By Luci Ashbourne

Date Posted: December 18 2013

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Luci Ashbourne is a teaching assistant and she has just completed her studies on the Mulberry Bush Organisation’s Foundation Degree in Therapeutic Work with Children and Young People which is validated by the University of the West of England.

 

How do we Understand and Work with Organisational Re-Enactment of Children and Young Adults Traumatised Backgrounds?

The young people that are referred to the Mulberry Bush School are some of the most emotionally traumatised children. They have often suffered severe neglect and abuse in early life. Working with the children can be an incredibly difficult task; the behaviours they present and the preoccupation that the children need, can be overwhelming. The staff who work at the Mulberry Bush are highly trained to try and understand the inner world of the child and see the behaviours as a communication. The school has a reflective culture and this approach is underpinned by psychodynamic understanding. This enables the staff to understand and process their own feelings and work therapeutically with the children.

It is during these reflective meetings and spaces, and using my reflective journal, that I first started thinking about the possibility of the children’s backgrounds being played out again and again. I would be involved in conversations about children who had been abandoned or emotionally neglected and often we would abandon the topic and move onto a ‘higher profile’ child. These were often the children whose paperwork would be late, handovers forgotten and one to one provisions repeatedly rescheduled due to unforeseen circumstances. I would wonder at the irony. This was not due to lack of skill or care of myself or my colleagues, it felt circumstantial and like it could not be helped. I would observe how one child, whose early life was one of chaos and confusion, a boy who had lost each and every person he ever formed an attachment to lose social workers, foster carers, teachers and key workers over and over again. I would listen to stories of a child whose mother had been abusive and neglectful; while the father had been the main carer and at the age of two the child had witnessed him die. It would be during these meetings that we would refer to the child’s unconscious attempt to ‘split’ good and bad. Good foster carer, bad school; good teacher, bad teaching assistant; good house, bad class and on and on it goes. With the full awareness of the possibility of this dynamic occurring around this particular child the treatment team would often be divided. It was like these ‘splits’ of good and bad could be seen if one was on the outside of them but equally unseen and acted out if involved in the process.

I am going to explore this phenomenon specifically by looking at a case study of one of the children at the Mulberry Bush School and linking his experience and that of the organisation to theoretical ideas. I will look into possibilities that this phenomenon may be determined by certain circumstances, experienced at a particular age or developmental stage in early life. It is important to note that during the process of researching this topic I found direct literature on the subject difficult to obtain and therefore will also use anecdotal evidence that I have gathered from my own observations and that of others in the school. I will also draw from Ronald Britton’s 1994 paper “Re-enactment as a Response to Family Dynamics” frequently as it was a highly valuable source that promotes greater understanding of what may be happening.

The research process, all along, was hindered by a sense that this topic could be difficult to think about. The people I interviewed are highly experienced reflective practitioners and it came as a surprise to find that many did not seem to understand where I was coming from when asked for specific observations and experiences. I even went so far as to ask my tutor to re word my questions to ensure that it was not just an articulation problem. It felt to me, very much that, awareness of the phenomenon was high but that discussing it was an arduous process; as was researching it. The literature is few and far between and I wondered if both of these experiences mirror each other.

I will refer to a case study of a boy ‘Eddie’ who has been at the school for four years. I will make reference to his journey, and that of the staff working alongside him as I discuss the different aspects of this phenomenon.

“Eddie was seven when he was referred to the Mulberry Bush School and simultaneously removed from his mother’s care at home and placed with foster carers. The trauma of losing all that he knew was significant despite the emotional and physical neglect Eddie had experienced at home that necessitated it. When Eddie first arrived at the School the adults who worked with him found him to be a very quiet and withdrawn child. He was diagnosed with attachment disorder and it was felt strongly by his network that forming secure attachments would be impossible due to the severity of the trauma he had experienced to the point where it felt hopeless to try and form them to begin with. Could it be that Eddie’s unconscious defence against having to live through another loss like that was to avoid have trusting and close relationships with anyone at all? If it was, this defence was successful.”

