23/02/2020
This is an article written for Context, the magazine for family therapy and systemic practice in the UK.
A playful way of enabling young people in the Care system to develop some positive feelings of BELONGING by Michelle Newman Brown
Passing ‘The Hug’: A therapeutically relationships and self-esteem
Michelle Newman Brown
‘The Hug’ is a soft, green frog with a lavender-filled pouch. This is ordinarily
used as a warm soother to help children feel calmed to go to sleep at night. It has now become a treasured possession for
a number of children currently living in residential care homes in Kent! They all receive weekly individual therapy and
once a month they meet with me in two groups for systemic therapy. A few sessions ago, I introduced the frog as a creative experiment and was pleasantly surprised at the effective and beneficial use this has had on so many young people. In this article, I am therefore hoping to share with you what I did in my context of therapeutic work and how I hope this could perhaps be added to every therapist’s tool kit – simple and easy to explain to children of most ages and abilities; immediate, medium and longer- term effects; playful, fun and thoughtful.
My work context
I work in a small therapeutic child-care service comprising two residential-care homes and two schools for children with backgrounds of severe trauma related
to physical, emotional and sexual abuse and neglect. The age range can span 5 to 18 and it is for both girls and boys who require this provision from any borough within the UK. Currently, one home has 7 children between the ages of 7 and 14 and the other has 6 children aged 10 to 14. The education system caters for many more children, as it provides for other local day pupils as well. There is a highly therapeutic ethos within the organisation, with all children being provided with individual therapy where required, monthly systemic therapy within each house, systemic therapy with families when possible, weekly multi-disciplinary meetings within the leadership team, monthly full care-staff team child-focused meetings and regular therapeutic staff training. There are in- depth therapeutic assessments carried out and some children stay longer term while others move on to foster care, return to adoptive families or move to birth families.
Setting the background context for ‘The Hug’
On a monthly Wednesday basis, the children return from school and go into
the lounge for their systemic therapy with me; all children are expected to attend
and invariably they do manage, even if it requires closer support from staff members. There are usually four adults with the six
or seven children. Support is emotionally provided by ensuring the more potentially fragile young people have an adult sitting next to them. There has been a clear format to this process with all young children getting changed first and then being given a snack and drink as part of the beginning of the therapy. We usually meet for 45 minutes and, whilst the format remains the same, the topics and experience vary. The overall intention for this process is to enable them to think more carefully about each other and to develop greater understanding, relationally. Due to the high level of close proximity of living together and, for some of them, also going to the same school, it has been recognised that the children require guidance and development to help them learn ways to tolerate and communicate their needs in socially acceptable ways. This can be incredibly difficult even for many high functioning, secure and confident adults, so for children who have high levels of lived trauma, poor role-modelling with states of hyper arousal, dysregulation and negative expectations, it is a complicated expectation.
However, we have developed an on- going culture of this systemic therapy and
I have experienced some good sessions. Examples have included role-plays, drawing, and discussions about words that felt like bullying. I have also had some situations where they call out chaotically, they are bored, someone is very disruptive and I’ve had occasional refusals to attend, but this article is focusing on the positive!
On the day ‘The Hug’ was born, the staff team in the house in which I was holding the therapy had informed me they remained concerned about the high
and increased level of negativity between the children. Some of them were being rude to each other; some had found ways
to tap into each other’s most volatile and traumatised areas and were using this to emotionally hurt them. In one scenario, there was the intent to create a situation
in which a young person became so angry he required restraint by staff. It is the ethos to help the young people work towards being able to regulate their own behaviour when they become angry, but there are
still times in which the emotion becomes
so overwhelming that some children need short, adult restraining interventions. At this point, the dysregulation had increased, and staff members were seeing it as something occurring more within the culture of the children than being about any one young person’s difficulties with family.
Theoretical connection
My theory base for ‘The Hug’ has its roots within ideas from appreciative inquiry;
“We can’t ignore problems – we just need to approach them from the other side” (Cooperrider & Whitney, 2001).
