The magic of puppetry in dementia care

copyrightKM2012Writing1BWIn this post Karrie Marshall, author of Puppetry in Dementia Care, describes using the power of puppetry to engage with emotions that go beyond words and memory, and how she was met with a tentative response on first suggesting the idea in adult care work.

When I first started talking about joyfulness in relation to dementia, people found that a difficult concept to consider. At conferences I noticed the majority of terms used to describe dementia conveyed a sense of hopelessness and despair. These difficult feelings are of course very real for many family carers and individuals facing a diagnosis of dementia. However, it is also important to acknowledge the real capacity for humour, positive relations, creativity and enjoyment.

My talks give examples from the book of uplifting experiences shared by people with dementia and their carers (family or paid staff). I love hearing members of the audience talk about their own experiences. People generally want better services or want to know how to improve dementia care. The talks help people see this is possible.

Throughout my career in nursing and lecturing I found people learned more and communicated better in a creative environment. My specialty is puppetry, but all art forms can reduce stress, increase confidence and improve interactions with or without words. I am interested in how we (professional care staff, family carers, relatives, artists and the general public) can use this knowledge to improve quality of lives.

Recently my talk for the Scottish Women’s Rural Institute focused on positive communication. Talks for local libraries give practical tips and creative ideas from the book. My university talks focus on person-centred care and compassion, which are major themes underpinning the book. The talks also offer opportunities to share best practice with carers and artists.

When I first introduced puppetry into adult care work, there was a hesitant response! But puppetry has a long history with adults (making social and political comment). There is also a magical quality to puppets. They engage with emotions that go beyond words or memory. I love the stories in the book that show how people with dementia focus on the puppet and completely ignore the puppeteers, the staff and the relatives!

One of the biggest challenges carers face is around relationship changes. Sometimes the nature of the dementia may mean reduced recognition of a loved one. For others the relatives are dealing with mood swings or behaviour changes. Learning how to let go of the relationship they used to have whilst maintaining a loving and meaningful connection is complex. In the book I show how this process is possible through creativity. First I explore a theory about relationships between care-givers and care-receivers that describes a progression towards alienation.  During talks, audience members give examples of feeling they are losing someone, or of drifting apart.

However, over the past ten years of working creatively with families and care staff and people with dementia, I know people can go beyond alienation. They can re-emerge into a different way of connecting that has moments of pure joy and wonderment. People have different ways of reaching this, but generally we find people with dementia get there faster!

Each experience of dementia is individual, and that is a key message in the book. Not everyone wants to be actively engaged, so we discuss the therapeutic use of silence and breathing in unison. Often I find this leads to participation. It works because people tune into where the person is. The book explores theories about human motivation and the importance of matching individual needs.

One of my favourite stories is about a man who people thought might not be interested in anything to do with creativity and certainly not puppetry.  He turned out to be one of our most enthusiastic participant puppeteers. He helped make a puppet of himself (instructions are given in the book).  This had great presence and character, as so many of the ‘soul puppets’ tend to have.  I often get a sense that the work helps us see people more clearly. Creativity has no boundaries.

It takes a long time – perhaps a lifetime – and a lot of practice to really understand what it means to be person-centred, to genuinely consider and positively respond to individual preferences. Yet this is at the heart of good dementia care. Writing the book helped me explore how we can better do this, and highlights the importance of support for carers to connect confidently and creatively.



Healing with body, movement and soul – a Q&A with Jill Hayes

Hayes_Soul-and-Spirit_978-1-84905-308-2_colourjpg-webIn this Q&A Jill Hayes, author of ‘Soul and Spirit in Dance Movement Psychotherapy’, explains why a transpersonal approach to Dance Movement Psychotherapy is so effective and shares her memories of a client whose work with soul and spirit allowed her to recover from addiction. 


How do you write about the connection between body, movement and soul?

I offer a particular perspective on the body and its movement as connected/joined to other living bodies and other living forms in nature. The body-self which feels and responds spontaneously and intuitively in relationship with other unique forms is given the name: soul. Soul is therefore the first response to being in the world as a separate living form. Sensitive and mobile, resonant and feeling, soul is born from the intelligent body, as a complete system.

Soul gets covered and becomes inactive/deadened by conventional, habitual response patterns. So to awaken movement from inside the body is to find a way back to soul: the creative core inside the living body.


