Healthy Attachments and Neuro-Dramatic-Play (Arts Therapies)

‘This heartfelt book offers practitioners and parents exceptional guidance about how to engage a baby or child in vital dramatic play as soon as it makes its presence known. Its pages brim with fun activities, sound reflections on their rationale, and above all, with authoritative optimism.’ – Dr. Alida Gersie, dramatherapist, organisational consultant and author ‘In NDP, Sue Jennings explores  the little understood process of the early shaping of the brain on the primitive, unconscious and nonverbal stage of mother-child interactions.  On this  journey, she brings to bear her considerable experience, solid intuition, and large heart. While most theoreticians tend to become too theoretical in the face of the unknown, Sue Jennings stays grounded in the body, intimate relationships, and moment-to-moment experience –  a methodology sorely needed in the synthesis of neuroscience, human development and adult life. I recommend that you take this journey with Dr. Jennings.’ – Louis Cozolino, Ph.D., professor of clinical psychology and author of The Neuroscience of Psychotherapy ‘Sue Jennings emphasises playfulness as a critical component in the early stages of developing attachment relationships and she highlights its contribution to neurological development. She provides a useful introduction to an important area; this book will entice and provide guidance to a range of practitioners, and parents, to engage in creative care of young infants and vulnerable others’ – Eileen Prendiville, Director and Core Trainer of Children’s Therapy Centre, Ireland ‘Another fascinating book by Dr Sue Jennings which gives an insight into the importance of a mother’s relationship with her unborn child and their interactions during the first six months. NDP builds the foundation for healthy attachment play and compliments the EPR paradigm. Examples of NDP enable the reader to identify what usually comes naturally in the development of healthy attachments. The extensive list of activities, games and interactions suggested by Sue will be invaluable for my therapeutic work in the future.’ – Sharon Morgan, Senior Social Work Practitioner and Play Therapist

by the same author Introduction to Developmental Playtherapy Playing and Health

Sue Jennings Foreword by Mooli Lahad ISBN 978 1 85302 635 5

Introduction to Dramatherapy Theatre and Healing - Ariadne’s Ball of Thread

Sue Jennings Foreword by Clare Higgins ISBN 978 1 85302 115 2

Art Therapy and Dramatherapy Masks of the Soul

Sue Jennings and Ase Minde ISBN 978 1 85302 181 7

Healthy Attachments and NeuroDramaticPlay Sue Jennings Foreword by Dennis McCarthy Afterword by Mooli Lahad Illustrated by Chloe Gerhardt

Jessica Kingsley Publishers London and Philadelphia

Extract from Wisdom and Hall on p.98 is reproduced with permission from the Random House Group.

First published in 2011 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Sue Jennings 2011 Illustrations copyright © TBC 2011 Foreword copyright © Dennis McCarthy 2011 Afterword copyright © Mooli Lahad 2011 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Every effort has been made to trace copyright owners and anyone claiming copyright should contact the publishers. Library of Congress Cataloging in Publication Data Jennings, Sue, 1938Neuro-dramatic-play and healthy attachments / Sue Jennings ; foreword by Dennis McCarthy ; afterword by Mooli Lahad. p. cm. Includes bibliographical references and index. ISBN 978-1-84905-014-2 (alk. paper) 1. Play--Psychological aspects. 2. Attachment behavior in infants. 3. Infants-Development. 4. Attachment behavior. 5. Play therapy. 6. Child development. I. Title. BF720.P56J46 2011 155.4’18--dc22 2010020288 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 978 1 84905 014 2 ISBN pdf eBook 978 0 85700 492 5

Dedication

Eileen Prendiville, Child Psychotherapist and Play Therapist, is a dear friend and colleague. This book is dedicated to her in appreciation.

Acknowledgements

I appreciate all the help I have received from pregnant colleagues, clients and friends. So many colleagues gave me time to discuss and challenge the ideas in this book and I appreciate their interest and thank them for their time. My children and grandchildren are always stimulating and stretching. Sue Hall is forever patient with my writings and muddles – thank you. Jessica Kingsley has believed in the project from the beginning and been so much help. And dear Peter, my husband, has supported me throughout the writing period despite some antisocial times. Sue Jennings (Susan Stein), Glastonbury, 2010

Contents

Foreword

Introduction Neuro-Dramatic-Play – Its Roots in Attachment and Play, Theatre and Ritual

9 11

╇1 NDP – Definitions and Theories

28

╇2 NDP and Attachment

46

╇3 NDP – Play and Play Therapy

63

╇4 NDP, Pregnancy and Birth

81

╇5 NDP, Childbirth and the First Six Months

98

╇6 NDP and Resilience and Empathy

115

╇7 NDP and Children with Attachment Needs

130

╇8 NDP in Fostering and Adoption

147

╇9 NDP with Teenagers and Young Adults

167

10 NDP and Children on the Autistic Spectrum

190

11 NDP and Children with Learning Difficulties

208

12 NDP for Practitioners

225

Appendix 1â•… NDP – 6 Months Before and After Play

240

Appendix 2â•…Embodiment-Projection-Role (0–7 years)

247

Afterwordâ•… NDP –the Wonders of Play and Playfulness in

Securing the Lives of Children

255

References

259

Subject Index

267

Author Index

271

Foreword

I am convinced that practitioners who work with children and with the adults these children become, are sorely in need of a basic introduction or reintroduction to the power and necessity of play, and the profound impact that play, or the lack of it, can have on children. There is much in our culture that denies this necessity, despite the contribution of theorists such as Winnicott, Erickson and many others who, though still read in schools and training programmes, seem not to make an impact on the ways we parent, teach and provide therapeutic help for our children. We have moved ever further into a dehumanised state of functioning and care providing, and thus we need to be reminded of what should seem obvious, which is that playing with children from their prenatal existence into infancy and childhood is intrinsic to emotional and physical health, the capacity for empathy and the development of a healthy ego. Sue Jennings does just this in her wonderful book, and in addition she adds to what is already known about attachment, empathy and resilience with new ideas from the field of neuroscience and her own ongoing work that deepens our understanding of play’s primacy. That the child is a consciousness in need of communication, interaction and play from early on is a revelation despite the obviousness of this, because we are all affected by a world that moves too fast for us to engage in relationships which afford both us, and our children, this type of connection. We must resist the impulse to ignore and bypass the rudiments of healthy development, and speak loudly in a language that affirms it. There is mercifully a movement afoot to correct the dearth of play in our current thinking and practising, and this book is at the forefront 9

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of this movement. Rather than attempting to convince those who cannot, or will not, see the full-blown consciousness in the eyes of a newborn child, this book celebrates this consciousness by describing ways of relating to it as parents, and helping children who have not had the good fortune to have been related to in such ways, and have suffered because of it. Mothers intuitively play with their baby, even in utero, if they are not too emotionally damaged to do so, and often even if they are. They sing, touch, dramatise and engage in many forms of sensory playfulness, which will help the child develop a healthy body sense. We can learn much about what is needed for health by watching what mothers and babies innately do. There is a wonderful ancient Nordic chant in the book that says it all: And did you sing as I came into the world? As you opened the door for me to come into the light? Sing at my birth and for all babies as they start their journey on this earth. Dennis McCarthy Dennis McCarthy has practised psychotherapy with children and adults for 35 years, and has developed a unique approach to play therapy, documented in his book If You Turned into a Monster… Transformation through Play, published by Jessica Kingsley Publishers. He is the director of Metamorfos Institute in New York State.

Introduction

Neuro-Dramatic-Play – Its Roots in Attachment and Play, Theatre and Ritual Franz Kafka once noted in his diary that a writer must cling to his desk ‘by his teeth’ in order to avoid the madness that would overtake him if he stopped writing. I suppose the same could be said of every creative activity that somehow permits us to come to grips with the demons of our past, to give form to a chaos within us and thereby master our anxiety. (Miller 1995, p.15)

Alice Miller really puts us in touch with the fact that we all have personal demons, and that creative activity is one way of ‘giving form to chaos’. This book maintains that many of our demons could be prevented if we become more aware of the emotional damage done to children at a very early age, through lack of attachment awareness. Neuro-Dramatic-Play is one way of both presenting the demons but also dealing with them.

Introduction This book is about the importance of Neuro-Dramatic-Play (NDP) with all children, unborn, newborn, and beyond, but especially with those children who are ‘at risk’. They may be at risk because they have been neglected, abandoned, abused or misused, but in all cases because their most basic needs have not been met. They have not had a good enough attachment relationship with their mothers or other primary carers. In subsequent chapters there is a description of the theories that underlie NDP, in particular an understanding of attachment and play, pregnancy and early months. The book then moves on to describe 11

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how NDP can be helpful for children with attachment needs, ‘looked after children’, teenagers and young adults, and children on the autistic spectrum and those with learning difficulties. The final chapter is for those people who are involved in the care of children: foster carers, adoptive parents, teachers, social workers, doctors, nurses and therapists. The appendices provide a wealth of ideas and techniques that can be applied with children, teenagers and adults.

The Theatre of Life Our lives are like a piece of theatre that unfolds in several stages and many stories. The seven stages of man (or woman), as described by Jacques in As You Like It, are a powerful statement of our progress through life, written by William Shakespeare in one of his most enduring plays. He says: All the world’s a stage, And all the men and women merely players: They have their exits and their entrances; And one man in his time plays many parts, His acts being seven ages. At first the infant, Mewling and puking in the nurse’s arms. And then the whining schoolboy, with his satchel And shining morning face, creeping like snail Unwillingly to school. And then the lover, Sighing like furnace, with a woeful ballad Made to his mistress’ eyebrow. Then a soldier Full of strange oaths and bearded like a pard Jealous in his honour, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon’s mouth. And then the justice, In fair round belly with good capon lined With eyes severe and beard of formal cut,

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Full of wise saws and modern instances And so he plays his part. The sixth age shifts Into the lean and slipper’d pantaloon, With spectacle on nose and pouch on side, His youthful hose, well saved, a world too wide For his shrunk shank; and his big manly voice, Turning again toward childish treble, pipes And whistles in his sound. Last scene of all, That ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans every thing. ( Jacques, As You Like It 2.vii: 139–167) However, although acknowledging the dramatic development of the whole person, this book will focus much more on the time of ‘mewling and puking’ and especially the time even before, when the infant is growing in the womb and experiencing its whole sensory system: temperature, sound, rhythm, touch and emotional changes of mood and energy. Mothers have a profound effect on the infant’s wellbeing through their own sensory experience. The telling of soothing stories and the playing of calming music can influence the state of trust and tranquillity for the mother and her unborn child. In the few weeks before birth, infants are already turning their heads from side to side, rehearsing their movements ready for feeding. After birth there is mirroring and the development of a playful attachment with the mother, which is an extension of the pre-birth attachment. We can represent this process in another way.

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Primary circles The circle of containment The circle of containment is established pre-birth as the infant is contained within the womb, the first circle full of safe waters (see Figure I.1). As the infant begins to make an impact on the mother, as she grows rounder and rounder, the mother is interacting with the infant in the circle.

The circle of care The circle of care is developing pre-birth as the baby stimulates an increasing awareness from the mother, and continues after the baby is born. It is symbolised by the mother encircling the baby in her arms. This will form the basis of the attachment between mother and baby.

The circle of attachment In the circle of attachment, the baby is now established within the care and containment of the mother, and develops a reciprocal playful relationship. There are sensory experiences, rhythmic games and ‘dramatised’ interactions.

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Attachment

Containment

Care

Figure I.1: Primary circles

What I have described through these circles is the basis of NeuroDramatic-Play which will be elaborated upon throughout this book. As a metaphor these circles are like a primary ‘theatre in the round’ between two performers, mother and unborn or newborn child. Neuro-Dramatic-Play is the crucial developmental process that progresses from conception to the first six months of life. This book also demonstrates that if NDP has not been established during this critical time, it is possible to intervene, through appropriate sensory, rhythmic and dramatic processes later in life, and still be able to make changes. It is never too late to play, and that makes all the difference. This feeling of optimism will continue throughout this book, and demonstrate, I hope, that we should never give up on children or teenagers. It is never too late to bring about changes and enable children and young people to be happier or more content. NDP needs to be placed within several frameworks in relation to child development and the primacy of drama in a child’s growth. First, it is relevant to re-establish the developmental paradigm of EmbodimentProgression-Role (EPR) that I have developed continuously since the mid-1980s, and established in Dramatherapy with Families, Groups and Individuals (Jennings 1990). EPR charts the child’s ‘dramatic’ development from birth to seven years and can be said to be the progenitor of NDP (see Jones 2010). EPR and NDP are both understood within the bigger overarching frame

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of Theatre of Body (ToB), which I have further developed since 2005. This leads into Theatre of Life from the age of eight years. If Theatre of Body and Theatre of Life can be understood as preventative, Theatre of Resilience (ToR: 2007a) is therapeutic (Figures 1.2 and 1.3). ToR is an important means of addressing NDP difficulties and attachment needs in older children and teenagers. THEATRE OF BODY/THEATRE OF LIFE (PREVENTATIVE)

Neuto-Dramatic-Play Conception – six months

Embodiment-Projection-Role Birth – seven years

Creative dance and drama Theatre in education Storytelling, music, art and theatre Eight – eighteen years

Figure I.2: Stages of dramatic development

THEATRE OF RESILIENCE (THERAPEUTIC)

Neuro-Dramatic-Play Therapy during pregnancy and first six months

Embodiment-Projection-Role Play and dramatherapy from birth to seven years

Social and therapeutic theatre Figure I.3 Re-staging of dramatic development

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Embodiment-Projection-Role EPR is a developmental paradigm that uniquely charts the progression of dramatic play from birth to seven years. Based on extended observations with babies, young children, and pregnant women, it provides a parallel progression alongside other developmental processes such as physical, cognitive, emotional and social. EPR is ‘value free’: it does not rely on a particular school of psychological theory; indeed it can be integrated into any psychological model or therapeutic or educational practice. EPR charts the ‘dramatic development’ of children, which is the basis of the child being able to enter the world of imagination and symbol, of storytelling and poetry, the world of dramatic play and drama. The early sensory attachment between mother and infant has a strong physical, rhythmic and dramatic component through playfulness and role reversal. Even in pregnancy the mother is forming a dramatic relationship with her unborn child (see NDP above). Competence in EPR is essential for a child’s maturation: • It creates the core of playful attachment between mother and infant. • It promotes sensory, embodied, rhythmic and dramatic playing. • It supports the child in creating images through clay and art materials. • It establishes the ‘dramatised body’, i.e. the body which can create. • It encourages the structures of storytelling and their interactive potential. • It is the basis of developing empathy through echo play and mimicry. • It gives a child the experience and skills to be part of the social world. Therefore EPR is a means of being able to work with children and teenagers to re-establish normative dramatic development. Increasingly I have discovered that the Embodiment stage is of primary importance:

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the experience of all forms of sensory interaction, rhythmic movement songs and games contribute to children feeling secure in their own bodies, and enable them to communicate with other bodies. For the older child, NDP techniques will need to be integrated within the EPR paradigm in age-appropriate ways. Not all tough teenagers will want to play with modelling clay and blow bubbles: nevertheless the examples in Chapter 9 challenge my assumptions. Winnicott (1982) himself describes the importance of the ‘play space’, the creative space between therapist and child. He also emphasised the importance of the mother–child relationship. NDP shows that the space between mother and unborn/newborn child is a playful one. These two developmental paradigms, Neuro-Dramatic-Play and Embodiment-Projection-Role, together form the bigger picture of Theatre of Body.

Theatre of Body: integrated circles Attachment is among other things a visceral, sensory and physical experience and the physical proximity between mother and child is of the utmost importance. However it is essential to remember that every culture produces its own movement, dance and rhythms and children can be disturbed by the imposition of other cultural forms until they have become embedded in their own. People can be cut adrift from their own roots unless they have been established in them. In ‘The Collective Body’ Adler (1999) says we were all born with a tribal body but also belong to an earth body. She proposes a movement approach called ‘Authentic Movement’ (derived from Mary Starks Whitehouse 1970), that gives us the opportunity to rediscover this process that has been influenced by the rapid move away from tribal living. Authentic Movement bridges many beliefs and practices: therapy, meditation, ritual, improvisation, individual and community group process. Adler (1999) also suggests that the loss of the community, the loss of the circle, ‘a sacred circle has contributed significantly to the creation of unbearable rage, isolation and despair’(p.192).

