Coral Tree April 07

“Keeping the conversation going” understanding and making use of relationship

as the vehicle for and context of the implementation of educational strategies

with troubled and troubling children

Peter KrabmanMedical Director

Coral Tree Family Service

April 2007

Coral Tree April 07

“Keeping the conversation going” understanding and making use of relationship

as the vehicle for and context of the implementation of educational strategies

with troubled and troubling children

Peter KrabmanMedical Director

Coral Tree Family Service

April 2007

Coral Tree April 07

Keeping the conversation going

A relationship which is:

Containing

Purposeful

Respectful

Reflective

Empathic

Playful

Coral Tree April 07

A containing relationship

• Give me your worst, I…

– Can and will handle it

– Can and will remain empathically engaged

– Can see the path and will guide you on it

• Containment for the containers

– Practical, personal & professional support

– Formal & informal debriefing environment

Coral Tree April 07

A purposeful relationship

• guidance and discipline over pragmatics and punishment

• Where and who will he/she be at 25?

• The zone of proximal development

• Responding to relational need

Coral Tree April 07

Coral Tree April 07

A purposeful relationship: promoting the developmental tasks of “latency”

• Engaging with society: culture, roles, rules, power, peers, productivity, work and worth.

• Erikson: industry vs inferiority

• Concrete operational thought: truth, justice, bad jokes

• internalisation

• “parentification”/ “pseudomaturity”

• Developmental disparities, eg advanced knowledge/ social control, delayed understanding/ social reciprocity/ affect management

Coral Tree April 07

Adapting and thriving during key developmental periods: adolescence

• Not a child, not an adult

• Erikson: identity vs role diffusion

• Idealistic, deeply superficial, meaning-driven

• Impulsive, sensation-seeking, immortal

• Desire for independence and desire for basic nurturing

• “parentification”/ “pseudomaturity”

• Developmental disparities, eg advanced verbal/ societal, delayed judgement/ affect management

Coral Tree April 07

A respectful relationship

• Respectful of this individual child

• Know, and don’t assume to know

• Respectful of child’s power

• Respectful of child’s perception of the problem, and readiness to change

• Respectful of all parties

Coral Tree April 07

A respectful relationship:

Working with “won’t” • Stages of change (Prochaska & DiClementes)

• Motivational interviewing

– Express empathy

– Develop discrepancy

– Avoid argument

– Roll with resistance

– Support self-efficacy

• (in the legal/ ethical context of dealing with adolescents & their families)

Coral Tree April 07

A reflective relationship

• I look at me, we at us

• Reflective conversation re. shared experience

• A key element of positive adult adaptation to childhood adversity

• A key element of safe and effective practice, balancing consistency with flexibility

Coral Tree April 07

An empathic relationship

• Emotion coaching (John Gottman):

1. Become aware of child’s emotion

2. Recognise the emotion as an opportunity for intimacy & teaching

3. Listen empathically, validating the child’s feelings

4. Help the child find words to label the emotion they are having

5. Set limits whilst exploring strategies to solve the problem at hand

Coral Tree April 07

A playful relationship: saying true words in jest

• A child’s need to be delighted in

• Maintaining positive engagement whilst giving frequent/ intensive guidance

• Disarming oppositionality

Coral Tree April 07

Coral Tree April 07

Aggression• Hot (Impulsive-reactive-hostile-affective) vs. Cold

(controlled-proactive-instrumental-predatory) aggression

• Opportunities for intervention in the cycle of aggression

Coral Tree April 07

Questions and discussion