At CareVisions we know that no child who has experienced trauma or abuse and who may use maladaptive strategies for coping with the effects of this is going to heal and learn to use different ways of coping without first feeling secure. We know that verbal reassurance is rarely enough for a child, they first need to experience safety and environmental protection in order to feel safe. It is therefore essential that we strive to create a safe place in the real world so that the child doesn’t need to in their inner world.

This is often made more difficult by the repeated pattern of placement breakdown that many of the children may have experienced prior to coming to stay with us. Many having been told that they are in a home to stay, yet within weeks being asked to pack their things away as they are moving onto somewhere new.

To create a sense of safety, therefore, we provide stable and predictable physical environments with clear-cut daily routines and expectations and a culture of ‘unconditional care’ - being there for the child for the long term. In practice, this means putting in place boundaries and communicating with the young person in a way that improves their understanding of how their past experiences have affected the way that they think, feel, and behave today.

This experience not only provides safety but also creates the correct "holding environment" that is nurturing, comforting and where healing can take place. It provides a ‘potential space’ within which it is safe for the young person to think about their trauma, and safely experience feelings about it.

In this way the milieu or ‘Living Space’ within a group living environment becomes the focus for the residential therapeutic care staff as they attempt to use daily events and processes as part of their therapeutic work.

Understanding the Child’s Behaviour

At CareVisions we understand that any child who has been abused carries around a set of habitual expectations and responses specifically designed for survival. All of our care staff continually strive to make sense of the child’s behaviour, bearing in mind that the child has developed in this way in order to provide themselves with a sense of safety and control in situations where they had none.

Members of our care teams do not take these behaviours personally rather they seek to understand where the behaviour fits into an established pattern, and in so doing attempt to arrive at a better understanding of why the child copes in certain ways.

Through this approach, our care staff learn to view the young person's behaviour as their way of ‘communicating’, and are then able to use this understanding to help the child e.g. identification of triggers, switching.

In this way, the skillful work based on the ‘here and now’ undertaken by our therapeutic residential care staff can help to alter the young person's internalised narrative of the past. The child views themselves as good or bad, smart or stupid depending on what messages they have gained from their experiences. The messages that the child gains from the experience of therapeutic residential child care slowly challenges and changes the internalised messages received in the past. These are often heard in the child’s dialogue ‘I am bad’, ‘I must be evil as no one loves me’, ‘It’s all my fault…" The care team's aim therefore is to help change the child’s beliefs relating to self through the process of natural positive reinforcement of the child’s strengths and abilities.

Therapeutic Relationships

CareVisions know that it is the relationships which the care staff develop with the young people that are of the greatest importance in the recovery process. We know that it is through these relationships that the young people can learn to make new meaning of their lives, to regulate their affect and to develop new internal working models about themselves, others and the wider world.

We therefore see our care staff as the primary therapeutic agents in the lives of the young people. The intensity of their contact with the young people puts them in a prime position to build intimate connections through which the young people can be exposed to experiences of care giving which differs significantly from that which they have been used to; care giving which is characterised by patterns associated with the development of secure attachments, i.e. responsive, empathic, available, attuned, sensitive, consistent, predictable and accepting.

We also know however that the young people we care for are resistant to change, that they rarely come to us acknowledging their difficulties and actively seeking change. Consequently our staff are trained to practice in a manner which meets with the least resistance to the process of change, to characterise their interventions with spontaneity, subtlety, authentic warmth and genuineness, and to make therapeutic use of everyday occurrences in the lives of the young people, which they are able to do so as a consequence of living alongside them and sharing their life space.

This can take many forms but most often relates to sharing moments of emotional significance, both positive and negative, with the young people, staying with them through periods of distress, surviving the extremes of their behaviour, conveying constant emotional availability, and ultimately helping them to create personal narratives rooted in a sense of personal agency rather than victimisation.

We know that the young people’s stories of their lives are constantly being recreated and that this happens intersubjectively, through dialogue, relationships and shared experiences situated in social contexts, that a person’s sense of self emerges and changes primarily in relation to others. We therefore seek to positively influence that process, to help the young people to make new meaning of their lives within the context of the relationships which they develop with us and the positivity which the care staff bring to their interactions with them.

It is this repeated exposure to experiences which challenge the young person’s existing internal working models, within the context of a safe environment and emotionally significant relationships which creates the cognitive dissonance necessary for change to occur. This is what allows the young person to begin to develop a different narrative about themselves, to reflect upon, re-evaluate and reframe previous experiences more positively and incorporate them into their new narrative, one that is “based on strengths, hopes, dreams, preferences and new possibilities” (Sax, 1997, p. 112)

We also know that the ability to tell a coherent and meaningful account of one’s life significantly enhances resilience in the face of adversity and therefore bodes well for the young people’s future life chances.

Our real goal therefore is to assist the young person to leave behind the stories that they carry about themselves which are limiting, restrictive and filled with pain, fear and despair, and to replace them with new ones filled with hope so that they can dare to live in the present with optimism.

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