Psychology Associates Annual Conference ‘The Mind and the Heart of the Other: Understanding, and intervening with, the impact of childhood trauma across the lifespan’.

Posted by on Jun 22, 2012 in Conference Reviews | 0 comments

 

 

 

On Friday 15th July 2012, Psychology Associates hosted their annual conference at Dartington Hall in Devon. This is the first conference I have attended since joining their practice as an Associate earlier this year. Psychology Associates is an organisation who pride themselves on delivering evidence based psychological interventions of the highest standards and are at the forefront of incorporating the very latest findings from world renowned researchers and practitioners in the field of trauma, attachment and neurobiology. Therefore, it was no surprise to see three of the most influential speakers headlining this event – Colwyn Travarthen, Graham Music and Dan Hughes.

 

Session One

Professior Colwyn Trevarthan, recently retired from his post at the Department of Psychology, University of Edinburgh, began the  morning with a presentation entitled ”Sharing Joyful Friendship and Imagination for Meaning, With Infants, and Their Use in Therapy”.  Colwyn Trevarthan integrated a range of research findings from the field of early infant - carer interactions from across the world. There is now ample evidence to suggest that from the very beginnings of life (both pre and post natally) infants are complex persons able to use their memory and imagination to act creatively in response to their primary carers. Infants have an innate sensitivity towards human interests, intentions and feelings. They enter the world primed and ready to make relationships. Colwyn Trevarthan showed a number of video tapes of very early infant – mother / father interactions which demonstrated the capacity of infants not only to respond to their carers by mimicking their facial expressions, for example, but also video tapes that illustrated the infant’s capacity to create, predict and elicit responses from their carers. He emphasised the importance of ‘rhythms’ in the infant’s mind and how all of us are born with an innate capacity to respond to music. The videos showed new born infants moving their arms and legs rhythmically in response to their mother or father’s singing or talking. Colwyn Trevarthan talked of how the infants engage in ‘conversation’ by using there bodies to respond rhythmically to their parents voices. They act in synchrony to the rhythms of conversation and follow the pitch and intensity of their carers vocalisations. This allows them to participate in ‘conversations’ with their carers. These early examples of conversation in new born infants he terms ‘Primary Intersubjectivity’ (photo-conversations) which allow for the sharing of intense emotional states. Carers and infants engage in a ‘dance’ that is joyful, finely tuned and forms a basis from which the infant develops an awareness of self and of relationships. As the rhythms and pitch synchronise develop, infants and carers are able to engage in ‘Games and Jokes’ and from a year old, can then engage in ‘Secondary Intersubjectivity’ in which they can negotiate shared intentions, companionships in tasks and meaning making.

 

Colwyn Trevarthan also talked of the infant’s experience when the rhythm of vitality is not shared and how joyful intimacy can then turn to an experience of distress. He presented on the infant’s responses to ’conversations’ with depressed mother’s and how infants express their “sadness at the loss of contingency when out of touch in the dance”.

 

Overall, his presentation demonstrated how these very early infant- care giving experiences (which are characteristically sensitive and attuned to the infant’s states and are responsive to the infants cues) are the vital building blocks for psychological well being in later life. His presentation made me reflect on my own parenting experiences with my one year old son and how often I feel tempted to pop him in front of CBeebies whilst I quickly respond to a few emails. As Colwyn Trevarthan said, the TV does not offer  a contingent response to the infant’s emotional state, it is a passive experience from which the infant can gain very little of value. What infant’s need is their mother’s availability and sensitivity to their experience. As I write this and he lays sleeping in his cot upstairs, I wonder (like I’m sure many of us do) if I have the balance right? Do I set aside enough time to focus on his needs and experiences and switch off from my own? How often do my own thoughts and worries intrude into my time with him? As always at these events, I also reflect on the experiences of the looked after and adopted children I work with. I think of the birth parents and how little capacity they often have to reflect on the needs and experiences of their children. I think of how easily the infants cues are missed or misinterpreted and I think about the disorganising effects of misattuned, harmful parenting on their developing brains and psycho-social functioning.

 

Session Two

Picking up on this theme, Graham Music, Consultant Child and Adolescent Psychotherapist from the Tavistock and Portman NHS Foundation Trust, presented on “The Good Things That Didn’t Happen Can  Be Worse Than The Bad Things That Did”. He talked of how often children who have suffered abuse (such as physical, emotional and sexual abuse) externalise their trauma and readily communicate their distress through their challenging behaviour. He talked of how neglected children often ‘shut down’ their emotional responses towards others as so often their attempts to engage with others had been repeatedly ignored or not responded to. Therefore, the attachment system shuts down and they no longer experience a need to reach out to others. Graham Music talked of how frequently these children might fall through the proverbial net. In their ‘shut down’ state, their failure to engage in relationships often results in very passive behaviour which for many is seen as unproblematic. Educationally, a child who sits quietly and appears to be getting on with things is unlikely to draw attention to themselves. The same applies to Child Mental Health Services who’s criteria for accessing support often falls around particular diagnosis favouring externalising behaviour (for example, Attention Deficit Hyperactivity Disorder, Conduct Disorder etc). For the neglected child, it is often the new parents (Foster or Adoptive) who are primarily aware of the child’s problems but again, may experience difficulties articulating exactly what is wrong (particularly with a very compliant, self reliant, passive child).

