Are the children cured yet?

I really believed I wasn’t going to mention ADHD again – and indeed I’m not. Because neither does Sami Timimi in his condemnation of the fast-cure parents who want instant results when treating their child’s bad behaviour and emotional distress. I found Timimi in The Telegraph last week, where he is quoted as saying: “With the widespread application of the techniques of medicine to manage our children’s behaviour and emotional state, particularly through use of drugs, we have achieved what I call the ‘McDonaldisation’ of children’s mental health.”

I know he includes ADHD in that because I have read his A Straight Talking Introduction to Children’s Mental Health Problems, but the book they are quoting from here is Childhood, Wellbeing and a Therapeutic Ethos, which has an enticingly wide selection of well-known contributors. The contents listing on Amazon is so good I have ordered it and will report back later when I’ve read it. That might be a while yet, because it’s scheduled as three- to five-week delivery. I guess that makes it a Christmas present to myself!

Moving tangentially from that thought, one of the chapters by Richard House is about “A Winnicottian and a Steinerean rationale for avoiding the premature ‘adultifying’ of children” – a bit of a mouthful! But this ‘adultifying’ is something we all find difficult to witness in our therapy rooms, since this is mostly a result of the society we’ve allowed to come into existence. It was only the other day that the MP Barry Sheerman lambasted the media coverage that has led to children enacting porn in the playground.

So what is the connection here? The fast food syndrome? Is it simply that parents can’t wait for their children to “cook” (grow up) properly for the correct length of time?

I’m sure I’m not the only counsellor who longs for parents to realise that kids need to be allowed to be kids and, for the duration, need parental time and attention. I think of a boy who wants only to play Ludo with me week by week as he absorbs what it’s like to have someone interested enough to be bothered, and also a girl who acknowledges she never has attention from her mother. At home, the partner is always there; out and about together, mum texts said partner and so isn’t entirely present. Both young people have a weary and worn view of life – mini adults in their resignation. Don’t you just hate to see it?

Medicating kids unnecessarily and shoehorning them prematurely into the adult world are equally obnoxious. No wonder they love coming to see us, however distressed they are.

To sleep, perchance to dream

News that teenagers need more sleep than they’re getting was forcibly brought home to me not only in the article in The Times the other day, but by a client telling me they spent most of the night awake and worrying, and another coming in hardly able to stay upright for his session having watched wrestling late into the night before.

In an age of personal TV recorders I would have thought the latter could have been solved. I suspect (oh horrible, mean thought) that Dad wanted some company while he watched, and that Mum probably wasn’t co-operating!

I never express disapproval of anything the client tells me but aim rather to discuss things, as indeed you all would in therapy, but I did wonder if not saying anything about his state of exhaustion would have seemed like approval.

But with regard to teenagers who find sleep hard, it is helpful to have a theoretical model that allows for psychoeducation. Like many therapists, I started off all pure and intent on merely understanding the meaning the client attached to things and working with that alone – but slowly and surely I’m thinking that colluding involves much more than I originally thought. Not telling them something is leaving them in ignorance. How can that be ethical?

If I live to be a hundred I will not have exhausted all the nuances of how best to help a client. And that’s probably because of the uniqueness of each one.

Nevertheless, I can only work in the here and now, and with that in mind, I have produced a “sleep hygiene” (what an awful word!) handout that I will use as and when it seems appropriate and is desired by the client. In a spirit of generosity, you may download it here if you wish!

Freudian vampires

It may be Friday 13th (for a few more hours) but it is a very funny day. Why?

I have just read Derek Draper’s opinions on Stephenie Meyer’s Twilight series. The New Moon film is due out within days (OK, Nov 20th if you’re bitten by the bug).

If you thought psychodynamic had given way to CBT, then just have a read of this article in The Guardian today.

Apparently the consensus is not that the book shows teenage love in all its intense desire (as I had innocently thought on reading it) but something much more Freudian:

Edward Cullen is the lover the young girl desires and fears. The reader wants to be devoured by him; she wants to be eaten, even if she is being very expensively educated and playing the viola reluctantly. “The vampire is a metaphor for the predatory yet alluring boy,” explains the psychotherapist and sometime spin doctor Derek Draper. “The young girl wants to be chased and she wants to be caught. Coarsely put, the bite stands in for penetration.” The fang, he says, is a penis.

I guess I mustn’t quote much more of the article – you need to go read it and gape in awe. But just a titbit more. Draper goes on:

“The vampire is also a metaphor for a teenage girl, because teenage girls are outsiders. They feel unformed and sickened by cravings they struggle to satisfy.” Who knew? It is hard to say to your parents “I want to devour and be devoured”, even if you live in north London.

