Attachment, Trauma and Resilience

Acknowledgements
Each member of the family should take this as a particular and personal thank you. You know that you have each brought unique gifts to the family, and that I am grateful to every one ofyou.

Lil Brooks tried her best to get me to write something readable. I hope she succeeded; ifshe failed it was through my inadequacy and not her lack of effort.

My colleagues at BAAF have encouraged me to write, and have been unfailingly supportive. 1 am indebted to them.

My parents have been a steady source of inspiration and encouragement.

lowe a debt of gratitude also to all the people who have produced research and theories and practice that have helped me in my efforts to make sense of the life I have shared with children. I also thank Trentham Books Limited, publishers of my previous book, Surviving Paedophilia, for permission to extract 'The Carer's Story - Rage' and 'The Carer's Story - Fear' for use in this book.

My husband Brian has been the single greatest influence in my life. If anything in this book speaks to you, then you will be hearing his voice equally with mine.

The author

Kate Cairns is a social worker and teacher who works as a trainer consultant for BAAF Southern Region. She is also the author of Surviving Paedophilia as well as several articles.

Attachment, Trauma and Resilience Therapeutic carinq

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ATTACHMENT, TRAUMA AND RESILIENCE

Patterns persisting over time: common sense is what welearn before we are two

What do we observe?: life with the child Securely attached children

Insecurely attached children Questions

What can we do?: approaches to living and working with chlldren willt unmet attachment needs

The four step plan

Thcrupcui ic rcpnrcut ing

Promoting affective attunement

Promoting rcinregrutivc shame

Relating to self and others: rage, reflection and reciprocity What happens>: theory and research about rage and anger What do We observer: signs and indicators of rage, reflection and reciprocity

Rage Reflection Reciprocity Questions

What can we do?: approaches to helping children regulate rage

Anger management Assertiveness Conflict resolution

7. Trauma: transformative experience Fear

What happens? - theory and research about traumatic stress Trauma

Traumatic stress

Spontaneous recovery

Post traumatic stress disorder

What do we observe? - signs and indicators of disorder Disruption of normal functioning

The behaviour tells the story

Questions

What can we do?: approaches to living and working with traumatised children

The three phases of treatment Grief

What happens>: thinking about less and grief

CONTENTS
55 What do we observe? life with the grieving child [38
Questions 140
57 What can we do?: approaches to living and working with 140
57 grieving children
60 8. Resilience: affirmative experience 141
66 Solitude [43
67 What happensi: thinking about the development (!( 14~
67 personal resilience 14(,
What do we observer: lif« with children who are
71 developlng personal reslltence
73 Questions 14\)
,74 What can we do?: promoting personal resilience with 149
78 children who find solitude difficult
80 Compassion [51
84 What happensi: thinking about the development of 151
social resilience 154
84 What do we observe?: life with children who are developing
88 social resilience
89 What can we do?: promoting social resilience with children 156
92 who find compassion difficult
92 Encourage social inclusion 156
Encourage personal and social efficacy 157
92 Encourage continuing change 158
95 Tranquillity 163
95 What happens?: thinking about the development of 163
98 trans personal resilience 164
98 What do we observe?: living with children who are
99 exploring tranquility , . 166
99 What can we do?: promoting transpersonal resilience I
100 '9. In the end 167
102 171 I
105 References
106 Glossary 175 I
107 179 J
Inde.~ I
III I
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ATTACHM EN" TRAUMA AND RESILIENCE

not be enough to see me through. I started to read and learn as much as I could about ideas from the wider world that might help me make sense of what I was learning from the children. Some of these great organising ideas are presented here. Others have been assimilated, and then expanded by more recent research and theory, so that I can make even more sense in retrospect than I could at the time (if I had known then what :: know now I might have made fewer mistakes). References are provided so that you can go through the literature yourself if you wish, I hope that I have faithfully represented the theories and research of others; any errors are mine and not theirs, and I am grateful to them for their wisdom and insight.

This book is not intended to be a manual, It does not tell you how to do it. Instead it provides a story to illustrate the experience offamily life with children who have lived through overwhelming stress, and an account of the ideas drawn from theory and research that helped me to make sense of this experience. It also includes suggestions for families and agencies about what we can do to promote recovery and resilience in children who have survived such adversity, These ideas are just that, and should never be treated as blueprints, but rather as prompts to your own creative thinking about the needs of the children entrusted to you,

It is particularly important to recognise that living with traumatised children evokes strong feelings and powerful dynamics, Every family is at risk of becoming dangerously disordered when living with such disorder. It is vital that good supervision and support are available to families providing therapeutic parenting. Such supervision should be emotionally responsive enough to carry the family through the many turbulent experiences that will assail them, and professionally informed enough to be able to discern the points at which the family is slipping towards the powerful vortex of disorder that follows traumatic stress. I hope this book will therefore be useful to such supervisors, and their supervisors, as well as to families.

The children here presented are composite. AU the separate elements of the events described actually happened, but to different children at different limes across the whole 25 years, Those concerned have seen and read the book, and have been enthusiastic that it should be available to others, We all hope that it will be useful to new generations of children separated from their families, and the adults and children of the new families that care for them,

ii

Part I

Making Love A story of creation and destruction

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AI'IN) !MINI.I l<AIJMA AND J(I~SILWNCE

'Me. I'm here. Listen to me. I want .. .' Becoming, a person already. Needing others, another at least, beginning to know dependency and trust. Making relationships.

Later, not much later, for we are clever creatures, after rage comes fear and the beginning of imagination. What if I am abandoned? I am dependent, I am vulnerable, I can be hurt, I am afraid. This, too.rimprinted in the brain forever. And if it is not imagination, ifit is real and true, then terror rules. No terror will ever surpass the terror of the abandoned child. All later fear an image only of this first and primal fear, the annihilation of the utterly dependent.

Then comes grief. Not an emotion, this, but a complex state of being in response to loss. Still an agent of change, though, the next experience on the way to personhood. Beyond fear, there is the reality of loss, and not one of us can live a life without it. Beginnings lead to endings, lives lead to deaths. How will the growing person build this knowledge into their being in the world?

The truly human emotions begin here. Solitude, compassion and the inner peace and joy of a self-aware tranquillity. Desire and rage and fear engage the primal nervous system of the brain stem, filling us with instant energy, priming our muscles for immediate action, providing a build up of inner force which resolves explosively. By contrast, solitude and compassion and tranquillity build energy which is sustainable and which resolves cathartically in an "oceanic" experience of connectedness and well-being.

Beyond grief, then, ifall goes well, is solitude. Alone but not lonely in a supportive universe, we can explore the full height and breadth and depth of our personhood. If, that is, our universe has supported us. If all has indeed gone well for us. Ifwe have taken desire and rage and fear and grief in our stride and into our being, and have grown strong and flexible

and resilient, then we will not be scared to be alone. .

After solitude, compassion. Alone we come into the world, and at the end we go to our graves alone. When we know this in our hearts, we can reach out to others. Equal in our mortality, we can at this point grow into our full humanity as we learn to share the sorrows and the excitements which shake the lives of our companions.

And, at the deep heart's core, tranquillity. A human has been created.

In a world of chance and change, love has been made.

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2;-Attachment'

AFFECTIVE ATTUNEMENT

Sit'down. t~is. A [ori )9~rney we had of it, to come to this birth. Nine months and mor~:'you being in no hurry to emerge from your warm sanctuary. I the impatient one, longing for our first meeting, rejoicing a/ready in your otherness.And a meeting it was indeed. You opened y~tlr eyes in an unfocused gaze of milky desire, and I was ca~ght forever In a bond of love like no other I had known.

'I can remember ten heads of home. I know their names. I remember my mother, and my gran, and my auntie, and three foster parents, and my mum ~ friend Gus whose real name was Caesar but they took me away from him.'

• • •

For children who suffer disorders of attachment, nothing, absolutely nothing, is easy or straightforward. Today breakfast has come and gone and he has not appeared. Yesterday, our day of rest, he arrived in our room at 5 a.m. with mugs of coffee. 'I wanted to do something for yoll· Aren't

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you pleased?' ; .

Struggling to sit up in bed, I remember when we used to sleep naked, limb against limb, the friendliness of it. Those days ended with fostering, which could be sponsored by the makers of flannelette nighties. Struggling, too, to find a calm voice, knowing he truly means well has no access to the same basic understanding of others that most of us happily take for granted. 'It's a good thought, but we still need to sleep, Shan;. You go back to bed, and we'll have a drink together later.'

Slam. Crash. Coffee and mugs meet wall and carpet. A meeting which will lead to a penn anent relationship if 1 don't get up and do something about it. And I have to get him to help me, get him to stay connected and take responsibility for what he has done. At five o'clock in the morning.

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along with this solution. The "fight" was really a scuffle, and no one has been hurt. Shane gives the pencil case buck (0 Daniel, and apologises so pleasantly that I should think [ am the only one who knows he still has no real idea ofwhat he's done,

Rachel, aged six: 'My Fiend Tessa s mum and dad have spilt up and she has got to choose who 10 live with. If you ever did that I would go and live with granny and I wouldn't ever come and see either of you ever again.'

Shane arrives home cheerful. 'Have you had a good day?' I ask, interested. 'Yeah, great. We watched a video in English.' He looks back at me with a face innocent of all guile. He genuinely has construed this as a good day, and that is how he will remember it. We have some work to do on this, I make a mental note, but not right now.

His social worker is due to arrive at any moment. I suggest we put the kettle on to make tea and biscuits for him, and Shane takes up the task with enthusiasm. He likes seeing his social worker. This is one of his most successful and comfortable relationships. He is central to it, and is clearly the focus of care and concern within it, yet it remains occasional and therefore superficial and, most importantly for Shane, it is a relationship in which his actions do not have evident consequences. I am grateful for this on his behalf. Grateful, too, that here wehave a local authority still able to provide some service to the children it looks after.

After they have gone off to the burger bar, or pizza palace, or wherever

else is serving its tum as a social work office, the rest of us gather for the evening meal. These occasional breaks allow us to have meals together without the continual jolting reminders of the painful gaps in Shane's understanding of the most basic things about the ways human beings relate to one another. He is intelligent, and sensitive, and loving. And at" some very early stage of his development he missed out on vital and fundamental learning.

Day by day he makes us aware of the basic relational skills which otherwise we would take entirely for granted. Non-verbal signals and simple relational sensitivities are nearly all missing for him. Trust is

8

" i

ATTACHMENT

missing. Fun and playfulness are missing. Curiosity and interest in the world around him are missing.

In place of all these he is left with a massive defensive egocentricity, uud u divided self'whleh simply CIlIll10t take responsibility 01' make pluus since the left hand has no idea what the right hand has done, is doing, or may be going to do. YeL with strangers he appears open aud friendly and trusting. His beautiful spaniel eyes gaze adoringly at anyone who might let him eall them his friend. We, who love him, arc afraid for him.

Now he arrives bouncing and spluttering with excitement. He has, by agreement, gone on from his meeting with his social worker to play in the park. There he has met up with a friend. Wants to go back to his friend's house. Wants us to lend his friend a bicycle to make the journey easier. 'Who is your friend, Shane?' 'Oh, he lives up the other side of the estate. He's in my class at school.' 'What's his name?' He looks at me blankly. 'I forgot to ask him. Oy!, he shouts towards the front door, 'What's your name? The old dear wants to know!'

'Shane,' I begin, thinking I ought at least to try, 'friends are people we know welL People we like and trust. Not just .. .' I give up. This is a time for decision not explanation, 'No,' I say, 'the answer's no. But you can bring him in and introduce him to me, and he can stay here for a while if you like.' Happy enough with this, he brings in a bedraggled waif, and proudly introduces him, having checked his name afresh in the hallway']: give them both drinks and biscuits, and Brian takes them off 10; a game of snooker.

Bedtime brings tantrums. The social worker had brought news of fresh rejections, as we knew he would. Now, at last, in the peace and quiet of the ending of the day, the message sinks in. 'Come on, Shane, time you were thinking of'bed,' I suggest. 'You shut your face,' he explodes, 'leave me alone, You're not my mum. I hate you. Just leave me alone.' Brian steps in, his deep quiet voice almost always effective in this situation. 'That's enough, Shane. Go to your room. We'll talk about it later if you

, : .'." "J" •

want to.' Shane stamps upstairs, slams one door,two doors, turns on his

radio at full volume. W~'wait, look at one another, wait a little longer. Sigh thankfully as the music is turned down. Now Brian will go and see if Shane wants to talk. 'Remember to make sure he packs his pencil case

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3::>N3nrS31[ aNY YY-InV1l1 'lN3Y1lHJYllY

ATTACHMENT, TRAUM A AND RES lLIENeE

doing everything possible within the resources available to them.

The decision is made that Kelly will return to us and with us, This is happy news, Less hopeful is the fact that absolutely nothing else in the situation looks like changing, except that some assurances have been given.

David. introduced to his new baby brother Tim, seems interested, even pleased. Later I hear him toddling to the bathroom and go to help him manage the mysteries of buttons and elastic. Instead, I find him attempting to flush his teddy bear down the toilet. As the manoeuvre fails, he drags the sodden creature out by its ear and holds it aloft. 'This is Tim,' he announces cheerfully.

I n the car on the way home Kelly maintains an endless flow of meaningless chatter. Eye contact produces a sweet and dazzling smile. She is evidently as happy as a child can be. I run through a mental checklist - tablets locked up; knives locked away; chemicals all safely stored. I think we have it all covered.

Arriving in time for the evening meal, Kelly is delighted to see everyone again. She might have been away a year instead of a week, so excited and pleased is she to be home. Throughout the meal she chatters on about friends in school, the latest gossip, television programmes she has seen and those she has missed. The others take the barrage good" naturedly, pleased to have her back, while reminding themselves of the need to put earplugs on their next shopping list.

Later the whole group get drawn into their own idiosyncratic version of hide and seck. and the evening passes cheerfuIly till supper time, Now suddenly Kelly is pale and quiet, sipping milk and nibbling at biscuits which the others arc consuming with gusto. J look across at Colin, note that he too has registered the change, is on the alert. 'I'm going to get ready for bed .. Night: she says, and disappears.

Within seconds we hear the sound of heavy dragging, followed by a crash. Both of us run for the stairs. Her door is closed, and blocked by some piece of furniture dragged across it. We can hear her sobbing, but she makes no response to me as 1 call her name. Colin fetches David and Rachel. Sometimes Kelly will respond to Rachel when she has gone

12

ATTACHMENT

beyond hearing the rest of us. 'Come on, Kelly, it's me, Rachel. Open the door, love.' 'I can't, Rae, I've had it. 1 can't do any more.' Then suddenly, shouting, 'I hate him, Rae, I fucking hate him. I wish he'd killed me when he had the chance.'

Together we force the door open enough for Rachel and me to squeeze in. You can lock away the drugs and the knives, but light bulbs shatter into sharp and cruel edges, Her hands and arms are bleeding profusely. Rachel pulls the chest of drawers away from the door, David arrives with a clean towel, Colin takes a pillow and a duvet to the car, and we set off for the casualty unit 15 miles away,

I hold her in my aims all the way there. She shivers and occasionally sobs, but has finally gone beyond words. In the hospital they remove .remaining fragments of glass, and dress her wounds. We point out that 'this is self-inflicted-and thatwe believe that Kelly is still very angry and upset. Is there any possibility of a referral for psychiatric assessment, we ask. With the resources available, injuries like this, which do not constitute attempted suicide, do not merit automatic referraL We are offered the option of going to our GP and asking for a referral to the waiting list, currently standing at about nine months. We try to picture what Kelly might be doing in nine months time.

At home, all of us by now very sleepy, we help her up to bed. I lean over and kiss her forehead. 'Good night, sweetheart, remember we all love you.' From somewhere she summons a cheeky grin, 'Just as well really, innit? 'Night.'

In my dreams, [retaliate. Smash. Batter to a pulp. Ferocious violence pours through me. [wake refreshed and relaxed. grateful for the versatility of the human mind.

"did hate you.mum' 'Yes.'

'I wanted to kill you.' ''Yes, you did:

'And now I love you.'

'I know. I love you too. Sleep well:

13

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door, and David and Tim emerge, still arguing differential equations; to make their own less frazzled way to schooL

A quick coffee with Brian, and I'm at the telephone for my morning call, so routine by now 1 could put it on a tape recorder, responses and all. We need help with this child. Promises were made to us, all of them broken, that we should have full support, everything we needed to make the placement work.

There was a time in our work w~en such promises meant something, when we safely took into our home and our hearts children whose battered lives and wounded spirits could find comfort and healing ina peaceful environment. But those days have gone, now the same needs stretch us to the limit and beyond, as those who once supported us have had their own work redefined. Once we could share the burden, which then became no burden; now priorities have changed, services reduced, and we are left dangerously exposed as the objects of attachment for seriously wounded children.

'She's in a meeting at the moment. I'll ask her to ring you.' 'Tell her it's urgent.' (Tell her I'rn falling apart. Tell her we're desperate. TELL HER TO READ MY LETTERS!) 'She'll ring you within an hour.' I say thank you nicely, the way I was taught, but know I won't be holding my breath for the 'phone call. Promises butter no parsnips, speaking of which, there are things to be doing.

A few tasks on, and the telephone rings. A miracle? No, the school head of year. Jay has attacked a boy during the games lesson, and needs to be picked up. Ever since his last suicide attempt, when the psychiatrist said he was too traumatised for psychotherapy to be anything but dangerous, Jay has been accepted at.school on the basis ofa special arrangement whereby if things get too tougb he can come home at any time.

At school, Jay is with the nurse. This attack, unlike others, was actually minor. Friends saw Jay start to "flip" and held him back from doing any great damage. But he is sitting huddled in the chair, shaking uncontrollably and hot to the touch. 'I'm sorry! I'm sorry! I didn't mean to!' Then he looks up, searches my face, 'I wanted to kill him. I really wanted to kill him. What's wrong with me?' I can't answer that, certainly not now,not here. The school staff have been wonderful; he is so able, so eager to learn and do well, they have made space for him, and, so far, he has not

16

TRAUMA

been excluded. Lets-nor push our luck. I soothe him, thank them, and take him home.

Five minutes in the car, and the verbal torrent starts. My driving, my looks, my age, myrelationship with Brian, my tastes, my friends, all are targets for the stream of jibes. I stonewall, focus my attention on the person behind the words, stay peaceable. As we get into the house, I stop him, turn him to face me, 'You're pushing me, Jay, Why are you doing that?' 'It's fun. Winding the staff up - it's what I'm good at.' 'So what happens then?' 'They send you away. Send you to your room. Tell you to get out of the Unit.iDo you want me to send you away?' 'NO!'

I look at him and smile. He grins, laughs, grabs me in a bear hug. 'You're too little to hug properly,' 'Perhaps you're too big. You should have been with us sooner. Lots of child-hugs on offer here.' He moves away from me, looks at me full in the face, 'I got lost on the way.' Ain't that the truth.

Peaceful now, we make cakes for tea. Yet still he is anxious, scanning my face and body language constantly for signs of displeasure, checking his progress with the simple tasks, belittling his own abilities. Then the mood changes, tension begins to build. I glance at the clock; the others will soon be home, more people to relate to, more mistakes to make.

r leave him clearing up and go to water the hanging baskets, knowing he will follow. As he comes round the side of the house, I spray him with

"

water. Our game. He runs, and I chase him. He laughs, shouts! grabs me

and wrestles the spray from me. Now he chases, I run. He catches me and sprays me. 'Right,' I say, 'we're quits now.' His face sets, he whisks the top from the spray and empties a stream of water over my head, drenching me. Then he steps back, trembling, begging me with his eyes not to be angry. 'Did I win?' 'Yes,Jay, you won.' 'Is that all right? You're not angry?' 'It's fine, Jay. It's a game. Now why don't you go and see if you can win against the computer?' HI! runs off happily, and I go and change my clothes.

Back in the kitchen, Tim arrives home and I ask, 'Good day?' 'So so.

