Book of the Month May 2020 - The Handbook of Therapeutic Care for Children

The Handbook of Therapeutic Care for Children: Evidence-Informed Approaches to Working with Traumatized Children and Adolescents in Foster, Kinship and Adoptive Care. Edited by Janise Mitchell, Joe Tucci and Ed Tronick.  Foreword by Stephen W. Porges.

I began reading this book as an Educational Psychologist currently working towards both DDP Practitioner and Neurosequential Model in Education Trainer status & having completed Parent Child Therapy training many moons ago. So, it should come as no surprise when I say that this book gave me deep, deep joy and had my neurons firing & wiring together & may have lead me to reach Peak Geek.

Porges begins by reminding us from the outset that Therapeutic Care incorporates not only a respect for the child, but a respect for their physiological state.  He talks of how this biological state is  the intervening variable in the  ‘opening or closing the (child’s) portal for trust & co-regulation’ and ‘ this will either facilitate the child feeling safe & trusting of others or become defensive & bias the nervous system to detect risk, even when there is no risk in the environment.’ 

Tucci, Mitchell & Tronick then take on the mantle of guiding us through this new paradigm – the principles of Therapeutic Care – the ways in which we help traumatised children to feel ‘biologically’ safe and how we navigate the complexities of all that this entails. While emphasising the primary importance of biological safety, the authors do not shy away from how this interacts with poverty, culture, power and organisational behaviour e.g. in Kickett, Chandran & Mitchell’s Learning from the experiences of Culturally Strong Therapeutic Care for Aboriginal & Torres Strait Islander Children and in Farmer & Kiraly’s exploration of the experiences of children in Kinship Care. 

Here, in one volume both the science and the art of supporting children to recover from developmental trauma is outlined. A crystal clear framework for practice lies within. I read it muttering to myself ‘Yes!! 100% this is what we do! A Therapeutic Specialist?? Never heard of that in this context but OF COURSE we can be.’  (Therapeutic Care expands the role of therapist to become relational brokers, network enablers & systems advocates for children in out of home care) The text gives life and a coherent framework to the many emerging & inter-related evidence based approaches to supporting children with developmental trauma. It pulls them together into a cohesive whole and is a seminal text for anyone and everyone involved in the hopeful endeavour that is being with children who have experienced developmental trauma. Unusually, it is both highly academic in its accessible theory and evidence, and practical with examples of real life approaches and of the framework applied in different ways in different settings. 

One of the text’s greatest strengths is the way in which it outlines a whole system approach: that healing is both brain based & relationally based in the ‘experience that occurs in the micro opportunities of the every day’ and that these experiences are rooted in the formation of trust, safety and relational practice across the totality of people who the child interacts with.  It takes a village, but it takes an organised, coordinated, well-regulated village immune to vicarious trauma & blocked care that is able to remain regulated. But hey, if the village slips up, the paradigm gives us some acceptance and self-compassion that allows us to pick ourselves up and get back to supporting each other in order that we can support the child. The approach enables relationships, thinks over the long term, pays cognisance to each individual child’s set of needs and pattern of developmental risk and strengths. It considers the physical and sensory environment and it cares for the caregivers, resourcing the network of relationships around the child to allow the child’s felt sense of safety to develop.  

Teicher & Munkhbaatar’s chapter on understanding the importance, type and timing of maltreatment on brain development and developmental risk was simply mind blowing, their emphasis on adaptive neural plasticity and the snakes and ladders impact of differing types of abuse and neglect at different developmental stages on different sexes was absolutely fascinating & has real implications for intervention. It is then later followed up with Perry’s chapter on a developmentally sensitive, neuro-scientifically informed approach to clinical problem-solving with its wonderful, hopeful reminder of the power of relationships:  ‘the best predictor of current functioning in youth is current relational health, not adversity’ and how its the ‘therapeutic web’ of relationships that lead to positive change & that felt sense of biological safety.  Later still, Malchiodi, gives us a highly practical guide to using the creative arts in keeping with Perry’s chapter on the brain’s need for somato-sensory regulation.

Both Schore and Hughes & Baylin in their chapters write beautifully about the humanity of love, inter-subjectivity an attachment.  Schore expands on Fromm’s work, looking at what we now know about our neurobiology and that our ‘motherly (carer’s) love makes the child feel: it’s good to have been born; it instils in the child the love for life and not merely the wish to still be alive…Mother’s love for life is as infectious as her anxiety’. In this way, we begin to understand the coping mechanisms children have learned to survive adversity – they have developed ‘mistrusting brains’ adaptively prioritising protection over connection. One of the primary goals of therapeutic care is to gently, sensitively and respectfully provide developmentally appropriate experiences, in every day interactions, across multiple settings, to allow these neural connections to reconfigure, allowing the child to experience  relational connection and feel and know the beauty of unconditional love. In Golding’s chapter, building on Hughes & Baylin’s work, both the reality & the humanity of healing that can take place are explored in an adoptive family when we keep in mind the principles of Therapeutic Care and principally DDP to affect longitudinal change. 

Throughout the book, Tucci, Mitchell & Tronick, sensitively offer us Practice Reflections from each chapter, weaving the thread of the principles of Therapeutic Care throughout and facilitating our learning. This is without a doubt a book that I will go back to and read time and time again, that will help me cement my practice and that of our team. It’s a book that made me proud to be a part of such a vibrant, hopeful and child centred area of work and reinforced both my belief in the power of relationships to affect change and my complete respect for children and the myriad of ways their neurobiology helps them adapt to promote their survival. This is a seminal text that helps us all become better informed as to how we might best help the children we support, love, care for and educate to move from survive to thrive. While predominantly focussed on Care Settings, there is so much in the chapters that those of us in education can apply to our interactions with the children in our care. It is a must read for everyone involved in enacting The Promise from the Care Review in Scotland.  And, as an Educational Psychologist I’m hopeful that a second tome follows, applying these same principles to a different setting to help expand that therapeutic web: The Handbook of Therapeutic Education ❤️ 

Ruth Miller 
​Depute Principal Educational Psychologist.  
East Ayrshire Psychological Services.

---