Resilient Therapy

Working with Children and Families

Angie Hart, Derek Blincow, Helen Thomas

• Publisher: Routledge
• Year: 2007
• Print ISBN:
  9780415403856
• eBook ISBN:
  9781134140107
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Whilst much has been written about the identification of resilience in children and their families, comparatively little has been written about what practitioners can do to support those children and families who need the most pressing help.

Resilient Therapy explores a new therapeutic methodology designed to help children and young people find ways to keep positive when living amidst persistent disadvantage. Using detailed case material from a range of contexts, the authors illustrate how resilient mechanisms work in complex situations, and how resilient therapy works in real-life situations. In addition to work with families, helping welfare organisations achieve greater resilience is also tackled.

This book will be essential reading for practitioners working with children, adolescents and their families who wish to help their clients cope with adversity and promote resilience.

Chapter 1
Conjuring up Resilient Therapy

Every blade of grass has its Angel that bends over it and whispers, ‘Grow, grow’.

The Talmud

Why pick up this book, let alone buy it and then even read it? You might think that therapy has been done to death. And there are scores of tomes and hundreds of journal articles about resilience on the market. We have systematically searched the literature, including books, journal articles and web-based information. Our quest has led us to scour international publications over the past 30 or so years. It may come as no surprise, then, that the library we have amassed fills a filing cabinet and nearly an entire book stack. It numbers over 500 publications. Some names come up more than once, but that is still over 300 authors around the globe defining, exploring, measuring and critiquing ‘resilience’ and related concepts.

Many of their publications tell us how to spot resilient children and young people. They also give us a lot of information on what particularly fragile children look like. Yet, when it comes to getting down to the nitty gritty of building resilience, the library shelves look less crowded. Of those 500 odd publications we have in our own collection, approximately 35 concentrate on this issue in any depth. Proof enough to us of Pfeffer’s point that, in tackling inequalities, we still have not yet accepted ‘that the skills of getting things done are as important as the skills of figuring out what to do’ (Pfeffer, 1992: 12) . Of course, the skills of getting things done with some children are quite different from getting things done with others.

Of these 35 publications, most offer ideas, programmes and activities that are designed for work with all children. Only a handful of publications concentrate on the most disadvantaged in our society. This book is for those children and their families.

Resilient Therapy (RT) presents a strategic methodology with its own frame of reference and practice philosophy. It is strategic because it harnesses a number of therapeutic interventions into a coherent programme. We refer to it as a methodology because it represents a particular approach to working with those interventions. RT draws on evidence from scholarship and from our own experiences with disadvantaged children and young people, their families and practitioners working alongside. The essence of RT is a relentless search for ways to help children and young people bounce up when life is particularly tough. We say bounce up, rather than bounce back, quite deliberately. Many of the children we know have rarely, if ever, been anywhere they can benefit from bouncing back to. Avoiding pathologising children, understanding how resilient mechanisms work in complex situations and building resilience (individual, family, organisational and community) are core to RT’s strategic approach. We call this ‘upbuilding’. Precisely what RT involves will unfold as the book progresses. However, this paragraph and the following two tell you what it comprises in a nutshell.

RT is delivered according to four key principles. These are RT’s ’Noble Truths’. They describe how we go about addressing the needs of the most disadvantaged children, their parents/carers and the practitioners and agencies who work with them. Working with these Noble Truths involves developing the skills of Accepting the precise starting point of children/ families, Conserving any good that has occurred hitherto, Commitment to working with them over a sensible time period and thoughtfully Enlisting appropriate others to help. In Chapter 2, we go into some detail as to what these Noble Truths really mean.

RT also represents a range of interventions that are the constituents of five separate, but related, conceptual arenas that we term compartments or remedy racks. These form a systematic whole, which, for some audiences, we have summarised through the device of a Magic Box. Interventions within each of these conceptual arenas are designed to increase resilient responses to overwhelming adversity. This may seem complicated, but the rest of this book will go through these ideas systematically and in detail. Let us summarise them here.