Where's Jay?' Always the first question. 'Playing on the computer.' He can relax now, slumped down, long legs stretched out, munching fresh cakes and chatting about school, the casting for the school play. what to

17

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'Downstairs, Brian has opened a bottle of wine for us to share with Rachel. David and Tim wander down to watch the news with us and share a quiet halfhour, This night unusually peaceful. No police on the doorstep. No sitting up waiting for the worst effects of substance abuse to pass. No storms and tantrums, leaving windows and doors to repair. Just a littio time to relax and draw breath before we see what nightmares the new nigh! may bring.

But first, a promise to keep. I tap on the door. He is sitting in bed, sticking football stickers in a scrapbook. His music is on, but not too loud. It really is an unusually peaceful night. [ kiss him on the forehead. 'Good night, sweetheart. Remember we all love you.'

'l know. Thanks. I love you too. Leave the light on.'

GRIEF

When the guinea pig died, we put her gently in a shoe box and covered her with flowers. We chose a spot in the garden under a rose bush, and dug a hole for her grave. She was laid to rest there, and we remembered what joy she had brought us in her long (for a guinea pig) life of gentleness and affection, her funny little ways, and how she helped to bring up Charlie the duckling when his mother was taken by the fox. We put a heavy stone over the grave.for we wanted her to return to the elements in her own sweet time. The fox should not have her.

'1 remember a baby boy. My mum bathed him and the water was too hot and he cried and cried. Then he stopped crying, and he was still, , and my mum put him in the airing cupboard. After that 1 got taken away .. '

'When my mum died, 1 was in a foster home. Thto people came to see me, and they talked at me for about half an hour. I didn't know what they were on about. Then one of them said, 'I'm sorry, but your mum's dead.' And the other one said, 'Do you want to go to the funeral?' I said 'No, thank you; and they went away.

• • •

20

TRAUMA

. .,'

At the age of eight, Tim became ill. Viral meningitis as a complication of mumps. Soaring fever andobviously excruciating pain. Rushed to hospital for tests, the good news being that it was viral and not Ii fe-thrcatcn ing. the bad news that it.must run its painful course, with no help for it hut some relief or pain und endless patient silting by the bedside providing soothing washes, and sips of fluid to prevent Tim dehydrating.

We brought him home and put him to bed, and everyone did their bit of being sympathetic and moving around as quietly as usually boisterous children can remember to be, They offered games and toys which Tim was too il1 to use or appreciate, made him cards and picked flowers for his room.

Then suddenly, as happens with children, Tim was better. One minute lying still and silent, utterly drained of energy and life, the next sitting up demanding chicken and chips, lemonade, and why can't I go out on my bike right now?

Now we were the ones who were drained, eight days and nights of constant attendance, no break and no relief, and suddenly all the house .. hold back to normal. We sat back with glazed eyes, and watched it all going on around us. And that, of course, was just the moment for the beloved old guinea pig to tum up her toes.

'She's not moving around much,' says Tina, her carer-in-chief, 'do you think she might have mumps like Tim?' '1 think she's got old age, Tina. Just be gentle with her 'and try to make sure she's comfortable.' ,

She watched as tirelessly as we had tended Tim. Sought out the tenderest tips of dandelion', provided extra sweet hay for bedding, touched and stroked as gently as a loving mother with her new-born babe. But nature had to take its course. At last not moving much became not moving at all, and even Tina had to accept her dear pet had gone.

We asked her what she wanted to do now and followed her requests, helped her to say goodbye. Afterwards, she cried a little, then carried on her life as though nothing had happened. No comments, no discussion, no issues arising, not even any change of mood or pace. Well, fine, we thought, after all it was only a guinea pig.

A few days later; though, the situation changed. This was not just a little clouding over, this was huge, billowing, storm-bearing, cumulonimbus monsters blotting out the sky. 'Come and play in the garden, Tina.'

21

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4 Resilience

SOLITUDE

Arrivingfor the evening meal.four years old, carrying a huge book under your arm like a city executive with his briefcase. 'Where have you been? I've been looking for you for ages.' 'In the caravan. I've been practising being on my own.'

'When they went out in the evening to the pub, my dad used to lock me in the bedroom and tie up the door with rope so I couldn't get out. All they left was a bucket in the corner. I used to draw on the walls with shit. Nothing else to do!

• • •

All good things, they say, must come to an end. In our household, washing machines do it with monotonous regularity. This last one consigned in disgrace to the garage, awaiting collection to go to the tip. The new one installed in its place in splendid, and no doubt short-lived, modernity.

1 am making bread while putting the new machine through its paces.

Bread dough is the one thing readily available to me that I know genuinely and palpably benefits from being treated roughly. Taking out all the frustrations of the week on this simple, wonderfully tactile mixture, I am convinced that this will be, by God, the best bread ever.

As I sd the dough to prove, I notice for the first time what has hccn evident in the background for some time, sounds of activity in the garage. Col ill, I think, doing something vaguely mechanical with car or lawnmower, Til,' other good thing about making bread is that there are stretches of time when the yeast is doing all the work, but I can still convince myself that I am busy. I pick up the paper and sit down to read.

Colin wanders in from the living room for a cup of tea, makes one for both of us. I try to think what it is about this which is strangely disconcerting. [ know what it is - what's going on in the garage?

24

RESILIENCE

The garage, in this least mechanical of households, has become a workshop. Allover the floor are little heaps and piles of things. In the middle,covered in grease and oil and utterly absorbed, is Shane. What was a washing machine has become treasure trove. At first sight the heaps seem random, but in fact there is clearly a sort of order and rationality informing this dismantling .• Casing is stacked separately from coils, circuit boards and wires separately from hoses and valves.

Shane looks up, his face transformed with a smile of pure joy. 'Look,' he says, 'look what I've found. This is for you, this bit. It's a fruit bowl.' He picks out what was once the glass door of the machine. He's right. It has a sort of beauty and an undoubted utility. It will sit on our table for years; Shane's gift to us alL

'And look at this,' he stutters, words tumbling over one another in his excitement, 'this is a magnet, see. It's huge, really strong. And see how this coil goes round it. It's lovely, that, like bright copper. Is it copper, do you think?' I agree with him that it is copper, and that copper is indeed very beautiful. I explain in simple terms my rudimentary understanding of the working ·of electric motors. He is speUbound, caught up in the magic of the way the universe works.

'Can I have this magnet? Please? For my own?' I say that of course he can have it. That he can have any parts of the old machine he wants to keep. But that magnets are very powerful, that he must be very careful about where he keeps it, and what he puts near it. His eyes widen with awe. That something so simple and plain could carry such power. That he can be trusted with it.

I leave him to the delights of his self-imposed task, and go back to put the bread in the oven, and share a quiet cup of tea with Colin. And where arc IIw others, (his peaceable day'? Colin has dum: the rounds ofthe house, has it clear in his mind that this is one of' those occasions when each one is happily occupied.

Kelly is busy with her "family", Fur weeks now she has been tak illg over and transforming the old caravan into a home for the fami Iy of old dolls and battered teddies she has found and rescued from all the corners of the- house where they have been abandoned in the course of other people's childhoods. Day by day she acts out the story of her life, the life she has lived and all the alternative lives she wishes she might have lived.

25

'~Jn1I!U JO ssouqsreq aqt ~U!tUOJJuoo ApBnW!S punoq aaJff!poo II JO laUMO poioxap Am: ljpM Stl llUU !Jl1M anuaff se s1 ldA alit 'unds Sl! JO puo alit 01 aWO;) 01 aAll4 saop cuo uallM puV 'aw!t J!a1{lJo osn a4l10J saaJ AlJaq :l~JI!4;) suoafiins A1BupalaA lllql JaAO;)S!p oi UOSBdl psq JaAaU saq BUn MOl[dWOS pue 'snqqarjo spaou IllO!P:lW Clql ul Olsllladxa curos ~u!dOIMap U! ;:lJnsllajd U:l)jP.l sP.q 'sasioq pun SMO;) JO siuouqra :lqt ci posn aJOlU 'tdA [ROO[ ::l4l 'Sd~ltlq;) ,\JJIlJ W::WS J!:ll!t]O spadu oqi moqa SJ:l)jBta1ll;) Aq pai -jnsuoo ualJO S! pUP. 'spunoJ~'\ll[d aimuoxpa pus sjooqos AllllU!Jd 'SlaUJO;) .siod uru 40!4M suoumusm IB;)O[ U! la'llt!w '\plla1 ouo pa!J!lUap! saq aqs '2u!JdsJJo J!aql pUB S[t!W!Ut! lal!]O SPJOOal snojnouour sd:la)[ aqs 'patprus pus palj;)Jll;}SaJ SBq aqs :ll:lq lOlA 'uouuann ldq a'Bll'Bua oi aq UB::> t! praq os 'aAa un JO )jU!]q ;}4t ul possad SBq paJ sJaq;)Ual reljt uads UOpllJtUa:)UO;) t! lJl!M 'lUllaltSUlB~ alp Ul ajq'll::mpa AJdlBq SB papJB'Bal S! t!U!l 'joolJOS ur

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If Tina is in with her rabbits, then for a while at least, all will be well with the world,

What of Jay? How does he fill his hours of solitude? Here is a mystery indeed. This child of chaos and offspring of disorder has discovered music, The school has a brass band, every student invited to join. 'I'll do that,' says Jay, 'I'll playa cornet.' Not at first, he didn't, at least not by any definition of playing that we could imagine. The sounds generated by that combination of boy and brass w~re excruciating. 'You see,' he said despairingly, '1 told you I was useless.'

Yet somehow he persevered. Hour after hour of solitary musical disaster. Then finally, and rather suddenly, music began to appear. Then what a world opened up. Not just the sounds he was beginning to be able to make, but 'Listen,' he would say, running into the kitchen and grabbing my hand, dragging me into the living room, 'come and listen to this!' A tape is playing, he goes and stops it, winds it back to a point on the tape counter, 'This is by someone called Bach,' he announces, full of the joy of discovery, 'now listen to this bit.' And he plays the bit of tape he has selected, listening with rapt attention. 'There. Hear it? That's another trumpet joining in with the first one. Can you hear it? And listen, it plays almost the same tune, see, but just not quite, Isn't that clever? Just that little change there? Beautiful.'

The trumpet has become his instrument. More versatile than the cornet, he can !'lOW play not only in a brass band but also in an orchestra and consort, and has travelled to various parts of the country to share in concerts and musical events. We found him a bursary, a special fund for gifted children ('Gifted? MeT), and bought him a trumper of his own.

If today is to be a day of solitary delights, I have no doubt what Jay

will be doing with his time. '

COMPASSION

'I'm glad we grew up with fostering: you said, years later. 'The most dangerous thing in the world is one-sidedness. With fostering, you have to know there s always more than one side to everything. You have to be able

28

RESILIENCE

to seeother people 'Sipoints of view. To feel how it might be to be standing in someone else's.shoes' .

'1 know you love me.,j know I've got more in my life than I ever thought 1 could have, everything I ever dreamed of. But it's not enough. It'sjust not enough!

• • •

We wake to an unearthly wail. A vixen? Surely they are already in cub. Running feet on the stairs, and Tina bounds into the room without so much as a knock. She whose experiences leave her painfully wary of adults, bedrooms, adults in bedrooms, and anything which might have anything to do with the sexuality of any creature larger than a rabbit. This must be an emergency.

The rabbits are the cause of it. 'Come. Please. Come now. There's something wrong. Something terrible.' She is so distressed I begin to be flustered myself, fumble over pulling on trainers and a sweatshirt.

Arriving in the conservatory, I can see the cause of her distress.

Through the spring and summer she often lets her rabbits take advantage of the fresh sweet grass by putting them out in runs in various parts of the garden. They must, I think, have had some contact with wild rabbits. Now they are clearly ill, eyes glazed, breathing shallow; I fear the worst.

With an arm around her shaking shoulders, I guide her into the house, . persuade her to sit down and eat some breakfast, promise we will ring the vet at the first opportunity. He, true to form, calls in on his way to the surgery, is clearly devastated by the scene which meets his eyes. He confirms what I had feared. 'Myxomatosis,' he pronounces, 'it's hitting the wild population again at the moment. They must have picked it up from their cousins in the garden.' Tina knows about rabbits, believes that this is the death sentence pe has just announced, is clearly bewildered, and frightened, as he reaches into the bag he has brought with him.

'Right,' he says, 'we'll need an isolation hutch for each rabbit affected.

Here's' a supply of syringes, cotton wool, saline solution, and glucose. Bathe the eyes of the affected rabbits every hour, and force a few drops of glucose solution down their throats.'

29

1£

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3:)N3I'lIS:nl GNV Vl'IIOVl:IL 'LN3l'11H:)VllV

ATIACHMENT. TRAUMA AND REStLiENCE

I

all her advanced years to be of interest to the England test selectors, we think, except that she never seems quite sure to whom the ball should be returned. On second thoughts, perhaps she really is good enough to go for selection.

First we cut the grass. Mowers and shears, lawn rakes and loppcrs, Taking it in turns to work and to flop down gratefully on the cool grass, keeping the jugs or iced lemonade under the shade ofthe trees topped lip fur anyone to help themselves.

The latest batch of baby rabbits, old enough now to be leaving home, are out in a run in the corner. Word has gone out that they are ready, we will have' a steady trickle of visitors today coming to choose their new pets. Other visitors will arrive as well. Friends of the children know that Sundays like this one are open house, that food on these days is free and easy, that there will always be games and activities to join and share.

Twenty-seven French schoolchildren arrived once with their English hosts, bringing their own picnic lunches, spending the afternoon learning the secrets of rounders and French (Really? French?) cricket.

That was the exception, however, Most Sundays, a gentle flow of peaceful activity, sometimes individual, sometimes shared, marks the passing of the hours. Hairdressing is one recent experiment, I notice. Hours of mutual grooming, daring forays with scissors and clippers. I remember how we thought we were bold getting to work with the Amami and the rollers on a Friday night. Now hair is truly a medium of selfexpression for boys and girls both, and not at all shy about sitting' on the grass with a towel round the shoulders trying an apparently endless range of styles from the interesting to the frankly outrageous. Somehow they put it all back to something approaching my definition of normality at the end as I breathe a sigh of relief thinking of the conservatism of schools and teachers and shopkeepers and, heaven help us, policemen and potential employers.

A water fight is being set up. I escape to the kitchen to prepare trays of food. Cooling water melons and salads, home-made bread, cold meat and cheese, crisps and nuts. We carry: them out and set them on tables. Hairstyles glamorous and outrageous are now uniformly transformed into the new wet and shaggy look, obviously set to take the world of youth culture by storm.

32

I shout to draw attention to the food, and the ravening hordes descend as the locusts once descended on the grain fields of Egypt. A new competition has developed, a watermelon-seed-spitting contest. We arc, 1 learned long since, a household doomed to coarseness and vulgarity. As I notice that Brinn is hotly arguing that, if not the winner. he has ill least come an honourable second in the contest, I can see that it is just as well [ have 110 uspirations to greater gentility.

Once replete, the gathering settles into quietness. Some wander off to be alone with their reflections. Others sit or lie companionably propped against one another, quietly reading, or playing cards, or simply snoozing in the sun. Some customers arrive for rabbits, are provided with boxes and bedding for their new pets, and strict instructions on the tender loving care such vulnerable babies need to survive and thrive.

Gradually the garden empties as people wander off to take the dog for a walk, keep dates with boyfriends or girlfriends, prepare homework for the week ahead. Brian and I sit for a little longer reading the Sunday papers, relaxing as we also prepare ourselves for the new week. We know these times of peace and tranquillity are vital for all of us, providing rest and refreshment, helping us all to grow in strength and resilience, know too that for some of our children none of this can be enough.

Childhood creates persons. We have seen it, the unfolding, the, wonder of it. But whatever creates, can also destroy. Children p~e tough and resilient. The children we have brought into our family to grow lip alongside those born to us, children we have cared for and grown to love as we love our own, these children are strong and brave, Amazingly strong, and more courageous than any child should have to be, more hurt than any human should have to bear. Children can be injured with wounds beyond healing. And when the community ceases to understand or to care, when services are reduced and facilities are withdrawn, then even the healing which might have been possible may be taken away.

The hospital ward is hot and stuffy, but I think that nothing will ever warm the ice in my bones. The fingers in mine are equally cold, and limp,

33

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5 About, feeli ng5

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On the map of the souls'journey there are no short cuts George Steiner (1961, p 3J~)

• • •

Themes of st1are~ humanity

:1 f t -: .;\

There are certain themes in human experience which recur often enough in art and literature -and everyday life for us to be able to consider them universal; If we think 'of our own lives or those of people close to us, we can 'recall experiences 'of' love, joy, grief, despair, tenderness and anger. These themes are reflected in art and music, literature and drama. They cross boundaries ·of time and space and culture; they are discovered in records of the anguish and ecstasy of great saints and mystics, and in the intrigues and jealousies of the humblest soap opera. Our fluctuating moods and feelings mark out rhythms and processes in our lives which form the ground of our shared humanity.

We may think of emotional experience as being rather like music. The notes, which can be isolated and named, may sound singly or may blend together to produce harmony or discord, The music may use many notes or few, may be complex or simple. The musicians have available the whole range of notes which can be produced from their particular musical instruments, although they may not know what those notes are or how to play them. Every note can be recognised and echoed by other instruments, each with its own unique timbre and inflection.

01' we could envisage a network of every possible human feeling forming a matrix within which our feelings flow. A useful image might be that of the television screen as a fixed network on which u recognisable pattern is produced by the movement of an electron beam continually picking out and activating different points on the screen. Similarly our feelings change; peacefulness is succeeded by rage, grief is transformed by joy, as now one and now another point on the network becomes dominant.

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Starting with feelings

I have found it more serviceable to begin from a rather different base in seeking this common ground. 1 recognise that whe~ I am challen~ed to consider something which I have done, or a particular pattern in my behaviour, my first recourse is to my feelings. As I try to understand and explain my behaviour I generally begin by exploring what I felt at the time. I know that if I feel sad oi happy, angry or tender, fearful or confident, these feelings will affect the things I choose to do and the _way I do them. Once I have located and described my feelings, I may go further and look for the roots of my anger or insecurity or whatever in some other chapter of my story, so as to change feelings in the p~esent through a healing of hurts in the past. Or I may instruct myself l~ the art Of. not taking things out on others, acknowledging and accept1~g the feehngs but choosing to change my response to those feelin~s. El~her way I am able to alter my unacceptable behaviour without doing VIolence to my

inner life.

H is clear to me that others, adults and children alike, are able to

undertake a similar discipline, and that such a shared discipline releases all of us into our full stature as unique individuals capable of maki~g and acting upon moral choices. To recognise and honour the reality of the inner experience, as well as the external phenomena of events and behaviour, is a courtesy which we usually claim for ourselves but often

fail to extend to others. . ,

Feelings are not the roots of our behaviour. These 'are found .in a

\ complex interplay between our genetic inheritan~e, temperament, ~~VlTO~mental influences, early experience, later learning, and the conditions in which we currently find ourselves: we shall explore all these later. B~t feelings are part of the ground of our behaviour, a part .which we h~ld in common and which we can therefore take as the baSIS of our Unity, a meeting place where we can recognise the landmarks bec~us~._ we h~ve been there before. I remember a comic parody of a psychiatrist saying something like: 'Which of us can honestly say we have never set fire to ~ great public building? I know I have.' The ~ar~dy works. because It contains a grain of truth, not just about psychiatrists, but also about all our relationships. If we are ever to offer comfort, strength, hope and

40

ABOUT fEELINGS

I

healing to one another, we do need to find' something in common. Yet our genetic inheritance, personal histories and learned patterns of behaviour are all quite different. The common ground we do have is our shared experience of anger or despair or loneliness or curiosity. Feelings are our starting point.

