​By Your Side Foster Carer and Adopter Guide: support for children moving families
by Vivien Norris (The Family Place 2019),
reviewed by Sheila Lavery
 
Transitions are understandably difficult for care-experienced children, not least because of the huge losses they involve or rekindle. Chief among these are the transitions from birth family to temporary foster care and from foster care to permanency.  

We expect a lot from children when we leave them to manage these moves without respecting their relational history and their ability to make sense of the conflicting and potentially overwhelming feelings such transitions involve.
 
So I was thrilled to read and review By Your Side, by Vivien Norris, Clinical Director of the Family Place. This genuinely trauma-informed guide for supporting both children and adults involved in the move to permanency joins the ranks of Norris’s other publications including Parenting with Theraplay (with Helen Rodwell) and Not Again Little Owl. This review is in respect of the foster carer and adopter guide, which forms part of a wider resource package including a practitioner guide and training programmes.
 
By Your Side acknowledges that starting well is crucial in adoption. It aims to do this by establishing a model of collaboration and containment. It employs DDP and Theraplay to provide consistency, playful connection, a coherent narrative, routines and rituals and a level of caring engagement so a child remains seen, heard and valued at a time when practicalities and planning often take precedence over emotional connection. The book aims to help the adults develop greater insight and empathy when moving a child. That means the adults must cooperate, manage their own feelings and model mind-mindedness and containment for the child.
 
It’s interesting that even though we know how attachments are built through rupture and repair we fail to use the huge rupture of transition as a critical attachment building opportunity and indeed, a key responsibility. Likewise, we may fail to recognise that the liminal space of transition between what was and what is yet to come is not a void but an opportunity for growth. Norris’s guide is hugely valuable in addressing this area.
 
 The manual begins by listing the seven core principles of the approach (see above) and defines the terms attachment and trauma, which helps to clarify the content that follows. The principles give a framework, goals and everyday examples of the By Your Side approach while providing the flexibility needed for every child and family’s unique experience.
 
By Your Side recognizes that the practical tasks of permanent placements and the excitement of a “forever” family means that adults often minimize or ignore the very real feelings of anxiety, grief, frustration, sadness, confusion etc., that a child may struggle to manage. In doing so we begin or continue a culture of, “if we don’t look at the tough stuff, it will go away” or we wait until a child is settled before addressing challenges. Norris addresses the reality of dealing with what comes up, as it comes up, in the here and now because that’s what being present for a child really means. She also asks us to consider our use of language and a child’s understanding of terms like “forever family”. It’s important to be curious about how those words fit with the child’s experience of family and the concept of forever, given the child’s current feeling state and developmental stage. For example, might we not distinguish between “first family”, “helping family” and “keeping family” rather than the usual fostering, adoption and care-order terminology.
 
What I liked most about this guide is that it puts attachment into action in this minute and every minute that we engage with a child, not somewhere down the line. It makes attachment the responsibility of each one of us involved in the child’s journey, not just the job of the “forever family”. Despite the abundance of attachment and trauma language on everyone’s lips, attachment is still not alive in the detail of care planning. There is still an expectation that a child will transfer attachment from one set of parents to another because it’s in their best interests. The system struggles to hold simultaneously the view of what is needed in the here and now with a long view of permanency. In reality minimising the pain of the transition undermines the chances of “permanency” or ‘forever” from the outset. When placements are not managed well subsequent transitions often become problematic and the adolescent transitions can become so difficult as to challenge the stability of everyone’s place in a “forever family”.
 
The sensitivity of the transfer of care from foster carer to permanent parent in the By Your Side approach means the adults can hold the child and the practitioners can hold the adult carers throughout the transitional process. For anyone familiar with DDP and Theraplay the detail of this approach will seem very familiar. I guess what is new is the packaging of those principles into a practical resource with a refreshing view of the space between temporary care and permanency as a bridge rather than a void.
 
As an adopter I questioned how some of the approach would work in practice. I was reassured that the midway review in the process could pick up on the fragility of some situations and the professionals could bolster any support needed for the child. Practitioners using the approach would need to be very skilled, hence the accompanying training, and the support system would need to be very robust. I’m also curious about what other supports might be available to help the adults in this vulnerable period. Still, it’s a great resource. Thinking as I often do these days about adoption disruption, the content of this guide is not only relevant to getting off to a good start in permanent placements, but together with the practitioner guide and training it would be a hugely valuable resource for repairing the hurt in families when the “forever” bubble is fit to burst and it provides a model of collaboration and support that gives adoption placements their best chance of success throughout the lifespan.