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Our embodied experience from conception and continuing through our early lives sets a marker on how we will develop: self-confidence, resilience, communication, generosity, empathy, trust and hope all have their early roots in our bodily experience in the pregnancy and attachment processes. ‘Thinking with the body’, ‘body intelligence’, ‘body memory’ are just some of the concepts used in therapeutic understanding of our physicality. The body is a primary means of learning (Jennings 1998) and early somatic experiences influence later physical and cognitive growth. An infant needs to develop a ‘body self ’ before he or she can have a ‘body image’ (Jennings 1998–1999a). The body self means that the person feels they inhabit their own body with confidence: the livedin body. Early attachment experience is strongly influenced by our body experience. Through the physical attachment to our caregiver we are able, later, to let go and explore independently. The body of another person holds and contains, and allows us to experience body boundaries. Embodiment is the first stage of our dramatic development (Jennings 1987, 1990, 1998, 1999a, 2003, 2004). The Theatre of Body is being enacted from the moment of conception to the time of collaboration (around six months), and from ‘birth-playing’ until ‘drama for real’ (around seven years). It contains the development paradigms of Neuro-Dramatic-Play and

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Embodiment-Projection-Role (see above). NDP addresses the dramatic basis of attachment, from conception to the first six months of life; EPR charts the dramatic development from birth to seven years as a child moves from the physicality of the first twelve months to the mastery and exploration of substances and objects during the projective stage. By four years old, the child is playing roles, inventing scripts, telling stories and improvising dramas from their own life or from books. But there are initially only two players in this dance and drama of life. Through basic enough attachment in the early days and months, the child experiences trust, affirmation and unconditional positive regard (Maslow 1968). This experience is embodied and it is playful, and it has elements of mimicry. This is Theatre of Body.

Dramatic development Play and therefore ritual, theatre and drama, all have a biological basis (Cozolino 2002; Jennings 1999a; Schechner 1991; Turner 1982; Whitehead 2003), and much is now written of the impact of healthy attachment and play on the growth of the brain. The need to dramatise is a primary drive, which is necessary for survival. We can recall children who failed to thrive because no one played with them and there was no social interaction. A spectacular example was when Western European people first saw the pictures from the Romanian orphanages after the revolution, in the early

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1990s. Babies and young children were depressed and dying, not because they had no food, but because there was no sensory play and no social interaction. This bears out the research by Harlow (1958: see Chapter 2) with rhesus monkeys that found that physical affection took priority over feeding. Even a soft cloth to cling to was better than no softness at all. The roles we play in everyday life and theatre are ‘embodied’; we understand our roles through our bodily experience. As infants develop, they are able to separate out the difference between ‘let’s pretend’ (dramatic reality) and everyday life. They have already experienced the ‘as if ’ of dramatic playfulness in their early playful relationship. Actors also work with ‘as if ’ and the concept of ‘emotional memory’ (Stanislavsky 1950) in order to find the authentic role or character. In order to understand roles and characters we need to look at concepts of ‘role’ and ‘performance’. However, we need to make a clear differentiation between the idea of playing a role as if I am this other person, the enacted situation, and the ‘as if body loop’ that is described by neuroscientists (Damasio 2000, 2003; Le Doux 1998), which is an imagined situation. The ‘imagined situation’ refers to the brain processes that are involved when we imagine something rather than actually doing it physically, or witnessing it in others. In the following examples, both Le Doux and Damasio talk about the imagined or ‘as if ’ bodily states: In certain situations, it may be possible to imagine what bodily feedback would feel like if it occurred. This ‘as if ’ feedback then becomes cognitively represented in working memory and can influence feelings and decisions. (Le Doux 1998, p.295) There are thus neural devices that help us feel ‘as if ’ we were having an emotional state, as if the body were being activated and modified. (Demasio 2003, p.155) Mirror neurons fire when an infant observes certain actions being performed by someone else. It is thought that mirror neurons contribute to social functions such as rituals and dancing, and ‘setting a good example’; (for an elaboration on this theme see Whitehead 2001, 2003).

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However, dramatic development must also include the theme of performance, and in certain educational circles performance was seen as a negative experience, with small children being made to perform for the entertainment of adults or an attitude of performance being more important than process. Slade (1995) suggests that it interferes with the absorption of the children: You will help the work and the children if, in the infant school, you try to avoid all playing to parents, use of formal stage and script plays, and use only a little dressing up. These things interfere with the absorption, and thus the sincerity, if they are experienced too soon. (Slade 1995, p.63) Dramatherapists have mainly shunned the idea of performance being in any way therapeutic, which is something I challenge. Theatre of Resilience culminates in a shared performance (see Chapter 12). Moore (2009) has written extensively on the Theatre of Attachment, and sees her therapeutic work as an opportunity to close old scripts and write new ones. She says about her play and dramatherapy practice: Here, play is performance when carried out publicly, performative when it is more private (Schechner 2006). When we enact one another’s social dramas, through awareness of original settings, we gain new perspectives. Since, in life history work, we benefit from the presence of others to assist our understanding I am drawn to Turner’s etymology of the word performance, from the old French, ‘parfournir’ meaning the ‘proper finale of an experience’ (Turner 1982) and not to do with ‘form’. This interpretation permits ‘performance’ to be more private, valuable for participants confronting intense pain and shame in the process of discovering their true strengths. (Moore 2009, p. 204) Moore (2009) sees her scripted performances as a means of creating bridges between the past, present and future life of looked after children, and their attachments and relationships. She integrates the foster and adoptive parents into these performances, which she terms ‘Theatre of Attachment’ (Moore 2009). Schinina (2004) writes: ‘Theatre has to be understood here as a means of developing relationships, communication, and expression

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that concentrates on the construction of roles’ (p.37). Everyone is playing differentiated roles in everyday life, and they are also playing imaginative roles when they play or perform in the theatre. There will be comments as to whether the performances are as good as expected. Together with Whitehead (2003) I would suggest that dramatic action, rather than language, is the foundation of culture and therefore individuals need to be socialised both into social groups as well as into their cultural forms. This means that the dramatic developmental process has a unique function in the socialisation of individuals and groups within different cultures. Furthermore it has major implications for resources for infants and young children as well as community initiatives. In every sense of the word we have a ‘Theatre for Life’ that grows out of Theatre of Body. It emphasises even more the importance of the dramatic nature of early attachment experience. Not only are we laying the foundation for the healthy development of the individual child, but also we are ensuring that the embedding of the child’s culture is available through a continuation of the dramatic development and process within social groups. Several theorists from theatre, social psychology and social anthropology have developed contrasting theories of roles and performance, which are relevant in this context. A brief mention will have to suffice within this complex frame of references. George Herbert Mead (1934), founder of Symbolic Interactionism, describes how people actually create reality by the way they act towards the world, and he contributed the following important concepts: • Self: Mead’s concept explains our ability to see ourselves as both actor and subject. The self is reflexive, meaning we can see ourselves as others see us. Mead (1934) suggests that the self is developed into a play stage and a game stage in childhood. • Play stage: this involves learning to take the attitude of a particularised other (a specific person such as the child’s mother). • Game stage: this involves learning to take the attitude of everyone else, and therefore learn how to function in organised groups.

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• Generalised other: the generalised other develops out of the game stage: it is a collective attitude of the community or society; persons can see themselves as belonging to their society by engaging in shared meanings of others. • I and Me: Mead suggests that the self is a social process – the ‘I’ is the immediate response of the individual to others; the ‘Me’ is the adoption of the generalised other. Therefore the human being is an acting organism. When we role take we are able to understand how our own actions will be perceived and interpreted by others, as well as understand how others perceive and feel themselves (Mead 1934). Through taking the role of the other, we are ensuring that empathy and a conscience are able to develop. Mead’s observations enable us to grasp the basic fundamentals of the dramatised self and other, both specifically and generally. Erving Goffman (1969) expanded Mead’s ideas and he developed a dramaturgical perspective to show how social reality is created through interactions and performances. Lemert, writing on Goffman, says that: It is our ability to carry off a convincing performance, to make people believe that we are who we say we are, we mean what we intend, and that the definition of the situation is what we have claimed by implication, is the means to impressing ourselves and others. (Lemert and Branaman 1997). Victor Turner’s important writings on ritual and ritual symbols, and the relationship between ritual and theatre have shaped the way anthropologists, theatre theorists and theatre therapists think about their work (Turner 1967, 1974; Turner and Bruner 1986). Turner developed some of the earliest ideas on theatre and anthropology, drawing on his own life: his mother was in the theatre and his father was a bankrupt engineer who divorced when he was only 11 years old. He was brought up by grandparents, living far away from his estranged parents. For me the anthropology of performance is an essential part of the anthropology of experience. In a sense, every type of cultural performance, including ritual, ceremony, carnival,

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theatre, and poetry is explanation and explication of life itself, as Dilthey often argues. Through the performance process itself, what is normally sealed up, inaccessible to everyday observation and reasoning, in the depth of sociocultural life, is drawn forth. (Turner 1982, p.13) Turner also says: My training for fieldwork roused the scientist in me – the paternal heritage. My field experience revitalised the maternal gift of theatre. I compromised by inventing a unit of description and analysis which I called ‘social drama’. (Turner 1982, p.9) I cannot help but identify with Victor Turner, being born of a medical doctor and a dancing mother, and I have seen how I have moved (sometimes lurched) between the polarities of medicine and art, even though my parents were together for over 60 years. Dramatherapy and play therapy continue to evolve in my thinking and practice, but even so I seek to free myself from those very terms, and move into playful encounters and theatre experiences. I invent structures and paradigms that are meant to contain but not restrict; I seek out variations on themes rather than fixed compositions. The Theatre of Life is started by the developmental and attachment theorists and is then continued by the ritual and performance theorists, weaving together a rich and vibrant tapestry. But it is theatre! Let us just recap our dramatic development, and see how we can emerge into empathic social beings. First, there is consonant play, where mother and baby do the same movements and sounds, singing and movements. Then the newborn infant usually echoes simple sound phrases or movement of the mother; this is followed by mimicry that is a reciprocal drama: the baby imitates the mother and then the mother imitates the baby. This develops into the dramatic act of mirroring; then even more complex dramas emerge when the infant begins to imitate both actions and sounds, as well an initiating them.

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The repetition of ‘ritualised’ actions that can include singing games and stories with sounds becomes a secure base from which creativity and improvisation can grow. Through the first social relationship and secure attachment, the infant feels secure within his or her body identity, to begin to explore dramatic playing. This dramatic development of infants is essential not only for healthy attachment and resilience but also for identity and self-esteem and the process of social integration into culture. The child needs to belong to the fabric of a social network with his or her own roles and expectations, rules and norms. Culture will include rites, rituals, dance, art, music, drama, theatre and of course storytelling. Trevarthen (1993/2006) suggests that infants from birth are able to communicate: It is the nature of human consciousness to experience being experienced: to be an actor who can act in relation to other conscious sources of agency, and to be a source of emotions while accepting emotional qualities of vitality and feeling from other persons by instantaneous empathy. (Trevarthen 1993/2006, p.121) However, he does say later that the focus of communication is marked by babies of six weeks or older: they still their movement, pause for breath, and everything is aimed to gain information about their mothers’ presence. Trevarthen has done extensive observational and laboratory research with babies and I am hesitant to challenge Trevarthen’s findings, but in my own work I put the start of this intensity much earlier, from birth, rather than six weeks old. The child is part of the rituals of a family and social group through which the embodied ideas and values of the culture are transmitted and embedded. Trevarthen has written extensively on the early development of babies, especially in relation to musicality and rhythm. He infers that even at an early age, a small infant is making sense of other people’s behaviour:

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Babies are born to find meaning in intense participation with the imagings and ambitions of older minds. They have a musical sense of time, and a language of emotions that matches that of the wisest adult, including sensitive feelings about the contingent appropriateness of other persons’ behaviours. And they soon build a ‘personal narrative history’ that connects moments of the present to an imagined future as well as a remembered past. (Gratier and Trevarthen 2008, p.122) There is an increase in studies of newborn babies and their development, but apart from Trevarthen, there is less attention paid to the minutiae of the communication of babies, and their playfulness. However, it is important that we keep both mothers and babies within the frame and look more closely at the qualitative communication that happens in the play space between mother and baby. We shall now commence our playful journey through this book and find new ideas, old images in new perspectives, refreshing approaches for working in difficult situations, and, I hope, some optimism for creative change.

Chapter 1

NDP Definition and Theories When I was seven I had a weird experience. I had my new football and I kept on playing, even though it had got dark and all the other kids had gone home. As I was walking home on my own, I looked up at the stars and thought, how long do stars go on for? Then wondered, how long is life? How long will I live? How long will I be dead? Will it be OK when I’m dead or will I feel different? Suddenly I was scared, and I ran all the way home, screaming and crying. I got into bed with me mam and dad, squeezed in beside them, cuddled close. I didn’t tell them why I’d been screaming. I just sort of hid it in my head. (Gascoigne 2004)

Introduction Neuro-Dramatic-Play is a new synthesis of several approaches to child development that include our greater understanding through neuroscience of the complexity of early brain development, the contemporary thinking on childhood attachment, and the emergence of play therapy and dramatherapy as a primary intervention with children and teenagers with emotional and behavioural difficulties. It is also influenced by the more recent synthesis that both nature and nurture are necessary for healthy child development. Whereas historically nature and nurture were seen as opposing factors in understanding human thought, feeling and behaviour, recent research by neuroscientists shows that nature and nurture are in fact doing the same thing. They are both building the human brain and its capacity to function. The brain of the baby is not built before he or 28

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she is born; the newborn infant will develop most of the higher brain after birth. Nature gives the brain its potential but it is the quality of the nurture (or the neglect) that will determine the eventual growth of the brain and its capacities. Much of what we now know about brain development and nurture has grown from ‘living research’ into the effect of deprivation on thousands of orphans from Eastern Europe. There is a joint irony that we understand much more about attachment behaviour from the work of Harlow (1958) and his cruel experiments on rhesus monkeys (see Chapter 2), and from the results of years of cruelty, neglect and abuse of babies and children under a politically repressive regime (see Chapter 2 and also discussed below). Neuroscientists have contributed to our greater understanding of the brain and how it functions. Le Doux writes about new perspectives on the relationship between nature and nurture, and Cozolino, a neuroscientific psychotherapist, puts forward his ideas linking social networks and neural networks: …the stuggle between thought and emotion may ultimately be resolved, not simply by the dominance of neocortical cognitions over emotional systems, but by a more harmonious integration of reason and passion in the brain… (LeDoux 1998, p.21) From the first moments of our lives, we exist within a complex matrix of social relationships. This elaborate social relatedness is organised and controlled by neural networks of bonding and attachment, play, predicting others intentions and being able to see the world through others eyes. (Cozolino 2002, p.172)

Background Although my own work with teenagers living on the streets in Romania and India has helped me to understand more fully my thinking behind Neuro-Dramatic-Play, it was my earlier research and writing that created the foundation for these more recent developments. Much of my early writing and teaching (Jennings 1983–2007) on dramatherapy and play therapy has focused on the developmental paradigm

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‘Embodiment-Projection-Role’ (EPR), which charts the ‘dramatic development’ of children from birth to seven years of age. These three stages of EPR and their appropriate transitions are essential for healthy development and maturation. They influence the development of both the right and left hemispheres of the brain as well as encouraging resilience and self-confidence. If children do not navigate the EPR stages, it can have serious consequences in later life. Indeed a child who has not been able to go through an appropriate embodied stage (E) may have a distorted body image and potential eating disorders. A child who struggles with hand–eye coordination and literacy, and maybe has little confidence in their own artistic abilities, may well have never been through the projective stage (P). There are many children who are unable to ‘pretend’, i.e. to take on the role of another (be it animal or person), because they have not been through the role stage (R), who will then play out destructive or isolated roles in everyday life. These children have missed out not only the role stage of EPR, but also the time of dramatic playing during the early weeks and months (see Chapter 3). They are unable to dramatise their roles but continue life in a series of day-to-day destructive encounters where they often play out roles of aggressors or victims. I have worked with children who will happily play at physical games or movement exercises (Sherborne 2001) or will create collage or self-portraits or intricate clay models, but they have been quite unable to play a role, i.e. to become someone other than themselves. To play a role means that we are able to play ‘as if ’ we are the other person (or creature). This is what I term ‘the dramatic response’ (Jennings 2005a), and it is only through being able to play dramatically, to take on roles in thought or action, that we are able to consider the feelings and experiences of somebody else. This is how we develop empathy and the child who cannot engage in dramatic playing will have great difficulty with understanding ‘the other’. Baron-Cohen and Chakrabarti (2008) have a very useful definition of empathy which is pertinent here: Empathy is a defining feature of human relationships. Empathy stops you doing things that would hurt another person’s feelings. Empathy also stops you inflicting pain on a person or animal. Empathy allows you to tune into someone else’s world, setting aside your own world – your perception, knowledge, assumptions or feelings. (p. 317)

