Monthly Archives: May 2012

Stop Blaming the Children, Dr Bruce Perry ft. Plan B

Dr Bruce Perry, M.D., Ph.D, American Child Psychiatrist and Ben Drew a.k.a Plan B, rapper and film maker, may not on the face of it have much in common.

In an interview with Evan Davis on Radio 4’s Today programme broadcast this morning, Plan B talked about the social exclusion of children and young people and the reaction to last summer’s riots.  He runs therapeutic music sessions in a London school with the ‘chavs’ and ‘hoodies’, so often the focus of middle Britain’s rage. He described the enormous challenges facing the children he works with and said,

‘These kids are having to deal with stuff that most adults do not have to deal with.’

Then he explained why the march to stronger discipline doesn’t work for children who are used to being excluded and told they are useless.

Dr Bruce Perry’s research is in the impact upon the young, vulnerable brain of trauma and stress, whether that is due to growing up in fear within violent and neglectful environments or witnessing murder and abuse, in other words, the sorts of children Plan B is working with.  In his book ‘The Boy Who Was Raised as a Dog’ in which he describes his experiences of treating such children, he writes,

‘They’d suffered trauma – such as being raped or witnessing murder – that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems.  And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems …..’

We have thankfully reached the position now where adult survivors of trauma, such as soldiers who have fought in battle, are recognised as suffering with stress-induced symptoms. We do not however allow our children the same right.  Where a soldier’s heightened startle reaction, their difficulties being in loud, busy places, is understood and sympathised with, our stressed and traumatised children are expected to get on with it and worse still have their symptoms written off as wilful and listed under ‘naughty’ or ‘disruptive’.  In busy schools, they struggle to concentrate and ‘do what they’re told’ and are then punished, excluded and maybe even medicated.

Those of us who care for some of our nations traumatised children, whether foster carers, adopters, youth workers or social workers will be well aware of this inequality in the rights of our children. The Schools and Education section of the Adoption UK message board gives a tiny snapshot of how they are viewed.  It is a catalogue of punishment, shame, lack of support, inaccurate diagnoses and heartbreak.  Every day I read a list of unsettling search terms which bring readers to my blog.  By
9am this morning one parent had entered ‘adopted son humiliated in front of class’,
the day before came ‘six year old in isolation at school’.

Neuroscience established, thirty years ago that young brains exposed to trauma and stress will produce behaviours in children such as aggression, defiance, anxiety and concentration difficulties.  There is plenty of evidence also which points to the most effective methods, therapeutic methods of healing young minds.  I don’t know why this weighty body of evidence has not trickled down more than it has into education, medicine, social policy and into general public awareness, as it has for adult mental health issues.  It takes some effort to see the world through a child’s eyes, to step away from blame and shame and the moral high ground has always been a more comfortable and familiar place to stand.  We will look back upon this period in history
with shame and wonder how we ever thought it right to discriminate against our
children with such lazy cruelty.

Dr Bruce Perry writes,

‘Ultimately, what determines how children survive trauma, physically, emotionally, or psychologically, is whether the people around them – particularly the adults they should be able to trust and rely upon – stand by them with love, support and encouragement’.

Plan B is doing just that, it’s about time the rest of us joined him.

Therapeutic Parenting, Day Four

Day Four, the final day of the course addressed some of the more extreme behaviours that those caring for children with developmental trauma may bear witness to.  This can be a tricky area, especially during those times when incidents pile one on to another; the danger being that we are frequently drawn into conflict and anger and morphing into either shouty nags or weepy recluses.

Firstly we must pick out the more major incidents and drop the smaller stuff.  I am currently practising the following phrase,

‘There’s five things which have happened, I’m going to deal with two of them and leave the rest.’

I am also waiting for a calmer break in which to deploy,

‘You’re throwing a lot at me at the moment, what is it you want to tell me?’ (expressed with raised but calm energy).

For most of us knackered parents and carers it can be difficult to differentiate and then deal appropriately with the really big stuff, namely the kicking, punching, biting of the brother, sister, dog or whatever.  And this stuff has to be clearly off-limits, unacceptable.  For this we were taught the Dan Hughes 60 Second Scolding, because clearly, when you’ve seen your child kicking their sibling in the head a bland ‘I wonder why you felt the need to do that’ is not, at that moment going to be anywhere near what’s required (although it is something to bear in mind once the storm has blown over).  The 60 Second Scolding acknowledges that when something really major has occurred there is shouting and anger from those around.  But unlike the uncontrolled, five minute, lecturing, head-fit that I am so practised at delivering, this version is short and controlled and focussed on teaching whilst keeping the shame to a minimum.  So it goes something like this,

‘I’m angry because ……., you did ……………, I think this might be why, ……….., it’s not acceptable, ………….tell me about it ………….., this is the consequence……….’

