“In some respects the therapy is the ‘order’ of the community and the ego- functioning and behaviour of the staff. The milieu, the whole managementstructure must reinforce and support this; if contradicted it will re-enact and echo earliest environmental failure and breakdowns.” John Withwell
“A therapeutic milieu must provide theright emotional climate for its patients sothat they can regain mental health. It will succeed in doing this to the extent that it is able to create a human and social environment which promotes the social solidarity of staff.” Bettelheim
“Social Care workers dealing withunintegrated and traumatised children are frequently at the edge of their emotional and intellectual capacity.” Campbell & Draper
“Psychological development is based on the parental capacity to tolerate andunderstand a child’s raw emotional statesof distress…. That it is the mother’s job to make sense of these bewildering sensations for the baby: to give them shape, coherence and meaning which then makes them tolerable.” Bion
“The focus for this is the provision ofprimary experiences for each child, in a dependent attachment with a specific member of the care team.” Tomlinson
So, questions must be asked….4.What is it that staff are asked to hold, or uphold, on a daily basis?6.How can we create the holdingenvironment for staff?
What is it that staff are askedto hold, or uphold, on a daily basis?
How can we create the holding environment for staff?
Management’s responsibility:Continuing source of encouragement,support, guidance and directionDemocratic approachShared sense of responsibilityFoster potential for leadership in others
“It is possible to have management withouttherapy but not therapy without management. Management includes safety, boundaries and all aspects of the organisational structure.Without these conditions, traumatised children will not be able to make use of therapeutic work…in residential and institutional settings the management structure of the whole organisation is relevant to the therapeutic task.” Menzies Lyth
What is it we are asking staff to do with all this? To provide a secure base throughthe use of themselves as the ‘good enough’ parent
So what can we do?Provide a safe physical presence to the childrenDemonstrate that we are reliable trustworthy grownups.We can try and protect the children from furtherharm from others and from themselves (That’s a bigask)We can be the recipient of the child’s anger, fear andconfusion (To be the bad object)
So what can we do?We can become emotionally available to thechild, to allow a dependency to develop whenneededWe can meet the child’s primary needs forphysical care (regression may or may not beinvolved here)We can provide clarity and honest answers tochildren’s most difficult questions (Why does mymammy not love me? Why did my brother hurtme?)
So what can we do?We can be forgiving and non punitiveWe can demonstrate an unconditional and nonjudgemental attitude at the most difficult times (whenstaff have been hurt or lied about)We can listen, believe, acknowledge, and empathize withthe child around the source of their trauma and suffering.We can provide new positive experiences which fosterthe child’s potential to grow and develop and whichaddress some of the voids in their lives. (Be they in theareas of play, education, sensory, or other)
So, what can we do? We can provide the child with the feeling ofbeen unique and special to someone in theirworld. (Special time, individual care and treatmentplan, key worker) We can strive to manage the child’s anxieties andreturn them to the child in such a way that thechild has more control over them.We can be professional and genuine at all timesand in all our dealings with the children and theoutside world around them.