Caring Relationships


 

 

caring realtionships -art 2

“The qualities of good parenting (and of close relationships in general) are essentially regulatory qualities: the capacity to listen, to notice, to shape behaviour and to be able to restore good feelings through some kind of physical, emotional or mental contact, through a touch, a smile, a way of putting feelings and thoughts into words.”

Source: Sue Gerhardt, 2004

Why Love Matters: How affection shapes a baby's brain

Feel Good People Make Feel Good Wards



Attachment is the most basic need of a young person, topping even hunger in its importance. That means parents, primary carers, teachers and ward staff are the heroic driving force behind great relationships. Empathy, warmth, patience, encouragement, mutual trust and acceptance are all relationship biggies. The parent-child relationship is at the heart of how young people develop all the most important feel-good qualities, including honesty, kindness, loyalty, generosity, a commitment to justice, self-esteem and the capacity to problem-solve. Research has shown that the best predictor of a young person’s health, and the most effective deterrent to risky behaviour, is a close relationship with a parent. A secure emotional connection with a significant adult figure reduces the risk that a young person will suffer from emotional stress, have suicidal thoughts or behaviour, engage in violence, or use substances (Dooley & Fedele, 1999 - ref link).
In this theme, we’ll focus mainly on staff members’ relationship with young people on the ward. We’ll touch on how staff are the compassionate experts who build-up, enable and support young people’s relationships with everyone involved in their lives, including families, carers, friends, schools and even pets. By expertly inspiring caring relationships, staff are socialising agents, and it’s essential that therapeutic work is always collaborative, and the impact it has on a young person’s needs is carefully and systematically monitored (The Centre for Social Justice 2011 - ref link). We also emphasise the importance of giving liberal, generous and sincere praise.
The ‘therapeutic alliance’ is the ability to form and nurture therapeutic relationships in which staff create a 'bond' with young people and their family, so they can work together to reach shared decisions. In this sense, it’s primarily about supporting healthy attachment, so young people and those involved in their recovery can have trust, and are able to be honest about their needs. The healthiest relationships are those which are honest, flexible, committed, warm and safe.

progressposter

“[Shared] decision making is not just a powerful tool... Clinicians reported that using shared decision making radically changed the way they interacted with service users, making relationships more open and transparent.”

The Health Foundation

Find out more

It’s essential that work with young people is always collaborative. Ward staff are socialising agents; the best relationships are those which are honest, flexible, committed, warm and safe. 

caring realtionships -art 3
“Early intervention and supporting people to solve the problems they face is all about human relationships. It is relationships which change people, not systems or processes or anything else… The empathy and trust that develops between a skilled practitioner and a parent, child or young person can motivate and equip people to change their lives.”

Donna Molloy

Early Intervention Foundation

Happy One-to-One-ness



As we explore in the Relational and Physical Safety theme, young people are more able to focus on building positive ways of coping when there is a structure to the ward day. For example, through staff and young people thoughtfully organising space and time. This can be especially vital for young people who feel muddled or detached, or whose home lives have not provided secure attachments. Here the ward becomes a substitute, a kind of surrogate ‘attachment figure’.

Mental health professionals need to establish attachment-like relationships with their young patients in order to support their recovery. Truly caring relationships are not based on detached supervision, observation and discipline alone, but on safety, comfort, support and mutual enjoyment and sharing.
The skill of remaining present with flexibility and clarity within ourselves allows us to be more wholly connected in relationships (therapeutic, professional or otherwise) and to respect each person's individual perspective. Being flexible with our responses gives us a way of choosing communication with the most therapeutic benefit.

Clearly, successfully building a positive alliance leads to happier outcomes. Warm, one-to-one support provided by ward staff is the most significant element in improving young people’s inpatient experience, and is an essential ingredient in any effective intervention. All fruitful efforts to positively shape a young person’s thoughts, feelings and behaviour come from safe and secure attachment. Which is why happy CAMHS ward partnerships count on generous staff members truly connecting with the young people in their care, and the significant figures in young people’s lives. The quality of these relationships has an enormous impact on the outcome of any CAMHS intervention, ideally providing a relational space in which everyone can be their most authentic self. This is a truly powerful gift. Undeniably, relationships are, in and of themselves, a transformative intervention, matched bar none, and that’s why they’re the catalyst for all the COLOURFUL themes.

It’s not surprising that research shows children and young people with a variety of mental health problems and their families tend to prioritise a healthcare practitioner’s ability to listen, and their accessibility, approachability and child-centredness over anything else. Find out more

Good relationships are key.

shutterstock_122981572

"...all children deserve time, attention and love from the adults in their lives. These basic qualities are so much more valuable than the always changing material and social concerns that can seem so important to young people."

