Sunday, August 16, 2009

An Interesting Idea from Australia

I was delighted to learn that this blog had readers in Austrailia, when I heard from Laurel Downey, Consultant to the Learning and Development Strategy, James Cook University (Cairns), Australia. Laurel writes: "I have been reading your blog regularly and sending it on to all the people I know working in therapeutic residentials - we think it is fantastic."

Laurel was kind enough to send me her work creating a model for residential care. It is entitled:

From Isolation to Connection
Therapeutic Care Practice Model

Laurel Downey
James Cook University, July 2009

Within this work, Laurel synthesis many ideas about trauma and recovery, as well as adding her own.

One though that caught my interest was Laurel’s discussion of the child’s Internal Working Model:

"The Internal Working Model develops from repeated experiences of relationship with the primary caregiver. IWM influences how the child sees him or herself and how they will respond to future relationships. Abused and neglected children have often developed a negative internal working model. They see themselves as unlovable, expect new care givers to reject them, see the others and the world as unsafe and that relationships cannot be relied upon to keep them safe."

Laurel suggests that staff need to provide "counter-intuitive care":

"Counter-intuitive care describes interactions that are contrary to what intuition may indicate and sometimes different to what ‘general parenting’ may provide. The staff’s interaction with the young person is based on an understanding of the internal working model of the particular young person... A counter-intuitive response is where staff recognize and respond to the young person's underlying attachment need, rather than their presenting behavior, or their stated need.

For example the young person who doesn’t acknowledge pain when hurt, still needs comfort and care, even if they cannot ask for it. This young person may feel disconnected from the experience of physical pain, and/or be unable to ask for help. The counter-intuitive response may be one of over exaggeration of care to give the message that when a young person is hurt, their pain will be acknowledged and soothed, they will be cared for.

Another example is where a young person appears to be ‘independent’ beyond their years, and not needing help with anything, but who may really require comfort, security and close proximity to staff even though their behavior implies they don’t need it. Rather than praise the young person for their independence, staff supply care, nurture, help and support without being asked, and challenge the young person if they object."

In our training we talk about our relationships as creating new templates of what relationships can be for the children. However, I think it would be a very helpful and productive exercise for teams to deliberately take time to identify what each child’s current working model of relationships is, based on their behavior. This could lead to a deliberate plan to provide the child with experiences that are opposite to that model, and that gradually over time build new more positive internal models.

Thanks, Laurel, for the opportunity to consider this concept in a new way.

Keep up the good work in Australia.


Megan Bayliss from Australia said...

Hi Patricia. I work with the wonderful Laurel Downey (I am manager of a therapeutic residential that Laurel wrote the model for). I am building a web site and would very much like to link to your blog. Would you give me permission for this please (one of our ethical requirements is written permission rather than just going ahead and linking)

Patricia Wilcox, LCSW said...

I would be honored to have you link to my blog. Please send me the address of the web site when you have it up so I can look at it!