Royal College of Psychiatrists annual meeting in Brighton

The Royal College of Psychiatrists, faculty of Child and Adolescent Psychiatry, get together every year at their conference. This year it was in Brighton. And I was invited.

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Professor Jonathan Green (University of Manchester), John Simmonds OBE (CoramBAAF) and I presented a session entitled ‘What are the needs of Children and Families during and after adoption – and is CAMHS failing to meet them?’. We formed a kind of medical/charity sector/user triangle.

I’ve learnt, when amongst medical people, not to use words such as ‘trauma’ (particularly ‘developmental trauma’), ‘attachment’, ‘dysregulation’, ‘dissociation’, ‘cortisol’, ‘trigger’ and so on. I’ve been told many times either overtly, or by eye-rolling that there are no such things and that my children (and I) should be well over it by now. As a result of one memorable CAMHS consultation I can no longer drive past the building without my stress-levels rocketing.

I ventured into the venue for the conference dinner the night before, with some trepidation. (I was terrified). The first psychiatrist I spoke to, tentatively, talked about ongoing research into pre-natal stress and cortisol levels, someone else talked about how boys and girls might react differently to trauma, then I heard about psychological models for carrying out life story work, ways of working with dysregulated children, studies into identifying the psychological needs of adopted children pre-placement, how trauma can look like other conditions and the importance of broad, all-encompassing assessments.

In short, I heard my experience (and the experiences of countless other families) and the language that fits those experiences taken as read. Some areas of contention perhaps, but that’s to be expected and not to be avoided.

Our session the following day was well received and some themes emerged; the profound impacts upon children of multiple traumas and the education of practitioners around this, a reappraisal of thresholds, a reappraisal of the system which tends to ‘silo’ children into existing pathways, the need for families to be held throughout their journey rather than ‘six sessions and you’re out’.

The nub of it all of course is the gross mismatch between resources and demand. Many families no longer express demand, by either suffering in silence, or finding their own alternative therapeutic support.  Some end up back in higher level psychiatric services and one must ask whether better, earlier intervention could go some way towards prevention.

For me, the biggest and potentially most effective untapped resource is families. As we know, the majority of all the good therapeutic work and healing takes place within families and yet many battle on unsupported and not respected. Not only that, parents educate themselves, they share information and feedback, they support each other and they fight systems some of which even to this day refuse to accept, despite all the evidence to the contrary, the profound impact upon children of trauma. And all this takes place whilst delivering high-octane parenting, day after day, 24/7.

As someone who is interested in not only parenting post trauma, but also economics, social systems and new models of delivering services I offer this:

  • Giving families(users) the resources and information they need to do the best job they can has got be cost effective, we are key members of the ‘team around the child’. Please also give us access to the evidence. It isn’t easy to find and some if it is expensive (lots of us don’t have jobs).
  • We would love to engage with you more, in a professional manner, not in a ranty, negative manner (although sometimes we may become emotional because this stuff is personal and cuts deep).
  • We would like you to engage with our groups too. We can fill a conference room with 350 people if there is a chance we can come away with hope, information and strategies that work. We like the great American speakers, which some of you don’t like so much but we’d be just as happy to listen to you. Where are you?
  • We come under criticism for lunging at non-evidenced-based interventions, and for being a bit loud and pushy. I think that’s partly because we stare into a giant CAMHS void – voids suck things into them, anything.
  • Every practitioner I’ve met (quite a few) who is offering therapeutic support to adoptive families has at one time worked for CAMHS. It suits me, because I’ve found what I need, but is sole-trader, private sector provision really a long-term, structural solution?

I know that at least one delegate who came to our session was expecting me to deliver a dirge of negative criticism of mental health professionals and CAMHS. I didn’t, because it’s pointless and disrespectful. It also leads us nowhere. I remain profoundly optimistic about the healing and progress that can take place with the commitment of families and wider teams who travel alongside a child. It’s long, hard and sometimes painful work and there are hard battles to fight along the way, but it can be transformative. Re-imagining a better future is part of that.