HRH The Duchess of Cambridge - ref link

The Six Stages of Attachment



Psychologist Gordon Neufeld (2006) has developed a brilliant model for understanding the way healthy relationships evolve. He’s set out six stages of attachment that create the foundation for almost every relationship a young person will ever have; starting with parents, and later with siblings, friends and intimate partners. Every relationship will follow the six-stage path of attachment. In her excellent book, Parenting Without Power Struggles, psychotherapist Susan Stiffelman (2012) helpfully describes the stages making up the relational journey this way:
1. Proximity

We start a new relationship with a desire to be in the other person's company.

2. Sameness

Next we find out that we have things in common, such as values and interests.

3. Belonging/Loyalty

As the relationship progresses, circumstances inevitably arise in which the other person does something to help us out, showing us that he or she is on our side.
4. Significance

If our connection goes deeper, the other person lets us know that we - and our connection - are uniquely special to them.

5. Love (or the appropriate equivalent)

Going deeper still, there comes the expression of fondness and affection.

6. Being Known

When we look at the people who become truly and deeply close to us, we’ll see that they have let themselves be known by us.
Obviously, these experiences must happen for both people in the relationship, if there’s to be a balanced and healthy connection.

Reliable one-to-one support is the most significant element in improving young people's inpatient experience, and is an essential ingredient in any effective intervention.

caring realtionships -art 4


Quality Time



The quality of the therapeutic relationship has an enormous impact on the outcome of any intervention with young people and their families. Of course, these relationships are, in and of themselves, a means for therapeutic growth. They require a fine balance of both professional skills and boundaries and the therapeutic use of self, which  certainly takes dexterity at times! Such a relationship creates a strong therapeutic connection, helping  young people to feel cared for, grounded, supported and able to move forward. While on a CAMHS ward, young patients need staff who will listen, notice, encourage and be able to boost good feelings, through a caring and genuine connection.
Helpful and therapeutic relationships are:

  • Protected

  • Safe

  • Authentic

  • Confidential (subject to limits)

  • Non-intrusive

  • Purposeful

  • And have a connecting link between the young person’s world and the practitioner.


Source: Adapted from Geldard & Geldard 2013

Counselling Children: A Practical Introduction 4th (fourth) Edition by Geldard, Kathryn, Geldard, David, Yin Foo, Rebecca published by SAGE Publications Ltd (2013)

Superb CAMHS staff…



  • And the young people they care for are partners in setting up and following expectations and rules.

  • Know that setting up and following expectations and rules is a coaching / modelling / safety process, and not about punishment or control.

  • Understand that their behaviour and emotions affect patients’ behaviour and emotions.

  • Model responsibility; they focus their attention and energy on the positive aspects of young people’s behaviour and advocate co-operation, not control. Brilliant wards promote collaboration and nurturance on every ‘level’.

  • Teach young people to think for themselves and develop self-control.

  • Build self-esteem. They know that healthy self-esteem is the main ingredient young people need to develop self-confidence and resiliency.

  • Learn from young people.

  • Develop response patterns that promote pro-social behaviour.
  • Are consistent; they say what they mean and mean what they say. They follow through.

  • Stay calm when their buttons are being pushed. They use expectations and rules that teach, not get even.

  • Connect special activities with pro-social behaviour.

  • Anticipate problems. They have proactive (not reactive) plans and strategies for managing tantrums, rule breaking, fighting, arguments and power struggles.

  • Have plans that teach the value of completing goals and the steps within them.

  • Don’t let challenging behaviour keep them from enjoying their work.

  • Are professional and authoritative yet warm and positive. They are serious about the importance of proper conduct, but they have a childlike sense of humour whenever it’s needed and appropriate.

  • Know how to appreciate young people, even when they’re ‘kicking off’ or pressing buttons.

  • Are open to change.


  •  


    Source: Influenced by a great summary of factors that contribute to successful parenting in ‘How To Behave So Your Children Will Too’ by Dr Sal Severe, 2004.)
    Listen to young people discussing what makes the ideal CAMHS worker:



    Nina Martynchyk says the love and care of the CAMHS nurses and support workers helped save her life.