Staff were concerned that there was
the potential for an emerging repeating pattern and that the young people may even create a ‘merger’. A merger culture is a very unsafe and unpredictable situation; usually the approach to this had been to separate the children and work with them individually as well as to hold a direct and linear meeting to deliver a message that this behaviour needs to stop. Whilst this does provide clear messages to everyone involved, it can also mean people notice and focus on the problems repetitively and enter a cycle from which they cannot easily escape. Naming the fears and difficulties could, in itself, further enrich the potential of the merging problem; the young people potentially ‘become’ as they believe others expect them to be. By using the approach of appreciative inquiry, I hoped to prevent this process of rumination and help generate creative and positive outcomes.
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Passing ‘The Hug’: A therapeutically playful group-technique to improve relationships and self-esteem
playful group-technique to improve
Cooperrider and Whitney (2001) explain that appreciative inquiry involves “searching for the best” in people, organisations and communities through the discovery of ‘what gives life’ to a system when it is at
its most effective and most economically, ecologically, and socially capable. I know that, in some respects, I was only working with a small group of children and their staff but my rationale was that if I began
a more positive experience altogether within the room and staff could experience, witness and emulate my approach and its impact, this would further work towards layering positive communication between everyone; the result being less negative beliefs, comments and expectations about the children, and more beneficial ways of breaking the emerging negative cycle.
There are four stages involved in appreciative inquiry: discovery, dream, design, and destiny/delivery. Cram (2010) writes that working through these stages can result in “transformational change sourced from collaborative inquiry with participants”. The focus of ‘The Hug’ in systemic therapy had its roots mostly in
the first stage – the discovery stage, the process of which is about, “eliciting a positive discourse (e.g. stories) about organisational, family or community life” (Cram, 2010). It
was my ‘dream’ that the group would speak positively about each other, connecting more particularly with the idea that this could have the effect of developing the community life more positively. I also believed that the various positive aspects
of different relationships within the community could also be brought out just as named in Whitney and Trosten-Bloom, (2010), who highlight that appreciative inquiry considers it is the relationships between us which give us all opportunities to raise our voices and be heard.
My belief was that, if I could encourage the children to say positive things about and to each other, the impact would be valuing, calming and not only build and develop from their individual feelings of insecurity and low self-esteem but relationally enable
Meet ‘The Hug’
at least some of them to feel positive in that another young person had noticed and named something of value. I hoped that the voices and stories that were heard would, “increase positive feelings, the positive talk ratio, and make generative thinking and acting more likely” (Bushe, 2007).
So, what did I do?
I believed this playful approach was not too great a risk; I did ponder what I would do if anyone made only negative comments.
What if they all said they had nothing good to say? What if one child was singled out
to receive no comments at all, replicating the possible developing negative culture? However, maybe because of my strong belief that a positive intended discussion will produce positive outcomes, along
with the knowledge that staff members would also be present to layer the positive comments, I remained committed to the idea – I would hold a systemic therapy with a focus only on the positive attributes of all
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Passing ‘The Hug’: A therapeutically playful group-technique to improve relationships and self-esteem
young people and carers. I would ‘ignore’ any comments about a merger culture, increased restraints and the intent of some young people to create chaos for each other. My intention was still the same as that of the care staff: I was just approaching it from the perspective of the early stages of appreciative inquiry. My confidence in the approach was fully embedded when
I thought not only to encourage ‘positive speak’ but to make it playful.
I looked around my therapy room
for inspiration. I needed a toy. I needed something that could be held each time someone was delivering their statement. My thinking was that the pace at which
we deliver messages needed to be slowed down. Just as with ‘outside witness’ ideas (White, 1995, Walther & Fox, 2012), the children needed the opportunity for
the positive stories to be ‘out there’ and experienced. I wanted the person receiving the information to have time to process what was being said, and also to feel the effect for him or herself as well as the
effect of all those in the room to witness the message. I did not want this to become simply about whoever is holding the cushion gets a turn to speak. In my mind, this was more than that. It was a symbolic representation of a positive connection between two people at a point in time that others could witness and experience their positive relationship as well. This could give that relationship validity, respect, value and power.
My reflexivity had already ruled out being able to actually hug each other, as we need to be mindful of personal boundaries and the impact of physical touching of each other due to the past histories of abuse.
