Home > Publications > Books > Living Alongside a Child's Recovery

Reviews

Reviewed By: Linda Bean
Date: June 2007

This book is one of a three-volume set that introduces the SACCS approach to working with children who have been traumatised by their experiences of sexual, physical and emotional abuse – and deemed 'unfosterable' because of their history of multiple foster care placement breakdowns.  (The other two books in the series describe therapy and life story work – for more information see CCYP October 2006.)

The aim of the SACCS integrated service is to help a child through the process of recovery so that they are able to make a successful transition to a new and permanent family.

The authors demonstrate throughout the book a deeply thoughtful and patient approach, which helps us see a traumatised child's behaviour as 'a communication, to be understood and given meaning', however destructive or neglectful it may be.  Short vignettes drawn from casework illuminate and amplify our understanding – for example, they describe a young boy, David:

As his birthday approached, David's behaviour became even more aggressive and destructive.  By spending time with him and talking about his birthday, the party, the food and his guests, and helping him make choices, anticipate his anxieties and demonstrate that his birthday was important to those who cared for him, David was able to let it be known that he had never really celebrated a special time before.  He eventually said that he didn’t care what presents he got as he always had them removed from him either through his behaviour, or his mother would sell them for drugs.

In addition, Pugh and Philpot help us fully appreciate the effect on carers coping with a traumatised child's attacks 'day in, day out for length periods'. This understanding informs the high value they place on supervision and outside consultancy.  In their view, supervision 'enables a carer to express his own feelings and think about them and respond to the child's projection', while consultancy provides 'a reflective space within which individual and group themes and dynamics can be explored'. 

By the end of the book, we can begin to 'imagine in' the world of a severely abused child and those who care for them, and respond helpfully.  This is a useful process for any counsellor/ psychotherapist support as well as specialist workers such as foster carers social workers and counsellor/ psychotherapist supporting fostering and adoptive placements.

This book is very practical.  It describes in detail – and explains the rationale for - the SACCS approach.  Pugh and Philpot discuss creating a therapeutic environment in the home, the process of bringing a child into a placement, food, feeding and mealtimes.  In addition, they consider the role of the key worker, how to meet a child's developmental needs and plan transition to permanent placement.

My only criticism is that I did not find the exercises at the end of each chapter helpful, as they seemed out of context and jarring.  Perhaps they would seem more fitting in a training context where it would be possible to talk about the ideas.

Reading this book was not a neutral act for me as I stopped fostering (for an inner-city London borough) after seven years – cynical, exhausted and full of despair.  Yet I feel inspired and moved by the work SACCS undertakes with some of the most fragile and damaged children in our society.  I really hope that the methodology they employ is used to inform practice training and in supporting foster carers and social workers.

This book was reviewed by Linda Bean

A BACP accredited counsellor/psychotherapist with a Masters in counselling and psychotherapy.  She uses an integrated model and currently works part time as a primary mental health worker for Havering Child and Family Consultation Service, and part time as a primary school in Waltham Forest.  She also has a private practice working with adolescents and adults and offers supervision to other counsellor/psychotherapists.

This review was first published in CCYP journal, June 2007.  This is the journal of Counselling Children and Young People – a division of the British Association for Counselling and Psychotherapy. 

 

Reviewed By: Carina Boyle
Date: 26 September 2007  

This is a thoughtful and understanding insight into the needs of traumatised children. It should find its way onto the desks and into the mindset of many professionals.

The book offers an adaptable model of care that can improve the resilience and wellbeing of young people traumatised through abuse. However, it requires a fundamental shift in how we fund, develop and manage this type of service.

The substance of the authors' work explores the concept of therapeutic parenting as a professional skill and places huge importance on the need to help children feel valued and accepted. They also encourage the creation of a therapeutic environment and offer suggestions about how to achieve this.

The book clearly identifies many important components to ensure the success of this approach, including: absolute commitment; child-centred recovery teams; and appropriate levels of resourcing and support for carers. The book also highlights that it is crucial to develop carers' skills, resilience and self-awareness.

Perhaps the model would be further strengthened if it contained a deeper analysis of helping children in recovery cope with ongoing relationships with their birth family and how to support the birth children of the foster carers involved. But maybe these issues are the material of future publications.

Notwithstanding, this is an important text with the potential to help develop or change practice and to influence how we plan and resource our efforts to help children recover.

Reviewed by Carina Boyle, assistant director of childrens services, NCH Northern Ireland.

This review was first published in Children & Young People Now 26 September 2007. 