The conceptual arenas are: Basics, Belonging, Learning, Coping and Core Self. There is a chapter on each of these in this book. The first three compartments Basics, Belonging and Learning include strategies and practices for working directly with children but also involve practitioners strategically linking with and reaching out to others. Most of the interventions in Coping and Core Self consist of a set of micro-therapeutic approaches designed for direct work with individuals. This is the major difference between the two. Core Self focuses on working at a deep intrapersonal level, whilst Coping provides children with strategies to manage better in the moment rather than waiting for some deeper personal transformation to occur. Of course there is some overlap between the two and like all the conceptual arenas, they are to some extent a pragmatic presentational device.

Masten, a developmental psychologist who has been working on resilience for many years, calls resilience ‘ordinary magic’ (Masten, 2001). She says, ‘Resilience does not come from rare and special qualities, but from the everyday magic of ordinary, normative human resources in the minds, brains and bodies of children, in their families and relationships, and in their communities’ (2001: 235). Her idea inspired our use of the magic metaphor to produce user-friendly materials with and for parents/carers and young people (see the diagram in the appendix).

We have drawn directly on the rich resilience research and practice base and added strategies and practices uniquely developed through RT. We have brought to this our own experiences, and some synergised research, policy and practice bases outside child and adolescent mental health. This has led to the development of new concepts, which, despite the wealth of research activity, have not, until now, been articulated within the research base.

Basics, for example, has an entire compartment of its own. As we shall see, our inclusion and articulation of this brings therapeutic approaches firmly into line with inequalities frameworks that have been developed quite separately. This represents something of a departure from traditional therapeutic concerns and introduces a clear politicisation of what we mean by ‘therapy’. Within other compartments, we trial specific techniques conceptualised as core features of RT. With a view to the five compartments, some will seem immediately familiar to the resilience aficionado, and some quite new. Even where they may seem familiar, we have moulded them to our own design.

So how did we pull all this together? A modest grant through our Community University Partnership Programme (www.cupp.org.uk) made it possible for us to experiment with research and practice development. For some audiences we have used the device of the magic box to plan and execute work with families, with practitioners, and to challenge organisations and blocks to resilient therapeutic work. We did this through individual consultations, systems analyses, workshops, drama and mentorship. Our metaphors/graphics for presenting materials have varied depending on the audience. Of the people involved in the development work many responded enthusiastically to the magic metaphor and related artwork. The idea of magic gave them a creative metaphor to free up thoughts and feelings, and also to laugh a little as they learned. This was something of a relief in an area of work that seems often hard and depressing, and it is worth noticing that having a sense of humour is also associated with resilience. So the magic metaphor helped some parents, practitioners and young people to experiment with what makes children more resilient and how short- or longer-term specific outcomes can be achieved.

Others preferred the more neutral language of ‘conceptual arena’, ‘mechanism’ and ‘intervention’. Still others using our methodology spoke of ‘building blocks’ or ‘tool kits’. These different preferences reflect a wide variety of learning styles in the people who have engaged in development work to date. This has presented us with a linguistic dilemma. We reflected this dilemma by using the terms ‘conceptual arena’, ‘compartment’, and ‘remedy rack’ interchangeably. Likewise, when we talked about ‘interventions’, we employed the terms ‘potions’ or ‘remedies’ to refer to the same thing. So the way we have designed RT for particular audiences has taken their varied tastes into account.

Sociologist Furedi is right to critique the truism ‘abused as a child, abusive as a parent’. However, to deny the ‘toxic effects of psychological damage’ seems somewhat cavalier (Furedi, 2004: 120). RT avoids pathologising children, but recognises that some children and their families need help. When viewed within an inequalities framework, we can also understand that this is their right.

