Books I am Reading

I have been caring for my post-surgery husband and thus have been away from my work for a couple of weeks. He is recovering well, if slowly. I wanted to share with you two excellent books I have read during this time period.

The first is Nurturing Attachments: Supporting Children who are Fostered or Adopted by Kim S. Golding (Jessica Kingsley Publishers, 2008). This was suggested to me by my Australian blog friend, Laurel Downey. Thanks Laurel!

In this book Ms. Golding starts with the stories of four children entering foster care, children much like the ones we all treat. She then follows their progress and the challenges and successes of their foster parents to illustrate the points she is making. It is very effective. The book is especially good at illustrating how the attachment styles of ambivalent attachment, avoidant attachment and disorganized/controlling attachment are created and how they play out in the child’s behavior as time goes on. She offers excellent strategies and ideas, but also emphasizes the difficulty of healing and the need for many repetitive experiences. I have a few minor disagreements with her use of consequences, but she does not emphasize rewards and punishments as the main source of healing. She describes the "House" model of secure parenting which gives an excellent framework for foster parents. I now want everyone I know to read this book. It not only offers a lot to foster parents and their support staff, but will have equal value to any one working with these children in congregate care or any other treatment setting. Ms. Golding is English, so there is also the fun of noting small language differences. The book is very readable and accessible.

The second book, on a very different note, is Brain Rules: 12 Principles for Surviving and Thriving at Work, Home and School by John Medina (Pear Press, 2008). This book is about how the brain works, and what it means for how we learn and work. It presents a lot of scientifically based information in a very readable, entertaining format. It is helpful to understand normal brain function in order to appreciate what goes wrong in the development of the kids we serve. Also, he speaks to the effect of stress on the brain. Furthermore, he presents a lot of information about what is necessary in order for people to remember things. One element is that we learn best in relationships (where have I heard that before?). Another is the importance of repetition. A lot of the information in this book is helpful in the healing process, and will also be useful in improving the training that we do.

If you read or have read either of these books, what did you think? Please click in comment and leave your thoughts.

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.

My Heart Sank

I was talking with staff about Jesse. We had gone over his childhood, with his addicted mother and absent father. We had discussed the fact that his mother describes him as having problems since birth. They had told me about his many attempts at treatment, his failed foster placement, and the other disruptions that had led him to our doors. Jesse is 13 years old and very intelligent. He is overweight, poor at sports, and has no friends. And he is mean. He constantly says awful things to others, and (because he is smart) often he finds the very most upsetting thing to say to each person. He has trouble with boundaries- often touching others in ways they don’t like, although not in overtly sexual ways. The staff has tried. They have explained to Jessie how bad he makes others feel. The therapist tries to draw out how bad Jesse has felt at times and link that to how he makes others feel. There has been no change. The staff is feeling hopeless.

Then the unit supervisor speaks: "There is nothing you can do about Jesse. We have tried everything. Jesse just likes making other people feels bad. He admits it. It makes him happy to hurt others."

My heart sinks.

What I wish for is that when confronted with a child like Jesse, staff automatically attribute his behavior to pain and hurt. The amount we feel that this child is a pain is the amount that this child is in pain. Why does Jesse like hurting others? What has happened to him?

I would like staff to see Jesse as a child who has no sense of power, no sense of self worth. The only way he can engage others is through making them feel bad- and he is very good at that. He sees others as likely to hate, hurt and abandon him- why not attack them first? He is scared, shame-filled and hopeless inside, and can only escape from these feelings by making others (including the staff) feel as bad as he does.

Jesse will be able to decrease his meanness when he feels better. The task is not to explain to him how bad his actions are. The task- and it is a very difficult one- is to help him to see how good his actions can be. To help him see his strengths, use his powers for good, establish control in more positive ways, and connect with others through constructive leadership. If Jesse can experience (and experience again and again) the many pleasures the world has to offer, he can find other things that can more reliably make him happy.

In other words- we have to show Jesse that he can like other things, besides hurting people- that friendship is possible, control can become leadership, intelligence can be admired and draw praise from the group.

How can we possibly make this kind of thinking more routine in our settings? How can we begin to realize that change from helping a child to feel better, rather than making him feel worse?

As always, I’d love your comments, just click on the comments button.

The Crucial Question

I was doing some training this week, and had just finished saying that if a child trashed the playroom, then worked to set it right, he should then be allowed to go to the movies once he was done, if he seemed calm and safe. He should not have a restriction that lasts beyond his having fixed the problem.

One child care worker obviously thought this was nuts. "You mean he should be able to go to the movies just because he fixed the room up? But then the kids will think they can do anything they want, and all they have to do is clean it up, and everything will be fine. They will be going crazy destroying this place. The child care workers will have no control at all."

The therapist was skeptical too. "Won’t we be setting them up?" she asks. "What about when they get to public school, where there are consequences for behaviors. We will have given them unrealistic expectations."

I think these are the crucial questions we must answer if we are going to actually change the way children are managed within treatment programs.

And what are the assumptions behind these questions?
1. That children are eager to misbehave and will choose to do so whenever they can "get away with it".
2. That only the fear of consequences prevents them from acting up constantly.
3. That a child care worker’s most significant source of influence on a child is the wielding of punishments and rewards.
4. That our reward and punishment systems will teach the children to stop doing disruptive behaviors and that learning will transfer to their next settings.

Do we actually believe these assumptions? I know I don’t.

I believe that children do well if they can. Children do not want to fail, to anger the adults around them, to be kicked out of programs, to be placed in residential. They do not WANT to trash the playroom, and they are not looking for opportunities to do so when they can get away with it.

What prevents you from acting up constantly? What prevents you from destroying your agency’s play room? Well, some of it may be fear of punishments, such as losing your job. But I’ll bet there is a lot more to it. For example, you have people and goals that you care about. You have hope. You have a sense that there are people who love you and would be disappointed if you got arrested. You have a positive idea of what kind of person you are. And when you are extremely frustrated (and I know you can be VERY frustrated at your job) you have skills to manage these emotions. You talk to someone, you take a break, and you go for a walk, whatever. You have other options other than room-trashing.

Child care workers have a chance to have a powerful and long lasting impact on a child’s life. They can rebuild a child’s brain. However, I do not think they do so mainly through their use of rewards and consequences. They change children through connected, caring relationships in which children build new ideas of how adults can be, how trust is possible, and how people can care about their needs. Through many, many repetitions of attuned caretaking, a child care worker creates a new view of the world for a child. And, the child care worker actively teaches the child skills through that relationship. She teaches the child that others care about her even when they are not physically present; that she is worthwhile and special; and how to recognize and manage her emotions.

This brings us to the question of what will help the child when he gets to public school. It isn’t that the child has to learn that there are negative consequences when he trashes a room. He already knows that. He has experienced a lot of negative consequences in his young life. The problem is: when he experiences a set back, he is not able to get help from others or draw on an image of anyone who cares about him. He is already convinced he is a lousy no-good person. His biology is over activated and over reactive. And he has no idea how to recognize his emotions and soothe himself. So he is plummeted into despair, fear and hopelessness. And his brain stops working. He is in danger mode, feeling like his very life is under attack. He has to do something to get away from all this pain- so he trashes a room.

In order to help him not get kicked out of public school, we need to teach him that he matters, people care, and he can get help. We need to help him calm down and feel safe. And we need to teach him specific emotion management skills.

This is where our power is. This is what will make a difference. This is where we have the ability to influence (rather than control) a child’s life.

So, help him clean up the room. Have a brief discussion of what he was feeling that led up to this event. Validate his feelings as much as possible. Talk a little about what else he can do when he feels this way. And then take him to the movies.