    "Although I don’t remember the dosage of medication that gave me such severe side-effects I couldn’t go to the Paralympics, I do remember the nurse who had offered to take me there with her spare ticket. I remember the nurses stepping in to offer to do my laundry because I had no family to do it for me…


    I recall how the receptionist at the outpatient unit, who had remembered me from my time there a couple of years earlier, would come upstairs to the ward to see me. Then there were the support workers who would sit by my bed and read magazines when I had no one to visit me.


    One nurse at Ellern Mede came into work on her day off to take me on a day out. And when it came to meeting my new foster mum for the first time, they made sure I was there with my chosen member of staff…


    Many important factors played a part in my recovery from anorexia, such as my friends, my social worker, my brother and my foster family. But without the NHS I probably wouldn’t be here. It is such a vital service.


    I worry when I think about all the cuts and the already extremely stretched mental health services and wonder what would have happened if it had all happened now. Would I even have been admitted? Or would the budget cuts mean I would have slipped through the cracks and been even sicker before I qualified for help? The NHS saves lives daily; we need to save it to save ourselves, our families, our friends, our neighbours and the most vulnerable in society.


    I am forever in debt to the employees of the NHS who not only saved my life physically but made me feel like I was worth something when I was adamant that I was not. Thank you."




    Source: The Guardian

    Young inpatients need staff who will listen, notice, encourage and be able to boost good feelings, through a caring and genuine connection.

    caring realtionships -art 6

    “The ‘mind’ part of mindfulness refers to caring with vigilance, as in saying ‘mind what you are doing’. The ‘full’ part refers to the entirety of what the current moment presents. We could therefore conclude that mindfulness is the skill of attending with vigilance and care to what is presently sensed and experienced, as completely as possible.”

    Nic Higham, 2015

    A Mindful Core in the Moment



    Young people learn about themselves through the way we relate to them and mindfulness is at the core of caring relationships. Ward staff have a responsibility to make sure they create harmony in their relationships and partnerships with young people.

    Young people respond to and reflect adult’s mood – especially their parents'. If you're feeling stressed, annoyed or tired, they’ll probably sense your mood and amplify it! So to positively manage both the moods and behaviour of young people, staff have to be able to manage themselves.
    When staff are mindful, they’re rooted in the present moment and are conscious of their own experience, as well as the experience of the young person. They’re more able to imagine and appreciate the world (both theirs and the young person’s) in all its emotional shades. Conversely, when we’re distracted by what’s already happened, or worried about what might happen next, our bodies are physically present but our minds are elsewhere. It’s not always easy to work out what young people need, but mindful listening helps staff evaluate and adjust what they’re giving. Mindfulness shows respect for the uniqueness of a young person’s mind, and their own emerging recovery pathway. This level of attention is the glue that holds relationships together.
    Both ward staff and parents need to handle young people carefully, if good relationships are to be maintained. It takes time to develop trust and to put a young person at ease, so they feel they can express themselves freely. This isn’t always easy, especially when they come across as rude or aloof. But it is possible to have an open and approachable style while always keeping an eye on professional standards. All children and young people need to be offered dedicated, one-to-one time in a safe, comfortable space, away from intrusions and distractions.

    shutterstock_267561851 - Copy

    Staff take time to nurture positive relationships and build trust with patients through their consistent responses to them.
    “Imagination in its… most transformative and revelatory capacity, is the power that enables us to empathise with humans whose experiences we have never shared.”

    JK Rowling at her Harvard commencement address
    As well as the practical elements, like finding the right room, this protected space is created by relational qualities, such as rapport and trust. Listening sensitively and actively not only ensures a good quality interaction, it also helps develop trust and build relationships.

    There is great strength in listening.

    Coupled with all of this are warmth, sincerity and belief. Showing belief in a young person while they’re being open about what they’re finding troubling will mean a lot to them, especially if they already respect the person encouraging them.

    There is great power in openness.
    Acceptance is fundamental to creating a mindful relationship. This doesn’t mean staff have to like or agree with everything they see or hear, but if they accept the young person for who they are in the present moment, and embrace them in an attentive way, their connection with the young person will be more secure and they’ll be more likely to have a positive influence in their recovery. Mindfulness isn’t just a new bag of tricks, it’s a fresh way of thinking, noticing and being aware. It’s remarkable what can happen when we listen very carefully to another person, without coming to fixed conclusions about what they’re saying, or who they are.
    Mindful relationships encourage:

    • Security, comfort, support (See Relational and Physical Safety).

    • Mutual enjoyment of conversation.

    • A space of confidence and commitment.

    • All experiences to become healthy, incorporated into a developing sense of self.

    • An inner sense of worth.

    • An experience/model of being cared for.

    • A vivid sense of transparency.

    • A journey of safe exploration.

