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 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 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 Springfields) from childhood to adolescence and (at Westfields and Hillfields) 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.
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.
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.
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.
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.
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 Quality Standards, children’s act 1989, children (leaving care) act 2001, children’s homes regulations 2015 and other related legislation and guidelines.