A facilitating environment, and what’s ‘therapeutic’? – Jane Keenan

This is an extract from Jane Keenan’s book: Kids in Care…How can I Help?

To achieve what I’ve described so far, is to provide a facilitating environment, an environment
which facilitates that move towards emotional health. And for us, health means more than just
an absence of illness – check out Donald Winnicott for more on all that, and Carl Rogers on
creating an environment in which others can learn and grow. It’s about creating a culture in
which a child’s needs can be thought about, and provided for, their feelings and distress borne
healthily, holding hope for their future, with the intent and aspiration for them to find a way
towards happy, productive adult life.

It takes deliberate application to build and sustain that culture, in a place where people live. The
children will bring expectations of how things should be, from their own family, and from perhaps
a number of other care settings. In residential, there are a number of workers, each with their
own family experiences. In fostering, there will be established family habits, and where a couple
haven’t parented before there’ll be some ironing out to do.

To explore this briefly, what do you do for breakfast?
Do you eat cereal? Toast…? With Marmite, jam, marmalade, peanut butter? Do you do that
standing, or sitting at a table? Is there a tablecloth on the table? Is it OK to have sugar on your
sugary cereal? Do you drink orange juice? Tea, or coffee? Is there milk – in the bottle in the
fridge, or in a jug on the side? Howabout a fry up… sausages, bacon, eggs – poached,
scrambled, fried – ketchup on everything? Plant based only? What do you do with your knife and
fork when you’ve finished – lay them side by side in the middle of the plate, or wherever they fall
when you’re done?

Perhaps you don’t have breakfast at all.

When I’ve run this exercise in a group, it quickly becomes clear there is a vast number of
possibilities, about what is normal for breakfast, what is the habit, for each individual, and how
that habit might change according to the day of the week.

Our children are going to need to know, how it is where they are now. They may view your
habits with scorn, suspicion, confusion or bewilderment. A residential team – with different adults
rotating on shift – will need to figure out the consistency of how it is, otherwise how are the kids
to keep up with how to meet the expectations of their behaviour, and to feel safe because the
provision for them is routine and predictable?

I have found the phrase ‘this is what we do here’ to be helpful in reiterating and embedding the
culture of where we are, without denigrating or being oppositional with the cultures of other
settings. It helps to create essential order, and predictability, to help children know how to get it
right, how to belong. And to be accepting, to acknowledge that people do things differently, is
also to avoid judgement, and offers an opportunity to establish what happens here. It helps to
maintain that important space to be balanced about how the child’s family did things. If we are
crudely and widely critical of the family, the child may have difficult feelings and be defensively
protective of them, making it harder for the child to be curious about and explore alternatives, or
to belong in multiple, differing worlds. A colleague also used to observe that our children are of
their parents… if we wholly castigate the parents, the child may struggle to feel there is anything
good in them either. I have found that humility of ‘there but for the grace of God, go I’, to be
enormously helpful.

A gentle, even “Oh OK, well, this is what we do here”; “Yes please, I know not everyone does,
but here we all sit and have tea together – that’s what we do here”; “OK – your turn to choose the
music in the car! That’s what we do here, everyone has a turn”… is applicable to a wide range of
what goes on where people live together.

Choosing breakfast earlier as an example isn’t random. The way in which our kids start their day
might set the tone for how well their day continues. To have spent the night alone, without
distraction from dreams, memories, flashbacks, or nightmares, might mean they feel pretty
fragile in the morning, susceptible to disorder, which might lead to chaos.

Aligned with the importance of routines, as above, a sense of order is helpful. A physical
environment that has been cared for, and is prepared to meet their needs, can be game
changing. The environment into which a child wakes, and then enters from their bedroom, can
be critical to how they manage their day – small frustrations might lead to much bigger feelings,
in their potentially, relatively unregulated state. So do you hammer on the door to wake them up
– startling them with loud noise and shouting – or do you first knock gently, to respect their
privacy, then attend to whatever works for them… a gentle touch on the shoulder or stroke of
the head, drawing the curtains slightly to allow a little light rather than full on glare, tell them
you’ll be back in five, and then it’ll be time to get up? Is there a plan for everyone getting in and
out of the bathroom in a timely fashion, or will it be a bunfight? Is their uniform ready, laid out,
easy to find and put on, or is the room a state, clean clothes tangled up with dirty piles on the

Our children sometimes struggle to keep an orderly environment, and can be very able to
ravage one in a momentary whirlwind! We can think of that as an outward expression of their
inner turmoil – and helping them move towards something more orderly is a great way of helping
them internalise that greater sense of ‘it’s OK, life is manageable, the basics are in hand’. We
might think teens, or even younger, should be able to organise themselves, indeed we might
consider that it’s age appropriate and developmentally proper to encourage them to do so. Yet
our children may never have had that help, and are often stuck in some ways at an earlier age.