I guess if that’s what the girls are thinking then it is truly a subconscious thing. What I hear them doing is discussing whether the actor playing Edward Cullen is how they imagined him and whether the film or the book version is better (referrring to the first book of course, which is the only one to have been viewed to date).

But it does help in the counselling room to have read what they read and seen what they see. Somehow it makes you acceptable. Less alien – less like the vampire they fear we are. Twas always so. (What they don’t know is what may or may not have been going on in my more aged subconscious brain while I was reading it – for I’m not sure either now!)

But I do wish more child therapists thought psychodynamically in the more modern sense – there is so much going on in a young person’s narrative if you look between the lines. But maybe not as far as the bloodsucking layer, of course. A great exponent of this way of thinking is Nick Luxmoore and his new book is a must-have for all of us: Young People in Love and in Hate. Have a look at it here, and put it on your Christmas present list.

Coaching courses

I have been investigating coaching courses. And it’s a long time since I wrote about it (see this post) so I thought I’d share my findings.

I seem to spend lots of time coaching teenagers, after we’ve sorted out their traumas, so that they can manage without me sooner rather than later. A qualification would be nice, though I don’t have a family systems one and seem to facilitate family sessions very well to the extent I need to without any formal qualification – though we did do systems therapy on my original training course. I’m under no illusions that this makes me a family therapist or indeed a coach.

So I went to the website of The Youth Coaching Academy. I have no connection with them at all so what follows is entirely independent. But you may be interested. I was actually looking for something that sounded more ‘me’ than the listed contents of the Oxford Distance Learning College’s Diploma in Child Coaching – mind you, that’s based on a ‘feeling’ about it in relation to my needs and is in no way intended to be detrimental. Mostly, in fact, because I couldn’t get them to distinguish between their two levels of course.

Back at the Youth Coaching Academy, I downloaded the audio of a module free – you might like to do the same; it’s 90 minutes, so it will take a while. Harry Singha certainly knows what he is talking about, although the first 8 minutes of the MP3 were rather ditzy as his interviewers introduced themselves!

The jury is out on the prospective value of the course as I haven’t enrolled – but in its favour is the fact that to get one of the three levels of certification you have to do recordings of ever more live sessions with clients. That’s good. No skiving off on theory alone. Their content sounds really good as well. (Why does winter always make me think of wood fires and cosy studying??) By the way, if anyone is wanting a school to have trained peer coaches, this academy runs courses for those too.

The other contender for youth coaching would appear to be the Youth Impact Coaching Course run by The Coaching Academy. Harry Singha makes an appearance on one of their live training sessions too, but he actually founded the Youth Coaching Academy and belongs there these days. The Youth Impact course is expensive, even by course standards but might well be good otherwise.

One thing Harry S said was about “credible adults”. Now that’s something we all understand. He said that if abused children believe all adults are bad, when they grow up to be one, they don’t like themselves. So they do all sorts of anti-social things and are equally happy if they die because they don’t care about their lives. When we, as therapists (or coaches or teachers) care, we provide a reference point that adults can be caring – and then they thrive.

This is illustrated in a tiny way by a client the other day who has had three sessions with gaps so far (not my fault!) – and when I said I’d see him next week, his face lit up and he said, “Two on end. Brilliant.” And I knew then that despite the breaks, I had that essential link so necessary before further work can be done and he can thrive. Thus far has been nurture, the next stretch is therapy, the final stretch will be brief coaching before setting him free – I expect you understand my passion for this process! We love kids.

ChildLine does us proud

Now here’s some good news. It cheered my day to hear that ChildLine is now offering a website where children can get online support. Yes, there are others, for sure, but ChildLine has a place in our national consciousness and will be well used, I reckon.

Funnily enough, this seems a really sane move. And that’s partly because the Government wants to start careers advice for kids as young as seven, according to a report in the Telegraph yesterday. In a perverse way, the more the powers-that-be roam into bizarre territory, the more the people out there that need our help will feel they must access it. It kind of plays into our hands as the sane ones! After all, we can’t be madder than the authorities who dream up these mad schemes! Children who are bullied, beaten or bereft of an attachment figure are hardly going to be thinking, Now do I want to be a gardener, a pilot, or a check-out person?

Anyway, this is a website address to have to hand for when it seems appropriate to mention it to a client: http://www.childline.org.uk/Pages/Home.aspx

So if people are going to turn to us more and more, isn’t it just timely that, for those of us in agencies and connected to commissioning (and everyone else if they feel so inclined), there is now a short publication available from the Family and Parenting Institute that talks us through using measures to keep track of change. It helpfully lists all the posh terms involved in such work and points us to suitable measures, with practical discussion on each. Really useful. You can download it from here.

