I have just finished watching this interview and found it really helpful.

https://www.thetraumatherapistproject.com/podcast/bruce-perry-md-phd-staying-emotionally-close-in-the-time-of-covid-19/

Some of it is Covid-19 specific, but actually it works out as a helpful summary/reminder of good patterns of regulating and relating before trying to reason and some great visuals on how the different parts of our brain work in times of stress. It’s about half and hour in total.

Why Love Matters is not a quick or easy read, but it is fascinating. It is quite long and academic* and I had to renew it from the library several times in order to get it finished – but I’m glad I did! why love matters really challenges the separation we tend to make between the physical and the emotional and argues convincingly for the connection between physical affection and loving interaction, and the healthy development of babies’ brains. Our emotions are not to be treated as separate from and/or less significant than our physical well being, and certainly not ignored. Instead, we need to lovingly and carefully investigate emotions with our little ones and to give them permission to be emotional beings. We need to make it so very clear to our vulnerable children that negative emotions are not dangerous enemies that we would rather be protected from / not have to deal with. Such stifling of emotions merely intensifies and reinforces the hyper vigilance they are already having to deal with. Instead we need to enter into that emotional world with them and equip our children to identify them and regulate them and learn to see what those emotions are telling us. Our emotions don’t always give us the whole picture – they aren’t necessarily reliable witnesses or the right things to take our instructions from – BUT they are always vital clues to help us see and understand the whole picture. When it comes to emotions / feelings the following statements are gold dust to our children’s ears:

• I want to hear you
• I want you to tell me
• I want to understand
  

Please note – I read this book some time ago now and do not have a copy – I made some notes which I have shared above, but they may not give a very good overall picture of the book.  

* By academic I don’t mean that it is all in professional speak – she is very good at putting things in layman’s terms – but the nature of the content she is covering is quite dense and scientific.

The Boy Who Was Raised As A Dog And Other Stories From A Child Psychiatrist’s Notebook – Bruce D. Perry, MD, PhD and Maia Szalavitz

This excellent book was recommended by Sarah Lloyd at a training day she ran on Building Underdeveloped Sensorimotor Systems (see below). Structured around real life cases it packs lots of science and theory into something very readable – I honestly couldn’t put it down. Not only is there the story telling around the individual children and their families, but also the narrative thread of how Dr Perry developed his Neurosequential Approach to therapy for traumatised children – sometimes flying in the face of the medical status quo. This approach focuses on how the timing (i.e. the point in the child’s development) of the trauma has specific affects on the impacts later on, and therefore on the best approach to therapy for that child. Explanations of the impact of trauma on how the brain develops and works are clear and specifically applied as Dr Perry compares various cases. Alongside the very clearly explained research the author’s genuine compassion and concern for each individual and for their parents and carers shines through.

Connecting with Kids through Stories – Using Narratives to Facilitate Attachment in Adopted Children – Denise B. Lacher, Todd Nichols and Joanne C. May

This clear and helpful book outlines how parents and therapists can use story to change the inner working model of children who have experienced trauma.

“The child’s experiences of attachment relationships, life events, course of development, and core beliefs are collectively referred to in this book as the inner working model.”

The book covers three different types of narratives: Claiming; Trauma and Developmental and Successful Child which work together to help our children shift the meaning they have attached to their experiences.

“Children deprived of a nurturing, attuned relationship early in life with a caregiver tend not only to construct a chaotic life narrative but also form mistaken, destructive conclusions about personal value and the meaning of experiences. Fortunately, children also possess the ability to embrace an alternative or the deserved ideal, and construct new narratives. The key to constructing adaptive life narratives is discovering the child’s inner working model.”

“Once a hypothesis is formed, narratives are constructed that target the negative and erroneus conclusions formed in early childhood. New beliefs develop that can change the child’s inner working model.”

The book is user friendly and clearly laid out – each chapter has a helpful summary (from which both the above quotes were taken) and lots of examples and case studies – one of which flows through the course of the book and therefore goes into more detail. It is more practical and less theoretical than some of the other books I have reviewed as it is outlining a therapeutic method and it does so in such a way that gave me the confidence to have a go.

