Friday, August 19, 2011

[Interview] Chris Nicholson

Chris Nicholson is a lecturer in the Centre for Psychoanalytic Studies at the University of Essex and has worked in a range of children's services for over 10 years.

In addition to that, he is a trustee of the Charterhouse Group of Therapeutic Communities; a fellow of the International Institute of Child and Adolescent Mental Health and a regular speaker at bi-annual conferences on the poet and author Robert Graves.

Chris Nicholson is also co-author of Children and Adolescents in Trauma: Creative Therapeutic Approaches (Jessica Kingsley Publishers, 2010).

In this interview, he talks about his work:

How did you first become involved in children's services?

In the mid-90s I was finishing a joint honours degree in English literature and Philosophy at the University of Kent, in Canterbury. I had rather immersed myself in the reading and read way beyond what was required for these courses. In consequence I had an experience which the poet Robert Graves illustrates in "The Philosopher" where Threading logic between wall and wall he finds that he has Truth captured without increment of flies, or, in other words, the impingement of actual physical existence. I left university with a strong desire to avoid bookishness, and so determinate to find direct work with people.

In this way I arrived, naively, with my neck exposed to the axe, in a small residential children's home in Kent. Here staff worked a straight 50 hour a week in 12 hour shifts including waking nights, often back to back - I was told this system provided continuity to the young people. In fact it exhausted staff leaving them less able contain the disturbing feelings being projected into them by the young people.

There were five young people living in the home aged 11 to 18 often with only one or two staff members on shift. They presented with regular violence, self-harm, absconding and property damage, and seemed to exult in creating chaos. There wasn't anything in the training or culture of the home that could be considered a theoretical model by which these things could be understood, but there were a few books in the staff office. Over the long waking nights, on those occasions where the young people were settled and the long list of staff chores were complete, I fell upon these books in desperation despite my earlier edict to avoid them.

I discovered that there was a distinction to be made between control of children, which the home focused on implicitly, and something called containment which I didn't fully understand. I also learned that where children's homes were experiencing a large amount of 'acting out' this could be due to the way the home was managed as opposed to simply being down to the children. This was a shock as I have great respect for the managers who seemed to be good people. Still, I began to look for any correspondence between management structures, policies, or care arrangements and children's behaviour.

Why are creative therapeutic approaches good to use when working with children and adolescents in trauma?

There are many reasons why creative approaches are good to use with young people.

I'll emphasise two.

The first has to do with the relationship that exits between art and psychodynamic thinking. In creative activities, for example, film, painting or literature, the interpretative potential of the underlying symbols, metaphors, and analogies, finds a commonality with psychodynamic thinking. In art, as in psychodynamic work, it is not merely the outward appearance of things which holds our attention, but all that lies beneath. When young people engage in creative pursuits they have the opportunity to offer their own instinctive metaphors and symbols. They can develop their own narratives throwing up exactly that kind of material which psychodynamic practitioners utilise.

The second concerns the need to address a certain rigidity in thought and behaviour. In reasonably healthy families, infants experience attunement to their emotional and physical needs so that they can internalise good experience and so come to trust their relationship with caregivers. Their own experience become validated through the recognition and adaptation of caregivers to their needs which in turn provides the internal space in which the core self (a strong ego or sense of self-worth) can become established. Gradually the infant develops a sense of understanding and adaptation between its internal world and that of others, especially through flexible, creative play and communication.

However, traumatic experiences are, to some extent, deterministic. If a child has grown up in a family where one or both adults operate in ways we would define as neglecting or abusing there are usually rigid modes of communication in place and these have the opposite effect to the healthy kind described above. For example, traumatic events during the first two to three years of life have far-reaching effects on neurological development. Those who experience early trauma are prone to a certain rigidity of intellectual and emotional response. Howe (2005) emphasised this trait:
They fail to adapt to and cope with change, whether in their own feeling states or external relationships. In effect, the brain lacks complexity. It operates in a relatively rigid, compartmentalized way, lacking integration between many of its key social, cognitive and emotional operations. 
(p.262).

The importance of a creative approach then, is that it can divert negative thinking and feeling down a different and altogether more positive pathway. Through sensitively handled, creative interaction and by the use of creative approaches with traumatised young people, their characteristic rigidity begins to loosen. New possibilities emerge, the mutative nature of create endeavours. In time, they may be able to see painfully familiar situations in different and helpful ways that can lead to their forming a new response.

Could you describe one creative approach to us and how it could be implemented?

I will briefly describe a creative approach I used with a group of five 15 to 16-year-old care leavers at Donyland Lodge in Essex.

Children who live with their own families tend to stay at home today into their early 20s due to extended education and economic dependence. The time allowed for looked after children to finish growing up is, by contrast, incredibly compressed, as they generally leave for independence or semi-independence at around 16 years. While this is happening, they have to cope with a host of problems which put added pressure on them, e.g. painful and chaotic family dynamics, how to make reliable friendships, overcoming huge distrust, not infrequent changes of social worker, finishing school and exams, not to mention the giddying psychological and physical experience of middle adolescence. It must feel to them like being in the back seat of a car as someone else accelerates along a dangerous highway.

