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Good Relationships Develop Healthy Brains
A Wholly Holistic Relationship
It’s a Goal!
Caring Coaching Questions
Skills and Qualities
Emotional and Social Competences
Education in CAMHS: Distinct and Hugely Therapeutic
Skills and Strength for Life
EQ is the New IQ
Featured Tools and Ideas
As you can probably tell from the title, this theme is about learning and growth! It focuses on how therapeutic relationships can nurture healthy development and gentle movement towards a young person’s own idea of holistic success. This involves the young person learning how to independently manage their symptoms and make the most of available treatment, as well as gaining new essential life skills and developing new, particularly life-enhancing activities, which they can carry into their everyday life.
A coaching approach can be really useful in clarifying how the young person will know when they’ve reached their goals, and what they’re already doing to reach them. While on a young people’s ward, they can be supported in working towards solutions, and in uncovering the skills that are needed. Psychosocial nursing can be used to tackle worries, and to work on supportive changes in their relationships and behaviour - changes that are important to them. It's crucial to help every young person discover something they can feel they are good at, and to show pride in their achievements. In providing a truly holistic approach, the whole of a young person’s life is embraced and explored, in order for them to reach their full potential.
Drawing power from what they do well can help the young person rise to the challenge of coping with difficult areas more easily. Of course, this doesn’t mean you should totally ignore areas of growth, just that these shouldn’t be majorly focused on at the expense of their strengths. (Fay & Foster 2014). However, it does mean avoiding situations that emphasise the young person’s weaknesses.
As you know, young people’s fluctuating journey is one of exploration, which means they can often test situations and press buttons! They challenge us to remain flexible and to maintain our emotional equilibrium (Siegel & Hartzell 2003). Young people need to collect new experiences, test boundaries and take risks (especially 15 and 16 year olds). Trying stuff out, experimentation and pushing boundaries are integral to their pursuit of independence. That’s part of their job at this stage in their life, and part of the work of CAMHS staff is to help them to understand and navigate safely through their emotions and self-discovery, learn from the past, have hope for the future and feel good about themselves as individuals. Relational security values the young person’s work of discovering and being true to themselves, so they can continue growing up feeling appreciated, self-confident and unrestrained.
A Wholly Holistic Relationship
Psychosocial nursing can be used to holistically explore areas of difficulty, and to work on positive changes in young people’s relationships and behaviour. Psychosocial interventions include a range of techniques, aspects of which can be applied to inpatient care. Interventions tend to emphasise strengthening and maintaining the young person’s personal, social and emotional development, before providing anything more specific.
It’s a Goal!
One of the main concerns for young patients is knowing when they are likely to be discharged (and the steps involved) in order to give them something to aim for. The length of their stay is important to young people in different ways. Some young people are keen that it shouldn’t be too long, so they can reintegrate back into normal life. Others feel that it shouldn’t be too short; to make sure they’re ready to move forwards from the ward. Either way, it’s most ideal if the focus is on the long-term, so young people are able to cultivate meaning, become inner-directed, and increasingly less directed by, and reliant on, external factors.
Caring Coaching Questions
As Solis says above, every temporary stumbling block carries within it a precious gift for success. Teaching this to young people on the ward (through reframing for example) is a very powerful thing. Motivating them to keep moving forward when success feels miles off is invaluable. It’s so important that they develop the courage and skills to move beyond stumbling blocks when (especially when) it would be easier to give up. Experiencing success creates internal motivation. Success creates more success. This kind of approach is far less stigmatising and pessimistic than one focusing on problems and deficits.
We believe that one of the best ways to teach young people to handle their emotions, manage their behaviour and develop self-control is a caring coaching approach. Young people can benefit greatly from having adult role models who are able to put things in perspective, and who can focus on fulfilling more significant emotional goals. For example, helping young people to understand that they may experience a range of different feelings, which may not always be mutually exclusive. For instance, someone being angry with you doesn’t always mean they don’t care about you (Dogra et al 2002). We now live in a world where a multitude of ‘answers’ are at hand, with a click of a button or a swipe of an app. This means today’s young people rarely puzzle over challenges, and so miss out on ‘cognitive-music-building’ and consequential thinking. One of the greatest skills ward staff can help them develop is the capacity to solve problems - to think them through, to get in touch with what they feel, and to consider the best options. A CAMHS ward stay can be an opportunity to learn the value of critical thinking.
Asking change-oriented questions can also be enormously powerful and revealing for young people. Questions encourage a young person’s thoughts and exploration. When they’re asked with curiosity and genuine interest, most young people will open up. Questions are a lot more effective than lectures!