But, what if the toy represented a hug? The toy would be a symbolic hug being given from one person to another for anything that had been noticed that was worthy of positive observation. I thought this would be fun, especially when I saw the green frog sitting forlornly on the side! I also thought this would make the process of saying a positive comment, for example from one teenage boy to another, less embarrassing or awkward because the whole set up of it was somewhat silly – a soft, crazy-looking frog is now a hug? Really??
The hug in action
The first session was held with a group of six children ranging from age 7 to 14 of mixed genders. Four staff members plus
me were also there. There had already been some curiosity, as I had been seen
in the kitchen, warming the lavender bag that can be removed from the front pouch. I let any child who was interested hold the frog and they all immediately held it in a snuggly, cosy way and put it to their noses to smell, as would perhaps be expected. There was genuine curiosity over what we would be doing today, although the older two males looked fed up and conveyed a message that I experienced as, “Michelle, you are wasting my time”. They made comments such as, “How long is this going to take?” “I don’t have anything to say.” “You can’t make me get on with J.”
In response to both the positive curiosity and the reticence, I was clear that today would be a short session but one in which
I hoped absolutely everyone would have
at least one comment to make. I explained that, whilst I knew that there had been some difficulties between some young people, we were not here to speak about that. I told them I am in a position where I have noticed so many good things about them all and wanted a chance to say them with everyone listening. I said that I think they all notice good things about each other but have forgotten or not had the chance
to say them. I then introduced the nameless frog and said that one person would start holding the frog and say something good about anyone in the room and then get up and take the frog over to that person. This was him or her giving the other person the positive message. Not only were they saying it, but also they would carry the message and give it to the person, who could feel the warmth from the message.
There was much laughter and comments from a few, and even understanding the double message of “giving the warmth”.
I reiterated that this was giving a hug
with the positive comment, and then the person who had been given the hug would continue the process with and for anyone of his or her choice. There was a risk at
this stage that I had not thought about: what if the receiver did not want to make any comment. Fortunately, because there were staff members who could also be commented upon, even the most negative young boy was able to participate by saying, “I like T because he helps me”. (Since I first began this group, some young people’s relational and emotional awareness has developed, and they are now able to be
the voice for less vocal members; in so
doing, they show their empathic nature and understanding of the nervous, reluctant voice. For example, M said, “I think T would say he’d like to give his hug to N and say, ‘I am going to miss you when you leave; you have been a good friend’”. T then simply has to nod or shake his head. This is developing into sophisticated layers of thought and interactional understanding between each other.)
Some of the messages were simple and others were more elaborate. Some felt far more sincere than others and some still held an undercurrent of negativity. One very close to the mark was, “This is for G because everyone says she stinks but she doesn’t... She’s got lots of nice shampoo and I like how she does her hair and it smells nice”.
A little 7-year-old was able to say, “I want to give J a hug because he lets me play in
his room, even when I was mean”. Another 13-year-old boy showed good reflexivity, saying, “I think J should have a hug because he has really turned his behaviour around and even when people have been trying to wind him up about his hair, he hasn’t kicked off. I hope I can cope better like J one day”.
Following that first session, on the following week, I took ‘The Hug’ to the other house within this organisation. The receptive response was similar, and one child even commented on having heard about it. Since these two sessions, I have been specifically asked by young people within both houses to bring ‘The Hug’ back and to go through the same process. The children genuinely enjoy the experience and, during a recent hug-passing session, the time was extended because they all had so many positive messages they wanted to convey. There was a certain level in which
I experienced some of them as wishing to outdo each other in providing the most thoughtful compliment rather than the intent of actually being thoughtful. One child simply wanted to have the last word. However, despite the sometimes lack of sincerity, there have been many wonderful, sparkling moments in which memories are being made. Stories are being repeated outside of the group and increasing comments about acts of kindness are being made and then reminded about in follow- on months. There has been a tremendous valuing effect for everyone as the constant witnessing, experiencing and hearing of positive comments has increased. The emotional and relational shift is evident, and the houses are calmer.