What is behind the phenomenon?

It is well known and researched that powerful unconscious processes affect individuals working alongside traumatised children. Often those working alongside them are placed in the role of an abusive person from the child’s past and the projections of intolerable emotions from the children can be powerful. The transference and projections are unconscious defence mechanisms against anxiety. The countertransference and projective identification can be held at individual, team, organisational or even network levels.

Transference can be defined as experiences and feelings that come from a past interaction or relationship with family members or significant others in earlier life. These beliefs and feelings sit in an individual’s unconscious mind and a return of these ‘old’ feelings can be triggered by ‘new’ events and interactions. Counter transference is the emotional reaction to these feelings by the ‘new’ person experiencing them. It is important to remember that one’s own early experiences will help shape these responses but understanding transference and countertransference can be a very ‘effective therapeutic tool’ (Pearson 2001).

Grant and Crawley (2002, p.18) define projection as “a psychological process that involves the attribution of unacceptable thoughts, feelings, traits or behaviours to others that are characteristic of oneself. Whereas in transference the therapist or others are experienced in having the same attributes as significant others, in projection it is the disowned aspects of self that are ‘transferred’ onto another”.

It is with relative ease that we can understand projection and transference affecting and evoking responses in individual and even in group interactions. It becomes much harder to understand how these toxic unconscious defences can affect entire departments, treatment teams and indeed organisations.

John Diamond (2012), CEO of The Mulberry Bush School, explains that projective pathways can be mobilised from ‘child to adult, from adult to adult, from team to team’ thereby explaining the phenomenon as one of ‘passing the feelings on’.

Furthermore, Emanuel’s (2004, p.163) paper ‘Triple Deprivation’ discusses that “trauma and disturbance associated with severe deprivation and abuse within children and families can impact on the professionals involved in their care, interfering with their capacity to think about and provide containment for the children and their carer’s, thereby compounding their deprivation”.

Britton (1994, p.79-80) uses a play or a theatre piece as a metaphor to help us understand the phenomenon starting with the family dynamics and moving through to other groups and networks around the child stating that, “the cast changes, but the plot remains the same”. Those that work alongside the children and the organisation itself can play a part in the drama that mirrors the family dynamics and child’s early experiences. This occurs unconsciously and is ‘expressed in action’.

Horne (1999, p.365) describes three different ways in which the unconscious process can seep into the system, which seem to reflect the research, views and opinions above:

• Mirroring process – identifying with and adopting roles of family members.
• ”Reflection of the dysfunctional family system itself – secrecy, denial, abuse, collusion and misapplication of power are then unconsciously repeated in the support systems, which , like the family, may also experience difficulty in seeing the situation, hearing the evidence and acting in the child’s interest.”
• Re-enact the internal world of the child. The defences and projections used by the child will find themselves, again unconsciously, lodged in the network where, unless the process becomes conscious, they will be harmful.

I will refer back to Eddie at this point and we can see that an unconscious collusion with an unhealthy dynamic was at play:

“The seemingly irreparable damage of his early experiences compounded by the loss of what he did have was serious. Being around Eddie was difficult, the adults and other children found themselves easily annoyed by him. The adults in particular found him at times intolerable and he became hard to think about. The household manager of his house described Eddie as a child easily forgotten. The adults found themselves missing Eddie off lists when planning things to do with the children, meetings and paperwork would be forgotten and rescheduled, only to be rearranged again.”

How can we be aware of it?

Ward (2003, p.98) reminds us that in the work with traumatised children, ‘the most useful information is conveyed unconsciously (by projective identification and transference) and that this means that good workers will be caught up with the child’s inner world view. Bad practice is not getting caught up in the first place but remaining caught up.’

So how can we ensure that we can see what may be happening?

Britton (1994) discusses the possible indications that may occur when these unconscious forces are at play on a professional level:

• The intensity of feeling aroused by a case. • The degree of dogmatism evoked. • The pressure to take drastic action or urgent measures.