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As a therapist, mother and grandmother, I am increasingly concerned by the lack of empathy shown by many children and adults, seemingly endorsed on TV shows: We are living in times where empathy seems to be absent in one or two generations of children; lack of empathy means that not only do we not understand how others feel, we are capable of inflicting enormous pain on them with no remorse or conscience. (Jennings 2007b)

The fertility clinic It was only in 1988, when I began to work in a clinic for people who had difficulties in conceiving, that I became far more aware of how EPR actually starts before birth in the sensory, projective and dramatised relationship between mother and unborn child. Indeed, there has been a burgeoning literature on the life of the unborn child and the fierce and often violent debate between the pro-life advocates and those who support abortion. Very tough questions have been asked concerning our reactions if we knew we were giving birth to a child with disabilities or a pregnancy that followed rape. This book does not enter this debate but acknowledges the increase in research on pre-birth development and external influences on the baby before he or she is born. Embodiment-Projection-Role are broad-based categories that encompass a wide range of behaviours and actions (for a detailed breakdown of these, see Jennings 1998), so I began to focus on the more minute detail of mother–unborn-baby and mother–newbornbaby interactions and playfulness (Jennings 1999a, 2003a, 2003b 2009a, 2009c) and discovered that EPR needed refining for these early months in a child’s life. It was some time before I found a description that could focus on this period between conception and the first six months of life, and decided that ‘Neuro-Dramatic-Play’ was probably as accurate a description as any. I am convinced that this is the critical time for NDP to make an impact on the future development of any child. Neuro-Dramatic-Play means that it is connected to the infant’s brain development; it also involves the dramatic response ‘as if ’, and it is connected to our capacity to play. Playfulness is a motif that permeates this book.

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The importance of women When I say NDP starts from ‘conception’, it may not be the actual moment of conception, although I firmly believe that a child conceived in violence, or without regard, can be affected by the immediate feelings engendered by the encounter, especially if these feelings persist throughout the pregnancy. Certainly when the mother is aware of her wished-for pregnancy (or is pleasantly surprised) and starts to react to the presence of another being, there are positive changes in herself and her unborn child (see Chapter 12 for discussion of McCarthy 2007). For many women this is when the baby first begins to move, and playful thoughts, dream states and emotional changes become more prominent. Despite early discomfort of morning sickness and exhaustion, and later feelings of grossness and exhaustion, pregnancy can be a playful and creative time. It is very sad when women feel under so much pressure that they feel they must work during pregnancy: there are not only economic demands but also societal expectations. The role of mother can be looked down upon and equated with being ‘just a housewife’. I think this is very confusing because in many ways mothers are valued highly, they are the carriers of the next generation and therefore they need time and attention to be mothers, but this is not always borne out with how mothers are treated, as if they cannot think for themselves or make a decision. And certainly as if they do not know better than the doctor! Furthermore, women are not supported adequately financially, whether or not they are married or single. Women have struggled for their rights for hundreds of years but things are slow to change. The rights of mothers to have a say over their own destiny and that of their unborn child is still a long time in coming, especially in western cultures. Historically women have been punished and killed for being midwives and attending to childbirth; their knowledge was thought to be from the devil and their perceived frailty meant that they were subject to wrong influences. It was a long time before women were allowed to deliver babies ‘officially’; when forceps were first invented, it was kept secret and only male doctors were allowed to use them. Things are different now but there still pervades the idea of the frail woman who needs to be cared for and who cannot think for herself.

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Most pregnant women I know are strong and feisty and capable of delivering their own babies if necessary! It is difficult for women who are able to manage their own births in a trance-like state to be prodded by ‘specialists’ who do not have the working understanding of the processes of labour. Childbirth is a private occasion, rather than a public display under the glare of bright lights and chrome. It can be compared with the difference between dreams and theatre. Dreams are our individual private experience, rather like a theatre in our heads, whereas theatre is very much a public and group event with spotlights and heightened effects. Childbirth is very private, personal, and indeed natural. It does not have to take place in a surgical space with costumed and masked attendants in starched white uniforms, under bright lights. So we know that the period of time from conception through the three trimesters to when the infant is six months old is the time for the basis of attachment to be formed. The period before birth is as important as the period afterwards (see Chapters 4 and 5). It is important to realise that neuroscientists have discovered not only psychological processes but also chemical secretions that are underlying the emotional attachment between mother and child. It is the interactions between mother and baby that are influenced by neurochemicals, so there is a constant flow of nature and nurture that eventually establishes ‘positive attachment’: ‘The internalisation of the mother involves an intricate network of visceral, motor, sensory, and emotional memories that can be involved in times of stress and can support the ability to regulate affect’ (Cozolina 2002, p.177).

The brain and the body Having identified the critical period for Neuro-Dramatic-Play (NDP) to take place, let us now look at what it actually is and what it actually does. Definition of NDP Neuro-Dramatic-Play is the sensory, rhythmic and dramatic playfulness that takes place between a mother and her unborn baby and mother and newborn from conception to six months.

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What does NDP do? Neuro-Dramatic-Play has a profound effect on the growth of the brain, the chemical balance of the body and the healthy attachment between infant and parents. It influences the future emotional and social maturation of the child.

Neuro-Dramatic-Play is the term I use to describe the play processes of ‘sensory play, rhythmic play and dramatic play’ because they make a direct impact on the neural pathways and the developing brain of the infant, as well as forming the basis of playful attachments through games and storytelling. The body is the primary means of learning, as we shall see in all the situations later described in this book. NDP makes an impact on several parts of the brain that at one time were referred to collectively as the ‘triune brain’ (Maclean 1985). Not all neuroscientists now believe in the layered brain theory of the reptilian, mammalian and executive layers, but nevertheless still make use of the analogy as a way of talking about the evolutionary brain functions. Cozolino (2006) suggests that Maclean’s model is very useful for therapists and teachers since it connects with both Darwinian and Freudian theories. He comments that: The triune brain presents an evolutionary explanation that may account for some of the contradictions, discontinuities and pathologies of human behaviours (Maclean 1990). Maclean described the human brain as a three-part phylogenetic system reflecting our evolutionary connections to both reptiles and lower mammals… Think of it as a brain within a brain within a brain, each successive layer devoting itself to increasingly complex functions and abilities. (Cozolino 2006, p.24) It is useful to consider that the instinctual brain (reptilian) that includes the amygdala is where fears both inherited and acquired are stored. The emotional brain (mammalian) is concerned with nurture and feeding. It is shared by all mammals, and probably contributes to attachment and care of small infants. The rational brain (executive function) is also referred

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to as the higher brain; it is where our lived and conscious experience is located, together with our informed decision making and reflection. NDP addresses all these areas of the brain through therapeutic play: predictable play that reassures the instinctual brain, sensory and rhythmic play that influences the emotional brain, and dramatic playing and stories that make an impact on the development of the rational brain. The reassurance through constancy and predictability is very important for the child who has become locked in fear and is unable to move out of their instinctual responses. Sensory and rhythmic playing are important ingredients of attachment playfulness. Dramatic playing and stories encourage both structure and curiosity. Research demonstrates (Sunderland 2006) that the growth of our early brain is dependent on the quality of our social interaction with our mothers (or primary carer): ‘Much of the infant brain is developed after birth, so it is very open to being sculpted by both negative and positive parent interactions. At birth your child’s higher brain, in particular, is very unfinished’ (Sunderland 2006, p.20). The reptilian brain is the most ancient part of our brains and is necessary for survival. It reminds us to take food, to keep warm or sheltered, and especially it warns us of danger and whether to ‘fight, freeze or take flight’. How many damaged children do we know who live their lives around food and fear; they seem to live only through survival mode. Deft attempts to bring about change through a new family or intensive therapy are not necessarily successful, especially when the attachment needs of the carer or parent or therapist become intertwined with those of the child (see Chapter 8). The emotional brain is located in the limbic system and as its name suggests is involved with the emotions as well as learning and memory. The higher brain is within the neo-cortex. Because at birth it is still ‘soft-wired’, i.e. not all the synaptic connections have been formed, it will be influenced by external influences in parenting and care. Loving interactions, affirmation and playfulness will have a strong influence on the growth of the higher brain and its functions. It is responsible not only for empathy but also for imagination and problem-solving, and the capacity to reflect. The rational brain needs to work in collaboration with other parts of the brain and not separated from the ‘emotional brain’ or the ‘instinctive brain’.

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Erik Erikson’s eight stages of maturation commence with ‘Hope: Trust versus Mistrust’ 0–12/18 months although there are variations (Erikson 1965/1995). He focuses on the quality of interactions between parents and children and says that if the small infant experiences ‘warmth, regularity and dependable affection’, their view of the world will be one of trust and thus hope. He is describing the basic qualities of a ‘good enough’ attachment. However, for many of the damaged children, the basic ‘Trust versus Mistrust’ stage has not taken place. A host of other fearful experiences have entered the amygdala, creating a self-perpetuating situation of Reactive Attachment Condition (Hughes 2006). The lower brain or the emotional brain is also called mammalian because it is shared with other mammals. All mammals appear to care for their young and also share with humans the capacity to be playful and social.

Whereas sensory play through touch and massage, soothing sounds and loving gestures and words strengthens the emotional areas of the brain including the thalamus and the hypothalamus, dramatic play helps to develop the potential for empathy that belongs to the higher brain areas. Empathy is also linked to the developing of a conscience. Our moral sense and our values are linked to how we should treat other people. Empathy is the ability to stand in someone else’s shoes and understand how they feel. We cannot empathise unless we can ‘take on the role of the other’ (Mead 1934) (see the Introduction for further elaboration of Mead’s ideas).

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Dramatic play and role play promote the capacity to step out of my own reality and enter someone else’s. It belongs to the higher brain area: We can only develop empathy if we are able to feel ‘as if ’ we are the other person. Therefore the early mimicry between mother and baby is enabling the possibility of acknowledging and feeling for ‘the other’. (Jennings 2007a, p.8) Much of what we have learned about the brain since the early 1990s has come about because of the exposure of the appalling cruelties in some Eastern European orphanages (Gerhardt 2004; Sunderland 2006). Large institutions with untrained staff meant that thousands of abandoned, disabled or orphaned infants received the most rudimentary ‘care’. Babies were abandoned in cots and fed with propped feeding bottles, with no physical nurture of any kind. Many small children were tied to their beds for long periods of time so that their limbs grew back-to-front or disproportionately. In some places children were fed alternate days which led to ‘scoffing, sicking-up, slow-eating’. Children snatched and scoffed as much food as they were able, then sicked it up again in order to eat it more slowly. This way they would not feel such hunger pains while waiting one or two days for the next food to arrive. We can see that these children were forced into their survival brains with little opportunity to develop their positive emotional lives or their capacity to play or empathise. Observation of these orphans has shown that the emotional and social neglect actually caused parts of the brain not to develop, especially the neo-cortex. The social function of the brain does not develop until after we are born: we have the potential but it develops through our interactions with others. It depends on the quality of these interactions whether we develop positive social relations that include trust and empathy. Since the orphans did not have social interactions at any meaningful level, it is not surprising that their capacity to create trust was severely impaired. Stressful experiences, such as separation from the person who feeds us and the food itself, increase the release of the ‘fear-chemical’ cortisol in the brain, which makes the infant wary and distressed. Many of these neglected children escaped from the institutions when they became older and spent their lives on the streets, railway stations

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or under bridges. Many children as young as seven years learned how to fend for themselves, rather than continuing to tolerate the cruelty and frequent physical and sexual abuse of the orphanages. There was no feeling of safety or security in the orphanages, and children chose to break free rather than stay as institutionalised victims. Gerhardt (2004) uses the phrase ‘emotional immunity’ to describe the positive affective development of babies and infants: ‘Good emotional “immunity” comes out of the experience of feeling safely held, touched, seen and helped to recover from stress, whilst the stress response is undermined by separation, uncertainty, lack of contact and lack of regulation’ (Gerhardt 2004, p.84) The development of our brains and the maturation of our emotions are therefore dependent on our early playful attachment. This loving interaction is a two-way communication, at first through touch, sound and gaze. The social interaction influences the development of the social brain, and without this interaction, the brain will not fully develop. Certain innate responses to fear, usually through freezing, are processed. Just as parents can reproduce their own attachment history with their children, carers and therapists can also get sucked into a destructive dynamic that can be addressed only with careful supervision and sometimes personal therapy (see Chapter 12).

Theatre of Body and Theatre of Mind Whitehead (2001) developed his ‘Theatre of Mind’ from ‘Theory of Mind’ – the capacity to ‘read’ other people’s minds (Baron-Cohen 2003). He says that Theatre of Mind develops at the higher levels of social intelligence. Humans are committed to living and experiencing through others: gossip, jokes, news, television – and of course theatre. Theatre of Mind happens both through our imagination and through performance. Whitehead (2001) suggests: • Mimicry is a reflex; it is copying. • Imitation is insightful; it is goal copying. • Mimesis has intentionality, voluntary simulation to represent actions, things, and people. (p.11)

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Very importantly, Whitehead suggests that mimesis includes pretend play, and that pretend play is necessary for ‘Theatre of Mind’. The study of pretend play reported here represents a collaboration between neuroscientists and social anthropologists. Our aim is to contribute to the knowledge base necessary for further theorizing and research, particularly in relation to autism and theory of mind, but also to answer some more general questions relating to the social brain. We assume that human culture must depend on implicit displays (such as dance) and mimetic displays (such as pretend play), and that these are the necessary precursors of the conventional displays that characterise and constitute human culture. (Whitehead et al. 2009, p.1) Baron-Cohen (2003) also says that pretend play is important. He suggests that ‘pretending’ is the first epistemological mental state that is understood by children. Autistic people are trapped in a here and now without insight into the past or future. He describes how an autistic boy said that he had to speak his thoughts out loud in order to know what they were; this is because he had no ‘mirror in his mind’. He therefore had to create a mirror ‘out there’. Again we are talking about the importance of ‘the dramatic response’ or the ‘as if ’ or indeed the capacity to make ‘pretend play’. This leads us into a further discovery from neuroscience which is the identification of ‘mirror neurons’. Their effect, especially on the growing infant is profound especially in relation to their development as social and cultural beings. Whitehead, integrating the work of Dilthey, Baldwin, Cooley and Mead, argues that ‘self awareness depends on social mirrors and shared experiential worlds’ (Whitehead 2001, p.1). Mirror neurons in the brain fire when humans and other animals perform specific actions and when they see another perform the same action. Babies at 36 hours old can differentiate between happy, sad and surprised human facial expressions. Within the first few hours of birth, newborn babies can imitate their mother’s expression and even stick out their tongue. Mirror neurons and their networks within the social brain link brains and bodies which may stimulate sharing and turn taking. Mirror neurons help to explain and justify theories of ‘role modelling’ and ‘setting an example’ that is talked about as a moral imperative, i.e. that

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this is a ‘good thing’. However, the underlying neurobiological basis cannot be ignored. Mirror neurons may also play a dominant part in organised group activity: dancing, hunting and other collaborative endeavours. Mother and unborn child anticipate the social mirroring that will take place after birth. Whitehead’s ideas influenced me when I began to re-examine my observations of mothers and unborn and newborn infants. The dramatic play or pretend play was very clear to me but I had yet to tease out what I was actually seeing in the sensory and embodied playfulness. I noticed that mothers would often rock themselves and their unborn child, and I have noticed that other women will sometimes rock while hugging a cushion without being aware that they are doing this. The encircled arms create a circle of safety, a circle that will soon become the circle of attachment once the baby is born. Almost like a ‘theatre in the round’ that encircles a ritualised containment of two people, one is very much dependent on the other. Perhaps this is another way of understanding playful attachment in the early weeks. A piece of ‘physical theatre’ that maintains the safe borders and guards against danger and intrusion until there is a cue to be a little more adventurous! This led me to explore the notion of ‘Theatre of Body’ which I think precedes Theatre of Mind in a person’s development. The early sensory and embodied play between mother and newborn child as well as being anticipated during the pregnancy has all the qualities of a ‘Duet for One’. Physically mother and baby are living life through each other’s physical proximity and non-verbal communication. The paradox of their closeness will enable the infant to eventually tolerate distance, and once the child is physically secure he or she can also tolerate absence. The early playing, which is physical and consonant between mother and child, is necessary before ‘the echo’: you smile – I smile. The consonance in the circle establishes the security of oneness before it is possible to establish difference. This circle of safety is important to establish before there are any extended absences of the primary carer. If there is prolonged absence before an infant can grasp ‘going away and coming back again’ then the result may be sustained anxiety and potential depression. Theatre of Body enables Theatre of Mind to follow developmentally.

