The Mulberry Bush School and UK Therapeutic Community practice for children and adolescents.

erni Conference, April 2013.

The Mulberry Bush School and UK Therapeutic Community practice for

children and adolescents.

John Diamond, CEO, Mulberry Bush Organisation.

Abstract.

This paper explores the development of the task of the therapeutic community work of

the Mulberry Bush School, which founded in 1948 is the UK’s most established TC for

children aged 5‐13. The paper also explores the legacy of the Schools founder, child

psychotherapist Barbara Dockar ‐ Drysdale, and the influences of other pioneers of

‘therapeutic child care’. The paper will argue that Dockar‐ Drysdale’s concept of ‘the

provision of primary experience’ as informed by her collaboration with Donald Winnicott,

supports the potential of a ‘lived experience’ as an agent for therapeutic change in work

with children and adolescents.

Links are explored between the work of these practitioners, and post World War 2 models

of group psychotherapy, which influenced TC work with children and adolescents as part

of a ‘British tradition’ of alternative therapy and education. The paper gives clinical

vignettes of the current multi ‐ disciplinary work of the School, including the incorporation

of neuro‐scientific research into the task of meeting the needs of chaotic children with

severe attachment disorders.

Introduction.

The conference today identifies a critical social issue: ‘how do we achieve psychological

wellbeing for children and adolescents’. It poses the questions ‘what environmental

conditions are required for our clients live safely with themselves, and others, in families,

schools and their community’. And ‘how do we enable C&YP to make and sustain healthy

individual and social relationships.’

I believe the answer to the questions is to enable young people to internalise ‘a lived

experience,’ of caring and empathic relationships within a nurturing and containing

environment. This is the role of therapeutic community work.

In the UK in the current context of economic austerity, the costs associated with therapeutic

care undermine this important and valuable resource. But there is a risk that those who

commission placements will focus on anxieties about the immediate cost, to the detriment

of the long term value.

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For those children who are placed in specialist services such as the Mulberry Bush School,

where we provide emotional holding as a ‘24 hour curriculum’ for children with severe

attachment disorders, I would argue that such provision is vital in providing the conditions

where children can begin to start to grow emotionally.

My experience of therapeutic community work with adolescents at the Cotswold

Community, and with children through therapeutic child care at the Mulberry Bush School is

one of providing a responsive service for these most emotionally unintegrated and

fragmented of young people. I want to share with you a case study of one girl who came to

the Mulberry Bush for specialist treatment.

I have called this Lucy’s story:

At the age of three Lucy was taken into care by social services. She had been discovered

living in a house which was being used as a base for trading in drugs and sexual relations. As

a result of living in this environment Lucy had experienced severe emotional neglect as well

as physical and sexual abuse. Lucy’s behaviour had become so disturbed that she was found

to be eating off the floor with several dogs which were also inhabiting the house.

Prior to admission to the Mulberry Bush School Lucy, was placed with foster parents. In

week 1 at the foster home her behaviour included wetting, smearing, self‐harming,

aggression, insomnia, inappropriate affection to strangers, extreme controlling behaviour

and cruelty to animals. Her insomnia resulted in one or other of her foster parents having to

stay awake all night with her. Attempts at schooling failed as her behaviours were so

aggressive and uncontrollable, she was therefore also severely underachieving. As an early

intervention to help her make sense of her chaotic life, Lucy started play therapy sessions

with the local CAMHS team. Her therapist described her as being in complete emotional

turmoil. During the sessions she was described as being highly aroused, tense and exhibiting

signs of physical and sexual abuse she had experienced, she showed no understanding of

keeping herself safe. Her therapist commented ‘she brings chaos and destruction into

everything she does’.

Lucy was referred to the Mulberry Bush School at the age of seven, and was placed in one of

our four care and treatment households living in a group with other children of primary age.