Healing Relational Trauma with Attachment-Focused Interventions. Dyadic Developmental Psychotherapy with Children and Families
Daniel A. Hughes, Kim S. Golding & Julie Hudson (2019)

I work as a Consultant Clinical Psychologist with fostered and adopted children.  This book landed into my hands as I approached the end of the Practicum to become a Certified Practitioner in Dyadic Developmental Psychotherapy (DDP).  And, wow, what a wonderful resource to have.  Its like having a DDP Consultant on hand!
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This is a ‘must have’ resource for anyone who wants to learn about DDP and develop their practice of it.  It begins logically with chapters that explain the guiding principles, theory and what is known about the neurobiology of attachment and developmental trauma.  It explains PACE (which stands for Playfulness, Acceptance, Curiosity and Empathy) as the attitude which helps to provide children with a foundation for safe and healthy relationships.  The experience of DDP is described.  One chapter addresses the ‘nuts and bolts’ of DDP; wisdom that I wish I’d had when I first began practising with this model.  Basically, you are told everything that you need to know to get started with DDP in a practical way. 

There is a chapter on working with parents therapeutically and helping them to develop parenting that conveys PACE.  The book then explains how Dyadic Developmental Practice can be used to create safe settings.  There is an emphasis on thinking about a child’s wider system and network, such as education, social work teams and mental services.  This chapter shows how DDP is more than a psychotherapy.  DDP is a framework for professional practice.  It is a framework for creating strong unified and connected teams around a child in which a shared understanding of the child can be explored and created.  This networking approach is essential for helping children to feel safe, understood and regulated, and it can provide the foundation for successful psychotherapy.  The book explores DDP in residential care, fostering and adoption, individual therapy.  Specific populations are focused upon such as children with learning disabilities, children who show violence to parents and adolescents.  The combining of Theraplay and DDP is described.  The experience of having supervision for developing one’s own DDP practice is described.  To conclude, the book finishes with a chapter on the evidence base.   

This book packs a lot of information into its 335 pages.  It is aimed at professionals although it has little jargon in it so would be accessible to a wider audience.  It is very easy to read and the inclusion of many powerful case examples bring the concepts and ideas to life. 

As I finished reading this book, I was delighted to successfully complete the DDP Practicum and become a Certified Practitioner.  I’m confident that this book had helped me in those final stages by giving me knowledge, support and motivation.  It’ll certainly be a book that I keep accessible, especially when I need reminding of how to maintain a PACEful approach in my work. 
 
Review by:
Dr Helen Rodwell, Consultant Clinical Psychologist,
Co-author of: Parenting with Theraplay; An Introduction to Autism for Adoptive and Foster Families; CoramBaaf Good Practice Guide on Supporting the Mental Health of Looked After and Adopted Children. 

Building the Bonds of Attachment: Awakening Love in Deeply Traumatised Children
(3rd Edition), Daniel A. Hughes PhD

This highly engaging and insightful book uses the story of Katie, a child at risk and then in foster care to explore the theory and application of Developmental Dyadic Psychotherapy (DDP), both in therapy in in therapeutic care.  Although the characters Hughes introduces us to (especially Katie) are an amalgam of real carers, children and Social Worker that Hughes and other practitioners have known over the years, they are believable.  The Inner World of “Katie” is well described, as is the seemingly endless patience of Jackie, Katie’s fourth foster mum.
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Through the narrative (novelistic) style, Hughes adopts, we get a revealing outline of blocked trust, blocked care, PACE in action and the process of PACEFUL parenting & therapeutic intervention.  Use of the Social Worker’s own developing relationship & parenting of his first child provides an opportunity for the reader to compare normal developmental pathways of relational styles, with the disordered reactions and thinking of Katie.

Each chapter is full of detailed descriptions of significant incidents followed by a reflective “commentary” section.  This allows the reader to refresh and summarise what has occurred, whilst checking their understanding of the trickier concepts and reviewing their own learning and development of ideas.

The introduction can be read alone as a helpful outline of attachment, why it is important and the role of therapy.  It also provides a helpful overview of the main aspects of attachment, and the important concepts that develop through early care, especially the role of attachment, empathy and intersubjectivity.  It provides a useful definition of trauma and the distinction between PTSD and developmental trauma.

At times the reader feels exhausted alongside the foster carers, especially Jackie, who are struggling to get it right for Katie and this is one of the books strengths – the ability to illustrate how difficult it can be to care for, and keep caring for highly traumatised children.  Although the outcome for Katie might be seen, by some, as too easy, for others it will be seen as an inevitable outcome of the hard work of therapeutic parenting where the aim is to build the bonds of attachment.  The reader never loses sight of wanting things to be better for Katie no matter how challenging she seems, because Hughes has drawn her character and the motivations for her behaviours so well.

