​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.

Parenting with Theraplay®
- Understanding Attachment and How to Nurture a Closer Relationship with Your Child by Vivien Norris and Helen Rodwell.

Forewords by Phyllis Booth and Dafna Lender, illustrated by Miranda Smith

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I love this book for so many different reasons!  It unpicks Theraplay - a complex, but really useful tool that has been tried and tested in the professional arena.  We see Theraplay introduced for all families wanting to better their relationships, whatever their challenges. It makes it accessible to the key people in children’s lives – their parents, carers, grandparents etc.  It speaks directly to these adults that children need as the “bigger, stronger, wiser and kind” people they can feel safe and connected with.  The book provides just the right amounts of the Theraplay principles of structure, engagement, nurture and challenge in the text and illustrations. This makes the model something we can make our own in our families. 

The first part of the book explains the history, theoretical development and research that underpin Theraplay. It explains why it is needed in some families and how it works. It begins to show why “returning to early and simple ways of playing together is like building up the foundations of your relationship.” Key concepts such as attachment, safe base and emotional regulation are explained, if you want this level of knowledge; likewise, the importance of touch and creating “moments of meeting”. Theraplay is based on what happens in healthy interaction between carers and their infants/babies and the elements that make up these interactions - Structure, Engagement, Nurture and Challenge - are fully explored. Helpfully, each section and each chapter has the same format and is introduced, chunked into bite sized bits and then summarised, so that you can pick out what is useful to you right now. Every section is full of suggestions of what you can do to shift the way you interact with your children. There are scenarios and check lists to help you think about your internal life and that of your children and many ideas about what to do to support your relationships. There are loads of examples of things you can do in daily living situations and well as games for more specific play time. What I found particularly helpful is that while illustrating each relational element and aspect that makes up Theraplay there is as much support for parents – possible ways to practice, to find the way forward, to have their own needs met etc – as advice on how they can support their children.

The second part of the book looks at the stressors of daily living that our children often need help with, whatever their age. It also looks at some of the behaviours that are the outwards signs of our children’s response to these and more complex causes of overwhelming stress. Just how the principles and practice of Theraplay can help address these difficulties are discussed in a warm, empathetic conversational tone. You feel as though the authors are really alongside you and your children.

I think that this book successfully conveys the “being” and the “doing” nature of Theraplay. It gives so many ideas to work on, practice and adapt so that we can get to know so much more about ourselves and our children. It empowers us to find our way to safer, repairable , fun and joyful relationships.

Roberta Manners 
Mother, Adoptive Mother, Grandparent, Certified Theraplay Practioner and Trainer.
 
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FOR THOSE ATTENDING THE THERAPLAY TRAINING IN EDINBURGH AND THE THERAPLAY CONFERENCE IN LEICESTER IN SEPTEMBER 2017 - THIS BOOK WILL BE AVAILABLE AT A DISCOUNTED PRICE!!!

DON'T MISS 'MEET THE AUTHORS' BOOK SIGNING AT THE THERAPLAY CONFERENCE

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

THIS MONTH'S REVIEW IS A LITTLE DIFFERENT -
A POSTER AND PRACTICE NOTES FROM THE FAMILY PLACE
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Using Theraplay to support transitions from fostering to adoption by Dr Vivien Norris and Sally Twigger.

Dr Norris begins the practice notes by stating “Although it is widely recognised that support over the transition from fostering to adoption is essential, many are uncertain how best to do this in practice”.

We recognise that transition is a complex process which carries with it many hopes and expectations for all involved.  It can be a tense and emotional time for the child the adopters, the foster carers and professionals.

Prospective adoptive parents will all have had their own particular journey to adoption, they will have attended preparation groups, have under taken an intensive home study , been to an approval panel and will have known the details of the child they have been matched with for a number of weeks, and will be desperate to meet and claim the child.  The adopters will want to begin to get to know the child to establish a relationship as soon as possible.  They may also feel nervous about being surrounded by other people who know the child well.  This can result in adopters feeling vulnerable and intimidated by an experienced foster carer who has effectively built up and managed a relationship with their child. 