What is it about the model of ego-soul-spirit that is so important in relation to DMP? How does it impact upon the bridges between them?

DMP makes bridges between ego, soul and spirit because all these aspects of self can becomes awake and conscious through moving bodies in the therapeutic relationship. DMP thrives on the premise of transitional space, constantly weaving connections between the felt-sense of life and the imaginings and thoughts about life. Articulating sensing, feeling, imagining and thinking is what DMP practitioners are trained to do.

Re-imagining and re-naming aspects of self as ego, soul and spirit provides vocabulary which can convey mysterious and sacred aspects of experience which are often neglected and sidelined in contemporary mental health practice. Recognising and asserting the conditions and the process through which mysterious healing occurs is important in re-conceiving and re-appraising potential methods for creating mental and physical wellness.

Mental health frameworks tend to favour observable, logical methods of practice. Sadly this cuts out a wealth of possibilities for healing. The invisible, the subtle, the energetic and ultimately the inexplicable need to be included in frameworks of wellness, for without them the palette of possibility dries up and is reduced to a few pale colours.

DMP awakens soul because it encourages participation of the whole body system in the process of change: it awakens the organs, the glands, the skin, the bones, the muscles, the fluids; it enlivens spirit through its attention to the flow of blood, the flow of breath and the flow of vibration through the living body, and it develops ego which listens to soul and spirit, inviting a mindful approach to appreciating and reflecting upon the felt sense of movement inside the body.


Describe the transpersonal approach to DMP and the experiential focus. Why is this so effective?

Transpersonal DMP is so effective because it contains a deep respect for a living process which happens despite the rational ego. It makes a place for the mysterious, inviting it to manifest in the therapeutic process. The welcoming of the mysterious brings new possibilities which cannot be thought by the rational ego, but can be imagined by the  psyche (a potential for imagining which is not limited by the experience of the ego) and felt in the soul body (which is joined to a living process uncapped by the separate self).

Transpersonal DMP invites the client to enter a creative flowing stream of potential growth and expansion through body, movement and imagination. Endlessly flowing and changing, movement and imagination create new pathways for the mover who trusts in the unknown and who can follow the call of unknown movement and unknown images.

Such transpersonal process is different to working with someone according to a rational theory. Theory often provides a rational pathway for the therapist to follow, offering a rational logic upon which to base interventions and to draft interpretations. Transpersonal practice rejects such assurances and puts its trust in an unfolding process which cannot be predicted, which offers riddles and confusions and surprises in equal measure.

In transpersonal practice the psychotherapist must give up looking for certainty and come home to uncertainty, to not knowing, to not being the expert, to being simply another vulnerable human being sharing an experience with the client. If both the therapist and the client can call up soul in the living body to provide clues to healthy living for the client, then that is enough. Entering into the experience of soul and spirit together is what makes the changes. It is effective because the creation of a flowing mobile relationship provides an axis of change. When both partners commit to being open to soul and spirit, a current of change is called into the process, inviting healing from the core of all life.

The Jungian vision of psyche as imaginal flow of change is present in this model: images pop up and startle the mover, guiding the moving body into relationship with patterns of balance and change, highlighting what is missing, what needs attention, what needs integration. Imagery is embodied and moved to expand the possibilities for growth and change.


How does the book explore soul and spirit?

The book explores soul and spirit both practically and theoretically, shaking the terms free from past cultural and religious contexts, but retaining their essential association with a sacred, mysterious movement of change. Case studies are used to illustrate the presence of soul and spirit in therapeutic practice. They exemplify how soul and spirit awaken a creative process of change.


Are there any cases of working with clients in this way that stick out in your mind? Why is this?

The case study of Lauren (Chapter 6) endures in my mind because she was able to work with soul and spirit to recover from addiction. In the containment of our joint commitment to her healing, Lauren was able to listen to her inner body (her soul) to understand that for growth and peace she needed to develop love and respect for her creative core.

First using images of psyche, which were strange, beautiful, frightening and unknown to her, Lauren moved and drew them to let them flourish and communicate, so that she became aware of the patterning of her extrovert self in the world, as well as aware of her inner potential, which lay frozen and unrealized inside.