A Profoundly Generous Act – iPM covers adoption

This week I was going to write an autumnal post filled with windfalls, bonfires, jam making and the like. I know. Yawn.

Then this morning, as I was testing a pizza recipe (more about that in future writings) iPM appeared on BBC iplayer.  I’d heard last week’s programme and been moved by it so decided to listen to the follow up .  IPM ‘does’ adoption really well, perhaps because it gives space and listens without judgment or agenda.  Last week an adopter talked with great eloquence about how her teenage son had spiralled out of control and the difficulties she’d experienced trying to access any kind of useful support.  He now lives away from home and the title of the article ‘I have an empty seat at my kitchen table’ I’m sure struck a chord with many adopters raising teenage children from near or far who have been traumatised as a result of experiencing abuse and neglect in their early lives.

This week’s programme ‘you stitch it back together again’ was bursting with feedback from listeners who have been through similar experiences and have come out the other side.  All had taken the trouble to contact iPM to offer the family hope for the future.  One was interviewed.  Sunderland University came forward to state their aim to become a centre of excellence in the UK for post adoption support (god knows we need one).

Some years ago a professional who has worked alongside our family for many years reassured me that although things may at times seem hopeless, all the good work, the extra-extra parenting, the hard thought out therapeutic responses, the long nights of reassurance, the standing firm during the storms, all endure, planted within the psyche of that young person and that there will come a time when the resultant healing will become evident, like the sun coming out from behind the clouds.  At times I have clung on to that reassurance for dear life.  I’m glad I have. Chez Donovan there is evidence of substantial healing; glimpses of incredible emotional intelligence, signs of gritty endurance and dreams daring to be dreamed.  We’re not through the woods, but we’re travelling with hope.

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I kneaded and reflected, as I have many times before, on the kindness and compassion of others who know exactly what it is to anchor around a traumatised teenager.  To reach out across the airwaves as these listeners did, to offer hope, was I think, a profoundly generous act.

 

A GCSE in Hysteria

A long time ago my friends and I took our GCSEs, which were then called ‘O’ (for Ordinary) levels. Not many grown ups appeared to give much of a care how well we did, including many of our teachers.  The teaching was, by today’s standards, worse than ordinary.  Still we did alright, mainly because we came from stable, happy, encouraging families which meant we had little to worry about over and above parties, boys and revision.  Only a small fraction of our year group went on to study A levels.  Many of our peers were horribly and lazily failed.  It was clear even to our sixteen year old selves that the education system needed pulling up by it’s bootstraps.

Fast forward thirty years and the hysteria around GCSE results is hard to avoid.  Now the successes and failures of our sixteen year olds are everyone’s business.  Politicians are serious and measured and take care to namecheck grade inflation and global competitiveness.  Head teachers earnestly praise the hard work and dedication of their pupils.  Parents are proud.  Young people are excited, relieved and proud and rightly so.

Distant relatives, family friends, friends of friends and friends of friends of friends and television reporters also get in on the act.  There is an unseemly level of competitiveness. Or is that me being a curmudgeon?  I don’t know. There just seems to be an awful lot of public boasting and prying and smugness.  It’s not pretty.  Some of it is quite mean.

For some young people and their families GCSE results are not the be all and end all (newsflash!).  It will be hard for them, nevertheless to drown out the hoop-la and keep focussed on the end game, whilst not getting too down-hearted about having failed to make it through the narrow gate into the promised land.  For some, that end game may be a career which suits  less-narrowly defined skills (which for instance could go towards filling the significant and economy withering skills gaps in construction, engineering and horticulture).

In our (adoptive) family, GCSE time is converging with emotional upheaval around identity, loss and making sense of the past and future.  It’s like being in a flimsy tent during a hurricane, when your torch has run out of battery.

