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Our primary task is to help children and young
people to come to terms with areas of their
lives in which they have experienced marked
difficulties, consolidate and support areas in
which they are functioning well, promote
educational and / or employment opportunities,
and enable them to move successfully to
sustainable and enjoyable fostering placements
or to live independently in their community.
Bowlby, Dockar-Drysdale, Winnicott, and
The
Therapeutic Community Approach
Our practice, and the
therapeutic provision we offer,
is most
closely related to that of the
Therapeutic Community Approach (acknowledgment duly given
to the work of Adrian Ward, formally associated
with Reading University, University of East
Anglia, and now The Tavistock Clinic).
This in turn is informed by an understanding of
psychodynamic principles largely as developed by
Professor
D.W. Winnicott, and by the founder of the
Mulberry Bush School, Barbara Dockar-Drysdale.
It is also
influenced
by the theory of attachment and
containment (as proposed by John Bowlby),
Group Relations
and systems
theory
developed through the Tavistock Institute by
Eric Miller and others, good parenting
skills and aspects of .
We provide a
safe and secure “emotionally holding”
environment in which the child or young person
is supported in developing “good enough”
attachments to the adults who care for them,
enabling them eventually (when they are ready to
do so) to explore the realities of the outside
world in which they live. As these relationships
develop, the young person is exposed to
alternative ways of living & relating through
their daily care and is enabled to shed
defences, practicing these alternatives until
they have internalised them sufficiently to
function more independently.
Psychodynamics
and Preoccupation
Adults are encouraged to become pre-occupied with the children or
young people. They 'live alongside the
children and young people in the home
environment, working
psychodynamically with the negative or damaging
experiences the child or young person has
suffered until such time
as the pain becomes more bearable (for both
child and adult), and
they feel able to move forwards in their lives.
Adults also present as positive role models
offering support, advise, and guidance to the
child or young person through their transition (at
Seafields and Springfields) from childhood to
adolescence and (at Westfields) from adolescence
to adulthood.
Daily Group Meeting
The daily group meeting forms an important
characteristic of the approach we use. The 'pure
model' of the therapeutic community follows the
notion that all members of the community can
provide as well as receive in therapeutic
exchanges, and indeed that it is the community
itself which is therapeutic, rather than that it
being primarily only the adult carers who engage
in the therapeutic task in a community or group
setting.
We have needed to modify this notion slightly to
address the fact that the children and young people in our
care require much adult support simply to manage
the task of living in a group setting and
sharing space, time and attention with others.
For many of them, their experiences
have left them without ways to deal with the
day-to-day pressures of normal everyday life,
and their response to the idea of sharing their
thoughts and feelings with others and accepting
help from others can lead them to feel the need
to disrupt, destroy and attempt to annihilate anything
around them that seems to be working!
Nevertheless, we have found that with skills in
patience, sensitivity, sound support networks
and understanding of the situations, adults are
able to gradually support children and young people in
finding and accepting help from others, and
increasingly, to offer support and assistance to
others around them.
Emotional
Containment
Through following the therapeutic community
approach, adults caring for and educating the
children and young people consciously use themselves to
develop appropriate relationships with, and
between, the children and young people in their care, and with
/ between other adults involved with this task. Through teamwork, adult carers provide a
planned environment and predictable pattern from
day to day, thus establishing a reliable
structure of emotional containment. This ensures that the conditions exist
for children and young people to experience having their
genuine physical, emotional, cultural, social, and psychological
needs met.
This approach also allows us to offer
children and young people who have suffered from previously
damaging experiences, a space in which they may
have a secure sense of childhood, where they
can gain a sense of stability of self and placement, be
offered good relationships, be respected, and be
offered a model for respecting others.
Facilitating
Environment
The Therapeutic Community
Approach has enabled us to develop living
spaces (the facilitating environments) which have
the feel of 'family homes' without the pressures
of family living, are sensitive to the needs of
the individual child or young person and the
group in which they live, and which can
accommodate their changing needs as they mature
and develop.
Integration and
Unintegration
The terms
unintegration and integration describe ideas
which are fundamental to the psychodynamic care
approach adopted across the whole of The
Lioncare Group. The following definition has
been taken from an article prepared by the
tutors at Reading University for students
attending the Diploma in Therapeutic Child Care,
and attempt to explain these terms and how they
relates to the therapeutic care of young people.
Ego Integration
The psychoanalyst
and paediatrician Professor D.W. Winnicott has
stated that there is an important relationship
between a child’s healthy emotional development
and its interaction with its primary care giver
(a role most usually assigned to the mother)
during the first year of life. Winnicott sees
the infant’s ‘inner world’ (i.e. internal model
or representation of the way an individual
perceives another person, experience or
situation occurring in the environment around
them) at this stage as
being a bundle of instincts, fears and
sensations, which the infant cannot think about
and therefore cannot differentiate.