What I particularly liked about Graham Music’s presentation was his willingness reflect and share his experiences of working therapeutically with children who had suffered severe neglect. He presented a case which included video taped of sessions of working with a young boy placed with adoptive parents. The parents talked of their concerns that the young boy might be on the Autistic Spectrum as he so rarely communicated his need for them and how different he was from their other adopted child. Graham Music shared his experience of this early session with the family and how easily he had attended to the parents narrative and felt barely aware of the child’s presence. He talked of the different feelings children who suffer profound neglect often elicit in therapists and their carers – ones mind ‘going blank’, or ‘wandering’, feeling bored and disinterested, finding the child hard to like and difficult to be with. Graham Music talked of how often these children are discharged from services prematurely or are at risk of placement breakdown. He talked of the need to attend to the ‘countertransference’ to help make sense of the child’s experience and the need to stay ‘psychologically alive’ to the child.

Graham Music talked about his therapeutic work with this child and his family and how his interventions aimed to reactivate the child’s attachment behaviour and his interest in relationships. He modelled for the parents his attunement to the child’s differing states and the importance of narrating his experience. In the session, Graham Music demonstrated his curiosity about the child’s feelings and intentions. This interest and acceptance he communicated to the child in the sessions enabled the child to begin to experience himself (and others) differently. As more of his feelings and experiences were recognised and responded to, the more he began to show of himself. He became ‘alive’ within the relationship, so much so that by the end of the therapeutic work, the young boy made it very clear he wanted his thoughts and feelings to remain very much alive in the minds of others by shouting them from the rooftops!! A very different boy from the one who began his journey sitting quietly in the corner of the room, passive and withdrawn.

Again, this work emphasised to me the importance of developing a meaningful relationship with the child rather than focusing on any particular technique or strategy as the agent for change. The child was able to experience himself as someone who was interesting, likable, enjoyable and worth knowing. Prior to intervention, the child had elicited the same despondent approach from his carers as he had experienced within his birth family. It made me think of how easily looked after and adopted children elicit the same pattern of response with their adoptive and foster parents, which were formed from their early experiences within their birth families. Foster and adoptive parents could often benefit so much from support which can help them to actively break these patterns of relating, so that their children can build a new understanding of who they potentially could be.

 

Session Three

The final speaker of the day was Dr. Dan Hughes. His presentation was named ‘The Reflective Heart’ which to me was a very apt title as my experience of this presentation was that it came very much from the heart. There was no power point presentation to Dan Hughes’ talk, he shared with us his experiences of working with families of children who had suffered abuse and neglect. He talked of the key constructs in his Dyadic Developmental Psychotherapeutic (DDP) approach to helping children recover from their abusive experiences and strengthen their attachments to new carers. He again emphasised the importance of the relationship in bringing about this recovery. Dan Hughes talked about the meanings children attach to their abusive experiences which occurred within their birth families (I am unlovable, I am disgusting, you will not like me, you will hurt me etc) and how these beliefs often prevented them from opening their hearts to developing new attachments with their foster or adoptive families. He talked of the need for children to rediscover who they are and form new beliefs based on their new relationships. Dan Hughes talked of the quality of  inter-subjective experiences within the therapeutic relationship with both the child and the carer. Connecting with themes in the earlier presentations, Dan Hughes again emphasised the need to attune to the child’s inner experience, maintaining focused attention so that the ”child’s enjoyable experiences are amplified and his / her stressful experiences are reduced and contained”. Again, linking with earlier themes, Dan Hughes talked of the importance of non-verbal communication – “the intersubjective dance” – in which eye contact, facial expressions, gestures and movements, voice prosody and touch, all communicate to the child how much their experience matters and is accepted without judgement or criticism. Dan Hughes talked about holding an attitude of PACE (Playfulness, Acceptance, Curiosity and Empathy) when working with traumatised children which helps to create the safety needed in which children can begin to explore their trauma memories and receive the help they need to reach a deeper understanding and attach new meanings to their experiences.

 

Dan Hughes demonstrated his approach by showing a videotape of a therapeutic session. Within the short clip, one could clearly see the positive regard he felt for the young person and how this was communicated to her on so many different levels. He was able to be playful, gently teasing the young person about light hearted issues which she responded to happily. Dan Hughes demonstrated a genuine curiosity for the young person’s experience, her difficulties trusting her carer and her use of aggression. Together, with the young person’s carer, they made sense of her mistrust and aggression in light of the abuse she suffered when she was a small child. For the first time, the young person began to open up about these early experiences. Although she appeared pained by the memories, to me, I also felt a sense of relief from her that finally, she had been helped to make sense of this very difficult past that had haunted her for so long. There were times in the video clip that the young person would look at Dan and her carer with what appeared to be amazement –  could they really be experiencing her so differently to how she had seen herself? The carer also did a remarkable job of letting the young person know that she was loved and again, this was communicated through the genuine warmth in her voice, eyes, posture and movement. There were some very touching moments in the video clip. I became particularly tearful when the young person stood up and said how much taller she felt. Again, Dan showed as much interest in this experience as he did for her more difficult experiences and helped her to think about the meaning of this. The foster mum mirrored  this experience and said how she also felt taller. As well as the themes of pride that emerged from their discussion, I wondered too if the young person suddenly felt lighter having shared some of the burden from her past?

Whenever I listen to Dan Hughes and watch him using this approach, I am ever more convinced that all foster and adoptive children who are struggling to feel safe in their new relationships with parents should have access to this therapy. I only hope that the research evaluating the effectiveness of this approach reaches the eyes and ears of the policy makers and that the much needed funding is made available to foster and adoptive families.

I am grateful to organisations such as Psychology Associates who continually promote the use of this and other attachment based approaches in the working with traumatised children and therefore play a vital role in raising awareness.