For those, the developmental task – a way of helping them to move on through those earlier
stages – is to allow some space for helping them with those things, helping them in ways you’d
help a younger child. So whilst ideally your thirteen/fourteen/fifteen/sixteen year old might sort
their own laundry, and school clothes and bags, it might be ok, and helpful, to help them until
they’ve acquired the skills to do it themselves.

This isn’t just pragmatic organisation, it’s so much more – it is holding the child in mind,
anticipating their needs, in a way adults may not have before, which has such an impact on their
sense of self, and their self worth, and their internal state… it can be transformational in helping
the young person shift from how to survive to how to live. I have certainly seen kids catch up,
moving from behaviour much younger than their chronological age, through the stage you’d
expect for that much younger child, and into behaviour more expected of how old they are now.

Eric Berne, founding fella of Transactional Analysis, described this as being like a stack of
pennies; if you place one coin on top of another, then another on top, and another, and
another… if you carefully line each one up to sit squarely on top of the last, you can build a tall,
stable stack, which will remain in place unless some external force is applied to it. But if one
penny is stacked a bit wonky, not quite where it should be, overhanging a bit, then the next one
placed will be less stable, and the one after that even less so… the subsequent tower won’t be
stable, won’t stand up… everything after the wonky one won’t work well. For our kids this is
what happens at developmental stages; to get to being able to sort out your own uniform, you
need to have had a bunch of other stages go well prior to that. Our task is to find ways to
straighten up the wonky pennies – gently tidy them into line, to generate the stability and security
that will facilitate growth of the stack; stabilise the foundation, and the rest can grow better. The
earlier the penny is out of alignment, i.e. the earlier in a child’s life things started to go wrong,
the more wobbly, less stable everything will be.

Check out anything on providing for developmental stages and gaps, and symbolic
communication, for more on this – Docker-Drysdale is a seminal author on the latter, and John
Whitwell has compiled a stash of helpful material, worth a rummage at
https://www.johnwhitwell.co.uk/ . Children of any age may benefit from opportunities we’d expect
for someone younger, until they’ve had enough and can move on, growing out of that as you’d
expect in a healthy environment. As always – check out with the team any strategies, to be
included in the care plan, and to consider what’s appropriate for each setting and each child. A
couple of examples are…

The worker who refused to leave a child, aged 11, when the child was highly agitated, despite
being invited strongly to do so, with many expletives. The kid physically ran away from the
worker for three months, then tried to physically fight the worker for three more months, then
seemed to ‘give in’ to the idea that maybe the worker could be trusted. Throughout, the child
was not allowed to physically hurt anyone, and there were firm expectations of their behaviour
with subsequent praise or consequences. The child’s interactions became more playful, in an
infantile way. In response, the worker began to offer, and the child to accept, nurturing
experiences more suitable for a younger child but the single most significant intervention was
the use of a ‘special food’ – an adaptation to the child’s individual and primitive need – the worker
began to keep at all times a special drawstring bag of small sweets of the child’s choosing. The
child understood that they could ask for these whenever they wanted and the worker would
provide them. The firm expectations and limits to the child’s behaviour remained. The intent was
to provide an unconditional provision, between child and particular care giver, especially one
that is orally satisfying, that an infant has the right to expect but that this child had not
experienced, whilst continuing to contain and survive the rageful and panicked manifestation of
their trauma. That unconditionality was tested sorely, and proved its worth! On one occasion, the
special food was demanded after the child trashed their bedroom, and was provided, albeit with
gritted teeth. The usual responses and expectations around the trashing remained the same,
but the adaptation had served its purpose – there would be no withholding of what had been
promised, no matter what the provocation or testing. And here’s the thing… after a few months
the child asked to change the special food into a weekly, new inexpensive small toy. A few more
months and they preferred a comic. This was taken to be an indication that the child felt stable
enough to move on… they were growing up, catching up developmentally.