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Most infants pass through the stages of sensory, rhythmic and dramatic play within the family that provides adequate attachment (Bowlby 1969/1971) and secure parenting. These three playful processes commence during pregnancy when mothers have playful interactions through movement and enactment (see Chapter 4) and continue in their most intense form until the infant is six months old (see Chapter 5). The dynamic quality of interaction between a mother and a young baby can be predictive of the emotional attachment relationship between them many months later (Jaffe et al. 2001; Trevarthen 2005). The emphasis in NDP is the sensory, rhythmic and dramatic essence of the mother–child attachment that forms the core of the playful attachment relationship (Jennings 2003a). Neuro-Dramatic-Play is the basis or foundation from which Theatre of Body grows. Many other brain processes are also being developed: this is the physical basis of trust, care, awareness, self-confidence, self-esteem and self-image, which need to be kept balanced.

Sensory play, rhythmic and dramatic play Making sense of the world around us happens through our senses and commences before we are born. We can sense temperature, sound, rhythm, touch and emotional changes while we are still in the womb and our mothers have a profound effect on our well-being through their own sensory experience. We are aware of our mother’s heartbeat and will synchronise it with our own heartbeat. Women who avoid sensory experiences, and perhaps find touch or stickiness distasteful, have difficulty in providing any sensory stimulus for their small children. Early sensory play experiences involve touch and holding, textures and smells, visual movement and colours, sucking and taste, voice and music. It can be messy as well as magical! Plastic bibs are no substitute for skin-to-skin contact. We can encourage pregnant women to create massage times while they sing songs to their unborn child. The telling of soothing stories and the playing of calming music can all influence the state of trust and tranquillity for mother and her unborn child. Most women rock rhythmically without being prompted, thus establishing the secure patterning of regular rhythms.

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Many women report that they tell stories and confidences to their unborn child and sometimes have a conversation in which they answer themselves as if they are the child. This process continues after the child is born when the mother takes on the imagined child’s voice in answering her own question. Mother and infant start to take turns in a non-verbal conversation that is very private and often very funny (see Chapter 5).

Throughout history we have needed to make sense of the world around us: we discover the rules of the universe and the need for the social group. So we tell stories (Storylore, in Jennings 2003a, 2003b) and imitate through ritual, rhythm, drama and dance our view of the world and our shared place within it. However this starts much earlier when we start to make sense of our world a few months after conception. Play and creativity in our relationship with our unborn child commences at the beginning, it is like a life rehearsal. There is a continuum that develops from the playful pregnancy, to playful consonance to playful echo and playful mimicry. This continuum is usually completed within the first three months of life. Not only are we rehearsing life while in the womb, but also we are making connections between the world outside the womb and ourselves. Babies do recognise birthing songs and music once they are born; they

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will shy away from harsh voices they heard before they were born, and they begin to have a sense of who they are in relation to their mothers in the way they are picked up and held as soon as possible after birth: ‘And did you sing as I came into the world? As you opened the door for me to come into the light? Sing at my birth and for all babies as they start their journey on this earth’ (Jennings 2003b, p.6). This ancient chant from the Nordic goddess of birthing, Uks Akka, reminds us of the ritual, rhythm and creativity that should be present at childbirth. Odent (1984) draws our attention to the enormity of the birth experience: Birth, like death, is a universal experience. It may be the most powerful creative experience in many women’s lives. It can either be a disruption in the flow of human existence, a fragment having nothing to do with the passionate longing that created the baby, or it can be lived with beauty and dignity, and labour itself can be a celebration of joy. (Odent 1984, p.xxii)

The early days and months The baby begins to make sense of the world through the sensory experience with the mother. The physical and emotional surge, which is the focus of the early weeks and months, creates the joyousness and excitement of primary play through the senses, especially through smell and touch. These sensory experiences, a kind of proto-play, create the primary attachment between mother and child but they also have a biological basis (see Chapter 2). This sensory proto-play is necessary for the development of healthy attachments and the expansion of the child’s place in the social world. The singing and the storytelling that started during pregnancy continues in the early weeks. Playfulness is always an important way of strengthening attachment. Infants, as we have said, notice faces and their expressions within hours of being born and quickly recognise the face of their mothers, detecting moods and times of being ‘switched off’. Faces smile at newborns and very soon the infant smiles back. The primal gaze between mother and infant of love and acceptance not only makes a

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social impact, but also contributes to the growth of the brain. Although babies are initially responding through smell, touch and sound, sight becomes increasingly significant, in their social development as well as in their brain development. Perhaps the old saying ‘Out of sight, out of mind’ takes on a new significance for us. An interesting sequence of therapeutic play is initiated by Aanand Chabukswar (see Kashyap 2005) in India. He talks about the three significant stages: ‘Intend – Pretend – Attend’. Through these stages participants first of all understand the aims of what they will do, in a safe playing space with a whole range of physical movements, games and dance (Intend); then they go into dramatisation, role plays and other experiences that can enhance their well-being and also address difficulties that will stop them moving on (Pretend); then through reflection and sharing and various means of carrying their experiences forward, participants take from the session changes to integrate into their lives away from the sessions (Attend). I see parallels between this way of working and the sequencing of NDP, where, we hope, the early sensory and dramatic experiences will be internalised by the infant and become a part of their lives as they grow and develop. We always need to remember that our brains are still forming after we are born, and that the creativity and security established during pregnancy will continue after we are born. We shall then complete the cycle of consonant play to echo play, followed at three months by another series of play stages: Embodiment–Projection–Role (EPR), which are all very physical. Neuro-Dramatic-Play is the basis for the healthy attachment relationship between mother and child during pregnancy and labour, and it makes an impact on the healthy growth of the infant. NeuroDramatic-Play influences the powerful connection between social development and brain development. The early positive regard between infant and mother helps to build the brain both before and after the birth. It is important that this first relationship is playful, rhythmic and dramatised and it needs to involve the whole range of sensory experiences: touch, sound, taste, smell and sight. Neuro-Dramatic-Play is epitomised in the loving interactive gaze between the parent and the infant. Especially in the early weeks, it

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reinforces everything the baby has come to expect. Before any social skills can develop, we have to have a basic system of reflexes: smiling, following others and imitating facial expressions. These patterns of interactions in turn lead to our capacity to regulate and tolerate our emotions, often mediated through the ‘echo gaze’. Neuro-Dramatic-Play allows us to be safely held within the ‘Circle of Containment–Circle of Care–Circle of Attachment’ or ‘Theatre of Body’ until we are ready to face new stimuli or risk-taking. If we are held, we are contained and we feel both safe and secure within the physical and emotional circle of attachment. This leads to the basic trust of ourselves, our carer and the world around us. Having established the basis of NDP, in Chapter 2 we shall look in greater detail at the relationship between NDP and attachment theory and application.

Chapter 2

NDP and Attachment ‘My mother is the most important person in my life,’ sobbed Charlie, ‘You can say what you like, but I’m not drawing toys and birthday cakes; I shall draw my mum as she was kind. She made us picnics and we went for walks.’ Charlie was in an adult group for survivors of abuse and despite being neglected and ‘lent’ to various relatives, still maintained his ideas of his fantasy mother.

Introduction I described in Chapter 1 the significance of Neuro-Dramatic-Play in the development of healthy ‘good enough attachments’ in unborn children and babies up to six months of age. I emphasised the importance of understanding this critical developmental time for the emergence of empathy and healthy social relationships. In this chapter we look at our understanding of attachment and how it relates to the subject of Neuro-Dramatic-Play. We shall see how NDP can ‘repair’ damaged attachments through therapeutic intervention (see also Chapter 7) and can help build resilience in children and teenagers (see also Chapters 6 and 9). I will also describe my assertion that attachment is present from birth rather than some months after the baby is born. There is extensive literature written on attachment from many viewpoints; suffice it here to summarise some important pointers in our understanding of attachment theory and then see its relevance to NDP’s therapeutic effectiveness.

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Early attachment theorists Spitz, Bowlby and Harlow There seem to be two significant articles concerned with our initial understanding of attachment theory, which came about in very different circumstances but at the same time. In 1958 John Bowlby (1907–90) published ‘The nature of the child’s tie to his mother’, which is a forerunner of his later thinking on attachment observation and theory. In the same year Harry Harlow (1906–81) published ‘The nature of love’, in which he demonstrated that infant monkeys preferred emotional attachment to food. Both articles created controversy in different spheres. There were angry reactions at Bowlby’s assertion that mothers were responsible for unhealthy emotional development in their children, and many people were appalled at the cruelty involved in Harlow’s experiments with laboratory animals. The former later modified his views in regard to mothers, and we now have the phrase ‘good enough mother’ or ‘good enough attachment’. There is less blame on mothers and greater understanding of the process of attachment. Before Bowlby came to the fore in his attachment work, René Spitz undertook a study of infants in institutions and made a film Grief – A Peril in Infancy (1947), which is a study of the sadness and isolation of infants with no attachment figures. His study is mirrored by the more recent exposure of the neglect and abuse in some Eastern European orphanages where babies were fed with propped bottles and left without nurturing care. Many children were tied to their beds for long periods of time, and now look as if they have cerebral palsy rather than having distorted limbs from their early cruel treatment. I will say more about the Eastern European situation in Chapter 6. The importance of John Bowlby’s thinking and writing and his persistence for his work to be heard and read, cannot be underestimated in the field of attachment. There has obviously been a reappraisal of his thinking in contemporary childcare and therapeutic practice but his basic tenets still hold. There are challenges to his attachment theories such as those from Harris (1998), who suggests that children learn more from their peers than they do from their parents. However I find her propositions rely more on values and skills that can be passed on

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from parents or peers, rather than the attachment foundation that will form the healthy basis for security, trust, empathy and relationships. Bowlby’s early work is based on observations of refugee children and children in hospitals and residential nurseries (Bowlby 1951). Bowlby became sceptical of the psychoanalytic focus on the ‘inner life of the child’ while neglecting actual events in the child’s real life. He observed that separation resulted in ‘protest, detachment and despair’, and this is the basis of what he terms ‘separation anxiety’. Bowlby was trained both as a medical doctor and as a psychoanalyst, but he became increasingly preoccupied with the effects of early childhood experiences on the later emotional and social development of the child. No doubt influenced by his own difficult childhood (loss of a beloved nanny at four years old and being sent to boarding school at seven years), his main preoccupation was with the impact on infants of separation and loss. For a long period of time his ideas were rejected by the psychoanalytic field who thought (and mainly still think) that a child’s inner world or the inner world of the adult was the most important object of study. They even considered that paying attention to the impact of the child’s external world was an avoidance of the real issues! Bowlby stuck fast to his theories and research despite this rejection, and continued to research and write. It has been suggested by at least one author (see Mooney 2010) that one reason for the dismissal of the relevance of Bowlby’s theories was that they caused extreme discomfort to others. Perhaps the analysts fall victim to their own interpretations that it is less painful to stay within fantasy life than face up to the discomfort and guilt of real life. Maybe we should do an attachment study of the psychoanalysts who leave their infants with child minders! It is interesting to note how many of the writers on the early lives of children (Bowlby and Erikson for example) had damaging and difficult experiences themselves during their early lives.

Ainsworth and the Strange Situation Another significant figure in early attachment work is Mary Ainsworth (1913–99), who was an American developmental psychologist working at the Tavistock Clinic in London. When she moved to London in 1954, she answered an advertisement by John Bowlby for

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a research assistant. She worked for him for several years in what was the beginning of a lifelong collaboration on writing and research on attachment. She investigated the effects of maternal separation on child development and then did research in Africa. In the 1960s Ainsworth developed a procedure, ‘The Strange Situation’ in order to observe attachments between a child and his or her caregiver. The Strange Situation is used to observe the amount of exploration the child engages in throughout the session and the child’s reactions when the caregiver leaves and returns. A child is observed playing in the room with the mother close by, a stranger enters, after a brief time the mother leaves and then returns a while later. Ainsworth maintained that the securely attached child will manage this situation whereas the insecurely attached child will become anxious (Ainsworth et al. 1978). Ainsworth used the following specific terms to describe different attachment patterns in children: ‘secure attachment’, ‘anxious ambivalent insecure attachment’ and ‘anxious avoidant insecure attachment’. These terms have since been elaborated and there is a comprehensive list in Prior and Glaser (2006). Although she is perhaps best known for the development of ‘The Strange Situation’, Ainsworth also completed much needed cross-cultural research when she lived in Uganda for two years. She observed Ugandan mothers and their children in their homes and recorded patterns of behaviour when the children and their mothers were separated. Children became concerned at the whereabouts of their mothers, and welcomed them when they returned. Ainsworth observed the increase of independence in babies once they could crawl but it was always necessary for the mother to be present as the lap to go back to if anything was scary (in EPR terms this is the transition to ‘the world beyond’ from the Embodiment play to the Projective play: Jennings 2007a). There is a significant lack of cross-cultural research in therapy and child development, but then many theorists claim that their westernbased models are applicable across cultures. In my own research (Jennings 1994) with the Temiars in Malaysia, their ‘total attachment’ produces infants that have greater hand–eye coordination, earlier walking and greater independence than their western counterparts. However, these infants are breastfed until four years old, discouraged from crawling and are carried in a sling until they can walk independently.

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Ainsworth and Bowlby jointly published Child Care and the Growth of Love (Ainsworth and Bowlby 1965). There is an excellent description of Bowlby and Ainsworth’s work in Prior and Glaser (2006).

Harry Harlow The American psychologist Harry Harlow is acknowledged as having provided important research in our understanding of attachment, but only the most hard-hearted behaviourist would condone his cruel methods and exploitation of animals. Indeed his experiments have paved the way for greater ethical rules in animal research. He is remembered for his research with rhesus monkeys and ‘surrogate mothers’. His interests focused on affection and child development. In his experiments he used ‘surrogate mothers’ that were made either from wire or from soft terry towelling. The monkeys were offered choices between the two ‘mothers’, the wire one having feeding sources whereas the towelling one had no food. Harlow (1958) demonstrated that the monkeys would spend most of their time clinging to the towelling mother whether or not there was any food. Furthermore if there was a frightening stimulus or the monkeys went to a new place, they would cling to the cloth mother and would only gradually explore their unfamiliar surroundings. Harlow (1958) claims that this demonstrates the child’s need for affection and emotional nurture from mother figures.