I wish we could delay exams for another year, but we can’t so instead it has become a time for setting clear priorities.  Our priorities right now are around emotional health and well-being, stability and therapy.  Our measures of success are about remaining in some form of education and more important than that, the preservation and evolution of our family unit.  A focus on education and training can come later.  This sounds like an active choice, but it really isn’t.  The emotional stuff is begging to be addressed right now.  I fear that if it’s not recognised as a priority it will make itself heard and seen until it is made a priority, either that or it will all be too late.  But how does this fit in with the ‘5 GCSEs and no excuses’ mantra that we get regularly beaten over the head with?

I’ve always had a sense that we will get there in the end, as long as we hold firm and remember what is important.  It’s not easy. It’s like swimming against a very strong current. People shout at you from the shore.  You doubt yourself. A lot.

Recovering from trauma, learning to live with what cannot be resolved and facing the most difficult questions about human strength and frailty are feats of the utmost human endurance.  These achievements may not say much about intellectual rigour, but do speak loudly about a person’s resilience, perseverance and emotional intelligence.  There are many ways in which a young person can pursue and become a success.  We all know this and it’s popular to say it, even out loud, in public, but all the evidence (Facebook) points to the fact that we don’t really truly believe it.

When our young people begin to feel strong enough to think about the future, perhaps to engage with education in it’s wider sense, to embark on a BTEC, to retake some GCSEs or to start an apprenticeship or a part time job then we mustn’t forget to celebrate them too.  They deserve it, because they will have achieved something significant with their hands tied behind their backs.

I wouldn’t for a moment go back to the rubbishy practices of my  1980s secondary school education, but I wonder if over-compensation (and fears over Far Eastern-dominated league tables) has swung things too far the other way.  I’m not arguing for excuses, but I am making a case for reasons: reasons alongside services, flexibility, patience and support.  It’s in all our interests that our young people get there, wherever that is, in the end.

The spirit spreads its wings (and toes)

2015 has been a turbulent year so far and all four of us were in need of a break together, away from it all.

Our ‘go to’ holiday is a week in a Eurocamp caravan in France.  This year we successfully managed a different campsite to the one we’ve been to before.  It was a bit bigger, with a bit more to do, but not too much bigger, or with too much more. Successful holidays for us have been built carefully, year-on-year, from small parts of adventure and big hunks of predictability.  Vary the proportions too radically and we risk suffering the fallout from boredom or anxiety. It’s hard to know which I’d opt for given a choice.

The bedrock of much that works successfully in our family is tradition and this is probably why, quite remarkably, we all managed to ease back on the emotional gas pedal for a week and truly, meaningfully relax.

Our traditions include incorrectly singing the overnight ferry ‘wake up’ tune (a hundred times), the cycle to the campsite shop to buy pain au chocolate in the morning, hours of swimming (and me screaming down the fast slide into the swimming pool), hours of rock pooling, loading up on Bugles (our French salty snack of choice) and a trip or two out to a creperie for a ‘fromage jambon’.

IMG_2026For me, an important part of the letting go of a summer holiday is reading.  Reading (minus an internet connection) frees the spirit to wonder to other places, gives it chance to stretch it’s legs, breath the sea air and recuperate from the endless onslaught of everyday life.

This year I meandered from Amy Poehler’s autobiography, to Harvest by Jim Grace , to Unreliable Memoirs by Clive James, to The Shock of the Fall by Nathan Filer and back to books 2 and 3 of Clive James’ memoirs.  In between I dipped in and out of Elizabeth Taylor’s enormous book of short stories – not quite a mille-feuille, but almost and just as delicious.

More than New Year, for me this is the time for resolutions.  A long walk along the shoreline, a half pichet of Muscadet, a nap, a read and then perhaps another nap helps to put things into perspective.  It was while I was reading Harvest that things started to fall into place.  I’d kayaked across the bay a few times, the sea was lit with fragments of sunlight, families were digging for oysters in the shallows and I dried off and entered the barbarity of land enclosures and the feudal system.  Someone died in the village stocks.  Their dead body got eaten by a pig. I began to wonder if my recovering soul needed a less fibrous diet.