A dedicated staff team lived alongside the children creating a reliable daily routine. The

structure of this routine included close supervision and support through all aspects of the

day: mealtimes, playtimes, bedtimes, transitions to school etc. The staff managed and

resolved the frequent behavioural breakdowns, arguments, rivalries and the general antisocial

behaviour of the group of children. With time Lucy responded to this re‐education in

relationships and started to understand that she could be helped to engage with normal and

respectful social living. Through this daily routine the care staff gave Lucy opportunities to

help her think and talk about her confused, betrayed, and angry feelings. She started to find

alternative ways of interacting, and little by little, started to come to terms with the

injustices in her life.

In the education area Lucy joined our foundation stage where she was helped to enjoy

learning again. Alongside an introduction to the National Curriculum the children are

encouraged to play with pre‐school equipment, listen to stories, sing, dress up and work and

play co‐operatively. After a year Lucy moved to the second tier class where expectations of

behaviour, application and learning are higher. She was still a noisy child, readily distracted

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and easily led into others misbehaviour but she made good progress and was able to move

to the top class a year before she left the school. During this last year she successfully made

a half day visit to a local mainstream primary school, supported by staff from the Mulberry

Bush.

During this treatment process at the school, periods at home with her foster parents were

still difficult with Lucy exhibiting her previous testing and challenging behaviours. However

the school placement offered some respite for her exhausted foster carers who were able to

recharge their batteries during term time. With time the foster carers also noticed an

improvement in her behaviour, Lucy was becoming more articulate about her needs and

started to display more loving and affectionate feelings. The carers began looking forward to

a time when she could come and live with them full time, and attend a local school with

teaching assistance. After three years Lucy was able to make this transition and return home

to her foster parents. She is currently doing well and the placement remains stable. She is

successfully placed at a local school for children with moderate learning difficulties and

despite being quite demanding, is no longer unfosterable nor unacceptably disruptive in

school or other social situations.

Residential care as emotional holding:

If Lucy had not received an early therapeutic intervention, the chances of recovery and a

good outcome from such early trauma would have been reduced, and her anti‐social

behaviour would have accelerated with the onset of puberty and adolescence. 

At the Mulberry Bush we consciously use all aspects of the community: one to one

relationships, group work and the social fabric of the community itself to develop a way of

helping children to live and learn together. Our approach ensures that children have their

individual needs met, but also that they are able to live and learn through the process of

being together in their household and class groups. Our belief is that being part of a group is

essential for children. It is only through a positive internalised experience of living together,

that we are able to prepare the children to return to live in families and attend mainstream

schools. So what are the component parts of our task and how do they work together?

The therapeutic milieu of the Mulberry Bush School.

The ‘Mulberry Bush Approach’ is our model of specialist therapeutic residential care,

treatment and education for children who have experienced early year’s trauma. Our

therapeutic culture has evolved over 63 years since the founding of the School in 1948. The

sum of this 63 year expertise could be described as: ‘the provision of primary experience

within a containing, nurturing and safe residential environment’. For the continuation of the

task, we are required to maintain such a structured environment, and to maintain and

develop a ‘clinical sensibility’ which enables staff to be remain preoccupied with the daily

experience of routines, behaviours, thoughts, feelings, projections and relationships that

exist between individual children and adults, their groups and teams, and with each other

across the community. The therapeutic task supports children to grow emotionally so they

can negotiate and make use of individual and social relationships. Essentially

psychotherapeutic work is a hermeneutic discipline: it concerns the creation of meaning

through interpretation.

Our work is underpinned by a synthesis of the following disciplines:

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1. Child psychoanalytic psychotherapy, as defined by Donald Winnicott, (including Dockar‐

Drysdale’s own distinct application of this work) and Melanie Klein.

2. Attachment theory, as defined by John Bowlby and Mary Ainsworth.

3. Ongoing neuro‐scientific research, and its relationship to attachment theory as defined by

researchers and practitioners such as Bruce Perry M.D., and Bessel Van Der Kolk, Especially

research into ‘complex trauma’ and Van Der Kolk’s diagnosis of ‘developmental trauma

disorder’ which is likely to be included in DSM V.

4. The concepts of Therapeutic Community, Planned Environment or Milieu Therapy, with three

distinct features:

 Group care for its account of the overall context and mode of practice.

 Psychodynamic thinking as an underpinning theory, with the concept of the ‘holding

environment’ as a specific model of practice.

