NVR in Southampton Denise Wilson Margaret Smith Background

NVR in Southampton Denise Wilson Margaret Smith

Background • BRS: (originally The Behaviour Resource Service) ‘Bringing Resilience and Strength’ • Tier 3/ 4 Child and Adolescent Mental Health Service (CAHMS) multi-agency team • Joint Funded by Health and Social Care since 2000 • Working with children and families in care or edge of care situations

Our NVR History Started using NVR with individual families in 2008 Started NVR parent groups in 2011 Co-founders of NVR UK 2012 Training programme formally established 2015 30+ professionals and Parents now practicing NVR • NVR in schools • NVR ‘hub’ for co-ordination and supervision • • •

How do we do NVR? We focus on: • INTEGRATION with other approaches we use • INVOLVEMENT of parents in development • RELATIONAL aspects of NVR (reciprocity)

NVR: A New Vision on Relationships

The PACE approach (Golding and Hughes, 2012) Playfulness Acceptance Curiosity Empathy

The ‘attitude’ of PACE • PACE is ‘at the heart of helping children with trauma and attachment difficulties as well as being helpful for relationship strengthening generally’ • The human brain is designed for intersubjectivity; This rests on the ability to understand the inner life of each other. If a child does not have influence on a parent, the parent will have less influence on the child. • ‘Connection before correction’ (Golding and Hughes, 2012)

The two hands of parenting Nurture and discipline

Playfulness A light, relaxed attitude is de-escalatory offers relationship; meeting the child on their terms Protective against shame (activates different part of brain) The power of doing the unexpected (disobedience) Exaggerated affect (mirroring) can promote co-regulation The parent notices the strengths and uniqueness of the child and reflects pleasure in these; the child is experienced positively • conveys optimism that things can change • Promotes reciprocity • • •

Acceptance • Nonjudgmental, unconditional acceptance of inner experience of child (not condoning the behaviour) • becoming aware of and understanding the inner life of another without trying to change it. • Create the conditions that will help the child to express it in different ways • not jumping straight to problem-solving (reassuring, rationalising, suggesting etc) • Raises parental presence (approachable) and strengthens relationship/ reciprocity

Curiosity • An attitude of not knowing; open, interested • Tentative wondering rather than interpreting. • Making sense together • Accepting different perspectives • Open to surprise • light bulb’ moments • Prepared to be wrong • Persisting with curiosity is de-escalatory • Curiosity increases connection and empathy.

Empathy • Recognising and sharing in the emotion whilst staying regulated e. g. experiencing anger without getting angry • Acknowledgment of child’s difficult feeling • The child feels understood and ‘felt with’; needs recognised • Antidote to stress • Connection before correction

Looking after oneself • • • Secondary trauma Easy to lose empathy with people exhibiting shame; A marathon rather than a sprint – persistence needs stamina Build insulation against blocked trust Can’t show empathy without caring for yourself (put on your oxygen mask first!)

‘blocked care’ – stress can ‘lead to the development of mutually defensive feelings between parent and child, when the child mirrors the parent’s stress and then exhibits signs of his or her own distress that the parent, in turn, mirrors back’ (secondary trauma). – As a result When parents are experiencing blocked care, they often focus narrowly on behavioural difficulties that they are having with their children………parents often hope to just “fix the problem” without making sense of the relational difficulties they are experiencing with their children Hughes and Baylin (2012)

Overcoming ‘blocked care’ NVR helps greatly with this: PERSISTENCE • Keep offering the relationship 9 relational gestures help to overcome ‘blocked trust’ • Retain flexibility : what worked yesterday might not work today. We need to be open to the uniqueness of the situation and respond in the best possible way. • Also true with the parents – we don’t know what will bring about the ‘light bulb’ moment • don’t need to get it right all the time

Self-compassion – Self kindness (relating kindly to ourselves, flaws and all) – Common humanity (focus on shared experience; acceptance, sameness, connection) – Mindfulness (able to be with what is in the present moment) Neff

Mindfulness techniques

Mindfulness supports presence • "mindfulness means paying attention in a particular way; • on purpose, • in the present moment, and • non judgmentally. " (Jon Kabat-Zinn)

Cognitive Well Emotional Well Reading, watching plays/films. Debating ideas. Planning and thinking things through. Fun. Unconditional time with others; friends , family. Opportunities to express feelings/ talk through problems Gives YOU Energy Spiritual Well Renewing sense of wonder. Maybe through religious beliefs, meditation, nature, uplifting music involvement with inspiring causes Balancing the wells of well-being Perspective & Balance Physical Well To counteract build up of tension, exercise, learn relaxation techniques, go for massage, eat and sleep well. Breathing techniques Creative Well Enjoy your senses and imagination. Appreciate the arts. Write/draw/sing/ dance. Play with colour, texture, sound, scent and movement. Mosley

Minded parenting (Kim Golding) • The ability a parent has to treat their children as individuals with their own mind. • Capacity for reflection and metacognition • Theory of mind; the parent’s understanding that the child has thoughts, feelings, beliefs and desires which might be different to their own. • Helps de-escalation and leads to raised parental presence

Understanding our responses

Our three brains in one

“High Road” Cortex Sensory thalamus Sensory Input “Low Road” Amygdala Emotional / Visceral Responses

The ‘handy’ brain model Dan Siegel

The Shield against Shame Unregulated shame > need to defend self From Golding and Hughes (2012) Minimise: It was only a joke! Blame: You made me do it! Lie: It wasn’t me! The more you target the behaviours, the more the shield will go up Rage: It’s so unfair; you’re always Picking on me!

