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.

The Power of Showing Up: How parental presence shapes who our kids become and how their brains get wired. 

By Dan J Siegel and Tina Payne Bryson
​
I was asked to review this book just as the COVID-19 lockdown was kicking in.  A social worker “to trade”,  I currently work as a Support for Learning Assistant in a local Primary School with children presenting with attachment and trauma related issues and children with autism. 

So when the schools closed, I thought I would have loads of time – however, with my own children at home, my husband also a key worker and our Education Department providing “learning at home” opportunities, time has not been on my side!!

However, reading this book has been a very welcome, and indeed comforting, distraction during such a strange and worrying time when connections, physical, emotional and “virtual” have become more important than ever.  When spending time at home with my children who are also feeling anxious, has meant I have become far more aware of how I am responding, reassuring and being mind minded – showing up for them.

Reading this book has helped me to reflect on my own parenting of my children, making sense of my own experiences and how these have shaped and influenced my attachment style and coping strategies and how these in turn have shaped my children and my relationships.  It is an optimistic book which says “you can do this” and I could actually hear Dan Siegel’s friendly voice as I read through the pages!

The book opens with what it means to “Show Up” and explains with clarity what is meant by the Four S’s (Safe, Seen, Soothed, Secure).  It goes on to explore what happens when parents don’t show up and, without using any incomprehensible jargon, enlightens us about the science of Attachment in a way which sets the scene for the rest of the book.  The Four S’s – Safe, Seen, Soothed, Secure are then assigned a chapter each to explain what happens when parents show up to provide these in a predictable, attuned way and also what the impact on children and adults is when this doesn’t happen.

Dan Siegel and Tina Bryson use neuroscience and attachment research as the basis for the book.  They share with the reader in a way which is easy to makes sense of,  what is meant by a secure and an insecure attachment and effectively describe the categories of attachment – Secure, Avoidant, Ambivalent, Disorganised – highlighting and explaining the causes, meaning and implications of each.   This provides a platform for the reader from which then to make sense of the Four S’s set out in each of the following chapters.

The Four S’s provide a concise, helpful and easy to understand “summary” of attachment research – not an easy task given the breadth of research, books and articles written over the years – but somehow Dan Siegel and Tina Bryson have indeed managed successfully to do this in a way which is easily accessible to parents, carers and indeed anyone involved in supporting and working with children and young people – and also adults who may struggle as a result of the impact of their early experiences.  The Four S’s are the building blocks of healthy development.

The book is full of helpful visual reminders and diagrams which illustrate what is explained throughout the text.  As a visual learner, I found this extremely helpful.  Throughout the book, themes are repeated in a beneficial way e.g. the importance of children feeling safe, seen and soothed and examples of what this looks like.  Reminders within each section pulling you back to the attachment research.   This “repetition” is helpful as it pulls all the themes together.   All Four S’s are pulled together in the final chapter which focuses on security.

One of the things I like about this book is that it repeatedly reminds parents that we are none of us perfect – nor do we need to be.   It is encouraging in that it highlights that it is impossible to get it right all the time and acknowledges that we all get it wrong.  The emphasis is on the balance that most of the time we are getting in right,  creating a predictable experience and world for our children.  It also provides the strategy of repairing things and apologising when we get it wrong – and that this in itself is an opportunity for building security and trust in our children.   Importantly, we are told this does not mean “spoiling” our children, letting them off with things, “being soft”, being permissive – that we can be attuned and connected and show up in a way which still keeps children safe.

There are explanations throughout the book about how the brain works in terms of areas of the brain, how these interact, and how these are impacted by the responses of parents, how the areas integrate and how this integration is the key to our health and happiness as adults.   There are numerous explanations around how we internalise our experiences of being parented.

I also like the way that the book tells us how to “show up” consistently for our children whether they are experiencing success or failures.  How we can provide safety, ensure they are seen and provide soothing, even when we are saying “no”.

An important theme throughout the book is that even those adults who have not had a positive experience in our own childhood of being safe, seen, soothed and secure, can successfully provide this for our own children.  We don’t have to repeat what we experienced.  The writers explain optimistically that providing we can make sense of our own experiences, however negative, that we can reflect on our past and understand how the absence or unpredictability of these building blocks impacted on our own mental model, we can then build positive attachments and can show up for our own children ensuring their development is healthy.   We can become attuned to our own children’s needs, emotions, feelings and thoughts.  

I think this book will be quite a revelation to some parents and carers and professionals reading it, specifically making sense of their own past, their own childhood experiences – there are questions at the end of each chapter which serve to make us think about our own experiences, our parenting of our own children and what we might do differently.  The authors explanation that the way we adhere to the Four S’s shapes not only our children’s’ emotional development but actually physically wires their brains, is fairly mind-blowing (though not alarming!)... but at the same time, makes so much sense and provides irrefutable evidence and examples of the importance of consistently and reliably being present – showing up – for our children in a way which allows them to thrive and get through life’s tough stuff.

As someone who feels I have a “relatively” good understanding of attachment and trauma (and also someone who appreciate a jargon-free text!),  I found this book well written with clearly explained themes, science and research.  It has condensed a huge amount of research into a clear and concise text.  This is a grounded, reader-friendly, optimistic and encouraging read, and most importantly, is easily accessible for parents and carers.  I would thoroughly recommend this book for all parents, carers and anyone involved in working with or supporting children and young people.

