Jenny Dover

Education as a Therapeutic Intervention

Definition of Child Mental Health

Health Advisory Service

A capacity to enter and sustain mutually satisfying relationships (peer/social skill)

The ability to play and learn so that attainments are appropriate for their age and intellectual level (cognitive skill)

Maladaptive behaviour being within normal limits (conduct)

Insecure Attachment in SchoolInsecure Attachment in School

‘In homes where the baby finds no mutuality, where the parent’s face does not reflect the baby’s experience and where the child’s spontaneous gesture is not recognised or appreciated, neither trust in others nor confidence in the self develop’ (Hopkins 1990)

Responses and behaviour become organised around the need to cope in the absence of support

Absence of self awareness and the capacity to articulate feelings places a greater emphasis on acting out

‘It makes a great deal more sense of much of the seemingly unreasonable or outrageous behaviour of many …. children if one bears in mind that they are often doing to others what they experienced as being done to them, both externally and internally’ (Boston and Szur 1983 p.3)

Levels of stress determine the nervous system around which personality becomes organised.

Memories do not remain in the past but becomes actions in the here and now – behaviour is a communication about experience.

Core Concepts of Attachment TheoryCore Concepts of Attachment Theory

The secure baseBowlby maintained that all of us, from the cradle to

the grave, are happiest when life is organised as a series of excursions, long or short, from the secure base provided by our attachment figures. We need to feel safe before we can explore the world.

Attachment behaviour. The aim of attachment behaviour is proximity or

contact with the associated affect of feeling secure and safe.

We know who we are because someone has ‘known’

us first.

School ExclusionSchool Exclusion

2 risk factors in school exclusion

Maternal illnessEarly separation from carer

School can be the first experience of a secure base – the persistent attenders!

Safety

Firm and consistent boundaries

Predictability and routine

Thoughtful separations and endings

Consistent carers

Identity and belonging

Curriculum content

Calming tasks

Symbolic containers! ------ School as a secure base

What The teacher must BE, KNOW What The teacher must BE, KNOW and DO to meet the needs of and DO to meet the needs of troubled young peopletroubled young people

Personal resources/emotional capacity (self awareness, containment, reciprocity, repair of ruptures)

Theoretical understanding/framework re behavior and learning: (transference, defences, attachment patterns, play)

The curriculum: (expression and exploration of feelings. Adapting tasks. A meeting place for teacher and child)

Containment Containment (melanie Klein:projective identification. (melanie Klein:projective identification. Bion:Containment 1959Bion:Containment 1959

A person receives and understands the emotional communication of another (guilt, anxiety, fear, joy) without being overwhelmed by it and communicates it back – restoring their capacity to think.

An infant ‘projects’ turbulent feelings associated with physical sensations into his mother. She receives the emotional communications of her baby and ‘contains’ them for him

She makes sense of them, showing the baby they are tolerable and meaningful, and gives them back in a manageable form.

The infant learns to recognise and manage such feelings for himself without needing the container of his mother.

Reciprocity (Brazelton,Stern)Reciprocity (Brazelton,Stern)

The infant seeks a contingent response from the carer

Reciprocity is a ‘dance’ between carer and infant where both are involved in the initiation, regulation and termination of the interaction

Repair of ‘ruptures ‘ to the interaction is vitally important for the infant. (Tronick)

Reciprocity is fundamental to the development of language

INTERNAL WORKING MODELINTERNAL WORKING MODEL

Bowlby described the “inner road maps” that children develop as a result of repeated early interaction with carer.

Their perceptions and expectations of adults and their view of themselves in relation to others are carried forward into new relationships

Disrupted Attachment

Inadequate or insensitive parental response results in insecure attachment

Organised patterns of behaviour develop to elicit response from parents

Avoidant; minimising attachment behaviour to keep a rejecting parent closer. Passive, withdrawn and little display of emotion

Ambivalent-resistant attachment: maximising attachment behaviour to elicit care from inconsistent parent. Demanding, clingy. Extreme distress and resistant to being comforted.

Disorganised Attachment: parent frightening or frightened. Parents source of fear and potential source of safety. Child attempts to solve this dilemma through highly organised ways of controlling parent and self reliance.