Support and practice • • • Recognising own triggers manage own responses Practising de-escalation strategies especially empathic scripts/one-liners Grow in confidence that they can be the agent of change

A key incident

Warning: the following clip contains strong language!

Escalation scenario Context: Luke is in foster care. NVR focus is on improving relationship between Luke and family when he sees them. The following exchange happened at the end of a family contact day after which Luke would return to his carers. The day was spent in a country park and had been really positive. All family members are packing stuff into the car. Luke is carrying Dad’s special camera and goes to stow it in the boot of the car. Dad: Be careful! That camera was expensive!! Luke: (under breath) Dickhead Dad: what did you call me? ? !! Luke: (louder) Dickhead…dickhead!! Dad: Don’t you call me names like that!. . Loser!! Luke: (storms off) F***ing tw*t. You’re not my Dad and I don’t want to be part of this f***ing family anyway.

From understanding to empathy

From reconciliation gestures to relational gestures • ‘Love gestures’, ‘emotional gestures’ • Priming (rather than after an act of resistance) • Key focus for raising parental presence: having the child in mind • Overcome blocked care (‘fake it ‘til you make it’) • In turn overcome blocked trust

Reciprocity through relational gestures • blocked trust can be overcome and relational gestures are made spontaneously by the child to the parent

Announcements with PACE • Self announcements • Mini announcements – Position statements – Strategic tools • ‘full monty’ announcements Child focussed Highly individualised Creative, playful Co-created Expression of parental presence; child feels understood and supported – connection before correction – Relational gesture in themselves – – –

Active resistance with PACE • Message campaign first • Use of shame reducing formula (and for appreciation messages (Uri Weinblatt) • Sit-ins creatively used n adaptations to the child’s needs (Uri Weinblatt) • Sit ins raise parental presence in a relational way

supporters • • Parent mentors Group Follow on Organise events Facebook Involvement of other agencies/teams hub

facebook support

NVR ‘in reverse’ Using the principles of non violent resistance from the position of a young person to effect change in family communication and relationships.

Case study John – 17 yrs. Referred to CAMHS Struggling to manage his own mental health well being Risk taking behaviours , self harm , low mood , self destructive behaviours Conflict in relationships within family and personal relationships Impact on education

Key elements • Looking after self – Understanding own responses; fight/flight – Replenishing the wells • Introduction to Ghandi and key ideas of NVR – Idea of resistance rather than battle/control • Practising de-escalation – Understanding parents’ responses – Using PACE • Raising presence – Emerging from isolation – Relational gestures to family members – Uniting with older brother – announcement

The announcement “ I want our battle’s to stop and I will not fight you. I have been unhappy for years and have never really felt that you really love me. I feel unimportant in your life and I want our relationship to change. I know you are ambitious for all us kids to achieve well in our lives and I want that for myself too. I am choosing to go to college and I am trying to change. I have been escaping and taking the easy way out. I am going to make mistakes but I am going to keep trying. I am letting Paul (elder brother ) know that I am telling you this. ”

outcomes • • • Empowered, motivated Improved mood Improved relationship with mum, sisters , step dad Attending College – good exam results Enjoying life; friendships, new relationship Part time job Writing a short story Skateboarding Driving lessons Festivals

Work in progress • • Further development of NVR in reverse Young people’s groups Work in schools Sibling groups

Thank you very much! Tack så mycket!

References • Golding, K S (2008) Nurturing Attachments: Supporting Children who are Fostered or Adopted, Jessica Kingsley Publishers • Golding K S & Hughes D A (2012) Creating Loving Attachments: Parenting with PACE to Nurture Confidence and Security in the Troubled Child, Jessica Kingsley Publishers • Hughes, D A & Baylin J (2012). Brain-based parenting: The neuroscience of caregiving for healthy attachment. New York, NY: Norton • Neff, K. D. (2011). Self-Compassion: Stop beating yourself up and leave insecurity behind. New York: William Morrow • Siegel, D. J. & Hartzell, M. (2004) Parenting from the Inside Out: How A Deeper Self-Understanding Can Help You Raise Children Who Thrive. New York: Barnes and Noble • www. selfcompassion. org

denise. wilson@southampton. go. uk margaret. smith@southampton. gov. uk