In other words,
the infant cannot at first differentiate between
itself and its environment (including its
mother), and is subject to the gales and
fortunes of internal and external physical
sensations, as well as to the swings of pure
‘feeling’. Examples of pure feeling are;
discomfort, pleasure, feeling warm or cold, full
or hungry (although at first the infant will not
even be aware of any difference between cold and
feeling hungry – things will simply feel good or
bad). Winnicott views these pure feelings as
potentially very powerful, even frightening,
feelings for the infant.
The role of the
primary care giver is summarised as ‘holding’.
This can literally be holding the infant or
child physically, providing appropriate comfort,
nourishment etc. It can also include holding in
the sense of ‘managing’ or ‘containing’ the
child’s emotional experiences for them, until
the child gradually learns to understand and
contain their own feelings. In this sense the
child is ‘merged’ in with the primary care
giver, who in turn gradually learns how to make
sense of the child’s experiences for them and
mirror this back so that the child can begin to
make sense of it for themselves.
The term ego
integration refers to the process whereby the
child gradually brings together (with help and
holding) all these fragmentary bits and pieces
of experiences to the point where they can begin
to hold themselves together. Ego refers to this
capacity to organise and make sense of one’s
experiences: what Winnicott is saying is that we
are not born with an ego, but that we develop
one, usually during the first year of life. He
argues that the infant is born with an in-built
tendency to develop and mature, and that this
tendency, when matched as it is in most cases
with ‘good-enough parenting, takes the infant
through these earliest stages to the point where
ego integration has taken place.
Unintegration
Most infants have
good enough experiences, do achieve integration
and thus have at least the foundations for
healthy emotional development (even though they
– we – may encounter all sorts of other
difficulties and develop various neuroses as
childhood and adolescence take their course).
However, small
proportions of infants have a much harder time
of it, and for various reasons do not manage to
make a satisfactory beginning to their emotional
lives. Ego integration is a very important
achievement, and if you do not achieve it at the
appropriate stages you are likely to remain in
the ‘unintegrated’ state of the new-born.
The kind of
things that prevent the process from happening
are chiefly related to things that prevent the
primary care giver from offering good-enough
‘holding’. For example, if the primary care
giver is always or usually so completely
preoccupied with their own emotional needs that
they cannot notice and respond appropriately to
the infant’s needs, there is little chance that
the infant will be able to feel safely ‘held’.
They are likely
instead to feel ignored, abandoned, dropped, but
without the capacity to even think about what
this means or understand what is happening. If
there is no one there to mediate and manage the
infant’s potentially chaotic experiences, the
infant is left prone to the full blast of
primitive instinctual fears and anxieties such
as the fear of going to pieces or falling
forever. This may sound dramatic, and it is
dramatic: to remain in the unintegrated state is
an extremely serious business, because it means
that the child has not achieved any sense of
predictability and understanding of people, the
world, or themselves. It is equivalent to the
term ‘failure to achieve basic trust’; it is the
stuff of which psychosis is made.
Consequences
If integration
does not happen, the child is left with either a
chaotic inner world, or with very little
awareness of the difference between its inner
world and other people’s feelings or external
reality. In some cases, they form a hardened
shell or ‘false self’ around their inner world,
built on compliance, which protects the child
from any real involvement with people.
This child is
likely to carry on interacting with people on
the basis of these highly problematic patterns
until dramatic things start to happen. Usually
this is when the child hits playgroup or school,
and things and people start to fly. People will
experience the child as wildly unpredictable, or
out of touch, or coldly manipulative, or vicious
and violent. In other words, they will see in
the child what the child is probably seeing
around itself, because they have no capacity to
trust themselves or anyone.
What is most
serious is that such children are most unlikely
to recover spontaneously without skilled help.
They may therefore remain in this highly
vulnerable emotional state through their
adolescence and into adulthood unless and until
such help is available. Some of them, of
course, will develop pockets of emotional and
intellectual functioning so that they can ‘get
by’ at a minimal level. But their fundamental
emotional emptiness will remain, and they will
be highly prone to rapid breakdown in to panic
and disruption when placed under the sort of
everyday social stresses, which most people can
handle without trouble.
Working in
partnership
The therapeutic
task carried out by The Lioncare Group
compliments, and is integrated with, the
responsibility we have been given by local
authorities to carry out the task of statutory
care. We therefore work in partnership with
local authorities to deliver individualised
programmes of therapeutic care and support which
complement and incorporate the young person’s
care plan, and embrace all aspects of the
national minimum standards, children’s act 1989,
children (leaving care) act 2001, children’s
homes regulations 2001 and other related
legislation and guidelines.
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