 Systems thinking as a way of holding the component parts together.

Currently, our provision for children consists of four defined task areas:

1. Group Living. in which the residential therapy is delivered as a lived experience by a dedicated

staff team who live and work ‘close in’ with the children in order to develop individual

relationships, and to help them achieve a way of living together as a social group. This work is

contained within robust and nurturing domestic routines, planned over each 24 hour period.

2. Education. To provide and meet the child’s entitlement to an age and stage appropriate

educational experience. Access to the National Curriculum is delivered within a nurturing

environment which pays equal attention to the child’s social emotional needs. The curriculum is

organised and delivered in practical and fun ways through which the children are most likely to

learn. The education area is organised in three developmental stages; foundation stage, middle

stage and top class. Children move up and through these levels as they become more able and

independent learners.

3. The Therapies and Networks Team: which aims to maintain and support close communication

and partnership working between the parents and carers of the children placed at the school,

and the referring network. In this way it serves the core residential task. The team ‘holds the

child and family in mind,’ and can provide outreach therapeutic support and interventions to

parents and carers. Our therapists provide mainly group and some individual therapy to the

children. Our consultant and Principal psychotherapist also consult to care teams, and run case

discussion clinics and internal case conferences. The drama and music therapist provide and

small group therapeutic sessions. Psychotherapy supports the core task by supporting children

to make a fuller and more meaningful use of the total residential experience.

These component parts of the therapeutic milieu, work together to provide an integrated

and holistic environment that is organised to maximise the emotional growth of each child.

The sum of the ‘emergent properties’ of each department on the child is difficult to

quantify. However, our observations of the emotional development of each child suggests

that when we achieve good outcomes, the ‘wholesomeness’ of this integrated approach has

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been internalised by the child. We are currently engaged in some ‘empirical’ research in the

shape of a 7 year longitudinal outcomes project to provide some hypotheses about the

effectiveness of the ‘hermeneutic’ approach.

I will outline key historical developments of our therapeutic task.

Therapy in child care: the foundation of therapeutic work at the school

In the early days of the Mulberry Bush, Barbara Dockar‐Drysdale and her young family shared

the original farmhouse with a group of deprived children who had been placed in Oxfordshire

during WW2 as part of the national evacuation campaign. Via monthly clinical consultations

with Donald Winnicott, and later a Freudian psychoanalytic training, Dockar‐Drysdale

provided the children with one to one therapeutic sessions. Her husband Stephen, recently

de‐mobbed after war service, supported the enterprise by providing robust boundary setting

‐ a ‘live’ authority for the group. We can imagine how this familial experience offered deprived

children an experience of ‘Oedipal’ parental roles. In 1948 their work achieved School status,

as a hybrid ‘special school and child guidance clinic’, and from thereon they were able to

employ a few staff, and the school began to grow.

Out of this experience Dockar‐Drysdale developed the residential treatment methodology

that she later named “the provision of primary experience” (1990). She conceptualised this

work in a series of papers which were later published in her books ‘Therapy in Child Care’

(1968) and ‘Consultation in Child Care’ (1973).

Robin Reeves, a former Principal of the school, and consultant child psychotherapist writes:

‘Dockar‐Drysdale’s primary experience seems to be an amalgam of the Winnicott concepts of

‘primary home experiences’ and ‘primary maternal preoccupation’. The term encapsulates

what Dockar‐Drysdale came to see as the essential element in therapy for children who had

missed out on that early maternal provision….her view of primary provision could be summed

up by saying that it was a matter of the caring adult having to feel and act like a mother with

her new born baby, and with the same preoccupation and sense of vulnerability. This is what

the ‘frozen child’ required as an absolute condition of change’ (2002)

Within this concept of “the provision of primary experience” Dockar‐Drysdale carried out her

most renowned work, defining different syndromes of deprivation, and formulating

treatment approaches to these syndromes. Maurice Bridgeland (1971):

“Dockar‐Drysdale has done her most important work in seeking to explain the nature and

needs of the ‘frozen’ or psychopathic child. The emotionally deprived child is seen as ‘preneurotic’

since the child has to exist as an individual before neurotic defences can form. The

extent to which there has been traumatic interruption of the ‘primary experience’ decides

the form of the disturbance. A child separated at this primitive stage is therefore, in a

perpetual state of defence against the hostile ‘outer world’ into which he has been

jettisoned inadequately prepared.”

