The application of psychodynamic thinking in a residential setting for children
By Charlotte Witheridge
Date Posted: December 18 2013
Charlotte started out as an Independent Visitor for Hammersmith and Fulham Council, then worked as a volunteer counsellor at ChildLine before taking up the post as a Therapeutic Care Worker at the Mulberry Bush School in June 2011. Charlotte is currently in the first year of a Foundation Degree in Therapeutic Work with Children and Young People, a course run by the Mulberry Bush Organisation and validated by the University of the West of England (UWE).
The application of psychodynamic thinking in a residential setting for children
by Charlotte Witheridge
The Mulberry Bush is a non-maintained, residential school which provides specialist therapeutic care and education for primary-aged children who have often experienced significant trauma in their early years. In this paper, I explore how key psychodynamic concepts might be applied to the day-to-day task of working with these children.
The application of psychodynamic thinking is a complicated and nebulous subject so I am keen to put this article in context. I work as a Therapeutic Care Worker at the Mulberry Bush School which offers provision rooted in psychodynamic theory, for “primary-aged children made vulnerable by their severe emotional and behavioural issues.” Through experiential learning, it is the school’s aim that the children, in its care, “discover helpful ways of living with themselves and others” (Mulberry Bush, 2013).
The idea is that “systemic thinking” will help “to interpret connections between people, events and feelings”. It is important for me to point out that, although I am not a trained therapist, there is an “emphasis on the potential for therapeutic communication” between all staff members and children, simply in “living alongside” one another (adapted from Ward et al, 2003).
For a number of reasons, frequently significant loss, a less than “good enough” parent and/or growing up in a transgressive environment, the Mulberry Bush child may well “remain in some version (or with some core elements) of the ‘unintegrated’ emotional state of a newborn” (Ward, A. 1998, p.17).
In consultation with Dr Donald Winnicott, Barbara Dockar-Drysdale, the school’s Founder, developed a method of therapeutic treatment, for these “unintegrated” children that she called “the provision of primary experience” (Mulberry Bush, 2013). “Winnicott stated that for a child to be able to have a sense of security, he first needed to experience emotional containment within his key relationships.” (Bombèr, 2007. p. 296). “Containment”, in psychoanalytical terms, refers to the symbiotic relationship between parent and infant, whereby the infant attunes himself to his parent, who will, in turn, respond to meet his most basic needs.
An integrated child will have some ability to moderate, translate, ameliorate, absorb and decipher one part of himself from another. Where the attachment or bond to a parental figure has been severed, or there has been disruption to the continuity of his experience, an “unintegrated” child will have adapted powerful defences against the pain of absence. A child traumatised in the pre-verbal stage of his development, is not separate from his being. His internal, emotional life is not accessible and this has a profound effect on his relationships, not just with individuals but with groups, systems, institutions etc.
In its role as a therapeutic community, the Mulberry Bush provides a test-ground for reintegration. In practice, boundaries, predictable routines and states of being are put in place to provide emotional containment for the child. In teams, care workers are permissive, rather than punitive, of chaotic, sexualised and challenging behaviour – impulsive, violent reactions to other children, self-harm, a desire to destroy their living environment, racist and antisocial language and attempts to abscond. The care worker provides intersubjective experiences and opportunities for the children to develop, play and learn, in different ways, tailored to individual needs, in the hope that this will give rise to yet more opportunity for therapeutic intervention.
Therefore, it is very important to think of this child’s behaviour as a communication and, in turn, to understand how and why our own communication, in response, may be “powerfully affected” (Bombèr, 2007) by a number of psychological processes, both conscious and unconscious.
Transference & Counter-Transference
Transference is “an unconscious process in which a child’s past experiences or interactions seem to influence how he regards and behaves towards the “here and now”, especially in relationships. It can sometimes seem as if the child is locked in the past, rather than being tuned in to his current circumstances” (Bombèr, 2007. p.301). “The notion of transference was first discussed by Freud, when he discovered that patients in psychoanalysis would begin to treat him as if he were a significant figure in their childhood” (Grant & Crawley, 2002. p.8).
The child’s template for forming relationships can be rigid as well as dysfunctional. Their memories and the roles therein have been integrated and the child may attempt to control the adult’s behaviour so that they conform to expectation. Containment plays an important part in making it safe for the child to have negative, sometimes even murderous, feelings about his care workers. Equally, the child must feel safe enough to attune himself to the carer, as if she were a parental figure. Where the child may have missed developmental experiences, the care worker might provide an important remedial experience for the child. If it is possible for a child at the Mulberry Bush to “incorporate” positive and functional relationships then he has a better chance of being able to “restructure (his) internal subjective world” (Grant & Crawley, 2002. p.9).