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Although there is continued criticism of his research methods, Harlow’s observations are still used in current attachment theories. Whereas the psychoanalysts had claimed that the feeding of the baby was the most significant event in the baby’s development, Harlow (1958) demonstrated repeatedly that comfort was far more important. Freud’s insistence on the primacy of the oral stage of infant development has in fact led to neglect or perhaps avoidance of the primary significance of comfort and safety for the small infant’s healthy development. As we shall see below, Erik Erikson emphasised the importance of the development of trust during the first year of life, and the predictability of feeding is only one aspect of a trustful attachment. The great forerunners of attachment theories, Spitz, Bowlby and Ainsworth, communicated and shared ideas with each other. They also had in common the fact that their ideas were ignored or rejected out of hand for many years. Together with Harlow, they laid the early basis of attachment understanding which is still relevant today, although there has been some modification and development of their original ideas. Attachment theory is based on a fundamental human (and animal) need of a baby for close proximity with an adult: ‘a baby human has a need to establish an emotional bond with a care giving adult’ (Laschinger 2004, p.xviii–xix). It is important to emphasise that it is not only the nearness of the adult but also it being a significant adult that is crucial. When this does not take place, then such children will have difficulties in communicating appropriately, feeling empathy and forming relationships. They often experience loss and grief for the attachment or bond that they never had. These feelings can often be expressed in antisocial ways including a lack of trust in a new caregiver (see Chapter 8). It seems as if the child has lost hope. Small infants lack the verbal skills to express their distress at the loss of an attachment figure or object and we have to infer their feelings from forms of crying, rage or withdrawal. It is suggested by many (for example Sunderland 2004), that we are pre-programmed to attach and lack or loss of attachment can trigger these emotional responses from our primitive brain, the amygdala.

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Attachment and mourning We know that early traumatic life experiences suffered by some children seriously impair their ability to form positive reciprocal relationships. Children who have been neglected, abandoned or physically or sexually abused will have difficulties in their emotional and social well-being unless there is appropriate intervention or a significant lifechanging event. Bowlby in his later writings spoke of the wider context of attachment: ‘Attachment behaviour is any form of behaviour that results in a person attaining or maintaining proximity to some other preferred and differentiated individual’ (1979, p.154). Bowlby also helps us understand the importance of mourning in trauma and loss and the effect of the disrupted attachment, in our work as therapists. There are serious consequences from disturbed and unresolved mourning processes (Murray Parkes 1998). Often we do not recognise how deeply children experience loss, not only of close relatives and friends but also pets, homes, special toys or schools. Small children are often kept away from funerals because ‘they wouldn’t understand’ or because ‘they are too young to know anything’. Yet small children form very powerful attachments to their friends and relatives, pets and possessions, places and routines. Sudden disruption or death, or the confusion of situations that are not explained to them, will create an emotional impact on a child that needs to be acknowledged and worked through. Mikey Walsh’s description of his own traumatic childhood well illustrates the importance of all attachment figures – even those are brief and transitory: I came to love Mrs Kerr. She was the only person who showed me tenderness and affection. To have one person believe in me and encourage me to be whatever I wanted to be was the most wonderful thing that ever happened to me. (Walsh 2010, p.114) Unresolved feelings of loss of the loved one can affect people throughout their lives and impair their capacity to form trusting relationships. We trust someone not to go away or disappear or get run over. We have learned to trust our environment and the security of our bedrooms

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and the compass in our heads that locates everything under our roofs. If we move to a new locality or are suddenly taken into care or have our house repossessed, our roots have been torn apart, often with no preparation. Small children feel very helpless with these losses, and severe disruption or separation can become a permanent way of life. Therapeutic intervention is necessary as early as possible in the child’s life unless the parents have done very adequate preparation work and ‘hold’ the child for the duration of the experience of loss.

Winnicott and Erikson Donald Winnicott (1896–1971) contributes much to our understanding of attachment, and he continually talks about play and playful spaces: to him, psychotherapy is about two people playing. Although some of his writing may seem a little archaic to modern practitioners, such as talking about infant deprivation in relation to loss or death of mothers and never to financial insecurity or impoverished environments, nevertheless he is a creative pioneer in the field of ‘transitional objects’ and ‘transitional phenomena’. He named the soft cloth or soft toy that represents the absent mother, the child’s first symbol, as the transitional object. He suggests that great harm is done if children are deprived of their objects with which they form very powerful attachments. He also names masturbation as being a part of ‘transitional phenomena’ and that children should not be stopped from auto-erotic activity.

It is unfortunate that many so-called care staff believe that masturbation is wicked, and I find, certainly in Eastern Europe, that staff are shocked when I teach the importance of allowing masturbatory activity, providing

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that it is done in private. In one day centre for children of working parents, a member of staff told a seven-year-old boy to put his hands on top of the blanket when he was having his afternoon rest. She placed a pair of scissors on the bedside chest as a reminder to him that she would cut off his penis if he touched himself again. The worst orphanages in some countries may have been closed down, but the attitudes of the staff do not necessarily change. The ‘Creative Care’ training programme in Romania, for example, which I designed and have run since 2003, is reaching only a small minority of staff. Winnicott (1965) tells us that: Perhaps the most common disorder of masturbation is its suppression, or its disappearance from a child’s repertoire of self-managed defences against intolerable anxiety or sense of deprivation or loss. (p.157) And, ‘From a study of what normal children enjoy, we can learn what these deprived children absolutely need’. Winnicott, although trained and practising as a psychoanalyst and for several years president of the British Psychoanalytic Society, nevertheless discreetly and indirectly developed his own approach to understanding children. In my view one of his most important contributions to understanding attachment is his belief in the creative impact between mother and child: creativity is a primary drive, presexual and forming the basis of the reciprocal relationship between mother and baby. I will return to this in more detail when we discuss playful and creative attachments in Neuro-Dramatic-Play. Erik Erikson (1902–94) is probably best remembered for the phrase ‘identity crisis’. If Bowlby had events in his own life that triggered his interest in attachment, there is no doubt that Erikson had much in his life to fuel his interest in the subject of identity. He was born from an extramarital affair and the circumstances were kept from him. He was given the name of his mother’s husband; this changed on his mother’s second marriage when he was adopted by his stepfather. His birth father was Scandinavian and Erik was blue-eyed and blond, but brought up as Jewish. Apparently he was teased at the Jewish classes for looking Scandinavian and the boys at his secondary school mocked him for being Jewish.

Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion

Generativity vs. stagnation Ego integrity vs. despair

3 to 6 years

6 to 12 years

12 to 18 years

19 to 40 years

40 to 65 years

65 to death

5. Adolescence

6.Young Adulthood

7. Middle Adulthood

8. Maturity

4. Latency

3. Locomotor

Intimacy vs. isolation

Autonomy vs. shame/doubt

2. MuscularAnal

18 months to 3 years

Basic conflict

Trust vs. mistrust

Ages

Birth to 12– 18 months

1. OralSensory

Stage

Reflection on and acceptance of one’s life

Parenting

Love relationships

Peer relationships

School

Independence

Toilet training

Feeding

Important event

Table 2.1: Eight stages of psychosocial development (Erikson 1968)

A sense of fulfilment and peace with others, or despair

Adults find ways to support the next generation or may feel alienated

The young adult develops close relationships or feels isolated

Teenager develops sense and identity, for example in gender role, politics and so on, or becomes confused

Child deals with demands to learn new skills or risk sense of inferiority/failure

Development of assertion and initiative, but possible guilt feelings

Development of physical skills and coordination. Child may develop shame/doubt if punitive care given.

Loving, trusting relationship with caregiver, or child develops fear and mistrust

Summary

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Initially he was a teacher of the arts in Vienna. He met Anna Freud, and decided to become an analyst and also a Montessori expert because of its emphasis on child development. When he emigrated to the USA he became the first child psychoanalyst in Boston with an outstanding reputation. Like Ainsworth, he was interested in cross-cultural studies and researched child development with the Yurok Native American tribe. His most useful contribution to our understanding of child development and attachment is his eight stages of the growth of the child, adolescent, adult and elderly person, rather than the five stages of ego development that Freud claimed (see Table 2.1). Erikson postulates that people who are able to survive the ‘crisis of adolescence’ are those who can deal with the transition into adulthood, and we will look at this more closely in Chapter 9. For this current discussion, his most interesting statement is regarding the notion of hope. Hope, according to Erikson, derives from the conflict between ‘basic trust and mistrust’ during the infant stage. We know that the child without hope is the child who is in despair; the child without hope does not thrive. There are children who just fade away and die because of their hopeless situation. I wonder how many of us can remember a teacher saying to us that we were hopeless, or that our skills or knowledge were hopeless. People who have been kidnapped and who have hopeful personalities usually survive their capture more effectively than those for whom there is a feeling of no hope and no solution. The child who can hope is the child who can trust the person who gives them care and nurture and is predictable in their attention. Hope grows out of trust and if there is basic trust in the early attachment, the infant is more likely to be hopeful and often optimistic. How many people do we know with the belief that if you think the worst then there is no disappointment? There are many others who have contributed to our understanding of attachment and who are constantly relooking at attachment processes and refining them within a contemporary context. Howe (2005) gives an excellent description of a contemporary approach to attachment, in particular focusing on neglect. A selection of work by authors and researchers is included in Gerhardt (2004). The literature is also

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burgeoning with our greater understanding of neuroscience and the impact on the development of the brain of the early attachment relationship. Although there is disagreement between attachment specialists as to significant times the primary attachment figure needs to be available to the infant, there is no dispute that the first six months are crucial for the baby’s welfare. Hence there is an increase in the number of projects for pregnant women and mothers of newborn babies to increase the positive attachments as a basis for later development. Again I emphasise that the critical time for NDP is during pregnancy until six months old.

What actually is attachment? Despite the extensive research and literature about the importance of attachment, and there is little dispute that good enough attachments influence positive social and intimate relationships, there is far less information available on the nature of the attachment itself. Writers describe the necessary ‘emotional availability’ of the primary attachment figure to the infant and their capacity to ‘fine tune’ to the infant’s needs. What does this actually mean in the reality of child rearing? Attunement and reciprocity are qualitative aspects of bonding that reflect mutual awareness, emotional resonance, and turn taking. The mother’s ability to resonate with the infant’s internal states, and translate them into actions and words appropriate to the child’s stage of development, will eventually lead to the child’s ability to connect internal states with words. (Cozolino 2002, p.191) I think it is important to state very clearly that the primary attachment figure needs to be able to play! Attachments are playful and from conception women are usually playing with their infants and through play are establishing the attachment. We know that there is a biological drive too, what is termed the neurochemistry of bonding, as described by Cozolino (2002): The neurochemistry of mother–child bonding is very complex: The warm and happy feelings; the desire to hold, touch, and nurse; the pain of separation and the joy and excitement of reunion all have neurochemical correlates that

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allow us to experience these wonderful feelings… Through a bio-chemical cascade, mother–child interactions stimulate the secretion of oxytocin, prolactin, endorphins, and dopamine. (Cozolino 2002, pp.176–7) The holding, touching and nursing between mother and infant need also to be understood in relation to playfulness. The mother needs to be able to play in a sensory way because that is how we develop our own senses and our senses are the most important aspect of our early embodied experience. It is through our sensory play of touch such as massage, stroking, finger-tipping, bathing and warm towelling that the infant develops a body-self (Jennings 1998). As Cyrulnik (2005) put it, ‘When the sensory developmental supports in the child’s environment are missing, the world no longer has an outline’ (p.13). The other senses – sight, hearing, taste and smell – are all part of the playful relationship as mothers look at their babies and pull faces and the babies do the same (the beginning of echo play); little sounds in toys, musical boxes and bells as well as the crooning and songs of the mother stimulate the hearing; and babies soon know if their mother has eaten something bitter or acidic as the taste of the breast milk is different! The smell sense in some ways is the most important as it is the way babies recognise their own mother compared with any other mothers. And we can observe the snuggling and snoozeling that the baby makes at the breast before actually feeding. NDP focuses on sensory play in a therapeutic setting if there are difficulties with attachment relationships. Many sensory experiences can be reproduced together with the rhythmic play that gives a basis for security. Rhythms of heartbeats, clapping, rocking and simple drum beats enable infants to be grounded in their bodies and in the sounds. As I said in Chapter 1, a crucial aspect of the attachment relationship is ‘as if ’ play – the dramatic play that includes imitating each other, echo play – mother playing as if she is the baby – baby playing as if she or he is the mother. NDP emphasises the dramatic response in early play and in NDP therapy. Storytelling is also important in NDP and can be very simple, autobiographical or the retelling of a favourite tale with expression and cadence. It has been suggested that mothers need to regress in order to play and I wonder whether this is just another psychoanalytic straitjacket.

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Maybe the mother has to relearn how to play, or to learn to play for the first time if she did not play as a child. However, I do not see this as regression. Playfulness needs to be a part of our lives ‘from cradle to coffin’ and so we need creative environments to try to make sure that it is possible. The importance of NDP very much belongs to the infant’s world at the very beginning. This is the critical time when babies need their mother’s presence, when absence cannot be held in the experience that she will come back. Small babies do not yet have that mental apparatus – when she is gone, she is gone. Once we are able to hold a symbol such as Winnicott’s (1965) transitional object, or the ‘representation of an event’, there is the increasing belief that the absence will be brief and soon there will be a joyous reunion. Even so, the small infant is as yet unable to have a representation of an event; he or she cannot yet hold on to a concept, and is left with the feeling ‘I have been abandoned.’ If this too early separation happens repeatedly, it will become set in some kind of maladaptive behaviour. Babies and toddlers eventually do acquire the capacity to hold a representation or image of a person or event, but it cannot be forced or hurried. The small infant is not yet equipped biologically or emotionally to deal with significant absences. When a loved person isn’t there and a child is too young to understand, it can be extremely painful. You can’t just say to a child who is missing his Mommy, ‘Look, don’t feel like that,’ yet adults often give that sort of message to small children. When we pry a distressed child away from his parent and urge him not to be ‘silly,’ we entirely underestimate the power of the massive hormonal reactions in his brain and body. (Sunderland 2006, p.51) Professionals need to assist parents to understand the trauma of sudden separation or early loss. It is not just a question of acknowledging and managing emotions, it is also an understanding of the chemical reactions in the body to undue stress. When small children are separated too early or for too long, their cortisol levels rise and can flood the brain. Cyrulnik says that once we can hold a ‘representation of an event’ (or symbol), it can be a turning point in dealing with our traumas. But for the very small infant, separation trauma feels sudden and permanent:

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Every trauma shakes us up and sets us on the path to tragedy. But the representations of the event enable us to make it a turning point of our personal history, a kind of dark guiding star showing us the way. (Cyrulnik 2005, p.12) If there is the possibility of caregiving responses to the traumatised child, the damage may be ameliorated in time. For example, the sudden death of one parent may be contained for the child by the support of the remaining parent, providing he or she is emotionally ‘available’. For some people, their grief is so overwhelming that they cannot attune to their child’s emotional needs. Nevertheless attachment distress generally provokes a protective caregiving response by those adults involved with the child.

Attachment distress is triggered by physical discomfort (illness, hunger, pain), feeling frightened or sudden separation from the attachment figure: not only physical separation but also psychological separation. Some mothers or caregivers are not available emotionally for the infant. This may be because of their personal attachment needs or sudden loss or trauma. It is easy to observe the outgoing nature and sociability of most small infants. They invite reciprocity; they seek dialogue through gestures and expressions, sounds and rhythms from a very early age, usually days and weeks rather than months. It is within close attachment relationships that children learn to make sense of themselves, other people and social interactions. They

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begin to develop mental representations of how to view the self and others: their internal working models contain expectations and beliefs about their own and other people’s behaviours. Babies begin to experience that they are lovable and accepted and that others, especially their mothers, are emotionally available to them with interest and concern. Bowlby (1969/1971) emphasises the dimension of protection and security and suggests that the ‘enduring affectional bond’ is rooted in biology. This is where we can see the need for NDP where there is an impoverished attachment or where a child’s most basic playful needs are not being met. Ideally we should seek to implement an NDP programme with mothers and their babies in order to enhance their attachment relationship. If mothers are unavailable, it is possible to enable carers to create the NDP potential with babies and infants. This is discussed further in Chapter 8. There have been several pioneers in the field of attachment, particularly John Bowlby, and we now have an understanding of the inability of infants to thrive if they do not have at least an adequate attachment with their primary carer. Neuro-Dramatic-Play is particularly indebted to attachment theory because it highlights those crucial early months in a baby’s development where a playful attachment needs to be developed. Neuro-Dramatic-Play consists of sensory, rhythmic and dramatic play that forms the basis of the playful attachment relationship. It is important that NDP can be structured within storytelling. Neuro-Dramatic-Play enables the development of trust and hope, and the capacity to empathise with others. It forms the foundation for the potential of future social relationships. Neuro-Dramatic-Play and attachment empower the continuing story.