The Primal Wound – Understanding the adopted child – Nancy Newton Verrier

Nancy Newton Verrier writes as both a psychotherapist and a mother – first to an adopted daughter and then to a birth daughter. It is a very important book to read to start to gain an understanding of the deep trauma experienced by an infant in being separated from the woman in whose womb he or she developed. When we think of trauma experienced by adopted children it is all too easy to concentrate on experiences since birth. In doing so we, all be it unwittingly, deny/minimise the impact of the experiences in the womb – in particular the emotional ones. From the very earliest days of development babies are forming relationships – primarily with their mother, but also with all those who frequent and influence their mother’s life. Without acknowledging the trauma of loss – universally experienced by each and every adopted child- even (or perhaps especially) a baby removed from its mother at birth – it is impossible to empathise with the pain our children are going through and therefore to draw alongside them in it. Primal Wound really helps to keep the reality of the adoption triad as an active element of our adoptive parenting. Our adopted children have birth mothers and in order to love them and care for them we must seek to understand this dynamic in their lives and allow it to be a dynamic in our lives and in our relationship with them. Not an easy task by any stretch of the imagination – as Nancy Verrier explores. She recognises the complications of comforting a child we want nothing other than wonderful things for, but who is crying not only in response to/as a result of a past physical or emotional experience they have suffered, but also for the loss of the mother who was perhaps influential in them experiencing it. All in all a vital read – underpinned “with information about pre- and perinatal psychology, attachment, bonding, and the effects of loss”.

Sarah began developing the BUSS model having noticed certain similarities between traumatised children who were being referred to her and for whom ‘normal’ therapies just weren’t working. Looking for the common factors in these children she noticed a lack of bodily integration – that they hadn’t got a concept of their own bodies in space.

You and I probably take it for granted that we can stop for a moment and become aware of how fast our heart is beating or how comfortable we feel with the temperature in the room. The children Sarah was working with had no sense of that – to such an extent that it showed in the pictures they drew of themselves.

But the issue here wasn’t that these children had broken systems which needed to be managed, but rather that they were underdeveloped systems that needed to be set in motion – like an intricate arrangement of dominoes all set up in an amazing pattern remaining upright because the first domino had never been knocked over. In this case by the right early care.

The therapy needed, therefore, is therapy to set those dominoes falling – and the great news is that because the system isn’t broken this can be done very effectively and with relatively swift results.

It was amazing to look into the way that good enough parenting develops a child’s awareness of their body and movement – from the vital movement that happens in the womb (movement which is reduced by drugs, alcohol and high stress) to the rhythms within time just spent gazing at Mum – reaching out to Mum’s face, legs kicking and maybe then going still as they get a bit overwhelmed by a loud noise or a raspberry being blown on their tummy, and then relaxing into movement again as their attuned parent calms them with a soothing voice. I had never thought before about any sort of link between good relationship, developing movement and a sense of ones own body. Without a present, interested, safe care giver babies will remain largely still – their only option out of the fight, flight or freeze trio. Even for a child removed at birth into a caring foster home there may have been restricted movement in utero; followed by time in special care; followed by a life full of meetings and contact arrangements etc – all of which are not conducive to normal bonding, attunement and developing at the baby’s pace.

In normal development, during the first year of a child’s life the process of growing into yourself on a bodily level is pretty all consuming – with language etc. taking a back seat at this stage. Getting this regulation base well developed is foundational to everything else that follows.

This means that looking at a child’s movement and how they hold themselves give some really good clues as to what was lacking when those early building blocks should have been getting put into place. How our children stand, sit, hold cutlery, come down stairs, eat can have important stories to tell. Stories that need to be listened to before jumping into addressing the wrong problem with the wrong type of therapy. For example, by taking a look at these bodily clues a child referred for anger management was able to build up his regulation rather than be bombarded with therapies to do with reason and relating.