RT facilitates productive engagement with children and families in the moment, rather than having to wait until their lives settle. For many, at least during childhood, it may never happen. RT gives practitioners explicit goals to work for in contexts that may seem futile and confusing. It can have the effect of advocating for children who may not have many other adults in their lives who do this as a priority. In the context of child disability and special needs, it can also help therapists ally with parents and carers worn down by the relentless demands of unsupported parenting. RT helps people understand that, however hopeless a situation might seem, there is always something that can be done to make things better for disadvantaged children.

In this book we will be demystifying ‘therapy’ and specific therapeutic techniques that are used in RT. This means unpacking concepts and using language to make interventions as accessible as possible. Language is important. When we talk of ‘Resilient Therapy’, some people hear the name differently. They hear ‘resilience therapy’. This might seem a fine distinction but it is crucial. We are not simply instilling resilience in children and families. We are configuring therapy to be resilient through and through. Resilient describes our experience of, and aspirations for the therapy we do. Resilient too is the effect on children, families and the practitioners who promote RT.

Another aspect of being resilient is that we hold to the view that there is always something that can be done. Our work aims to be relentless in this respect. There are no exclusion criteria and we will try anything if it helps children to do better. We think our approach helps children beat the odds when they are stacked against them.

In sum, RT is a matrix of resilient mechanisms that works resiliently on those who use them. We think that the therapy we practice should role model the resilience-enhancing processes that we want children and their families to develop themselves.

Talking of role models, a key message throughout this book is that the people carrying out RT, and the approach they take, really matter. We use the term ‘resilient therapist’ or ‘resilient therapy practitioner’ to describe those who apply the methodology.

We are not only describing professional therapists here. There are perhaps a few elements of RT better left to them. But most of the techniques and certainly the principles and ideas can be drawn on by any competent, reflective, helping practitioner. This most definitely includes parents, carers and indeed children and young people themselves. So our approach aims to be as user friendly as we can make it. Other therapies are not so inclusive. Although there have been some moves to take therapeutic work in this direction, historically therapy has tended to have the opposite reputation. We consider this issue in our final chapter. For many, therapy still conjures up an image of an affluent elite lying on the couch in the thrall of a privileged expert. Even those therapies such as multi-systemic therapy that have been specifically designed to work in the context of constellated disadvantage are certainly not that easy to simply pick up and run with (Henggeler, Clingempeel, Brondino, & Pickrel, 2002).

RT does need to be resilient in this sense too. It starts in, and remains committed to, tackling those areas that therapies have found it so difficult to influence. These are situations where the odds are heavily weighted against us as practitioners, parents or children trying to achieve any change for the better. As we say, there are no exclusion criteria in RT, but that does not mean that it is vague and unfocused. Many findings of resilience research can be applied to every child. So too can RT. Yet the children for whom we are writing, the ones for whom we have most acceptance, energy and commitment, are the most disadvantaged children in our society. They have been termed deprived, distressed, delinquent, poor, at risk, unequal, abused, neglected, excluded, special needs, vulnerable and so on. In academia, there is a veritable debate about what language describes them best (Lubeck & Garrett, 1990). Earlier we introduced the term ’constellated disadvantage’ to think about their lives and identities. The concept is not meant to conjure up a starry bright night sky. Rather it brings home the fact that, for some children, disadvantage comes in many shapes and sizes, often all at the same time. Each individual disadvantage can, and probably does, interrelate with others to generate new patterns of disadvantage, each with varying consequences. These include the ‘negative chain reactions’ that Rutter has so clearly articulated (Rutter, 1999). Socioeconomic status, mental illness, ethnicity, disability, genetic inheritance, sexuality and geographical location may all feature. It is to the children in constellated disadvantage that we give most thought in this book. Our practice examples and illustrations are all geared towards working with and for them.