The early therapeutic milieu was managed by the staff who provided ‘close in’ lived

experiences of containing and nurturing routines, along with robust behaviour management,

through which the ‘authentic’ and chaotic child emerged. Attachment to (then ‘dependency

on’) an adult was supported, and in the case of the ‘frozen child’ a localised regression to the

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‘point of failure’ was therapeutically managed. Often a regular and reliable symbolic

adaptation, termed a ‘special thing,’ was introduced within the relationship. This allowed the

child an experience of primary adaptation to need, and an experience of the ‘rhythm’ of close

bonding and ‘nursing’ with a primary carer:

‘’ it was this familial or social factor Dockar –Drysdale particularly attended to. It led her in

due course to a greater appreciation of the therapeutic potential of ‘ordinary devoted carers’

within a setting such as the Mulberry Bush. She seized on the fact that, even without specific

training and qualification as therapists, carers could become the critical focus of a child’s

regression to dependency, provided that the requisite therapeutic support systems were in

place’’ ( Reeves, 2002)

Most often this symbolic adaptation would take the form of the child’s ‘focal therapist’

providing a food chosen by the child, such as a boiled egg or a rusk with warm milk. The child’s

choice of food often had a significant primary connotation. As the use of the ‘special thing’

became embedded in the work, staff began to use this as a way of meeting the needs of the

child. They found that the provision improved the child’s sense of security, reduced

delinquency (stealing as self provision to ‘fill up’), and the localised and protected time

seemed to help children cope with their feelings of envy and jealousy when having to share

the adult with other children in the group care setting.

This ‘attachment’ model of meeting need, with special attention to symbolic communication,

still underpins our work today. In Dockar ‐Drysdale’s view, for chaotic ‘unintegrated’ children

the traditional ‘psychoanalytic hour’ was not enough, they required a total environment in

which therapeutic interactions could take place within the routines of child care, she did not

place the primacy of therapy as being outside of daily child care routines, hence the

development of the concept and methods now known as ‘therapeutic child care.’

If we juxtapose this history with contemporary childhood trauma theory we start to see some

interesting links. Sue Gerhardt’s (a psychoanalytic psychotherapist) book ‘Why Love matters’,

(2004) explores current neuroscience which shows how the brain of the human baby

physically grows, and synapses connect, as a result of being in a loving relationship, nurtured

and stimulated by the mother or primary carer. The flip side of the coin, if the baby

experiences ongoing neglect and abuse, then the evolving brain is flooded and overwhelmed

by stress, releasing adrenalin and the stress hormone cortisol. The impact of this flooding of

the brain by cortisol and the undigestible traumatic experience is literally to freeze the growth

of the brain. The brain becomes ‘hard wired’ to expect trauma, the inchoate personality

adopts states of hyper arousal as a defence to protect itself from the perceived hostile

environment.

Although this physiological process was unknown in the 1950’s,Dockar ‐Drysdale wrote her

paper ‘the residential treatment of frozen children’ in 1958. In this paper she describes

experiences and offers clinical vignettes of working closely with the most ‘cold’ and

‘hardened’ of children referred to the school. It is as though she intuitively predicted this

concept, as she describes these children as ‘emotionally frozen’ at the ‘point of failure’.

Dockar‐Drysdale regarded these as the most ‘unintegrated’ children. A modern clinical

diagnosis would likely be that the child is suffering a disorganised attachment disorder.

Planned Environment or Milieu Therapy: using groups and the environment as a therapeutic

medium

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Between 1996 and 2001 due to a successful fundraising campaign the site was redeveloped,

and the children moved to inhabit the four newly built households and education area. This

achieved the strategy planned by Staff and Trustees to develop a new therapeutic model of

group living within a purposely planned environment, to improve and broaden the

therapeutic experience for children. This new experience of therapeutic group living and the

planned environment, led to a creative re‐appraisal and exploration of the theory and practice

of group based and milieu therapies.