Despite bright, wondrous flashes of hope, the next few (ten?) years are going to demand that I and those around me try as hard as we can to stay strong, healthy and positive.  I see no other way but to steer clear of too much gratuitous misery, hand-wringing and hopelessness, and to fill up with the good, life-affirming stuff.

I remain positive about the tremendous impact that therapeutic families like ours can have on growing lives, but we carry a heavy load on our shoulders  It took a holiday to remind me what we are built on, and that is good times and a healthy spirit.

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definitely ‘nature’

 

Sunderland University Training – CEL&T

The Department of Social Sciences at Sunderland University has launched online training for those working with, parenting, or otherwise supporting children who have experienced loss and trauma (CEL&T).  The training is aimed at those working in social work, education and healthcare as well as foster carers, adopters, kinship carers and others.  The units are affordable, can be done at home and can be clocked up as Continuing Professional Development.

My book The Unofficial Guide to Adoptive Parenting is the basis for the three units I’ve produced.  They are (readers will not be surprised to learn) focused on the messy, lived realities of parenting children who have experienced loss and trauma and the approaches and techniques that I have found the most effective.  I’ve worked hard to make the training fresh and practical and I’ve woven in the ways in which children and families may best be supported.  The units all contain written material, links to other resources and are voiced by me (I can confirm that listening to one’s own voice is up there on the list of Most Excruciating).

There are currently nine units available from a variety of ‘service users’ and professionals including Dr Wendy Thorley, Stephanie Hunter, David Harrop and Voices Making Choices and there are more to come.

As well as it’s development of online training, Sunderland University has hosted two conferences to date which focus on the voices of children who have experienced loss and trauma and ways in which services could better tailor support by listening to these voices.  Another conference is being planned for next year.  There are many individuals and organisations working to improve services and there is of course much more to be done and many obstacles blocking the way.  I’m proud to be a part of Sunderland University’s programme.  It’s rolled up it’s sleeves and got on with it, and I like that approach.

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Time for some Me Advice

I am drowning in end of termliness. My head is full, I’ve a looong list of things which can’t be put off any longer and I am struggling to complete even the easiest of them.  It’s time for some Me Advice:

  1. Get enough actions done to ensure you are not avoiding people on email, or phone, or in person. Things will not get any easier by avoiding people.
  2. For instance, pay the school bus driver, even though it’s annoying and you need to find his bank details and then get your card and put it into the annoying little calculator and …. and ….
  3. Find the Euro Post Office card and find the login details and work out how much you have left on there from last year. Then probably buy some more Euros soon. REALLY soon.
  4. Get new font tyres for your car because you were warned about this weeks ago and why did you not organise it then because it doesn’t take long to sort out and if you don’t you will have an accident and it will all be YOUR FAULT.
  5. Do something with the blackcurrants which you grew and picked and which are now rotting in the fridge.
  6. Likewise, go and give those flowers to your poorly neighbour, before they turn to compost and she starts to think you don’t care.
  7. Try not to feel guilty that you haven’t read and responded to the enormous NICE draft guidance on attachment.  Some mountains are just too arduous and pointless.
  8. Try and stay true to what’s working at home and at school. It’s working. That’s good. It’s the only evidence you need.
  9. Avoid that end of year assembly because you know it will make you feel like sobbing into your hair (again).
  10. Do stuff, read stuff, watch stuff, eat stuff which makes you feel happy. Now is not the best time to bombard yourself with the weight of world unhappiness, to get depressed about the labour party, or to feel angered about people wanting to kill foxes because it’s their right, or their tradition, or something.
  11. Adoption is mind-shatteringly complex but sometimes it needs to be simple. You and me, we’re doing the best we can. And we’re doing alright. Let’s put our fingers in our ears, eat ice-cream and enjoy the summer.280

Red Magazine Smart Woman of the Year Nomination

Dear Friends,

I am writing to ask you to consider voting for me as your Red Magazine Smart Woman of the Year 2015.

