Christine Bradley (2018): Revealing the inner world of traumatised children and young people.

Revealing the inner world of traumatised children and young people: an attachment-informed model for assessing emotional needs and treatment

Christine Bradley with Francia Kinchington. Foreword by Judith Trowell.

£24.99

London: Jessica Kingsley Publishers ISBN 9781785920196 239 pages

https://www.jkp.com/uk/revealing-the-inner-world-of-traumatized-children-2.html

Professor Celia Roberts, Professor of Gender and Science Studies, Dept of Sociology, Lancaster University writes…

I am a social scientist and adoptive parent of two children, one of whom experienced neglect as an infant and toddler. Adopting through the Local Authority, I have been fortunate to receive a wide range of training opportunities – provided by adoption charities, the Local Authority, and by CAHMS-employed psychologists. I have also attended professional conferences about childhood trauma and trawled through a groaning bookshelf of titles from Jessica Kingsley Publishers. I am part of a small support group and follow online discussions about adoptive parenting. I religiously read Adoption UK’s magazine and website. I guess you could say, then, that after a decade of being an adoptive mother, I am reasonably well-informed about childhood trauma and its effects on adopted children.

In all this training and reading, however, I have only very rarely encountered the work of Donald W. Winnicott. Indeed, psychoanalytic approaches in general tend to have a very low profile in this field, at least as far as I have experienced it. Instead, one finds, after brief discussion of Bowlby’s attachment theory, elaboration of ideas of co-regulation, attunement and trauma, and, more recently, neuroscientific accounts of the brain-body and ‘brain-based parenting’ (the work of Daniel Hughes is exemplary here).[1]

It was with much pleasure and excitement at the novelty, then, that I read Christine Bradley’s new book , Revealing the inner world of traumatised children and young people: An attachment-informed model for assessing emotional needs and treatment. Although the book is oriented towards professionals working with children and young people (including foster carers), I feel it has huge amounts of wisdom to offer adoptive parents. I have certainly been recommending it to my circles of friends! What the book offers, in my view, is a fresh mode of categorising and organising the kinds of difficulties children who have been abused and neglected experience. Most refreshingly (and in stark contrast to the more typical ‘attachment style’ accounts which tend to figure attachment styles as permanent character traits), Bradley’s WInnicottian model figures these categories of unintegration and attachment patterns as developmental. In this model, children and young people can, with the right adult help, progress through the various developmental stages, moving towards greater integration and more secure attachment styles, and consequently, to happier lives. For me, then, this book both very robustly describes the great difficulties that many of the adopted children I know experience AND gives parents and young people hope that things can get easier. This view chimes with the more trendy neuroscientific view that promises neuroplasticity until at least 25 years of age, and provides us with clear guidance on the kind of support that will bring kids into these different forms of relating to others and to their histories.

The book contains helpful tables of children’s ways of being – suggesting questions that carers (and parents?) could ask about particular children’s behaviour in order to gauge at which stage they are currently operating: frozen child, archipelago child, caretaker child, fragile integrated child. It describes the kinds of reactions one might see to various stressors and explains what might be going on for the child in those moments. Bradley provides detailed guidance towards building appropriate treatment plans and ways of living with the children that will facilitate their development through the maturation stages. Most of this is focussed on therapeutic communities rather than traditional households, but there is nonetheless much of value to adopters and home-based foster carers here: not the least, frank acknowledgement of the serious psychological difficulties of living with a child or young person with problems of integration and attachment and advice on how to take care of one’s self in order to be able to keep providing helpful care. It was fascination and inspiring to read stories about Bradley’s and others’ encounters with children at these various stages, and what forms of words and actions had helped the children move forward.

Throughout this book, Winnicott’s compassion for children’s suffering and his deep interest in the problems of living and parenting shine though. Bradley provides us with a clear and useful reformulation of Winnicott’s ideas, based on years of professional experience, rending his (and other key theorists’) concepts suitable to the contemporary moment. This is pure gold for adopters in my view – I hope it will be read by many and gain its rightful place on those Local Authority and adoption charity training courses that make adopters’ lives possible. Of course, a book directly oriented towards adopters would be a wonderful sequel to this volume!

