- Report: Between Love and Behaviour Management: the Psychodynamic Reflective Milieu at the Mulberry Bush School
- Authors: Heather Price, David Jones, Jane Herd; and Alice Sampson, Journal of Social Work Practice, 32(4) (2018)
Some of the most disruptive, disturbing children and young people are in residential child care, often viewed as a placement of “last resort” after multiple family-based placement breakdowns. The children arrive with feelings and behaviours that test to the maximum their carers’ efforts to empathise, to stay emotionally committed, to hold limits in a non-retaliatory way and to bring about change. The Mulberry Bush School (MBS) is one such placement of “last resort”, a therapeutic residential special school caring for primary-aged children with severe social, emotional and behavioural difficulties.
Children at MBS return to their foster, adoptive or birth families for some weekends and outside term time, although from autumn 2018, MBS has offered 52-week care. The children’s experiences of neglect, abuse and loss inform the nature of MBS’s therapeutic work with them and with their families during the three-year placements at the school.
The founder of the Mulberry Bush School, Barbara Dockar-Drysdale, used psychoanalytic ideas about the protectiveness of defences to help her understand the behaviour of children who were hard to reach.
She saw that “frozen” children’s difficulties stemmed from trauma, leaving them unable to understand their feelings; instead, they could only act on them. Dockar-Drysdale believed that the children needed a sufficiently safe and containing environment to allow them the chance of a “primary experience”, to facilitate the development of a capacity to reflect on events rather than simply react. These insights and principles now have support from neuroscientific research.
Researching the school
The qualitative research study based at the University of East London (UEL) was commissioned by MBS as a complement to University College, London Institute of Education’s quantitative research study. Whereas the Institute of Education’s study focused on outcomes, the UEL study considered process, taking into account the need for staff to have a supportive environment to read their own behaviours and reactions, individually and collectively, as a form of communication about dynamics in the setting.
A core dimension of the UEL study, which was also congruent with the MBS philosophy, was the use of naturalistic psychoanalytic observation, developed within psychoanalytic child psychotherapy and extended for use in relationship-based social work. The focus for the observer is on taking in, and recalling, the detail of intimate family interactions. The method contains a strong experiential element in that it puts the observer in touch with powerful and potentially distressing states of mind.
As part of the research process, the UEL team obtained informed and ongoing consent from the children being observed, providing opportunities for discussion of the project individually and in a whole school meeting as well as with the children’s school council. Staff also gave consent to be observed and before participating in interviews.
Evidence was gathered from 30 process-recorded observational records from visits conducted over a 15-month period, eight interviews with children about to leave the school, 13 interviews with frontline staff, eight interviews with senior staff, seven interviews with professionals from external agencies linked to the Mulberry Bush’s outreach service, and documentary and archive material. Pupil interviews included questions about what was good about MBS and what was not so good and how they thought MBS was different or similar to past placements. Staff interviews introduced topics such as the individual’s reasons for working at MBS, challenges faced at MBS with the children and the organisation and support put in place to assist them.
The researchers noted many examples of staff attempting to hold a moment-by-moment balance between maintaining the setting as a safe and secure base for the children, while also being willing to work with the children’s very disturbed and angry feelings. This created edginess and tension. A willingness to work with potentially dangerous and explosive feelings is linked to the staff’s training in reading behaviour as a form of communication of inner, unconscious or hard-to-process emotional states.
The study found that the Mulberry Bush, as an organisation, provides a milieu for its staff that contains elements of therapeutic provision paralleling those provided for the children. In this climate, staff can make sense of their own behaviours and reactions and see them as a source of information about the dynamics in the setting.
The children’s milieu
The setting of the school is immediately striking. MBS consists of a large central green area with attractive family houses grouped around it. A larger main building contains the school, which has multisensory and soft play areas and classrooms with large gardens as well as a wild nature area. The grounds are well kept, and the multi-purpose sports areas are in fine condition. Everything is accessible to the children in their free time. Damages are quickly attended to, giving a quiet but insistent message that damage is reparable and the children and their environment are valued.
In the mornings, children make their way with their carers to the on-site primary school. The “hand-over” to educational staff includes an honest account of the evening, night and morning the child and group has had. All transitions to new settings and tasks, and changes in the setting or timetable, are managed carefully so that the children can begin to engage with, tolerate and eventually cope with these more successfully.
The researchers found a gentle but noticeable observational stance adopted by the adults, who listen carefully and frequently comment and “wonder aloud” about states of mind and explanations for behaviour. There is a strong emphasis throughout the day on play, modelled by the adults. Humour is very evident and used to defuse the emotional impact of situations. Staff are consistently warm and the researchers were made consistently welcome.
The notion that “behaviour is communication” emerged as almost a mantra shared throughout the staff group. There was a clear willingness to work with potentially dangerous and explosive behaviour that could be read as a form of communication of inner, unconscious or hard-to-process emotional states. The observations of the research team were that the MBS understanding went beyond an awareness that traumatised children might “act out”, to a willingness to allow children’s feelings to surface and stir up other people’s feelings, including their own.
Researchers suggest that sensitivity to shame was an important aspect of the work of the school. They believe shame to be an important component of what lies beneath their frequent diagnoses of “conduct disorder” or “oppositional defiant disorder”. MBS staff indicated an awareness that punishment or disapproval would overwhelm children with feelings of shame so that any processing of feeling would then be impossible.
The staff milieu
All staff members working directly with the children undertake a free, mandatory Foundation Degree Award (FDA) part-time, delivered in situ by senior members of the Mulberry Bush training and consultancy team. Analysis of the interview data showed evidence to suggest that the studying also created a powerful bonding effect that appeared to increase trust between staff, particularly as many of the assignments under group discussion centred around self-reflexive journals or experiential learning.
A commitment to self-reflection was conveyed in the staff culture. In interviews, senior staff members explained the need for this, because of their understanding of the intensity and strain of the work and the depth of the confusion and exhaustion it could generate. All had worked as teachers, therapeutic care professionals or child and adolescent mental health workers for considerable lengths of time.
It was understood across MBS that staff would have feelings that might threaten to boil over in uncontrollable and exposing ways, but that the experience of having to work something through by admitting these feelings in public and hopefully finding that others have them too is rendered normal, survivable and not the whole picture. As with the children, if staff can be helped, over time, to share these experiences, the reflective spaces provide an important place for therapeutic working through, allowing for personal growth.
The research concludes that the psychodynamic approach taken does not rely on ‘love’ or ‘intuition’ in staff when they build relationships with the children. It deliberately does not emphasise one-to-one ‘special’ bonds. Equally, the reliance is not upon behaviour modification in creating a calm, ordered, secure environment. Although both these elements (of love and intuition on the one hand, and behaviour modification on the other) might make a contribution, the research did not find these components to be central in this milieu. Instead there was a requirement that staff place themselves empathically within the children’s own emotional and relational field, whilst still maintaining a reflective, observing distance. This was to enable staff to ‘read’ the children’s behaviour for meanings beyond the emotionally obvious. This is not easy and takes time, training and a whole-school approach. From this basis, staff can support each other to assist the children to reflect on their feelings and actions, to know themselves better and to have more self-restraint and self-respect.