Although I am scruffy and tired a lot of the time I would like the opportunity to talk about modern adoption, kinship care and fostering in the mainstream media.  These opportunities don’t come along very often.

I would like for there to be a little more empathy around the place for children and young people who are not able to live with their birth families, some of whom have known the worst of times.  I would like for children to be accepted, understood and supported, not blamed, when they exhibit behaviours which may seem baffling, but which in the context of broken beginnings make complete sense.

When they are angry, when they find it hard to be still, when they struggle to make the choices that others think they should, when they find education difficult to engage with – I would like us to show a little more understanding, to perhaps try and see the world through their eyes and to let this inform our responses.

I would like the routes from broken beginnings into educational under-achievement, chronic lack of self-belief, self-harm and the criminal justice system to be be over-grown and impassable as a result of the splendid growth of high quality, compassionately delivered services.  I would like those parenting and in other ways supporting children and young people to be robustly and compassionately supported themselves, because standing alongside and acting as a loved one’s emotional scaffolding can be a relentlessly difficult and lonely business.

By stepping back from blame, by listening and believing, by acting with compassion in all our professional, social and casual interactions with children, young people and those supporting and parenting them we increase the likelihood of healing.  Healing opens up the routes to brighter futures.

I’d like to take this unexpected opportunity to express all of this.  And I’d be lying if I didn’t say a party would be nice too. If there is one and I get to take a friend, then I’d like to extend an invitation to the kind woman who made the effort to nominate me.  We’ve never met but I guess we’d have a lot to talk about.

Happy summer and don’t forget to #takecare

Sally

A Day in Hay (on Wye)

 

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I spent yesterday in Hay-on-Wye in the company of a lovely group of adopters, foster carers and a certain Dr Vivien Norris (who is, in my humblest opinion, the kind of Consultant Clinical Psychologist that every adoptive family and foster family needs in their lives).

I presented a day based on my most recent book The Unofficial Guide to Adoptive Parenting, which is all about messy, lived experiences and getting it right some of the time and forgiving ourselves when we get it wrong.  We talked about how much of the most difficult aspects of therapeutic parenting are not about delivering prescribed methods but about understanding our child’s inner narrative and experiences and going from there.  We took a long look at how much of this style of parenting is about us, the parents, because it’s difficult, emotional, often provocative stuff, in which our own personal hopes, dreams and values our intricately bound up.

The reason I like getting out of my own domestic bubble is that I am reminded of what an valuable, enormous and often unsupported job adopters and foster carers do.  Many of our children are hampered by what are, to most of the population, unimaginable levels of past neglect and abuse and parenting them requires great skill and fortitude.  Yet we can find ourselves more than unsupported in our role, we can be criticised and blamed.

Of course it’s not all as grim as that.  There are pockets of fabulous support within our local authorities, schools and NHS.  But right now, it feels like that’s what they are: pockets.

Children are profoundly impacted by their experiences of neglect and abuse and they and those parenting them deserve and need far more compassion than appears to be on offer right now.

Thanks to everyone who came and engaged so honestly and with so much energy and humour yesterday.

Good Enough Gardening

Sometimes it’s either make an Angry Pie or it’s disappear into the garden to ponder some of life’s many imponderables, imponderables such as: is it big bin week or just recycling box week? why does Andrew Marr look such a knob on that blue scooter? and why exactly did I click on *that* newspaper article while I was on my holidays?

Physical work in the outdoors is a way of allowing my brain to work through things in it’s own time and to come up with it’s own perspectives on unbalanced infuriating articles challenging issues. It’s my version of mindfulness and I find it suits me better than stillness.

People often assume that because I was a gardener, my own garden will be a picture of National Trustedness.  It isn’t.  Here are a few pictures. And these are by far the best bits.