Another kid, out of control at school, experienced the same sort of limits on unacceptable
behaviour, and to an expectation of routine, alongside the availability of very nurturing attention
e.g. cuddles, hair washing and being read to. It was observed after a few months that they
tipped a high backed armchair over and lay on the blanket that had fallen onto the floor, looking
up at and playing with the dangling headrest – as though they were a baby on a playmat with a
mobile. Three months further, the child tipped the same chair over but this time arranged the
blanket so that the arrangement became a den. Again, this was considered to be an indication
of moving through developmental stages.

It’s important to note a bit more about the developmental age / chronological age thing. Our kids
do still need to function wherever possible according to their chronological age, in settings that
require it or with other kids e.g. classrooms, sports teams, playgrounds etc. These adaptations
to younger needs are helpfully kept more private, where the child lives, but can help the child
prepare for and decompress from ‘managing’ elsewhere. Other strategies to help the child
manage an environment ‘chronological-age appropriately’, do not need to address the
developmental needs. For example, green and red cards in the classroom for the child to
communicate without words if they need a few minutes out, or breathing exercises, practised to
prepare in advance or to interrupt a difficult moment. These kinds of techniques help with
communication and self regulation – both consequences of developmental trauma – but are not
targeted at filling the developmental gaps, rather intended to promote and support
chronological-age functioning.

Within the examples above are strategies, implemented actively, but also simple observations,
and – importantly – acceptance. The environment allows space for the child to be and to explore,
noting and recognising the behaviour as a communication, with an acceptance of and respect
for where the child is, from which we can understand more and adapt accordingly. The child
using the chair as playmat then den, didn’t need an active intervention, but did benefit from an
active acceptance, no one laughed or made fun of a child behaving like a baby, no one told
them ‘don’t be so silly, you’re far too old, time to grow up, pick that chair up and go and tidy your
room’… space was afforded for the child to have a good experience of exploring in ways they
hadn’t been able to, or hadn’t had enough of, or hadn’t had a good experience of… and then
perhaps they were helped to tidy their room later, because tasks appropriate to the
chronological age can occur in parallel to allowing this space.

In fact, for me, we can boil our (O.U.R.) therapeutic task down to three stages:

● Observe… the behaviour, and be attuned emotionally. If we’re not looking – not noticing
the indicators of what’s going on for a child, we can’t take them into account and be
informed by them about what the child needs. Be present, pay attention, observe what is
there to be seen. Then…

● Understand… that behaviour has meaning, is a communication, and that what you are
feeling may be laden with information about what the child is feeling. If we’re super
observant but don’t understand – don’t recognise – that what we’re seeing means
something, we won’t make use of what we’ve noticed. This doesn’t necessarily mean
understand exactly what the behaviour means, at this point, simply recognise that it does
have meaning for the child. Recognise that what we’ve observed has meaning, from
which we may be able to make sense of the child’s needs. Then…

● Respond… in a way that meets those needs. This is about making an adequate
response; one that is attentive to the individual child, in that moment. For example, how
do we know that a baby needs feeding? Typically, they’ll cry, and the attentive parent will
figure out – sometimes by a process of elimination – what the particular need is in that
moment. So, we feed the baby. We provide a food that is appropriate to their age and
ability to digest. How do we know when to stop feeding them? We recognise the signs
that they’ve had enough. So we stop. That is an adequate – an appropriate response. If
we recognised the baby needed feeding, but gave the wrong food or didn’t recognise
when to stop, and force fed the infant, that would be an inappropriate response,
inadequate for their needs.

This response may be a well informed interpretation of the behaviour, to understand
what the child needs, or it may be more instinctive, without wholly being able to say
exactly what the need is about.

O.U.R. task is to find a response that meets the needs of our children, as we’ve observed them.
This is an iterative process, that allows for, indeed demands, attention to change and growth…
as the child’s needs change, so does the response.