And as we all know from long and bitter experience, the consequence must be specific and related.  I like the ‘you’ll help me clean so and so’s room’, or ‘you can help me tidy the toys’ as it gets useful things done, we bond surprisingly well over cleaning and we can look at our work and feel jointly proud.  Taking things away, in my experience, doesn’t work (the resultant shame hangs over them like a cloud and they will show they don’t give a shit until they have no belongings left, no money and no rights to do anything enjoyable at all).

Our course tutor, the esteemed Mr R is brilliant at all this and has put me back on track many times.  Of all the golden nuggets which he handed out over the four day course I will leave you with this one. We are all human and therefore fallible and none of us was raised to raise children with developmental trauma.  We will therefore make lots of mistakes along the way, which is natural and unless we experiment and practise these techniques we won’t reach our children let alone help them to reduce their shame and process what has happened to them.  So let’s all be kind to ourselves, cut ourselves some slack.

I felt the need to write about this course because I know that many carers and adopters around the country do not get access to such good quality, practical training and they should.  So as the government talks of giving out vouchers for free parenting classes in Boots, remember that we should all have a right to ongoing training and support; we are after all raising some of the most damaged children in our society, and it isn’t child’s play.

Therapeutic Parenting, Day Three

On Day Three we learnt about the power of narrative and storytelling for helping traumatised children make sense of things.  Many of our children are never of their own free will going to offer to explore their feelings, or admit to doing something naughty, or going to want to look into their past.  They will rage and kick and break. They are hostage to their rages and we can become hostage to them too if we are not careful. We need to bridge the gap between the rage and the feelings on their behalf, help them explore their most shameful feelings, in an accepting way.

I have been trying to use narrative for some time now with some success.  When I have not been successful it has been because I have not bought myself time, my thermostat has flipped out and I have dived right in there with something angry and shaming.  I am learning to step back and plan a strategy, even if I am boiling mad.

I am finding Dan Hughes’ ‘I wonder’ questions the best place to start.  So instead of saying(or maybe I’m sorry to say ‘shouting’),

‘I CAN’T BELIEVE you’ve taken a ten pound note, which is MINE and HIDDEN it in your school bag, that’s STEALING, the POLICE come when grown-ups STEAL,’

I tried removing said ten pound note and thinking on it for a while, away from him lest his ‘cocky’ behaviour set me on a path of mutual destruction.  I found that in a few minutes of thinking time I worked out why he might have taken the money, what it was he wanted.  I also remembered what I had learnt earlier in the course, that due to their missed development our children are impulsive and can’t see ahead to consequences (oh that cruel double whammy).  Quite quickly I wasn’t projecting ahead ten years and imagining a criminal mastermind, I was empathising with him.

‘I wonder why you wanted the money?  I’ve been thinking you might really have wanted to buy those trading cards and I can understand that.’

He went bright red in the cheeks and went for an immediate denial.

‘Nothing bad is going to happen and I love you and we will talk and sort everything out after school.’

He went to school without any further murmur of denial or any rage.  When I picked him up from he bus stop that afternoon, he got in the car and muttered ‘sorry ’bout earlier’.  This might not sound much like a breakthrough, but it is chez Donovan.

‘Thank you for apologising.  Now would you like a takeaway for tea and we’ll sort everything out?’

He was ecstatic and yet the thought crossed his mind ‘mum’s gone mental, I’ve done something terrible and she’s taking me to buy Chicken Korma’.

In short, we heated our curries, ate them at the table, explored the lure of the trading cards and why we don’t take things from each other.  I employed all my best curious and empathetic techniques and the narrative was the key.  Lest the super nannies out there think I’ve been a total fool, I also gave him some chores to do as a consequence, some things I know he enjoys and we can do together.

In happy, well-attached families with birth children I can see that the short-sharp or even long and drawn out punishments might be effective responses to taking money.  For us, we must never forget shame.  Our children are full of shame and if shame is raised their behaviours only escalate (trust me on this one).