One word of caution at this point Emotional experience, like Oscar Wilde's truth, is rarely pure and never simple. There is a risk that in directing our attention towards the feelings of others we may come to believe that we understand them. There is no intention in this exercise to analyse, or explain, or even sufficiently describe the inner world of the children in our care. This remains private; and will, fortunately, resist any disrespectful attempts to make it otherwise. We are, more appropriately and humbly, looking for a little common ground on which to stand, a little 'insight into and stern compassion with the state of being' of others (Tustin, 1981, P 178). This insight and unsentimental compassion can form the basis for a loving and perhaps a healing relationship.

The process of relationship thus begins with what we know and what we have learned about ourselves and others. We set this alongside our observations of the behaviour of the other and our understanding of what we have learned of their story. We can then begin to make guesses about which element of the repertoire of human emotional experience is predominant in this person at this time.

As we test this out, in our actions and words, things begin to happen.

We find that we are reaching towards the other, whatever th,ei~ age or status, from those who are newly born to those who are on the threshold of dying, where they are, not in some set pattern of relationship, but in a real interchange between individuals. People usually respond to this, feeling not only that they have had their feelings recognised and acknowledged, but also that they have been recognised as persons with dignity and value. Even when our guesses are wildly wrong, and they often are, our children may respond at this level. Indeed we may elicit their kindly sympathy: 'They may be stupid but at least they try.'

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3:::>N3I'lIS311 aNY I;lJAlf1V1U 'lN3WH::>V.llV

ATTACHMENT. TRAUMA AND RESILIENCE

The third and final section examines the affirmative experiences ofbuilding resilience. exploring the personal. social and spiritual developments through which children discover their unique place in the world and the girts they bring to it.

44

6

Attachment: formative experience

Infair desire thine earth-born joy renew. Robert Bridges

The depth and dream of my desire, The bitter paths wherein I stray - Thou knowest Who hast made the fire, Thou knowest Who hast made the clay. Rudyard Kipling

FEELING GOOD.:BEING GOOD: AFFECTIVE AnUNEMENT AND REINTEGRATIVE SHAME

This chapter examines, th~ experience of stress arousal and desire in infancy, the processes of attachment that result from such arousal, and the implications of attachment for human development. Desire and arousal in this context do not 'relate to adult concepts of sexuality, which are a later development in our human experience. Desire and arousal here relate to the universal ~){perkmce of needing being translated into wanting and, through resolution of this stress, into satisfaction. The second section

.' .', . '. . . ' , . I ' '

provides a description of the behaviours andpattems which' indicate

secure attachment 'in' babies, infants and older children, and those that

" :f: ..... '. __ .

suggest unmet at~a:chment needs. Finally, the third section proposes

activities and interventions which we can provide to promote and enrich secure attachm~nt~rid to compensate for the harm caused by unmet needs and promote recovery from impairment,

.' ' ... ) , ,

WHAT HAPP~NS1: thinking about attachment

.. - _- . ,-, "

Born to be-sociable: babies in their social setting

Human babies are borndefenceless, vulnerable and utterly dependent on the community that.receives them, Fortunately, if all goes well, the receiving community will be disposed to nurture the child. For it is clear that the whole community, consisting of the family, its supporting network

45

Lt

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AITACHMENT, TRAUMA AND RESlLlENCE

months gestation. All the senses develop before birth, and a foetus ~ithout sensory impairment will show responsiveness to touch, taste, heanng and

vision (Kart-Morse and Wiley, 1997, Chapter 3). . .

Injury to the developing foetus will have an impa.ct on this new brain and body. Such injuries may be caused by any tOXIC sub~;~nce able to cross the placental barrier. Drugs, alcohol, nicotine, some tOXInS produc~d by illness, prenatal malnutrition and possibly the toxic effe~ts of~aum~tJ.c stress in the mother may all interrupt and damage the rapid prohfera~lOn of cells in the new brain (McNamara, 1995 and Kart-Morse an~ WIle:" 1997). Thus babies may be born already injured, or depleted l~ t~e1f resilience to the stresses and strains of life. They may also suffer Injury during the birth, and again these may include significant injuries to the

forming brain. .. . .

Once the baby is born the real work of brain building begins, ThIS little scrap of humanity is, as we have said, utterly dependent for her very survival on the goodwill of those who nurture her. If she is in fact he.' the~ the vulnerability is at least as great, and may be even greater; certainly It will be likely to manifest itself later in different ways de~ending on .the gender of the child (Perry, 1999) of which m.ore later.Y~t nght from birth the baby does show behaviours which actively contnbute to her own survival, When placed under stress such as hunger, discomfort or fear, the baby produces distinctive activity which serves to draw the attention of a caregiver. We call this activity attachment behaviour. ..

Broadly speaking there are three types of attachment beh~viours.

Babies can do things which make the adults around them want to interact with the baby in order to get them to stop it; this has been called aversive behaviour, It would include such behaviours as crying, screaming, breathholding, and anything the baby can invent or discover which dr~ws a response from the one who holds the key 10 life itself, th~ pn~lIry l';u·l·gin'r. TIll' in lillli soon discovers that there are other types 01 behav.lOur which can produce an even more agreeable response from the caregiver. These arc behaviours in the baby which have been described as attractive, and they include smiling, making eye contact, vocalising, laughing, and other mutual delights which the baby will explore with the encouragement of a suitably engaged and doting carer. Finally, the baby becomes increasingly able to produce active behaviours such as moving towards

48

ATTACHMENT: FORMATIVE EXPERIENCE

the caregiver in order to grab the needed attention and achieve the desired relief of stress (Howe et al, 1999).

Like everything associated with infant attaclunent, these types of behaviour are very persistent, and it is noticeable that even in adulthood, people who did not find attractive behaviours rewarding, people whose caregivers did not respond tz· infant charm, are likely to resort to aversive behaviours under stress. They do things which make those around them act to get them to stop it. Others, fortunate enough to have had more responsive caregivers, are likely to take a more active Or interactive approach to the relief of stress.

Growing points: fOllrstages of brain development

The baby's brain is now organising itself at an astonishing rate. This organisation begins from the foundations, the brainstem, which forms the substratum which will determine the possibilities open to later levels of brain structure, the midbrain, the limbic brain and the cortex. It is clear that, Once the basic number of brain cells has been set by halfway through the pregnancy, the brain is then organised and shaped by the formation of connections within those cells. This organisation, building the brain from the foundations upwards, is "use-dependent" (Perry, 2000). The nU~ber, na~re and location of the connections made are determined by the interaction between the baby and the environment.

Attachment behaviours are the key to this early infant brain develop-' ment. Stress is toxic to the brain, causing profound changes i{n brain structure and function in the interests of survival. When the baby attempts ~o engage the caregiver through attachment behaviour, the urgent desire IS for the carer to enable the baby to modulate and recover from the stress which has provoked the behaviour. Babies with available and n:sponsivc

. caregivers enter into n relntionship in which each nttunc» to the other lind together they experience relief of stress. Both baby and carer will go through a cycle of stress arousal, stress modulation and the pleasurabte experience which follows the soothing of stress. Most babies (55-70 per cent) are fortunate enough to have such a relationship with their caregiver (Howe et al, 1999).

Under these conditions, babies' brains develop optimally given the particular genetic and temperamental inheritance they each have at their

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petence, artistic flair, musical ability, aesthetic appreciation, and the ability to integrate all these into social relationships.

Family matters: the part adults play in infant attachment

The first effective empirical procedure for testing the theory of attachment being developed by John Bowlby was the "strange situation" experiment devised by Mary Ainsworth. Since attachment behaviour is produced by babies and infants in response to stress, this procedure involves exposing infants to minor stress and recording their responses. The key to the success of this procedure was the production of an ethically acceptable stress situation which was entirely and reliably repeatable and therefore valid as a tool for comparing the responses of different infants. The elements of the test situation which produce the stress are: a room which is a new environment to the child; the presence of a stranger; the temporary absence of the primary attachment figure.

These basic elements were combined into an effective procedure which allowed Ainsworth, and many others since, to draw a clear picture of the range of behaviours infants in the age range one year to 18 months produce in response to stress. She became aware of three distinct and different patterns in these behaviours, which she classified as secure attachment, insecure avoidant attachment and insecure anxious ambivalent attachment (Howe et al, 1999, Chapter 3). Main and Solomon (ibid, p 33) later added a fourth distinct type of response which they called disorganised attachment.

It was clearly now possible to analyse and classify the behaviour ofthe young children in this situation of stress and anxiety. Yet at the heart of attachment theory was the understanding that the infant is not developing in a vacuum. It became a matter of urgent importance to try to discover what part the adults were playing in the development of the patterns of attachment behaviour. Main and Goldwyn (Howe et ai, 1999, p 36ff) developed the Adult Attachment Interview to enable accurate comparison between the accounts different people give of their childhood. They demonstrated that it was possible to discern four distinct patterns or styles of narrative in response to this structured interview,

Researchers were then able to carry out the Adult Attachment Interview with parents-to-be before the birth of their child, and .to compare the

52


results in due course with the behaviour of those children at one year to 18 months in the "strange situation" research procedure. The results have been an overwhelming vindication of attachment theory. A clear correlation has been discovered between the attachment style of the caregiver and the attachment pattern of the infant. .

Such studies have shown that adults invited in a structured way to provide a narrative about their childhood do so in a characteristic fashion which allows a classification into four groups, or four different attachment styles. The researchers describe these as secure and autonomous, dismissing, preoccupied, and unresolved. Whilst there are obviously factors which add complexity, broadly speaking, infants develop an attachment pattern at one year which is closely linked to the attachment style of their main caregiver or caregivers. If the attachment style of the main caregivers is very different, the infant may develop a different attachment pattern towards each of the carers. These patterns are essentially the mechanisms whereby the infant meets the needs of the caregiver in order to try to ensure that the caregiver will in turn meet the intense dependency needs of the infant.

The majority of people (usually 55-70 per cent) show a secure and autonomous style of attachment. They produce a coherent, emotionally congruent narrative, which gives a clear sense that they have processed and dealt with the issues of their childhood. This seems to be true whatever the quality of their childhood experience. As adults they are in touch with" those issues but not actively engaged with them. Such parents, klI other things being equal, have infants who develop secure attachment patterns. These are babies who are cared for by adults who are emotionally available and responsive without being interfering or overwhelming, The baby can safely trust that in a stress situation the adult will be able and willing to protect and comfort the child, and to provide soothing so that the stress response diminishes and is replaced by pleasurable sensations. The pleasure derived from such soothing is mutual in an attuned attachment relationship; the carer as well as the child show physiological evidence of a pleasure response (Hughes, 1997, P II If).

About' one in five of the population produces a dismissing style of Attachment Interview. They provide a narrative which is thin and sparse and lacks any congruent feelings. Indeed they are actively dismissive of

53

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form cannot begin to equal the sheer persistence and energy infants devote to practising their developing skills.

J:WIIl years OIlC to four the limbic system develops. Now we arc building on the foundations laid in the brainstem to regulate our emotional lire and til establish complex interactive commuuieution bused on the tull flowering of our capacity for attachment and empathy. We discover that words are also patterns, and have meaning, and, astonishingly, can change the world. We discover that human beings live in a matrix of communication, nearly all of which is non-verbal. and we build patterns of interaction which again will be persistent throughout our lives, and deeply resistant to change. We also begin to discover that we live in a wider environment to which we can relate as separate individual beings, and not just through the medium of our attachment figures, and that we can have an effect on that environment.

These foundations will be well established before the thinking cortex really begins to be organised, and the shape it takes will be largely dependent on the infrastructure already built. From years two to six this immensely complex integrative and cognitive structure will be forming. Now we become capable of abstract thought, of cognition and metacognition, of learning and learning how to learn (Bateson, 2000). If all goes well, this cortical development will be taking place after a foundation of secure attachment has been laid, for only then will we be able to develop our full human capacity for integrating our physical, emotional, intellectual, social and spiritual development into a graceful and harmonious dynamic structure which will become the unique and infinitely valuable entity - a human personality.

And if all does not go well, what then? Personality is not a given from birth: we grow as persons as our brains grow, a?d as brains can be damaged, depleted or injured, so can· the developing personality be harmed. Fortunately all is not lost. What cannot be repaired can be helped. At no time in our lives are we illl1l)une from harm or from helprwe can never get away from our vulnerability as humans, but neither are we ever beyond reach of healing. The next section describes the behaviours and patterns we can observe in securely attached babies, infants and" older children, and in somewhat more detail the behaviours and patterns we can observe in those surviving unmet attachment needs. The final section

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proposes activities and interventions that can enrich the developing brain and provide healing for those already impaired.

WHAT DO WE OBSERVE?: life with the child

Securely attached children Babies

Attunernent is the key to attachment in babies; the mutual and reciprocal relationship 'between the caregiver and the baby through which each learns about the-other and becomes changed themselves (Hughes, 1997, Chapter 2). A baby does not enter the world as a blank slate, waiting simply for the world to make its mark on this emptiness. Every child born arrives with their own pre-birth history, their own unique experience of birth itself, and their own individual genetic predisposition and temperament.

Babies may be born placid or irritable, sleepy or wide awake, shy or outgoing; they are unique individuals from the moment of their arrival. It is for this reason that a parent may have two children and be able to attune to one and not to the other, producing a very different attachment outcome within one family group. We can therefore assess the quality of attachment and the progress of development in babies not primarily by the nature of the child's individual behaviour, but by observing the baby in relationship with the primary caregivers. " "

Whatever their temperament, babies in an attuned relationship show their distress when they feel it, and respond to the caregiver who responds to them. If physically healthy and unimpaired, they will show firm muscle tone without rigidity, and will respond with pleasure to touch and rhythm, If there is no sensory impairment, they show art early preference for the human face.and the human voice, 'and will track to sight or sound; this tracking soon shows signs of distinguishing between the main caregivers and other people.

Securelyattached babies move easily from aversive to attractive attachment behaviours; they smile, gurgle and coo and vocalise both actively and responsively with the- carer. They show playfulness and curiosity and are generally interested in the world around them. Although it may take some time, babies with attuned caregivers usually establish a

57

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exist as isolated individuals, nor even as separate but linked actors in an unfolding shared drama. Rather we are both the product 8:1d the producer of our. shared environment, shaped by our experience of others even as we shape our own destiny and contribute to the shaping of our world.

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Older children

Children who have been fortunate enough to live in an environment promoting secure attachment and who have had no impairment in their ability to interact with that environment will have developed the capacity to regulate both stress and impulse adequately. They are engaged with others and their environment, experience empathy, are emotionally expressive and will have internalised the social inhibitions and taboos of their cultural milieu. By the time they reach school age, they will already have a rich command of language to which they have been exposed, and will be able to give verbal expression to internal states as well as describing external objects. Liberated from the excessive anxiety and excessive shame of children with unmet attachment needs, they are able to explore their world with curiosity, playfulness, imagination and joy.

The general approach of securely attached older children to other humans is one of interest (Howe et ai, 1999, p 55), and they are open to the possibility of trust-based relationships while able IO make judgements about the trustworthiness of the other. They distinguish between types and degrees ofrelationship, have relationships which are close, confiding and intimate, and are able to form new close relationships if they meet someone with whom attraction to intimacy is mutual. In moving through the dance of forming and exploring relationships they use and understand language and non-verbal communication precisely, gracefully and In culturally appropriate patterns;

Insecurely attached children Babies

Lacking a secure attuned relationship, babies are unable to develop regulation of stress. At this stage of development there are only two alternative responses available to the infant subject to unregulated stress in order to promote survival - dissociation or hyperarousal. Even at this early stage of brain development, awareness is not unitary but is split into

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different components functioning at the same time; dissociation is the process by which the brain protects the organism from becoming totally overwhelmed by generating patterns of automatic splitting of awareness in response to repeated e:o:periences of an overwhelming nature. Perry (1999) shows how such splitting progresses from being a trait to becoming a state of brain function impervious to further adaptation. Babies who respond to stress with dissociation will continue to have that as a patterned response to stress throughout life.

Hyperarousal; by contrast, is the state in which unregulated stress continues to affect the entire organism; it is, at the level of the organism, a less despairing response than dissociation, directed towards maintaining the energy to keep trying to defend against the devastation of being overwhelmed. In older children, hyperarousal will lead to a fight or flight response, while younger hyperaroused children will freeze and regress as the only effective defence for them is to engage a rapid adult response to protect them. Thus freezing in response to threat is an extreme attachment behaviour, demonstrating to any available adult the urgent need to attend to a child too threatened to cry out.

In general, Perry (1999) suggests, there is a continuum of probability as to whether children become dissociated or hyperaroused when subject to overwhelming stress. Many factors affect the outcome, but there is a tendency for children who are younger at the time of trauma to dissociate, while older children are more likely to remain hyperaroused: girls are more likely to dissociate, boys to be hyperaroused; children who stiffer direct pain or torture tend to dissociate, those who observe the violation of others tend to remain hyperaroused; and children who experience helplessness or powerlessness associated with the trauma (end (0 dissociate while those who are actively involved in the event remain hyperaroused .

The effects of dissociation and hyperarousal are global. Everything we ean observe about a baby will be altered by unregulated stress. Thus we see babies who cry constantly or babies who never cry at all; babies who jump at every stimulus, and babies who are unresponsive even to extremely startling stimuli; babies whose muscle tone is perpetually tense and rigid, and those who are floppy and unco-ordinated; babies who avoid eye contact, and those whose fixed gaze is disconcertingly empty; babies

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A TT ACHM,ENT, TRAUMA AND RESILIENCE

What we.observe are children who are inhibited with the force of taboo from experiencing their own needs, or their own basic drives, or even . their own innate affects. They are equally powerfully prevented from accepting any interaction which disturbs their core self-definition of shamefulness, they are children who will resist or disengage from any environment or relationship which is inclusive and accepting, or which provides them with positive messages and praise. How do you manage the paradox that a child who may desperately need to do well in school may trash their bedroom or burn their 'school books if they get a good report? How do you live with children whose response to any compliment is to cut themselves or destroy their possessions?

The inner experience of shame is of painful exposure, transparency and vulnerability. When shame is reintegrative, this momentary pain provides the energy to seek reattunement. When shame is disintegrative, it provokes instead the urge to hide, to build defensive strategies against the pain, and to attack the perceived source of the pain. Thus we see children who are concealed from those around them by constantly telling lies, often pointless lies, and who may be unable to distinguish fact from fantasy. Children may also be controlling and dominating, or rigidly perfectionist, or may constantly seek to blame or punish others. These are all defensive strategies to control or transfer the pain of being shamed. And we also see children who actively seek reinforcement of their own shamefulness, needing constant reassurance that they an; as horrible as

they believe themselves to be. .

When children are subject to developmental disruption during the period when the mid-brain is developing, their motor control may be affected. They may be seen as clumsy and unco-ordinated, or the distortion of underlying development may be reflected in difficulties with spatial perception and sensory awareness. Children in this situation may be identified as dyspraxic, suffering from "clumsy child syndrome", or they may be disconnected from their own sensory interface with the environment, literally not being aware oftheir own bodily presence in the world. I have known children who did not know whether they were hot or cold, or did not know how to make a choice between simple alternatives when, for example, shopping for clothing or choosing food in a restaurant.

As these injuries in early growth are carried through into the next stages

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of brain development language, memory and the construction of meaning are all adversely affected .. Children may have difficulty with forming or understanding words or sentences, or may be able to construct language but not be able to use it as a tool to make sense of the world. Distortions of perceptual awareness may lead to difficulties with reading or writing or making sense of pictures or objects.

Other areas of brain function adversely affected by disrupted attachment are linked to the capacity for empathy and social connectedness. Children may defensively protect against social interactions which engender shame for them, but they may also be simply unable to make the social connection in the first place. And children Who have experienced disrupted attachment commonly are unable to experience empathy. They are, after all, thinking and feeling with a very different brain from most of those around them. They have no access to the inner experience of others.

Older children

It is when children begin to take their place in a wider social environment that living with a different brain really begins to result in social exclusion. Although children will usually continue to struggle hard to find a way to be true to themselves and still to be part of society, it is often an unavailing struggle for children who are so different from the norm.

