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Education as a Therapeutic Intervention

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1 Education as a Therapeutic Intervention
Jenny Dover

2 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) Definition of Child Mental Health Health Advisory Service

3 Insecure 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. Insecure Attachment in School

4 Core Concepts of Attachment Theory
The secure base Bowlby 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.

5 2 risk factors in school exclusion
Maternal illness Early separation from carer School Exclusion

6 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

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

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

9 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 Reciprocity (Brazelton,Stern)

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 INTERNAL WORKING MODEL

11 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. Disrupted Attachment

12 Defensive behaviour in the classroom
The omnipotent child The omniscient child The helpless babyish child The child who projects uncomfortable feelings into teacher or peer The child who avoids the challenge of the task/denies difficulties The child who keeps moving or cuts off The child who uses the task to distance teacher or keep her near etc Defensive behaviour in the classroom

13 Secure Insecure/Anxious Avoidant Resistant/Ambivalent Disorganised
Attachment Patterns Identified by Strange Situation Study (Ainsworth 1969) Secure Insecure/Anxious Avoidant Resistant/Ambivalent Disorganised

14 Disorganised Attachment
Strange situation In Class Parents may be traumatised, drug abusing or have mental health problems. Frightened/frightening Child experiences chronic uncontained anxiety Hypervigilant Tries mixed approaches (approach/avoidance) to connect with parent 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 14

15 Psychological processes affecting relationships
Henry, 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

16 Putting 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) Putting Feelings into Words

17 Containment/The teacher’s task
He is open to children’s communications and projected feelings without being overwhelmed. He makes sense of these He conveys his understanding to the child through words or actions Eg 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….” Containment/The teacher’s task

18 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 Teachers/Containment(continued)

19 Therapy is about making and breaking stories about self As 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 it’s hard to focus on the work Storied self

20 Reciprocity and the teacher
Learning takes place within a mutual relationship. The teacher and the student influence each other. Can overwhelm or underwhelm each other Interaction 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 Reciprocity and the teacher

21 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) Reciprocity

22 Implications: Disorganised child
Early identification Highly structured environment Prof network important Avoid Shame Conceptual thought difficult Immature stage of learning Control of teacher Action replaces words as communication When he aroused appeal to ‘thinking’ brain Use headteacher Implications: Disorganised child

23 Disorganised continued(2)
Build in physical activity Cannot self-regulate feelings Hyper-aroused/dissociating Be on hand not intrusive Trauma triggers Drawings Hypervigilance Overwhelmed or restricted by creative activity Left brain tasks to calm him Avoid SHAME Disorganised continued(2)

24 ….and for the staff A safe place to discuss Seek support
Develop consistent plan Review practice …..from reaction to reflection – the work discussion group ….and for the staff

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