 

Gard2Gard1Gard3Gard5Gard4We went away for half term to visit relatives and to do some outdoorsy things in Snowdonia.  It was intricately planned in the way these things have to be, but was successful.  After a difficult few months it was good to feel the wind in our hair again.

CPV – a few thoughts and lessons learned

  • At the core of CPV is violence but it is also about threat, intimidation and control.  Living with these behaviours means living in fear and living on your nerves. It is exhausting and can leave us unable to describe what is happening in our homes.  When we are rendered speechless, it is easy for others to assume we are exaggerating, or not coping because we are weak.  This is the main reason why I’ve written about living with CPV.  I think that you need to live it to really understand it.  Those supporting families who have not lived it need to listen and believe.

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  • The first time that a social worker said to us ‘I get that this is more than a meltdown, that it is terrifying’ we felt the biggest sense of relief that someone understood.
  • The social worker who ‘got’ the violence, taught us how to hold our child when he was lashing out and completely out of control.  Together with the therapeutic work that comes with holding this has been the single most effective strategy we have been taught.  I would go so far as to say it has been a game-changer.
  • Underlying CPV is trauma and blinding fear.  It is visceral rage.  During these times, no amount of reasoning works.
  • We have made progress by exploring what the anger and aggression is about. This can only be done after the event and not in the eye of the storm.  I started by wondering ‘this anger feels like it’s about something really huge, not something like whether or not you had any sweets left’.  I went from this to a guessing game, where I had to do the guessing ‘out of ten, how close do you think I am, ok, changing classes?’.  The response may be 5 out of 10.  I would always throw in a few silly guesses to keep things light.  One day I hit on on something significant and it allowed us to explore it in more depth. It was important for me to say ‘that must feel devastating and scary’ because that would often cause a little light to come on and I would see hope and connection in the eyes of a frightened child.  It has also been important to say ‘I understand why you feel so angry, I feel angry for you too’.

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  • If an episode of aggression resulted in destruction, we usually cleaned up the the mess together, whilst talking about what had happened.  I have no idea whether this kind of repair was effective or not.
  • When everyone has recovered, it’s important to be curious about what these episodes feel like for the child.  We managed a few dialogues which helped me to understand ‘red brain’ and what I was doing or not doing which either made the situation better or worse.  This ‘we’ll solve it together’ approach has worked for us.
  • We have a plan in place, just in case things get really serious.  I am lucky to live across the road from two police officers who are unflustered by aggressive behaviours and who I trust to help me intervene if ever I need them to. Every once in a while I check in with them to make sure they are still happy to be part of our back up plan.
  • I won’t ever know for sure, but I think that the early work we did around CPV has made our teenage years significantly less violent than they might otherwise have been.  Aggression has raised it’s head a bit lately.  Holding is now impossible so my immediate response is about keeping everyone safe and allowing the raging person to run for cover. I have however drawn a line, ‘if you ever physically hurt anyone in this house I will call the police’ and I mean it.
  • I am uneasy with some of the language around CPV and the term CPV itself.  It’s important to me that we don’t forget that our children are operating from a place of intense fear.  They don’t wake up in the morning and consciously decide to harm us or our belongings.  At the same time I’m not seeking to deny the high impact that these behaviours have on families.
  • Early and sensitive interventions, that involve the whole family and are cognisant of a child’s early experiences are where we should be headed I think.  There needs to be a greater consideration of FASD too.  Those living with violence need much greater support and understanding, plus a break every now and again.  And may I put in a plea for proper research into violent behaviours and what does and does not help.
  • Speaking without any research behind me, I wonder if some children have been so damaged by their early experiences that they cannot function within a family setting.  We need to be honest about this and not place children expecting everything in the garden to be rosy.  Right now, there is no incentive for adopters to speak honestly about their experiences and for the right decisions and interventions to be implemented.  We need to move to a place of informed realism because without it we are stuck with optimism, and when that fails, blame and it’s just not good enough.