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Chapter 3

NDP Play and Play Therapy In my father’s lap everything was yellow and blue, I longed to swim like the boys. ‘Of course not’ said Father I should’ve run from him, leapt off the wall. I should’ve said ‘No’ to him! But I sweated on his lap in my blue woollen dress. I’ve always longed to go back to Acre… (Zuabi 2010, p.43)

Introduction In the previous chapters we have established a working definition of Neuro-Dramatic-Play and how it develops in normal child development during a critical time from conception to six months of age. We have also seen how NDP is central to the establishment of a good enough attachment relationship between mother (or other primary carer) and the newborn child. I have mentioned the major pioneers in attachment theory and practice so they will not be repeated here, apart from reminding the reader that so much of our work is about relationships, and play is one means of relating to someone else. In that context of course it is Winnicott who had such a profound understanding of children, mothers and playfulness: I suppose that everyone has a paramount interest, a deep, driving propulsion towards something. If one’s life lasts long enough, so that looking back becomes allowable, one discerns an urgent tendency that has integrated all the various and varied activities of one’s private life and one’s professional

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career. As for I can already see what a big part has been played in my work by the urge to find and appreciate the ordinary good mother…for me it has been to mothers that I have so deeply needed to speak. (Winnicott 1957) It is now time to consider the relationship between play and play therapy, and make the links between NDP and Neuro-Dramatic-PlayTherapy (NDPT). There are many publications on both play and play therapy (see the References), and a single chapter cannot possibly do them all justice. It must suffice for me to give some brief comments on both fields and their connectedness, on the ‘play to play therapy’ continuum where playing can be considered a ‘preventative’ activity and play therapy a ‘curative’ activity. There is a large overlap in the middle where children are able to generate their own play to help themselves; this often does not need the intervention of play therapists. Teachers also have an important role to play (see Chapter 12) in maintaining the status of play within the educational framework, as a source of selfdiscovery, learning and development. Play and play therapy are the means through which we can contextualise Neuro-Dramatic-Play, and see how it can be developed for infants, children and teenagers where it has not taken place in early life. In Chapters 1 and 2 we saw that playfulness is the central core through which mother and baby are able to establish a healthy attachment during pregnancy and the first six months of life. As I emphasised, primary playfulness between mother and baby includes sensory play, ritual play and dramatic play. Playfulness is not only the means by which a mother expresses her care and concern, it is the care and concern, it is the relationship.

Play and playing Theorists going back into the mists of time have debated the importance or otherwise of children’s play. Whereas Plato (1974) was adamant that child play was ‘the biggest menace that can ever afflict a state’

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(similarly he wrote about the dangers of the actor), Aristotle was more positive in his ideas about play being important for the socialisation of children. He also believed that children’s play was the origin of poetry (these ideas are developed in Goldman 1998). Cattanach (1992/2008) gives an overview of the interest in play and the attempt to study it scientifically from the Victorian age. Play has also been linked to studies in education and as early as 1917, Caldwell Cook was emphasising the importance of play as a natural means of study. It is interesting that significant writers such as Caldwell Cook (1917), Peter Slade (1954), Brian Way (1967) and Richard Courtney (1968) have all emphasised the importance of play and drama, and the child as a natural actor. However, both in ancient and more modern times, actors have been despised, vilified and not treated as ‘true artistes’. Classed with tinkers and other itinerants, they were unable to have a status within western society. So difficult was it for them to obtain any sort of insurance that the actor’s union, Equity, eventually created its own insurance company. In contemporary media, actors are asked to endorse products, have their private lives examined and generally stay in the public eye through events in their day-to-day lives, rather than their acting. Play, acting, pretence and dissembling all seem to be enmeshed in our thinking as being untrue, lies and even psychopathic: it is the conman on the doorstep who is able to convince us to part with money because he is a good liar. It is the politician who covers up the corruption with lies that shocks us; ‘If only we had known’ or ‘truth will out’, or as Polonius advises his son Laertes in Hamlet: This above all – To thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man. (Hamlet 3.i: 78–80) We also need to remember that one word for the actor in Greek is hipokcritiki, which is the word from which we get hypocrite and hypocrisy. It would be easy at this point to get into the realms of philosophy and the nature of ‘truth’; let us stay with the idea of pretend play and

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why it is disturbing for some people to accept. Of course when we are working with people on the autistic spectrum we know that ‘let’s pretend’ is very difficult because in the main they are concrete thinkers (see Chapter 10). There seems to be confusion in the differences between ‘everyday reality’ and ‘dramatic reality’ (Jennings 1998). Mothers will play at pretend games with babies, but then become concerned at their children lying when they report a more romantic notion of school than the harsh reality (Jennings 1999a). Play is dismissed as being silly, a waste of time and not important when compared with the necessary world of work. A group of local fund-raisers in the mid 80s said that they would not raise money for a play group for the children ‘to waste their time scribbling’! It is only recently that anthropologists have been starting to take an interest in children’s play in its own right, and a lot of time is being spent in definition and observation. Goldman (1998) states that anthropological monographs about child play, including make-believe play, are extremely thin on the ground: Play analysts have suggested that such neglect is an outcome of the way academia itself, a quintessentially adult pursuit, perpetuates and embraces a socio-historical legacy which devalues infant interaction. Thus the most conspicuous facet of children’s behaviour – their indulgence in ‘play’ – has often been typified as irrational, trivial, non-productive and decidedly something other than work. (Goldman 1998, p.xv) Goldman (1998) also suggests that: And yet the topic of ‘as if ’ play is, I believe, an area of potential and consequential effect for anthropology. Such lucid phenomena provide a unique window onto current interests about human imagination, about images of modernity, about how roles are imbued with distinct ‘voicings’, and about how these in turn get translated and transformed into mythic texts. Amongst the myriad of ways in which anthropology has sought to locate itself in respect to understandings about the ‘imagination’, pretend play offers a unique and

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ethnographically grounded tangent along which to pursue such quests. (Goldman 1998, p.xvi It is encouraging that the Convention on the Rights of the Child was adopted on 20 November 1989 by the United Nations General Assembly. Article 31 states: ‘Every child has the right to rest and leisure, to engage in play and to participate in recreational, cultural and artistic activities.’ Moyles (1989) points out that there are three more or less accepted benefits for play within education, and its essential inclusion within the curriculum: • the acquisition of language • the capacity to problem solve • the development of creativity. Parents and teachers alike can more or less accept the first two premises, but often have great difficulty with the third; creativity can be seen as ‘arty’ and not relevant for a modern school syllabus. Moyles (1989) goes on to say: If we accept that being able to express oneself effectively is a ‘good’ outcome of education then nowhere is this more likely to happen for younger children than in creative activities associated with play. The child as ‘creator’ appears in a majority of play contexts… Children constantly create and re-create ideas and images which enable them to represent and come to terms with themselves and their views of reality. These can be captured within children’s talk, drawing and painting, craft, design, music, dance, drama and, of course, play. (Moyles 1989, p.70) Although intellectually there appears to be a greater acceptance of the importance of play, especially in the early years settings, play groups are now facing stringent financial cutbacks and nursery places are more and more limited. We value the importance of physical play and games, and a direct link has been demonstrated between physical play and alertness and effective learning. As playing fields are sold off to developers, there is less and less room to play, and swimming and other outdoor activities such as conker games are so beset by health and safety procedures that

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schools may give up. In 2010 snow storms in the UK led to many schools being closed in case children got hurt. How many of us can remember the wonderful school days in winter when we were allowed to play outdoors and throw snowballs, build snowmen and women, create a slide or build an igloo? We could indulge our bodies and imagination to the full with little need for adults. Perhaps the award-winning film The Snowman (1982) from the story by Raymond Briggs touches our ancient snow memories. It has music, cartoons and lyrics by Howard Blake and the one song, ‘Walking in the Air’, is sung by a St Paul’s Cathedral chorister. It is a story about a developing relationship between a small boy and the snowman he has built. The snowman comes into his house, fiddles with all the technology and then boy and snowman go off on a motorbike, scaring many animals as they go. The song starts as they fly through the air to the land of the snowman where the boy is the only human. Eventually returning to earth, the snowman melts in the morning sun and the boy wonders if he has dreamed everything, but he finds the scarf that the snowman gave him and he knows what happened is true. Maybe the fact that it was voted into fourth place in UKTV’s greatest TV Christmas moments in 2000 shows its wide appeal, not only in the UK. What is the appeal for old and young people alike? It is also a story that can be shown and read to children or an individual child that can stimulate their imagination, take them into a fantasy land where they can understand things differently. And of course at some level there is an acknowledgement of loneliness in both of the characters, an exploration of strange objects and situations and an experience of the temporary nature of some encounters.

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Karen Stagnitti is one of the most important current practitioners and theorists of play as a therapy. In her book Play as Therapy she says with co-editor Rodney Cooper (2009): Play not only affects a child’s development and inner world, but contributes to his or her development as an active, dynamic and open ended process that continually challenges and facilitates growth, development and individual competence. How children play, where they play and what they play, largely reflects their culture and environment. (Stagnitti and Cooper 2009, p.16) A cross-cultural understanding of play is very important or we can get into a mind-set that stays with a generalist view that ‘play is good for you’; there is no point in starting cultural conflicts by, for example, suggesting to a group of Gypsy children that they all sit on the floor, when they have been socialised into a strong ethic that floors are dirty and fit only for animals. Similarly, the idea of rough and tumble play would be quite out of place for some families from India. In an East Indian study, Roopnarine et al. (1994) comment that unlike their western counterparts, parents rarely engage in rough stimulating activities. In a culture that values physical closeness, fathers show their affection through physical holding. Parents engage their children in a wide variety of games and physically close play. These occur during massage, during informal sessions when the mother is resting with the baby, or when the mother is engaged in routine caregiving. Although the games vary from region to region and across age groups, there are common elements mirrored in them: physical closeness, their high tactile nature, social messages about the culture, and their rich linguistic content. (Muralidharam et al. 1981, p.15) The writers continue with descriptions of play interactions that involve not only tactile stimulation but also singing. A delightful example is given of a game from Bengal called ‘Kan, Dol, Dol’, where the mother and child sit facing each other and holding each other’s ears. The mother rocks her baby and sings:

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Kan do, dol, du luo ni, Ran ga ma thae chiruni, Bar ash be ek hu ni Ni ye ju be ta knu mi. Which translated means: The bride is decked and waiting The bridegroom will come just now And take her away. (Muralidharan et al. 1981, p.15) Play observation across cultural groups will yield ideas about identity, values, relationships and myth making. It will illustrate not only how children learn important adult skills, but also how the imagination will create narratives and rituals that are congruent with the beliefs of the people themselves.

Play can be messy Many children go through a stage of messy play before they become more ordered in their playing. I want to draw a distinction between chaos and mess! Most of us have memories of puddle-jumping or swishing through leaves when we were young. Beckerleg (2009) says in a delightful beginning to her book that is all about messy play: How I came to discover messy play. I don’t think I discovered it, more it discovered me. I have always been messy. From an early age I was in the garden cooking with weeds and earth; filling the sandpit with water; digging a muddy hole to find water or Australia, whichever came first; making perfume from stagnating rose petals; and making ice-cream from milk and butter and leaving it by the fire to set! As a child – there is no doubt – I enjoyed being messy. I have continued this theme into my adult life and have enjoyed a great deal of messy play with my own children. (Beckerleg 2009, p.17) Mess making is an important time in sensory play where children are discovering all their senses in a variety of media from bubble to finger paint to sand and water play. In the early sensory play in attachment

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development, there is dribbling of milk at feeding time, discovery of saliva as mothers suck their baby’s fingers, lotions and potions at bath time and nappy changing. Children return to their own messy play as they explore food and saliva, often irritating parents when they are sticky. Messy play is a means of discovering order: by making a mess I can learn limits, containment and borders. It is also a means of developing sensory play, and may continue in some form into adult life. For example, gardeners and farmers create and work with lots of mess; nursery and infant school teachers have mess as part of their working day; cooks and caterers mix lots of ingredients by hand, and know that their hand-mixed baking gives better results than that done with mixers. They are sensitive to, and creative with, the ingredients. There are some occupations where perhaps there is less pleasant mess to be dealt with, such as doctors or nurses or vets. Mess-making sensory play is an important stage in the embodiment process for the infant.

Messy play is not chaotic play Messy play can sometimes be mistakenly confused with chaotic playing: play that has lost its boundaries and is literally out of control. A mother will cry out in desperation, ‘What a mess!’ when perhaps she means, ‘I can’t live with this chaos.’ We all recognise the moment when a child ‘loses it’; often there are two heightened red marks on the cheeks, a burst of uncontrollable energy and all the toys are swept to the floor, jumped on or wrecked in some other way. It is important to observe the ‘chaos cues’ and remind children of the contract (things are not broken or destroyed in the play room). The therapeutic use of the therapist’s voice can create a stability through rhythmic cadence (music therapists are superb at this). In the basic principles of NDP, rhythmic playing is an essential means of grounding and stabilising. This can be achieved through songs, drum beats and physical games that involve rhythmic movement. There are more NDP therapy ideas in the appendices that address more difficult situations that teachers and therapists dread in their caring work. I also describe very practical methods such as worksheets and therapeutic stories about mess and chaos in Creative Play with Children at Risk (Jennings 2005b).

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We all know families who seem to live in a perpetual state of chaos, where all cupboards and surfaces melt into one jumble: junk is pushed to one side while food is consumed from the packet and the milk bottle. And this is how they live and meet the world, unless someone in the family decides that ‘enough is enough’. I know one such family where the daughter has decided that she cannot live in such disarray and has transformed her own bedroom into a model of cleanliness and tidiness; she is studying Korean language and culture, which is an extremely organised way of life. There are situations where the chaos has become destructive. Take, for example, the family who live with the extremes of a parent with bipolar disorder, where often the normal organisational limits have been dissolved: night and day merge into one another; meals are eaten in the middle of the night; the house is in turmoil from energetic bouts of creativity and then total despair. There is also the chaos and confusion that comes from an abusive family where the norms and values are turned upside down. In some situations children are made to engage in inappropriate sexual behaviour; for others they become the carers of their parents who abuse alcohol or drugs. Some of these children may well be taken into care, and some of them may be referred for play therapy.

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Playfulness and play In NDP I refer frequently to primary attachment being a playful interaction between mother and small baby (Jennings 2009a, 2009c): playful has been defined as ‘fond of or inclined to play; done in fun’ (Concise Oxford Dictionary: Allen 1990). In order to play we must have an inclination to be playful. Playfulness is defined by Cordier and Bundy (2009) as a web with four quadrants – intrinsic motivation, internal control, freedom to suspend reality, and framing – and playfulness at the centre, and that playing varies in balance between these quadrants. Heathcote talks about ‘the suspension of disbelief ’ (Heathcote and Bolton 1995) that is necessary for drama work with children. When we pretend and enter ‘dramatic reality’, our everyday ideas are suspended in order for the imaginative processes to have their own life. If we have an inclination to be playful, then we will play in some form or other.

Play therapy The British Association of Play Therapists uses the following definition of play therapy: Play therapy is the dynamic process between child and play therapist in which the child explores, at his or her own pace and with his or her own agenda, those issues past and current, conscious or unconscious, that are affecting the child’s life in the present. The child’s inner resources are enabled by the therapeutic alliance to bring about growth and change. Play therapy is child-centred, play being the primary medium and speech the secondary medium (www.bapt.info). There are many different systems of play therapy that have grown and defined themselves with their own set of core practices since the early 1990s; there is now ‘approved’ training for play therapists with codes of practice and ethics. There is now a comprehensive training in ‘Playwork’ (Brown 2006) and several play therapy training approaches (McMahon 1992; West 1992). There were some significant early pioneers in the field of play and therapy who paved the way for others to follow. Margaret Lowenfeld (1979) developed her ‘Make a World Technique’ using a sandtray and

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small toys; she had an enormous collection of little figures and produced lists for therapists of toys to acquire so that the child would have plenty of choices. Sandplay as a therapy has been developed by Jungian child therapists as a discipline in its own right (Ammann 1991; Kalff 1980; Weinrib 1983). Other play therapists incorporate sandplay into their wider range of techniques (Jennings 1999a, 2005b), the difference being whether the sandtray is central to the therapy or whether a child or adult has a choice of the sandtray and other play materials. In my own work I use a circular sandtray as another means of containment within the safe circle. The influence of Carl Rogers (1951/1961) has been profound in the exegesis of child-centred and non-directive play therapy. Virginia Axline with her book Dibs in Search of Self (1964) made a profound impression on many people working with children, and her early text, Play Therapy (1947/1989), paved the way for many future play therapists. My abbreviated summary of Axline’s (1947/1989) eight basic principles which ‘guide the therapist in all non-directive therapeutic contact’ is simple (p.73): 1. The therapist must develop a warm, friendly rapport. 2. The therapist accepts the child exactly as he is. 3. The therapist establishes a situation where the child feels free to express his feelings completely. 4. The therapist recognises the feelings in the child so these may be fed back for the child to gain insight. 5. The therapist maintains a deep respect for the child’s ability to solve his own problems. 6. The therapist does not attempt to direct the child’s actions or conversations in any manner. The child leads, the therapist follows. 7. The therapist does not attempt to hurry the therapy along. 8. The therapist establishes the anchor of the therapy in the. real world, and makes the child aware of his responsibilities in the relationship.