Unable to regulate either stress or impulse, they are liable to behave in ways which are seen as extreme and bizarre. Unable to engage with others or with their environment, to experience empathy, or to be emotionally'

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expressive, they are experienced by others as alien and uncomfortable

beings. They will be working to a different set of taboos and social inhibitions from their peers.

They will be unlikely to. have access to the rich and varied language of their peers, and will probably be unable to express inner states through language, which in turn leads to impoverishment of the ability to feel at all. Non-verbal communication is ignored or misunderstood. They are chronically subject to excessive anxiety and excessive shame, and these effectively preclude the curiosity, playfulness, imagination and joy with which. securely attached children approach life.

Children with unmet attachment needs are constantly in survival mode, and have little interest in others except as possible resources to be used.

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ATTACHM8NT. TRAUMA AND RESILIENCE

If you arc unable llllllli:!f thi~ commlunent, do not undertuke the work.

It will damage you. If the adventure is for you, then proceed to step two.

Step 2: personal support

It is essential when living and working with children with unmet attachment' needs that we establish and maintain our own close, confiding, inti mate relationships. This is the source of our own sanity and is a resource to sustain our own resilience. The work will challenge and may destroy both. It will also challenge the durability and flexibility of our own secure attachments. It is vital that we pay attention to these relationships, giving at least as much attention to relationships which are mutual and reciprocal and sustaining as to those which are more problematic, more demanding and which will be a net drain on our resources.

It is not enough to think about these personal relationships before you set off on the journey with the child and then forget about them. We live in a dynamic universe, and everything changes. You need to keep paying attention to these relationships, and to other close, confiding, mutual relationships which may form, and to treat these as having a higher priority even than your work with the child.

These relationships are not only a source of support for you, they are the check and balance, monitoring that you are not changing in harmful ways. Dan Hughes (1997, p 214) says that if we join the child everybody loses, but if the child joins us everybody wins. As ~e keep the child company on their journey, change happens. You will not be the same person at the end as you were at the beginning, and neither will the child, It is imperative that all the change is in the direction of building attachment and not in the direction of destroying it. Yet the powerful experience of this work can result in us losing our way and going with the child into their own cold and frightening world; What we want is to enable a terrified child to enter safely into the warmth of secure attachments.

As well as the changes which occur in your life as a result of your work with the child, close relationships also change in their own right, they have a dynamic life oftheir own. Again it is important to keep an eye on all the relationships in your social network, to ensure that you are not overtaken by events, finding yourself alone and friendless just when you most need a supporting presence.

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ATTACHMENT: FORMATIVE EXI'i;RI!;NCE

If you do not with reasonable certalnty have the protcctiuu (It' dose. confiding, intimate relationships to sustain and support you reliably throughout the time you arc giving commitment to the child, then do ntlt proceed with the work, It will damage you. If you do have access to trustworthy and intimate others who are reliable sources ofmutual support and joy, then go on to step three.

Step 3: professional supervision

Whatever your role in providing for the needs of children with unmet attachment needs, you must ensure that you have access to professional supervision. It is even more important that direct carers - parents, family network caregivers, adopters and foster carers - have access to professional supervision and support than it is for child care professionals whose work with the children is not carried out in their own life space.

Those who are closest to us will provide the core support which will keep us sane and resilient. But they will not be able reliably to provide the essential overview of the system which will reveal the direction in which we are moving, will alert us to any risks, and will propose systemic solutions which will be beyond the scope of our own vision; we cannot see the ocean when we are swimming in it. Only the professional supervisor can take on this function.

You may be fortunate enough to have clear structures of accountability which provide appropriate supervision in your work with the child, If not: it is necessary to find a supervisor for yourself and to submit yourself to a discipline which may often be uncomfortable but which will be essential for your safety and the safety of your family. Since this relationship too will be dynamic, it is important to keep the situation under scrutiny, and to make sure that your needs are met throughout the whole time of your commitment to the child. Over the course of the changing relationship with the child, even people who have access to professional structures of supervision may from time to time benefit from external consultation.

Although professional and external to your immediate relationships, supervision or consultation may be provided in many ways. It may not necessarily be frequent, it need not be costly if you are relying on your own funds, and it should be set within clear boundaries. It may be provided by any agency employing people with the skill and knowledge to assess

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3J.N3nIS3'd aNY VVIlflY'dl 'lN3WH:lVllV


Working with attachment issues

It is necessary when living and working with children with unmet attachment needs to maintain both stress and shame at manageable levels, while also providing the maximum possible opportunity for the child and the carers to develop a relationship of affectional attunement and reintegrative shame.

The child's ability to manage both stress and shame need to be constantly appraised and reappraised. Initially the environment should be constructed to keep both to an absolute minimum, and then gradually more everyday stresses and ordinary shame-inducing experiences can be added for the child to learn self-management in a setting increasingly similar to that of their peers.

In the composite children portrayed in Part I, Jay was unable to manage the stress of contact sport in school, and needed to be temporarily removed from that environment for the safety of others; he was also unable to manage the stress of other children coming home from school, and needed that stress to be defused and strategic alternatives to be provided. Shane was unable to manage the shame of having his gift apparently rejected, or the shame of his theft being discovered, and in the one case responded with rage and in the other with dissociation. In both cases he needed help to stay connected to what he had done, and to accept some logical consequences for his behaviour.

The environment should be one which enables carers to produce and sustain a certain attitude towards the child (see Hughes. 1998). and all those couuniuing themselves to the welfare of the child will take their part in creating and maintaining such an environment. Above all, rcparcntcd children need to be. and to be able to feel, safe in their new selling. I shall usc this word SI\FE as a mnemonic 1'01' the required busic attitude of carers; it is just an aid to memory. the important thing being to grasp the nature of the underlying attitude which carers need to maintain throughout their time with the child. They need to have, and to hold through all adversity, an attitude towards the child which is Secure, Attentive, Friendly and Empathic.

72

ATTACHMENT: fORMATIVE EXPER.iENCE

Carers commit themselves to be:

Whatever their own attachment history and life story, by the

, .

time they. are living and working with insecurely attached

children, carers must be able to function as stable and adaptable persons, with a stability which cannot be destroyed by any disturbance the child may bring into the household. [ have thought of this as creating a still centre to which the child can always return.

ATTENTIVE The carers should be interested in the child, curious about this other human being sharing their household. They will be learning the child as a unique person, and deeply respectful of the child as a whole person whose very survival in the face of profound adversity demonstrates courage and resourcefulness. This attitude of benign interest will carry carers

SECURE

through many storms.

FRIENDLY Children need us to love them, but are likely to find the experience overwhelming. I find the concept of friendliness as an attitude helpful; not friendship, which comes from others, but friendliness. We do love our friends, and we also can be light and playful with them. These qualities of love and joy, combined with passionate commitment to their well-,

being, is what children need from us as carers. "

EMPATHIC Carers must be able to be empathic with the children. Many people unconsciously avoid empathy with children who have suffered such intense early adversity. To place ourselves inside the experience of such desolation is disintegrative, and we protect ourselves against disintegration. So carers need help to maintain empathy; the rest of the care team should commit themselves to keep the empathic carers safe.

Promoting affective attunement

The shape and structure of an effective environment to address the needs of children with unmet attachment needs and promote affective

73

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,


adults and it must be structured 50 that giving up the overwhelming need to be in control is the obvious minute-by-minute choice the child will make.

Choice is itself an issue. During the toddler period of limbic brain development, the establishing of autonomy and self-determination are key tasks for the toddler (Erikson, 1963). Children who have experienced disruption of this process will have difficulty, sometimes extreme difficulty. with choosing. I have known children in their late childhood for whom choosing between drinks on offer, or choosing food in a restaurant, or choosing clothes, are overwhelming tasks. The result may well be an older child producing a toddler tantrum in a very public place, which does not endear them to anyone.

The care team needs to work together to construct an environment in which the child can survive and begin to lay down new patterns of behaviour. Again this will be a slow process, much slower than it is in infancy, for then the brain is just developing as brains do, whereas now we are asking the child to invent patterns and connections for which the brain has no template (Miranda et aI, 1998).

For the carers, this part ofthe work will be even more demanding than the establishment of affective attunement. The child may resist developing the trust to allow the carers to engender patterns for regulating stress, but at least when stress regulation happens it feels good. Here we are asking the child to trust the carers enough to allow these adults to take over co.itrol and provide patterns which eventually will allow the child to manage shame and regulate impulse. This will not feel nice while it is happening, and frazzled parents oftoddlers will have sympathy with carers who must go through the same processes but with much bigger children and for so much longer.

Those who support the carers must therefore be ptepared for this work to be demanding and sometimes exhausting. It is important that supervisors monitor the situation and prevent the carers from becoming exhausted. Equally important is for the supervisors to ensure that the carers do not come to accept the dominance of the child, and adapt to living with a child who has taken over the running of the household.

All the adults must understand the situation. Throughout this whole stressful process they must never forget that eventually the child will be

76

ATTACHMENT: FORMATIVE EXl'bRlLiNCE

Exafuples"of tnterventions to promote reintegrative shame
Environment '"' ~ctiVities for carers" Agency interventions
Physical environment Ensure that adults and not Provide supervision
Safety is the first . children establish the and consultation for
priority. Children need emotional tone of the carers.
to be safe even when household.
they lire out of their Make sure that every-
own control. Encourage children to one is aware of the
Design the environment express thoughts and day-tu-day care plan
to allow constant unob- feelings, and accept them. for the child, and
tr usive su pervision of supports the struc-
children. Be clear about Greatly limit choices. tures which will
physical boundaries in Explain to the child that support the child.
the use of the house, chuice is too hard for them
and exclude children at present, because they did Monitor the situation
from private space such not learn to make choices carefully; ensure that
as the bathroom when when they were a baby, but every adult concerned
others are using It. that they will be making is able to maintain the
Consult children about more choices when the SAFE attitude.
decoration, furnishing adults who care about them
and so on, but do not can see that hey are ready. Provide clear
allow choices until the structures for com-
child Is ready for them. Show steady, friendly plaints and for main-
Be clear that it is the concern for the child's taining the human
adults who are making struggles to accept the rights of the child.
all the decision in the discipline of living with
home, but that other people. If therapists are
children's views are available to work with
listened to. , Provide clear logical the child and the
consequences for SOCially carers, ensure that
Time unacceptable or disruptive the therapy and the
Provide clear time behaviour. Ensure that this daily care are Integra-
structures for days and is not punitive. Ensure that ted, and that-the
weeks, and acknowledge it Is always carried through, adults work 'together
or celebrate calendar and that shame is always to provide safe struc-
events. Allow the child followed by reintegration. tures for the child.
limited choices around .
timings, prepare them Practise altern ative Provide material
for events and then inclusion. Remove the child support for activities
stick to the times given. from a situation where with the child, and
Alternate restful their behaviour is lnappro- also for making good
periods with more priate, and keep them close any damage which a
stimulating activity. to you. Use temporary child out of control
exclusion ONLY where no may inflict on their
People other course provides safety. surroundings at
Ensure that all the Express anger; if you feel It, times.
children in significant but only in short bursts, not *Ideas drawn from experience and from the work of Dan Hughes (1997, 1998)

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they arc still alive and unharmed. In doing so, you re-establish dialogue. The child discovers the delights of reciprocity.

;. ,

WHAT HAPPENS?: theory and research about rage and anger

In terms of survival, rage is the third active option when confronted with an aggressor. The first option is appeasement; if we become small a.nd still and harmless, and smile, the aggressor may be deflected. Amplify the activity of the limbic brain a little and the impulse will be to run away; flight can be an effective way of staying alive. Fin~)]y, i~ nei~her of the above is effective, the increasing stimulus to the limbic brain will produce the impulse to attack; if all else fails, try fighting. These are the three basic survival strategies all located in one small area of brain tissue called the amygdala (Carter, 1998, p 90).

In the adult brain, the responses of the limbic brain are being continuously mediated by thinking. The survival strategies which are the 'quick and dirty' (Ledoux, 1977, quoted in Carter, 1998) responsiveness of the amygdala are kept in their place, to be activated only under extreme threat to life. The infant brain is not stable, however, and knot fully developed yet. The immature cortex does not have the: capacity to regulate these responses. The young child can experience rage in relation to any offence.

There is a fractional time lag between the limbic system response to the offensive or threatening stimulus and the informati/on about the stimulus event reaching the cortex. We have already started to react before we can start to think about what we are reacting to. Whatever the automatic limbic system response - appeasement, flight or fight - once the thinkin.g brain gets hold of it, that response will be overridden unless the threat 1S intense. In almost all situations we meet as adults in everyday life, none of those responses is appropriate. Instead we will consider the situation on its merits, and make a judgement about the response we want t<:) make.

The cortex can fail to regulate the outburst of rage in three different situations. Firstly, in traumatic events the intensity of the stimulus overwhelms the thinking brain; the cortex cannot regulate the response. Secondly, after certain illnesses or injuries, including some lasting injuries following intense trauma, the limbic brain spontaneously generates the

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ATTACHMENT: FORMATIVE EXJ'I,J{fI!NCI,

impulse to attack; since nothing is happening in the outside world, there is no information from the environment to the cortex, and it is impossible for the cortex to inhibit the action of the amygdala. Finally, the signals from the cortex to the limbic system, the mechanism to override the fight response, may just be too weak or too diffuse to be effective, which is what happens in the brain of the toddler,

In young children the cortex is still developing. They are not able to override the powerful activity arising from the amygdala. They simply do not yet have the connections between the cortex and the limbic system in place to transmit clear focused inhibitory signals of sufficient power to restrain the activity of the amygdala. The cells in the prefrontal cortex do not mature fully until adulthood, but the process of gaining management of the activity of the amygdala can be accelerated.

Yet again, it is the response the child gets from the social setting that actually shapes the developing brain. The child who is helped to manage and later to inhibit rage is the child who grows the brain cells in the prefrontal lobe to inhibit the action of the amygdala more rapidly. Activity in brain cells also makes them more sensitive and easy to activate; in terms. of the power of the brain, practice really does make perfect. The cells in the prefrontal cortex that specifically act to inhibit the activity of the amygdala are most effective in children who develop them early as a result of interaction with secure attachment figures and then use them

~~ ,

The interactive process most protective against later violent Behaviour {is] the formation of a secure attachment relationship ... Here in one relationship lies thefoundation of three key protective factors that mitigate against later aggression: the learning of empathy or emotional attachment to others; the opportunity to learn to control and balance feelings, especially those that can be destructive; and the opportunity to develop capacities for higher levels of cognitive processing.

(Karr-Morse and Wiley, 1997, p 184)

As social beings violence both fascinates and terrifies us. Originating in the limbic system, violence is one of a limited set of basic survival strategies. These limbic system responses, and the emotions that accompany them, induce a focused state in humans, which may be called a

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certain people, or being in certain situations. When the impulse to attack is inhibited, the muscles tell the story.

The problems arise when the inhibition is missing or distorted. The impulse is arising from the limbic brain interpreting complex stressors as extreme threat. The prosocial response is to have access to a wide and flexible range of mechanisms to do something else with the energy generated. The antisocial response is to attack. If the inhibition is missing, this antisocial response may be a straightforward physical attack causing harm to the person of another or the environment. If the inhibition is distorted, the attack may be against the self, or it might be a non-physical attack against another causing emotional harm through verbal and nonverbal communication.

In human beings, as in ail animals more likely to be prey than predator, the impulse to survive, through attack ifnecessary, is benign. The impulse is benign but almost always misplaced in a world too complex for the simple limbic brain. The response to the impulse may be equally benign, utilising the energy for creative and prosocial activities. Or the response to the impulse may be harmful, in people who have not been able to develop the powerful and flexible links and pathways in the brain needed to inhibit the impulse constructively. Children, whose brains are still developing, will need the help of adults in their community to create such graceful and flexible responses; thus each unique personality develops in the interaction between the person, the social system that contains them, anti the 'Wider environment (Bronfcnbrenncr, 1979).

WHAT DO WE OBSERVE?: signs and indicators of rage, reflection and reciprocity

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Rage

Attacking others

Children who are unable to regulate rage adequately may be subject to sudden outbursts of violence or chronic anger or both. Sudden violence may erupt apparently out of the blue, and be very frightening for all concerned. It sometimes involves considerable harm to others. The precipitating cause will always seem out of all proportion to the response, but will involve frustration or shame or fear on the part of the attacker.

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Two children playing together amicably enough; one makes a mistake in the play, the other smiles ., sympathetically? mockingly? - and within seconds the smiling child is on the floor and the other is on the run. The combination of frustration and shame for the first child provoked an instant and intense response. The explanation - 'he was laughing at me' - is recognised by everyone concerned to be inadequate.

... many children who become impulsively violent had, as babies, subtle neurological abnormalities ... But these beginnings are not in themselves causal. Neurological differences only render a child more vulnerable to negative environmental circumstances. Whether children become poets or ax murderers depends on the interaction of biological and socialfactors ... Though the processes are complex and often the injuries are unintended, when it comes to our babies, we reap what we sow.

(Karr-Morse and Wiley, 1997, p 182-183)

If sudden rage is frightening to live with, chronic anger is wearing. Living with children who are constantly expressing angry feelings is abrasive and can erode the fun and laughter in any household. Chronic anger may be expressed directly as physical bullying, or irritability and fault finding; the level of physical, verbal and non-verbal violence may be sufficient to cause significant harm to others. Or it may be expressed indirectly as talc bearing or innuendo; again this may reach extreme levels of predatory . .attention to the weaknesses and vulnerabilities of others.

Angry children who dissociate may get others to be angry for them.

Watch out for the child who never seems 10 express un allgry word, hill somehow is always surrounded with furious people. Children who needle others until they provoke a response against a third party can disturb the equilibrium even of very stable groups. And children who need others to be angry will find that the world is full of angry people in every setting.

Attacking the self

Young children who feel angry and are unable to regulate rage experience a dilemma. The people around them with whom they feel angry arc the very people 011 whom they depend for survival. If they attack those on whom they are dependent, they may remove the source of their survival,

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ATIACHMENT. TRAUMA AND RESILIENCE

recoil from it. Touching her arm I try to get her attention; she ignores me twice, but finally faces me. 'What?' she snaps. 'That's too loud,' I say, holding eye contact and indicating 'the personal stereo device. 'So?' - furious rage expressed in a word. I look at her a moment longer and then look away. After a minute, as I check off the seconds on my watch, she turns the device off. 'It's finished now. Satisfied?' she growls. For the rest of the half-hour journey we share I am the target of non-verbal anger of great apparent force, although when she gets up to leave she carefully avoids physical contact with me (a little accident would have been quite easy, and I half expect it). Other passengers break their own rules of nonverbal contact to offer silent thanks, though I know they find my behaviour almost as unsettling as hers.

Reflection

Some time in the second year oflife, unless prevented by impairments of function, the child begins to develop a sense of self. Damasio (1999) refers to the development during the second year of the autobiographic self, the self that both exists and tells itself the story of its own existence, This is.a step on the way to the development of the reflective self, able not only to act and to tell the story of that activity, but also ':0 evaluate the emerging narrative in a social context.

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Social accountability

This social accountability, the capacity to account for 'ourselves within and to our social milieu, is considered by Shotter (1984) to be the foundation of selfhood. It is clear that the child who is acquiring through social interaction the ability to inhibit impulses, including the impulse to destroy, is also acquiring the capacity for self-conscious reflection.

The impulsive behaviour of the young child provokes a response which interrupts the affective attunement that is the background state of securely attached children. The caregiver thus reflects to the child a sense of self as separate from the carer, an active self whose activity can be evaluated. At the same time, the carer provides the securely attached child with much evidence of approval and joy in their existence as a distinct and effective other. Episodes of shame are balanced with experiences of delight in socially acceptable and interesting behaviour. And the child who has

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developed through shame" the sense of a separate self, can now share in that delight. They can acquire the beginnings of selfhood, discovering the joy and the anguish of a self-aware life.