    • The young person to understand themselves and their world, especially their relational world. (See Understanding).

    • An allowing of hate and anger to be noticed and met with thought and care.

    Skilled helping



    Skilled helping creates a sense of involvement, or a caring presence when working with another person. The main techniques of skilled helping can be learned by anyone and are remembered by the acronym SOLER:

    (Egan, G. 1965 - more info here)

    1. The first condition of skilled helping is to accept the emphasis is on the young person’s agenda, not yours.

    2. The second condition is that the core principles of genuineness, respect, and empathy are upheld.

    3. The third condition is that the skilled helper practises active listening throughout.


    • Sit squarely

    • Open posture

    • Lean forward when necessary

    • Eye contact

    • Relaxed body language

    Within a safe, nurturing, open setting many young people may feel more able to share their feelings, but those who self-harm (self-cutting is the most frequent form of self-harm among young people) often find it difficult to ask for help, because they:

    • Think the experience will be a one-off event that they can manage.

    • Want to put the experience to the back of their minds.

    • Feel they have nobody to share their feelings with.

    • Have no idea how to access services.

    • Are concerned that their coping strategy will be taken away from them if they’re prevented from self-harming.

    • Feel worried they’ll be judged as attention seeking or stupid.


    • Believe their physical injuries are not serious enough to need help.

    • Are anxious that ’going public’ with their self-harm will limit their future career opportunities.

    • Are concerned they will lose control over the situation if their behaviour becomes public knowledge.




    (Source: adapted from National Workforce Programme, 2011- read more here)

    When staff are mindful, they’re rooted in the present moment and are conscious of their own experience, as well as the experience of the young person, without judgement.

    caring realtionships -art 5

    Getting Connected



    Emotional connection is supported by getting perspective on one’s own internal state, including our thoughts, needs, desires, feelings, beliefs, goals, purposes and reasons, while being able to acknowledge another person’s state without reactivity. Young people flourish when they feel truly connected and understood. It’s within their emotional connections with others that they gain a deeper sense of themselves, and develop healthy means for relating. The brain undergoes a total overhaul in the teenage years and throughout this time, young people are operating more from their 'emotional brain'.
    “Relationships are the absolute heart of humanity. We are neurobiologically designed to be in relationships. We are neurobiologically designed to be able to read and respond to other people. And we are neurobiologically designed to reach out and seek relationships with other people.”

    Bruce Perry, M.D., PhD. 2003

    Cited in Loving Parents: Raising Hurting Children
    The way the CAMHS ward team communicates with young people plays a part in their ongoing development. Staff members’ ability to offer sensitive, ‘give-and-take’ interaction fosters their sense of safety, and has an impact on lots of other aspects of their lives. Young people need to feel deeply connected to dedicated staff, so they feel secure, and their brains can work well to regulate their emotions and benefit from the caring help they are offered.

    This involves meeting the young person exactly where they are, in their own world, and sensitively journeying with them towards their unique recovery. After all, the young person’s recovery belongs to them. They’re able to feel rooted in the relationship with an open and mindful staff member who believes in them and their unique journey.

    It's an awesome feeling for your patients when you sit alongside them, being aware of their feelings and connecting with their experience. The impact of empathy on young people cannot be overestimated: it can be used positively in any part of ward life.
    “A central theme emerging from the views of young people was the value they attached to having ready access to people they could build up a relationship with, start to trust, and open up to.

    The amount of contact young people have with staff is crucial in their perception of what helps. Staff being able to have a relaxed chat with young people was highlighted, along with groups and sessions, as being key in helping them feel ‘normal’...

    Some young people spoke about needing to feel that it was not ‘just a job’ to staff, that they genuinely cared. This allowed them to trust, and so confide in staff. Attributes they rated highly included staff who were friendly, who listened, and were welcoming, flexible and genuine.”

    From Young Minds' excellent Where Next - New directions in in-patient mental health services for young people - Report 2'

    image_4_1

    Once safety is provided, young people are more able to explore and blossom based on their talents, interests and fullest potential. What is safety? Safety comes from the rupture and repair of everyday caring relationships, as the young person feels able to express the full range of their feelings - from murderous rage to overwhelming feelings of love, from a frightening falling apart to being safely held. You can teach a young person that their feelings are not enemies or threats to their existence; that each one of them deserves kind and uncensored attention, exploration and integration. Sometimes powerful energies just need to rage in them for a while. Sometimes the tender tears and emotions need to flow or stream out of them in order to accommodate more hope and love. They may need to feel their emotions more deeply and fully before they can connect with sources of healing. When young people are helped to face the present moment, however forcefully the storm rages in them, within a climate of curiosity, gentleness and honesty, they can uncover surprising gifts.
    When trusting relationships and the comfort that comes with them are sustained, both the staff member and young person are more able to be ‘mind-aware’ (to mentalise), and get a sense of each other’s feelings and thoughts. The superb clinical psychologist Daniel Hughes (2009) describes this as a ‘vital connection’ and highlights four things (formed around the mnemonic PACE) that boost the young person’s emotional and reflective skills within a relational space of safety and exploration.
    These are:

