Building the Bonds of Attachment by Dan Hughes - DDP

I have been reading the above book, recommended by a clinical psychologist in my team and thought I would share a few of my musings.

This book has been particularly interesting as it follows the story of one young person called Katie who has specific problems forming attachments as a result of the neglect she experienced in her life and subsequently she has many foster placement breakdowns. Eventually she moves to live with a highly therapeutic foster carer and the book follows this foster carer's interventions, together with the work of the therapist she sees regularly. 

One thing that stood out to me was the fact that the book specifically explains that for children with these attachment difficulties, many of the standard behavioural interventions that you might use on children, even children who are 'troubled' are unlikely to work for children with this internal working model. The book also highlights the difference between shame and guilt, and that although guilt incorporates a degree of empathy and caring about other people, which these young people might not yet be capable of, they are often gripped by shame, based on their early years experiences  - shame which is a much more internal concept than guilt.

One of the elements of the book that is key is for the foster carer to adopt 'the attitude' which is summed up by the acronym PACE - playfulness, acceptance, curiosity and love. In some ways i found the book quite depressing, because I can't imagine finding many carers who are able to show the incredible degree of strength, compassion and resilience that this foster carer shows - continuing to try to adopt this attitude even in the most testing of times.  However, even if one can't adopt this attitude everyday, its helpful for me to understand the key traits, both for my own direct work with young people and when talking with foster carers who are being challenged by young people.

Another element I found particularly thought provoking was the idea of limiting the number of opportunities the child has to sabotage something - which reinforces their own notion that they are bad/evil. One example from the book, was when Katie moved to live with this foster carer and it was approaching her birthday. The carer asked the therapist how she should celebrate her birthday and whether she should plan a party. The therapist discussed the fact that Katie has sabotaged every party held for her in the last few years in foster placements and so to do so would only give her the opportunity to repeat this behaviour. The therapist recommended having a very 'low key' celebration - a cake at dinner time so that Katie could have a positive experience. When KAtie asked why she wasn't having a party, the carer was able to reflect to her that she wished that Katie was ready to have a birthday party and they'd really love to give her one but at the moment she's not ready for this - hopefully it's something for the future.  I was able to reflect on similar situations with the young people I work with, in particular one who is not coping at a mainstream school and how I feel that by continuing to send him there and for him to get excluded or told off for bad behaviours, we're potentially setting him up to fail by giving him these opportunities to sabotage on a daily basis.

The therapy sessions are also very interesting and seemingly quite radical in their approach. The therapist alternatives between playful and tactile behaviour with KAtie - tickling her, stroking her etc and then a more serious approach where she discusses her behaviour that week. She supports Katie to voice some of her inner feelings to her foster carer eg I hate it when you do this, I feel like i'm a bad child etc and when Katie can't say the words, the therapist says them on her behalf. 

Dan Hughes has developed all of this into his Dyadic Developmental Psychotherapy (DDP). DDP is based on and brings together attachment theory, what we understand about developmental trauma, the neurobiology of trauma, attachment and caregiving, intersubjectivity theory and child development. It specifically is used with children together with their caregiver to help them to learn to trust. One of the children I work with has been in DDP over the past year and I have seen the outcomes and the change in the level of trust this child has with his foster carer and the disclosures that he has been able to make, the emotions he has been able to display since being in this therapy. 

Has anyone else has any experiences/learnings about DDP/Dan Hughes/PACE attitude? Would love to hear.

Impressions of a Newly Qualified:

So, it’s been a very long time since I’ve written a blog post about life in social work – which perhaps tells you all you need to know about how busy it is!

I’ve been qualified now just four months, but have been working in a Children in Care team just over 18 months, first as a student, then an unqualified keyworker, and now as a NQSW.

So what are my first impressions…where to even begin..

-          First is to say, I still love it. I love the variety of the work, I love working with children and young people and having the privilege to play such an important role in their lives and I love thinking of new ways to carry out direct work – exploring new resources, going on great training ( have used my AYSE budget to go on 2 days with the Child Centre for Mental Health – would really recommend, although they’re on Saturdays.)

-          I have definitely felt surprised and at times, a little overwhelmed, by how much responsibility you have so quickly. I have probably said this before, but whilst working in advertising, you were always part of a big account team, and everyone knew what was going on and was playing some kind of role in the account. As a social worker, sometimes it can feel a little more isolated, and the responsibility is very much on you as an individual worker, to share information, where you think relevant, with your supervisor, or your wider POD – if you work in that way. I think communication is vital – not just in the way we learn about in training – in terms of sharing with the wider multi-disciplinary team to avoid child protection crises, but for more informal things too. I like to chat regularly to the supervising social workers/link workers about anything that is going on for my children and is having an impact on their foster carers – it also helps me feel part of a wider team.

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      But yes responsibility is a big part and something I take pretty seriously and like to seek guidance wherever possible. I have recently been preparing a child for their transition to adoption – the first one I have done. I have found it has made a huge difference asking a therapist to sit down with me and give me guidance on the best way to handle this transition, discussing the right timing for revealing information to the child and strategies as to how to do this. It has left me feeling so much more empowered and it’s been amazing watching how well the transition has been going (fingers crossed!)

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I    ’ve learnt lots about attachment and its implication for neuroscience – through my training and in turn different techniques to use – including art therapy and play therapy techniques and a greater understanding for why many Looked After Children are constantly drawn to extremes and chaos – for them, a life in the middle is not familiar. It was, my hero – Camila Batmanghelidjh, who discussed this on one of my training days, that helped me to understand one of my teenagers a bit more clearly.

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            I’ve felt blessed that we have such a great bunch of professionals at work – everyone is kind and friendly and this makes a huge difference to day to day life. We do a tough job and one that often be emotionally draining, so being able to laugh and joke in the office can make all the difference

To conclude, I think, in a not particularly philosophical way, that the job is what you make of it. I recently had a student shadow me for a couple of visits and she was asking for some advice (which given my limited experience, was probably not too profound!)  but I talked about the importance of the little things. I’ve just sent out all my cards to my teenagers wishing them luck for their GCSEs. Whereever I can, I try to send birthday cards. I’ve put all their GCSE exams in my diary so I remember to wish them luck – my mum would never forget to wish me luck, and we’re their corporate parent. I did the same as a student for one of my kid’s SATS exams. I think it’s important to text or email just to check in with the young people and see how they’re doing, show you’re holding them in mind. I pushed to get budget to take them for a meal on their 16^th birthday.

My favourite part of the job is advocacy. Advocating to get these kids what they need and deserve and trying where possible to push the limits.

All of this is hard to do inbetween the mound of paperwork and constant deadlines. And without a doubt you can feel hit over the head with emails about targets and data. But we know why we do the job and as long as we can remember that, it’ll be okay (I tell myself!).

On another note, there’ been some amazingly interesting tv shows of late:

From 15,000 kids and counting on Channel 4, to Louis Theroux’s documentary on sex offenders in America, BBC3’s prison programmes – life and death row, life behind bars, death behind bars etc. Love this stuff!

Anyway, that’s all for now!