Staying on your game as a therapeutic specialist

Mar 2020

Written by Noel Macnamara

What follows is a mixture of tips, reminders, encouragement and hopefully a little bit of inspiration.

  • Start with your “why” – Knowing your why is a key essential to success in your role as a therapeutic specialist. As Simon Sinek’s research into leadership has shown, the why comes first. The why is your origin of purpose. You need to connect to your why to feel like you belong, to connect to your professional communities, and circles of relationships. A clear sense of why has a higher purpose, cause, or belief. The why matters. The why inspires behaviour. Clarity of why is key. When the pressure is on (and the pressure is always on) it helps to be clear on why you’re doing this work in the first place. It helps to keep you and your practice and focus on track. It can motivate when you’re tired and pull us back from losing our balance when things get dysregulated.
  • Patience, patience, patience – The complexity of problems across physical and psychosocial health, and interpersonal and behavioural difficulties take an extended period to develop in the young people in residential care. When children and young people enter the OOHC system it’s easy to forget this. When their behaviour seems entrenched and reluctant to change, patience is a great virtue. Patience can assist us in seeing beyond the challenging, worrying or confronting behaviours of the children and young people in residential care and allow us to empathise with the lonely, frightened and humiliated child within. There is no quick fix. Also, as a therapeutic specialist, you recognise as with people and change, organisational change takes time, attention and is generally messy, slow and complex. It is not linear. Additionally, like people, organisations are continually evolving, changing and developing. Therefore, organisational change not only needs time and effort, but also an acknowledgement that it is not being trauma-informed and arriving at a final destination, but it is rather about working towards becoming more and staying as trauma-informed and responsive as possible.
  • Remain Curious – Albert Einstein said: ‘The important thing is not to stop questioning… Never lose a holy curiosity’.  Curiosity is a state of active interest or genuinely wanting to know more about something it allows you to embrace unfamiliar and complex circumstances. The children and young people in the ITC service all have complex histories and behaviours. Caring for such children is highly complex and challenging. When we are curious, we see things differently; we use our powers of observation more fully. We sense what is happening in the present moment, taking note of what is, regardless of what it looked like before or what we might have expected it to be. We feel alive and engaged, more capable of embracing opportunities, making connections, and experiencing insight and meaning and meaning. Curiosity requires one to be what I call ‘slow-to-know’. Assuming there is always another ‘right’ answer; we can be surprised by every response and push ourselves to listen for the not-yet-said so we always have another question to ask. Also, remember that the mind is like a muscle: it becomes stronger with exercise, and there is no better mental exercise than curiosity.
  • Stay on the learning curve – Be the best version of yourself by adding to your knowledge and understanding. Once we stop learning we limit the help we can provide. Reading is a great way of adding to the learning we do on-the-job. Those who read learn; those who learn read. Continue to learn more professionally. Join a study group, learn from others. attend continuing education conferences and workshops about trauma informed work, and evidence-based interventions. As Fenton (2015) reminds us “We are more likely to find something we are looking for that to stumble upon something unanticipated”.
  • Focus on safety and trust – Safety and trust are paramount and without them, everything else exists on fragile ground. Therefore, safety and trust are the foundations and need prioritised and kept at the heart of all decisions, interactions and structures for both young people and staff. Safety and trust are even more important given that we know that fear, anxiety and stress can restrict and constrict. So, when staff/organisations feel unsafe, dysregulated, anxious and in survival mode. They can find it harder to think, explore, reflect, be playful, progress, regulate, relate and process information. We must find multiple different ways to increase feelings of safety and trust and decrease threat, fear and dysfunction in our relationships with residential and other staff. To be effective therapeutic staff must be able to think, feel, reflect and find ways to re-charge, process and release rather than react.
  • Influencing others-maintaining their status – Our brains are wired to be competitive. We get a rush when we win… at even the most trivial thing. It can be surprisingly easy to accidentally threaten someone’s sense of status. A status threat can occur through giving advice or instructions, or simply suggesting someone is slightly ineffective at a task. When threatened, people may defend a position that doesn’t make sense, to avoid the perceived pain of a drop-in status. In most people, the question ‘can I offer you some feedback’ generates a similar response to hearing fast footsteps behind you at night. As a therapeutic specialist part of your task is to provide a range of feedback. Understanding status as a core concern can help you avoid creating a threat response in the individual or group. Recognition and congratulations for work well done have an unambiguously positive impact on our sense of status. So does the feeling that our work has meaning and that we are valued. Investing in these provides a platform of good will and better enables staff to hear critical feedback without experiencing a loss of status.
  • Seeing the woods for the trees – Working with children and young people whose traumatic experiences goes back to the preverbal stage in their life it is not surprising that their feelings of distress are expressed through acting out behaviour. However, therapeutic residential care should not be in the business of simply trying to control behaviour but rather helping children and young people gain insight into what drives them towards acting out so they can begin to work with staff in employing strategies to manage their behaviour. The aim being over a period of time for children and young people to develop inner controls. I think it was Bruno Bettelheim who said that a child’s successful treatment is made up of doing the best you can each day and for a lot of the time it doesn’t feel like success.

The ability to keep going even through the most difficult periods is a feature of therapeutic residential care. Therapeutic residential care has a therapeutic specialist to help develop the therapeutic task. It can be difficult for the residential staff teams to “see the wood for the trees” amongst the bizarre, unpredictable and overwhelming behaviour of the children and young people. In my experience it takes someone who is outside the immediate dynamic of the care environment to help make sense of the behaviour and assist staff to be able to make a trauma-informed shift which encourages them to move away from assuming or thinking, “what is wrong with this young person?” and instead to move towards reflecting “what happened to you?, what matters to you?, who are you?, what do you need?” and “ what is strong in you?” the therapeutic specialist constantly gives meaning to Alexander Den Hejjer’s famous quote: When a flower doesn’t bloom you fix the environment in which it grows, you don’t blame the flower.

  • And, finally, Look after yourself – None of us can do an optimum job of helping others if we’re neglectful of our own needs. It helps to remember these three very effective strategies for taking care of yourself as a Therapeutic Specialist: Reflection, Regulation and Relaxation.

Reflection: Take time to reflect on the work you are doing, your relationship with the staff team, and the assistance that you might need.

Regulation: It is important to acknowledge and regulate the feelings that working with trauma evoke in you. For example, caring for these children can often trigger unresolved issues from the past in staff and ourselves. Manage your own emotions and responses by:

Relaxation: As important as reflection and regulation is relaxation, allowing you to renew your spirits and energy.

This may not be new, but hopefully, it will be a useful reminder of some things that can help you hold your nerve, maintain your stamina and keep going with the really valuable work that you do!

Noel MacNamara
Senior Advisor, Centre for Excellence in Therapeutic Care


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