THE HOLDING ENVIRONMENT

“In some respects the therapy is the ‘order’ of the community and the ego-functioning and behaviour of the staff.

The milieu, the whole management structure must reinforce and support this;

if contradicted it will re-enact and echo earliest environmental failure and

breakdowns.”

John Withwell

“A therapeutic milieu must provide the right emotional climate for its patients so that they can regain mental health. It will succeed in doing this to the extent that it

is able to create a human and social environment which promotes the social

solidarity of staff.”

Bettelheim

“Social Care workers dealing with unintegrated and traumatised children

are frequently at the edge of their emotional and intellectual capacity.”

Campbell & Draper

“Psychological development is based on the parental capacity to tolerate and

understand a child’s raw emotional states of distress…. That it is the mother’s job to

make sense of these bewildering sensations for the baby: to give them shape, coherence and meaning which

then makes them tolerable.”Bion

“The focus for this is the provision of primary experiences for each child, in a dependent attachment with a specific

member of the care team.”

Tomlinson

So, questions must be asked….

1.What is it that staff are asked to hold, or uphold, on a daily basis?

2.How can we create the holding environment for staff?

What is it that staff are asked to hold, or uphold, on a daily

basis?

How can we create the holding environment for staff?

Management’s responsibility:

Continuing source of encouragement, support, guidance and direction

Democratic approach

Shared sense of responsibility

Foster potential for leadership in others

“It is possible to have management without therapy but not therapy without management. Management includes safety, boundaries and

all aspects of the organisational structure. Without these conditions, traumatised children

will not be able to make use of therapeutic work…in residential and institutional settings

the management structure of the whole organisation is relevant to the therapeutic

task.”Menzies Lyth

What is it we are asking staff to do with all this?

To provide a secure base through the use of themselves as the ‘good

enough’ parent

So what can we do?

Provide a safe physical presence to the children Demonstrate that we are reliable trustworthy grown ups. We can try and protect the children from further harm from others and from themselves (That’s a big ask) We can be the recipient of the child’s anger, fear and confusion (To be the bad object)

So what can we do?We can become emotionally available to the child, to allow a dependency to develop when needed We can meet the child’s primary needs for physical care (regression may or may not be involved here) We can provide clarity and honest answers to children’s most difficult questions (Why does my mammy not love me? Why did my brother hurt me?)

So what can we do?We can be forgiving and non punitive We can demonstrate an unconditional and non judgemental attitude at the most difficult times (when staff have been hurt or lied about) We can listen, believe, acknowledge, and empathize with the child around the source of their trauma and suffering. We can provide new positive experiences which foster the child’s potential to grow and develop and which address some of the voids in their lives. (Be they in the areas of play, education, sensory, or other)

So, what can we do? 

We can provide the child with the feeling of been unique and special to someone in their world. (Special time, individual care and treatment plan, key worker)

 We can strive to manage the child’s anxieties and return them to the child in such a way that the child has more control over them.

We can be professional and genuine at all times and in all our dealings with the children and the outside world around them.

We can provide……

HopeJoy

Fun