    Playfulness
    Acceptance
    Curiosity
    Empathy

    When young people are helped to face the present moment, however forcefully the storm rages in them, within a climate of curiosity, gentleness and honesty, they can uncover surprising gifts. This involves meeting them exactly where they are, in their own world, and journeying with them towards their unique recovery.

    caring realtionships -art 7
    “Effective interventions depend above all on the staff who deliver them, but staff need support to work with children with severe and complex problems. They need reflective opportunities, consultation with relevant others and appropriate supervision of their work.”

    Department of Health, 2009 - from here

    Flexibility, Regular Reflection and Consistency



    Although it’s not always straightforward, consistency is crucial for boundaries to be clear and maintained. Boundaries are what young people crave, even when, and especially when, they’re not able to be consistent themselves. For example, sticking to a commitment is a massive thing to young people and it builds trust. They need to know you mean what you say. They need people who follow through. You can significantly enhance the inpatient experience by being more consistent. Consistency is the most important element in your relationship with young people, yet it’s the most frequently overlooked (Dr Sal. Severe, 2004). Combining consistency with mindfulness will increase your flexibility and responsiveness. Adding proactivity, which is about communicating effectively, will help you stay flexible enough to adapt to changing circumstances.
    As we say throughout CAMHeleon, mindfulness is about giving focus, and focus takes energy and attentiveness. Each moment on the ward brings something new and will require something different from us. Perhaps one of the biggest challenges of being a member of staff on a CAMHS ward is always being able to respond in flexible ways - it’s also one of the greatest skills.

    All of us, young people and adults alike, are open to powerful emotions that we can’t always ignore or switch off. Instead of shaming ourselves when these emotions are triggered, we need to step back, work out what we’re thinking or feeling, and identify the underlying source of what we’re experiencing. Self-control and self-regulation are two crucial qualities of a mindful staff member. Mindfulness helps you evaluate your own reactions, to make sure they won’t inadvertently manipulate or influence the way you relate to a young person.

    Of course, regular supervision and reflective practice is a massive help here.
    thumb_IMG_9785_1024
    thumb_IMG_9786_1024
    In the words of Siegel and Hartzel (2003):

    “Response flexibility is the ability…to sort through a wide variety of mental processes, such as impulses, ideas and feelings, and come up with a thoughtful, non-automatic response. Rather than merely automatically reacting to a situation, an individual can reflect and intentionally choose an appropriate direction of action. This ability is a cornerstone of emotional maturity and compassionate relationships.”

    Source: Parenting From The Inside Out (Mindful Parenting)
    Response flexibility applies equally to staff and patients, but it’s particularly hard to maintain when feeling powerful emotions, especially negative ones. So what’s the answer?

    We think it all comes down to a relational approach that combines high responsiveness with clear boundaries and loads of warmth. Warm responsiveness. The basic principles of this approach are very familiar to ward staff and include:

    • Setting clear limits and standards.

    • Monitoring behaviour.

    • Consistently enforcing important limits, while allowing young people autonomy.

    • Communicating with ease, without being obtrusive.


     
    Source: adapted from Boniwell, 2015 - read more
    When these principles are followed non-punitively, in a space of empathy and respect, they become gifts you should feel proud of and one of the best demonstrations of compassion.

    It all comes down to a relational approach that combines high responsiveness with clear boundaries and loads of warmth. Combining consistency with mindfulness will increase your flexibility and responsiveness.