In constellated disadvantage, child protection dilemmas, treating severe mental distress and managing disability are deeply woven into the fabric of daily practice. We can add to this list working with people who are sceptical of professional involvement. They are likely to be in a permanent state of crisis and placement instability. How to make a difference to children’s mental health and emotional wellbeing in such contexts is a persistent challenge that can drag us down. RT gives us a focus for our endeavours and keeps us energised.

This is very important because not all practitioners will have a working knowledge or personal experience of constellated disadvantage. Those of us who do, may all too easily forget what hardship actually feels like, or we can also too readily assume that our own experience is universal. Working with race, ethnicity and cultural difference in the context of constellated disadvantage can be particularly challenging; a very foreign land, if you like (West Stevens, 2005). Some practitioners will need to develop an ‘inequalities imagination’ (Hall & Hart, 2004; Hart, Hall, & Henwood, 2003; Hart, Lockey, Henwood, Pankhurst, Hall, & Sommerville, 2001). This involves a thorough understanding of the effects of health inequalities in its broadest sense and puts this awareness at the heart of practice. However, knowing that systems fail children and that they are the victims of poverty, disablism and other inequalities can engender confusion over what needs to happen therapeutically. In RT this context of inequality and social exclusion is worked through as a specific focus so that the practitioner’s work is not overwhelmed and eventually undermined by it.

Introducing Janice, Louis, Sally and Jason: Constellated disadvantage in process

Time now to tell you about what constellated disadvantage looks like for some of the children we have met over the years. We will be drawing on their stories throughout the book. Of course we are not giving you any real names or actual circumstances. But the realities these stories are based on are all true.

Janice, age 6, is of Anglo-Irish family background. She has already been excluded from school and sent on her way from five foster homes. Janice has a diagnosis of foetal alcohol syndrome, thought to bring with it global and specific learning difficulties. There is some potential for her to catch up once settled in a long-term placement, but she is unlikely to achieve functional literacy and numeracy. Janice is angry and violent towards her brothers, both of whom have been moved to separate new carers. She hits people or stares into space in her spare time. A succession of social workers, assistants, placement support workers, volunteer mentors and children’s advocates have all tried to befriend her. Janice defecates in a corner whenever she sees her birth father. Her name comes to the top of the Child and Adolescent Mental Health Services (CAMHS) waiting list—she is a priority case. She is assessed at a joint appointment by a psychiatrist and a psychologist. The letter back to her referrer describes her as ‘too disturbed for therapy at the present time’. Her networks are described as ‘not sufficiently stable to support Janice through the therapeutic process at the current time’. She is referred back to Social Services and her case is closed.

Seven-year-old Louis. White British. Louis is once again living at home with his birth mother and three much older siblings. Louis has only just moved back to live with them. Before that he was in and out of foster care. Louis has an ugly burn scar on his head where tea was tipped over him when he was two. His social worker visited the home one morning and cajoled his mother out of bed. The social worker went with Louis’ mother to the GP to get some anti-depressants. The medication has at least helped her get dressed in the day and out in time to pick Louis up from school. But still Louis is sad, angry and failing at school. He spends at least six hours a day on the game boy a charity bought him. His mother thinks it keeps him calm alongside the medication he takes in the day. Louis plays football at lunchtime on Thursdays, when his learning support assistant misses his own lunch break to help Louis join in. Social services sent the family to CAMHS. Louis sees a psychiatrist every now and then for a Ritalin prescription. He has a diagnosis of Attention Deficit Hyper-activity Disorder (ADHD). The family were d...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Boxes
• Acknowledgements
• Abbreviations
• Chapter 1 Conjuring up Resilient Therapy
• Chapter 2 Four Noble Truths for resilient therapists: Accepting, Conserving, Commitment and Enlisting
• Chapter 3 Basics as a fundamental part of Resilient Therapy
• Chapter 4 Belonging
• Chapter 5 Learning
• Chapter 6 Coping
• Chapter 7 Core Self
• Chapter 8 Making organisations work
• Chapter 9 Configuring RT for practitioners
• References