Then through somatic practice, initially alone and then increasingly with me (intuitive tactile connection informed by many sources: Body Mind Centering, Authentic Movement, Cranio-Sacral Therapy, Mindfulness) Lauren delved deeper into her soul and deeper still to find spirit, realigning herself with spirit, listening to her need to connect fluidly, responsively, respectfully and truthfully with the world around her.

To move forward with integrity, Lauren needed to accept herself as she was. To accept herself as she was required the development of love, as joy felt in witnessing life in her own unique form. Without affirmation from an external source through touch, energetic resonance, parallel emotional sensing and imaginative empathy, it would have been hard for Lauren to love herself. A therapeutic relationship potentially provides a core relationship of growth which the client has perhaps never before experienced. This core relationship in which the client’s life and creativity is loved by the therapist, energizes the client’s commitment to her own life, so that she comes to appreciate that she has all she needs inside her to find her own way, because her body soul is sacred, it joins her to all life. She becomes capable of unraveling the past and unfolding the present trusting that the impetus from her core is a sacred impetus which will unfold her potential creatively and without distortion, so that she can become who she was intended to be; she understands that propelled by body and psyche, her blueprint will fulfill itself.

Celebrating the stories of Sesame

Singing 'The Little Green Frog', led by Frankie Armstrong (standing), Jenny Pearson beside her.

Singing ‘The Little Green Frog’, led by Frankie Armstrong (standing), Jenny Pearson beside her.

JKP was delighted to attend the launch of Dramatherapy with Myth and Fairy-tale: The Golden Stories of Sesame by Jenny Pearson, Mary Smail and Pat Watts at Central School of Speech and Drama in North London on Saturday 15th June.

The launch was crowded with the authors’ colleagues, former students, friends and family, all keen to celebrate this exceptional book – among them Alida Gersie, who wrote the foreword, and JKP author, Sue Jennings. Jenny Pearson and Mary Smail regaled their audience with anecdotes of myth and fairytale in action, as well as reminiscences of Sesame days past. We were treated to two a cappella myth-based songs by Frankie Armstrong, world renowned singer and Voice Workshop leader, who also opened the occasion with a rendition of the warm-up song, ‘The Little Green Frog’ (with help from Jenny’s young grandson, Dylan).

The event was preceded by ‘Pat Fest’ – a tribute to Pat Watts, one of the authors, who unfortunately did not get to see the finished book, but who was responsible for committing her share of the stories to paper (originally on scraps of paper and envelope backs, as her co-authors revealed at the launch!). As a key figure in the history of the Sesame course and the creator of its first Myth element, many people came to rejoice in Pat’s remarkable work and legacy, and she was honoured with an enactment of ‘The Flowering Tree’ facilitated by Jeni Treves and Alison Kelly, coordinators on the Creative Arts supervision training course (CAST).

It was a hugely enjoyable evening and a wonderful way to celebrate this special book.

Below are a selection of pictures from the event:

Frankie Armstrong sings a ballad.

Frankie Armstrong sings a ballad.







Jenny Pearson sining the book. In the background, picture of Pat Watts (the third author who sadly died while the book was being written) and three of her paintings.

Jenny Pearson signing the book. In the background, picture of Pat Watts and three of her paintings.

Mary Smail reading from the book. Next to her, Frankie Armstrong and Jenny Pearson, with her grandson Dylan on her knee.

Mary Smail reading from the book. Next to her, Frankie Armstrong and Jenny Pearson, with her grandson Dylan on her knee.

Mary Smail speaking to the crowd, with Jenny Pearson behind her.

Mary Smail speaking to the crowd, with Jenny Pearson behind her.

'Forever Mountain', a story from the book, told by Jenny Pearson, with Frankie Armstrong seated on her left

‘Forever Mountain’, a story from the book, told by Jenny Pearson, with Frankie Armstrong seated on her left.

Entering into the realm of imagination – an extract from Dramatherapy with Myth and Fairytale

Pearson-Smail-W_Dramatherapy-wi_978-1-84905-030-2_colourjpg-web Jenny Pearson, co-author of ‘Dramatherapy with Myth and Fairytale’, explains how this extract, from one of the chapters written by the late Pat Watts, expertly guides the reader through the process of preparing groups to enter into the realms of imagination, ready to begin a myth enactment.