Over the last decade, 2000‐2010, this conscious process of physically separating out and

differentiating spaces for group living and educational learning, has also led to a greater

professionalisation and demarcation between the two as integrated but separate tasks.

Dockar–Drysdale developed her work in an era when group psychotherapy and the concept

of the therapeutic community were still recent innovations. She had met the psychiatrist

Marjorie Franklin and David Wills who had both been involved in the ‘Q’ camp experiments

of 1936‐1940, in which staff and young offenders built a small community and lived together

as a prototype ‘therapeutic community’. By 1945 Franklin had written and published her

manuscript ‘the use and misuse of planned environment therapy’. Similarly, in the USA across

the 1940’s and 50’s, Fritz Redl and David Wineman defined their version of residential

treatment calling it ‘milieu therapy.’ Their work was defined and published in ‘children who

hate’ (1950). The terms planned environment (U.K.) and milieu therapy (U.S.) are used

interchangeably in the following section.

The concept of planned environment therapy has a strong psychoanalytic legacy, reaching

back to 1928, when Marjorie Franklin set up a ‘psychological and psychotherapeutic

discussion group’ at her consulting rooms in Harley Street. Meetings of this group included

the psychoanalysts Dr. Kate Friedlander, Dr Melitta Schmideberg (Melanie Klein’s daughter)

and Dr. Adrian Stephen. The ‘Q’ camps planning committee also included Dr Denis Carroll

(Portland Institute for the scientific study of delinquency) who later worked as an army

psychiatrist at the Northfield military hospital, where the concept of the therapeutic

community was developed.

By 1963 Franklin had set up a planned environment therapy discussion group, which led in

1966 to the formation of the Planned Environment Therapy Trust ( PETT) to promote ‘the

serious clinical study of the use of the environment as a means of correcting asocial and other

related character deficiencies’. Franklin claimed that ‘planned environment therapy has long

reached the stage of a serious branch of psychotherapy’ and psychotherapist Arthur Barron

described it as ‘the only method that provides a viable method and approach to the

residential care and treatment of the maladjusted’ (Bridgeland,1971).

The concept of Planned Environmental Therapy; using the totality of the environment

including the diversity of relationships, and everyday activity in service to the recovery of the

child, helped develop the concept of the school as an integrated and holistic therapeutic

environment.

As our therapists Caryn Onions and Jennifer Browner write:

‘’Milieu therapy offers children an environment that aims to understand and make sense of

their inner muddle, turmoil and pain. It allows children opportunity day‐in and day‐out to

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explore their inner world and its impact on their current lives and relationships. But if this

were all it did, it would be likely to overwhelm children in a swamp of transference from which

they could have no respite. Milieu therapy has other jobs too: it seeks to manage children’s

feelings on their behalf, to set clear limits and boundaries, to leave room for cooling off times,

where the focus is not on feelings, and for building up an alternative internal world based on

ordinary experiences and healthier relationships. Milieu therapy, in a different way from

individual therapy, tries to ‘localise’ the transference so that there are times in the day when

children can just begin to live their lives’’ (2011)

For chaotic and deeply mistrustful children, the planned environment offers opportunities

for a variety of relationships, and structured experiences which, over time, can be internalised

by the child. At the Bush, our model of group living is created by staff enacting a ‘conscious

use of self’. For children who have previously found the intimacy of family, and class groups

intolerable, the Mulberry Bush milieu is often the first time that they can begin to internalise

the nurturing and healing effects of the group. Children live in a group but more importantly

as a group. They play and do their school work between different groups. This combined

patterning across the community creates and builds a day to day experience of ‘the other’

which requires children to challenge their self reliant and mistrustful view of the world, and

start thinking about the ‘social and emotional’ through co‐operation and understanding

others individual and group needs. As a ‘society in miniature’ it provides the condition where

disaffected children can develop a sense of the value of the group and community through

the experience of a range of group mediums. These include daily household meetings, group

living therapeutic groups, class ‘circle time’, the weekly ‘drumming circle’ and

psychotherapeutic music and drama groups. In this way, groups and the milieu in which they

are set are containing for the children because each interaction can be observed, managed,

and talked about. Such a sense of purpose is built into the everyday routines and activities.