I thought I would just include this quote - from the page of the book just before the Contents page, as I feel it reflects these times:-
“If ever there is tomorrow when we’re not together...
There is something you must always remember.
You are braver than you believe, stronger than you seem,
And smarter than you think.  But the most important thing is,
Even if we’re apart ...... I’ll always be with you.
- Christopher Robin to Winnie-the-Pooh (Pooh’s Grand Adventure)

Shona Thain
Support for Learning Assistant (and former Social Worker of 25 years)

The Neurobiology of Attachment-Focused Therapy - Enhancing connection & trust in the treatment of children and adolescent by Jonathan Baylin and Daniel A Hughes 

The focus of this book is set with a quote from Colwyn Trevarthan Emeritus Professor of Child Psychology and Psychobiology, University of Edinburgh.
“If we are to protect young children from harm …we will have to value more and give response to what children bring to human life-the eager spirit of their joyful projects beyond their seeking to survive.” 

How can therapists and caregivers help maltreated children recover what they were born with: the potential to experience the safety, comfort, and joy of having trustworthy, loving adults in their lives? 

In order to address this question this book shares the work of Dan Hughes and Jon Baylin in their development of a science based model of attachment focused therapy that links clinical interventions that are informed by an understanding of brain functioning on attachment and relationships. Thus Dyadic Developmental Psychotherapy (DDP) is linked to neurobiological processes.

Neuroscience shows that negative experiences lead to the development of a neural “alarm system” called the mid brain defence system linked to chronic defensiveness- the core of blocked trust.

The treatment is to target the mid brain alarm system – the part of the brain sensitised by pain suppression and chronic defensiveness evident in children who have developed blocked trust –the suppression of inherent relational needs due to poor care. 

The prefrontal cortex is activated in order to support new learning and move from mistrust to trust. This is done through techniques of reversal learning, fear extinction, memory reconsolidation, reflection, and reappraisal. The therapy ensure adults send messages of approachability and trustworthiness into child’s brain. i.e. not being defensive adults in order to ensure provision of comforting enjoyable experiences with adults. Safety is key in developing this trustworthy environment. 

Underpinning this approach are the key DDP elements of PACE – playfulness, acceptance, curiosity, empathy which are utilised by the therapist in work with children, parents and families. 

The content of the book is laid out in such a way that the reader is informed by the new science of attachment and the bio behavioural processes of trust, mistrust and trust building. This is rich and informative. The focus then leads on to the means of change in the brain functioning in order to bring about therapeutic intervention. There are summaries for some chapters (those providing theoretical background) which are an excellent learning aid. The chapters on intervention are very well illustrated with clinical examples which bring alive the approach as well as reminding the reader of the pain for the children and families involved. 

In drawing the book to a close the focus is directed to the future and the possible expansion of the DDP model looking at more processes to decrease chronic stress and defensiveness. 

The linking of the constantly developing information on brain functioning with attachment focused therapy is very successfully achieved in this book which will provide those working with children and families with potentially both an increased body of knowledge and an improved skill base.

​Ann Rooney
Consultant / Trainer

There is no better guide to how children develop their rich emotional, relational, and creative lives than is the wisdom of Colwyn Trevarthen, Jaak Panksepp and Phyllis Booth.  In this book, all three make it clear that reciprocal play--play that involves joy and delight, magic and music, often rough and tumble, always engaging in the back and forth of spontaneous encounters and movements--is a central component in the full development of children.  
            
In the first chapter Trevarthen and Panksepp summarize clearly their view of human development:  “We are born with a moving body, ready to share its rhythms and melodies of joy or anguish.  Our vitality is by nature that of a dancer or musician, and this intelligence in movement gives us signals to be shared. (p. 39).”   In the Forward, Booth gives us a brief glimpse of how Winnicott saw play between the child and psychotherapist as being at the heart of the creative changes that such meetings attempted to foster.   Play too, is the central core of Theraplay, a treatment modality developed by Booth that moves play from the focus on the symbolic play of traditional therapies to the reciprocal, expressive, movements of delight and engagement that occurs within Theraplay between the child and therapist and the child and parent. 
            
Attachment theory and research stresses the importance of safety that is established in the infant-parent relationship within which the young child learns within joint activities with the parent to regulate their affective states and begin to make sense of the world.  The reciprocal, moment-to-moment engagement--often characterized by music and  rhythms that have been called “the dance of attunement”-- between infant and parent is the foundation for the child becoming safe to explore the larger world of relationships with peers and developing interests.  Through reciprocal play, the rich inner world into the minds and hearts of others--family and friends--becomes open to the child.
            
When children have had the misfortune of developing a troubled or disorganized attachment with their original caregivers, these children need to develop relationships with their new caregivers that feature the presence of comfort (for attachment) and joy (for companionship).  Repetitive nonverbal communications that express empathy, delight, interest, and wonder are central in these children learning that they are able to trust these caregivers.  Joint activities that involve music and dance, spontaneous intentional movements requiring a shared focus and cooperation are important ways to engage these children to develop their trust.  Similar activities with their peers are often crucial both in helping the child to both return to the past with joint activities that they had needed but did not receive, as well as moving into the future into groups of friends. 
            
Inclusion, Play, and Empathy offers a great variety of ways to become engaged with children who have had difficult beginnings while guiding them to participate in those spontaneous, joint activities of creative play that they desperately need.  Music and dance, but also all sorts of shared intentions and activities, are presented in this book as ways that will facilitate children’s neuroaffective development in group settings.  Therapists from many countries and all persuasions share their insights attained through their creative therapies that are likely to offer ideas for engaging children to both parents and professionals alike.
 
These programs cannot replace the child’s need to develop safe relationships with their primary caregivers characterized by comfort and joy.  However they may well complement such relationships and, in fact, the child’s participation in these crucial experiences of play with peers, maybe actually help them to become more open to exploring a closer relationship with their caregivers.  The therapies presented in this well-edited book are excellent examples of “therapies that enhance the deep creative and restorative powers of human nature (p.49).”

Dan Hughes PhD
​Founder of DDP