Centre of Knowledge

The Model in Practice: Understanding the Lighthouse Therapeutic

Family Model of Care™

Theoretical Underpinnings of TIP

Attachment Theory

Object Relations Theory

Trauma Neurobiology

Psychological Wellness Theory

The Lighthouse Experience

Overview of the Model

HomePLACE

Playful, Loving, Accepting, Caring, Empathetic

Family Primary Experience

Individualised Care

Individual Development Plan

Professional Development

Plan Staff

Developmentally Focussed

Not Chronologically

Time/Holding Space

Therapeutic/ Recovery Oriented

Sense of Community

Recovery Process

Psychologists Care Team Carers Young Person

Intake

Process Presenting Issues

Referrals Identify

Intake interview Confusion/diffusion

Consultation Mental health issues

Psycho-social screening Drug & alcohol issues

Placement meetings Disconnected

Immediate gratification

Induction

Process Presenting Issues

Visit homes Attachment difficulties

Dinners Cold feet

Family meetings Culture shock

Community events Guarded

Meet carers and young people

Debrief with intake worker and carer

Holding Environment

Process Presenting Issues

Primary experience Reactive attachment

Attachment with carer Traumatic experiences surface

Relationship building Resistance to boundaries

Trust, safety, stability and security Substance issues may resurface

Home Mental health issues

Develop confidence and self esteem Family conflict

Window to future Transference and counter-transference

Transition to Autonomy/Independence

Process Presenting Issues

Coping skills Resistance to change/separation anxiety

Skills development Regression

Support networks Cold feet

Established healthy attachments Internal conflict

Community networks Grief & loss

Transitional object Excitement vs. anxiety

Transitional planning

After Care

Process Presenting Issues

Assertive outreach Financial issues

Transitional development planning Accommodation/housing

Carer relationships Mental health support

Ongoing relationships with young person Separation anxiety

Inter-dependent living Community support

The Recovery Process

Elements of Recovery

• Therapeutic Relationships

• Group Experience

• Physical Environment

• Sense of Community

• Organisational Culture

Therapeutic Relationships

A central aim of the therapeutic relationship is to provide a safe relationship in which

the child can then work through and integrate unresolved aspects of their traumatic

experiences.

From the position of being engaged in a positive attachment relationship and

through observing other healthy relationships, the young person can then acquire

experience and skills to develop and manage other relationships in their life.

Barton, Gonzalez & Tomlinson (2012)

Therapeutic Relationships

…evidence is accumulating that human beings of all ages are happiest and able to

deploy their talents to best advantage when they are confident that, standing behind

them, there are one or more trusted persons who will come to their aid should

difficulties arise. The person trusted, also known as an attachment figure, can be

considered as providing his or her companion with a secure base from which to

operate.

Bowlby in Barton, Gonzalez & Tomlinson (2012)

The Group Experience

Traumatized young people need a healthy community to buffer the pain, distress

and loss caused by their earlier trauma. What works to heal the young person is

opportunities to increase the number and quality of relationships. If we don’t give

children time to learn how to be with others, to connect, to deal with conflict and to

negotiate complex social hierarchies, those areas of their brains will

be underdeveloped.

Perry and Szalavitz (2006)

The Group Experience

The group processes provide an opportunity to observe group dynamics and where it is

helpful to intervene in a way that disrupts destructive dynamics that may be developing

For example, difficulties within the group may be projected onto one person who could

then become a scapegoat for the group’s difficulties

An opportunity for everyone involved to establish their sense of self by making their own

unique contribution. For everyone to reflect on what is happening for themselves, for

others and the whole group. This enables the members of the group to learn about their

own feelings, thoughts and relationships and to consider this alongside other people’s

experiences

Therapeutic Environment

Traumatised people benefit from caring

environments that are attuned to their

emotional states.

…where workers can adjust the

environment to support emotional

regulation, and can provide predictable

responses and routines that assist in

reducing hyper-arousal.

(Tucci, Mitchell and Goddard, 2010)

Physical Environment

Child abuse and trauma often

happens within a wider context of

neglect, where the environment

the child lives in reflects the

parent’s lack of attunement to their

needs. The home is often uncared

for, unstimulating, chaotic and

sometimes unsafe.

The environment is warm, friendly, nurturing, calming

and aesthetically pleasing. It contains facilities that can

support and enrich a child’s life. The home is a place

for growth, development and a means of balancing the

need for being sociable with privacy. It is a place where

positive memories can be made and life-long

relationships established. Most importantly, the home is

a safe place and sanctuary.

Barton, Gonzalez & Tomlinson (2011)

The Community

Sense of community:

The feeling that one is part of a readily

available supportive and dependable structure.

Sense of community transcends individualism

in that to maintain such an interdependent

relationship one does for others what one

expects from others.

Sarason (1974)

Sense of Community

Ideally, children are raised by their family and extended family within the

context of a supportive wider community. Many of the children that we

work with have been alienated and disconnected from their local

community. Many of the children’s lives are transient, due to running

away from unsafe relationships, or being moved around by the system

from placement to placement.

Barton, Gonzalez & Tomlinson (2012)

Therapeutic Circle of Care

Organisational Culture

Traumatized children cannot heal within traumatizing - or traumatized - organisations, and instead such organizations can make children’s problems worse.

Bloom (2005)

Organisational Culture

• Organisational wide understanding child development and impact of trauma

• Consistent trauma informed approach incorporated across systems and processes

• Clarity as an organisation of the primary task

• Young people are provided a holding environment - feel safe & protected

• Opportunity to learn to deal with grief & loss in a healthy way

• Long term consistent and repetitive work

Organisational Culture

• Opportunity for the child to develop healthy attachment

• Promote the direct expression of feelings

• Systems that support staff to manage complex nature of the work

• Enhance motivation for growth and future success

• Provide opportunity for connections with wider community

Organisational Parenting

Organisation

Internalised by the child

Operations/ relationships

attuned to the therapeutic

task

Relationships, language,

communication, leadership and

authority = Environment

experienced by child

All staff role model a

healthy sense of

community

Variety of relationships

& circle of care

Provides a therapeutic

milieu

The Organisation as Therapist

TFMC Process of Recovery

Individual Development Plan

LearningPhysical developmentEmotional development

AttachmentIdentitySocial development

Autonomy / life skillsRelational and community ConnectednessFun / play / recreationTransition planning

Psychological Healing Process

Identity confusion Attachment difficulties

Holding spaceTrauma workDealing with loss and rejectionDeveloping insight and awarenessBuilding trust in relationshipsInternal working models

Developing autonomyNew skills consolidationConfidence in relationship building

Lighthouse Process Intake Induction Lighthouse Home Transition After Care

Time-frame Weeks / Months Months / Years Months / Years

Feedback and Evaluation