The neuroscientific agenda: advances in the understanding of trauma and abuse on a child’s

developing brain.

So how does neuroscience also play its part in underpinning our understanding of the impact

of trauma on children

In recent years there have been huge advances in our understanding of the effects of

trauma, neglect and abuse on a child’s developing brain. These findings have helped confirm

what staff in residential settings have been experiencing with such children. Research has

shown (Perry et al 1995; Gerhardt, 2004) that the brain of the newborn baby actually grows

in response to nurture, love and positive touch, and carries on like this well into the second

year of life. Chemicals such as the hormone oxytocin are released during these positive

interactions promoting loving feelings, reducing the impact of stress, and boosting the

immune system.

However the brains of infants like Lucy who experience ‘severe neglect, physical and sexual

abuse’ can have areas which simply do not develop healthy brain connections. When early

experiences are traumatic, different chemicals are released which create unhelpful nerve

pathways as well as increasing blood pressure, heart rate and stress levels. It is likely that

from early on, perhaps pre‐verbally, Lucy became habituated to this agitated stressed way

of being and that this contributed to her insomnia, hyper vigilance and unprovoked

outbursts.

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In the same way we know that environmental risk factors associated with childhood trauma

can lead to a lack of attachment and poor outcomes for children. Environmental risk factors

that diminish resilience in the personality include: family breakdown, parental drug

addiction, major losses such as bereavement, neglect, sexual and physical abuse and

domestic violence. These factors often become co‐morbid and compound to decrease the

chances of the child’s successful adaptation to his or her home, school and community

environment.

‘the child exposed to chaotic or threatening caregiving develops a sensitized stressresponse

system that affects arousal, emotional regulation, behavioural reactivity,

and even cardiovascular regulation. These children are at risk for stress‐ induced

neuropsychiatric problems in later life’

(Perry, 1998, p.40)

Over 62 years the evolution of the school as a therapeutic environment has required an

openness to new theories and ideas. Recent advances in neuroscientific research tell us that

just as traumatic experiences freeze and dysregulate children’s emotions, over time the

experience and delivery of empathic caring relationships can work to ameliorate and modify

these psychopathological states. Vittorio Gallese calls this process ‘intentional attunement’.

Our growing knowledge of the role of ‘mirror neurons’ in the brain, creates a physiological

basis to our understanding of emotional experience. According to Gallese the ability of

mirror neurons is in creating what he calls a shared ‘embodied simulation’:

‘When I see the facial expression of someone else, and this perception leads me to

experience that expression as a particular affective state, I do not accomplish this

understanding through an argument by analogy. The other’s emotion is constituted,

experienced and therefore directly understood by means of an embodied simulation

producing a shared body state’

(Gallese,V. 2005 p. 5)

This understanding supports and complements our intuitive and psychodynamic

understanding of building close relationships. Through the provision of empathic and

nurturing experiences ‘reflected’ by adults and ‘mirrored’ by the child, we can help children

understand that meaningful relationships and social living is possible. It deepens our

understanding of how children can internalise adults as caring role models.

For children such as Lucy a fundamental lack of a sense of security and attachment with a

primary carer causes them to experience the world as hostile, dangerous, and persecutory.

A lack of secure attachment undermines the child’s ability to construct self in relation to the

primary carer. Rather than developing a coherent personality, their sense of self is fragile

and fragmented.

This traumatised state of mind has been referred to as ‘unthinkable anxiety’ and

consequently children defend themselves against these unprocessed feelings of anxiety,

betrayal, despair and mistrust through chaotic, aggressive, and sexualised behaviours. In

extreme cases where the attachment experience has been so disrupted, and the child’s

‘internal working model’ becomes ‘disorganised,’ they can act in violent and aggressive

ways, apparently showing little concern or empathy for others.

