The Mulberry Bush provides integrated 38-week and 52-week specialist residential therapeutic care, treatment and education for vulnerable and severely traumatised primary aged children and their families from across England and Wales. The children struggle with all aspects of mainstream life and require a residential placement, which is evidence of how difficult it has been for them to live in a family.
There has been a family team at the Mulberry Bush School for over 20 years in a variety of forms. In 2011, the team merged with the therapy team to become the Therapies & Networks Team in order to draw on a broader range of skills and experience, enabling this new multi-disciplinary team to offer a wider variety of interventions to families and carers. While there are many interventions we use as a team, there are two we want to concentrate on in this paper: Family Weekends and what we have called Promoting Family Attunement.
Family Weekends
One of the first areas we focussed on as a combined team was how to better engage families in the school’s work with their children. It was from this starting point that the idea of a Family Weekend was developed. These weekends give us the opportunity to invite a group of families with broadly similar needs to stay at the school for two nights during one of the regular exeat weekends for the children. Activities are planned which encourage joint learning and a chance to have fun together alongside staff from the school. There are also parent/carer groups throughout the weekend where adults can reflect on their experiences with their children in a facilitated space. Meals are jointly prepared by staff and families who all sit down together to eat. In addition, there are plenty of opportunities for parents/carers and staff to talk informally about their experiences with the children, which encourages mutual respect and understanding. The aim has been to offer this to as many families as possible and to hold Family Weekends up to three times a year. These events allow parents and carers to see how Mulberry Bush staff interact with and look after their children and for staff here to learn from the families, which engenders collaborative relationships between home and school. As a team, we regularly visit other organisations and we have not seen other residential schools offer this kind of experience to families in this way.
In order for these weekends to work, the beginnings of a therapeutic alliance with the family needs to be established. Encouraging families to devote the time and effort needed on their part can be a challenge as the weekends can be demanding for them. Feedback from parents and carers has shown us how anxious they are in anticipation of the weekend and we support them both emotionally and practically to attend the weekend in whatever way possible.
With many pressures on the time commitments it can also be a challenge to staff these events and to help workers see the long-term value of them. Furthermore, the weekends put pressure on the organisation, which needs to find ways to release staff from their usual duties without compromising the day-to-day care of the children. We have found that there is a core group of people who are keen to commit regularly to this work and others who will be a part of it when it involves a child with whom they work regularly.
Between July 2011 and January 2019 there were 13 Family Weekends involving 36 families. On average 3 families attended per weekend.
47 parents and carers completed a feedback form at the end of their weekend. We asked the question; Please rate the Family Weekend – where 1 = poor and 10 = excellent. Out of 47 parent/carer feedback forms, 8 (17%) scored the weekends between 5-7 whilst 39 (83%) gave the weekends a score of 8 and above.
| Score | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| Number of responses | 0 | 0 | 0 | 0 | 1 | 2 | 5 | 16 | 8 | 15 |
In 2016 we added this question ‘are things getting better at home?’ to our annual child questionnaire. Out of the 8 children whose families have attended a family weekend since adding this question, 1 child (12.5%) rated ‘No/not much’, 6 children (75%) rated ‘Nearly always/ yes’ and 1 child (12.5%) refused to answer.
| Score | No/not much | Sometimes | Lots of times | Nearly always/yes | Refused to answer |
| Number of responses | 1 | 0 | 0 | 6 | 1 |
Another way to look at the impact on families of these weekends is to look at some of the ways in which carers talked about the differences between home and school before and after the weekend. Here are two extracts from a piece of research with Mulberry Bush families (Onions 2018) which highlight the tensions that can arise between home and school.
When talking about the differences between home and school one parent said ‘I think it’s too much, I mean she’s got boundaries here and boundaries there, it’s too much for her’. This highlights how it can be difficult for parents to be comfortable with the different expectations and approaches of the two settings and raises areas of work for the team.
Another foster carer struggled with a child talking about what she did at school ‘She said at school I’m allowed to do this, at school I’m allowed to do that, and I said to her, school is one thing, but you are actually at home now and at home we don’t allow that.’
Parents and carers making such comments is one indication to us that they could benefit from a Family Weekend as it could reflect unconscious rivalries between parents and the school. By inviting them to take part allows them to be part of a collaborative process and to come to a shared understanding of the child. This can help reduce tensions through mutual understanding of the different dilemmas facing both the carers and the school.