“The myths and fairytales in this book are stories from long ago that have survived the centuries because they have been loved and because they carry wisdom and healing. They have survived because people have told them to their children and grandchildren who have remembered them, written them down, created books and plays, dances and films around them, and told them to their children.

In the drama and movement therapy practiced by the authors of this book, the stories take the form of simple, straightforward scripts. The opening chapters take the reader through the experience of entering into the stories as improvised drama and living them in role. The Sesame approach to myth enactment requires no previous experience of ‘acting’ or ‘dance’. Participants are invited into a given space and taken, step by step, toward and over the threshold that leads into the realm of imagination.

This is how Pat Watts, who created the Myth module of the Sesame training at Central School of Speech and Drama, describes the process of entry into that magical Land.”

Read the extract here


What is it like to be a Life Story Work Consultant? From JKP authors Katie Wrench and Lesley Naylor.

Katie Wrench and Lesley Naylor, authors of the new Life Story Work with Children Who are Fostered or Adopted, give their fascinating insight into a day in the life of a life story work consultant.

Life Story Work with Children Who are Fostered or Adopted cover

Life Story Work with Children Who are Fostered or Adopted

A Day in the Life…

Katie: 8.30 Arrive at work and try to catch up with emails. Reply to a birth mother who has reluctantly agreed to meet to support me with information gathering for her son’s life story. Need to book a room for a couple of hours, anticipating that she will need to express her feelings about the legal proceedings and the role of Social Care in her family life before I will be able to explore more positive stories about the child and their family life. Mindful of what a big decision it has been for her to meet with me, but also a little apprehensive about how I’ll manage strong feelings in the room.

Katie: 10.00 Session with an eight year old looked after boy and his foster carer. We are three sessions into a therapeutic life story intervention. I decide to assess the child’s emotional literacy. He is a big football fan – plays and has a season ticket to watch his local team – so I use footballing magazines to encourage him to create some Mood Boards. Together the three of us trawl through the magazines looking for images of footballers that express a range of basic human emotions – happiness, sadness, anger. I encourage the child to identify the feelings and he uses me and his carer as able assistants to cut the images out ready to stick onto his boards. I am surprised by how well he manages with this task. He is not a very articulate child and it would be easy to assume because of his history that he would struggle to identify non verbal communications, including recognising facial expressions in others. We create boards that will be a great tool later in the sessions when it will be important to support him to express feelings about events he has experienced in his birth family. This is also a good opportunity to get to know more about what is important to him in the here and now. The foster carer is invaluable here in reinforcing his strengths and sharing successes he has experienced in placement. I come out of the session feeling energised and privileged to have been able to share and celebrate his achievements.

Lesley: 11.30 Life story clinic appointment. This is a chance for social workers to discuss a piece of life story work they are doing with a young person, whether it’s for a baby about to be adopted or with an 18 year old who has spent his whole childhood in care.

The social worker comes in full of enthusiasm and questions, which is always a good start. She’s working with a 14 year old boy who has had many short term placements and a very muddled up idea of why he came into care at the age of four. He desperately wants to know more. We start by trying to unpick the tasks in this piece of work; thinking about the whole thing can be rather daunting, especially when it’s only one of so many other jobs of the social worker. We think about where the information for the story can come from and who should be approached. I encourage the social worker to look not only at the official Social Care story to be found in the files but to find out who else knew this boy and what alternative stories could they tell? Family members, nursery and school staff, previous foster carers may all help to bring this boy’s story to life for him. Funny stories; moving stories; things we will never find in the files-and so important.

Then we move on to the time spent with the child and what to actually ‘do’. I want the social worker to consider activities to help the child to feel safe so that he is supported to both tell and hear his story. We plan some activities in the ‘here and now’ such as likes/dislikes, what this boy is good at, what his safe place would be like. We move on to thinking about giving the child a space to reflect on his own memories of his past. This is so important in order to know where to take the work and to assess how able the child is to access his thoughts and feelings about what happened to him. I suggest the activity of sculpting to help the boy express his views on past and current relationships. Having a bag of objects for him to use as symbols of the people who are or have been important in his life creates a 3D genogram which can tell us a lot about how he views his world.

