Exclusive Interview with Chris Nicholson
Chris Nicholson is a co-author of the new JKP title
Children and Adolescents in Trauma:
Creative Therapeutic Approaches. He is a Lecturer in The Centre for Psychoanalytic Studies at the University of Essex. Formerly Therapeutic Services Manager at Donyland Lodge, a therapeutic community in Colchester, he has worked in a range of children's services for over 10 years. Chris is a Trustee of the Charterhouse Group of Therapeutic Communities and a Fellow of the International Institute of Child and Adolescent Mental Health. He is a regular speaker at bi-annual conferences on the poet and author Robert Graves..
How did you first become involved in children’s services?
In the mid-nineties I was finishing a joint honours degree in English literature and Philosophy at the University of Kent, in Canterbury. I had rather immersed myself in the reading and read way beyond what was required for these courses. In consequence I had an experience which the poet Robert Graves illustrates in 'The Philosopher' where 'Threading logic between wall and wall' he finds that he has 'Truth captured without increment of flies', or, in other words, the impingement of actual physical existence. I left university with a strong desire to avoid bookishness, and so determinate to find direct work with people.
In this way I arrived, naively, with my neck exposed to the axe, in a small residential children's home in Kent. Here staff worked a straight 50 hour a week in 12 hour shifts including waking nights, often back to back – I was told this system provided continuity to the young people. In fact it exhausted staff leaving them less able contain the disturbing feelings being projected into them by the young people. There were five young people living in the home aged 11 to 18 often with only one or two staff members on shift. They presented with regular violence, self-harm, absconding and property damage, and seemed to exult in creating chaos. There wasn't anything in the training or culture of the home that could be considered a theoretical model by which these things could be understood, but there were a few books in the staff office. Over the long waking nights, on those occasions where the young people were settled and the long list of staff chores were complete, I fell upon these books in desperation despite my earlier edict to avoid them.
I discovered that there was a distinction to be made between control of children, which the home focused on implicitly, and something called containment which I didn't fully understand. I also learned that where children's homes were experiencing a large amount of 'acting out' this could be due to the way the home was managed as opposed to simply being down to the children. This was a shock as I have great respect for the managers who seemed to be good people. Still, I began to look for any correspondence between management structures, policies, or care arrangements and children's behaviour.
Why are creative therapeutic approaches good to use when working with children and adolescents in trauma?
There are many reasons why creative approaches are good to use with young people. I'll emphasise two. The first has to do with the relationship that exits between art and psychodynamic thinking. In creative activities, for example, film, painting or literature, the interpretative potential of the underlying symbols, metaphors, and analogies, finds a commonality with psychodynamic thinking. In art, as in psychodynamic work, it is not merely the outward appearance of things which holds our attention, but all that lies beneath. When young people engage in creative pursuits they have the opportunity to offer their own instinctive metaphors and symbols. They can develop their own narratives throwing up exactly that kind of material which psychodynamic practitioners utilise.
The second concerns the need to address a certain rigidity in thought and behaviour. In reasonably healthy families, infants experience attunement to their emotional and physical needs so that they can internalise good experience and so come to trust their relationship with caregivers. Their own experience become validated through the recognition and adaptation of caregivers to their needs which in turn provides the internal space in which the core self (a strong ego or sense of self worth) can become established. Gradually the infant develops a sense of understanding and adaptation between its internal world and that of others, especially through flexible, creative play and communication.
However, traumatic experiences are, to some extent, deterministic. If a child has grown up in a family where one or both adults operate in ways we would define as neglecting or abusing there are usually rigid modes of communication in place and these have the opposite effect to the healthy kind described above. For example, traumatic events during the first two to three years of life have far-reaching effects on neurological development. Those who experience early trauma are prone to a certain rigidity of intellectual and emotional response. Howe (2005) emphasised this trait:
'They fail to adapt to and cope with change, whether in their own feeling states or external relationships… In effect, the brain lacks complexity. It operates in a relatively rigid, compartmentalized way, lacking integration between many of its key social, cognitive and emotional operations.' (p.262)
The importance of a ‘creative’ approach then, is that it can divert negative thinking and feeling down a different and altogether more positive pathway. Through sensitively handled, creative interaction and by the use of ‘creative’ approaches with traumatised young people their characteristic rigidity begins to loosen. New possibilities emerge, the mutative nature of create endeavours. In time, they may be able to see painfully familiar situations in different and helpful ways that can lead to their forming a new response.
