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.