- dyadic developmental psychotherapy2-- as a treatment for maltreated children in the UK. What is it about DDP compared to other approaches that makes it worthwhile considering the relatively high financial cost?
I think it’s worth considering, because it is different to existing psychotherapeutic interventions for children who have experienced abuse and neglect in that it promotes what Mary Dozier calls ‘a gentle challenge.’ Old-fashioned psychotherapy is very much led by the child; the child leads what happens in the room and the psychotherapist follows. That is sensible for the great majority of children, but if you have children that don’t signal their needs, that kind of child-centred approach is maybe not going to be successful. What I like about DDP and what gives it potential is the idea of PACE: playfulness, acceptance, curiosity and empathy. The PACE stance is a bit more gently challenging; you are not letting the child get away with hiding under the table and not engaging in therapy. In a playful, accepting and curious way, you are going to be saying, “The things that happened to you in the past are probably what’s making you sit under the table, but you have these good parents here who are ready to give you a good snuggle, so come and experience the love that’s available for you.” It's more directive in a gentle way. We also know from our research that therapists who are using it are very enthusiastic. So I think it has a lot of potential and needs a trial.
What are the barriers to seeing a wider availability of DDP in the UK?
One of the things the NHS should be proud of is that we carefully review the evidence base for those interventions. We haven’t yet got a robust evidence base for DDP. We need randomized, controlled trials if it is going to be commissioned.
Over the last ten years, there has been a resurgence of interest in attachment. Training on attachment is popular; it has almost become a buzzword. But are we really putting attachment into action?
I think so. It is a bit of a double-edged sword. I was at a meeting in England a couple of years ago with lots of social workers and academics. I think I was the only child and adolescent psychiatrist. People were saying, “All this early years stuff and attachment stuff; it is kind of flavor of the month.” I was thinking “Sorry!” So there are, in some circles, people who don’t see the importance of it. But again, that is one of the reasons I am happy to be living and working in Scotland because we have developed a shared language. Scottish Attachment in Action has to be patted on the back for that. There are other groups working towards a much more nurturing place to live. For example, it is wonderful that in education we now have this idea of, ‘How Nurturing is Our School?’ This is not some kind of soft option or some wishy-washy place. If we are nurturing children, they can thrive, and they can do well emotionally, behaviourally, and in their attainment.
But isn’t there a problem that attachment can remain too theoretical and abstract? Our understanding of attachment still does not make enough of a difference in how we make decisions; for example, in the way we work with a child who is being disruptive in school and being threatened with exclusion. Are we underestimating the difficulty of how to put what we know about attachment into practice?
There is a problem: attachment has been very laboratory based. The measures recommended for use in clinics are too cumbersome. For example, the gold standard measure for attachment in young infants is the Strange Situation Procedure3. I think that is probably the most important scientific advance in the twentieth century. However, it takes two or three people about twenty minutes to actually do it, and that is not including the set-up time and the hour and half to rate it. It is not feasible in the NHS. That is one of the reasons we are trying to develop better tools like SAM. We want to develop things that are quick and easy. In terms of intervening with children in schools and families, it is about trying to translate the learning from research into practice. Things like ‘How Nurturing is Our School’ are phenomenally important because teachers who understand the roots of children’s behaviours are going to change the ethos of the classroom. I wouldn’t underestimate the importance of talking about attachment. We have to keep harping on about it. This is not flavour of the month. Attachment is a fundamental instinct that allows children and young people to plug into what they need for their development, and there is a reciprocal caregiving instinct in adults to respond to that. That is the glue that holds our society together.
We welcome responses to the kinds of issues Helen raises in the interview. We plan to edit these responses and put them on the Scottish Attachment in Action website to give us a bigger picture of how we are putting attachment into action.
Following on from this interview, the next recording will be David speaking with our Chair of Trustee's, Edwina Grant.
1. Ruairi, Life Story Collection: Poems after Adoption About Life Before Foster Care. Leicester UK: Ruairi; 2012. A link is available from http://drawingtheidealself.co.uk/drawingtheidealself/Downloads.html
2. DDP stands for Dyadic Developmental Psychotherapy. It is a therapy and parenting approach that uses what we know about attachment and trauma to help children and families with their relationships. Further information is available from http://ddpnetwork.org/uk/
3. The Strange Situation Procedure was developed by Mary Ainsworth and is used to assess the attachment relationships between young children and their caregivers. The child is observed while strangers and caregivers.
The latest posts from David Woodier our chief blogger, and the SAIA Team.