Could you describe one creative approach to us and how it could be implemented?
I will briefly describe a creative approach I used with a group of five 15 - 16 yr old care leavers at Donyland Lodge in Essex. Children who live with their own families tend to stay at home today into their early 20s due to extended education and economic dependence. The time allowed for looked after children to finish growing up is, by contrast, incredibly compressed, as they generally leave for independence or semi-independence at around 16yrs. While this is happening, they have to cope with a host of problems which put added pressure on them, e.g. painful and chaotic family dynamics, how to make reliable friendships, overcoming huge distrust, not infrequent changes of social worker, finishing school and exams, not to mention the giddying psychological and physical experience of middle adolescence. It must feel to them like being in the back seat of a car as someone else accelerates along a dangerous highway.
Due to this, the outcomes for young people include having higher levels of homelessness, lower educational attainments, higher rates of unemployment, greater dependency on welfare benefits, unstable career patterns, higher levels of offending, and problems with mental health and substance misuse. With poor interpersonal skills, low self-esteem and confidence the scene is set for social isolation and further disaffection.
How can we help already disaffected young people in such a way as to prepared them for what lies ahead? How can we help them to gain the kind of experiential learning which might give them some slight gasp of how important it will to prepare now?
At Donyland we integrated Life Skills into the curriculum from age 15 yrs and included a wide range of teaching relevant to care leavers. We began the course with bridge building. The young people are provided newspaper, cellotape, glue, string, scissors, a ruler and other arts and crafts items. They are asked to build a bridge that spans, say 10 CMs in height and 40 CMs across, and that a toy car can travel over. We give them 40 minutes to do this exercise. But 25 minutes in we tell them that there has been a change of plan and then now have only 5 minutes left to complete their bridge. This causes great anxiety. But then, just as the 5 minutes are nearly up, we inform them that things have again changed and they still have 5 minutes left.
You can imagine how much emotional holding and support the young people need during this activity and how robust the staff need to be to manage the consequent acting out in terms of resentment, sabotage of their own and other's bridges, doubt about completion or quality and so on. But all this comes to fruition later as we unpack the underlying significance of the bridges. This is your bridge from Donyland into independence. How easy is it to get on and off the bridge? How stable is it? Does it have any supports and who or what are those supports going to be on your actual journey? How did you deal with the stress evoked? Did you help or hinder each other? Did you ask for help from adults or feel that you had to go it alone? What influence did this have upon your bridge? The young people are asked to assess each other's bridges and say what might improve it and how this links to leaving care.
We also connect this exercise with research into leaving care, for example Mike Stein's What Works in Leaving Care? and talk to the young people about what has been learned from previous care leavers. Finally, to really help the staff team get in touch with the plight of young people at this stage in their lives, they (and they means care, education, administrative, ancillary and management staff) were all asked to undertake the same exercise in training.
Would you be able to tell us about your work with Therapeutic Communities?
Whatever people say about Therapeutic Communities (TCs) they are remarkable places. After my first experience of working in a children's home, coming to work at a therapeutic community for 21 mixed gender adolescents in the Essex countryside was a revelation. Here there was a model based upon a number of key theorists, only some of whom were involved in TCs. Winnicott, Bion, Dockar-Drysdale, Bowlby and the American Efrain Bleiberg (who emphasizes ‘reflection function’). There were also pot-belly pigs, goats and rabbits, gardening, hovering and mountains of washing up. Alongside community meeting and art therapy, the routines of daily life were conscripted as a part of the therapeutic milieu – everybody could play a part to support community life.
