Sunday, June 16, 2013

More Staff Training Modules

Here are a few more training modules to use in staff meetings. These are meant to supplement more formal training, not to introduce new concepts. They are designed to be used in existing forums such as staff meetings or treatment teams.

Adapted from Risking Connection®

Teaching Objectives:
1.    Understand what feeling skills are
2.    Understand that they are learned
3.    Develop strategies to teach them 

Children learn feelings skills through attached relationships with care givers. All the thousands of times things go wrong (a child falls and hurts his knee) and the caretaker intervenes (here, I’ll kiss it and make it better) the caretaker is teaching the child something (love heals). Caretakers teach children to use connections, to feel they are worthwhile, and to identify, use and manage emotions. Our children have had inadequate care taking and multiple caretakers. Often their caretakers have been too absorbed in their own pain to help their children. So the children are not taught the skills they need. Since they don’t know how to rely on adults for help; and they don’t feel they are worthwhile; and the don’t have feelings management skills small setbacks send them into deep wells of intolerable feelings. These feelings are fear and hopelessness. In order to escape these feelings they resort to symptom behaviors, which help in the short term but have long term negative consequences. We cannot just order them to stop these symptoms. We have to teach them the skills to not need these behaviors.

Team discussion: 
What do we do now to increase the children’s ability to use their connection to us for comfort? How could we do this better?
What do we do now to increase the children’s sense of self worth? How could we do this better?
What do we do now to increase the children’s ability to identify and manage their feelings? How could we do this better?

Leader: Emphasize:
Feelings management skills are learned.
Our most powerful strategies for change are to teach feelings management skills within the context of attached relationships.

Teaching Objectives:    

1.    Understand the power of shame and how it influences children’s behavior
2.    Learn how to combat shame 

Shame is a major barrier to relationships. Shame develops because the child blames himself for everything that has happened to him, rather than blame the adults who he loves and upon whom he is dependent. The shame-based child is sure that any one who gets to know his horrible inner core will reject him, and hence relationships will only lead to pain. Shame leads to attack, to move away from others. Taking responsibility for ones actions is not possible when to do so means experiencing ones utter worthlessness.

Shame based children feel it is intolerable to be visible because of the hateful inner core they perceive within them selves. Their anticipation of rejection is so powerful they avoid connection. Any perceived incoming slight is quickly turned around to “kill the messenger” before the powerful shame can be felt. The inner parts of a child that try to protect him refuse contact with others because all contact is painful. He tries to send us away. The impulse of guilt is to reach out and repair…. The impulse of shame is to hide and attack…
The antidote to shame is sharing…To tell the secrets- what is shareable is bearable. These secrets may be specific events, but also may include how sad, confused, hopeless and vulnerable the child feels inside.

Shame Exercise

Team discussion:

What do we do in our programs that adds to shame?
            What can we do to decrease shame?
            How can we talk about problems in non-shaming ways?
            How does shame interfere with “taking responsibility for ones behavior”? 

Leader: Emphasize:
            The power of shame
            The healing power of connection 

Adapted from Risking Connection®

Teaching Objectives:
1.    Our interventions should be guided by our understanding of the client, their history and their current functioning
2.    Restorative tasks can be a way for the client to practice new ways of getting their needs met 


We know that all the behaviors we call symptoms or problems are solutions for the client. The client is escaping intolerable feelings by doing a behavior that helps in the moment, even though it has long term negative consequences.
Give examples, and ask for examples from participants, of things we do that help in the moment and have long term negative consequences. Example: smoking, over eating, shopping. Emphasize the point that they really do help, otherwise they would be easy to give up.
It is important to think about how a given behavior helps a client. That will give us many more creative interventions.

Discuss one or both of these scenarios


Jeffrey is an 11-year-old-boy who has a history of witnessing domestic violence and multiple separations from his grandmother who raised him.  Child protective services finally removed him from his grandmother’s care when they found for the 3rd time that Jeffrey was left alone at home over night.  He was referred to your facility for his explosive anger and defiant behavior.  Staff has noticed that Jeffrey becomes especially defiant during the evening routine – he often refuses to eat his evening snack, will not get into his pajamas, or brush his teeth.   Battles with Jeffrey that often include him pushing staff, spitting at staff, and restraints will often go on for over an hour.  Even when staff allow him to sleep in his clothes, he finds other ways to engage staff like banging his head in his room or playing his radio so loud it is disruptive to other kids.  Staff worked on a sticker chart to motivate Jeffrey to complete his evening routine. It worked briefly, but soon staff were having long arguments with him over the details of the sticker chart. 
            (Leader emphasizes Jeffrey’s fear of being alone and how actions keep staff engaged; mention how in old system we would give Jeffrey and early bed- how would that help?)
Alexandra is a 14-year-old-girl who has a history of trauma and several foster placements.  She has a history of self-injury and suicidality.  Staff has noted that in the last month she’s been opening up to a few of them in a new way that she has not before.  Last week, it was announced that one of the unit therapists (not hers) was being transferred to work in another program.  This morning staff observed that she was wearing long sleeves even though it was 90 degrees out.  When a staff asked why, she told her to “f__off.”  She eventually revealed that she had been scratching herself with a paperclip.
(Leader emphasizes how staff leaving reactivates Alexandra's distrust and fears, she cannot communicate this directly, she feels vulnerable because she had begun to trust.)

Leader: Emphasize:  

Understanding the meaning and function of the symptoms gives you many more options for intervention.

Please comment as to whether you are finding these helpful so I can decide whether or not to post some more. Thanks!











1 comment:

Anonymous said...

It's helpful!