Touch and Emotional Containment

Laura SteckleyCELCIS/SIRCC/GSSW

EFeCT Conference:Conflict Management: Strength Based Approaches

22 March 2012

There is a sensible way of treating children. Treat them as though they were young adults. Dress them and bathe them with care and circumspection. Let your behaviour always be objective and kindly firm. Never hug or kiss them, never let them sit on your lap. If you must, kiss them once on the forehead when they say goodnight.

JB Watson, 1928(cited in Richards, 2000)

Structure for today

• Touch: benefits and difficulties

• Containment and related complexities

• Relationship between touch and containment

• Implications for practice

Touch

• Touch is the first of the five senses to develop• Research is becoming unequivocal as to the

developmental and ameliorative affects of touch

• Links between touch and the development of the hippocampus and decreased levels of cortisol

Touch Research Institute

• Numerous studies on the impacts

of touch– Mother infant studies – Massage– Comparative studies across cultures (a few slides

down)

Touch

Skin to skin contact between infants and mothers by six hours over the first three days after birth.

After 1 month soothing fondling commands eye contact

After 5 years IQ tests language tests

(Field, 2001)

Touch

Sexual abuse recovery

• 1 group received relaxation therapy• 1 group received 30 minutes of massage 2x weekly

for a month

• Both groups reported a decrease in anxiety and depression

• Massage group had a decrease in stress hormones• Relaxation therapy group reported an increasingly

negative attitude towards touch.

Touch

Participants threat of and actual electronic shock– Handholding improved

affect regulation and bodily arousal

– Higher quality relationship correlated with higher levels of improvement

(Coan et al., 2006)

Touch

• Difficulties associated with children’s experiences of transgressive touch– Intolerance of or ambivalence about touch– Staff fears and a culture of suspicion

• Touch deprivation– Sleeping patterns– Suppression of immune system– Increase in aggression

• Puerto Rico 180; France, 110; Florida, 2; England, 0(Field, 2001)

Moral Panic

An intense societal preoccupation with an event, phenomenon, person or group deemed to be a threat to societal order or social values (hence the moral part);

The perception of the degree of threat tends to be exaggerated (hence the panic part).– Witch hunts, McCarthyism/Red

Scare

Touch and Moral Panic

• Prescriptions and proscriptions– Addressed by Ward in relation to residential child care in

1999– Importance of seeing touch as a form of communication

• Addressed in educational settings (Johnson, 2000; Piper & Stronach, 2008).

The touching of children in professional settings had increasingly stopped being relaxed, or instinctive, or primarily concerned with responding to the needs of the child. It was becoming a self-conscious negative act, requiring mind-bodily split for both children and adults, the latter becoming controlled more by fear than a commitment to caring (p.iix).

Containment ≠ Constrainment

Term is often (mis)used disparagingly to mean keeping a lid on or warehousing kids.

Containment•Notion first introduced by Bion (1962)•The infant projects the unmanageable feelings onto the primary care giver, who in turn reflects them back such that they become more tolerable for the infant.•Continual process of hearing and absorbing cries of fear, anger, hunger and discomfort and responding accordingly comprises early experiences of containment.

– Very strong parallels with processes of attachment

Containment• Early, ongoing experiences of

containment enable the development of thinking to manage experiences and emotion.

• When individuals’ experiences of containment are inadequate or significantly interrupted, cognitive and emotional development are affected.

• Uncontainable feelings and experiences are normal and arise throughout the lifespan.

Application

• Bion applied this model to the relationship between therapist and client, stressing the importance of metaphoric containment as part of the process of healing and recovery.

• Containment and related concepts have been subsequently applied to a range of relationships and settings, including education, social work, consultancy and even business.

Definition:

“Containment is thought to occur when one person receives and understands the emotional communication of another without being overwhelmed by it, processes it and then communicates understanding and recognition back to the other person. This process can restore the capacity to think in the other person” (Douglas, 2007, p.33).

Containment involves:• Caretakers ‘absorbing’ the

experiences of those seeking their care to:– Better understand ‘careseekers’’

needs and how to meet them– Contain parts of careseekers’

experiences, helping them to identify, verbalise, and make manageable those uncontainable feelings.

(Kahn, 2005)

ContainmentContainment

This concept can also be applied to the This concept can also be applied to the more complex network of relationships more complex network of relationships amongst and between staff and children amongst and between staff and children in residential child care.in residential child care.– Involves directly addressing via verbal Involves directly addressing via verbal

interpretationinterpretation– Also involves the use of daily activities, Also involves the use of daily activities,

transitions, leisure time, and even the transitions, leisure time, and even the physical environment towards the…physical environment towards the…

– ……development of a containing atmosphere development of a containing atmosphere in which children feel (over time) accepted, in which children feel (over time) accepted, respected and understood. respected and understood.

(Ward, 1995)(Ward, 1995)

Containment—Containment—the role of a the role of a

therapeutic milieutherapeutic milieu

A therapeutic milieu can assist the A therapeutic milieu can assist the client in holding or containing her client in holding or containing her painful emotions, allowing her to painful emotions, allowing her to express internal conflict in a way express internal conflict in a way

that can bring about a greater sense that can bring about a greater sense of personal responsibility.of personal responsibility.