I think this is enough for now and the social worker goes away hopefully feeling more confident and armed with some practical ideas. I felt the session went well but I always wonder whether I touched on all the points I needed to or gave too much information and overwhelmed the social worker. It always feels good to be able to share my experience and knowledge with new workers and one of the advantages of the clinic is that she can always come back as the work progresses.

Katie: 1.00 Meeting with the Steering Group looking at how IT services can support Leeds social workers in the life story process. A new IT service has been commissioned and we are looking at what system requirements we can request that will provide some structure around the process. I am keen to emphasise the need to avoid a manualised approach that ignores the importance of the relationship between the child and worker/carer in the life story process and to highlight the need to personalise the life story for every child. That said, I’m relieved that some thought is being given at a senior level to how as a local authority we can ensure that all looked after children have timely access to high quality life story work – both in terms of process and end product. This new system will save a lot of time for workers by locating all information relevant to life story work including photographs and video as well as text together.

Katie & Lesley: 3.00  Meeting to discuss the training to be delivered in the summer to social workers and social work assistants who are engaging children and young people in life story work. We review the evaluations from the last training to look at areas where we can improve on the material we deliver. A priority for social workers is accessing support in sharing difficult information with children and we think about how we might create a resource that will provide some guidance and structure around common concerns such as domestic abuse, drug and alcohol misuse and parental mental health issues. As always it is important to stress that any information sharing needs to take into account the child’s chronological age, cognitive and emotional abilities and developmental stage.

We both feel very passionately about training delivery and really enjoy engaging with social workers around a subject we feel should have a much higher profile for all looked after children.

At the end of the day we reflect together on our growing understanding of the relevance of life story work in supporting children’s recovery from experiences of trauma and abuse. We are realising that we are increasingly using a therapeutic life story approach as the first intervention before considering our more traditional therapeutic training as art and play therapists.

You can find out more about Katie and Lesley’s book and order your copy here.

Being Seriously Playful: Sandplay Therapy With Adults

By Lenore F. Steinhardt, author of the forthcoming book On Becoming a Jungian Sandplay Therapist: The Healing Spirit of Sandplay in Nature and in Therapy.

We live in a time of rapid transitions. The norms of fifty years ago concerning gender and parent roles have changed: men cook and care for children, women work in technological fields and direct companies. As well, children are informed about the world instantaneously from computers, and smartphones,which may cause a change in the roles of today’s parents and teachers.

There have been changes in the therapeutic milieu as well. Both children and adults attend various group expressive therapies as well as individual therapy. There is also much interest today in C.G.Jung’s wide concept of the psyche, that includes the inherited archetypes of the collective unconscious, as well as the personal unconscious (described by Freud), and consciousness. Among the major archetypes (Mother, Father, Child, Hero and Self) the Divine Child archetype has been popularly called the ‘inner child”, that part of us that we need for new beginnings, growth and creativity.

In sandplay therapy it becomes activated and urges us to play, be creative, discover and invent spontaneously with sand and miniatures. It also provides symbolic access to parts of our psyche that we have long forgotten- some may prove useful in solving problems, and in choosing new life directions, and some may help to identify difficult life events that we may have forgotten, but that continue to prevent development. Sandplay works with the entire psyche. This means that through symbolization with objects, sand and water, a person can gradually acknowledge in symbolic form, both problems and inner sources of strength. Jung noted on himself that the child within can find solutions to problems through play that the rational mind cannot access.

Today’s adults are more able to accept their “inner child” and their need for non-directive spontaneous play. What at first seemed “childish” becomes “childlike” and very moving. Often an adult begins Sandplay with a rational approach, choosing objects and moving the hands in the sand according to a preformed idea. But at a certain point play will also evoke early memories of spontaneous play, and the sandplayer will transition to a freer symbolic play.

Some important points for adults who do Sandplay are:

1. to relax and accept that there is an inner source of creativity, curiosity, discovery and new directions that has its own volition and is not connected to rational thinking.

2.  to relax and accept that there is an “inner guide” (sometimes called intuition) that accesses new images that may be at once strange and familiar, that we don’t need to interpret.

3. to relax and accept that there is a felt sense in the body while doing the work, that does not need to be explained, rationalized, justified, or understood. This may lead to enjoyment, or one may be swept into expressing something that is painful, but that wants to be seen and understood, at least in symbolic form.

4. to relax and accept that answers are within us, and that we are larger than we know, and have much more unknown depth and potential than we are aware of.

