Reflective Book Review of “Working with Relational Trauma in Children’s Residential Care”

‘Working With Relational Trauma in Children’s Residential Care’ is intended by its three authors as a training resource and guidebook that provokes thought and provides guidance for practitioners. The book’s thorough treatment of trauma-informed childcare compliments our foundational Crossreach texts (Practice Model, TCI, and Beacon House) and focuses specifically on DDP in residential settings. The opening chapters explain key DDP principles, applying familiar terms such as attachment theory, intersubjectivity, the window of tolerance, PACE, and storytelling. The book explains theory in an accessible style, with its application to practice brought to life by an array of case-studies, illustrations, and reflective exercises.

The concentric layout of “Figure 1.1 The DDP Practice Model” (p. 44) echoes “Our Primary Task” illustration in Crossreach’s Practice Model (PM, p. 6). DDP principles are centred on the child and encompass the whole organisation.

The book’s reflective and illustrative format prompted me to write a reflective review using its images as discussion points while reflecting on my first year in residential childcare. In that period I became familiar with a basic aspect, or more precisely a dual-aspect, that is ever-present. By this I mean a duality of soft PACEful virtues on one side and firm boundarying virtues on the other. It is often from the tensions surrounding how soft or how firm practice ought to be that disharmony emerges within teams and individuals. Residential Care, in keeping with its dyadic approach, harmonises soft and firm virtues through a “balance of boundaries and empathy” (p. 126). A number of illustrations and passages frame childcare as this two-part soft/firm endeavour.

Connection and Correction

Chapter Five, “Co-Creating the Meaning of Love” (pp. 109-128), features the image above (p. 118), which provides familiar framing of soft and firm virtues through Dan Hughes’ axiom: ‘no correction without connection’. The image shows that connection comes not only before correction, but during and after as well. The composite case-study of Aadesh (p. 119-123), a ten year old boy with significant developmental delay, demonstrates how DDP interprets pain-based behaviour (being unsafe in the car) as a learning opportunity,rather than a trigger for adults to “move into punishment mode” (p.124).

Through the mutual reinforcing of connection and correction Aadesh progresses from shame to guilt (about endangering others) marking a crucial step in his overall developmental journey. DDP’s nuanced approach continuously fine-tunes soft and firm virtues in keeping with a basic principle that “the ‘tighter’ the boundaries around a child, the more empathy is required” (p. 117).

The Two Pillars

In the illustration below, “The Pillars of Residential Care”(p139), soft and firm aspects are idealised as twin supports titled Relationship and Structure. The two pillars capture the necessity of unity. Having one without the other is not feasible, and even a subtle elevation of one over the other would destabilise the whole system.

“We think of this as the home being supported by two pillars. Relationships are one central pillar in residential care. The balancing pillar is structure … the staff team works together, providing each other with relational experiences alongside structure. This same experience is then offered to the children.” (p139)

The passage emphasises the centrality of relationships (like connection it comes first) and highlights the adults’ role as cultivators and models of “relational experience alongside structure”. While the theoretical ideal depicts soft and firm virtues standing in perfect symmetry, in practice the pairing can be viewed less favourably as a mismatch. Practitioners caught in the either/or of a dialectic (rather than the both/and of the dyad) may worry that being too PACEful compromises structure, or that being too structured compromises PACE. These tensions can escalate over the delicate matter of consequences, described in the book as “a big deal in residential care! Indeed, they are one of the major causes of team disagreements.” (p. 116)

Chapter 6, “The Pot Noodle Story”(pp. 129-152), offers a light-hearted inroad to understanding team disagreements. A care manager complains about a team-meeting dominated by a 45-minute argument over how many Pot Noodles a child should consume. The team’s investment in this seemingly ordinary matter highlights how unconventional our residential ‘family’ is. Our children are separated from their biological families and parented on shift patterns by various workers from separate and generally more conventional family structures. The book articulates this multiplicity in trauma-informed, attachment-aware terminology: “In residential care complexity is added to complexity. Multiple parenting figures with multiple attachment histories, some traumatic, care for and educate multiple children.” (p. 129-130)

In the quest for balance, consistency and unity are viewed as key makers and markers of balance in the milieu. As a staff interviewee attests, “the most important thing when you’re working in a team is everybody’s working in unison with each other” (p. 135). While caregivers seek collective unity, the Pot Noodle Story suggests realisation of it is frustrated by diversity. This brings to mind another duality: unity and diversity—a sociological outworking of the ancient philosophical problem of ‘the one and the many’. In our residential case, how can a complex multiplicity of persons come together under one roof sharing a singular vision? And how can we cater for each child’s unique personality within a single system of care?

These questions invite soft and firm virtues back into the mix, stirring further tensions within teams and individuals. Theoretically, team members could be arranged on a spectrum of positions between soft and firm extremes. At one end, a child could be permitted as many Pot Noodles as they please, while at the other end the snack could be banned altogether as a serious health risk. Edwina, a co-author of the book places herself on the softer side, and interprets this as a reaction to her own childhood experience of firm parenting that “tended to be over-boundaried with high expectations” (p. 127). This section of the book observes a residential refining process in which overly-soft practice firms up and overly-firm practice softens.