The co-ordination process can be emotionally painful for foster carers who have cared for the child for a long time sometimes from birth.  Foster carers will have supported the child through some difficult experiences.  They will have integrated the child into their family and will have developed empathy for the child’s experience.  They will have supported the child to meet their developmental milestones and will have established rhythms’ and routines that the child will be familiar with.  Many foster carers can experience difficult feelings about the imminent separation from a child in their care.  This can be even more complicated and sensitive if the foster carers have previously expressed an interest in caring for the child on a permanent basis.

The workers have also known the child and supported the child through difficult and distressing times.  They will have contact with the birth family and will have facilitated family contact which is often fraught.  They will have been instrumental in removing birth parents parental rights and responsibilities and are invested in securing a good outcome for the child parents who will meet the child’s life long needs and offer the child an opportunity to heal, grow and develop.  In my experience everyone comes to co-ordination with hopes, dreams and high expectations, and it is possible to lose sight of the child’s needs when so many conflicting adult needs are at the forefront.

In her piece Dr Norris reminds us that children who are transitioning from one family to another, and who have a history of developmental trauma face complex difficulties.  They are likely to have a fragile sense of trust in adults and sensitivity to being triggered into a survival state, or to regress to earlier ways of relating which means they may move away from rather than towards their main attachment figure (the foster carer) at times of significant stress.  They are also likely to hide their fear and miscue; that is to give signals that they are fine and self-sufficient when they are feeling frightened.  In addition their capacity to think and make sense of what is happening to them is likely to be highly compromised and exacerbated by fear.  They may not be able to process and retain information or respond to logic and their sense of time may be distorted. Foster carers will often report that things have been explained clearly to a child but ‘they act as if they haven’t heard it’.  Alongside age related development and a child’s concept of time, children who are highly anxious may be able only to think in minutes or seconds and any discussion of the future beyond that may be meaningless.  This obviously presents challenges in terms of how to be of most help to children who are moving family.

The purpose of a transition is to move a child from their foster carers to their  adoptive parents.  This is usually achieved.  In my opinion that makes how we do the co-ordination even more important as we should be child focussed and protective of the child recognising their distress as described by Dr Norris.
The co-ordination plan focuses on practical arrangements but these arrangements should be put in place to support the child to transfer their sense of trust from his primary care giver to their adoptive parents. 
Dr Norris’s approach helps us to put the child in the centre and supports the child to make use of their main attachment figure.

With my colleagues I have put into practice Dr Norris’s approach to good effect. The use of theraplay in transition has made everyone more aware of the importance of transferring established loving ritual.  We are more conscious of need to know more about the child’s rhythms and to transfer these from the foster carer to the adopters. We are more conscious of putting in place a co-ordination plan aims minimise the trauma that the child will experience during the transition.  We want to know what soothes and what excites the child.  We pay greater attention to the continuity of the sensory environment and to the non verbal means of communication such as touch, play, music and transitional objects.

I have found the poster helpful, as it supports us to think about the impact of developmental trauma and the implication for the child when they are experiencing another move.  It is helpful to think about potential issues, the implications and goals that underpin the transition process.

This model recognises the foster carer as central in supporting the child throughout coordination and it is essential that they are well prepared for and well supported throughout this process.  Their social worker has a crucial role in relation to this and needs to be available to the foster carer during the co-ordination process.  Foster carers need to be enabled to undertake this piece of work and it is important that other departmental demands are kept to a minimum where possible (e.g. additional foster placements, LAC Reviews for the child).

As Dr Norris points out even children who are well prepared for moving placements can find the experience confusing and anxiety provoking.  This model recognises and accepts the child’s experience and helps us all to remain child focused throughout this difficult and challenging process.

I would recommend that all workers, foster carers and adopters read Dr Norris’s piece alongside her chapter in "Healing the Hidden Hurts".

Anne MacKenzie 
Senior Practitioner at City of Edinburgh Council