And remember, next time a child says they are going to be a famous footballer, it won’t be juvenile role-yearning. It will be the result of a careers advice session…

Up with social pedagogy!

I cannot believe that the same government that has introduced a Social Pedagogy pilot in children’s homes throughout the country is also allowing a giant-sized school to be built. Nottingham Academy will have 3,600 young people in its walls when they finally finish building the new blocks. Community size and wellbeing are known to be linked, for goodness sake.

If you haven’t heard the phrase “social pedagogy”, you can find information on the progress of the pilot on the DSCF site here, and an old Guardian article explaining it with examples here. I hope they’re progressing well, because one of the things we find in child therapy, and indeed in adolescent therapy, is that young people thrive in a small environment with a safe adult or a small safe group of peers. Why, then, would we build a huge school in which they feel overwhelmed and unimportant? That will be joined-up thinking, then!

With so much social, behavioural and emotional disruption in society among young people (not the majority, I accept), the Government would do well to concentrate on what works and focus carefully on whatever meets that need. Small groups, attachment needs met, sense of belonging and being appreciated – not many of my clients in therapy have all this.

Even okay children need these things; behaviourally challenged children need them even more – and our help when they are falling by the wayside. They are not a child therapist’s easiest clients (I talk from experience!) but helping them to success is even sweeter.

For BESD, the claims are that there are four main ways of “treating” children, (they are outlined here), and social pedagogy is one. The solution-focused part of this article makes a good case for this method of working with BESD, because it deals with the preferred future rather than the unwanted past.

I would add tapping (EFT) to this list for two reasons. One is that it accesses bodily feelings as well as cognitive issues, and another is that it can be used with a bear. Yes, you heard right, a bear! Have a look here at Tappy Bear to get the idea. It involves something we all know about – and that is: mirror neurons.

It works like this: when a child (in this scenario) puts the problem on Tappy Bear, views Tappy Bear with all “his” problems, and then taps for the bear’s problem behaviours and feelings, the child fires off mirror neurons in himself and so is also affected by the tapping procedure.

Neat – but identifying the child that can be helped in this intimate, understanding and nurturing way in an aerodrome-sized school will not be easy. That’s why I say hurrah for ideas about social pedagogy.

Fiction that helps understanding

Forgive me if this seems an unusual post, but I’m deep in reading the six finalists in the YoungMinds book award 2009.

No, I’m not a judge – I wish! But I read about the shortlist and decided I would read them all.

I always read teen fiction because I’m also a writer for children, but this was extra. I wanted to see how mental health was portrayed in books that young people themselves read and recommend to be shortlisted. It counts as research for my own “work in progress”, which involves a dad who is suffering with PTSD after returning from Helmund Province. The central characters are twins of 15. Watch this space. No, delete that – this is a mental health blog. But I can always learn something about young people – and I think that’s the idea behind the award, actually!

If you’re interested to read and discover what appeals to the 12+ age group in this genre, here is the list (with an indication of issues in brackets, though you can’t reduce a novel to its issues). I got all six from Amazon for around £26.

A Perfect Ten – Chris Higgins (eating issues, bullying, guilt over a death)

Without Looking Back – Tabitha Suzuma (custody battles)

Ostrich Boys – Keith Gray (death and ashes)

The Stuff of Nightmares – Malorie Blackman (fear of dying)

Bang, Bang, You’re Dead – Narinder Dhami (living with a mum’s mental ill health)

Ginger Snaps – Cathy Cassidy (starting secondary school)

So as you can see, a wide range. Much to be learned, I’m finding. I hope some of you will perhaps not only read the odd book from this list (they’re great reads, by the way), but have them available if bibliotherapy is your thing. Or even just to know what your client is talking about! (For that, I could use a course on Stephanie Meyer’s Twilight Saga which they all seem to read!)

Doing us out of a job?

A new report by Ofsted has highlighted exactly how the top 20 primary schools in deprived areas are managing to achieve excellent outcomes. Funnily enough, their values and ethos are not so different from our own, as child therapists.

Here are a few examples:

1 Staff visit homes before the child starts school

I am convinced that most issues that young people present with at this age have much to do with home life in one way or another and that seeing how things happen in the home and the dynamics of the relationships there is key to helping the child.

2 Pupils discuss their learning and learn about learning

Most young people really want to understand what is happening to them and why. It empowers them and makes them feel there is hope for change. This is as true emotionally as of learning – and often the two are closely connected anyway.

3 Schools tackle concerns about special needs early on in the nursery and reception classes

We always want to make an early intervention to avoid later more complex and costly ones. And – in a school counselling situation, at least – we rely on the staff being aware of mental health issues and referring children appropriately and in good time.