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Passing ‘The Hug’: A therapeutically playful group-technique to improve relationships and self-esteem
Some further reflections by the young people include;
“G is really clever.”
“For M because he looked after N when he was really struggling last weekend. He even lost his horse-riding and didn’t complain.”
“X has settled in here really well even though he arrived just before Christmas. That is really hard. Well done, mate.”
“D keeps his room really nice.”
“F for still getting up and doing well in the play, even though she’d just found out her dad wasn’t coming to see her.”
“J is really good at cooking!”
“N has done really well to be ready for fostering. I’m gonna miss you but you deserve it.”
“S is amazing at football.”
“K bought a box of 24 jaffa cakes with her own money and gave them all away except 2.” (Lots of further discussion was generated with this comment)
“For A for helping me when I didn’t manage when my contact didn’t happen.”
Six months on – evaluation in brief
Day-to-day life
Staff members commented that they notice there has been a genuine growth
in emotional connectivity and social awareness between some of the young people; it is also recognised that this may have happened anyway as this is the nature of the on-going therapeutic work but, historically, this had shown more as individual development than growth in how the young people interacted with each other. One manager told me she noticed a definite calmer environment following some of the sessions, sometimes even for a few days because the young people, “were more tolerant of each
other”. Another staff member told me he believed the improvement in behaviour
in one young boy was directly connected with raised self-esteem gained from the positives recognised and named by his peers in our sessions. Interestingly, an individual therapist also commented to me how impressed she was with the increase in recent months with a young girl’s shift in self-esteem and how her ability to trust in the therapeutic relationship had grown. Again, maybe this would have happened, but this therapist made the connection to the group work as helping change K’s self- narrative enough to use her therapy more helpfully.
During ‘The Hug’ therapy sessions
A number of children now ask me when we are having systemic therapy and look forward to it; during one month, it was not possible and two different boys asked if we could still have it another week – a significant difference from the reluctance shown by one of them initially!
I noticed both adults and young people alike settling comfortably into the process as the pattern became established. Initially, it had been observed that there had been a contradiction between desperately wanting to receive a positive comment yet finding it emotionally difficult to hold on to due to the lack of
fit with personal narratives. Now, most
of the founder members of these groups receive the comments positively, listen carefully to what is said, more detail is given in the telling of the message and greater sincerity is clearly evident. At times, the rest of the group add to the story and greater depth is provided, thus enhancing its validity further. Those young people who still find it more difficult – for example a 12-year-old boy frequently hides behind a sofa – are helped by others in thoughtful ways such as still giving them compliments and then providing possible reasons as to why they are finding it hard to accept them. As explained above, some are also able to come up with messages they think others would like
to say. Without instigation from me, the
young people have also started including others who are not present and ensuring the messages are passed onto them!
This work will be continuing indefinitely as it has become an established part
of the culture for emotional, social and behavioural change.
References
Bushe, G. (2007) Appreciative inquiry is not (just) about the positive. OD Practitioner, 39(4): 33-38. Cram, F. (2010) Appreciative inquiry. Mai Review, 3: 1-13.
Cooperrider, D.L. & Whitney, D. (2001) A positive revolution in change: Appreciative inquiry. Public Administration and Public Policy, 87: 611- 630.
Walther, S. & Fox, H. (2012) Narrative therapy and outsider witness practice: Teachers as a community of acknowledgement. Educational and Child Psychology, 29(2): 10-19.
White, M. (1995) Reflecting teamwork as definitional ceremony. In M. White, Re-Authoring Lives: Interviews and Essays. Adelaide: Dulwich Centre Publications.
Whitney, D.D. & Trosten-Bloom, A. (2010) The Power of Appreciative Inquiry: A Practical Guide to Positive Change. San Francisco: Berrett-Koehler.
Michelle Newman Brown is a consultant systemic psychotherapist who has remained committed to work within therapeutic residential care for over 27 years. She provides systemic therapy, training, staff consultation and supervision to a number of foster agencies and therapeutic care homes throughout the UK. Given any opportunity, she makes use of play as a helpful means of engagement and communication.
Email: nbconsultancy@icloud.com
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