Therapeutic Approaches in Work with Traumatized Children and Young People http://avaxhome.ws/blogs/ChrisRedfield Community, Culture and Change (formerly Therapeutic Communities) Series editors: Rex Haigh and Jan Lees Community,CultureandChangeencompassesawiderangeofideasandtheo- reticalmodels relatedtocommunitiesand culturesasawhole,embracingkey TherapeuticCommunityconceptssuchascollectiveresponsibility,citizenship andempowerment,aswellasmultipisciplinarywaysofworkingandthesocial origins of distress. The ways in which our social and therapeutic worlds are changing is illustratedby theinnovativeand creativework described in these books. Therapeutic Communities for Children and Young People EditedbyAdrianWard,KajetanKasinski,JanePooley,AlanWorthington TherapeuticCommunities10 ISBN1843100967 The Time of the Therapeutic Communities People,PlacesandEvents LiamClarke TherapeuticCommunities12 ISBN1843101289 Therapeutic Communities Past,PresentandFuture EditedbyPenelopeCamplingandRexHaigh ForewordbyJohnCox TherapeuticCommunities2 ISBN185302614X Introduction to Therapeutic Communities DavidKennard TherapeuticCommunities1 ISBN1853026034 Therapeutic Approaches in Work with Traumatized Children and Young People Theory and Practice Patrick Tomlinson Foreword by Paul van Heeswyk Community, Culture and Change 14 Jessica Kingley Publishers London and Philadelphia All rights reserved. No part ofthis publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use ofthis publication) without the written permission ofthe copyright owner except in accordance with the provisions ofthe Copyright, Designs and Patents Act 1988 or under the terms ofa licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1T 4LP. Applications for the copyright owner’s written permission to reproduce any part ofthis publication should be addressed to the publisher. Warning: The doing ofan unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. The right ofPatrick Tomlinson to be identified as author ofthis work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. First published in 2004 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Patrick Tomlinson 2004 Foreword copyright © Paul van Heeswyk 2004 Second impression 2005 Library ofCongress Cataloging in Publication Data Tomlinson,Patrick,1962- Therapeuticapproachesinworkwithtraumatizedchildrenandyoungpeople:theoryand practice/PatrickTomlinson;PrefacebyPaulVanHeeswyk.--1stAmericanpbk.ed. p.cm.-- (Therapeuticcommunities;14) Includesbibliographicalreferencesandindex. ISBN1-84310-187-4(pbk.) 1. Psychictraumainchildren--Treatment. I.Title.II.Series. RJ506.P66T652004 618.92'8521--dc22 2003026800 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN-13: 978 1 84310 187 1 ISBN-10: 1 84310 187 4 ISBN pdfeBook: 1 84642 073 3 Printed and Bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear Contents foreword 11 PaulvanHeeswyk,Associationof ChildPsychotherapists acknowledgements 14 Introduction 15 Emotionalunintegrationandintegration 18 Emotionalcontainment 19 1. The Cotswold Community 22 Thetherapeuticresourcerole 23 Thetherapeuticresourcemeeting 24 2. Primary Provision – Theory And Practice 26 Adaptationtoneed(theprovisionof‘specialthings’) 26 Workingwithomnipotentbehavior 30 Emotionalpreoccupationandtheprovisionwemakeforchildren 31 Transitionalobjectsandtheuseof teddybears 33 Thetherapeutictaskwithemotionallyunintegratedchildren 34 Theroleoffocal-carerandback-upcarer 37 Theimportanceoffoodinatherapeuticsetting 39 Mealtimes 40 Foodandchildren’sphysicalweight 41 Theprovisionoffoodanddrinkforchildrenandadults 42 Children’svisitsduringbedtime 43 Providingopportunitiesforprimaryprovisionandmattersrelated toprivacyandsafety 45 3. Therapeutic Task with Emotionally Integrated Children – Theory and Practice 48 Workingwithfragilelyintegratedchildren 48 Workingwithemotionallyintegratedandunintegratedchildrentogether 52 Criteriaforassessingwhetherachildisreadytomoveon 54 Becomingemotionallyintegratedandmovingon 56 Themovefromaprimaryhouseandfuturecontactwiththechild 57 Thereferralprocessfromaprimarytosecondaryhouse 58 4. Therapeutic Education 61 Theinterrelationshipofeducationandtherapy 61 Theimportanceofeducationinthetreatmentoftraumatizedchildren 64 Thechild’sexperienceofseparationbetweencareandeducation 66 GCSEsandtherelationshipbetweenachild’sacademic andemotionaldevelopment 67 Regressionwithintheeducationsetting 69 House–schoolhandovers 70 Theinvolvementofachild’scarerwithhistimeinschool 71 