    caring realtionships -art 8


    Committed Conversations



    Young people love it when caring adults commit (with flexibility of course) to their request for individual quality time. The Mental Health Act Commission (2008) concluded that all wards should make sure patients have guaranteed time with nursing staff, away from all other activities, by introducing ‘patient protected time’ arrangements and we wholeheartedly echo that proposal! However, opportunities for purposeful conversations and interactions aren’t limited to set times; they’re ongoing, often spontaneous and absolutely part of the fabric of the ward. And they don’t have to be formal or stick to a certain framework or approach. What matters most is that they take priority, are young person-focused and caring.
    onetoone
    Upon a secure relational base, we're more able to help young people explore, to learn new, healthier patterns of behaviour and to develop new relationships. Heroic staff understand that a young person who's ‘acting out’ is communicating they need help with their emotions, and they see ‘mischief’ as an opportunity for growth. Every action communicates something of importance, but it’s not always easy to navigate difficult conversations, especially about particularly tricky issues. Staying committed throughout will definitely help young people to eventually have healthy grown-up relationships and teaching them the art of speaking their truth is essential (Susan Stiffelman 2015).
    Here are some tips on having a great conversation:

    • Really listen, don't prepare to speak.

    • Decide what your commitment is in the conversation, for example, to have an open and honest relationship. Notice your thoughts and feelings as it goes along, but base what you’re saying on values instead.


    • Tempting though it is, try not to focus on fixing people's problems. Give space for the person to discuss what’s happening for them, and only give advice when invited to do so.

    • Strive for clarity.

    • Ask what people need and say what you need.


    Source: adapted from Kendall, R, 2014

    Blamestorming: Why Conversations Go Wrong and How to Fix Them
    "At the times when a child’s life goes shaky... it is important to give positive messages, anchored with a hand on a shoulder and a clear look in the eye: whatever happens, you are special and important to us. We know you’re great."

    Steve Biddulph, 1999 - read more here

    What matters most is that purposeful conversations and interactions take priority, are young person-focused and caring. Every action communicates something of importance.

    caring realtionships -art 9  

    "Staff should constantly look for positive praise as a backdrop to the ward day. The positives should be shared and, if possible and acceptable to the young person, this should be public. Mistakes and difficulties deserve the right of privacy, although if another person is involved, reparation should include them. The ward community should be reassured that no one person’s sadness, anger or upset is unmanageable.”

    Ward Manager

    Praise You Like I Should



    A young person’s special blend of skills, attributes and talents should be highlighted and celebrated at every available opportunity. Interestingly, experts propose that young people need to hear about four positive statements for every negative comment to offset the effect of negative comments. Relating to ward staff is an unusual situation for a young person, especially if they usually experience adults talking about them, rather than with them. Praise is one of the most undemanding rewards to give; it costs nothing, takes very little planning and is enormously rewarding for you to give and for young people to receive. While ‘descriptive praise’ works wonders, every young person can benefit from praise that isn’t necessarily associated to a specific achievement, but simply reflects a more overall appreciation of who they are.
    Positive feedback is the most powerful tool you have to improve a young person’s behaviour and self-esteem. All children need encouragement, especially those with poor self-esteem and/or those who lack persistence and determination. By praising specific behaviour, you clearly encourage healthy decision-making (Severe 2004). More here: How To Behave So Your Children Will Too
    "Children learn how to guide and organise themselves internally from the way we guide and organise them with our words, so it pays to be positive."

    Steve Biddulph, 1999 - read more here
    Encouragement…

    • Gives young people a boost of motivation.

    • Helps them through difficult situations, and to face fears and withstand stress.

    • Helps them solve problems and feel successful.

    • Provides support, trust and belief.

    • Shows trust and confidence in their abilities and decisions.

    • Recognises effort and improvement.


    (Adapted from Severe 2004)
    Positive feedback:

    • Feels good to give and receive.

    • Emphasises good behaviour and teaches young people to think.

    • Increases motivation.

    • Creates feelings of success.

    • Improves a young person’s self-esteem.

    • Gives young people self-confidence.


    • Motivates young people to seek goals.

    • Develops responsibility: ‘When I make good decisions, I feel good’.

    • Promotes healthy family relationships.

    • Encourages young people to talk.

    • Teaches young people to be positive to others.

    • Is easy to use effectively.


     

    Source: adapted from Fenwick and Smith 1998

    Adolescence: The Survival Guide for Parents and Teenagers
    “…tune in when they speak, listen to them when they’re attempting to express feelings and avoid ignoring them when they’re speaking their teenage language, either verbal or nonverbal; then you will surely hear something worthy of praise. If possible, praise the way they’re thinking about things, praise their problem solving skills and certainly praise any displays of empathy or kindness they discuss.”

    Greenberg and Powell-Lunder, 2010

    Teenage as a Second Language: A Parent's Guide to Becoming Bilingual (Paperback) - Common

    How to use encouragement


    Show trust:

    • ‘I like the way you handled that.’ 

    • ‘Knowing you, I’m sure you’ll do well.’ 