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Non-directive play therapy in skilled and experienced hands can make enormous differences in the life of troubled children. Many children who are ‘out of control’ find a means of developing their own inner control through this method. Some non-directive play therapists use this approach but with interpretations based on Freudian or Kleinian principles, so possibly Axline’s tenets numbers 5 and 6 would not apply to them. Violet Oaklander developed an influential approach drawn from the theories of Fritz Perls and Gestalt therapy. Her book Windows to Our Children (1978) is still a delight to read. Gestalt play therapy is founded on the basic tenets of Gestalt theory where individuals are perceived as more than the sum of their parts, and where all behaviour is regulated by a process of homeostasis. According to Blom (2006): Integration as an objective of gestalt play therapy requires that children as a holistic entity, must be helped to integrate their cognition, emotions, body and senses in order to complete unfinished business on their fore-ground. All of these aspects of the child’s holistic entity should be attended to during assistance-rendering. (p.54) By complete contrast there is a school of cognitive and behavioural play therapy that is task centred and goal orientated, which works through a structured programme of play therapy to deal with specific issues (for a discussion of directive/non-directive play therapy, see Carroll 1998). Some directive play therapy is used to prepare children for, say, hospitalisation and treatment; it is also used for addressing chronic nightmares in children (Marner 2000). Cattanach (1992/2008) has devised A Model of Play Therapy to Heal the Hurt Child which is based on a narrative approach and social construction theory. She says that it is based on the stories we tell about ourselves and the stories that other people tell about us. She continues: Abused children often have dominant stories told to them by the perpetrators of their abuse and through their behaviour and talk seek to have these opinions reinforced by those around them. They constantly set up situations to prove the dominant story that they were ‘naughty’ or ‘bad’ or ‘sexy’. In

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Play Therapy the themes the children present in their social world also appear in the imaginative stories they express. In therapy we play together with these imaginary stories, expanding themes, changing and shifting meanings, exploring alternative plots and solutions until the stories develop in ways that can support the child and not lead to further exploitation. (Cattanach 1992/2008, p.51) We have also had innovations in approaches called ‘filial therapy’ and ‘theraplay’, which are briefly described below.

Filial therapy The goal of filial therapy is to enhance the parent–child relationship (Landreth 1991/2002). It was first developed by the Guerney couple in the 1960s, and since the early 1990s has been refined and defined by Landreth (1991/2002). Landreth combines instructions to the family, role playing of difficult situations, and supervision of play situations between parents and children. Landreth suggests that professionals collaborate in this approach, for example by having counselling and filial therapy with a parent, and someone else seeing the child for play therapy. Landreth acknowledges that it is a short-term intervention. Sue Bratton in collaboration with Landreth, Kellam and Blackard have produced a workbook of a tenweek programme that can be used by parents, teachers and therapists.

Theraplay From its beginnings (Jernberg 1976), Theraplay is clear that it is an ‘attachment based therapy’. Theraplay has four dimensions that are modelled on a healthy parent–child relationship: 1. Structuring: Parents are trustworthy and predictable, and they help define and clarify the child’s experience. 2. Engaging: Parents provide excitement, surprise, and stimulation in order to maintain a maximal level of alertness and engagement.

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3. Nurturing: Parents are warm, tender, soothing, calming, and comforting. 4. Challenging: Parents encourage the child to move ahead, to strive a bit, and to become more independent. ( Jernberg and Booth 2001, p.17) They are clear that it is not for all children and families, and there may be occasions where longer-term insight-focused play therapy could be needed.

Play therapy dimensions model This approach to play therapy has been developed by Yasenik and Gardner (2004) as an organising framework for therapists, and as a means of making decisions regarding interventions. It is based on four quadrants: conscious/unconscious on a vertical axis and directive/ non-directive on a horizontal axis. The dimensions are created by a vertical axis from conciousness to unconsciousness, and a horizontal axis from non-directive to directive; this creates four quadrants and the therapist is free to choose a quadrant that best serves the interest of the individual child. It is extremely useful for considering starting

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points for children in therapy and the ensuing development into the appropriate mode of intervention.

Neuro-Dramatic-Play and play therapy In Chapters 1 and 2 we saw how NDP is a means of more fully understanding the relationship between mother and baby during pregnancy and the first six months of life. We considered the basic components that enhanced the attachment relationships of: • sensory play and messiness • rhythmic play and ritual • dramatic play and mimicry. The application of NDP principles in a wide variety of situations is described throughout the book, and there is a long list of NDP techniques and materials in the appendices. In this chapter on play and play therapy, I give a precise description of how NDP principles can be used as a structured intervention in play therapy with children of all ages.

Sensory play Many children will not have had the primary experience of sensory play while they were growing or when they were born. Indeed many people find birth a messy experience and one they do not want to remember. However, the slipperiness and holding, warm washing and towels, warm breast, food and massage are just some of the important sensations of the early hours and days after being born.

Rhythmic play There are children who have not developed and internalised a sense of repetition and predictability; there was no awareness of mother’s and infant’s heartbeats; there was no rocking or clapping, no phrases and chants; and there may well have been unpredictable outbursts of physical abuse or shouting. Rhythmic play is also vocal through humming, chants and songs, and NDP intervention includes singing and drumming.

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Dramatic play When you are very small this needs two people but many children have not been given the time or the patience from a significant adult to establish this playful activity: mimicry and funny faces, copying and changing, building up to a happening…1, 2, 3 – here it is! All these forms of playing are primarily embodied activities that serve different functions in the baby’s neurological, emotional and social development.

Sensory, rhythmic and dramatic elements in play therapy Neuro-Dramatic-Play therapy can now be applied as a discrete model of attachment based intervention for children, teenagers and adults. NDP therapy is appropriate for children and teenagers with attachment difficulties and where playfulness is absent in primary relationships. There may be emotional or behavioural difficulties, disassociation, and abuse in all its forms, including self-harm. It is also appropriate in situations of loss and bereavement, family break-up, trauma and learning difficulty. NDP therapy is applied as a short-term intervention: initially 12 weeks that has boundaries and is contained in time and space. Further blocks of 12 weeks can be put in place if necessary, after careful consideration, but the staff will consider the developing skills of the parents and other family members in continuing the NDP. Support is given to families to continue the play but also allowing it to mature into new stages of development. NDP therapy is unique in that it is usually conducted in small groups with a one-to-one ratio of adult and child, with one or two facilitators. Depending on the severity of the situation, the one-to-one will be another professional, volunteer or student in training. As soon as possible another member of the family needs to become part of the dynamic so that each child has two adults, one family member and one professional. Eventually the progression will lead to the professional (apart from the facilitator(s)) withdrawing from the situation and the parent continuing the playing with their child.

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Therefore it can be seen that NDP re-creates the early attachment dynamic and allows the opportunity for re-parenting a child within a group context. The group can all be involved in the rhythmic and dramatic playing. As far as I know this is a unique approach because it takes place with in a group setting rather than individually. NDP therapy moves on to another major life stage after the satisfactory completion of the essential sensory, rhythmic and dramatic playing stages, which is called the Theatre of Resilience; described in Chapter 12. Chapter 4 addresses Neuro-Dramatic-Play development during pregnancy and childbirth.

Chapter 4

NDP, Pregnancy and Birth

As I was laid in my mother’s arms, Granny Ivy with her dyed black bouffant hair, mouthful of gold teeth and physique of that of a child said ‘that is the fattest child that I have ever seen in my life, Bettie! A little pig boy’… the night Bettie Walsh gave birth to a pig has gone down in family folklore. (Walsh 2010, pp.15–18, 22–3)

Introduction The words ‘playful’ and ‘pregnancy’ do not usually go together. The subject of pregnancy usually becomes serious with lots of things that potential parents must pay attention to: appointments, scans, diets, exercises and a host of decisions regarding location of the birth and the support and economic systems that need to be in place. My contention is that whatever the circumstances and whether the baby was planned or even wanted, the overriding quality of playfulness could make a very big difference to the worries, doubts and possible despairs. Unfortunately, therapists and counsellors become involved only when there are issues around extreme anxiety or difficulties with fertility, and not always then. Selwyn well describes the mixed feelings that women experience once they know they are pregnant: Motherhood is commonly discussed as though it involves only pleasurable feelings. When faced with the reality of pregnancy, many mothers have a mixture of feelings: disgust at changes in body shape, joy if the pregnancy is wanted, or terror at the forthcoming labour. (Selwyn 2000, p.21) 81

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This chapter focuses on the importance of the NDP processes that usually start during pregnancy and suggests a programme of NDP that can be a part of preparation both for the birth and for life outside the womb. It also provides some developmental pathways that can heighten understanding of the gradual development of pre-birth attachment. This chapter emphasises that the NDP process is not exclusive: it needs to be a part of all the pre-birth preparation and antenatal checkups and classes. NDP needs to be within the ‘pregnancy circle of care’ that focuses on biological development, physical preparation and playful preparation (Figure 4.1). • The biological development is usually addressed in the antenatal clinic through examinations and scans. Medical staff will monitor the healthy stages and growth milestones of the unborn. • The physical preparation is for the mother for the good of herself and for her unborn. The antenatal clinic usually has classes that include breathing and posture, as well as general advice about pregnancy. • The playful preparation can happen in a class or can be practised by the woman with her partner or alone, throughout the pregnancy.

Developmental

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Figure 4.1: Circle of care

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Within the circle of care approach, I am focusing mainly on the playful segment for the development of NDP. The ‘Circle of Containment – Circle of Care – Circle of Attachment’ (Jennings 2009a) is being developed in a new book, Playful Pregnancy – Positive Children (Jennings, in preparation). We consider the other aspects of pregnancy that interweave with the playful. For example when a woman is feeling horrendous because of early morning sickness, she will not be feeling very playful! Nevertheless if her body is tired and feels misshapen, there are relaxation exercises she can do with her imagination that will restore the playful mind-set and act as a calming agent. Many of the techniques that are suggested for pregnancy play will be already practised by many women; here they are developed and expanded, and placed within an attachment context. This will then have a coherence that can be understood within the 40 weeks of the pregnancy.

The growing relationship A mother’s relationship with her baby usually starts during pregnancy when a small flutter occurs which indicates the beginning of movement. That butterfly wing sensation is often referred to as ‘quickening’, meaning that the baby is a living being. Sometimes women are not sure it is happening and it can take a few flutters to convince them that the baby is really there. The earliest movement that can be sensed by the mother starts at around 16 weeks, although the foetus has already been moving around for several weeks. Now that it is felt to exist in reality, the relationship between mother and baby can begin to develop in playful ways. This relationship, if supported and encouraged, will create the roots for a healthy attachment once the baby is born. Selwyn also makes the point that parents are affected by the opinions and trends around them, and by their own mental and physical health as well as their family and social relationships: Parents are affected by dominant discourses, by changes in their own physical and psychological health and changes in relationships with extended family and friends. In turn, foetal development is affected by these changes and by the wider environment. Understanding the interaction of these

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systems is important, as professionals involved at this point in development are often concerned with only one aspect. As we learn more about foetal development it is becoming clearer that professionals will have to be more aware of the impact of all these systems on the mother and foetus to ensure better outcomes for all. (Selwyn 2000, p.21) For some women and men too there is also a heightened awareness of a potential baby when they have difficulties in conceiving. Once a couple have made a decision to have a baby, the longer it takes, often the more desperate they become. After a year of trying, followed by the visits and the checkups, there are often feelings of inadequacy and blame; conception becomes the focus of the relationship and sometimes it puts too much stress on the potential parents. I will not discuss further issues around fertility, as I have written about them elsewhere (Jennings 1994); there is no doubt that the more stressed people become, usually the less chance they have of conceiving. People do challenge this idea and ask what about the child conceived from violence such as rape? This is a different situation from the prolonged anxiety, often over years that can affect the balance of the entire hormonal system. Generally speaking, stress is not helpful for conception, pregnancy, birth or babyhood!

Important milestones during pregnancy The growth stages during pregnancy indicate when there is a growing awareness of the new life and the potential for playing (Figure 4.2). We can see that during the first trimester there is physical development, but very importantly, by the end of this trimester the brain structure is complete.

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First Trimester 4 weeks

Layers of cells multiplying and dividing very rapidly; outer layer becomes brain, skin, hair; middle layer becomes muscles, bones, blood vessels, genitalia; inner layer becomes lungs, liver, digestive system and bladder. 8 weeks

‘Baby shape’ with curved spine (slowly changes in next two weeks); central nervous system developing quickly, heart begins beating, has four chambers; limbs and digits recognisable; brain developing, bones hardening; webbed feet. 12 weeks

Heart almost fully developed, brain structure complete; facial features emerge, hand and foot webbing changed; circulation working, bones getting harder; digestive system works, respiratory system stimulated by breathing practice.

End of First Trimester 16 weeks

Mothers usually experience quickening, beginning to move; end of fourth month baby beginning to look ‘human’; variety of facial expressions, may yawn, suck thumb; finger and toe nails growing; thyroid producing hormones. 20 weeks

Lungs formed, kidneys fully formed and working, tooth buds appeared, heartbeat is stronger; immune system developing alongside digestion and lungs; senses are developing: taste, smell, hearing, sight and touch. 24 weeks

Very rapid brain growth; breathing amniotic fluid in and out of the lungs; a lot of movement, almost as much as newborn; aware of sounds and bright lights; memory may be starting, organs developing; eyes still closed. Twenty-four weeks is the time in most countries when a baby is thought to be viable and capable of living independently from the mother, although of course premature. 28 weeks

Eyelids open, nervous system maturing; everything growing and strengthening; responds to mother’s changing moods especially if stressed; cortisol can enter placenta from mother and affects baby; increased awareness of baby.

End of Second Trimester 32 weeks

Baby has less room to move than before when floating in amniotic fluid; eyes can focus and blink, hearing attuned to outside world; important development of lungs to enable breathing outside the womb; hair growing and overall baby is plumper. 36 weeks

Hair is thickening and eyebrows formed; all major organs are mature but lungs continue to develop; lots of movement means muscles have grown stronger; baby has filled out and overall is chubbier; still considered premature if born at 36 weeks.

40 weeks

Baby is ‘rehearsing’ feeding, turning head from side to side and trying to suck; ready to be born; heart and lungs ready for changes; mother’s antibodies passed to baby; the newborn baby dependent on mother for protection from infection; bones of skull still soft for the delivery.

Figure 4.2: Important stages throughout the pregnancy

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Figure 4.2 shows the important stages of development during the 40 weeks of the growth of an embryo into a baby, ready to be born. What is extraordinary is how the many complex pieces all fit together and start working. With the discovery of ultrasound and other imaging techniques, it is possible to see far more inside the baby than before. Many things are happening including slight movements before we are even aware of it. The progress from a cluster of cells to a fully formed baby is still a wonder. If we look at Figure 4.3, we can see that there are several bursts of energy that are crucial for the understanding and practice of NDP.