By contrast:

• Inappropriate unconcern.
• Surprising ignorance.
• Undue complacency.
• Uncharacteristic insensitivity.
• Professional inertia.

(Pg. 79)

He also goes on to explain that any kind of ‘acting out’ on a professional level may only become apparent when it emerges in varied forms under the same configuration and recognising the ‘provocative or paralysing effects can give pause for reflection’.

The work at The Mulberry Bush School is underpinned by reflective practice. All employees are encouraged to keep a personal reflective journal and the structure and routine of the school at all levels is one of a reflective culture. Individual supervision, team meetings and reflective spaces all help to shape this culture and foster a natural tendency towards reflective practice.

Reflective learning, through the practice enables integration between theoretical and practical themes and issues and practitioners are able to ‘actively learn’ through personal experience as opposed to being taught or told. Reflective learning also ‘provides a foundation for challenging dogma and prejudice’ and encourages practitioners to inquire and question. (Thompson and Pascal, 2012)

It is within these reflections that one or more people may notice any indications that this may be occurring. It is this awareness that Britton (1994, p.86) reassures us can lead to a ‘realisation, and change as a consequence of realisation, rather than change as an alternative to realisation may prevent patterns that cross not only individual, but generational boundaries’.

The Mulberry Bush School identifies a treatment team for each child, this comprises of the child’s key worker, teacher, therapist, family network practitioner and other significant people that work with the child. The treatment team meetings are facilitated by a household manager who has an overview of the child. The idea behind the treatment team meetings is not only so that information can be communicated about the child but that by bringing all the different people together, any emerging themes or dynamics will become apparent and staff will be aware of each other’s difficulties and endeavour to provide a consistent approach when working with the child and support one another with any particular difficulties.

Looking at the case of Eddie in this context we can see how valuable reflective practice is in escaping the collusion that was previously occurring on an unconscious level:

“Because reflective practice is a core part of the therapeutic community at the school, the team were able to notice that this was happening. They discussed during treatment team and children’s meetings how odd it was that even the most organised and conscientious individuals were struggling to hold him in mind. They began to question whether this phenomenon could an unconscious dynamic that was being played out throughout the team and the wider network. Eddie was happy to be in the background and did not seek out attention or affection from anyone. It became clear that this was likely his unconscious defence against repeated trauma was indeed facilitating a level of neglect from everyone around him.”

Can we predict it?

Britton (1994, p.82) argues that the compulsion for professional individuals and organisations to repeat unconscious patterns are instigated by defences against anxiety; the more primitive the mechanism, the more likely the phenomenon will occur.

Klein (1996), in her paper “Notes on Some Schizoid Mechanisms”, discusses anxieties that relate to very early infancy and cause the child’s ego to develop defence mechanisms against this. Klein describes the first defensive ‘position’ as a ‘paranoid schizoid’ one with the most primitive defence mechanism ‘splitting’ as part of projective identification emerging; “‘good (gratifying) and bad (frustrating) breast”. During this time the baby will experience intense fears of annihilation and persecution. This happens as part of normal development. When the mother is able to respond to and contain these intense feelings the infant can begin to bring these ‘split off’ aspects together and move into the ‘depressive’ position. This position is a much more introspective one which fosters an insight into ‘psychic reality’ and more appropriate and realistic responses to feelings of grief, loss and guilt emerges in the form of a need for reparation. Without good enough care the infant is unable to work through the paranoid schizoid position which leaves them with these primitive forms of defence in place.

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Furthermore, Britton (1994) proposes that families who operate within the paranoid schizoid position, due to their own early experiences often ‘evoke unconsciously determined action in those around them’. In such cases, the process of projection, projective identification and splitting can foster the perception that one member of the family is the inherent source of all of the difficulties causing the scapegoat phenomenon to occur in which the child identifies with these projections which often leads to a referral to a specialist unit.