5. to relax and accept that there are wounded inner structures that can be changed and healed in Sandplay, without rational understanding. With less energy needed to suppress memory of difficult events, more energy is available for positive change in daily life. Decisions will be better based on real needs, actual potential, and be more productive or satisfying.

6. Sandplay can also be visually beautiful. The sense of creating something beautiful, feeling the artist in oneself, is life affirming, and can carry over into feeling self-assured in other areas of one’s life.

Play Therapy Dimensions Model book launch

May 24th, 2012 saw the book launch of the Play Therapy Dimensions Model: A Decision-Making Guide for Integrative Play Therapists  by Lorri Yasenik and Ken Gardner, held at Giuseppie’s restaurant in Alberta, Canada.

“It was a well-attended event with wonderful Italian food, wine and a great Jazz band! The focus of the evening was one of celebration of children.”

See the article and photos from the event here:

‘Without a life story, a child is adrift, disconnected and vulnerable’ – Dr Bruce Perry on the value and power of the Life Story approach

By Dr Bruce Perry, adapted from the Foreword to the new book, Life Story Therapy with Traumatized Children, by Richard Rose.

A fundamental and permeating strength of humankind is the capacity to form and maintain relationships – the capacity to belong. It is in the context of our clan, community and culture that we are born and raised. The brain-mediated set of complex capacities that allow one human to connect to another form the very basis for survival and has led to the ‘success’ of our species on this planet. Without others or without belonging, no individual could survive or thrive. This need is so biologically powerful that when an infant is given signals from his caregivers that he is ‘not wanted’ and does not belong, the brain’s neural networks will activate a ‘shut down’ response and induce a ‘failure to thrive.’ And even with calories (but without the physical manifestations of ‘love’) this infant will lose weight and may die. This early life manifestation of the power of belonging has many related neurophysiological features later in life; the stress response and ‘reward’ networks in our brain are all interwoven with our ‘relational’ neurobiology. When familiar and welcoming human interactions are present, we feel pleasure and safety; we are regulated, we belong. When we are disconnected, when we are marginalized, we feel distressed, we literally feel pain.

This powerful, regulating, rewarding quality of belonging to a group, a family, a community and culture is not just focused on the present. We each feel a need to be connected to the people of our past; and without being able to draw on this connection – this narrative – it is almost impossible to envision hopes and dreams for a connected and safe future. It is the very part of our brain that is most uniquely human, the neocortex, that allows us to store, sort and recall our past as we construct the narrative that becomes the pathway from the past, and it is also the neocortex that envisions our pathways into the future. The neocortex allows humans to tell time; to create complex symbolic representations and associations that we have transformed into various forms of language; in music, art, writing (all inventions of our past) we are able to re-tell our story. The story of our people, where we come from and how we belong; our cortex helps us process, sort and sequence events and to store both our personal experience and the narrated experiences of others; the story of our parents; our parent’s story of our childhood before we could make narrative memory; the story of their parents; the history of how we belong.

Story telling is a unique and permeating quality present in all cultures across every era. The first and universal function of narrative in song, ceremony and story is how we have come to be, where we are connected, where we belong, where the connections were broken, lost, repaired. And in the cortically mediated narrative of storytelling of how we belong and how we have come to this point comes a powerful regulating, anchoring, reassuring and rewarding neurophysiological effect. It is no surprise that humans, the storytelling primates, are fascinated by narrative, poetry, novels and movies. The majority of our arts will portray personal narrative in some fashion.

This crucial aspect of the human condition – belonging, knowing your narrative – is damaged for many. And damaging the narrative of a people (cultural genocide) is at the core of a destructive, transgenerational process that has many negative manifestations; as odd as this may sound, the neurobiological consequences of stripping a community or culture of their language, customs, religious beliefs or child-rearing practices are devastating. The individual stress response systems and ‘reward’ neurobiology in a marginalized, disconnected and culturally fragmented group will be compromised and predisposes individuals of that group to a host of mental (e.g., depression, suicide), physical (e.g., diabetes) and social (e.g., increased substance abuse) problems. This is seen in Aboriginal communities in Australia, First Nations communities in Canada and Māori communities in New Zealand, among others. The neurobiological consequences of the destruction of narrative for a people are devastating.