Social unaccountability

Children with unrnet attachment needs have restricted 'access to this reflective world. Distortions in the social construction of inhibition lead to difficulties with relationships, both with people and with the wider environment. Language development will be affected; securely attached children by the second year are beginning to be able to talk about who they are and how they are; insecurely attached children lack such inner state language. They tell us about the harm they are enduring through their inability to tell us how they are.

Reciprocity

As children discover self through interaction with others, so they can begin to relate to those others as beings like themselves. If the first step on the road to personality is trust, as Erikson believed (1963), then the next, autonomy, is equally a product of the social context in which the child is growing. Once the child can begin to regulate impulse, there is the possibility of choice, and ofthe making of right choices. Then, for the securely attached child, their trust can be reciprocated.

The child trusts the life-sustaining caregiver, providing that funda-. mental experience of reliance on a reliable universe which will carry most humans through even quite. devastating experiences. Then, as the child becomes more effective as an active participant in this exchange, the caregiver trusts the child. This provides the child with the foundation for the second great assumption that secure humans make about the universe; they are able to believe that they are individuals worthy of respect from self and others. The third basic assumption (Janoff-Bulman, 1992) is that the universe has meaning, which arises as the reflective individual engages with the puzzle of relating to others and creating both a personal and a shared narrative from the experience.

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self or others. Hence the overwhelming impact of being praised, or or recognising the praiseworthiness of others. Such triggers to rage are bewildering for those around, and frightening for the child.

It is hard to maintain an attitude of friendly attentiveness through the irritations and storms of daily life with children who struggle with impulse: shame and rage. Yet it is necessary to come back to that basic attitude as many times as our serenity is ruffled. It helps to ask yourself informed questions that illuminate your observations of the child. Such a questioning approach creates the space in which it may become possible to reflect on how life is for the child.

Examples of useful questions

How does this child deal with impulse? How do they deal with anger?

Does the child provoke anger in others?

Are they able to express their feelings in words? Are they able to be assertive?

How does this child deal with conflict?

WHAT CAN WE 007: approaches to helping children regulate rage

Anger management

There are a number of tried and tested approaches to anger management programmes for adults that can successfully be adapted to help children with managing anger. These tend, however, to rely on engaging neglected inhibitors or creating new inhibitions through learning. Children with insecure attachment patterns do not have establishedimpulse inhibitors, so cannot be helped to engage such existing but underused inhibitions. They will need considerable time and patience before they will be able to develop patterns of self-regulation.

It is therefore important that carers give at least as much attention to the environment as to the internal experience of the child, establishing a safe milieu (Bettelheim, 1974) in which' the child can join the carers and begin to develop new patterns of sociability. It is, as

92

ATTi\CIIM~NT; FOil MATIVi': !\Xl'I',I{lI'Nl 'I'

ever, vital to learn the child. Whut uiggcrs rugc for (i1is child? What aspects of the environment arc soothing? Whn: provides su Ic stimulation, without provoking a rage response? Once these factors arc recognised, and recognisable in other settings, then potentially overwhelming stimuli can be reduced to a manageable level. Then when the child has stabilised, the occurrence of everyday events, which for this child have been overwhelming, can be gradually increased to something more like normality as the child becomes more able to regulate their own responses.

Equally important elements of the environment are the other people who make up the human ecology of the growing child. Children with poorly developed inhibitors for rage need to be able to see those around them managing anger and conflict constructively. This is partly about being with people who are able to regulate their own impulses while being clear and open about their feelings.

Managing anger is not about never feeling angry, nor is it about pretending to feel something else; it is about recognising the inhibited impulse to destroy and transforming the energy to other uses. Similarly, resolving conflict is not about pretending that there is no conflict, but about dealing with others respectfully and openly to sort out the inevitable conflicts that arise when self-aware social beings try to live together, Children also need to have the experience of seeing that people who have lost control of their impulses apologise and make reparation. To ,err is "

human, to make good the error is even more humari. ;' ,

For the child, the first step to managing anger will be to recognise the inner experience of the impulse to destroy before acting on it. Insecurely attached children may have little capacity to recognise inner state changes; whatever approach to anger management is being tried, and carers will need to experiment, the aim will be to promote recognition of how it feels to be getting angry. Then the child needs to be able to gain some control over that experience.

It is important to stay with the unique experience of the child. One boy said he got a buzzing in his head when he was about to "blow". He could gain no control over the buzz directly, as a sound, but when asked what colour it was (the limbic brain does not distinguish sense from nonsense) he said it was brown. Once he found he could turn the brown buzz pink

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together without conflict. We are self-aware beings, conscious of our separate identities and our individuality, even as we are dependent for our well-being on our social network and our intimate relationships.

Learning to resolve conflict is part of preschool experience for securely attached children. By the third and fourth year (If life, most children are able to tolerate frustration without misperceiving it as threat, and are able to inhibit the impulse to destroy the source of the frustration, shame or fear. These young children are ready to progress in their social skills as they learn to negotiate with others over conflicts.

Children with unmet attachment needs, however, find it much more difficult to distinguish between unpleasant affect and threat. These children will tend to respond to conflict with appeasement, avoidance or rage. They will need to be taught to confront conflict constructively, trusting that sociable beings can always negotiate a settlement. Such learning will be a slow process for people who have developed neither the foundation of trust nor the social structures of autonomy on which such negotiated settlements depend.

Those caring for insecurely attached children need to learn formal approaches to conflict resolution and to be creative in applying these to family life. They also need to explore ways to teach such approaches to children who struggle to recognise their own feelings, needs and wants. let alone being able to recognise that others have similar claims On the unrvcrsc.

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96

ATTACHMENT; FORMATIVE I:Xi'IiRII'NCI',

.
Examples of Interventtens to promote the beginning ofself-control,
reflection and reciprocity
Environment Activities for carers Agency interventions
Physical environment Learn formal techniques for Ensure that carers
It requires some thought anger .management, have access to formal
and constant reappraisal assertiveness training,· and training in anger
to provide an environ- conflict resolution and management, assert-
ment that is both low in spend time reflecting on iveness and conflict
stimulus to rage and yet how these can betranslated resolution.
Interesting and stimula- into useful tools for this
ting to children child at this time. Ensure that super-
developing assertive- visory staff have also
ness and negotiating Practise these skills in your undertaken such
skills. It will be worth own life, and discuss openly tralning, lind can
the effort, however, and the experience of so doing. supervise carers
gradually the need to appropriately in
restrict stress levels can Help children find words putting the training
be relaxed as the child for affects and feelings, into practice and in
develops strategies. The and to distinguish between teaching it to children.
aim is to normalise different feelings in
gradually, remembering different situations. Assess the well-being
that the world beyond of all members of the
home will contain much Encourage children to caring family and
to make us angry. wonder about the feelings ensure that no one is
of others, and to explore the being victimised or
Time effects of negotiating with bullied.
Ensure that time struc- others
tures include periods of Provide resou rces for
relaxutton and low ~:nc()urn~1: the USI: I)f the family tn explore
srlmulus, Help the child expressive media such as self-exp resslon
nlllnllgc such limes, and writing, drawing, painting, throu::,h II range of
be prepared to offcr and IIny of the ereutlve and medii. lind 1I~·th·lli~·s.
SUlllWd for children performing arts, and then /
whu find luw dlmulu! eucouruge chlldrcn h. talk Eucnnrlll-:'· chlldn·n
environments challeng- about what they are doing. and carers to prepare
Ing. This support should for formal meetings
include helping the Teach children about lind til expr e ss them-
child to put into words listening and taking turns selves in a range of
their feelings, including in conversation, and show settings.
boredom and ennui, them that you also listen
and to identify and and value the contributions Promote multi-agency
value quiet happiness of others in discussion. provision to meet the
needs of the family.
People Teach children how to
Recognise people who apologise if they have hurt Provide specialist
act as frequent triggers someone, and be ready support and consult-
to rage and help the; always to apologise if you ancy as needed.
child to develop have been hurtful.
strategies for contact Provide respite for
with those people. carers and their
families. 97

66

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A'TACHMENT. TRAUMA AND RESILIENCE

with actual or realistically perceived threat to the life or personal integrity of self or others. Then there must be a response to the event which includes fear, helplessness or horror. Thus trauma is by definition a combination of an external event and an internal experience.

Take note that the event may have occurred to "self or others". It is important when looking at the needs of children who have been in situations of domestic violence to recognise that we can be traumatised by witnessing the violation of others. There is some evidence that disorders may be even more common and more severe among those who have witnessed extreme violence, for example, than among the direct victims, however terrible their experience (Harris-Hendricks et al, 2000, p 26).

Traumatic stress

Those fortunate enough to develop through infancy without major disruptions emerge from the toddler period as sociable and convivial people. Whatever their particular heritage and temperament, they will have a preference for liking and trusting other humans, they will find others interesting, and they will be able to live with others in social groups;

Although always adapting and changing throughout life, the brain is fully formed around the time at which, in our society, children are going to school. Under ordinary circumstances children are there, like adults, responding to their environment in a way which engages activity across all levels of the brain (Carter, 1998). In extreme danger, however, the brain responds differently. The limbic system is activated instantly when the threat is perceived, and the body is flooded with stress hormones.

Small doses of stress hormone tone us up and make us more alert and active. 'But dosage is crucial. In a traumatic situation the stress hormone levels-are toxic to some aspects of our functioning; we are actually injured by our own survival response. The organism prefers survival with injury to extinction.

The effect of this stress hormone overload is to alter the functioning of the entire personality. Brain, body and social relatedness are all radically changed. The state-regulating brainstem and emotion-regulating limbic brain take over and critical areas of the cortex and mid-brain are blocked as blood' supply to them reduces (van der Kolk et al, 1996). Specifically,

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oxygen to the area known as the hippocampus; which ordinarily has many functions including acting as a communication route between the limbic brain and the cortex, a sort of cognitive map for feelings, is reduced. And part of the brain called Broca's area, in the left frontal cortex, which allows us to express internal experience in words is also deprived of oxygen. 'Thus at the point of trauma there are no words for what is happening to us because the areas of our brains which generate the words are turned off. Trauma is always wordless terror' (Cairns, 1999).

Physically, the body is instantly prepared for flight or fight. All activity is suspended which slows us down or which uses oxygen that will be needed for urgent action. Digestion, elimination (which may occur spontaneously) and sexual arousal are all temporarily stopped. The long muscles of the arms (for hitting) and legs (for kicking and running away) and shoulders and jaw (for biting) tense up in preparation for action. Heart rate, blood pressure and breathing all alter to ensure the oxygen supply to these muscles.

Socially, attentiveness to others is restricted and the capacity to experience joy through social interaction ceases. People who can otherwise engage with others in a mutual and reciprocal relationship which is pleasurable begin to see others much more as means to an end when overtaken by the need to survive. There is a numbing of social responsiveness, and of feeling, so that victims of trauma can seem to be shut behind a glass wall, present in the. social exchange, but somehow not ,really,. participating. The lights may be on, but in important ways there is no one at home to greet visitors.

In adults and physically mature older children, trauma generates the full flight or fight response. Children, however, are generally flight animals (Roberts, 2000). Adult humans are curiously balanced between being predators and being prey, but children have the responses of prey animals when confronted with threat. The overwhelming urge is to be elsewhere: Given open space the prey animal will run; when cornered they will either switch off, reducing the pain and terror through reducing consciousness, or they may then use teeth and claws in a desperate last attempt to avert catastrophe.

Traumatic stress disintegrates the structures of personality in children whose brains are fully developed. It distorts the developing personality in

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This cycle of alternating intrusion and avoidance continues until the whole traumatic experience has been safely processed and rendered harmless. By that time the victim of trauma has ceased to be a victim and become a survivor. The trauma has ceased to be an ever-present reality dominating life, and become a memory of something unpleasant that happened in the past and is now over.

Recovery is not complete yet. The trauma has been consigned to the past where it belongs, but the survivor is not restored to wholeness. For traumatic stress disintegrates the structures of personality, and diminishes the sociable and convivial human being to a defensive and defended isolate. The recovering survivor needs now to undertake a further journey of discovery. They need to find answers to the question 'Who am I, now that I am not who I was before?' to redefine their own identity in the new world in which they find themselves. And they also need to explore their own personal and social power and efficacy in that world, now that they have stopped feeling helpless and hopeless. Finally, they need to let go of the miserable greyness which will have covered them since they entered the gloomy world of terror, and open up to the possibility of joy and delight.

There are three factors necessary for recovery from trauma, all other things being equal. We can see that there are also three phases to the rec~very process:

stabilisation; 2 integration; 3 adaptation.

Those who have survived trauma are fully reunited with the flow of their live's when they have travelled all the stages of this journey. More than this, many find that they feel that they have been positively transformed in the process (Tedeschi and Calhoun, 1995). There is a change of perspective and of value which follows recovery from trauma, and many survivors find that they are never the same again. They often feel that in certain respects their lives have been enriched by the ordeal. There are many ways of interpreting this experience, and the shades of meaning are not lost on the survivors, but the fact is that this common though extra-

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ordinary experience can have the effect of stretching the personality to explore beyond previous limits. To pass through the black hole of trauma is to emerge into a new world.

Post traumatic stress disorder

Recovering from trauma is painful and distressing. It may be some small comfort for the survivor to know that not recovering is worse. If we do not have the social environment or personal resilience to process, integrate and adapt to the trauma, or if the traumatic events were so horrific that they overwhelm even substantial social and personal resources, then we face the prospect of being unable to recover.'

"Then the troubles begin. It is intensely disturbing to go through the process of recovering from traumatic stress when we are in a safe environment, have already 'established internal processes tor regulating stress, have secure attachments, arid have access to supportive people with whom we have the close confiding relationships which will enable us to feel safe with them and enable them to commit themselves to keep us company on a difficult journey.

If these elements are missing, the victim of trauma must either bury the trauma and hope it stays buried, a task no more likely to be successful than most of our attempts to dispose forever of highly toxic waste, or enter into the recovery process hoping that it will be effective even in the absence of key essential ingredients. These are not options open to " conscious choice. The decisions, if such they are, are made at the [~vel of the organism; whichever of the two equally uncertain courses is taken, survival and health will be the aim.

Recovering fro~ trauma involves allowing the personality to disintegrate and reform. We need our social network to hold us safe while we fall topieces, keep us company while we make the journey of exploration which at last leads to a new identity, and act as surety that we have continuity, that even utterly changed we are still the same people they have always known and loved. It is clear that, if vital elements of the equation .are missing, that can be a dangerous, indeed a catastrophic process which will disintegrate the personality,

Burying the trauma may seem the more hopeful course. Unfortunately, traumatic stress is highly toxic and tends to penetrate even the strongest

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Numbing: cutting out all distractions

Trauma also produces physical, psychological and social numbing. Survival is the' aim, and anything which slows down vital responses is dispensable. So self- generated opioids provide relief for the pain which may be produced by this threat to existence itself; an average sized adult male triggered to trauma will spontaneously generate the equivalent of eight milligrams of heroin. Pain slows us down, and however useful its function under ordinary conditions, threatened with extinction it is a luxury,

Emotional responsiveness is equally a luxury of safety. It can be dispensed with under extreme threat, and given that it will take time, energy and attention away from surviving, that is just what happens. Feelings close down, and the parts of the brain which provide words for feelings, allowing our language-based brains to process the feeli?gs, are also deprived of oxygen (van der Kolk et al, 1996). Instead of the usual rich mixture of affects and feelings available to humans, the disordered person is reduced to an emotional range which goes from extreme fear to extreme rage with no points in between. The rate of acceleration from rest to terror would be the envy of any sports car fanatic. Rest being, of course, ilsel f a relnt ivc term. Whar the trauma viet im til inks or as rest would be uncomfortable for non-traumatised people.

Tuuuun produces II ~"Hldilioll culled anhedonia, the loss ofthe cupacity 10 experience joy (van der Kolk et al, 1996, p 421). Joy is vital to human beings, it is the prime motivator for non-essential activity - which, of course. is why it is turned off under extreme threat. In particular, interaction with other people beyond the most basic Fvwords (fight, flight, feeding an~... reproduction) is motivated by the possibility of joy. Conversation, intimacy, discourse, playfulness and simply keeping company with others are activities which humans find pleasurable, except when the capacity for joy has been excised from their lives by trauma. Then life is a dull grey wasteland, days are to be got through, and other people are threats or resources orjust not of any interest at all.

Intrusion: living in the past

Trauma is not over when it's over; it will not leave us 'alone to get on with our lives. Once disorder has set in, it is as though the trauma is perpetually

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present, even when there is no memory of it at all. Nightmares, panic attacks, obsessive thoughts about the specific trauma, or if that is out of awareness, then about anything catastrophic, strange compulsions to reenact what cannot be remembered, all these are the everyday experience of those who must live with the effects of unprocessed trauma.

Deprived of emotional responsiveness, and unable to process experience, the disordered person has only two responses to events which trigger re-experiencing of the trauma- terror and rage. People whose attachment history has given them perfectly serviceable mechanisms for regulating stress and impulse lose those controls under the impact of traumatic stress disorders. They are then subject to the primal terror of annihilation and the dizzying sense of being out of control in response to stimuli which may be more and more objectively neutral.

For once in the grip of disorder, the intrusive re-experiencing of trauma may be triggered by events far removed from the original traumatic experience. An abused child may register the sound of a stair creaking as associated with the onset of abuse; later they may have no recall of the

. abuse itself, hut may be triggered to a traumatic stress response hy sounds reminiscent of a creaking stair. it is clear that the range 01' possible stimuli of this order is vast.

Such triggering can also become progressively further removed from the origiuul truumntic avenin. A child hears Il trigger souud while p'lillling a picture at school and suffers a panic attack; later, the same experience of panic may be triggered by the smell 0[' paint, or the prospect of an urt lesson, or seeing the art teacher in the street. It is very easy for false conclusions to be drawn about the origins of traumatic experience, and the original experiences may be buried under many layers of secondary trigger incidents.

In the end the kindled limbic system, desperately struggling for equilibrium in dealing with unprocessed traumatic material, may be generating such a stream of catastrophic inner experience that the victim is effectively being retraumatised by their own disrupted internal processing. This is the vicious spiral of PTSD. Without any external stimulus at all, the nightmares, flashbacks and catastrophic thoughts can be enough in themselves to create new traumatic stress.

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under different headings and from the perspectives of different agencies often contributes to the fragmentation of the personality which is the most devastating result of traumatic stress. We struggle to discern aspects of the needs of the child which qualify for an intervention from an agency, and so we ask the wrong questions. Is this, a health problem? A mental health problem? An educational problem? A drugs problem? Or is it perhaps aproblem for the criminal justice system? We go on adding to the number of ways the behaviours may be institutionally addressed, and in so doing we add to the burden of disintegration. Until we can achieve as a society a deep integration in our approach to trauma, we will continue to see problems multiply.

With all of that in mind, a few illustrative areas of behaviour we may observe wi II be considered.

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Hyperactivity: life in perpetual motion

Sleeping patterns are disturbed, with nightmares and night terrors being frequent Children may be unable to get off to sleep, or they may wake up at irregular hours. Some children find it hard to go to sleep, but then are exhausted in the morning and find it hard to get up.

Children may be constantly on the go and constantly seeking a high stimulus environment, having a space between inactivity and boredom about as long as the patience span of city drivers at a change of traffic lights, Attention will be limited and carers learn to speak inshort sentences if they hope to keep the whole sentence in the child's awareness. Concentration will also be difficult, as perceptual fields are attuned to threat, and both vision and hearing tune out from tasks which are not threatening. It is hard for traumatised children to see a page of print, when their peripheral vision is scarming the' environment for threats. And they will lose the natural human preference for the human voice, as their healing automatically tunes out non-threatening sounds.

Hypervigilance is a symptom of traumatic stress, and it makes for very jumpy children who find it difficult to feel settled anywhere, In a new or strange setting, they will be scanning every aspect of the environment for potential threats, so any change to daily living patterns is exhausting for them. Others cannot be taken for granted as trustworthy, so tnat any accident, injury or illness may lead to a breakdown of the

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fragile structures of trust. I have seen children well established in placement who became terrified when carers needed to remove ii splinter or wash a wound.