Combining this approach with reflective listening, or empathic listening as it’s sometimes called is an invaluable strategy. It helps young people move through their difficult feelings more quickly and easily, towards acceptance or problem solving (Janis-Norton 2012). And those who grow to accept themselves are more likely to develop a stronger sense of self-confidence.
Ultimately, young people need to know they’re inherently worthy of love and happiness, so they’ll be able to soak up all the good that comes their way (Susan Stiffelman). Building on direct experience is really effective here. Remembering goals they’ve already achieved gets them in touch with their potential, and helps them feel more confident about the future.
And here are some corresponding skills and qualities that parents usually want their children to develop:
Life skills are developed by young people having the right to make mistakes and to process these and learn from them. The path of recovery isn’t linear. Two steps back and three forward is, in sum, a step forward. Making it a habit to express appreciation helps staff - and therefore young people - shift away from focusing on what’s wrong, towards celebrating what’s great (or at least get a balanced picture). Appreciation is at the heart of almost every quality we think of as moral, which is why we mention this vital capacity throughout the COLOURFUL themes. It’s the ability to value ourselves and others and to be mind-aware.
Interestingly, recent research at Rutgers University reveals that people who felt a setback was within their control were more likely to persevere afterwards. Bounce-back-ability is what we need. Read more here.
Having self esteem
Having an accurate and positive self-concept
Experiencing a full range of emotions
Taking the social context into account in expressing feelings
Controlling the emotions
Increasing emotional intensity and frequency
Using information about the emotions to plan and solve problems
Experiencing a full range of emotions
read more here.
What Is Social and Emotional Learning?
From: Collaborative for Academic, Social, and Emotional Learning (CASEL)
Social and emotional learning (SEL) is the process through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.
SEL programming is based on the understanding that the best learning emerges in the context of supportive relationships that make learning challenging, engaging, and meaningful.
The short-term goals of SEL programs are to (1) promote students' self-awareness, social awareness, relationship, and responsible-decision-making skills and (2) improve student attitudes and beliefs about self, others, and school. These, in turn, provide a foundation for better adjustment and academic performance.
The Five Social and Emotional Learning Core Competencies
CASEL has identified five interrelated sets of cognitive, affective, and behavioral competencies. Educators, parents, and policymakers who recognize that the core SEL competencies are necessary for effective life functioning also know these skills can be taught.
Read more here
Missing school for just a few days a year can damage pupils’ chances of gaining good GCSEs, according to a report published by the Department for Education. A 2016 survey found that many school leaders reported increases in the number of students suffering from mental health and wellbeing issues over the past five years. More than half (55 per cent) said there had been a large increase in anxiety or stress, and over 40 per cent reported a big increase in the problem of cyberbullying. Nearly eight out of ten (79 per cent) reported an increase in self harm or suicidal thoughts amongst students. Read more here.
Mainstream schools should have strong links with CAMHS, for those pupils identified as at risk. Reassuringly, Government guidance created by the Department for Education in consultation with the Department for Health has given assurances that mainstream schools will get help in identifying and best resolving mental health problems in pupils. Guidance will increasingly be made available to all schools, with the aim that those who are unwell will receive appropriate help at an appropriate time (read more here).
The think-tank 2020 Health recently argued that every secondary school, or chain of schools, should have a head of wellbeing. There’s a strong case for it. “Education professionals see a clear need to raise wellbeing support for both pupils and staff.” Paul Burstow, former Lib Dem MP for Sutton and Cheam (from here). A head of wellbeing – what a brilliant idea!
The Royal College of Nursing has emphasised the critical importance of school nurses in improving the health of the nation’s children. They said that by working closely with children, as well as their parents and teachers, nurses could have an important role in helping pupils with their mental and emotional health (theguardian.com).
EQ is the New IQ
Nowadays, emotional intelligence is becoming more important than intellectual intelligence. While they’re on the ward, you can help teach young patients to be good decision makers, manage their own feelings as well as accept and empathise with the feelings of others, and to see difference as a quality rather than a threat. These skills give young people a greater insight, as well as the self-conﬁdence they need to pro-socially solve problems (Severe 2004).
However, emotional intelligence can’t be bought or rushed. Young people's innate capacity for emotional intelligence matures over time with the slow emergence of identity, and the gradual building-up of life experiences (Payne & Ross 2009). For this skill to develop, it's important that they gradually arrive at some insight into and acceptance of their own feelings and behaviours, and what they might be needing at any given moment.
Emotional intelligence also partially comes from a young person’s inner world, including their emotions, being acknowledged by someone who is willing and able to listen and provide reflection. Acknowledging informs a young person’s emotional intelligence and encourages language development. It also demonstrates understanding and acceptance.
Read more on acknowledging in the Opportunity and expression theme.