    • ‘I think you can do it.’  

    • ‘I’m sure you can decide this by yourself. But if you need help, I’ll be right here.’ 

    • ‘I’d like to know your opinion about . . .’  


    Show the importance of hard work:

    • ‘If you keep working, you’ll probably get it.’

    • ‘Working hard pays off.’ 

    • ‘Hard work isn’t always easy, but it’s always worth it.’  


    Point out strengths and improvements:

    • ‘It looks as if you worked hard at . . .’  

    • ‘Look at the progress you’ve made in . . .’

    • ‘You’ve really improved in . . .’  


    Teach young people to learn from mistakes:

    • ‘So you made a mistake. What can you do about it?’

    • ‘If you’re not satisfied, what can you do?’  


    Encourage responsibility:

    • ‘It’s up to you.’ 

    • ‘If you want to.’ 

    • ‘You can decide that for yourself.’ 

    • ‘Your decision will be fine with me.’  


     

    (Adapted from Dr Sal. Severe, 2004)
    Applauding the ‘small’ achievements is one of the simplest, but most effective ways to boost young people’s happiness. Praise needs to be specific, succinct and enthusiastic. A quick touch, a smile, eye contact and words of appreciation recreate the attachment cycle of touch, talk, and eye contact, and show the young person that they’ve been noticed (Gregory & Kupecky 2002). Praise also needs to be genuine. Young people are disproportionately sensitive to adults’ inner feelings and aren’t easily fooled by a few nice-sounding but hollow words. So praise won’t do any good if deep-down the praiser isn’t being honest.

    From a solid foundation of self-worth, helped by your generous appreciation of them, everything else becomes a little easier for the young people in your care.
    Giving praise - top tips:

    1. Descriptive Praise becomes even more influential when you summarise what you’ve noticed about a young person by talking about a particular quality. Adding their specific qualities to your praise helps young people believe and integrate new values. “I love your passionate poem. You’re an incredibly skilled writer!” 

    2. Communicate specific appreciation. Descriptive Praise is about noticing and feeding-backprecise observations. “The way you calmly handled your session with Dr Roberts was really impressive. I appreciate it was tough for you. You showed a lot of confidence and self-control.” 
    3. Slow down, stop what you’re doing and mindfully pay attention to exactly what the young person is doing that impresses you - even if it's something like the extent of their anger/explosion showing you just how strongly they feel about the situation or issue!

    4. Only ever say what you mean and mean what you say. Young people are great at spotting false praise.

    5. Focus on the young person’s own progress, while trying to make sure that in every conversation with them, you’re consciously trying to give them hope for a better future.

    6. Connect a specific strategy (for example, mindfulness) that led to a particular outcome (for example, feeling calmer).



    Check out 100+ ways to praise a young person here

    Positive feedback is the most powerful tool you have to improve a young person’s behaviour and self-esteem. Praise needs to be specific, succinct and enthusiastic. By praising specific behaviour, you clearly encourage healthy decision-making.

    caring realtionships -art 11


    Warm Reflection, Safe Exploration



    Young people’s emotional development is boosted when they’re able to develop their reflective skills. Warm and sensitive validation of their thoughts and emotions helps them work out what triggers their feelings and can neutralise difficult parts of their experience.

    With your compassionate presence - your ability to hold even the darkest feeling or thought - the unacceptable can find a place to rest in acceptance. Painful memories and future fears can surface without shame, the darkness can meet the light of secure and sensitive disclosure, be felt as much as possible and integrated in a space of relational safety.
    thumb_IMG_9782_1024
    This approach welcomes safe exploration of different responses, giving the young person the capacity to cope with adversity and accept their limitations and qualities more easily, while feeling better about them. Individuation (the process by which we become distinguished from one another) is an important part of growing up but it involves a commitment, from both staff and young people, to invest in the young person’s unique values and actively explore new ones.
    There are a number of remarkable qualities that can promote lasting wellbeing and prosocial qualities and they should be the main emphasis of therapeutic relationships.
    These qualities include the ability to:

    • Balance and coordinate our needs with others.

    • Be reflective.

    • Fairly and generously assess our behaviour.

    • Receive feedback constructively.

    • Change our behaviour based on our own and others’ assessments.

    • Manage destructive feelings.

