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Author's Note: This is an old-fashioned academic paper written by me (Steve Bracken ... twigg) before the advent of internet and easy access to endless information. All the characters mentioned, including the books should be "Googleable", though some may be out of print. I am posting it here because it is as interesting and readable now as it was in 1999.

There are lessons we should all remember. Kids don't change. They may have cell phones, computers, a language and music we don't "get", but they don't change, and, unfortunately, neither does the abuse and neglect suffered by so many of them.

I commend my Diary to you all ... I hope you enjoy reading it as much as I sweated over writing it.

twigg

"The crux of a child's deprivation may be perceived as the absence of an adult who, parent-like, shows constancy of care by being sufficiently present and emotionally available to be receptive to the child's feelings and to "think" about them".

Shirley Hoxter: "Psychotherapy with Severely Deprived Children" 1987

In this context what is meant by "thinking" and what are the implications for adults working with severely deprived children?

The history of Residential Childcare, from the Poorhouse to the present day has been driven by a growing understanding amongst childcare workers, their managers and associated professionals in allied disciplines, of te need to address the emotional damage done to children through an absence of "good-enough" parenting.

When Leila Rendel and Phyllis Potter founded the Caldecott Community in Cartwright Gardens, St Pancras, London, in the year of 1911, they could have had no idea of the developments that would take place over the next ninety years. Nor would we recognise many of the practises undertaken all those years ago. Indeed, by modern standards, the work of pioneers such as Rendel and Potter would be dismissed as inappropriate today. It is, however, illuminating to read an extract from the first Annual Report of this fledgling organisation.

"The School was started partly in the hope that it would help to form the much needed link between the care bestowed upon the babies of the neighbourhood and the teaching and supervision given to the older children in the Council Schools, but chiefly perhaps in the hope that the children might enjoy the instruction which is usually absorbed by the children of the wealthy in their own nurseries and by virtue of their happier surroundings. The teachers have ever before them the desire to awaken in the children that independence of spirit and joyousness of life, which alone will give them the power of realising to the fullest extent the possibilities of development within their reach".

(E Lloyd. p.7)

Whilst the practises of adults caring for children in modern establishments have changed and evolved to encompass the teachings of Winnicot, M. Klein, Bion and many others, surely the sentiment underlying the above statement remains as true today as it ever was. The idea that an establishment should consider first the needs of the children must be implicit in the statement that:

"... teachers have ever before them the desire to awaken in the children that independence of spirit and joyousness of life ..."

To bring us more or less up to date, the Dartington Social Research Unit has identified five conditions from "Research for Good Standards in Residential Care"  (Hardwick & Woodhead p. 95)

Condition three sets as a goal for the institution that of meeting the 'primary' needs of children. Primary needs being defined as those needs that necessitated an absence from home.

The symptoms leading to children being removed from home and placed in residential care are invariably due to the failure to provide 'good enough' parenting. The expectation is that the Unit will address, as far as possible, the emotional deprivation suffered by the child, in an attempt to foster emotional development. This would hopefully be a natural consequence of meeting the Dartington conditions raised above.

It is in this context that Hoxter talks of an adult 'thinking' about a child. SHe goes on to say:

"... it entails (rather) the capacity to hear experiencing the child's feelings and one's own accompanying feelings until they have undergone a process of internal modulation enabling the adult to make a response in keeping with what the child has communicated, rather than a reaction directed by the adult's own emotions".

(Boston & Szur p. 125-126)

This concept was first described by Melanie Klein who gave us the expression 'Projective Identification'. She was describing how, in a good relationship between a mother and an infant, the infant is able to introject it's own pain through the appropriate response of the mother. The result of this process in a healthy relationship is the building of the infant's own, separate. identity and normal ego development (Klein).

The capacity of the mother to reflect upon the projections of her child and convey to the child that such feelings are bearable was described by Bion as 'reverie'. The mother acts as a 'container' for the overwhelming emotions and the space she creates in her mind - her 'thinking' or 'reverie' - allows the child to feel 'contained'. (Bion)

It would follow, therefore, that if this process were either absent or severely disrupted, the normal development of the child is impaired, and the work required to be done to address these needs would have to be highly individual in it's approach.

This approach to working with children and young people has consequences both for the type of establishment provided to care for them, and the adults working within it.

Historically, children's homes were large and largely forbidding institutions. Great emphasis would have been placed upon conformity to 'house rules', to exercise, to religion and other aspects of life deemed to build moral character. The role of the adults working within such establishments was largely one of ensuring that the routines were adhered to. Doubtless many of these homes were a material improvement in the impoverished backgrounds of the children within, but there could have been little space for any identification of individual needs, nor facilities to meet those needs that were identified.

This institutional approach may well have provided sufficient levels of care to afford many children the opportunity of a basic education and to have their primary care needs for food, warmth and shelter met. But the children in a position to benefit from this must have had at least some consistency in their early parenting. The severely impaired, the unintegrated children whose 'acting out' could not be contained within such an organisation would have found themselves in an "Approved School", where controls on behaviour could be applied quite harshly, or in a mental asylum, or simply abandoned to fend for themselves.

