Therapies

Art therapy is the use of art materials for self-expression and reflection in the presence of a trained art therapist. Clients who are referred to an art therapist need not have previous experience or skill in art; the art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client’s image. The overall aim of its practitioners is to enable a client to effect change and growth on a personal level through the use of art materials in a safe and facilitating environment.  Through creating art and talking about art and the process of art making with an art therapist, one can increase awareness of self, cope with symptoms, stress, and traumatic experiences, enhance cognitive abilities, and work towards change.

An account is given of attachment theory as a way of conceptualising the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality which unwilling separation and loss give rise. Through it incorporates much psychoanalytic thinking; many of its principles derive from ethology, cognitive psychology and control theory. It conforms to the ordinary criteria of a scientific discipline.

Certain common patterns of personality development, both healthy and pathological, are described in these terms, and also some of the common patterns of parenting that contribute to them. (John Bowlby)

The therapist's approach is an eclectic child-centered approach so the young person feels valued, seen and heard in a non-judgmental way. Much of the clinical thinking is from an attachment perspective working in a style that the child responds to best. Many children who are in the care system have experienced some level of trauma in their past; many arrive with symptoms of P.T.S.D. (Post Traumatic Stress Disorder). In these cases we find it helpful, for the client, to use a cognitive behavioral approach to help them to manage and break old cycles of thinking (cognitive distortions) and work towards re-creating new ones.

This approach is very useful for young people who self harm; self harm is a big issue for many adolescents in care, this is something that often manifests itself when a young person attempts to manage un-manageable feelings without the help of others. Our staff team are trained in understanding and treating self-harm and can access regular clinical supervision when they are working with children displaying these behaviours.

A core psychological assessment is made over a period of three to six months and this informs clear direction in ways to meet the child's needs and enable correct treatment.

John Bowlby (1977, 1980) described his attachment frame work as “a way to account for the propensity of a person to form lasting affectional bonds to particular others, and to explain psychological disturbances, including anxiety, anger, depression and emotional detachment, that could result from disruptions such as separation, loss or threat of separation.”

Music Therapy is provided with the child and therapist using state of the art computer software in the Mac studio. Music therapy allows the child to explore their life story through adding vocals. The background music is created with the guidance of the therapist (who is a keen musician familiar with all the latest sounds). This intervention often leads to personal discovery and a growth spurt in the child's self-confidence. All the work is recorded and a personal CD is created to document the audio experience. The child can then reflect upon their journey in therapy via the music that they have created. Some children enjoy the process so much that it can lead them to talking up music or singing lessons, developing their skills and increasing self-esteem. This creative intervention is one in which the child feels less defensive and does not feel overwhelmed by the word 'therapy'.

The therapeutic community is an integral part of our provision. We provide a high quality therapeutic milieu where the children can feel safe and begin to achieve and to heal. As well as the children's weekly, programmed therapy sessions we have a regular therapeutic group meeting, which is led by our therapist and a senior RSW. The group gives the children the opportunity to reflect upon relationships within the home; focusing on understanding each other better and resolving differences within the creative work group. In the group different themes are explored; e.g. bullying, drugs, relationships. The group explores these themes is sundry ways, which can involve discussion, dramarama and art. The groups are highly successful and the children all reflect back how much they value the sessions and how helpful they find them.

“The most helpful intervention for children with any type of behaviour problem, regardless of the cause, is providing a living environment which encourages growth. For this to occur the child must feel physically and psychologically safe and underlying needs must be met. The child's daily living experiences must provide opportunities to have his/her needs met and to learn more about him or herself.

(V Fahlberg, 2004)

Therapeutic Crisis Intervention
Country Care follows the University of Cornell Therapeutic Crisis Intervention programme (Version 5). This is a Crisis Prevention and Management System first developed in 1980, subsequently revised, and in widespread use in the UK, Ireland, USA, Canada and Australia.

The key rationale is:
“In our work in residential child care, the most important tool we possess in helping young people change, grow, and develop into well-adjusted members of society is ourselves. Our ability to relate to the young people we care for in an open, sensitive, consistent, and caring way is perhaps the single most important contribution we make. It is a fundamental assumption of residential treatment that the adults who spend the most time with a young person, regardless of who they are, can directly affect their behaviour and learning, and hence, growth.”
(Therapeutic Crisis Intervention 2001)

Therapeutic Crisis Intervention embodies a therapeutic approach to crisis prevention and management designed to reduce the need to rely on high-risk interventions. The programme provides a structure to help make sense of a child’s difficult behaviour. Staff are taught specific techniques to prevent and manage crisis situations. This includes understanding the distinction between situational and maturational crisis; the stress model of crisis and at what stages certain techniques can be employed; proactive and reactive aggression; the use of a variety of intervention approaches and specific behaviour management techniques (e.g. caring gesture, prompting, planned ignoring and positive attention, hurdle help, time away). Staff are given specific direction on active listening skills, managing non-compliant behaviour, and averting a crisis.

Staff also employ the Life Space Interview, a therapeutic, verbal strategy for intervening with young people that was developed by Redl and Wineman in the 1950s. This is an intervention that occurs in the child’s own life space, it uses their own reactions to difficult situations as a vehicle to change their behaviour and expand their understanding and insight into their own, and others, behaviour and feelings. The Life Space Interview can be used after any crisis event. It does not solve the problem; it is an ongoing strategy to help teach the child better coping skills. At Country Care all staff are consistent in the use of this technique.

Therapeutic Crisis Intervention also teaches a range of safety interventions, including releases and physical restraint. Physical interventions rest on the principles of a maximum amount of caring with a minimum amount of force and the goal of de-escalating the situation by reducing stimulation.

Written records are made of all Life Space Interviews and physical safety interventions. The Manager countersigns restraint forms. All staff are trained in Therapeutic Crisis Intervention techniques and receive regular updates. Any concerns about practice are initially overseen and addressed by Robin Barker, Manager. Robin Barker is an accredited and very experienced Trainer with the University of Cornell. Robin Barker has also undertaken training in Recovery for Staff, which provides for how staff should be debriefed and supported after any incident.

External supervision and support is also available from Dominic Hodgkinson who regularly visits Country Care. Dominic Hodgkinson is also an accredited trainer with the University of Cornell.

We have excellent links with local services and draw upon these services as necessary for individual children.