[1] For an analysis of this shift, see: Mackenzie, A. and Roberts, C. (2017) Adopting Neuroscience: Parenting and affective indeterminancy, Body & Society 23(3):130-155.

Prof Adrian Sutton Director, Squiggle Foundation writes…

Christine Bradley’s excellent book arises from psychoanalytically informed work with profoundly troubled and troubling children who, one also needs to acknowledge, can be extremely troublesome. Failures of environmental provision and adaption at the earliest stage of their lives have left them unable to capitalise on the more usual, but inherently special, qualities of good-enough everyday care and education even when special adaptations, including psychotherapy, have been possible. These children present major challenges to those involved with them and the children themselves are unable to stop themselves being the authors of their own downfall. These are children who are said to be “unintegrated”.

Integration is a central concept in Winnicott’s schema of developmental processes: “…if one can conceive of a fully integrated person then that person takes full responsibility for all feelings and ideas that belong to being alive. By contrast it is a failure of integration when we need to find the things we disapprove of outside ourselves… One thing about a healthy person is that he or she does not have to use in a big way the [unconscious] technique of projection in order to cope with his or her own destructive impulses and thoughts.”[1]

For the individual whose integrative abilities fail, life becomes reliant on their own or other people’s enactments and the evocation in other people of states of mind that cannot be contended with in any other way. These unintegrated individuals present what Winnicott referred to as “a matter of both personal and social diagnosis.”[2] Their own inability to integrate experience means they cannot be supported in their development through the more usual forms of social integration or even a constellation of adaptation of their ordinary family care alongside psychotherapy. Barbara Dockar Drysdale, working in the setting of residential therapeutic care, described their plight “not having had primary experience, [such children] cannot make a transference, they have not reached guilt or anxiety. They need… primary experience with a therapist, who must do something for a child which would normally happen spontaneously to a mother and child during the first months of life. This is work involving synthesis not analysis.”[3] Their reliance on projective defences means that those providing their therapy and care require an equivalently containing and integrating environment to sustain them in seeking to re-establish healthier developmental trajectories, re-establishing maturational processes where possible and adaptive mechanisms where these are not possible.

Bradley’s book provides an excellent and accessible explanation of the concepts and framework underpinning the approach. It will enable readers to recognise, understand and respond to unintegrated children in ways which can counteract cycles of repetition: it promotes a robust, empathic but unsentimental approach, and counteracts the influences which may promote a ‘moral attitude’[4] towards, or against, the children. Most importantly, she formalises this into a structured Needs Assessment which will enable practitioners to recognise much more clearly who and what they are dealing with and whether their ways of responding are more or less likely to be of benefit. Experience in using the framework will enable practitioners to track progress, identifying and differentiating regressions in the service of health as opposed to unhelpful psychological and relational processes which may emerge. Supporting this presentation is acknowledgement of the need to attend to providing a Facilitating Environment for those upon whom the children depend.

Although sub-titled “An Attachment-Informed Model”, I would like to emphasise the essentially Winnicottian nature of the model Christine Bradley presents and the profound influence of the work of Barbara Dockar Drysdale. It takes us into a world which cannot ever be objectively described – the personal experiences of these children and those caring for them which need to be held in and by the mind and through the care of the body – and does it in a way which makes more likely the emergence of a good-enough internal world and provision of an external environment which can prevail despite the assaults upon it.

Christine Bradley’s book should become a standard text for teachers, students and practitioners in child mental health, social work practice and social policy formulation.

[1] Winnicott, D.W. (1960) Aggression, guilt and reparation. Chapter 16 in Winnicott, C., Shepherd R. & Davis, M. (1984) Deprivation and delinquency London & New York. Tavistock Publications 137-9.

[2] Ibid 223

[3] Dockar Drysdale, Barbara. (1990). The Provision of Primary Experience. London: Free Association Books.

[4] Winnicott D.W. (1953) ‘Symptom tolerance in paediatrics’. In Through Paediatrics to Psychoanalysis. London: Hogarth Press and the Institute of Psycho-Analysis. 104

Adrian Sutton

May 2018