For anyone who has suffered sustained trauma being present in the moment (particularly moments that trigger memories of the trauma) is really hard. All their senses are trained to one thing – threat. They are stuck in a very basic loop and everything else is shut down / blocked out. At the point of trauma it is of course really useful to be able to shut down all but the most necessary systems – however after this, for normal life to go on, for good development and relationship building etc it is just as important to be able to re-access these systems. To experience, be fully ‘in’ the whole of the moment they are actually in now with all their senses, and their whole bodies. As Sarah says: “The limbic system is key! If children are functioning in a flight or fight mode they are not going to be absorbing new experiences in a way that allows them to store them so they can have access to them when they are under stress.” See The Brain – Limbic Systems below.

The Vestibular System: This system is like the stable base of a crane. it is not our though – but our head neck, shoulder girdle, and trunk. Well developed it gives us Gravitational Security (feeling sure of where we are compared to the ground) and Core Stability. The more movement experiences the body has from head to foot the better.

The Proprioceptive System: This system is the arm of the crane. It is to do with sensations and feedback from within the body – messages travelling from the muscles to the brain and back to ascertain how much pressure, force etc. to use. Working well there is good integration between the left and right sides, upper body and lower body…

If those technical terms are a bit much for you the good news is that it works its way out in practice in very simple ways. For example in the wonders of tummy time and crawling which between themselves just tick so many boxes. Tummy time (as opposed to cross legged circle time) doesn’t rely on, but helps build core strength. Gives you lots of feedback as to where you are in space. Crawling: as they uncurl their fists and get all sorts of feedback from the ground, as they get left and right side integrated in motion… While the children coming to see Sarah had learnt to walk and sit and come down stairs it was really important to go back to those missing building blocks of early tummy time and crawling without which their vestibular and proprioceptive systems have not had a chance to properly develop.

Tactile systems: This system is all about messages from outside the body. (Recommendation: David Linden TED talk) At birth our tactile systems are all about survival. There are loads of receptors at work with the sole job of of protecting and helping baby survive. If the baby then receives plenty of experiences where they face a need and it is met and explained and worked through with a caring adult the survival receptors recede allowing a discriminating, exploratory function to develop. Without that sense of safety and that repeated pattern of need / fear and then reward those receptors will only ever stay in protective mode – making it very hard to face all the new tastes and sensations the world throws at us all the time.

There is a need to re-calibrate the limbic system by “working on the protective arm of the tactile system – building associations between ‘mouthly activities’ and pleasure…”

Tactile therapy is the best place to start as it is a great way to get children out of the basic survival loop and into the details of the moment right now. It can be lots of fun and easily adapted to be do-able. It can be used in initial sessions to establish a base line of where things are and then to see progress.

Ideas for activities to develop these various systems
Vestibular and Proprioceptive: Commando crawling, stepping stones, tight rope along the floor; use of exercise balls as watching telly.
Tactile: taste tests – do these two crisps taste the same or different? If that is too hard – which of these is a banana and which is a carrot? If not ready to discriminate may need to grow oral strength – blowing various size balls with a straw. Bubbles in a glass. Sucking up yogurt through a straw. Use of feely bags, writing on backs with your finger, or massaging hands with a roller ball…

Helpful Hint: Activities that stimulate the proprioceptive system are CALMING: carrying something heavy, pushing something big, press ups, wall squats, lying on their tummies, sucking something thick through a straw….

We had a great day yesterday (July 2019!) at the above workshop – the only negative was that there simply wasn’t time to fit everything in. Helpfully we were sent lots of reading to do beforehand, so even though we didn’t address, for example, Resilience as much as Alison and Jennifer would have like to, we do have the information to work through. In terms of attendees – there was a good mix of professionals, prospective adopters (both approved and still in the assessment stage) and ‘active’ adopters bringing specific issues with them.

The Attachment Workshop built on some of the basic foundations given in the earlier / Assessment Stage training days and served to bring together several strands in a way that was helpfully consolidating for me as a prospective adopter. Words and themes such as attunement, modulation, the importance of names and special objects, PACE Therapeutic Parenting, inner working models etc. were all helpfully revisited and further developed into an ever clearer more integrated picture.