It is the same with individual maltreated children. A fragmented, damaged, discontinuous personal narrative puts an individual child at risk. A child that is lost within her own family, community and culture is neurodevelopmentally vulnerable. Without a life story, a child is adrift, disconnected and vulnerable – their neurobiology of reward, stress regulation and relational interactions are all altered – in negative ways – without a cortically mediated coherent personal narrative. Our conventional efforts to ‘treat’ them will often be frustrated and ineffective. Sadly, most mental health interventions with maltreated children do not pay any attention to the child’s story. The focus is the manifestation of pathology – the symptoms. Make Billy stop swearing, hitting, running away – make Billy pay attention, be respectful, comply. We lose sight of how disconnected Billy is and often we actually contribute to the fragmentation and disconnection of his life story – a brief but telling story to illustrate how our efforts to ‘protect’ maltreated children can add to their confusion and disconnection. We often make these children worse.

At the beginning of an evaluation of a ten-year-old boy in foster care at our ChildTrauma Academy clinic, I asked him his name:

‘Which name do you want to know?’

‘What do you mean?’

‘Well, I don’t know my name, I guess. My new mum calls me Thomas. My last mum called me Leon. And when I visit my grandmother she calls me Robbie.’

‘What name do you tell your friends to call you?’

‘I don’t have any friends at this new house.’

‘Do you know what your biological mother named you?’

‘I think she named me Baby.’

As I looked through the records I could see that he was born a few weeks early. He had been in the Pediatric ICU and had never been named by his mother. His discharge records stated: ‘Baby Boy Jones’. Ten placements and four ‘names’ meant he was disconnected and adrift with no personal narrative. But ‘fix him’ if he acts out. He is inattentive, disrespectful, struggles in school and won’t do as he’s told. Fix him. Find the right label. Give him the right drug. Our current approach to these maltreated children has lost sight of the essential element of healing – and that is reconnection. Connect to the present and increase the number and quality of relational opportunities but, as important, reconstruct your past connections, lay out your disconnects and clarify your personal journey to the present.

A life story approach such as that described in Richard Rose’s new book Life Story Therapy with Traumatized Children helps children to reconnect by reconstructing their personal narratives, echoing the fundamental storytelling powers known to our ancestors who incorporated storytelling into all of their healing practices and rituals. In other words, storytelling therapy reflects not just knowledge of human healing; it is a manifestation of wisdom about humankind. The value and power of the life story approach, which is both developmentally sensitive and ‘trauma-informed’, cannot be underestimated. For any clinician working with our most disconnected children it is a wonderful way to help them reconnect – and heal.

Dr Bruce Perry, MD, PhD
Senior Fellow, The ChildTrauma Academy, Houston, TX
Adjunct Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University , Chicago, IL

Copyright © Jessica Kingsley Publishers 2012.

Life Story Therapy: Externalising feelings and perceptions through a chronological process

Richard Rose, child trauma intervention specialist and author of Life Story Therapy with Traumatized Children: A Model for Practice, shares some of his experiences of using life story work with traumatised children.

The unique concept of the life story approach is that it has a defined process:

The beginning (stage 1) requires the Therapeutic Worker to detect the past, to collate the stories of those around the child and to collect tangible items, such as first shoes, first books, cultural and religious material (e.g. Christening, Confirmation, Bar or Bat Mitzvah);

The middle (stage 2) provides the opportunity for the child to externalise their feelings and perceptions through a chronological process. To explore, challenge and conclude to the point that they can reframe their understanding and internalise their sense of self;

The end (stage 3) is the production of the book, the record of all that has been produced by the child, their carer and their Therapeutic Worker. The book becomes the history of the child and concludes with their hopes and desires for the future.

In short, all good stories have a beginning, middle and an end – therefore all narratives have a similar structure, time limited, focused and achievable. The child understands the sequence of discussion and can be helped to make sense of the past, present and plan for the future.

This second book uses case studies to illustrate the various exercises available to the life story Therapeutic Worker. It also details case studies and tools that might be useful to all those working within the social care and education fields. Although the case studies are short, I hope that they illustrate how useful such activities prove to be in communicating with traumatised children. I have considered attachment and trauma, their effect on the brain and on the development of the child, and have used case examples to explore these crucial areas.