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Dissociation: splitting up is sometimes not so hard

There are various defences the beleaguered mind may try to protect against the continuing stress injury. One which some children may already have in place as a result of their attachment experiences is the defence of dissociation. Whether it is an existing strategy, or newly discovered under the impact of the trauma, it is an effective defence to get through the immediate impact of the stress. Unfortunatelyit has longer term effects which can be devastating to the personality.

The capacity to split awareness so that at least part of the self is kept safe through even the most painful and destructive experience means that humans are able to be very resilient. Unfortunately it also means that we can disintegrate and still function, We are self-aware beings and we relate to our environment through our consciousness; when that consciousness splits apart the personality is radically fragmented,

Sometimes the splitting, although persistent. is purely trauma related, the self creating a fragment to contain the trauma that will exist alongside the everyday consciousness but only be active when confronted with another traumatic event. People thus affected speak of entering a different type of consciousness, which they recognise as continuous with previous .' trauma-related consciousness (van der Kolk et al, 1996, p 191ff), but not continuous with everyday awareness, This is a relatively benign level of dissociation, although any dissociation at the point of trauma is a risk factor increasing the likelihood of disorder.

Por others the impairment of ordinary functioning as a result of dissociation is much more profound. These are people for whom the separatedparts of personality become as it were persons in their own right. These victims of disorder are likely to attract the label of dissociative identity disorder (DID). The outlook is particularly grim for children who dissociate in response to trauma, for they are much more likely to develop lasting disorders, and even more so for those for whom dissociation is already a fixed response to stress as a result of early attachment experiences.

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the missing carer or the abuser, who would have been the object of strong feelings had those feelings not been excised by trauma. Then, through the power of counter-transference, we feel in ourselves the powerful feelings which .~re denied to the child. So traumatised children can come to generate quite irrational and unreasonable rage and misery in those who live and work with them.

Traumatic identity: defined by disaster

Trauma shatters the core assumptions that define human consciousness. Survival requires that babies make certain assumptions about the world. Ronnie Janoff-Bulman (1992) describes these basic and necessary illusions that enable us to function as the assumption that:

• the world is benevolent;

• the world is meaningful;

• we deserve good things.

Traumatic events rapidly unravel these beliefs. This leaves a vacuum in our most fundamental cognitive constructs about the world, and nature always abhors a vacuum. Human identity is founded on beliefs about ourselves formed as the environment reflects back to us an image of who we are (Shatter, 1984). Once traumatic stress disintegrates the core of our personality, the busy mind quickly; forms another set of beliefs more fitting to the world as we now perceive it to be. These new beliefs or schemas become the foundation for a new identity which may be thought of as traumatic identity.

Traumatised people invariably develop temporary or permanent identity beliefs which are trauma based. The resulting cognitive schemas have a pervasive effect on all other personal constructs. The victim of PTSD may state and live out such beliefs as: 'I have no control over my life'; '1 am the sort of person to whom bad things happen'; 'People who love me always hurt me'; and 'I don't deserve anything good to happen'.

Children who hold core beliefs like this are not likely to have happy lives until the beliefs change. Yet our core beliefs structure our identity, and it is no small matter to change our sense of our own identity. In so many ways we work with children to enable them to form and retain a

116

TRAUMA: TRANSFORMATIVli I'XI'I'I\\I'N( '1'

strong sense of identity, but here we actively invite children to let go or their identity as victim, and to search for a new sense of self. They will resist accepting the invitation.

Memory disturbance

Traumatised children often have no memory of the traumatic events which have disrupted their lives. Sometimes they have fragmentary memories, but they are not able to have formed narrative memories of the events until after they have recovered from the trauma. This traumatic amnesia distresses the child, and we see children struggling to make sense of the gap in their thinking. While on the one hand being avoidant of trigger situations, on the other, and confusingly for the observer, they may seek out situations which seem reminiscent of the past, apparently in an effort to reduce the painful self-doubt that plagues all of us when our memory lets.us down.

At other times children are unable to forget the trauma, or more usually certain sensory aspects of it. This hypermnesia takes the child into a perpetual inner world of tormenting images and experiences of the trauma

as though it were happening in an eternal present moment. We can see the child present in body but absent in spirit, living in a perpetual daydream

- although living nightmare would be a more accurate description of the experience. The child may be said to hear voices, which may be an uncontrollable inner replaying of the voices of abusers, or may be supject ~ to visual images or overwhelming feelings which have no promptin the present external environment but are internally generated.

The third type of memory disturbance after trauma arises from the reduced oxygen supply to areas of the brain, and particularly to Broca's area. Ordinary memory relies on the formation of links and narrative, and without Broca's area we are unable to create the narrative. The result 'is a distressing disturbance of short-term memory.

Children whose short-term memory is poor are frustrating to live with.

Ask them to go upstairs and perform a simple task, and by the time they have climbed to the top they have forgotten what it was you asked them to do. These, are children who never have the right kit for school, cannot remember changes to routine timetables, forget appointments, and always fail to bring home the vital letter seeking permission for them to go on

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own physiological responses, emotional experience and behaviour are deprived of this ability by the gross physiological changes arising from unprocessed trauma. Being in a permanent state of high stress arousal prevents self-control.

Since a sense of control matters, children who cannot achieve selfcontrol often become very controlling of others. This has the added bonus of making them feel safer, since other people are part of the environment and everything about the environment seems threatening, therefore other people are a threat.

Children may also be stuck, or have reverted, to the "magical thinking" of early childhood under the impact of trauma. They then feel that they have to be in control of everything or it will stop working. They may believe that they can predict or control the future, or that they are responsible for the safety of others which can be assured by magical acts. One child had to perform six rituals at bedtime to keep his absent mother safe; another needed to stay awake until after midnight every night otherwise so~neone in the bouse would die before morning.

Efforts to reduce di s: sonance

Safety is essential for people to be able to recover from trauma. Yet if we simply lake u truumutised child and place them in II sale environment, after a while they start to feel crazy. Their inner experience is of being terrified. The outside world no longer matches their inner experience, for it is safe. When our inner world and our outer world fail to match we feel crazy. This is one of the most uncomfortable feelings for a human being; it is like being annihilated as a person.

We have taken note that the child cannot control their inner experience when in the grip of PTSD. The only way the child can stop feeling crazy therefore is to make the outer world unsafe enough to make sense of the inner experience of terror. Traumatised children will make their world chaotic and dangerous in order to feel sane. Just when everyone around them is feeling that things are going well for them, they will press the self-destruct button.

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TRAUMA: TRANSFORMATlV£ EXPERIENCE

Psychosomatic and psychogenic disorders

Children living with this level of permanent overwhelming stress may suffer a range of illnesses and ailments. Every body system and organ is affected by stress. The resul~s of long-term exposure to traumatic stress can include headaches, breathing problems, digestive disorders, pain in the joints, backache and immune system disorders.

Children also express their absent feelings through bodily changes, a process called somatisation (van der Kolk et ai, 1996, p 183fT). Thus when another child might feel excited, a traumatised child may produce an asthma attack or a headache, and what would be mild anxiety may appear as diarrhoea or indigestion.

Children who have been victims of abuse, especially sexual abuse, may suffer health-related anxieties, even when they have no conscious memory of the abuse. They may be anxious about bodily functions, or the changes of puberty, and will need special care to be taken to provide them with good information and reassurance about their bodies. their developing sexuality, and their changing sexual identity. They may also suffer sexually transmitted diseases for which they will need treatment,

Fear begets fear. It is very difficult to maintain the still centre of adult security when Jiving with children who Jive with such terror. The basic SAFE attitude, in which the puzzle of relating to other unique persons is addressed with friendly interest and curiosity, is a protector against the stress of daily life with such disorder in the household. Informed questioning of your own observation can generate the reflection on the experience of the child. Then common ground is discovered without needing to be sucked into the vortex of trauma yourself.


Is it likely that this child has experienced a traumatic event? Do they seem easily startled?

Are they readily overwhelmed by stress? Can they relax? How?

Do they suffer nightmares or night terrors?

Do they experience panic or terror in everyday situations? Are they easily provoked to rage?

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A1TACHMENT, TRAUMA AND RES1LlENCE

This is not an argument for delaying help for the child until they are in a stable placement - a familiar Catch 22 situation - but it is a plea for ensuring that therapy is preceded by the provision of at least minimal safety and stability.

Learning about trauma

The child and everyone who is concerned with the child must be able to understand what is happening. Knowledge is power, and anyone who has suffered the effects of traumatic stress needs to know what has happened to them, what is happening to them and what the future may hold as they recover. This knowledge normalises the situation and helps children to understand that they are not mad or bad, but have been injured by events in their lives.

Similarly, as people around the child come to understand even the most bizarre elements of their behaviour as indicators of the injury they have suffered, it becomes much easier to work together to keep everybody safe. This does not reduce the responsibility of key agencies to carry out their own core tasks; the education system must provide for the educational needs of all students, the criminal justice system must protect the public from crime, and so on. But it does mean that these agencies will recognise the needs of traumatised children and young people as radically different, in some ways, from those of their non-traumatised peers.

It also means that these and all other agencies will need to acknowledge that the trauma does not reside within the child, it is the social system that has been injured. Such injuries require a systemic response (Apter, 1986). If we do not provide structures that promote the healing of traumati~ stress injuries, we perpetuate the injury to the social fabric. People who are disintegrated, socially disconnected, terrified to the point of unpredictable violence or self-harm, and terribly compromised in terms of their own mental health (Richardson and Joughin, 2000) will be both a drain on, and a threat to, the life of our community.

Learning or relearning words for feelings

Like the other two steps in this first phase of treatment, getting the brain engaged. or re-engaged with the processing of feelings is often forgotten. It is of little value to start working with a child on processing trawna until

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TRAUMA: TRANSfORMATIVE EXPERIENCE

1 ~

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they have begun to be able to feel and to process those feelings.

Again this is a part of the treatment programme which will involve everyone associated with the child. When the child is constantly encouraged to recognise and put words to feelings, when emotional literacy is encouraged in every setting and by everyone concerned, it becomes a matter of course for the child to practise what is initially so hard.

Children need to be encouraged and enabled to speak the feelings, and adults also need to be open and authentic with the children about their own feelings and thoughts. Carers and teachers, social workers and therapists, play leaders and child minders all need to be aware of the need to keep exercising the words-for-feelings bits ofthe brain. Games; stories, mealtimes, bedtimes, rides on buses, playtime in the park, anything and everything can be an entry point to speaking the feelings.

Phase 2: integration

Fuses, switches and safety valves: controlling and managing

physiological reactions

If children cannot begin to process trauma without having words for feelings, equally they cannot safely process trauma until they are able to regulate their own physiological reactions. This may be a point where medical intervention is needed; there are drugs which seem to help (van der Kolk et ai, 1996, Chapter 23).

There are many other approaches which may help different children.

I

The key factor is the child gaining their own sense of control over reaetions

or sensations which previously seemed unmanageable and led to overwhelm. Relaxation techniques help some children, including breathing exercises which teach the child to alter physiology by gaining some control of autonomic functions and progressive relaxation exercises which create awareness of the state of the long muscles. Massage, SHEN therapy (a physical therapy designed specifically to address the physical and emotional effects of trauma) and biofeedback (a method of enabling people to monitor their own physiological responses) might also be useful.

Staying very close to the metaphor of the child's behaviour may dissolve the sense of powerlessness in the face of their own impulses. It may sound simple to notice that, if a child is banging their head against 11 brick wall, they could benefit from discovering the metaphor in words,

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and destructive beliefs. For the child these are not beliefs but facts. Anyone who contradicts an obvious fact cannot be taken seriously. When we deny what for the child is evident reality, we simply lose all credibility with the child. At best we will then be seen as out of touch and not worth listening to. At worst we will be perceived as sinister and threatening, since it is hard to understand the motives of someone who keeps contradicting obvious truths, and traumatised people are always predisposed to find others threatening.

The key to helping the child to be free of the grinding destructiveness of negative cognitive constructs is to introduce choice. Without contradicting the original scheme, other possibilities can be introduced. The child can then be invited to think about what for them would be evidence that the new possible belief was valid. For example, what if one person who loves them does not hurt them? Could this provide evidence for the possibility that there might be some people in the world who can love them and not hurt them?

The whole living environment can become the setting for a constant discourse on the nature of reality. If children learn to think deeply about issues less close to the core of their being, then as they progress towards recovery it becomes more and more possible for them to use the developing flexibility of their minds to challenge their own core beliefs. Despite the immense courage required to undertake such a journey, children will do it. For traumatised people, courage is the necessary quality they always develop. It takes courage to live through each day with PTSD.

Phase 3: adaptation

Making contact: re-establishing social connectedness

Children who have emerged blinking from the dark cave of traumatic stress are entering a new world. They will need to relearn important skills, and for those traumatised at a young age, the skills may need to be learned for the first time. In particular, children need to discover or rediscover the delights of social connectedness.

Ordinarily human beings like to be in relationship with other human beings. Trauma damages this predisposition. The child needs to find out that relating to other people is worth the effort, that it makes them feel

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TRAUMA:TRANSFORMIITJVE EXI'HRIL:NCE

good. Working with a group of young men who regularly sniffed glue, I asked if any of them had any times when they felt happy when not under the influence of glue. One deeply troubled boy suddenly looked very surprised and said 'I'm happy now!' It was a revelation to him to discover that he was happy just being with his friends in a safe place, without any extra help.

The key thing was to name the happiness. Until he put it into words he was completely unaware that he felt good. He recognised the sensations experienced when. sniffing glue as pleasurable, but did not name to himself the happiness.of.simply being safe and comfortable and with friends, and therefore had no idea how much he was enjoying that basic pleasure. Children need to be .encouraged to engage in relating to others, and then they need to be encouraged and enabled to put words to the experience. Without the weirds the experience will be useless because it will make no contribution to building healthy patterns in the mind.

Making a difference: re-establishing personal 'efficacy

Only at this relatively late stage of recovery will the child really be able to make use of work to help them build self-esteem. Now is the time for all the activities and interests the recovering child can take on that might have the effect of enhancing their self-confidence and self-concept. Now

is the time for praise and congratulation, for now at last the child will be able to hear the positive comments and relate them to their own core .self- r-

image. / '

The entire environment needs to be reflecting this positive self-image back to the child. We can encourage children at this stage to take a real pride in their own personal space. Valuing the space that is identified with the child is also giving a message about valuing the child. Children who have been wreckers of bedrooms and of their own property often become quite house proud at this stage of their recovery.

Clothing and other aspects of personal appearance can be very confidence-boosting for the recovering child. Children who have been self-neglecting may become able at last to take pride in choosing their own clothes and keeping them smart, or to make choices about personal hygiene and appearance that mark a real ability to feel in control of their own self-presentation.

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Provide consultancy as needed.

Activities for carers

Environment

Agency interventions

feelings. Be prepared to name and talk about your own feelings.

take notice of anyone who provokes a relaxation response, and encourage that soothing relationship.

system being overwhelmed.

Provide respite for carers as needed.

This stage of recovery needs frequent revisiting throughout the recovery process. As the child progresses, each new stage of recovery may destabilise and produce new terrors. Then there needs to be a new period of grounding and stabilising for the child to re-establish their sense of safety and the assurance that they will not be overwhelmed.

Examples of interventions to promote integration

PIII'~icQI environment ThOll t.\U\>I."1[t .. u, -n 1 non needs 10 promote and contain Ihe therapeutic process. Safety and predtctabilitv are central. but the child will also need to begin to feel in control of their own space. Children should have their own room and be allowed to let that space reflect their fluctuating relationship with themselves. Mess and muddle may reflect the chaos inside. Attempts to clean up or decorate show the beginnings

or self-care, and so on.

Having established safe :ldh'lCi~·s. 1I0W Ust· thl'sl' IH' enable the child 10 establish control over their own physlulogy. Teach appropriate activities to soothe stress and 10 1II11nngf.' slulml' and rage.

Assess therapeutic 1U'~'ds 1'lIn'fully lind provide thc~'apy

as needed.

Set measurable outcemes fur therupy and ensure that the process Is regularly reviewed and monitored. It is easy for therapy for traumatised children to become part of the problem instead of the solution.

Allow and encourage the child to join in pleasurable activities of all kinds with you. Cooking, gardening, house maintenance, vehicle maintenance, cleaning, painting, craft work, music

making. .

Maintain clear role boundaries between agencies. Ensore that carers are clear abo1lt their role during periods of therapy •. '

Provide reg;1Ilar wtH~1lCJ" co.tact ... cau-etllaada ~~. ....._-.3iIii .... ',.

f

~~.: ....

~-\~

..

Be prepared for storms during periods of formal therapy. When children return to tile household

Art materials, musical from therapy sessions

instruments, mood traumatic material will

altering lights and music., han been adivated and the

slightly increased rnc:tioDS may be UttflQe.

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---.:.~-." ... ~ .. ~-~ ..

TRAUMA: TRANSFQRMATIVE EXPERIENCE

surprises can all be traumatic events, and with fully informed about
useful at this stage of places associated with the work of the others,
recovery. trauma, may be part of the
therapeutic process. Allow Provide regular super-
Time for'strong reactions. Take vision and support for
While travelling the steps to ensure safety. the carers. Watch for
Integrative stage of their issues of safety, and
journey, children will Actively seek and use super- ensure that carers,
find that time distorts visio.n and consultation. Stay families and wider
and it is hard to keep In dose touch with therapist, networks are not put
to routines and patterns. and be informed about the at risk when
processes and predictable children are acting
The time environment outcomes of therapy while out during periods
needs to be structured maintaining confidentiality of therapy.
but flexible. Children on content.
should never be Take care of the entire
penalised for lapses of Keep boundaries around care family. Check
.. time awareness while role •• Carers are not who is being aHectcd
recovering from trauma. therapists, they are by the changes In the
Jnstead they need re- providers of a therapeutic child during therapy,
IIIIU ranee Ih u I It Is bard envlrenmcnt. Children need
for them to manage to have safe spaces and safe Provide respite as
time structures, lind people where they can try tn needed for carers.
Invited to [uln us In live In the present. It I~ hllrd
finding ways to help enough for traumatised Provide therapy IOf
them malntaln II slife children to keep the past carers or nny
structure, from Intruding into the members of the tare
present when those bound- ramily netwnrk if Ihey
People aries are safely kept. are affected by
Children will be highly secondary trauma-
dependent at this stage, tisation.
and will be disturbing I
/
to others. They need Provide consultancy
encouragement to relate as needed,
to adults, and to let
adults meet their
dependency needs. 133

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AITACHMENT, TRAUMA AND RESILIENCE

Grieving is universal, but such rites and rituals are culturally specific to different communities and traditions; what they have in common is that they provide a way for people to accomplish the personal transformation of grief within the protection of the community as constructively as possible. Rites of mourning and of transition allow and encourage the dislocated self to rediscover a place within the group, marking' and containing the absences that are grieved.

WHAT HAPPENS?: thinking about loss and grief

Art, literature and music point to the truths of human grieving. Every place touched by human life has evidence of the human relationship to death, loss and bereavement. As a child I sat on ancient tumuli and thought about the ancestors. Archaeology suggests that humans have linked themselves to the dead since the earliest times. In one afternoon r watch my kitten forget his mother, so far as I can tell. My twenty years fostered child comes to ask me to help him find any trace of his. We can, it seems, let go but not permanently forget so long as consciousness and memory interact.

OUf grieving takes many different forms but there are common threads. Loss shakes us so that we are often numb at first, simply failing to register the evidence of our senses that our world has changed forever. Then there is often a time of denial, when we minimise the loss and convince ourselves that our new state is really better than the old. We may spend time searching frantically then for alternatives to what has gone, before at last we are strong enough to allow ourselves to confront our truth and know that we can never be exactly as we were, Then sadness takes us over, and despair as hope of recovering the old order disappears, and rage that we must at last remake ourselves and acknowledge the real imperfections of our old state as well as the absences in the new. At last we rediscover the blessings of affection, as our friends who have stayed with us through the darkness help us forward through the maze and out into the familiar new world. Thus humans negotiate the journey of grief (Fahlberg, 1994, p 155).