In addition to revisiting and building on some familiar ideas – a couple of newer concepts also came up for me: Affect and NVR and Coherant Life Narrative…..

Affect: What we experience emotionally has an effect on us which we as the caregivers need to be aware of and manage. It will affect our physical feelings, our psychological feelings and our facial expressions. When we are less successful at managing affect it is also a chance to admit this to our children and model regulation – to name the emotions we were feeling and if necessary to apologise for the way it then effected them.

NVR: Non-Violent Resistance. This is not simply refraining from physical discipline, but rather it invites us to completely re-position ourselves in relation to our response to unwelcome behaviour. Quoting from the following link: “Within a family setting Non Violent Resistance focuses on developing strong relationships between the parent(s) and child.  It does not try to change the child through consequences or rewards, but uses ‘parental presence’ as an alternative.” https://sarahpfisher.com/what-is-non-violent-resistance. See also my Book Review on Connective Parenting by Sarah Fisher – post date 25th September 2019.

Coherent Life Narrative: This tied into my reading in Connecting with Kids through Stories – see Book Review post date 20th September 2019. But whereas the emphasis there was on the therapeutic use of stories in shifting inner working models, here it was more about being totally committed to helping your child develop as coherent a picture of their whole lives as possible. Having a coherent life narrative is a massive factor in resilience – the ability to bounce forward from adversity. And so we need to work hard to enable our children to have a narrative that answers questions truthfully and in a way they can understand. Questions about who they are and what happened to them and for that story to be open and accessible and valued. Not open for all and sundry to flick through like a coffee table book, but not hidden away on a top shelf somewhere in hope they will forget it either. Keeping and sharing the stories behind our children’s names are an important chapter in this story.

Different Types of Attachment: We looked at (and the reading we were sent covered) the various types of attachment which will soon start to become familiar terms to you – even if differentiating between the finer distinctions remains a bit of a mystery! Basically 95% of children experience healthy attachment – whether securely (60%) or insecurely – ambivalent or avoidant (35%). The remaining 5% are classed as having RAD – Reactive Attachment Disorder. For those suffering from RAD feeling in control is paramount as the only person they can trust is themselves. This means that it feels safer to reject and sabotage safe / loving / positive parenting (such as being praised) than to receive it and feel out of control.

Building Blocks: Good attachment is built with a series of building blocks. If these have been disrupted early on the whole structure will struggle. The neural pathways and connections associated with secure attachment may not have developed and in their place negative pathways will have sprung up and life becomes a minefield of false threat triggers. Within the safety of a secure attachment babies soon start to move beyond their basic protective reaction to the unknown and startling. A secure attachment gives us the space to learn to receive and sift through the multitude of noises, smells, textures, sights etc. that constantly bombard us and ‘dismiss’ them as non-threatening without even registering that we are doing it. Where attachment has been disrupted that sifting process has not had the chance to develop and the instinct to protect remains dominant leaving little room for exploration and stifling the brain’s ability to file things under S for SAFE.

The good news is that new pathways can be forged – but….. it takes a lot of repetition and time!

Imagine an overgrown field with a well worn path through it. Well worn because you have travelled it every day of your life – again and again.

Now imagine that it turns out to be the wrong path! You can’t just reverse the situation overnight. New ‘paths’ need to be travelled again and again to open them up and the old ones left neglected and disused. Easier said than done – it’s hard going making new paths and it feels very ‘unnatural’. Those old pathways have a massive ‘home advantage’ and helping our child to re-train their auto pilot is a long term undertaking.

But just knowing about this dynamic can transform our parenting right now. It teaches us to look under whatever behaviour has grabbed our attention (the tip of the iceberg) and identify if our child is experiencing a fight or flight or freeze reaction and if so what triggered* it. We are then going to parent them appropriately – looking after our frightened child rather than disciplining our naughty child. We can name the feelings they are experiencing and help them to self-regulate – all the while treading those new pathways together.