One of the important benefits of Family Weekends has been the children seeing home and school coming together and having fun. For many of the children at the school, their experience has been one of fracture in their network. Children often prefer to maintain separation between different elements as they often only come together at points of crisis and conflict. The weekend experience can help to show them that there are positives to be had when home and school work together.
Our feedback form also asks parents and carers ‘What went well for you?’. Here are some replies:
‘seeing and experiencing the warm atmosphere between our children and staff’ (foster carer)
‘it was quite an effort to make it here but having protected time to talk together was good’ (adoptive parent)
‘unsure about the whole thing and very nervous at the beginning – but one of the best things we’ve ever done’ (birth parent)
We also ask residential staff whether their relationships have changed with the children or their parents and carers.
‘X has mentioned it a couple of times since. He has mentioned about me now having a bigger connection with his family and life outside of school. Things like “you know my family now”, “you have seen my sisters now” and he seems to quite like that. I have used sentences like “what would your mum and dad think about …” when alongside him since the weekend and that has helped link home and school for him and me.’
‘After the weekend I was more able to communicate with Y (mother) and I got a better idea of what things were like between her and her husband. ‘
A further benefit experienced by carers and parents who attended the weekends was connecting with others who have similar family situations, for example, foster carers or adopters who have a child in residential care. The benefits of peer support have also been recognised by research and professional literature (Luke & Sebba 2013 and Selwyn, Meakings & Wijedasa 2015). In response to the question, What went well for you? many responses echoed the one below.
‘being in a group of foster carers together and sharing information and experiences’ (foster carer)
In response to this feedback, we have implemented foster carers’ and adoptive parents’ groups at the school, which each meets three times a year.
Promoting Family Attunement
This work evolved from the team’s awareness that, for some families, while the child might be doing very well at the school, improvements at home were much less consistently achieved. These families were often very engaged with the work of the school and would work closely with their assigned Family & Networks Practitioner (FNP). However, the insight gained by the parents and the changes in the child did not appear to translate into improved family life.
A questionnaire sent out to families revealed that many would welcome interventions during the child’s time at home and we wondered whether it would be possible to do therapeutic family work in a safe way in the family home, addressing the difficulties where and when they arise.
Most of our families had engaged with local services such as CAMHS without successful outcomes and we therefore wanted to try to develop a therapeutic framework that we could use in a non-clinical setting, eg in their home, to help improve family relationships. All the families had unique issues but there were common themes around which we felt we could build a package of therapeutic work for each individual family. Understanding each other and mentalizing (Fonagy et al 2002) each other’s internal states was one common area of difficulty, along with just simply being able to enjoy each other’s company and have fun together. Safety in the home and improved attunement and sensitivity were also shared needs. We were clear that we did not want to teach families how to parent ‘our way’, nor to offer traditional parenting work, which many of our families had already engaged with in the past. This work was to help the whole family understand each other (mentalization skills), think about how they function together and be supported to find better solutions and ways of communicating.
The intention of the work, based on systemic and psychodynamic thinking, was to help families make decisions and choices that work for them, by stepping out of tried and tested unhelpful ways of interacting with each other. This meant that the planned therapeutic activities would sometimes need to take them into areas that had traditionally been difficult and problematic for them – not so much that they would not want to continue the work but enough so that the difficulties could emerge for us to work with.
In order for this work to be safe we felt that it needed to be staffed by a combination of therapists, FNPs and residential staff. The residential staff needed to be able to intervene physically with the child if necessary (although we have not yet needed them to do so in this work) and who were experienced, had a good relationship with the child and could work effectively with their parents and carers. They also needed to be able to adapt their usual way of working to a different therapeutic model.
In addition, we needed someone with a trusting relationship with the parents. This made the role of the FNP very important. We were aware of how intrusive and exposing this work might be, particularly with families who may have had difficult experiences with professionals previously, and the FNP was crucial in laying the groundwork and ensuring that the family was fully aware of the potential difficulties of being involved. We did not want parents feeling they had been tricked into doing this.
The team involved needed to be confident enough to be flexible and fluid – that is, to hold on to the principles and aims of the work, even when the planned route to these aims (e.g. activities and conversations) were not working or took an unexpected direction. For this to be possible, the staff would need to be skilled at remaining thoughtful under anxious and stressful circumstances and be able to continue to communicate with each other. The team undertaking the work needed to be able to learn and retain new therapeutic understanding and skills and to use this learning responsively. It would further require a level of creativity and an ability to think quickly and on the go without becoming reactive.