An example of what we may be able to understand, and what we may not, is in one child’s
relationship with custard. This kid was overweight, and part of their care plan was to eat
healthily. But if custard was on the menu, the child’s behaviour would palpably change when it
appeared. The workers did not immediately know the change was in relation to the custard.
They observed the problematic behaviour, and a change in behaviour, with recognition that the
behaviour would likely mean something, which led to wondering about what was going on, and
thinking about whether this was an opportunity to make an intervention by finding a good
response… a response that would somehow meet the needs the child was communicating,
even though those needs were not fully understood. The pattern noticed was as follows… in a
small group around a table, the custard would be served from a jug by an adult also at the table.
This child’s demeanour would change from being relaxed and affable, to tense and agitated,
increasingly so as their turn for the custard approached, and more so if they had to wait for a
number of others. This behaviour change did not occur with other foods, sweet or savoury. Once
the custard was poured for the child, they would grab the bowl, putting an arm around it
protectively, lower their head and eat as quickly as possible, almost snarling at anyone who
interfered or interrupted. As soon as they finished, the child would ask for more, even if others
were still waiting for a first helping. This was difficult in terms of ordinary social expectations –
waiting your turn, sharing, having polite manners etc, but also in relation to the care plan of
healthy eating. There was no discernible reason for custard to be more meaningful to this child
than any other sweet milky substance, it just was. More problematic still, was that this often
occurred at lunch time, in a dining hall with other tables of children, with school to continue
after… disruption might run into more than just this meal table, and interventions based on only
the social and healthy eating fronts – ‘No, just hang on a minute please’, ‘Eat nicely please’, ‘You
know you cannot have seconds’… would lead to significant behavioural disruption.

The pattern was discussed by the team around the child, and a change in approach by the
workers followed, with a clear and positive impact on the child… when the custard arrived at the
table, this child would be served first, would be provided with a full bowl without comment, and
actively offered seconds as soon as they’d finished once everyone else had also been served.

That second portion would be as much as the child wanted, in fact once lots had been poured
into their bowl, the question ‘Is that enough, or would you like more?’ was asked. There was to
be no comment on the child’s behaviour whilst eating. The difference was immediate… on the
first occasion of the changed approach, the usual, wide-and-bright-eyed agitation and
impatience was observed, the usual behaviour whilst eating, surprise and pleasure at being
offered more for seconds, but replete delight upon finishing that, instead of a ruined afternoon.

The second time, being served first elicited a ‘thank you’, though still agitated. Protecting the
bowl still happened. The child noticed the offer of seconds, with slight suspicion, but also a small
smile and a ‘yes please, thank you’. The third time was more relaxed, and after not many
repetitions, all the problematic behaviour dissipated, to the extent that custard was no longer a
flash point. The intervention became unnecessary, because the behaviour went away. Whatever
the significance had been for the child, the approach had satiated the need underpinning it, the
child was able to move on.

It was never discussed with the child, no attempt was made to have them ‘talk about it’, or come
to terms with the meaning for themselves in some way. A particular, formative trainer from whom
I learned a lot in my early years, used to talk about ‘interpretation can be persecutory’… I
understood that to interpret the child’s behaviour, and share that with them, can feel intrusive
and punitive to them… persecutory. They cannot always know and be in touch with the impacts
of their trauma, and it can be very exposing to bring that – or our best guess at interpreting that –
to their attention. These experiences are very raw for the child.

I’m not suggesting that custard, or provision of it, is inherently significant, to any child or to this
particular one! I am not suggesting there would inevitably have been a trauma for the child
actually involving custard, although it’s possible – we don’t know. Rather, I’m assuming it is
symbolic in some way. We can speculate and hypothesise about scarcity in this child’s history,
about perhaps previously competing for food, but why that did not extend to other foods we do
not know, or about the symbolism of sweet milky substances being representative of early
feeding experiences that perhaps didn’t go well… we don’t know and it doesn’t matter… we may
never know these things, and it doesn’t matter. The child was stuck, in some level of need that
manifested in their behaviour in a particular situation – this was noticed, thought about, and an
adequate, an appropriate symbolic response was found, as an exception to and even though it
was contrary to other needs in the care plan, and that symbolic adaptation to individual need
helped the child to grow emotionally, to move on.

As much as I have light heartedly acknowledged, in order to clarify the symbolism of adapting
around an observed need, that custard is unlikely to be a source of trauma for that child let me
also just mention another child’s relationship with milk, on cereal. The actual, literal reality for
this other child is that they had previously experienced a man ejaculating into milk before
making the child drink it. That fact was known, and the approach to whether, or how, the child
was offered milk was adapted accordingly, not for symbolic benefit but for the simple, literal
reality of the child feeling safe.

Often we just don’t know, we cannot know, we can only pay attention; observe, understand that
there is meaning of some sort for the child, and strive to adapt a response that helps the child
feel ok and move on.

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