*Where attachment has been disrupted there will be lots of false triggers that turn a seemingly non-threatening thing into something terrifying.

Some parenting styles to avoid: The Kangaroo – over protective / The Jellyfish – tired, touchy and hypersensitive / The Ostrich – head in the sand / The Rhino – charges in and others to aim for…. The St Bernard – there with sustenance, a solid presence / The Dolphin – who depending on the circumstances dolphins will swim ahead of, beside or behind their young.

A couple more recommendations to chase up: Dr Hazel Harrison – Upstairs and Downstairs Brains / Holly Van Gulden – using the language of ‘PARTS‘ / Treating Traumatic Stress in Children and Adolescents / ACEs training – Nigel Holme

You don’t go long in the world of adoption without learning the acronym PACE.

PACE is a helpful way to remember some of the concepts you need to keep to mind when parenting therapeutically – i.e. parenting children who have suffered trauma – as described by Dan Hughes.

Playful: While we can’t be playful all the time – and at particular points of conflict, anxiety or panic it might not even be appropriate / helpful – we do need to incorporate lots of silliness and fun into our parenting. Therapeutic doesn’t equal serious, academic and dull!

Accepting: A lot of the stress in dealing with an issue actually comes from our expectations and disappointments as parents. We expected a certain activity to be enjoyed; we always imagined being a sporty family; we just wanted a visit to Grandma’s that didn’t involve a meltdown; why can’t I sit for 5 minutes with a cup of tea while they play quietly – all my friends’ children seem to manage it – just 5 minutes is that too much to expect?

If we can accept our children as they are and not wish they were just a little more…. or a little less…. we will be more able to approach issues and conflicts with patience and possibly even a bit of a sense of humour.

Curious: The wonder of “I wonder if…” This is our chance as parents to play detective. Most behaviour doesn’t occur in isolation – but is the tip of the iceberg and a clue to what’s going on at a much deeper level. A tantrum after losing a game might not be a simple case of being a sore loser – it might be the final straw after a series of events in which our child has felt more and more out of control, or more and more inadequate and incapable. The parenting needed here then isn’t to ask them: “When will you learn to lose a game without throwing it across the room?” or “Why can’t you ever lose without having a tantrum?” but empathetic questions like: “I wonder if losing this game makes you feel like you aren’t good at doing things?” Obviously asking the right questions gets easier the more you know your child and the more you know about your child, but we can always have a go. Sometimes asking the wrong question actually gives them a chance to say “no” and prompts them to explain what is going on.

Why questions are really hard for children to answer even in the best of situations – let alone when their brain is stuck in the basic loop of fight, flight or freeze. When will you… ? why didn’t you…? How could you… ? are all the opposite of accepting and all put distance between us and our child. What we are aiming for is to accept where we are at that point with our child, that right now our child is not able to regulate themselves, but needs our help. Our compassion, not our challenge. Our task at this stage is not to show them that throwing the board across the room is unacceptable behaviour, but to work out what is going on, help them to understand it; and then together to return to a state of calm. This links in with another phrase I came across early on in my adoption journey – Connection BEFORE Correction. It is not that you are never going to correct their bad behaviour, but at that point it isn’t your first priority. If a child has never received encouragement or worse has been repeatedly told how useless they are then maybe what they need is some understanding and a cuddle.

Empathy – Empathy is sitting with someone where they are, not having to fix or minimise with comparative statements such as “at least you aren’t as bad off as…” but just crawling into their painful place and sitting alongside them there.

Until typing this up I hadn’t quite clicked before how interlinked and interdependent each part of PACE is. Acceptance is vital to curiosity, and empathy oozes out of acceptance and curiosity. It can be hard to be playful when so much is not as you want it to be, or when you just can’t understand what makes your playmate so difficult – but with empathy, acceptance and curiosity the playfulness can be protected and in turn bring warmth into the relationship which enhances the acceptance and the empathy.

So let’s keep on trying to P.A.C.E ourselves!