This would suggest that the earlier in life any neglect, trauma or abuse occurs, the likelihood that this phenomenon will occur. It also suggests that another indication that may increase the likelihood further is if the parents and other family members operate with the mental mode of the paranoid schizoid position. The

Mulberry Bush School works with many children who have experienced trauma at a very young age, often pre verbal or even from birth. They have often been born into inter-generational neglect and abuse and therefore the staff at the school are highly likely to experience these painful, almost intolerable projections.

What are the benefits of awareness?

It is clear that this phenomenon does indeed occur, and often in organisations that work with traumatised individuals. It is also clear that it is paramount to the individual that these unconscious and unhelpful defence mechanisms are challenged in order to foster healthy relationships and mature coping strategies. Any unrecognised, unconscious collusion will bring about repeating, detrimental patterns and experiences.

Briggs (2004, p.38) reiterates that “the environment may become an emotionally depriving environment if the adults either miss the point of, or become overwhelmed by, the child’s communications through difficult to manage behaviour. When a whole staff group or network does this, then triple deprivation is the outcome”.

“For such ‘multiply traumatised’ children their adverse early experiences create defences against feelings about parenting or ‘oedipal knowledge’, which can deny them a capacity to think about emotions and relationships. The school helps them reach a depressive position, the ability to think about feelings, rather than to remain in the ‘blind eye’ of the paranoid-schizoid position. Steiner (1985) writes about how in the drama of Oedipus the theme of ‘turning a blind eye’ emerges between participants. Oedipus blinds himself in an impulsive rage when the truth about his father is finally disclosed. This story implies the importance of remaining open to ‘seeing’ our impulses and states of mind, otherwise ‘not seeing’ or the creation of ‘blind spots,’ in our work may lead to the development of such a closed system. Hence the need at the school for ongoing reflection on our work, relationships and actions through the use of reflective support structures.” (Diamond, 2012)

Britton (1994) discusses ways of dealing with these difficult and often paralysing dynamics. Firstly he say that we need to accept that it does indeed happen; and often. He states that when we feel at our most incapacitated we can use that space to give pause for thought and reflection. This reflective ‘space’ can enable an individual to give essential attention and understanding to demanding interactions with a child, to process difficult emotional and engender meaningful responses. With meaningful, consistent identification and bringing it into consciousness on an adult level in order that we can tolerate the difficult feelings.

Ward (2003, p.98) argues that “it is the institution’s responsibility to provide opportunities to ‘debrief’ staff; that is, it is essential to the good practice of a therapeutic community that there are formal meetings in which staff can help each other to understand how they have been caught up in the work and to understand the meaning of the material.”

So what did the reflections of the staff working with Eddie lead to?

“After discussions and the realisation that this was a collective experience, remaining conscious of it enabled the team to put responses and practical strategies in place to hold Eddie in mind with the hope that he may begin to feel thought about and invest in a trusting relationships. Eddie’s key worker was to make a conscious effort to put him on the agenda in meetings and to let Eddie know that she was thinking about him as often as possible. This was not easy as Eddie did not initially respond to the preoccupation and it felt, for a time like a contrived, rehearsed experience that was difficult for both Eddie and those around him to engage in. However, in time it began to feel more natural and real. After six months it became obvious that Eddie was no longer the child that was hard to hold in mind and when he presented difficult behaviour the adults did not experience the feelings of annoyance and hopelessness that had been so overwhelming. In turn Eddie was able to begin to enjoy a high level of preoccupation and invest in relationships and interests that could be of value to him. Eddie thoroughly enjoys being at the school he is well liked and thrives in the environment. Bringing the unconscious defence mechanisms of such a traumatised child into adult preoccupation helped to change these unhelpful dynamics not only for those who are aware of it but by enabling the child to access healthy and mature coping strategies”

What if our efforts seem to be futile?