In her book "The Provision of the Primary Experience", Barbara Docker-Drysdale describes the work undertaken at both of the Units she established. The Mulberry Bush, in the early sixties, and at the Cotswold Community in the seventies. That change to current practise was necessary is evidenced, at least in part, by the fact that Richard Balbernie lead a team whose mandate was to transform the Cotswold Community from a traditional 'Approved School' for adolescent boys into a Therapeutic Community serving the same client group. It is the notion that therapeutic intervention with children and young people can effect emotional growth that has the greatest implications both for organisations and the staff serving them.

Case Study:

My practise was as a manager within a small independent unit in Kent, England, designed to work with children from about the age of five, on the basis of therapeutic intervention. Whilst I had some input into the overall structure and working practises within the unit, the majority of my time was spent working with a small group of the current residents. The management of the unit recognised right from it's inception in 1982, and long before my arrival, that a number of issues commonly causing difficulties within Residential Care needed to be addressed. These fell  broadly into two distinct categories:

1. Issues concerning adults performing direct work with children and young people

2. The management of the Philosophy and Care Policies which guide the staff in their work and form a reference for measuring outcomes.

Individual adults performing effective therapeutic intervention are likely to face a number of difficulties that are required to be managed.

"Listening" to children. Acknowledging and bearing their feelings of unbearable pain and despair. Responding appropriately, that is in a proactive, not reactive, manner. Being there in the morning.

Hoxter states the following:

"By helping the staff to bear having a clear look at the subtle complexities compounding their identification with the underprivileged, we can both help them to deepen their awareness of a child's feelings and also to obtain a more self-respecting appreciation of the value of what their receptivity and steadfastness can provide for the child. The alternative is likely to be a rapid changeover of staff ... "

(Boston & Szur)

The management in the Unit saw their role as one of enabling the staff to do their jobs. Primarily through a recognition of the fact that a child cannot return to being an infant (however desirable that might be) and that therapeutic intervention can be achieved symbolically.

When Andrew arrived at the unit his behaviour and actions suggested that this boy did indeed seek a return to the very earliest experiences of the mother/infant relationship. Such was his level of need that the staff, quietly and without fuss, returned Andrew to "demand feeding". He was offered food every hour of his waking day. It may only have been a slice of apple or a small sandwich, but this work, together with other interventions and direct therapy allowed enough growth for Andrew to return to a more normal family. (for further information on work with Andrew please see Case Study C. Hardwick & Woodhead p. 200-205)

This suggests immediately that, unlike the infant/mother relationship, the adult need not be present all the time. However it is felt important that the children have evidence that they are being "thought about" during periods of absence. This can be achieved in a number of ways and I will give two examples:

1. Children are expected, where possible, to make their beds on a morning. Despite this having normally been done, whilst the children are at school their beds are re-made. Pyjamas are folded neatly under pillows and their favourite teddies arranged as the children like them. Any member of staff can do this as we all do it the same way.

2. During periods of longer absences we do subscribe to the widespread practise of sending postcards to children, but even when away for shorter periods much can be achieved. I remember during a fairly short absence collecting a brochure from a bicycle shop. When I returned and gave it to David he was delighted. He had assumed that because I were not there he would have to wait that bit longer for his new bike. Another member of staff returned from two days off with socks she had remembered that a child needed. The child could not believe that the adult had 'thought about' him while she was away.

We worked a basic forty hour week. A myriad of small examples of the type above, we felt, gave the children the impression of a much greater presence while allowing adults the necessary space to lead their own lives.

In seeking to address the second category, that of designing an appropriate and enabling philosophy of care and working practises, the management of the Unit have been mindful of the need to create a "Home for Children", as opposed to a "Children's Home".There would seem to be little point in tearing down the Institution and replacing it with working practises that place obstacles in the way of child-centered activity. As a result, rotas must be flexible, demarcation lines blurred and all children and young people are discouraged from seeking out senior staff for decisions. Thes and other policies were carefully designed to encourage adults to intervene in a positive and informed manner.

As the basis for the most effective intervention is a clear understanding of the issues of child development, there was a strong commitment to staff development training and supervision. This was conducted by managers within the Unit and also by outside consultants who, in some cases also offer individual therapy to the children and sessions of staff training and supervision.

References:

Dockar-Drysdale, B (1990) The Provision of the Primary Experience Free Assoc. Books

Boston & Szur (Editors) Psychotherapy With Severely Deprived Children Mansfield Library (1990)

Hardwick & Woodhead (Editors) Loving, Hating and Survival Ashgate Publishing Ltd (1999)

Lloyd, Elizabeth The Story of a Community Not Published avail. from Steve Bracken (twigg)

Bion, W R Learning From Experience London Heinemann (1962)

Klein, M Notes on some Schizoid Mechanisms "The Writings of Melanie Klein" London Hogarth Press Vol. III (1946)

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