Containment

•Is never static

•Is complex

•Has literal and metaphoric dimensions

Containment

Challenges include:

•Holding the literal and the metaphoric in mind at the same time

•Differentiating own feelings from those absorbed from young person

•Counter-transferenceDiminished energy, insight, increased focus on control, emotional unavailability, provoking and/or punitive interactions

Containment for Containment for ContainersContainers

Needed not only for the demanding Needed not only for the demanding and complex work of meeting and complex work of meeting children and young people’s children and young people’s containment needs, but to enable containment needs, but to enable carers to respond to complexity, carers to respond to complexity, uncertainty and risk…uncertainty and risk…

……particularly in the current risk-particularly in the current risk-averse, increasingly bureaucratic averse, increasingly bureaucratic approaches to practice (Ruch, approaches to practice (Ruch, 2005).2005).

Unit ManagersUnit Managers

Pivotal role in providing Pivotal role in providing containmentcontainment

Increasing fragility of organisations Increasing fragility of organisations due to continual restructuring and due to continual restructuring and redeployment of staffredeployment of staff– Diminishes organisational containmentDiminishes organisational containment– Increases pressure on individual Increases pressure on individual

managers as containersmanagers as containers

Containment for Containers

Necessary nesting function of containment

Containing relationships between staff and

young people

Systems of Staff Support

Staff meetings

Consultancy

Supervision

Other functions of management

Ruch’s Holistic Containment

Holistic containment• Emotional containment

(feeling containment)• Organisational containment

(doing containment)• Epistemological containment

(thinking containment)

Relationship between touch and containment• Touch can be an important element of a containing

experience;• It can also create anxiety, both for the child/family

member and for the practitioner;• The clarity of our thinking has been distorted by

uncontained anxieties related to touch (and to abuse, particularly paedophilia);

• Practitioners’ need for touch rarely, if ever, addressed.

Relevance to conflict and strength-based approaches• The capacity of touch to unlock and enhance

existing strengths • Central relevance of communication and

relationship – to touch and to effectively working with conflict

• Necessity of clear thinking, hence the necessity of containing environments and relationships, for effectively working with conflict

So how might we proceed?

With meeting our own containment needs?

With meeting the containment needs of our staff?

With meeting the containment needs of Children and Their Families?

So how might we proceed?

To touch?

Or not to touch?

When, why, how?

Touch cannot be sensibly separated from the context of relationships…

References

• Bion, W.R. (1962). Learning from Experience. London: Heinemann (1967).

• Coan, J. A., Schaefer, H. S. and Davidson, R. J. (2006) 'Lending a hand: social regulation of the nueral response to threat', Psychological Science 17(12), pp. 1032-1039.

• Douglas, H. (2007). Containment and reciprocity: Integrating psychoanalytic theory and child development research for work with children. Hove: Routledge.

• Field, T. (2001) Touch, Cambridge, MA, The MIT Press.• Johnson, R.T. (2000). Hands off! The disappearance of

touch in the care of children. New York: Peter Lang.• Kahn, W.A. (2005) Holding fast: The struggle to create

resilient caregiving organizations. East Sussex, Hove: Brunner-Routledge.

References

• Piper, H. and Smith, H. (2003) ‘“Touch” in educational and child care settings: Dilemmas and responses’, British Educational Research Journal, 29(6), p. 879–94.

• Piper, H. & Stronach, I. (2008). Don’t touch! The educational story of a panic. London: Routeledge Taylor & Francis Group.

• Richards, G. (2000). Putting psychology in its place: A critical historical overview. Second Edition. London: Routledge .

• Ruch, G. (2008) 'Developing "containing contexts" for the promotion of effective work: The challenge for organisations', In B. Luckock and M. Lefevre (eds), Direct Work: Social work with children and young people in care, London, British Association for Adoption and Fostering.

References

• Ward, A. (1999). ‘Residential staff should not touch children': Can we really look after children in this way? In A. Hardwick & J. Woodhead (Eds.), Loving, hating and survival: A handbook for all who work with troubled children and young people. Aldershot: Ashgate Arena.

• Ward, A. (1995). The impact of parental suicide on children and staff in residential care: a case study in the function of containment. Journal of Social Work Practice, 9(1), 23-32.

• Winnicott, D.W. (1965). The maturation process and the facilitating environment. London: Hogarth.

Laura.L.Steckley@strath.ac.uk

• Steckley, L. (2011). Touch, physical restraint and therapeutic containment in residential child care. British Journal of Social Work, advanced access published July 7, 2011, 1-19.

• Steckley, L. (2010). Containment and holding environments: Understanding and reducing physical restraint in residential child care. Children and Youth Services Review, 32(1), 120-128.

• Steckley, L. (2009). Therapeutic containment and physical restraint in residential child care [Electronic Version]. The Goodenoughcaring Journal, 6, n.p.

CYC-Online Monthly Column

Steckley On Containment• November 2010• December 2010• March 2011

Steckley on Touch• November 2009• December 2009• March 2010• May 2010