Workingwithbreakdownintheschool 72 Learningsupport 74 Schoolhomework 76 Educationstaff’sinvolvementwithneedsassessments 77 Workingonconflictbetweencareandeducationstaff 78 5. Play 80 Opportunitiesforplayinhouses 80 Playandactivitywithchildren 81 Childrenplayinggamesthathaveanelementofdanger 83 Thesymbolicandreality-baseduseof toysinchildren’splay 84 Theuseofsensoryexperienceroomsforchildrenwithlearning difficulties 85 6. Therapeutic Communication – Individual and Group 86 Meetings for Children Theuseofindividualmeetingsinthetreatmentofemotionally deprivedchildren 86 Therecordingofchildren’sindividualmeetings 94 Theuseofdollsandotherfiguresinchildren’smeetings 94 Talkinggroups 95 Thepotentialuseof housegroupmeetings 96 Howdoadultsworktogetheringroupmeetings? 98 Timeboundariesandworkingthroughdifficulties 100 Workingwithchildrenwhofinditextremelydifficulttobeingroups 102 7. Language 104 Theuseoflanguage 104 Thingswesaytochildrenthatfeelinappropriate 106 Theuseofhumor 107 Theuseofshouting 108 8. Delinquent Excitement and Subculture 110 Delinquencyasasignof hope 111 Workingwithdelinquentexcitementandsubcultureingroups ofchildren 113 Workingwithexcitementinthegroupaboutdrugs 114 Howdoweworkwithaspectsof youthculturethatmaybeoffensive? 115 Tarotcardsandothertypesof fortune-telling 117 9. Authority, Consequences and Reparation 118 Workingwithconsequences 118 Workingthroughdifficultieswithchildren 121 Authority 123 Authorityandcontainmentintimesof change 125 Theuseoftheword‘boundaries’ 126 10. Gender Issues, Sexuality and Dress 127 Thegenderbalanceinteams 127 Dressandappearanceinwork 128 Dressandsexuality 129 Menwearingearringsatwork 130 Theprovisionofsexeducationforemotionallyunintegratedchildren 131 Children’ssexualityandinvolvementwitheachother 134 11. Working with Absence and Break Periods 137 Goingawayforbreakperiods 138 Workwithchildrenduringbreakperiods 139 Supportforchildrenwhoareawayforbreakperiods 140 Workingwiththeimpactof staffillnessandabsence 141 Staffmeetingsandmattersrelatedtoabsence 143 Staffattendanceonexternalcoursesandtheimplicationsfortreatment 144 Achild’scarerleavinghimsomethingwhenshegoes 145 12. Leavings, Endings and Beginnings 147 Preparationforachild’splannedleaving 147 Markingachild’sleavingfromahouse 148 Specialtripoutprovidedforachildbyanadultwhoisleaving 150 Thecontinuingcontactwithachildafterheleavesahouse 150 Futurecontactwithanadultwhohasleft 151 Workingwithacarer’sleavingandthecareofindividualchildren duringthischange 152 Thetransitionbetweencarerswhenachild’scarerleaves 154 Theintroductionofanewchildtothehouseandschool 155 Changeofleadershipandpossibleimpact 155 13. External Reality and Protection from Impingement 158 (intolerable disruption and stimulation) Childrenusingtoysandmagazineswithviolentandoffensiveimages 159 Howdowemanagethingschildrenbringbacktothehouse? 159 Workingwithnewsitemswithchildren 160 ThemassacreatDunblane(1996) 161 Theimpactofexternalprocessesontreatment 162 14. Working with Violence and Aggression 164 Understandingviolenceandaggression 164 Howdowerespondtoparticularlyviolentattacksonstaffbychildren? 166 Howdowetakeviolenceseriously? 167 Howdoweunderstandachildwhoharms,injures orkillsalivingcreature? 169 Physicalrestraint–whatwelearnfromtraining 170 Genderissuesinrelationtothetherapeuticmanagementofviolence andphysicalrestraint 172 Physicalrestraintandphysicalholding 173 Bullying 174 15. Working with Strong Feelings and Supervision 175 Thesupervisor’stask 175 Supervisionwithastaffmemberwhohasbeenphysically attackedbyachild 177 Workwithchildrentowardswhomwehavepowerfulangryfeelings 178 Whatisourapproachtoworkwithachildwhowefeelisstuck? 179 Vulnerabilityinresidentialworkwithchildren 180 16. Management Structure and the Therapeutic Task 182 Management,treatmentandsafety 182 Contactbetweenseniormanagersandhouses 184 Staffhoursofworkinrelationtothetherapeutictask 187 Thereductionofhoursstaffworkanditsimpactonthe therapeuticapproach 188 Dowehaveenoughunplannedtimeatwork? 191 Preservingthinkingspaceindifficulttimes 192 17. Special Events 195 ThegivingandreceivingofpresentsatChristmas 195 Birthdays 197 Groupholidays 198 18. Other Questions, Other Possibilities 200 Workingwithchildren’sparents 200 Bedwettingandsoiling 202 Children’sclothingandappearance 203 Childrenbuyingtheirownteddybears 205 Ticklingandplayfighting 206 Peergrouprelationshipsforchildren 207 Thepossibleimplicationsoflockablecupboardsorboxesforchildren 209 references 211 subject index 214 author index 223