Since Bowlby, we have known that children also grieve though they may take a different path (Bowlby, 1991). Young children may have little

136

TRAUMA; TRANSfORMATIVE EXPERIENCE

concept of the adult concepts of bereavement and loss, but they ~o have affectional bonds as we have' seen, and their own sense of meaning and purpose in the world. All these can be lost, and such losses will produce

the personal and social upheaval of grieving. .

They tell me I stood in corners burning-in my mourning. Restrained myself against their embraces. I was three years old.

. .. I have known other women with cancer - other women who died ... She becomes the model for them all.

(Michelle Cliff, 1980)

Children who suffer losses while they are in the shelter of their own families will be able to grieve in and through the embedded patterns of ritual and mourning that every family, community and culture shares. Displaced children, children separated from their families for any reason, will inevitably be grieving ar:d will probably also be deprived of the familiar structures for holdingand containing that grief.

Securely attached children who are grieving within the safety of their own families will find comfort and strength, and be developing resilient patterns of mourning and adaptation, through their attachment to those who love and protect them. Children with unmet attachment needs recovering from losses while remaining in their own families will struggle mote but may still be contained safely within the cultural structures of

, /

mourning in their family and community, i

Securely attachedchildren who suffer separation from their attachment figures will experience both loss and fear (Fahlberg, 1994, p 133ff). If they can find safe enough carers, however, they may draw from them the comfort they expect and, trust to be provided by loving adults, and so remain resilient and able to mourn. This will be more likely if the carers are within the same cultural community so that grief and loss are dealt with in ways familiar to the child. Separated children whose patterns of attachment are insecure will be less able to draw on the comfort of substitute carers even though they accept those carers as offering parenting; for children who have not experienced reliable relief and comfort from their own parents will not recognise that parenting might provide such benefits.

137

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self, Every discovered joy in the changed world carries the reproach of faithlessness.

Children who grieve need us to be responsive but not intrusive. They need us to be prepared to engage with them in the dance of grief, a dance to music they alone can hear. And finally they need us to lead them back from the isolation of grieving into joyful connectedness with a world that is, after all, full ofIight and sound and colour and delight and other people.

It is important to be clear about the location of the grief when living with children who are grieving, Everyone experiences some grief in a lifetime, and the grieving children can easily trigger feelings of unresolved grief in us. Again, generating a reflective space through the use of your own informed questions may help you to stay in touch with the child's experience without it becoming your own.


Has the child experienced significant loss, or changes in life patterns? Are they able to express their feelings about these?

How do you know what they are feeling';

Do they often seem disconnected from the world around them? Do they seem self-absorbed?

Do they need help to cope with ordinary tasks that other children of their age could manage unaided?

Are they often sad? Irritable? Withdrawn?

Are they able to cry and to take comfort from others? Are they able to talk about their life before their loss? Are there signs of progress or do they seem to be stuck? Are they able to enjoy new experience yet?

WHAT CAN WE DO?: approaches to living and working with grieving children

We do not know how to deal with people who have been bereaved. Should we speak or stay silent? Would they like our company, or would they prefer to be left alone? Do they want us to encourage them to re .. establish old patterns, to try new things, or to rest from activity and let the emotions

140

TRAU MA: TRANSFORMATI VE EX PER1ENC E

flow? There are no formulae. to tell us what to do, and our guesses, intuitions and best intentions may all be wrong,

It is true for. all human interaction, of course, that we can only do what seems good to us'at the time and see what happens. We will make mistakes. Yet somehow we feel that the simple fact that loss is universal ought to make us more accomplished in dealing with it. Practice does help, of course, but only when it is accompanied with a basic humility in the face of the vast and unfathomable range of response of human beings to the experience of loss. First' give yourself permission, therefore, to make mistakes and courage to acknowledge them.

There are aiso good practical approaches·to dealing with those who grieve. It is helpful to get training in dealing with bereavement and grief _ better still if the training relates specifically to living and working with bereaved chiidr~n.'·It is important not to hurry the. child through the processes of grieving, and equally important to be active in encouraging the child to talk about what they have lost from their lives, Allowing children to be sad, and giving them opportunities to allow themselves to be happy, are both part of the dance of grief.

The child needs you to take the time and trouble to learn them, and having learned them to accept them with all the feelings of , thoughts and feelings and behaviour that go with grieving. You will also need to be aware of the losses . and bereavements in your own life. As we live with those who grieve, our own wounds can be reopened. Children need J,ls to .' be able to separate our losses from theirs, so that they can stay connected

to their own experience without feeling inhibited by the need to protect us from being hurt. You have to be strong yourself to bear the grief of

others.

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the same child at different times. We are all vulnerable, but some are more vulnerable than others, and all of us are more vulnerable to some events than to others,

Resilience is not the same as invulnerability (Schofield, 200 I), but in beings who can never be invulnerable, and human beings can never be that, resilience is the obverse of vulnerability. It is closely linked to the internal working model of the world generated through attachment experiences, Children ascribe meaning to their experience based on their personal internal working model, and it is the nature of the meaning they generate that will determine their resilience to that experience. Once children arc able to generate meanings that lead to creative and constructive responses to events, they are set on the road to developing resilience,

Children who believe that they are to blame for the losses and hurts in their 1 ifc will experience new loss and hurt as evidence confirming their own lack of worth and helplessness; they will be less likely to be able to respond lo such events with creative energy. Children who believe that adults, or men, or teachers are to blame for their pain will experience fresh pain as confirming or extending those beliefs; they will be unable to draw comfort and strength from their relationships with adults, or with particular types of adults. Our internal working model of the world provides the basis for adaptive or maladaptive personal and social responses to events,

A young man who has grown up with drug-using paren~s interprets any adversity in his life as a reason to seek medication for the pain. When he experiences stress, he reaches for the heroin. As he progresses towards recovery, his belief systems change. Now the many difficulties in his life - homelessness, lack of money, being a victim of violence - begin to be interpreted as evidence that he needs to change his lifestyle, The pain that previously was the evidence that he needed drugs becomes the evidence that he needs to let go of drugs.

In constant interchange with the environment, the child develops more or less creative and effective ways of building their experience into their developing personality. Key attachment relationships provide the raw material out of which the child constructs a perceiving and interpreting self, a uniquely vulnerable and resilient self. As Maggie Ross says in her study of her life as a religious solitary: 'We are all, each one of'us, solitary;

144

RESILIENCE, AFFIRMATIVE EXPERIENCE

1

that in the end each is a unique creation of God, and alone because of that uniqueness .. .' (Ross, 1988, P 3).

Aspects of personal resilience include insight - the capacity to reflect on our own sensation and make sense of it (Wolin and Wolin, 1993, Chapter 4) - and independence -vthe capacity to negotiate enough separation from others to create a safe personal space (Wolin and Wolin, 1993, Chapter 5). Children who have been able to develop insight and independence are in a good position to be able to form a coherent and balanced narrative of their lives. This will provide them with a continuous sense of self, with a sense of personal identity and with the basis for self-esteem.

One of the greatest difficulties with the concept of personal rcsil icncc i.B also one of the most encouraging, The building of a personal construct ofthe world is very hidden; we can never be sure how another person is experiencing the world. Children may sometimes pick up on tiny clues that they nrc loved, or respected, or valued and thus trunslonu their sci r· concept so radically that they begin to perceive their whole world through different eyes. It will be very hard for the observer to know that this critical transformation has happened.

Karr-Morse and Wiley (1997) show in the true story of two brothers how small influences may create large effects. In a life full of distress and trauma, one brother had some experience of being valued and encouraged, the other did not, Among many slight differences in apparently similar lives, these contributed to very great differences in outcomes for the two

/

boys. By the age of 20, one was a convicted murderer on death row' and

the other was a student in college. Yet these things were so slight: a loving tone in .the voice of a grandfather, a grandmother who could relate encouragingly to one brother but not to the other, a brief experience of foster ,care in a home that offered love and respect recognised by one of the brothers but passing unnoticed by the other. Another example of the power of small interactions:

A young care leaver ... was asked ... what had made him a "success" despite the difficulties he had experienced growing up in care, He cited as an example someone who had listened to him. a doctor who had seen him as a child. He asked the .doctor; 'Do you sometimes give people 'drugs just to keep them quiet?' The doctor replied that he did not, but went on to say that it was an interesting question and that he

145

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ATTACHMENT,.TRAUMA AND RESILIENCE

boredom; it takes very little drop in stimulation for them to feel edgy and dissatisfied.

Children who struggle with solitude are frightened of separation. Once they begin to trust those who care for them, they may find it frightening to be left. Going to bed may also give rise to high anxiety for children who are frightened of being alone. Children who have previously been punished by isolation may be especially vulnerable to anything that seems to echo the ordeal of being separated from others and forced onto their own overstretched resources.

When impulse regulation is difficult for children, they may find the physical presence of the carer helps them to control destructiveness. If they are left on their own, they may set about destroying their environment, Parents and carers often comment that they had only left the child untended for a moment, yet something in that brief time had been destroyed, stolen or damaged. Children with little sense of self become quickly overwhelmed. If their carer is absent, they seem to lose their sense of being an effective individual able to make choices and act upon them. Instead the impulsive emotional mind takes over, and chaos rules.

. Children who are subject to excessive and pervasive shame are also unable to find comfort in solitude. Introspection is harmful when it leads only to self-blame and shame. Then the child may become locked into an experience of overwhelming shame which must be either absorbed into the growing personality or transferred to others. Neither of these is healthy, and the child will often avoid solitude after experiencing once the corrosive effects of introspection in the presence of pervasive shame.

When children who would prefer to avoid solitude find themselves alone, they may try to soothe the stress this evokes. Rocking, thumb sucking, stroking fabrics, masturbation, and making rhythmic or humming noises may all be an attempt to soothe or distract themselves for children who find solitude stressful. Others may try to alter the numbing effect of the fear of loss or abandonment with self-stimulating behaviours. Head banging, hair pulling, scratching or cutting may all be attempts to engender feeling in a body numbed with stress. Masturbation may be a means to stimulate sensation, as well as a means of soothing stress arousal. Some children when overwhelmed may switch off completely and go to

148

RESILIENCE: AFFIRMATIVE EXPERIENCE

sleep; this is unlikely to be refreshing sleep, however, and they wake up

still overwhelmed and still scared to be alone. .

Observation is of little benefit until you can make sense of It. In learning the child you will need constantly to ask que~ti~ns of y~ur own experience of the child in order to get closer to the child s experience of

the world.

Examples of useful questions Does this child enjoy solitude?

Do they still need to be in the physical presence of a carer? What type of solitary activity might help this-child develop? What are their special interests?

What are their special skills? •

Which of their senses gives them most delight?

W~AT CAN WE 001: promoting personal resilience with

children who find solitude difficult .

Children who have unmet attachment needs benefit from the physical presence of adults as much as possible. A~ the same time, they n~ed. to develop the capacity for solitude. How do we meet these conf1~ctmg needs? It is important to spend time with children comfortably III the same space, but not directly engaged with the same activity. Children who become aware that we like to share time in this way can feel t~~t they are acceptable to us for who they are, and not just for the things that they

do.

This has a double benefit. The child becomes more at home with their

own being in the world, and it becomes more straightforward to deal with matters of discipline when children arc more confident that we acc~pt them as they are. It is a delicate negotiation to be with someone wh~le they explore their own solitude. Parents of secure toddlers do. this, however, without difficulty. The preoccupations of very young children are rarely of gripping interest to adults. Carers produce just eno~gh interest and engagement to allow the toddler to know that there. IS a connection, and just enough distance to ensure that the young child IS also discovering their own unique perspective on the world.

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Examples of interventions to promote personal resilience
Physical environment
Plenty of personal space Children need to be with Families will need
to explore their own people who are at ease with supervision and
solitude (it may not be their OWn solitude. Active support to provide an
the space set aside for engagement with your own environment that
them in the home). self-discovery and self- allows the child to
Children often choose a development helps the child move from depend-
location that is special to make their own adventure, ence towards
to them for this explora- to set out on their own autonomy.
lion - a den; a particular journey.
tree, the space under a Provide access to
work bench or table. Commit yourself to activities respite can if
Children exploring that bring you joy and con- necessary to allow
solltude will benefit tribute to your growing carers to model self-
from a rich and stimula- sense of identity. Allow development and self-
ting environment with children to see the pleasure j discovery. Carers who
access to many materials and uncertainties I' f such 1 have been absorbed
and media to help the personal journeys of with earlier stages of
exploration. discovery. child development
I may need encourage-
Time Establish a family ment to engage with
The rhythms of solitude atmosphere in which it is I activities that are just
are different from those ordinary for people to make for them; physical
of the social world. discoveries, to express them- exercise, classes, art,
Children who. are really selves in many dllferent poetry, craft, reading,
making the journey of ways and through many organised religion,
self-discovery will need different media, and to spiritu al exercises -
those around to keep an have periods of solitude and anything that allows
eye on the clock for reflection. them to explore and
them, and tokeep them express themselves
in touch with the Make available private can be encouraged.
requirements of every- spaces and quiet corners.
day life. Provide resources to
Encourage children to keep enable carers to create
People journals and photographic an environment that
C hlld ren who are records of their life. encourages self-
making this exploration discovery.
withdraw a little from Provide access to physical -
the social world. It is activities, musical Ensure that agencies
important- that they do instruments, art materials, work together to
not lose contact with books, ~ournals, newspapers, promote self-
others. If children have poetry, craft materials, discovery for the child.
issues to work through gardens, animals, cultural Liaison between
about contact with their experiences, whatever may different agE ncies
birth families, these will contribute to the journey working with the
surface whenever they of exploration this unique child and family is
are engaged with the child will be making. vital when the child
question: Who am I? is addressing these 152

RESILIENCE; AFFiRMATI VE EXP E Rl ENeE

They may need special Promote and encourage issues.
contact with members of formal life story work, and
their birth family at such appropriate contact with or Provide formal life
times, or if this is not learning about birth family. story work as
possible or appropriate, appropriate.
they will need help to
work through the issues Enable and encourage
they cannot address contact with birth
directly. family as appropriate. between self and other may persist or recur, with results ranging from the disastrous to the comic. 'Put your coat on,' my grandmother in her later years used to say, 'I'm cold.'

Generally children in the primary school years have made the extraordinary leap from egocentricity to awareness of the reality of perspectives other than their own. The developing brain has become a social organ, and the child is able to move from primary attachment relationships to group membership. Carol Gilligan (1998) has observed, that girls and boys develop differently in terms of this decreasing egocentricity and increasing consciousness. She describes the stages of development in girls as being concerned with care, which moves from self to others at around the age of seven, and then during adolescence shifts again towards universality.

The child at first is centred on care of the self, which may include being interested in the care of those she sees as an extension ofl'h.erself, her attachment figures. Then she is able to experience the separate and alternate perceptions of others in her immediate community. This produces a sense of group membership, and a capacity to share the views of others. It also leads the child to be very sensitive to those views, and this stage of development is sometimes called conformist or conventional, reflecting the strong group identification of children at this point in their lives. In adolescence, however, the child may develop a wider perspective, and become able to put their sense of group identity in a more universal framework. These stages in the development of compassion have been described by Ken Wilber (2001, p 20) as egocentric, ethnocentric and worldcentric.

Boys, according to Gilligan (1998), take a different developmental

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reciprocal story telling being an experience of overwhelming shame and self-concealment. Diminished capacity for empathy leads to socially inappropriate responses and behaviour. All these lead to exclusion from

the group. _

Human groups are unforgiving of difference, especially in childhood.

The group will exclude those who are not able to fit in. Extremely anxious individuals, whether actively anxious or avoidant, will protect themselves hv self-exclusion. Even if we do not take our most vulnerable children away from society and shut them up with others of their kind, they are likely 10 hc excluded or to exclude themselves. And like calls to like, for the child needs a group to belong to, so we see socially vulnerable children finding peer grnllps nt"llihel' sudally vulnerable children, Policies nf'socinl inclusion arc ineffective unless and until we address these dynamics.

WHAT CAN WE DO?: promoting social resilience with children who find compassion difficult

Encourage social inclusion

Children will need help to be included in the groups that will help them grow. This is work that will involve a response from the whole community, Schools, health workers, activity groups, cultural and religious groups, neighbours, shopkeepers, police and anyone else who may encounter or be encountered by the child will need to be alert to the part they have to play in helping. They need to understand that in these encounters they contribute to the growing or diminishing resilience of the child, and that it is in the best interest of the whole community to promote the resilience of our most vulnerable children.

Schools in particular have a key part to play in developing resilience.

Sonia Jackson has shown that, above all else, staying within mainstream schooling is a predictor for successful outcomes for children looked after in public care (Jackson, 2001). This is not surprising once we recognise that school is the centre oflife for most school-age children. The attention of the school-age child is appropriately shifting away from the primary attachment group to wider social groups and groupings, School is where they spend a large proportion of their time, and it also provides a range of social. experiences.

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Other groups also matter, however. Carers may need to work hard at promoting inclusion for children whose behaviour may lead them to be excluded from the wider community, There is work to be done with the child, to help them to develop social graces that will be enough to carry them through, There is also work to be done with the community to help people understand the needs and responses of very anxious and easily overwhelmed children.

Encourage personal and social efficacy

'Here the work is first to strengthen a sense of identity and to build selfesteem in the child, giving them a more settled base from which to venture inlo sociu] relatedness, Then the child will need to be encouraged In develop new skills and abilities, both personally and socially. Finally the child will need their moments of empathy, areas of insight and understanding, and positive group roles to be recognised and valued, so that they can begin to feel that they have something to contribute to groups.

Identity work will include and extend earlier life story work. Now the emphasis in such work will be on the strengths and resiliencies that the life story has provided for the child to use as a foundation for daring to enter into new social groupings. It will also need to include the preparation of an appropriate cover story for the child, so that they can tell their story to others without being damaged in the telling. It is important at this stage that life story work enables and encourages the child to join identity , affirming social groups beyond the immediate attachment group ot fami ly (Gilligan, 2001, pp 16-19).

Such life story work will allow the child to create their own truth from the bare facts of their life. It will also explore and sustain key elements of social identity such as ethnicity, religion, language and culture. There are particular issues for life story work with black children in a predominantly, and dominantly, white society, Ryan and Walker (1999) provide helpful advice onenabling children to develop their own life narrative,

Everyone connected with the child has a part to play in enabling the child to build appropriate self-esteem. Noticing and commenting upon the child's aptitudes, abilities and personal qualities are of immense benefit to the developing personality. This is not to make the child into a bumptious self-advertiser. Indeed, sensitively and appropriately done, it

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has had a troubled start in life may show this in their feelings and actions at times, but we will try to keep such troubled behaviour at home and not at school. We also made a promise to our children: for the rest of our lives we will take a parental interest in you so long as that is what you want.

For the next three years, until the age of 14, Bonita was reasonably settled in placement and catching up at mainstream school. She developed many new interests and activities. At the same time she experienced increasing mental and physical health problems, including self-harm, violence, volatility, and eating disorders. She was often absent from placement in attempts to return home. During this period her next younger sibling was received into care, but the others still remained at home.

We maintained the approach of keeping home as a safe arena to contain difficulties as far as possible, leaving school relatively trouble free. We encouraged a range of interests and activities outside the home for Bonita 'and all members of the foster family. It was a priority for us to establish and maintain close liaison with school and social worker.

By the time she was 14, we felt it was impossible for us to maintain the safety of the placement, and Bonita was removed to a children's home nearer to her birth family. We remained in touch with her while she was at the children's home. Her high-risk behaviour led to her being moved to a special unit in Wales, far away from her family and from us. Once there our letters to. her were withheld. Bonita was very unhappy at this placement and-asked to return to our foster family. She moved, at our request. to a bridging placement for two months and then returned to her placement with us.