Defensive behaviour in the Defensive behaviour in the classroomclassroom

The omnipotent child The omniscient childThe helpless babyish childThe child who projects uncomfortable feelings

into teacher or peerThe child who avoids the challenge of the

task/denies difficultiesThe child who keeps moving or cuts offThe child who uses the task to distance

teacher or keep her near etc

Attachment Patterns Identified by Strange Attachment Patterns Identified by Strange Situation StudySituation Study(Ainsworth 1969)(Ainsworth 1969)

Secure

Insecure/Anxious

◦Avoidant◦Resistant/Ambivalent◦Disorganised

Disorganised AttachmentDisorganised Attachment

Strange situationParents may be

traumatised, drug abusing or have mental health problems. Frightened/frightening

Child experiences chronic uncontained anxiety

HypervigilantTries mixed approaches

(approach/avoidance) to connect with parent

In Class Highly reactive to change Hyperactive or dissociated Distrustful of teacher and

very controlling of her (caretaking or punitive)

Reacts to hidden triggers in the environment

Responds to structure and predictable environment

Absence of empathy Brain hot-wired for

fight/flight/freeze Highly sensitive to SHAME Concrete thinking

Psychological processes affecting Psychological processes affecting relationshipsrelationshipsHenry, Osborne and Saltzberger-Wittenberg (1983)

describe the strong feelings that can be aroused by close association with troubled children:

the teacher is likely to arouse in pupils many emotions experienced in the parental relationship and so become imbued with parental significance with positive or negative implications – transference

the teacher acts as a temporary container for pupil anxiety when faced with a challenge – increased tensions

the teacher can experience the uncomfortable feelings experienced by the pupil – inadequacy, stupidity, helplessness, fear, anger - projection

Putting Feelings into WordsPutting Feelings into Words

“When you put feelings into words you’re activating this prefrontal region and seeing a reduced response in the amygdala. In the same way you hit the brake when you’re driving when you see a yellow light, when you put feelings into words; you seem to be hitting the brakes on your emotional responses.

(Dr Daniel Hughes 2009)

Containment/The teacher’s taskContainment/The teacher’s task

He is open to children’s communications and projected feelings without being overwhelmed.

He makes sense of theseHe conveys his understanding to the child

through words or actionsEg choosing a story containing issue with which

child struggling eg Hansel and Gretel with child fearing abandonment

Naming feelings “I know it is hard to wait but I will come over to your desk soon….”

Teachers/Containment(continued)Teachers/Containment(continued)

Bringing a child to sit closer to her when he seems agitated

Using competitive educational games with a hostile child where he can ‘beat’ her through learning

Paying close attention to clues in his creations and approach to learning eg misreadings – and sharing this understanding with the child.

Observing his preferred way of relating to her and responding

Storied selfStoried self

Therapy is about making and breaking stories about selfAs teachers and parents our responses help children

build a narrative about themselves.e.g. I’m someone who finds it hard to take risks because

getting things wrong can feel terrible. But I’m able to use help to…

e.g. I can get angry very suddenly because I expect to be bullied….being near to an adult helps me think…

e.g. I need to keep an eye on the teacher in case she forgets I am here..so it’s hard to focus on the work

Reciprocity and the teacherReciprocity and the teacher

Learning takes place within a mutual relationship. The teacher and the student influence each other.

Can overwhelm or underwhelm each otherInteraction needs to be regulated so that they

experience each other in manageable doses. Ruptures need quick reparation

Teacher needs to engage the child, hold his attention, monitor tolerance for frustration and also excitement and terminate the encounter appropriately

ReciprocityReciprocity

Unless the (young person) experiences himself as being able to have a positive impact on the adult , he is not likely to be receptive to having the adult have a positive impact on him.” (Dr D. Hughes)

Recognising the power of relationships and relational cues is essential to effective therapeutic work and, indeed, to effective parenting, care giving, teaching and just about any other human endeavour.”(Perry)

Implications: Disorganised childImplications: Disorganised child

Early identificationHighly structured environmentProf network importantAvoid ShameConceptual thought difficultImmature stage of learningControl of teacherAction replaces words as communicationWhen he aroused appeal to ‘thinking’ brainUse headteacher

Disorganised continued(2)Disorganised continued(2)

Build in physical activityCannot self-regulate feelingsHyper-aroused/dissociatingBe on hand not intrusiveTrauma triggersDrawingsHypervigilanceOverwhelmed or restricted by creative activityLeft brain tasks to calm him Avoid SHAME

…….and for the staff.and for the staff

A safe place to discussSeek supportDevelop consistent planReview practice

…..from reaction to reflection – the work discussion group