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In response to these adverse experiences, children adopt behaviours which appear to be

designed to keep adults away. At the school we regard these behaviours as misdirected

communications for a need for security and attachment. In this sense one aspect of our task

is to understand behaviour as communication. Such ‘traumatic’ behaviours influence those

adults who work closest with them. For these workers these ‘unthinkable’ feelings often

reflect the original intensity of feeling in the child.

Working closely with disturbed children is anxiety provoking. Chaos and aggression are

never far from the surface. The effective management of anxiety is a therefore a critical and

key concept in providing a safe and nurturing environment. How this anxiety is

acknowledged and contained is critical for successful work with emotionally damaged

children.

Staff qualities in residential care.

As I explored in Lucy’s story, engaging with the process of the lived experience of daily

routines in residential life allows staff and children to develop close relationships. The

weave of conscious and unconscious interactions can be felt, observed, thought about and

talked about. It is within this ‘close in’ experience, that children start to internalise nurturing

and empathic interactions; the building blocks of good experience; leading to them

developing a better understanding of their feelings and sense of self.

In their work with Lucy, through regular supervision and consultation, care workers were

supported to talk about their emotional experience of working with Lucy in order to

understand the despairing and desperate feelings that Lucy was ‘transmitting’ or projecting

into them. This understanding allowed staff to feel emotionally freer, and more able to

respond in insightful and empathic ways towards Lucy. In the absence of such reflective

spaces, the risk is that the team might simply mirror and react to such processes by

becoming punitive, or rejecting of the child’s behaviour, rather than understanding it as a

form of communication.

The aim of our training including our foundation degree is to explore this match between

training and practice. Workers are encouraged to bring their own experiences into the

themed seminars, and by doing so import elements of the process of their practice into the

process of training. When there is a sufficient match within the training session,

opportunities are created for deeper reflection, allowing care workers a better understand

of how they interact as transmitters and receivers of these conscious and unconscious

elements.

So in conclusion I wanted to finish by saying that the Mulberry Bush Approach‐ our model

of practice for the care treatment and education of traumatised children continues to

evolve from the synthesis of a number of theory bases, traditions, and legacies. I believe it

continues to evidence that well managed relationship based residential care really can

contribute to the psychological wellbeing of our society’s most emotionally troubled

children.

Finally to finish, I would like to share some key outcomes of our work.

On entry to the school:

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100% of children have conduct disorders.

96% of children have attachment disorders.

62% have difficulties reading

65% have difficulties writing

58% have difficulties with maths.

As a result of placement at the school:

91.4 % of parents, carers and referring professionals have told us that as a result of a

placement at the Mulberry Bush School, their child is more able to build healthy and

mutually trusting relationships.

92% of children who on entering the school were unable to be placed long term with a

family were able to do so by the time they left.

Overall progress in academic progress is good or outstanding in all subjects.

100% of children are able to be placed in a suitable school on departure, being able to learn

and be taught.

REFERENCES.

Bridgeland, R. (1971). Pioneer work with maladjusted children. London. Staples

Press.

Dockar‐ Drysdale, B. (1968) Therapy in Child Care. London. Longman.

Dockar‐Drysdale, B. (1973) Consultation in Child Care. London. Longman.

Dockar‐Drysdale, B. (1990) The provision of primary experience. London. Free

Association.

Franklin, M.(1945). The use and abuse of planned environmental therapy. London.

Social and psychological Series.

Gallese,V.(2005) Intentional Attunement. The mirror neuron system and its role in

internal relations.

www. interdisciplines.org/mirrors/papers/1

Gerhardt, S. (2004) Why Love matters. How affection shapes a babies brain. London.

Routledge.

Onions, C, Browner, J. (2011) Spaces for growth: where milieu therapy and

psychotherapy meet. Unpublished paper.

Redl F, and Wineman, D. (1950). Children who hate. New York. The Free Press.

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Perry, B. and Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation. A

neurodevelopmental view of childhood trauma.

Child and Adolescent Clinics of North America. 7(1).

Reeves, R. (2002). A necessary conjunction: Dockar – Drysdale and Winnicott.

Journal of Child Psychotherapy. 28(1), 3‐27.