One young person I worked with did not want to talk about the things that upset her. She was resistant to the idea of life story, but through the Jenga and Family Tree exercises (discussed more in my book), she was able to engage in play which required her to share information about her likes, dislikes, worries and hopes. By the third session, this young person stated, ‘I am ready now.’ From then on she produce thoughtful, insightful and distressing perceptions. As she talked these out – externalising them – she was able to illustrate her life and understanding on ‘wallpaper’ and, towards the end of the work, reframed her sense of self and internalised healthier thoughts of herself and those around her.

I also worked with an angry primary school child who had been hurt by everyone who had had previous ‘care’ of him. He was alert, poised and preoccupied with possibilities of hurt, either by me or his carer or by himself. There is still debate about re-traumatising children by visiting the past, and there is a possibility of this if the Therapeutic Worker is unsure, impatient, too patient, etc. By using memory boxes, fact/fiction/fantasy and heroism models, he was able to work through his anger and his pain. We used the Behaviour Tree to do the same by thinking about the source of his behaviour, the actions of those in his past and the consequences for those in his present and future.

I hope that by reading my new book, people will be able to use the examples of practice in their work with children. I trust that some readers will want to learn more about the positive outcomes for children who undertake life story, and how, if we can unlock the child’s past, we can release their potential for the future and help carers deal with the present. I am honored that Dr Bruce Perry has written a foreword to my book and have found his interest in my work both supportive and inspiring.

Copyright © Jessica Kingsley Publishers 2012.

Free to Download! Creative Drama activities to help children with emotional and behavioural problems

Book cover: Creative Drama for Emotional SupportHere, drama therapist Penny McFarlane shares two fun useful activities from her latest book, Creative Drama for Emotional Support, that will enable parents, carers, teachers, youth workers and others to help the little ones in their care manage difficult emotions and situations.

Mr. Angry Man

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The purpose of this activity is to help prevent the child from being overwhelmed by his emotions. By encouraging a way of considering the emotion as something separate and outside oneself, the intensity is lessened and the feeling becomes more controllable. Mr. Angry Man presents a fun and enjoyable way of using this externalization and most children I have worked with have found personifying the feeling, drawing it out and then interacting with this character to be a novel experience. Somehow it seems to appeal to the spontaneous and whimsical in a child.

This activity usually proves to be more effective if used with an individual child in a quiet and uninterrupted setting. I usually start the session with some discussion about the ‘big feeling’, which sneaks up on him from time to time. We talk about how annoying this is and how much better life would be if we could simply tell it (or him!) to go away: the problem being, of course, that we need to recognize ‘him’ before he pounces. By doing this it is as though the child and I have joined forces against the ‘big feeling’. I am on his side!

Most children then find it easy to visualize and draw this character. Depending on the child and situation, the enactment that follows can be both entertaining and empowering for a child. As Mr. Angry Man I sneak up on the child who is, for example, just beginning an argument with his parent/friend/teacher and dissolve in a heap when the child turns on me shouting ‘Go away’. Again most children find their ability to control this situation, as epitomized by my reaction, to be hugely funny as well as confidence building.

The Two Islands

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The transition from primary to secondary school can be a time of great anxiety for many children. By creating an ‘as if’ scenario the child can explore his apprehension and find out what it is that he is afraid of. More importantly, he can also discover how he can help himself to make this transition by looking at what he may need to take with him, actually or metaphorically.

Many children, on crossing over to the future island and sitting there for a while, discover that it is nothing like as scary as they had imagined. Some children, having made the transition, do not even want to go back to the original island. I remember one child with whom I was working, having crossed backwards and forwards a few times, decided that he was even going to throw away the stepping stones as he ‘didn’t need them anymore’.

Of course, this activity does not only apply to transition between schools but can be used with any imminent change in a child’s life. It can also be helpful in addressing, retrospectively, a period in which there may have been numerous changes. With one little boy who had changed school, house and family on many occasions, we created an island for each stage of his life. He then sat on each island in turn and remembered at least one good thing to take from that island. Using soft toys to represent all the good things, he hopped via stepping-stones to his island of now. Surrounded by the toys and with a big beam on his face, he announced that he would need a bigger island because there were ‘too many good things to fit in’.

Copyright © Jessica Kingsley Publishers 2012.