But, just as a child may transfer a blueprint of relationships past, so may the care worker alongside him, only to be complicated further by the distortion of any transference from the child. This is counter-transference, a term used to “describe a process in which we…might feel as if we are compelled to respond to a child in a way that is unusual or out of character – as if we were behaving like someone else.” (Bombèr, 2007, p.295).
Transference is a useful “tool for investigating the forgotten or repressed past” (Brown & Pedder, 1979) but it may have considerable bearing on the way in which a care worker builds her rapport with a child; she must, therefore, be mindful of her own professional boundaries. Containment by the community at large, ethics and rules should ensure that the relationship remains within the therapeutic context.
In my limited experience of key working at the Mulberry Bush, I bought, to supervision, the strong feelings this relationship seemed to evoke for me, as well as concerns about how I might be affected by the “loss” of this child as and when he made the inevitable move to another house in the community. The child had been removed from the care of his mother not long before his arrival at the school so I suspect the loss was still raw and pervasive. Similarly, I have no children of my own but an increasingly strong maternal drive. Decoding the transference and counter-transference here was an interesting and necessary exercise; it gave me an opportunity to address issues of dependency, for both of us, and, perhaps more importantly, to think about how I defend myself against this in future relationships where the role dictates that I have a preoccupation with one child in particular.
An understanding of transference, in practice, is important for a number of reasons not least because in “psychodynamic models of therapy, experiencing, understanding and interpreting the transference is considered a core element in engendering client change” (Grant & Crawley, 2002. pp. 2-3) and it is the responsibility of the care worker to think about who is fulfilling what need, to facilitate shifts in the relationship and to achieve the kind of fluidity needed to effect that change.
Projection and the Paranoid Schizoid Position
“Projection is the term given to the unconscious pushing out of a part of the personality onto other people or things. By pushing out the difficult feeling, the problematic content is controlled and the individual feels a – temporary – sense of release.” For the care worker “it might feel as if it is difficult to know where the feelings are coming from, and the intensity of them might lead one to question one’s own competence and professional worth. The task is to look, in detail, at behaviour as a form of communication and an expression of feelings.” (Greenhalgh, 1994. p. 53).
An unconscious process, projection is “considered a defence mechanism; it helps to protect the individual from a perceived threat and to reduce the intolerable anxiety and conflict” (Grant & Crawley, 2002. p.18).
On a day-to-day basis, this seems to be something I might experience “in the moment”. I have observed children talking to one another, or to their toys, in language or tone discordant with the situation, person or object. For example, a child shouting at her Barbie doll – “What are you doing, you stupid girl?!”
For a number of months, one child at the school would tell me regularly how much he “hated” me and would often refer to me as “an ungrateful little brat”. His words, attitude and body language implied and, on some occasions, made me feel that I was small, powerless and culpable. With reference to this child’s particular history, it would likely mirror something he feels about himself. I wonder if this helps to alleviate some of the humiliation he might have felt, in different circumstances, with different adults? Was this a useful way for him to negate, what we, as care workers, might see as, a rather distorted view of himself?
Alternatively, I wonder if there was an element of the paranoid-schizoid position, a concept developed by Melanie Klein, “to refer to a state in which the individual wishes to remain in control of experience. In this state the individual lacks the capacity to tolerate negative feelings – these are split off and experienced as belonging to someone else. The individual is then able to experience himself as being totally good.” (Greenhalgh, 1994. p. 309).
In recent months, I am conscious that there seems to have been a significant shift in my relationship with this child. He will seek me out in much more positive circumstances, when he needs respite from a chaotic group or a playtime, one-to-one. I have yet to make sense of this, but I wonder if, in managing his projections, over time, and maintaining some semblance of the relationship, certainly from my end, I have played a part, for him, in making tolerable something he had internalised as intolerable?
Described by Philip Stokoe as “the main language of the therapeutic community” (Stokoe, 2003), projective identification is a “process whereby individuals and groups expel parts of themselves (into another person or object) and unconsciously identify with the projected material seen in others. The person or object is then experienced as if it were the projected content.” (Greenhalgh, 1994. p. 310).
First discussed by Melanie Klein, these “primitive processes are usually driven by the need to defend against aggression.” (Hinshelwood et al, 2006. p.126).