The TCs I've worked in were always striving to develop, to redefine themselves in the light of the ever new experiences young people brought to the community. They advocated not so much children's rights (which is policy driven), but their equality and humanity, and ability to take ownership of their lives and the life of the community to which they'd come. Children appreciated the fact that what they had to say, however distorted by previous experience, mattered to the adults and would be thought about. They also witnessed staff having to learn, and be self-reflective and take responsibility for their own actions openly. The sense of children and adults struggling and striving together could be very powerful and enabled some very hard to reach children to make contact with others in a meaningful way and feel a part of something larger.
My work was mostly around admission, assessment and leaving care. For young people, these experiences can feel like being forced, being judged and being pushed out especially where they already feel dragged from pillar to post and constantly assessed. The art was in finding ways to ensure these actives could function as a part of the therapeutic endeavour, and might, if careful handled, become a corrective experiences of which the young person was very much an active part.
I'm pleased to find that London Placements are using membership of the Community of Communities annul review cycle as a criteria for determining if a placement is considered therapeutic. In my experience, a therapeutic community, like any therapeutic service, can only remain therapeutic, through constant striving, reflection about how it operates, experiential training and a process of assessment and review from external sources.
What are you currently reading in your spare time?
Most of my reading, spare or otherwise, relates to the course I teach at Essex University, Therapeutic Communication and Therapeutic Organisations. Staff working in residential child care, in psychiatric adolescent units or in schools need to have read Hinshelwood on organisations, Salzberger-Wittenberg on the emotional issues of teaching and learning. They need to know about early development from Klein, Stern, Bowlby and Wadell.
But if they are anything like me, they may also be sustained by poetry, like that of Robert Graves, who I'm always reading, or Rilke who heals the heart while breaking it over and over:
'Each torpid turn of the world has such disinherited children,
to whom longer what's been, and not yet what's coming, belongs.'
Cary's recent biography, The Man Who Wrote Lord of the Flies is fascinating. Golding wrote well about children and how they see the world in many of his books other than Lord of the Flies, and Cary, despite his superior tone, can't help but admire him. The next novel I plan to read is Christina Stead's The Man Who Loved Children. I discovered this through the extraordinary introduction by Randall Jarrell which is a work of art in its own right. My wife has just lent me several books on the Oedipus Complex, and I'm reading Pollyanna with my eldest daughter. So, happy families! Finally, I'm half way through Richard Glover's 1804 epic poem Leonidas (as in the recent film 300). This suits me nicely. A different kind of egg for Easter.
Copyright © Jessica Kingsley Publishers 2010
Children and Adolescents in Trauma: Creative Therapeutic Approaches
Edited by Chris Nicholson, Michael Irwin and Kedar N Dwivedi is available now.
More details of the book
JKP News
The Times has featured a piece on JKP author Phoebe Caldwell winning The Times/Sternberg award for work with autism.
The Times Schoolgate Blog have featured a piece by Linda Goldman author of JKP book Great Answers to Difficult Questions about Sex.
Social work in the news - some of the articles in the media this month
Children and Young People Now have featured an article about how the Laming proposal could cost authorities £116m.
Community Care have published a story on how Unison campaigns to boost appreciation of social workers.
We are pleased to announce that you can now follow us on Twitter and find us on Facebook!
This month's author feature by JKP author Liz Hoggarth
Outcome evaluation – help is on the way.
In 2006, I was asked to work with a group of local Children’s Fund projects to help them evaluate their outcomes. Much of the jargon floating around sounded dry as dust and a long way removed from the practical everyday work with children, young people and their families. That could not have been further from the truth. With Hilary Comfort and other colleagues, I started to unpack the pressures on these projects to demonstrate the positive results of their work, their lack of know-how about evaluation and the real need for ways of building achievable evaluation methods into everyday practice. It soon became evident that those projects that could not show the impact of their work would simply not survive as the commissioning processes kicked in. They desperately needed help in understanding the concept of outcomes and in finding ways to show the difference they made in the lives of clients.That experience has been repeated many times as the drive in national policy to improve outcomes has affected so many settings across the partnerships of social work, education and health.