Reviewed by Nancy Burke, USA
Date January 2008

The treatment of children with histories of abuse and abandonment is so difficult, and requires so many emotional, intellectual, temporal, social, and organizational resources, that the provision of any additional insight based upon real-world success is always welcome indeed.  Living Alongside a Child's Recovery: Therapeutic Parenting With Traumatized Children, which is the third in a trilogy of volumes based upon the three-pronged treatment approach used by SACCS (presumably a treatment agency, though oddly enough, the acronym is not, to my knowledge, spelled out at any point in the text), offers just insights, providing both instrumental and emotional guidance to individuals and agencies attempting to aid those children and adolescents whose life beginnings have been most problematic.  In accordance with the book's aims, I will discuss it within two frameworks, assessing it both as a scholarly companion to the treatment literature and as an experiential companion.  In general, I suggest that while, as a contribution to the academic literature, it proves disappointing in any number of respects, as a guiding voice, it is a useful and highly recommendable aid to clinicians on the front lines of treatment.

The aim of this particular volume is to discuss in detail the process of therapeutic parenting as this might optimally be practiced by the staffs of residential treatment facilities.  In essence, therapeutic parenting is, as it sounds, a process of reparenting but a form in which the different aspects of parental functions are fulfilled by a number of institutional facets and practitioners who, unlike literal parents, have extensive grounding in the attachment and psychodynamic developmental literatures (in itself an optimistic assumption, containing many implicit laudable recommendations).  Thus, the authors appeal to these literatures in order to provide explanation, context, and justification for their methods.  This is where, in academic terms, the trouble starts.  I suggest that the literature review and contextualization provided by the authors is less effective that it might have been for at least four reasons, which I will elaborate in turn: it is disorganized, it is incomplete, it is insufficiently ambitious, and it fails to make clear its theoretical debt to the resources from which it draws.

The disorganization of the theoretical sectional (for instance, in one example among many, the section on trauma and the brain, which really isn't necessary in the first place, includes more reiteration of the tenets of attachment theory than it does of the tenets of neurology, and also provides case material that is completely unrelated to issues of physiology and neurology: p.29, etc.), undermines the authors' efforts because it conveys the sense that these introductory chapters were simply added as an afterthought, discouraging the reader's investment in the material from the start.  Further, the disorganization of the discussion of the literature prevents the authors from forming an argument for their particular treatment approach and conveys the sense that theory is being painted with such a broad brush that no specific general tenets can be drawn from it.

The theoretical sections are incomplete in that they draw from narrow segments of the developmental literature, providing no views that contextualize or challenge the resources that support their perspective.  Further, although the authors seem to be guided most comprehensively in their clinical approach by the writings of Winnicott, his ideas are not presented in sufficient detail to allow the reader to appreciate his contributions to their clinical and organizational decision making.  For instance, the authors might have offered a focused summary of those of his ideas that most inform their treatment program (e.g., ideas about the survival of the object, primary maternal preoccupation, ruthlessness and the pre-ruth, the facilitating environment, the environmental mother, the capacity to be alone, and so on; Winnicott, 1965, 1975). 

Indeed, even among Winnicott's writings, there is conflict and room for interpretation; without a more pointed and comprehensive discussion, the authors run the risk of sentimentalizing that theorist (he is easily, and tragically, susceptible to this), and giving the impression that he advocated total and seamless provision rather than a developmental process in which lack of provision, and even the explicit struggles by the parents to metabolize emotions such as rage and hatred, are necessary for growth.

I suggest that the book is insufficiently ambitious because, although the authors clearly describe an active and thoughtfully constructed treatment program that draws from an enormous pool of collective experience, they never seem to bring their observations to bear on the exciting theoretical debate.  Precisely because their clinical acumen and empathy are so acute, one might imagine that their work could be used to speak to specific controversies in the field so that their dialogue with the literature could feel more like a real, two-way dialogue.

I claim that the authors fail to make clear their theoretical debt because of many of the ideas they use are so closely associated with an established theoretical viewpoint (largely Winnicott's, with healthy measures of Bowlby thrown in) that the attribution is already obvious to the reader, making the lack if explicit acknowledgement seem ungenerous if not deliberately obfuscating.

Although the reader wishing for an overview of child and adolescent residential treatment might be encouraged to go elsewhere, the authors' accessibility, openness, and obvious empathy for those in their care allow the book to assume the position of a trusted mentor to residential clinicians in search of a more experiential, narrative guide.  Its exhortation to therapists and aides to remember that even the most self-destructive and intolerable behaviours are rich communications that have meaning, while not original, it too rarely articulated, always welcome, and especially persuasive coming, as it does from a treatment milieu in which it is obviously so well practiced.

The assessment parameters the book provides are immediately useful (though perhaps they could have been more so, had they been placed further to the front of the book); its colloquial styles renders it friendly and accessible; the attention to detail it encourages stands to sensitize administrators and planners; the frequent and nondefensive use it makes of outside consultants serves as a refreshing and stabilizing model; and, perhaps most of all, its provision of hope for clinicians for whom metabolizing the hopelessness of those in their care is an often overwhelming aspect of the work renders the book both likable and valuable.  For all of these reasons (and, of course, more), I would encourage directors of programs such as the one on which this book is based to distribute it widely among their staffs and to expect, as a result, to see improvements in the lives of patients and clinicians alike.

www.psycinfo.apa.org/psyccritiques