Hughes skilfully outlines, through the examples he describes, the need for constant self-reflection on the part of therapeutic carers, including support to explore their own attachment history and the necessity of having access to the support of a therapist who is focused on the development of the relationship between carer and child.  By accompanying Jackie and Katie through their therapy sessions, the focus of the problem is shifted from a “within child” model (and the reader is given an example of this type of therapy in Katie’s first therapist) to a “within relationship” model.  By making the mind shift to seeing the problem located within relationship and knowing how they work, the message of this insightful, highly readable book is one of hope.  Things can change.  Children can be helped and healed.

Lesley Craig
Educational Psychologist
Clackmannanshire Educational Psychology Service.

The Boy Who Built a Wall around Himself
by Ali Redford, illustrated by Kara Simpson.
 
This little book is intended for 4-9 year olds but carries a message for people of all ages.

Written by adoptive mother, Ali Redford, it tells the story of “Boy” who, finding “everything  scarily wrong”, builds a protective wall around himself because no one seems to  care.

Fortunately for Boy, there is help at hand in the form of “Someone Kind “who persists in engaging with him and helps to break the wall down.

The text of the book is perfectly complemented with illustrations by Kara Simpson who captures, in comic book format drawings, the isolation felt by Boy and the playful and imaginative attempts by Someone Kind to help him. The use of “Boy” and “Someone Kind”, instead of names, allows any child listening to the story to relate to it at their own level.

There are messages in this book for all those involved in the care of traumatised children.  Firstly, that helping children to heal from past experiences takes persistence and time, that for a child to give up their “wall” can be very scary for them and that the way forward is through a positive and consistent relationship with a secure adult.  Dan Hughes would approve of the way “Someone Kind engages with the child in a playful way!  Most importantly the book gives a message of hope that, in time, children can heal from past experiences.
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Talking about “walls”, both physical and metaphorical, seems topical these days! There are lessons that can be drawn from this useful little book - that talking is better than silence and building bridges more helpful than building walls.  This book would offer encouragement to any child hearing Boy’s story and to parents / carers as well.  Although small in size it gives a big message!

Star rating ****
Heather Drysdale
(Systemic Psychotherapist/Adoption and Fostering Consultant)

Parenting a child who has Experienced Trauma.
​By Dan Hughes with Matthew Blythe
Published by CoramBAAF
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Dan Hughes defines simple and complex trauma; explains the effects of both and the aims of supportive treatment programmes. This part of the book is tightly packed with vital information to educate parents and advice on how to begin to understand and support their children; particularly those who have experienced complex trauma. Hughes suggests that parents and therapists need to “mentally search for the child under the problems and help that child emerge”. 

By being Playful, Accepting, Curious and Empathetic (PACE) parents can communicate that they love their children “for better or for worse”.  Being and relating in this way helps parents give their children the experience of greater safety, even though their children are wired to distrust them. PACE also enables parents to be “emotionally strong, present, confident and comforting” and able to protect their ability to care. Hughes deals with the differing relational needs that traumatised children are likely to have at different developmental stages of their lives. He also provides a very useful introduction to the educational and social issues traumatised children contend with. Hughes theoretical introduction is complimented by the final section of the book in which Matthew Blythe describes his life as the father of his adopted twin boys. Here we hear how early trauma impacts on the development of each of the boys and how Matthew struggles to understand and support them. Their roller coaster journey together will be familiar to adopters and adoptees as well as full of insight.      

My 21 year old son has also reviewed the book. He says: “As a young adult who has experienced complex trauma, I found the section about the effects of childhood trauma very useful.  It helps explain why I feel the way I do sometimes and why I behave in the way I do sometimes. This information has given me ideas about how to help myself”.

“The chapter on symptoms, prognosis and treatment describes how my early life felt to a point of scary accuracy! The treatment suggestions, based on Playfulness, Acceptance, Curiosity and Empathy (PACE) make sense and, if put into practice consistently, work well. However I would say I struggle with the empathetic response that Hughes suggests. I don’t want somebody walking in my shoes with me. I want them beside me, but pushing me on with reassurance. Some people may gain a sense of greater safety from empathy but I do not. That said, the section on helping your child develop internal safety is helpful. It explains that telling someone to ‘forget about it’ or ‘get over it’, is very likely to fail. This is because even as little as a smell or sound can make you feel unsafe/angry/irritated.”

“Some parts of the book seemed obvious to me, however not many people have been through interpersonal trauma. I think the people who will benefit most from this book are teachers, mental health professionals, the police and anyone else working with young people. They all need this knowledge and understanding to get beyond reacting to how young people behave.”

Roberta Manners and HH