Centre of Knowledge. The Model in Practice: Understanding the Lighthouse Therapeutic Family Model of...
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Transcript of Centre of Knowledge. The Model in Practice: Understanding the Lighthouse Therapeutic Family Model of...
Centre of Knowledge
The Model in Practice: Understanding the Lighthouse Therapeutic
Family Model of Care™
Theoretical Underpinnings of TIP
Attachment Theory
Object Relations Theory
Trauma Neurobiology
Psychological Wellness Theory
The Lighthouse Experience
Overview of the Model
HomePLACE
Playful, Loving, Accepting, Caring, Empathetic
Family Primary Experience
Individualised Care
Individual Development Plan
Professional Development
Plan Staff
Developmentally Focussed
Not Chronologically
Time/Holding Space
Therapeutic/ Recovery Oriented
Sense of Community
Recovery Process
Psychologists Care Team Carers Young Person
Intake
Process Presenting Issues
Referrals Identify
Intake interview Confusion/diffusion
Consultation Mental health issues
Psycho-social screening Drug & alcohol issues
Placement meetings Disconnected
Immediate gratification
Induction
Process Presenting Issues
Visit homes Attachment difficulties
Dinners Cold feet
Family meetings Culture shock
Community events Guarded
Meet carers and young people
Debrief with intake worker and carer
Holding Environment
Process Presenting Issues
Primary experience Reactive attachment
Attachment with carer Traumatic experiences surface
Relationship building Resistance to boundaries
Trust, safety, stability and security Substance issues may resurface
Home Mental health issues
Develop confidence and self esteem Family conflict
Window to future Transference and counter-transference
Transition to Autonomy/Independence
Process Presenting Issues
Coping skills Resistance to change/separation anxiety
Skills development Regression
Support networks Cold feet
Established healthy attachments Internal conflict
Community networks Grief & loss
Transitional object Excitement vs. anxiety
Transitional planning
After Care
Process Presenting Issues
Assertive outreach Financial issues
Transitional development planning Accommodation/housing
Carer relationships Mental health support
Ongoing relationships with young person Separation anxiety
Inter-dependent living Community support
The Recovery Process
Elements of Recovery
• Therapeutic Relationships
• Group Experience
• Physical Environment
• Sense of Community
• Organisational Culture
Therapeutic Relationships
A central aim of the therapeutic relationship is to provide a safe relationship in which
the child can then work through and integrate unresolved aspects of their traumatic
experiences.
From the position of being engaged in a positive attachment relationship and
through observing other healthy relationships, the young person can then acquire
experience and skills to develop and manage other relationships in their life.
Barton, Gonzalez & Tomlinson (2012)
Therapeutic Relationships
…evidence is accumulating that human beings of all ages are happiest and able to
deploy their talents to best advantage when they are confident that, standing behind
them, there are one or more trusted persons who will come to their aid should
difficulties arise. The person trusted, also known as an attachment figure, can be
considered as providing his or her companion with a secure base from which to
operate.
Bowlby in Barton, Gonzalez & Tomlinson (2012)
The Group Experience
Traumatized young people need a healthy community to buffer the pain, distress
and loss caused by their earlier trauma. What works to heal the young person is
opportunities to increase the number and quality of relationships. If we don’t give
children time to learn how to be with others, to connect, to deal with conflict and to
negotiate complex social hierarchies, those areas of their brains will
be underdeveloped.
Perry and Szalavitz (2006)
The Group Experience
The group processes provide an opportunity to observe group dynamics and where it is
helpful to intervene in a way that disrupts destructive dynamics that may be developing
For example, difficulties within the group may be projected onto one person who could
then become a scapegoat for the group’s difficulties
An opportunity for everyone involved to establish their sense of self by making their own
unique contribution. For everyone to reflect on what is happening for themselves, for
others and the whole group. This enables the members of the group to learn about their
own feelings, thoughts and relationships and to consider this alongside other people’s
experiences
Therapeutic Environment
Traumatised people benefit from caring
environments that are attuned to their
emotional states.
…where workers can adjust the
environment to support emotional
regulation, and can provide predictable
responses and routines that assist in
reducing hyper-arousal.
(Tucci, Mitchell and Goddard, 2010)
Physical Environment
Child abuse and trauma often
happens within a wider context of
neglect, where the environment
the child lives in reflects the
parent’s lack of attunement to their
needs. The home is often uncared
for, unstimulating, chaotic and
sometimes unsafe.
The environment is warm, friendly, nurturing, calming
and aesthetically pleasing. It contains facilities that can
support and enrich a child’s life. The home is a place
for growth, development and a means of balancing the
need for being sociable with privacy. It is a place where
positive memories can be made and life-long
relationships established. Most importantly, the home is
a safe place and sanctuary.
Barton, Gonzalez & Tomlinson (2011)
The Community
Sense of community:
The feeling that one is part of a readily
available supportive and dependable structure.
Sense of community transcends individualism
in that to maintain such an interdependent
relationship one does for others what one
expects from others.
Sarason (1974)
Sense of Community
Ideally, children are raised by their family and extended family within the
context of a supportive wider community. Many of the children that we
work with have been alienated and disconnected from their local
community. Many of the children’s lives are transient, due to running
away from unsafe relationships, or being moved around by the system
from placement to placement.
Barton, Gonzalez & Tomlinson (2012)
Therapeutic Circle of Care
Organisational Culture
Traumatized children cannot heal within traumatizing - or traumatized - organisations, and instead such organizations can make children’s problems worse.
Bloom (2005)
Organisational Culture
• Organisational wide understanding child development and impact of trauma
• Consistent trauma informed approach incorporated across systems and processes
• Clarity as an organisation of the primary task
• Young people are provided a holding environment - feel safe & protected
• Opportunity to learn to deal with grief & loss in a healthy way
• Long term consistent and repetitive work
Organisational Culture
• Opportunity for the child to develop healthy attachment
• Promote the direct expression of feelings
• Systems that support staff to manage complex nature of the work
• Enhance motivation for growth and future success
• Provide opportunity for connections with wider community
Organisational Parenting
Organisation
Internalised by the child
Operations/ relationships
attuned to the therapeutic
task
Relationships, language,
communication, leadership and
authority = Environment
experienced by child
All staff role model a
healthy sense of
community
Variety of relationships
& circle of care
Provides a therapeutic
milieu
The Organisation as Therapist
TFMC Process of Recovery
Individual Development Plan
LearningPhysical developmentEmotional development
AttachmentIdentitySocial development
Autonomy / life skillsRelational and community ConnectednessFun / play / recreationTransition planning
Psychological Healing Process
Identity confusion Attachment difficulties
Holding spaceTrauma workDealing with loss and rejectionDeveloping insight and awarenessBuilding trust in relationshipsInternal working models
Developing autonomyNew skills consolidationConfidence in relationship building
Lighthouse Process Intake Induction Lighthouse Home Transition After Care
Time-frame Weeks / Months Months / Years Months / Years
Feedback and Evaluation