Case study: Jessica

During my two years at the school 11 year old Jessica had been with the same foster carer’s, she refers to them as mum and dad and they were making solid plans for the future together. Jessica had struggled to form appropriate attachments and it felt like she was really making progress at school and at home. She had experienced a number of sudden losses in foster care and at the school which mirrored her early experience of neglect from her biological parents. It felt, to all, as though this dynamic in her life had really shifted and things were going well. Sadly and suddenly her foster carer’s announced that due to circumstances out of their control they were moving to Australia and could not take Jessica with them and they moved before the long summer break from school. This loss was compounded by Jessica’s teacher not returning after the summer break. I decided to speak to her keyworker and find out what his feelings were about this repeating pattern for Jessica. He said:

“Jessica has been at the school since 2009 in that time she has had four sets of foster carers which only one of them has been intentionally permanent. There is a pattern of Jessica being dropped and not held in mind by social services, she has had four social workers in her time at the school as well. All have required a lot of prompting to have input around Jessica. These are patterns that Jessica has experienced since she was a child and being dropped and not thought about by her parents, this would have been at a pre-verbal level, which has then been repeated throughout her life. Most recently by her last foster carers, a relationship that Jessica had given all of herself to and seemed to have broken the cycle of being dropped and that feeling of not trusting her relationships with adults. Since then Jessica has got new foster carers, whom she appears to have tried hard to make a relationship with but feels as though it is just going through the motions and expecting to be dropped again. As adults we have discussed not wanting to engage with these new carers and how much of that is Jessica’s projections of wanting us to do it for her so she won’t be hurt again.

We have tried hard at the school not to repeat these patterns but haven’t been entirely successful even though we make a conscious effort. Jessica has had three key workers. Often in team meetings people talk about forgetting Jessica’s targets and things we are working towards with her, this feels like a repeat of Jessica not being held in mind and we have gone back and repeated pieces of work for the benefit of Jessica and ourselves. We felt like we made real progress when Jessica first started going to her previous foster carers and had a couple of new people on her network we made a conscious effort to meet more often between reviews to help the levels of communication and feeling of not being able to think of Jessica when there is too much space between meetings. This felt like a real shift and Jessica’s behaviour at school and at home reflected this. After her foster carer’s left Jessica’s behaviour began to deteriorate although she was more engaged with her feelings than she has been before and put a lot more reliance on the adults at school and used adults she had more history with to support her through this time. As a network we get the sense of going back to square one with a new social worker and new foster carer’s and there being a repetition needed but not feeling like we could do it all again. Could have been Jessica’s feelings or ours, this may have been that sense of helplessness that there was nothing more we could do other than just keep Jessica here full time.”

Emmanuel (2002) discusses a further aspect of the re-enactment phenomenon which “relates to the situation of ‘drift’ in relation to care plans for children who have suffered serious abuse and neglect” specifically in regard to children who have been in a state of limbo in terms of permanency or adoption and may still have access to birth parents with many short term foster placements. He describes how many of the most disturbed children in this state of limbo display a ‘disorganized attachment pattern’. Children with a disorganized attachment disorder have simultaneous impulses to be comforted by and flee from a frightening or frightened mother figure. The child is left in limbo on both these levels it is not uncommon for this paralysis to be reflected in the professional network. The professionals working alongside the child may feel all they can do is be there for the child without fully engaging with the family. Could it be that this is an insight into what is happening around Jessica and her network? Her keyworker mentions feeling that all we can do is keep her at the school full time and also the dilemma of not wanting to engage with her new foster carers. He also mentions that Jessica was more engaged with her feelings after her most recent loss. I would argue that although this case is not a straightforward as that of Eddie’s story, in the case of Jessica, the ability and resilience of the adults to tolerate such unbearable feelings again and again on behalf of Jessica has indeed fostered a shift in the defences she presents when faced with such terrible loss.