In planning the work, we used ideas from psychodynamic, systemic and mentalization based theory models and adapted many activities used in Multi-Family Therapy (Asen and Scholz 2010). There were broad aims for the work which were shared with everyone. However, as the work progressed, after each weekend, the aims became more specific to that family, taking into account the particular ways of relating that the team had come to see and understand.
We have trialled this work on three families so far and have found that a level of intensity is needed for it to have an impact. It is important for families to continue to think about it in between sessions and for these reasons, we have found that two-day periods, at least, to begin with, have worked well, with weekends being the logical time for this to take place. However, every family is different and this needs to be thought about individually. There may be good reasons for this to take place one day at a time as whole weekends may be too intense for some families to bear. It is crucial that there is sufficient time for the team to debrief after each day as the intensity of the work means that there will be tricky moments for the team, both individually and as a group, and these moments need thought and airing time.
Experience has shown us that it is best to plan for the first day of the work only, to begin with and to allow planning time at the end of that day for the next. This work is demanding and can be anxiety provoking, and we have found that having more activities and plans than we are likely to need to use is helpful. This sort of over-planning removes a layer of stress from the process and enables workers to feel that have ideas at the tip of their fingers at moments of stress and tension when thinking on your feet becomes more difficult.
Planning each day following the previous also keeps a focus on what the family needs and what has been shown to be helpful, rather than on what the therapists want to do.
For each weekend we planned a range of activities that would allow opportunities for the family’s needs to come to the surface and the aims of the work to be explored. Some examples include:
- family-therapy type sessions, focused on opening up dialogue in a child and family friendly way
- play and activity based sessions, focused on what the family has enjoyed doing together (these should be planned but can arise spontaneously) and aimed at having fun and laughter together; mealtimes;
- unstructured times, in which day-to-day family strains and strengths could emerge
- parent/couple sessions
- ‘down’ time.
Our planning attempted to bring out the difficulties in the family enough to work with but not so much that the family felt excessive anxiety or out-of-control. At all times, we tried to maintain a stance of curiosity about what was happening between family members and were prepared to stop what was going on and ask questions to encourage mentalizing.
We learned that it is crucial to remember that the planned sessions are a means to an end and the focus should always be on the broad and more specific aims. Furthermore, the team working should always be looking for ways to help the families solve their own problems and make things work for themselves, rather than on managing problems or telling families what to do.
We also did work with the members of the family between the more intensive periods of work. But not generally as a whole family. This work included a range of therapeutic interventions such as:
- therapeutic letters
- homework for parents/carers and, where appropriate, the child
- reflective parent sessions
- work with the child based on the intensive work.
These tools helped to keep the work alive between sessions and to keep families owning it and taking responsibility for it, rather than leaving it to staff to own it on their behalf. How families did or did not make sense of these ‘in-between’ pieces of work and tackled the homework was useful information about family functioning.
With the development of new buildings at the Mulberry Bush, we are now in the very fortunate position of being able to host families here, rather than at their home. While there are many positive reasons to take this work to the families’ homes, it can also be a restricting factor. We have a large lounge and kitchen what can accommodate groups that are larger than the average family, with bedrooms easily accessible and a sizeable garden. Food is a very important element of this work and being able to prepare nourishing meals – preferably with everyone taking a role – it becomes less of a worry and another opportunity to work with the family. There are also practical implications as most members of staff can go home at night, rather than having to stay in a nearby hotel. However, it is helpful to have the option of hosting families here or going to their homes, as each family will have different needs.
References:
Asen E., & Scholz M. (2010) Multi-Family Therapy: Concepts and Techniques, Hove: Routledge
Fonagy P., Gergel, G., Jurist E.L. & Target, M. (2002) Affect Regulation, Mentalization and the Development of the Self, New York: Other Press
Luke N. & Sebba J. (2013) Supporting Each Other: An international literature review on peer contact between foster carers, Oxford: Rees Centre, University of Oxford
Onions C. (2018) Retaining foster carers during challenging times: the benefits of embedding reflective practice into the foster care role Adoption and Fostering (42)3, 249-265
Selwyn J., Meakings S. & Wijedasa D (2015) Beyond the Adoption Order: Challenges, interventions and adoption disruption, London: BAAF