Once Bonita was clear she wanted to. return, the interim placement was agreed to allow two months for us to negotiate with school for her to return to them. It also gave the opportunity to set a clear placement contract with Bonita, enabling her to get some recognition of the feelings of others in thefamily, and giving them time to prepare for her return. Sire then returned 10 us, wit/restarted school 011 a restricted entry GCSE programme. Ve,:v close liaison between school andfoster family was set lip to try 10 ensure a smooth transition after six months absence.

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Bonita remained with us and at school until she was nearly 16, and took and passed five GCSEs, four at grade C and above. There were still many concerns about her mental and physical health and safety, however. One week after her exams finished, she left the foster home and returned to a childre~'s home near to her family. Three days after her sixteenth birthday she ran away and got married. Her first baby was born when she was 17, Bonita had no contact with us for two years, then when she was 18 she and her husband moved home and were living near to us, her foster family. A second child was born the following year. There were still many concerns about Bonita's mental and physical health.

We warmly accepted the renewed contact with Bonita, but were careful . 10 set clear boundaries about the nature and extent of our involvement with her.

When she was 21, Bonita left the marital home,

The foster family offered support, within boundaries, to Bonita and her husband and children.

At the age of23, Bonita remarried. Two more children were born over the next two years. Bonita and her second husband set up their family home nearby. Concerns about mental and physical health continued, but Bonita's mental health was beginning to improve by this time. She was increasingly able to seek and make use of therapy,

We offered continuing support to the reconstituted family.

By the time she was 26, Bonita had decided to take an access course at a local college with good creche facilities. She later completed a full time level three access course in four subjects: English, Psychology, Environmental Studies and Sociology, as well as retaking GCSE Maths. She passed in all subjects, her lowest mark being 92%. At the time of writing she was preparing to enter full-time higher education.

It is clear that everyone here made mistakes. We certainly did us till! care .. family. The agencies involved also made some mistakes. with the possible exception of the school, whose staff made heroic efforts to contain and support Bonita (this might be considerably more difficult in the current

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experience. It is very hard indeed for children who have suffered these pains to feel that they exist as a self connected to other selves, yet they often do.

There are those who hold the view that beyond compassion there are further steps, or stages, or waves of human development. There are those who assert that children have a spiritual life, or the possibility of con-. sciousness that transcends and includes the self. Such views and assertions are found in the work of diverse people including deep ecologists like Bateson (2000) and Capra (1982), developmental psychologists such as Graves (Beck and Cowan, 1996) and Maslow (1968, 1970), and transpersonal psychologists such as Wilber (2000, 200 I).

These remain potentially controversial views; I have come to them because of what I have learned from children, Like Jane and Robert Coles (1990), and Steven and Sybil Wolin (1993). I have observed that the children with whom I have lived and worked have deep concerns. I have also discovered that they prosper in their development when we address those concerns as spiritual needs. Making the assumption that children can develop transpersonal consciousness, while not assuming that they will or should., allows for the greatest possible responsiveness to each

unique individual. .

I have used the term tranquillity to indicate a state of peaceful joy, or perhaps what Treya Killam Wilber (Wilber, 1991) described as 'passionate equanimity'. It is not a state reached by most of us more than fleetingly, but I consider that children do experience such states, and that they are deeply healing ..

WHAT DO WE OBSERVE?: living with children who are exploring tranquillity

Before we are able to enjoy tranquillity we need to be able to recognise and value the experience. Children need to be able to learn what peacefulness is and what its meaning might be for them. Initially they will be learning by observation. If they live in a household where quietness is valued, they are likely to learn to value it. Winter evenings in from of the fire, summer afternoons in peaceful places, quiet moments during a long journey. Gentle physical contact such as resting against one another, or

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RESILIENCE: AFFIRMATiVe EXPERIENCE

brushing and combing-hair, may increase the sense of ease and wellbeing. Quiet music Can add to the peacefulness if silence itself is still too threatening to the stressed or frightened child.

Activities can be added that enhance rather than diminish the tranquillity. Reading, knitting, sewing, drawing, making models, sharing poetry, making music can all add to the quality of time spent together. Sometimes children like to learn relaxation or meditation techniques, and can find the practice of these immensely healing. Always there need to be markers to help the children identify and recall the experience. 'I do like these quiet evenings together', 'It's so peaceful here'; any comment or image that holds the experience for a moment so that children begin to develop a pattern for peacefulness.

Children may bombard us with questions about our own spiritual journey, or they may want to make their own exploration in deep privacy. They can be encouraged to keep a journal, in words, or paintings, or craft work. They can gain immensely from being exposed to art, music and natural beauty. It can also help children to connect them with the biographies of others, especially people who have made the journey from adversity to fulfilment.

Children who are beginning to explore transpersonal issues will be full of conversation. I have seen this ignored or diminished in some settings, yet the questions and dilemmas raised by children can be the source of profound discourse if treated with respect. 'Where was I before ,. I was a baby?', 'How do we know we both see yellow?', 'Why/does it hurt when people call me names?', 'Why have some people got a lot of money when other people haven't got any?', 'What happens when we die?' - sometimes it can seem that there is no end to the questions.

If these are treated with the weight they deserve, and many of the questions children ask will tax the resources of the greatest philosophers, then children begin to discover a discourse which genuinely assumes that they have as much to give as to take in intimate relationships. We can learn so much from the questions of those who have not learned not to ask.

The answers children discover also need to be treated with appropriate

respect. A child struggling .with traumatic deaths confides that he has found something out. 'Look', he says, 'see these conkers?' I agree that I

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ATTACHMENT, TRAUMA AND RES1LlENCE

1

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Education

All our children sustained their place in mainstream education, sometimes with great difficulty, and all attained five or more GCSEs. Fourteen of the fifteen completed courses in further or higher education after the age of I (i. and the one who chose to go straight into employment has never been unemployed. Unemployment has been a rarity, and work has spanned the full range of' manual, skilled manual, professional and managerial.

Emotional and behavioural development

We discovered over the years that (or traumatised children the storms of adolescence are both more profound and more extensive than they are in the lives of children who have experienced less adversity. Many of our children suffered considerable, even extreme, disturbance during the years of their adolescence; some images of those experiences have been presented throughout this book. As time passed it became clear that the processes of adolescence were being shifted sideways, so to speak, by the pressing unmet needs from early childhood, and that the period of adolescence itself seemed to take longer to traverse. Thus the years characteristically occupied with young adulthood were often taken over with continuing and often extreme adolescent feelings and behaviour.

Yet as time passed and family attachments remained unshaken by the storms, the assurance and confidence of emerging adulthood followed. The majority are now over 30, and are living lives that they find as satisfying and fulfilling as those of their peers. They have achieved adult autonomy. Others have reached that stage of self-motivation and selfdetermination in their 20s, and some are still on the journey, but draw inspiration from the lives of those who are further along the road.

Identity

All the members of the family who were separated from their birth families sustained or rediscovered relationships with members of those birth families during their childhood, with our help. Some have chosen to continue or extend those relationships, others have found.that their sense of identity lay elsewhere. Those who are of mixed heritage seem as adults

168

IN TIlE HNU

I

comfortable with the various strands of that heritage, and have made . ~ d and conscious choices as adults about their own sense of mrorme ivid I identity. All seem settled and at ease with their sexuality. and indivi ua

sexual identity. Growing up in a Quaker household the children were free to explore their spirituality and any religious affiliation they felt dra~1l to, Some ail adults would express an identity with a religious (;O~mll~lty; most express some sense of spirituality in their lives, both in their act lOllS

and in their fields of interest.

Family and social relationships

Those who are still in touch with members of their families of origin seem now to be able to sustain these relationships without undue difficulty. Within our own family group, relationships are generally supportrve and mutually warm. There are a number of birth sibling groups, and these arc recognised as having a particular quality, but all the members of that generation relate to one another as siblings. They visit one another, and take on the role of aunts and uncles for one another's children. We have family gatherings for weddings and funerals, special anniversaries and occasions. Every few years we have a grand shared holiday.

Most have already shown a capacity for commitment in adult relationships, some are married or in committed long-term rel.atio~ships. They have supported one another as siblings through many of the JOYs, and the griefs, which deep and significant relationships bring with them. ,~~ those- . who have chosen to have children have committed themselves to this, and none of their children has ever been in the care system. Despite the difficulties some had in learning the meaning of relationships in childhood, all now show great gifts for friendship. They are, collectively and individually, kind, loyal and generous, and these qualities are appreciated by·~heir friends:· . . .

Social presentation

The group that would identify itself as family spans a diverse :ange of class, culture, ethnic backgrounds and age across four generations, for grandparents and great-grandparents have .all.had .an .influence o.n the children in terms of social presentation. ThIS diversity IS reflected III the

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ATT,\CHMENT, TRAUMA AND RESILIENCE

REFERENCES

Demos, V (ed.) (1995) Exploring Affect: The selected writings 0/ Silvan S. Tomkins, Cambridge University Press,

Joseph, S, Williams, R and Yule, W (1997) Understanding Post-Traumatic Stress:

A psychosocial perspective Of! PTSD and treatment, John Wiley,

Karr-Morse, R, and Wiley, M (1997) Ghosts/rom the Nursery: Tracing the roots of violence, Atlantic Monthly Press,

Kaufman, G (1992) Shame: The power of caring, Schenkman Books, Koestler, A (1964) The Act of Creation, Hutchinson,

Maslow, A (1968) Towards a Psychology of Being, Van Nostrand .

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Coles, R (1990) The Spiritual Life of Children, Houghton Mifflin. Csikszentmihalyi. M (1993) The Evolving Self: A psychology for the third millennium, HarperCollins.

Damasio, A (1999) The Feeling of What Happens: Body, emotion and the making of consciousness, William Heinemann.

De Zulueta, F (1993) From Pain to Violence: The traumatic origins 0/ destructiveness, Whurr,

Erikson, H (1963) Childhood and Society, Norton.

Fahlberg, V (1996) A Child's Journey Through Placement, BAAP,

Maslow, A (1970) Motivation and Personality, Harper and Row,

Mather, M and Batty, D (2001) Doctors for Children in Public Care: A resource guide advocating, protecting and promoting health, BAAF.

McNamara, J (1995) Bruised Before Birth: Parenting children exposed to parental substance abuse, BAAF.

Figley, C (1995) Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, Brunner Maze!.

Miller, A (1990) Thou Shalt Not Be Aware: SOCiety's betrayal of the child, Pluto Press.

Gilligan. C (1998) III a D(fj'erent Voice: Psychological theory and women's development. Harvard University Press.

Miranda, L, Arthur, A, Milan, T, Mahoney, 0 and Perry, B (1998) 'The Art of Healing: The Healing Arts Project, Early Childhood Connections'. Journal of Music and Movement-based Learning, 4:4.

Gilligan, R (200 I) Promoting Resilience: A resource guide on working with children in the care system, BAAF.

Harris, T (1970) 1'111 OK - You're OK, Pan Books,

Harris-Hendriks, J, Black, D and Kaplan, T (2000) When Father Kills Mother:

Guiding children, through trauma and grief, Routledge.

Howe, D, Brandon, M, Hinings, D and Schofield, G (1999) Attachment Theory, Child Maltreatment and Family Support: A practice and assessment model, Macmillan,

O'Donohue, J (1998) Eternal Echoes: Exploring our hunger to belong, Bantam Press,

Oaklander, V (1978) Windows to our Children, Real People Press.

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Perry, B (1999) Effects of Traumatic Events on Children: Interdisciplinary

education series, Volume 2, Number 3, Child Trauma Academy.

Hughes, D (1997) Facilitating Developmental Attachment: The road to emotional recovery and behavioural change in foster and adoptive children, Jason Aronson.

Hughes, D {I <)l)l\) Building thl! Bonds ofAuacluncnt: Awakening love in deeply troubled children, Jason Aronson.

Perry, B (2000) Brain Structure and Function, I and 1I: Interdisciplinary education series, Volume 2, Number 2, Child Trauma Academy.

Richardson, J and Joughin, C (2000) The Mental Health Needs of Looked After Children, Gaskell.

Roberts, M (2000) Join-up: f/OI:I'I.! sensefor people, Harpcrf'ollius.

Jackson, S (cd.) (200]) Nahotiy Ever Told Us School Mattered: Raising the cducutiona] «ttuinmrnts ul,'hildl\'11 ill care, BAA!",

Ross, M (1988) The! Fire (!rYrmr l,(fe: A solitude shared, The I.amp Press,

Janoff-Bulman, R (11)1)2) Shattered Assumptions: Towards a new psychology of (rallma, The Free Press,

Ryan, T and Walker R (1999, 2nd edn) Life SUllY Work. BAAF, Salmon, P (1985) Living in Time, Dent.

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GLOSSARY

Cortex The cerebral cortex mediates all conscious activity, including planning, language, speech, problem solving. It is also involved in the creation of narrative memory and perception and recognition of environmental stimuli.

Dissociation A defence against overwhelming stress where the individual cuts themselves off from conscious awareness of their senses, that makes use of the human capacity to split awareness.

EMDR Eye movement desensitisation and reprocessing is a therapeutic technique that involves using certain patterns of rapid eye movements while holding an image of the trauma and the feelings associated with that image. It seems to work, although explanations for the success remain at the level of hypothesis.

Empathy The capacity to imaginatively enter into the experiences of another human being.

Hippocampus A structure of the subcortex shaped like a seahorse. It is part of the limbic system and is importantly involved in emotional regulation, linking words to feelings, learning and memory.

Hyperarousal A disorder involving persistent deregulated stress. Hypervigilant Unable to relax, constantly scanning the environment for threat.

Imaginal flooding A therapeutic technique that enables the person to revisit the trauma safely in imagination and to discover that they can survive.

Implosion therapy A version of imaginal flooding in which the person is encouraged to experience that they can survive a level of traumatic re-experiencing they believe will be disintegrative.

Insecure attachment A pattern of attachment where the infant's need for physical proximity and emotional security is based on insufficient experience of a responsive and attuned caretaker. As a result the infant develops a generalised, internal expectation of an unresponsive and dissonant set of relationships that damages the capacity to appropriately deal with loss and frustration. Insecure attachment is a pattern in which the child's needs for affective attunement, stimulation, stress regulation and impulse regulation are not adequately met by the attachment figure. This results in persistent anxiety for the child.

Limbic system A group of linked structures in the' brain centrally involved in emotion, memory and the processing of complex social and emotional information.

Meta-cognition Cognition is knowledge, or thinking that involves what we know. Meta-cognition is the structure of knowledge, or thinking that involves pattern-matching. Cognition and meta-cognition are activities of the cerebral cortex.

Midbrain Those structures in the brain that follow the development of the brainstem and control motor activity, appetite and sleep patterns.

Neuron A brain cell that receives and transmits information. Neurons . form complex networks that are shaped by environmental experience.

Neurophysiology The science of brain and body.

Non-directive hypnosis A therapeutic technique following the work of Milton Erickson in particular. The therapist enables the person to enter a deeply relaxed state, and then works through the person's own metaphors for their experience to create alternative possible responses to stimuli, including traumatic stimuli.

Parasympathetic The sympathetic branch of the nervous system operates when bodily activity increases and energy is being expended; the parasympathetic branch of the nervous system operates when bodily activity is decreasing and energy is being restored. Self-assertive emotions tend to produce sympathetic nervous system activity, selftranscending emotions are more likely to produce a parasympathetic response.

Reintegrative shame The process through which the carer, by breaking and then re-establishing attunement, enables the young child to develop regulation of the shame affect and of impulse.

Secure attachment A pattern of attachment where the infant's need for physical proximity and emotional security is based on sufficient experience of a responsive and attuned caretaker. As a result the infant develops a generalised, iitternal expectation of a responsive and attuned set ofrelationships that encompasses the capacity to appropriately deal with, loss and frustration. Secure attachment is a pattern in which the attachment figure adequately meets the child's needs for affective attunement, stimulation, stress regulation, and impulse regulation.

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ATTIIClIMi'HLTRIIUMIIIIND I(ESILIENCE

disintegrative shame, 59, 62 dismissing attachment style. 53 disorganised attachment, 52, 138 di~~(jcialioJl. 42. 'i0. 60 (i2. 72. ss,

95.113-115.147

dissnnal1"~', 1 ~o

drugs, 4X, 63, 66.112, 144, 145 drug treatment tt)r I'TS(). 125

education, 71,119,159-161,168 education about trauma as part of treatment. 124

egocentricity, 9, 153, 154 emotional experience, 31-44, 115,130,134,140--142,147,

168

empathy, 51, 55, 56, 60, 65, 73, 74, 81,83,91,118,156,157

energy changes and emotion, 42 environment, 46, 49,62,70--72,75, 77,81,87-88,93,97,102,105, 120,123,127,129,131-134, 139, 142, 162, 144, 146, 162

ethnicity,46, 157, 169 ethnocentricity, 153 eye contact, 48, 61, 88

fear, 58,82,84,87,91,98-102, 108,110,121-122

feelings, 37--44.81-88,92-97,108,

115,124-125,140--141 fight or flight, 61, 107 - formative experience, 45-97 four-step plan for living and

working with children, 67-71 friendliness, as attitude of carer, 73

180

gender, 48, 50

genetic factors in development, 46,

49,57,74

grief. 43, IJ5·142 group membership, 153 guill, l;W

health as dimension of

development, 167 humour, 51

hypcrarousal, 50, 60-61, 74, 107 hypermnesia, I 17

identity, 62-63, 104-105, 113, 116, 119,121,145,147,153,157, 168

impulse regulation, 148 inhibitions, 60, 64-65, 81, 82-84,

92-95

insecure attachment, 79, 92 insecurely attached babies, 60--62 insecurely attached infants and

toddlers, 62--65

insecurely attached older children, 65-66

insight, 41,145,157

integration, 104, 112, 122, 125-128, 132

internal working model; 144 interventions, 45, 57, 71, 75, 77,97, 131-134,142,152,162 intrusion, 104, 107, 108

joy, 42,104,108,118,130,164

learning difficulties, 118

limbic system, 43, 49,51,56,59, 74, 76, 80-84,93, 100, 103, 106-110,115

memory disturbance, 117-118 mctil-co1/.nition,56

midbrain, 49, 51, 55,107 mourning, 135--138, 142 muscle tone, 57, 61

narrative memory, 47, 103, 106,

126

nature/nurture debate, 46 neurons, 47, 50 neurophysiology, 46

non-verbal communication, 56, 60, 65,84,85,88

numbing, 10 1, 107, 108, 118, 148 nurture, 45, 46, 48, 63

opioids, endogenous (endorphins), 108,119

parasympathetic reactions, 42, 177 participatory emotions, 42 personal efficacy, 123,129, 158 personal resilience, 105, 143-146,

149, 150; 152

personality, 51, 56,101,106,113, us, 144,146,148,157,162 pervasive shame, 63, 148 physiological changes, 42,83,94, 119, 120, 122, 125

post traumatic stress disorder (PTSD),105-121

prenatal malnutrition, 48

INill::\

preoccupied attachment style, 53, 54

processing trauma, 125 -12X, 132 promoting affective attunement, 73-74

promoting reintegrative shame. 74-7H

psychoanalytic theory. 3Po psychosomatic disorders, 121

questions that may he useful, 66-67,92,121-122,140,149

rage, 78-88,92-97,115 reciprocity, 78-80,84,89,97, 154 recovery from trauma, spontaneous,

102-105

reflection, 66, 78, 79, 88-89,97 reintegrative shame, 45, 59,62, 70,

72,74,77,79 reparation, 59, 93

resilience, 44, 68, 130, 143-166 respect for self and others, 91-92 restitutive emotional experience,

i 130,134

SAFE attitude for carers, 72-73 school, 109, 114, 117, 118-119, 153-155,156-158,159-163 secure and autonomous attachment style, 53

secure attachment, 45, 52-53, 57-60,70-71

securely attached babies, 57-58 . securely attached infants and toddlers, 58-60 "

181

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