4 Calmness is encouraged in school as it compensates for children’s very turbulent backgrounds

The calm atmosphere of the therapy room (on our part!) enables the children to confront issues and work on them. If this is reiterated in the classroom, the brain’s thinking parts will be able to function so much more effectively.

5 There is a strong and explicit focus on play, sociability and enjoyment

Too few children have these opportunities these days and I applaud these schools for realising what matters. Play is how children learn. Sociability is how they will learn to get on with adults in later life. Enjoyment is often lacking except in our rooms!

The reason Ofsted has published this report is to enable other schools to learn from best practice.

Best practice for therapists is a somewhat thorny issue, since the RCTs are not done in a real situation. However, this list from America names a few therapies that they reckon are best practice (scroll down to the set of slides headed ‘Identified Best Practices’), including Parent-Child Interaction Therapy (you can read a case study here), Trauma Focused CBT, Multisystemic Therapy, and Dialectical Behaviour Therapy.

Play therapy, on the other hand, recognises both directive and non-directive modes for treatment of trauma, as is evidenced in this excellent article by the Trauma Awareness and Treatment Center (an American outfit – hence the spelling!).

This is a long post – I hope you find something useful in it!

A child’s metaphor for PTSD

Just thought I’d pass on an idea that came to me when cogitating on a young client referred with PTSD after a road traffic accident. I wanted an easy-to-grasp way of normalising what was happening so they’d have some hope it could be solved – ie a metaphor. Readers of this blog will know I love metaphors.

If we assume that all responses to an incident are downloaded into the body and stored until they can be discharged later, and if we assume that sometimes they don’t get discharged or organised or whatever, then we have an overloaded and unstable part of our mind where things are not processed yet, and are constantly bothering us in the present because they need seeing to.

So picture this. Why not invite the child to learn how his mind is at the moment? We’d give the child toys (Lego cars, toy vehicles, puppets, plastic figures etc) to hold, one at a time, two at a time, until can hardly carry them in their arms. We’d agree with them that it’s awkward, some fall off, their body will be constantly adjusting and alert to keep the pile steady. In this state, they “can’t manage”, can’t do their usual activities on account of the pile, find it a bothersome “nuisance”, are permanently afraid of more coming along to be held, and constantly hypervigilant as to whether something is about to fall off. They might even find it hard to sleep, holding that pile!

Now – what to do about this problem? Well, if we help them to unload the toys together and put them in neat sets/rows, they can actually see if they want one back in their hand, they can revisit them if they want, but they will feel they “can manage” them, it’s “okay to look and pick up” when they want, they wouldn’t be “afraid of the toy problem” and could get on with other interesting things, just like they did before. And we’re going to help them sort the pile out.

Well, it was just a thought. You can use it, adapt it or leave it!

There’s a good article about PTSD in children in general at Hidden Hurt.

And may I again mention the new Routledge book about a cognitive therapy approach to PTSD? I mentioned it in my last post and you can find it here, but it bears mentioning twice. I can thoroughly recommend it for everyone whatever your model. It covers all the same things we’d need to know anyway. Except of course my lovely metaphor…

World Mental Health Day

This is scheduled for Friday 9th October this year.

I am sitting here pondering what I might do to acknowledge the event in a meaningful way. It’s entirely un-me, of course, to do anything at all on these occasions, but suddenly I find myself drawn to contributing my tiny bit to improving things.

But what to do?

Perhaps I could invite parents from the village to come and talk at a sort of “tea and children’s mental health” session. Or maybe invite people to come and learn the basics of EFT so they can use it for themselves and teach their children this effective self-help therapy. Possibly even do a special offer of five sessions for the price of three  for parents who wish to access help for their child (or does that liken our services to that of a supermarket chain?).

Of course, as soon as I write these suggestions down, I realise it is but a drop in the ocean of human need. Two of them might also open up issues of risk, which would need addressing during the planning stage.

This idea of risk tied to making an effective contribution to mental health immediately rang a connection in my head to BACP’s Divisional conference for CCYP, which takes Risk as its theme this year. And here I am wondering if the risk of taking action on World Mental Health Day is just too risky to be worth it. Ha! The conference theme hadn’t seemed terribly interesting till just now…

So I shall book to be at the CCYP conferences in November and February (you can access details from here) and I shall proceed with planning my action for Friday 9th October. Of course, we run into an instant set-back – that’s the day of BACP’s annual conference, so I will have to make my little contribution on an earlier day. How about calling it “Pre-empting world mental health – come and make sure you’re OK by the day itself”??

I’ll let you know what happens.

I just found a newly published fabulous book on PTSD in children and young people. Have a look at More off the Press, tabbed at the top of this page. Or find it here. A must-have book.