The Two Hand of Parenting

While the two-pillars presented the perfect balance, it could be argued the image was too abstract and unmoving to capture the fluid nature of real-time developments on the ground. Dan Hughes’ The Two Hands of Parenting (p.238) offers an ambidextrous solution to managing soft and firm virtues in complex environments.

“The two hands of parenting emphasizes the importance of pairing the emotional connection, regulation, and co-creation enabled by PACE with the external support provided by supervision and emotionally connected discipline” (p. 238).

PACE features throughout the book as a cornerstone of the DDP model, with its practical application through the Two Hands of Parenting brought to life in the case-study of Andy (p.212-3). When a stand-off develops between Andy and staff members over access to gaming controllers an on-call manager arrives and de-escalates the situation. Rather than re-examining his behaviour, the manager prioritises connection by validating Andy’s feelings, “This must be really difficult for you, Andy” (p. 213). Having established connection, the manager guides Andy towards the intended location in a co-operative, dyadic manner. “Hand one connected first with the young person’s experience underlying their dysregulation. Hand two provided the boundary, structure, and consequence” (p. 213).

The two hands illustration is subtitled, “the cascade of PACE needs some containment” (p. 238), with the hands functioning as a firming-up measure at the end of Chapter Ten “The Cascade of PACE” (225-239), illustrated below (p. 226).

“PACE is like a cascade of water … PACE flows down and through every tier of the
organization. All can swim together in the tiered pools of PACE.” (p226)

The water illustration presents PACE as a soft element flowing “throughout and beyond the organisation” (p. 239). The water theme continues through the chapter, allowing for insightful scenarios such as a child learning to swim. The teacher’s connective and corrective repetitions of holding and releasing in the pool models the pattern of care in residential settings (p. 227). Relationships progress in cycles of giving and taking, we let go and take back in a reciprocal dance of soft and firm manoeuvres that guide the child progressively forwards. “Two hands are needed for the child to learn to trust in adult care, then to trust in adult authority, and, ultimately to trust in self as they mature into confident, independent, and autonomous adults.” (p239)

The Duality of Theory and Practice

The pairing of soft and firm virtues in the two pillars and the two hands, highlights a further duality of theory and practice. This entails perceivable tensions between the ideal milieu portrayed in training and textbooks and the lived experience of staff in practice. Staff reflecting on training “noted how much sense the theory made to them in the room but how challenged they were to put some of what they were learning into practice” (p. 221). In the either/or of a dialectic, theory makes sense in the training room but not in the home. Scholarly ideals are easily overshadowed by the realities of practice: the orderly calm of the two pillars was all-too quickly disquieted by a Pot Noodle, and the interviewee’s desire for collective unity implies it goes unfulfilled. In our diverse residential families each individual person has a will to realise their own vision of the ideal, but what we want and what we get can be two very different things.

To imagine our milieu free of tensions would be as unrealistic as imagining a life or a world without challenges or inconsistencies. Thankfully, this book takes the pragmatic approach that “tension in the team is both inevitable and necessary. From tension can arise creativity and change.” (p.147) This is especially the case in homes where “complexity is added to complexity”, we cannot expect reality to mirror the ideal. But then, by its very nature, an ideal transcends the real; if it were attainable then it would cease to be an ideal. Therefore, tensions between theory and practice are as inevitable as they are in human relationships.

As role-models, our handling of tensions and attitude towards disappointment can model resilience rather than dysregulation when people or circumstances do not meet our expectations. Our children are watching us and learning how to navigate the world through us, “They notice how everyone relates to everyone else” (p. 148). Our attitude is crucial when we consider how profoundly disappointed our children are at not having their ideal home. Many are subjected to massive ideal versus reality dissonance; the fairy-tale family they wanted and the nightmare they got are worlds apart. It can be heart-breaking to hear an abandoned child cry “I hate my life”, it speaks directly to this aching chasm between where they are and where they want to be. They come to us with “jagged stories of shame and terror” (p. 103), piles of rubble instead of pillars and clenched fists instead of PACEful hands.

In a case-study Mary asks her residential caregiver “Does my mum love me?” (p. 100) A disarming question that throws the caregiver onto the horns of a dilemma where answering yes or no is equally problematic. A quote from Dan Hughes highlights the empathy and curiosity of PACE “Mary wow, that’s a brave question… the answer is I don’t know whether your mum loves you or not. I really want to help you figure it out, though, as it’s so important to you to know.” (p. 102) The honest curiosity of “I don’t know” does not deny the tensions but opens a door into the child’s inner world and an opportunity to help rebuild their lives.

By addressing the dualities of childcare and embracing their tensions, Residential Care invites a broader application of dyadic principles to our whole system of care as well as human relationships. In a dyadic manner we can unify theory and practice along with soft and firm virtues, connection and correction, and many other dual aspects that feature in childcare. Through this dyadic approach, pairings can progress interdependently, navigating obstacles as they grow together, much like strong human relationships mature through inevitable tensions. This review followed my own train of thought while reading Residential Care, others who spend time in the book will find their own avenues for reflection. For those seeking immediate practical value, a comprehensive index section provides a wealth of subjects for the busy practitioner to pick up and read for quick insights and ideas.

Matthew Scotland

Support Practitioner
Crossreach
Lennoxtown, Scotland

This review is also available for download from the link below.