Due to this, the outcomes for young people include having higher levels of homelessness, lower educational attainments, higher rates of unemployment, greater dependency on welfare benefits, unstable career patterns, higher levels of offending, and problems with mental health and substance misuse. With poor interpersonal skills, low self-esteem and confidence the scene is set for social isolation and further disaffection.

How can we help already disaffected young people in such a way as to prepared them for what lies ahead? How can we help them to gain the kind of experiential learning which might give them some slight grasp of how important it will be to prepare now?

At Donyland we integrated Life Skills into the curriculum from age 15 years and included a wide range of teaching relevant to care leavers. We began the course with bridge building. The young people are provided newspaper, cellotape, glue, string, scissors, a ruler and other arts and crafts items. They are asked to build a bridge that spans, say 10 centimetres in height and 40 centimetres across, and that a toy car can travel over. We give them 40 minutes to do this exercise. But 25 minutes in, we tell them that there has been a change of plan and then now have only 5 minutes left to complete their bridge. This causes great anxiety. But then, just as the 5 minutes are nearly up, we inform them that things have again changed and they still have 5 minutes left.

You can imagine how much emotional holding and support the young people need during this activity and how robust the staff need to be to manage the consequent acting out in terms of resentment, sabotage of their own and other's bridges, doubt about completion or quality and so on. But all this comes to fruition later as we unpack the underlying significance of the bridges: This is your bridge from Donyland into independence. How easy is it to get on and off the bridge? How stable is it? Does it have any supports and who or what are those supports going to be on your actual journey? How did you deal with the stress evoked? Did you help or hinder each other? Did you ask for help from adults or feel that you had to go it alone? What influence did this have upon your bridge? The young people are asked to assess each other's bridges and say what might improve it and how this links to leaving care.

We also connect this exercise with research into leaving care, for example Mike Stein's What Works in Leaving Care? (Barnados, 1997) and talk to the young people about what has been learned from previous care leavers. Finally, to really help the staff team get in touch with the plight of young people at this stage in their lives, they (and they means, care, education, administrative, ancillary and management staff) were all asked to undertake the same exercise in training.

Would you be able to tell us about your work with Therapeutic Communities?

Whatever people say about Therapeutic Communities (TCs) they are remarkable places.

After my first experience of working in a children's home, coming to work at a therapeutic community for 21 mixed gender adolescents in the Essex countryside was a revelation. Here there was a model based upon a number of key theorists, only some of whom were involved in TCs ... Winnicott, Bion, Dockar-Drysdale, Bowlby and the American Efrain Bleiberg (who emphasizes reflection function).

There were also pot-belly pigs, goats and rabbits, gardening, hovering and mountains of washing up.

Alongside community meeting and art therapy, the routines of daily life were conscripted as a part of the therapeutic milieu ... everybody could play a part to support community life.

The TCs I've worked in were always striving to develop, to redefine themselves in the light of the ever new experiences young people brought to the community. They advocated not so much children's rights (which is policy driven), but their equality and humanity, and ability to take ownership of their lives and the life of the community to which they'd come.

Children appreciated the fact that what they had to say, however distorted by previous experience, mattered to the adults and would be thought about. They also witnessed staff having to learn, and be self-reflective and take responsibility for their own actions openly. The sense of children and adults struggling and striving together could be very powerful and enabled some very hard to reach children to make contact with others in a meaningful way and feel a part of something larger.

My work was mostly around admission, assessment and leaving care. For young people, these experiences can feel like being forced, being judged and being pushed out especially where they already feel dragged from pillar to post and constantly assessed. The art was in finding ways to ensure these actives could function as a part of the therapeutic endeavour, and might, if careful handled, become a corrective experiences of which the young person was very much an active part.

I am pleased to find that London Placements are using membership of the Community of Communities annual review cycle as a criteria for determining if a placement is considered therapeutic. In my experience, a therapeutic community, like any therapeutic service, can only remain therapeutic, through constant striving, reflection about how it operates, experiential training and a process of assessment and review from external sources.

What are you currently reading in your spare time?

Most of my reading, spare or otherwise, relates to the course I teach at Essex University, Therapeutic Communication and Therapeutic Organisations.

Staff working in residential child care, in psychiatric adolescent units or in schools need to have read Hinshelwood on organisations, Salzberger-Wittenberg on the emotional issues of teaching and learning. They need to know about early development from Klein, Stern, Bowlby and Wadell.

But if they are anything like me, they may also be sustained by poetry, like that of Robert Graves, who I'm always reading, or Rilke who heals the heart while breaking it over and over: Each torpid turn of the world has such disinherited children, to whom longer what's been, and not yet what's coming, belongs.

Cary's recent biography, The Man Who Wrote Lord of the Flies is fascinating. Golding wrote well about children and how they see the world in many of his books other than Lord of the Flies, and Cary, despite his superior tone, can't help but admire him.

The next novel I plan to read is Christina Stead's The Man Who Loved Children. I discovered this through the extraordinary introduction by Randall Jarrell which is a work of art in its own right.

My wife has just lent me several books on the Oedipus Complex, and I'm reading Pollyanna with my eldest daughter. So, happy families!

Finally, I'm half way through Richard Glover's 1804 epic poem Leonidas (as in the recent film, 300). This suits me nicely. A different kind of egg for Easter.

(c) Jessica Kingsley Publishers 2011

This article was first published in the Jessica Kingsley Publishers Social Work Newsletter in March 2010

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