Britton (1992, p.83) does warn us that it is crucial to accept small changes and not losing sight of them. ‘Expecting a quick transformation is unrealistic.’ and also that this task will not be an easy one. Indeed he states:

‘When professional workers are called upon to resist unconscious collusion in order to become aware of an underlying dynamic configuration, they will find themselves going against the grain of their own emotional inclinations’

Conclusion

Working alongside the children at the Mulberry Bush School can be debilitating, amazing, terrifying, sobering and inspirational. The aim of this research was to bring together useful statements and research in a way that may be helpful to individuals and teams experiencing frustrations with one another, with the children and the wider network. This is a reminder that we should not blame ourselves or each other if we do indeed find ourselves caught up in this phenomenon, but actually see it as a helpful tool and insight into the inner world and early experience of the child. If we can recognise what is happening, without judgement of anyone involved we can utilise our own reflections and that of others in order to begin to tolerate and even change the difficult feelings evoked. The reflections from any individual should be taken with as much weight as anyone else. Hierarchy, in this context is unimportant, other than that those who are more experienced reflective practitioners may therefore recognise unhealthy responses, actions and non-actions but we are all as susceptible as each other to being absorbed in these dynamics. We also must remain confident that faced with even the most difficult and powerful dynamics the reflective culture of the school and that of each individual can promote seemingly small changes that are paramount for the development of the inner world of the traumatized child.

Luci Ashbourne.

References:

Briggs, A. (2012) Waiting to be Found: Papers on Children in Care. London: Karnac Books.

 

Briggs, A. (2004) “Reversing a Spiral of Deprivation: Working to ameliorate the relationship of staff and boys in a residential home”. Journal of Social work practice, 18 (1) (online) http://dx.doi.org.ezproxy.uwe.ac.uk/10.1080/0265053042000180536 {Accessed online 25th October 2013}

Britton, R. (1994) Re-enactment as an Unwitting Professional Response to Family Dynamics: Crisis at Adolescence. London: Jason Aronson Inc.

Diamond, J. (2012) “Creating a ‘third position’ to explore oedipal dynamics in the task and organisation of a therapeutic school”. In ‘Waiting to be found: papers on Children in Care’, Edited by Andrew Briggs, London: Karnac Books.

Emanuel, L. (2002) “Deprivation x 3”. Journal of Child Psychotherapy, 28 (2) pp.163-179.

Grant, J. and Crawley, J. (2002) Transference and Projection: Mirrors to the Self. Maidenhead: Oxford University Press.

Horne, A. (1999) The Handbook of Child and adolescent psychotherapy: Psychoanalytic approaches. East Sussex: Routledge.

Klein, M. (1996) “Notes on Some Schizoid Mechanisms”. Journal of Psychotherapy Practice and Research, 5(2), pp.160-179. (online) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330415/pdf/160.pdf {Accessed online 30 November 2013}

Pearson, L. (2001) “The Nurse Practitioner: The Clinician-Patient Experience”: Understanding Transference and Countertransference, 26 (6) pp.8-11. (online)http://uwe.summon.serialssolutions.com/2.0.0/link/0/ eLvHCXMwY2AwNtIz0EUrE4xTTIxTzRMtDRINTcyTDBJTDMwtU1KNEg3NzYBtaPCJGy4uZj4eJs5Rph48iPLNTYiBKTVPlEHZzTXE2UMXVlrG JyaBBgKSS4rjzc1MDI0MQOdIiTHwJoJWheeVgHePpYgzsKYBozBVHFSsigPNFGfgiLAMD7WI9PaDcIVgXL1i8BYnvcIScWApDk4BusZ6BgDW yTMA {Accessed 24th November 2013}

Thompson, N, and Pascal, J. (2012) “Developing Critically Reflective Practice”. Reflective Practice: International and Multidisciplinary Perspectives , 13 (2) pp.311-325. (online) http://dx.doi.org.ezproxy.uwe.ac.uk/10.1080/14623943.2012.657795 {Accessed online 27th November 2013}

Ward, A. (2003) Therapeutic Communities for Children and Young People. London: Jessica Kingsley Publishers.

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