    Young people’s emotional development is boosted when they’re able to develop their reflective skills. Warm and sensitive validation of their thoughts and emotions helps them work out what triggers their feelings and can neutralise difficult parts of their experience.

    caring realtionships -art 10

    Non-Mental Health Staff



    While all nursing staff usually have excellent communication and interpersonal skills, those without specialist mental health knowledge or training can sometimes feel unable to tap into these skills, due to their own anxiety and lack of confidence over the distressing presentation of conditions such as self-harm or psychosis. This often comes from a fear of saying the ‘wrong’ thing, or a belief that it’s problematic to help someone with a mental health condition (the whole ‘can of worms’ thing) without being a specialist.

    Happily, CAMHS staff are characteristically more than willing to offer support and guidance to their non-mental health colleagues, whether in person or on the phone. Every hospital should have liaison mental health services with specialist staff, trained in mental health, who are on hand to make sure that young patients get the right care, and are referred for further support if needed. Similarly, some of the more well resourced services have a primary mental health worker, who can provide specific training and advice.

    The confidence of non-specialist professionals can also be boosted by recognising that they almost certainly already possess the communication and interpersonal skills needed to support young people with these kinds of problems. (You can find out more about this here)
    This is part of the message of Brief Encounters. Brief Encounters (www.brief-encounters.org) looks at how relationships between staff and emotionally vulnerable patients are nurtured through ‘caring conversation’. It’s informed by the evidence of the recovery power of conversation to help people with mental illness or those in extreme distress, where there is no actual diagnosed mental illness.

    The magical thing is that even a simple, sociable conversation can have a profound impact on someone who is in a vulnerable emotional state. It can also increase ‘relational security’ - having someone to relate to emotionally increases feelings of safety, and therefore they’re more likely to stay on the ward and participate in their treatment.

    coverforsite

    The magical thing is that even a simple, sociable conversation can have a profound impact on someone who is in a vulnerable emotional state.

    caring realtionships new


    Featured Tools and Ideas



    Click on the headings below to read more and add a selection of ideas and tools to you own "Palette"

    My Shared Pathway - My Relationships Workbook

    My Shared Pathway - My Relationships Workbook

    mysharedThe following extracts are from the 'My Relationships' workbook produced by My Shared Pathway:

    "The relationships we have with other people are very important to our well-being and our recovery from mental health difficulties. We have relationships with many different people in many different areas of our life. We have relationships with our family, our friends, our neighbours, people who help support and care for us, all the professional people we come into contact with and, while in hospital, the other people we live with on the ward. We will probably have relationships with some professionals we might not have had relationships with befor"

    "All of our relationships have an effect on our lives, on how we feel and on how we behave. Those around us can have a very strong influence on us and our recovery from mental health difficulties. We will need to build relationships with people who understand where we’re coming from, how we are now and how we want to change. There may already be people in our lives that support us and we will need to make sure we maintain these. There may also be relationships that have a negative effect on us, and we may require help deciding what to do about these"

    "In this part of My Shared Pathway, we’ll look at all your relationships, the ways you relate to other people and how to make sure your relationships are helpful to you in your recovery from mental health difficulties. We will look at how healthy, positive relationships can help reduce your harmful risks, while supporting you to take positive risks to live the lifestyle you want to lead."

    Click here to download the booklet in pdf format. Also, be sure to check out the Unique Recovery Journeys theme page of CAMHeleon. 


    The importance of affiliation, structure and autonomy support

    Study: The importance of affiliation, structure and autonomy support

    Drawing on decades of evidence linking authoritative parenting to better mental health outcomes for children, a team of Montreal-based psychologists note how warm, nurturing parenting (‘affiliation’) and clear, consistent expectations and discipline (‘structure’) have been acknowledged as key components. But they argue that a third important dimension - parental respect for children’s own ideas, feelings and initiatives (‘autonomy support’) has received less attention than it deserves.

    The results of their study showed that parental skills relating to structure and affiliation both increased significantly, following an intervention to introduce autonomy support into the parenting of a group of parents. There was also an increase in positive attitudes towards autonomy support, with parents making more use of relevant strategies. Parents reported that their child’s mental health had significantly improved and that problematic behaviour had reduced. Children’s feedback also suggested that their sense of happiness, self-esteem and life satisfaction had significantly improved too.

    You can read more about their work here.





    Search

    Ideas and Tools Palette Ideas and Tools Palette 0
    View, edit or print your palette
    What does this mean? - learn more


    A Random Idea:

    Get to young people before their mental illness develops or gets to a point of crisis.





    COLOURFUL Themes Menu

    Caring Relationships
    Opportunity and Expression
    Leisure and Therapeutic Activity
    On and Off the Ward
    Understanding
    Relational and Physical Safety
    Family and Friends
    Unique Recovery Journeys
    Leisure and Growth