Understanding and deciphering these feelings from one’s own is an ongoing challenge and the accumulated stress of traumatic experience for children at the Mulberry Bush, means that some of these roles carry a potent charge.
I worked, for a number of weeks, alongside a child with a history of severe domestic abuse. Our relationship was complex. Often without any apparent trigger, he would appear to target me, to throw objects directly at my face or to the back of my head, seek to get me alone and to use the opportunity to intimidate or to hurt me.
Conversely, when calm, he would want to sit very close to me, to play with my hands and to talk to me in a squeaky, vulnerable, baby-like voice. The duplicitous nature of his behaviour became extremely unnerving for me; in response, I seemed to be playing out two roles simultaneously – neither of which I could recognise as being “me” – one, fragile and sad, the other tense and ill at ease.
Klein believed projective identification to be an “unconscious fantasy aimed at getting some distance from unpleasant sensations and, therefore controlling them”, which might make sense given this particular child’s familial history.
For a while, after he had moved on from my care, I would avoid working alongside him and found it difficult to look him in the eye. This, in itself, was very uncomfortable. Wilfred Bion “pointed out that projective identification actually does have an impact on the other” (Stokoe, P. p.85) so, in retrospect, perhaps I can now reconcile my uncharacteristic feelings.
In her book, Understanding Your Baby, Sophie Boswell writes that “a baby can become terrified and distraught when things are feeling wrong inside her, physically or emotionally, and we are bound to be caught up in the force of her feelings”. (Boswell, 2004. p. 21). Since there is some discrepancy between the chronological and emotional age of most children referred to the Mulberry Bush, this is a useful way in which to make sense of the turmoil they might be experiencing “inside”.
Ultimately, practice is our greatest concern. Developing, using and sustaining relationships with individual children could, arguably, become unworkable without some understanding of key psychodynamic concepts to process the “force” of these “feelings”.
Recognising and deciphering one psychodynamic concept from another is a difficult task and it means persevering with something that is always “potential” – there is no clear resolution. However, the catharsis of making sense of what a communication might hold can leave the care worker feeling unburdened, clearer and more creative. Attention to her feelings, thinking and reflecting on communications and demystifying ways in which relationships impact one another should help the care worker to become more containing; she can consciously put in a “gap” between her and the child, rather than re-enacting a role, for example.
Although, it has not been the focus of this paper, it is important for me to point out that individual relationships have strong implications for group dynamics. This is why reflective practice and interpretive discussion is crucial. Adults working alongside the children, in any capacity, need to bring together and process conscious experience and thought, to think about which interactions took them by surprise and to start to pinpoint unconscious feelings.
Equally, at “an intuitive level, a child care worker may become deeply involved in a relationship with a child and this may well be helpful…The risk, however, is that what is intended to be empathy or a version of preoccupation may unconsciously become unhelpful ‘collusive merger’, in which the inner worlds of child and worker become confused with one another”. At this point “a situation can be guarded against by the presence of a third person to act as catalyst, giving insight and support to the therapeutic relationship” (McMahon & Ward, 1998. p.32).
As a group, care workers need to look for the disparities and shifts in their working relationships with children and, in turn, to balance empathy with an appropriate, emotional distance.
At the Mulberry Bush, linking a child’s behaviour to an adults’ feelings and vice-versa can only lead to informed decisions on how we develop individual Treatment Plans and manage all relationships within the community, to encourage best practice and to achieve better outcomes for the children.
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Boswell, S. (2004) Understanding Your Baby. London & Philadelphia: Jessica Kingsley Publishers.
Brown, D. & Pedder, J. (1979) Introduction to Psychotherapy. London & New York: Routledge.
Dockar-Drysdale, B. (1991). The Provision of Primary Experience, Winnicottian Work with Children and Adolescents. Northvale, New Jersey & London: Jason Aronson Inc.
Grant, J. & Crawley, J. (2002). Transference and Projection. Maidenhead, Berkshire: Open University Press.
Greenhalgh, P. (1994). Emotional Growth and Learning. New York: Routledge.
Hinshelwood, R., Robinson, S. and Zarante, O. (2006) Introducing Melanie Klein. Cambridge: Icon Books.
Stokoe, P. (1998) ‘Group Thinking’ in Therapeutic Communities for Children and Young People. London: Jessica Kingsley Publishers.
The Mulberry Bush School (2013). Learning to live, living to learn. Available from: http://www.mulberrybush.org.uk/. [Accessed 13 October 2013]
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