Many of us react instinctively against further demands to produce evidence, especially quantitative information – we know all too well that progress with clients is made up of tiny, often faltering, steps forward that are extremely difficult to demonstrate or quantify. There are downsides to the outcomes approach as there are to other systems of planning and evaluation. But the question of outcomes is a perfectly legitimate one. The number of visits made to a family is beside the point if the risks are not picked up and appropriate interventions are not identified to begin to help people deal with the problems. The number of counselling sessions provided is hardly important if in the end they made no difference for the person seeking help. We must address outcomes in order to improve services.
My guess is that many readers of this newsletter will also be struggling to grapple with the intricacies of the commissioning process and the demands that they should provide evidence of the positive outcomes of their work. We found that many managers and fieldworkers were having to cope with trying to evaluate outcomes on top of the direct work with clients and that there was very little material available to help them. Whether in statutory services, the voluntary sector or even in private companies engaged in care or education, workers are facing the same questions. How do you define your outcomes? How could you show that users have grown in confidence? How do you help staff to understand what data they must collect and why? How can you enable clients who have communication difficulties or disabilities to identify the progress they have made? How do you structure an evaluation report to satisfy commissioners?
That is how our journey started - to write a practical handbook that could be a reference point for practitioners on outcome evaluation. We have seen some good projects die because they could not produce evidence of their outcomes. We have seen others grasping the nettle and embedding effective systems of evaluation and going from strength to strength as a result. The experience is far from theoretical – we hope it can prove useful to many others.
Copyright © Jessica Kingsley Publishers 2010
Liz Hoggarth is the co-author of the new JKP title A Practical Guide to Outcome Evaluation.
More details of the book
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Content links
JKP Social Work books
Quick Guide to Community Care Practice and the Law
Michael Mandelstam
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A Practical Guide to Outcome Evaluation
Liz Hoggarth and Hilary Comfort
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Children and Adolescents in Trauma:
Creative Therapeutic Approaches
Edited by Chris Nicholson, Michael Irwin and Kedar N Dwivedi
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Making Sense of Child and Family Assessment
How to Interpret Children's Needs
Duncan Helm
Coming Soon!
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Arts Activities for Children and Young People in Need
Helping Children to Develop Mindfulness, Spiritual Awareness and Self-Esteem
Diana Coholic
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Helping Children to Cope with Change, Stress and Anxiety
A Photocopiable Activities Book
Deborah M. Plummer
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Working with Young Women
Activities for Exploring Personal, Social and Emotional Issues
2nd edition
Vanessa Rogers
Coming Soon!
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Working with Young Men
Activities for Exploring Personal, Social and Emotional Issues
2nd edition
Vanessa Rogers
Coming Soon!
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Cognitive Behavioural Therapy for Child Trauma and Abuse
A Step-by-Step Approach
Jacqueline S. Feather and Kevin R. Ronan
Coming Soon!
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Rebuilding Lives after Domestic Violence
Understanding Long-Term Outcomes
Hilary Abrahams
Coming Soon!
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A Practical Guide to Caring for Children and Teenagers with Attachment Difficulties
Chris Taylor
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Safeguarding Children from Emotional Maltreatment
What Works
Jane Barlow and Anita Schrader McMillan
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Rights, Risk and Restraint-Free Care of Older People
Person-Centred Approaches in Health and Social Care
Edited by Rhidian Hughes
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The Survival Guide for Newly Qualified Child and Family Social Workers
Hitting the Ground Running
Edited by Zoë van Zwanenberg
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Leadership in Social Care
Edited by Zoë van Zwanenberg
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The Child's World
The Comprehensive Guide to Assessing Children in Need
2nd edition
Jan Horwath
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Young People in Love and in Hate
Nick Luxmoore
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Learning Through Child Observation
2nd edition
Mary Fawcett
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Just Care
Restorative Justice Approaches to Working with Children in Public Care
Belinda Hopkins
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A Short Introduction to Attachment and Attachment Disorder
Colby Pearce
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Creative Coping Skills for Children
Emotional Support through Arts and Crafts Activities
Bonnie Thomas
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Quality Matters in Children's Services
Messages from Research
Mike Stein
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Telling Tales About Dementia
Experiences of Caring
Edited by Lucy Whitman
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