Once the vacuuming consequence has been carried out I must remember narrative again.  I must tell Jamie the story back starting of course from ‘you’ve been doing really well lately’, moving to ‘and then I found some money had been taken’, then on to ‘but you apologised and that was great’ summarising with ‘and then we talked about it over our curries’ and concluding with ‘and you’ve done that vacuuming really well’.

At the time of writing he has been calm at home for three days, which is something of an achievement.  If we can make it over the weekend I’ll be singing and dancing.

Therapeutic Parenting, Day Two

For those of us caring for and parenting children with Developmental Trauma it is clear that established methods don’t work.  Most of us will have tried warnings, consequences, behaviour systems and ignoring.  Some of these may work, some of the time, but for most of us they don’t work at all and can even make matters worse.  Exhausting the traditional methods leaves the toolbox empty, and parents and children living in a war zone feeling stressed and exhausted.

Shame is central to Therapeutic Parenting because our children are bathed in the shame that what has happened to them is somehow their fault. On top of this they know that life is dangerous, unpredictable and unsafe and that trust and love only make them more vulnerable.  Threaten to take away a toy, or an outing and they will be more convinced still that they are undeserving and bad.  They may appear not bothered, or they may shout and rage at you.  Either way, something’s for sure, they’ll repeat an offense over and over until you gasp ‘nothing works’.

Dan Hughes the American Clinical Psychologist who has done so much to establish effective therapeutic methods of working with traumatised children, advocates the use of PACE.  PACE stands for Playful, Accepting, Curious and Empathetic.  This is the way we must approach and reach our children.  It means that we must try to see the world through their eyes and stay with them through the most difficult times.  We must ask ‘I wonder why you kicked your sister in the leg’ ‘I wonder why that made you so angry’ ‘I noticed that you found that hard’ ‘I wonder what that was about, let’s try to figure it out together’.

It is very hard to do and requires practise but it works.  It helps to reduce the shame and anxiety our children feel and gives them the message that someone is listening and understanding.  Playfulness, humour and fun help our children to see that we experience them as likeable individuals who we choose to spend time with.  That’s not to say that they must learn some behaviours are unacceptable, but even appropriate consequences can be managed using PACE.

All this has been the refresher that I needed and I have learnt some new things too.  The golden nugget of the day was Acts of Random Kindness, little rewards given at unexpected moments because our children exist and not because they’ve done something to earn it, in other words,  because they’re worth it.


Therapeutic Parenting, Day One

I am attending a course this week on Therapeutic Parenting.  Although I like to think I’m already a therapeutic parent, sometimes I lose sight of the ‘hows’ and ‘whys’ amongst the strains of caring for children with Developmental Trauma.

Day One focused on the ‘whys’.

It is quite simple really.  Babies are not born with fully formed brains.  They need loving eye contact, consistent care, the comfort of another, the presence of trustworthy adults who deliver in order to develop the parts of the brain which we take for granted.  We were shown two brain scans; one of a Romanian child, who grew up in an orphanage, one of a child who grew up in a loving home.  The differences in frontal lobe activity and development were astonishing.  It brought home to me that what our children and their carers are struggling with is brain damage.  Yet it is so much easier to judge their behaviour as naughty.  Why won’t they just do what they are told?  Stop answering back?  Stop lying? Stop hurting others?  Why are they so manipulative, controlling? Why won’t behaviour systems work?  Why do they repeat behaviours over and over?  The answer in the main is that they just can’t help it.

I spent some time sat in the garden with my son yesterday. I don’t know if he was in the mood to talk or whether I was open after a day of training, maybe a combination of both, but he recounted another troubled day at school.

‘I’m fed up with getting into trouble for things I don’t even know I’m doing,’ he said.

I empathised with his feelings of frustration.

‘If you could choose between me with Tourettes or me like I am, what would you choose?’

I paused to contemplate the struggles of living with Tourettes. ‘I’d choose you as you are.’

‘I wouldn’t, never, ever, ever. I would never choose to be like I am.  Always in trouble, always the one who needs special this and that and even you have to learn how to look after me.  If I had Tourettes people would know what that was and understand me.  And I wouldn’t have all those scary images in my head.  I just want to be normal like everyone else.’

He was emphatic.  It was a rare moment of supreme honesty and it bowled me over.  This is what it is like to grow up with Developmental Trauma.