Important birth stages in more detail It is significant for our discussion that the earliest sensory responses take place at 20 weeks (although taste appears even earlier, at 14 weeks), even before a baby is considered officially a ‘baby-person’. This demonstrates how important the sensory system is and how gradually it is developing during the nine months of pregnancy. We know that babies experience smell and taste, can see changes of light and can recognise music while still in the womb. They are also capable of a lot of movement, but individual babies vary. Isadora Duncan (Daly 1995) used to say that she danced in her mother’s womb! During the first trimester of pregnancy, women are usually feeling anything from slightly unwell to awful if there is constant sickness. Life and pregnancy suddenly take on a less rosy view, but fortunately for only a few months. Even before the quickening, the baby responds to the food eaten by the mother as the sense of taste becomes very strong indeed. One study showed that after birth babies had a preference for some of the foods that their mothers ate during pregnancy (Stoppard 2008). At 24 weeks babies react to the shining of a bright light and they are aware of their mother’s voice. The mother’s voice sounds louder in the womb than it does to anyone else and the unborn child becomes very much aware of the whole lilt, the cadences and rhythm and flow; the baby will recognise its mother’s voice over any other once he or she is born. Shouting and harsh sounds make an impact on the baby and it may jump at a sudden noise.

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20 weeks The area of the brain where the senses are located has become active and the baby is able to experience taste, smell, hearing, sight and touch.

24 weeks Very rapid brain growth; breathing amniotic fluid in and out of the lungs in preparation for independent breathing; a lot of movement, almost as much as a newborn baby; aware of sounds and bright lights; memory may be starting; eyes are still closed.

28 weeks Eyelids open; responds to mother’s changing moods especially if stressed; cortisol is able to enter the wall of the placenta; mother more aware of the baby’s presence.

32 weeks Eyes can focus and the baby’s hearing is attuned to sounds from the outside, especially mother’s voice, aware of tension in voices; remembers music.

40 weeks Baby is ‘rehearsing’ feeding, turning head from side to side and trying to suck, ready to meet the world. Figure 4.3: Important birth stages for sensory, rhythmic and dramatic development

Music being played during pregnancy will be recognised later and babies do make a choice about the music they like to hear. Often a favourite piece of music heard during pregnancy will be played at the birth and will then be a calming influence after the baby is born.

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At 28 weeks the baby is certainly affected by the mother’s moods; many specialists think this happens earlier and encourage positive feelings and non-violent language right from the beginning of the pregnancy. If the baby cannot yet hear the raised voices, he or she can certainly sense the tension in the mother’s body; the baby can become wary, scared or depressed in the womb as well as after birth. At 32 weeks the hearing is fine-tuned to hear things outside the womb and the eyes have begun to focus and are functioning; the hearing also is more alert. At 40 weeks the most amazing things are happening: a fine-tuned little role play is taking place: the baby is rehearsing the movements needed for feeding. The baby is moving its head from side to side, just as it will when searching for the breast to feed on, and is also practising sucking movements. A ‘rehearsal of living’ takes place in the womb of the skills that the baby needs for survival: a drama is being played out before we even see the world!

Imposition or attachment? Unfortunately the downside of this knowledge is that some parents become competitive and impose learning of the unborn child leading to overstimulation, in the hope that the baby will be born with a greater intelligence or be more successful in life. Mothers will walk around with cassettes taped to their bellies in order to programme their baby’s thinking. We can see families in all walks of life not only wanting the best for their child but also wanting the child to be the best. This is the difference: to be the best means an extraordinary level of competition and pressure on the as yet unborn child. And we know that many children who have to ‘perform’ to their parents’ wishes may well have difficulties as teenagers or young adults. The development of an eating disorder is one way of gaining control over one’s destiny, and that can have alarming consequences. Our society still has not got the mix right of being able to inform parents on the one hand, but not dictating rigid child-rearing rules on the other. It is fortunate that the philosophy of children being empty vessels

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that are filled with appropriate beliefs and knowledge by religious institutions, schools and parents is generally a thing of the past. We know that the primary relationship where there is reciprocity between mother, carer or infant provides the best foundation for learning, whether it is emotional, social or academic learning. What is important is not the stimulation but the development of the relationship and the more we can focus on the prebirth attachment, the more the transition to mother and babyhood will be both beneficial and pleasurable. Being aware of the various developments during the three trimesters can help plan a progression of exercises to gradually increase the bonding between mother and unborn baby, which will encourage the attachment process and lead into the playfulness that lies ahead.

Playful pregnancy We know that generally mothers experience their baby being more active at night and more still during the day. When the mother is moving around she is lulling her baby to sleep in the cradle of the placenta. Perhaps the vigorous movement of the baby at night is a rehearsal for her, preparing the new patterns of brief and interrupted bouts of sleep! Babies do need attention in the night but the calmer the child, the less demanding they will be. Nothing is more distressing than a cycle of deprivation where a mother will feel exhausted with constant nightwaking; her exhaustion is then communicated to her baby, who makes even more demands. One outcome is that sometimes mothers give up breastfeeding so that fathers can bottle feed in the night and mothers can get more sleep. A more satisfying alternative could be to ensure that mothers get the opportunity for sleep and rest in the daytime in order to restore their energy. Once women know that they are pregnant then playfulness can begin, and some of it will be quite spontaneous. If people already have a playful nature and perhaps the child was conceived in a playful way, then already the seedbed for the creative development is being prepared.

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The balance of the ‘Circles of Containment – Circle of Care’ during the three trimesters The first trimester is the time for all the developmental stages to be put in place and to begin to interconnect (Figure 4.4).

Playful

Figure 4.4: First trimester

During the first trimester the developmental aspect overrides both of the others: they are important but are not in the foreground. Considerations of the mother’s physical state with constant sickness take over and the baby can be seen as a monstrous being! However, it is important to encourage playful and creative thinking. During the second trimester everything is becoming more balanced (Figure 4.5).

Playful Developmental

Physical

Figure 4.5: Second trimester

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Obviously there is a strong focus on the developmental but with the surge of energy that usually comes in the second trimester, a range of creative activities can start between mother and baby, and the beginning of the physical preparation will take place, with classes and opportunities for sharing with other pregnant women. During the third trimester, all the processes that encourage attachment will outweigh the others, if the physical and developmental stages are progressing without concerns (Figure 4.6).

Developmental

Physical

Playful

Figure 4.6: Third trimester

The importance of massage and rhythm During the first trimester it is important that women do only very gentle strokes of their belly. However, a head and neck massage is very soothing, reassuring and calming. It is important not to massage the rest of the body while the pregnancy is settling down: there will be plenty of opportunities in the third trimester.

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The active embodiment of the relationship in a gentle massage can be accompanied by soothing humming or singing, which is culturally sensitive to our own ritual and music. The rhythm of the massage and sound is important too as we remember that the baby is constantly aware of the rhythm of the mother’s heartbeat. Rhythm is the regulator of life, it creates predictable and stable patterns, and it is the container of anything unpredictable that may happen and catch us unawares. Remember how we will rock a baby when he or she is distressed and how we can rock with a cushion to soothe ourselves. Massage and rocking are probably the most important activities to establish the initial attachment. Stoppard takes a positive stance towards activities during pregnancy: If you talk and play music to your unborn baby, and massage her through your bump, you can make her feel calm, tranquil, safe and loved. When she’s feeling this good her brain is bathed in love hormones such as serotonin, which help her develop into a healthy, happy baby. (Stoppard 2008, p.9) Mothers can use gentle music as well as singing during massage and they should be encouraged to dance with their babies. Music needs to be enjoyable – not too vigorous obviously, but rhythmic and fun. The baby will be affected not only by the swaying of the dance but also by the pleasure hormones that are activated when women are

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enjoying something. The baby will be hearing music during the second trimester as well as feeling the rhythms through the mother’s body. More and more is the baby becoming sensitive to moods and tensions and anxieties so the more the mother can exude positive thoughts and feelings, the better. There are also special swimming classes for pregnant women, or the woman can go swiming on her own: she will need to take advice on which swimming forms are best. Women will be swimming in water just as their baby is swimming in its own waters too. Making sense of the world around us happens through our senses and commences well before we are born. We can sense temperature, sound, rhythm, touch and emotional changes while we are still in the womb and our mothers have a profound effect on our well-being through their own sensory experiences. If women do nothing else, the telling of soothing stories and the playing of calming music can influence the state of trust and tranquillity both for them and their babies. As well as the very physical aspects of massage and movement in the playfulness aspect, woman may well be joining a yoga group or special antenatal classes. It is very helpful to be with others who are engaged on the same journey and fellow pregnant women provide a lot of support. It is easy to become isolated during pregnancy and allow fears to build up. Yoga for pregnancy is an excellent movement system and enables women to keep calm and focused and it is also very reassuring for the baby.

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During pregnancy many women do report that they talk to their unborn child, they tell him or her secrets and daydreams, stories and gossip. Mothers will confide in their babies and share all sorts of hopes and fears. The earlier that this communication can take place the better, because it is also part of the attachment process. Usually it begins once we are aware of the baby’s presence, once the quickening has happened. There are many ways to talk with unborn children and it is a matter of what it comfortable for the individual. There is no prescriptive way and many women do it anyway. The following are some suggestions we can make to pregnant women: • Not using words but passing loving and caregiving thoughts. • Whispering a secret or sharing a joke. • Telling a piece of light-hearted gossip. • Making up a story about mother and the baby. • Short pieces of conversation – ‘Hey, what are you doing down there? That was quite a kick!’ • Sharing dreams and waking dreams of life and fantasy futures. • Singing songs, humming and crooning, perhaps with gentle music. Women will, I am sure, think of many other ways of communicating with their unborn child or the communication will just bubble up from their own playfulness. They may feel silly but also they will find it quite enjoyable. Sometimes it is easier to have these conversations in our heads than in reality. Sometimes the stories and conversations will take on another dimension and this is likely to happen more in the third trimester, when the baby is also practising little role plays about life. Mothers will talk to their baby and answer themselves ‘as if ’ they are the baby: a private piece of drama indeed. It often starts just as a conversation, the baby acting as a commentator on what the mother has to say. The mother will also say or think something like, ‘Well, if you could talk, you would be telling me to buck up a bit’; the mother is imagining the dialogue with the child even though she does not speak as the child. It can also become a dialogue with mother expressing her own and

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her baby’s voice. Then she is establishing what I call the ‘dramatised relationship’ (Jennings 1999a), which means that initially the mother takes on fun and playful roles in relation to the unborn child which will then be slowly established between mother and newborn child. This is a very important part of the development and could be termed the crux of what NDP is about. If the mother begins to role play before the baby is born and even ‘role reverses’ with her baby, she is setting the scene for the baby to be able to do this eventually. If we play the role of the other, we then have some idea of how that person is thinking and feeling: we are beginning to be in their shoes. And if I am able to be in someone else’s shoes, I have the capacity to develop empathy and a conscience. If I always stay stuck in my everyday role, I will never have the chance to use my imagination and wonder what it must be like to be this other person. Especially during the last trimester, the mother needs time to daydream and imagine beautiful worlds, to tell or read stories, to create scenes to enact with her baby in which she plays the baby’s role. You will also find fathers entering into the role plays, though less often. Fathers will have conversations about who ‘this special little man might become’; if the father knows it is a boy he will often identify with him so his conversations are more equal. If the baby will be a girl, the father is usually much more protective and keeps his role of looking after his little girl.

The baby is born! During the first few moments of a baby being born there is an overwhelming sense of relief that it is all over! It can often be a long and painful event, with anxiety that everything will be ‘all right’, which ends in this very sticky and wet bundle being placed in your arms. You don’t know whether to laugh or cry, and the staff can be funny as well. I was told after one of my children was delivered: ‘You look after the upstairs department dear and we will take care of everything downstairs!’ This is now a real baby who can be held and seen whereas during the pregnancy it is an imagined child. Mothers have thought what the child might be like when he or she is born and have had imaginary conversations and stories. A lot of time is spent, especially in the last

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three months, focusing on who this child might become. We also idealise this baby – it will be perfect in every way and not create sleepless nights and messy days! Then there is the transition to the real baby with its constant demands and mess and seemingly never ending hunger. Usually this transition is relatively smooth, especially with the biological drive to see our baby as endearing and perfect anyway. Mothers may feel elated or exhausted, or both mixed up together; emotions and hormones will take time to settle down. Fathers will also be adjusting and wonder whether to look at the mother or the baby! New mothers need lots of affirmation! Isn’t that why all the flowers arrive? Flowers of course are symbols of fertility and are making a fertile statement. Fathers have an important role to play immediately after the birth in celebrating the joint creation of the new life and its safe delivery. Mothers and midwives can be encouraged to focus on the NDP stages during the pregnancy and to anticipate the birth. Relaxing showers and baths can be helpful, carefully chosen music that has been played during the pregnancy can be available for birthing. And in my opinion the most relaxed birth will be in a birthing pool. The baby will try to imitate the expression on the mother’s face within hours of being born. I have described this earlier as ‘the dramatic response’, the first step in dramatic playing that is such an important part of the attachment process. The concept of NeuroDramatic-Play both as a natural process and a therapeutic intervention will be developed throughout this book.

Neuro-Dramatic-Play being established during pregnancy and in preparation for the birth During pregnancy, NDP ensures that the infant grows in the three major areas, developmentally, physically and playfully, within the ‘Circle of Containment – Circle of Care – Circle of Attachment’. These three circles have been established during the three trimesters. NDP enables sensory, rhythmic and dramatic play to be developed through the three trimesters, slowly anticipating the birth.

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Sensory play: the stresses during pregnancy are addressed through sensory massage of the mothers’ back, shoulders and feet; babystroking increases. Rhythmic play: Rocking and rhythms (through heartbeats and music) are increasing; mothers will sing spontaneously. Dramatic play: The baby is demonstrating the potential for role play and he or she is practising skills before birth. The gradual growth of mother and baby’s interactive playfulness is happening within the womb and there is the beginning of reciprocity. Chapter 5 continues the birth process and the first six months of life. I think professionals should encourage mothers to consider home births and a birthing pool rather than talking them out of them.

Chapter 5

NDP, Childbirth and the First Six Months I was born in very sorry circumstances. Both my parents were very sorry! That’s an old music hall gag, but in fact it wasn’t very far from the truth.When I talk about my childhood, friends inevitably compare me to Oliver Twist. And that wasn’t so far from the truth either. (Wisdom with Hall 1991, p.11)

Introduction This chapter first of all focuses on the birth itself and all the beliefs and ideas that surround childbirth and the immediate post-partum time. We shall see that there are many attitudes concerning both the physical needs and the emotional ones that come to a climax at the moment of birth. Not all specialists agree on best practice and mothers can be left floundering in conflicting views of the medical professions, as well as family and friends. We shall also look at the continuation of the NDP process for the newborn baby within a context of support and practical assistance that is crucial for calm and creative development.

Hospital or home? Childbirth is a normal process that traditionally is contained within rituals, singing, chanting, massage and a range of cultural norms that herald the safe delivery of the new child. Sadly it must be said that in the UK certainly there is far more emphasis on the sanitised birth in the hospital, and yet hospitals have shown that they cannot deal with the MRSA infections that are often fatal. My late father who was a very 98

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successful general practitioner (GP) always said that childbirth was his most favourite activity in medicine because it was normality rather than illness. He always favoured home deliveries even though there was a marked shift to hospital confinements after World War Two. Although all the indicators suggest that home births are safer and that there is less risk of infection than for hospital births, having a home birth is more difficult in the USA and UK compared with other European countries (Stoppard 2008). Many doctors insist on the first baby being delivered in hospital before there is any consideration of a home birth for the next child. There is now an increase in the use of birthing pools and mothers wanting to give birth at home, which illustrates our desire for a less technological and more human birth experience. The birthing pool creates a continuation of the ‘safe waters’ of the womb; it also helps to alleviate some of the extreme pain, and provides an immediate context for warm bonding through smell, touch and sound. Odent (2001) suggests that the attraction of pregnant women to water has primeval roots; he believes we were created ‘aquatic apes’ and inhabited the coastal plains. He said that this could also account for the need of our brains for fish oils. He also describes how pregnant women are attracted to water once they hear the tap running and have been known to get into the birthing pool with just a little water at the bottom! Some hospitals are now creating birthing units and have pools, facilities for playing music and for father friendly units. However there are still issues around ‘who is in charge’. We have developed a deepseated and historical belief that ‘doctors know best’. Many doctors and midwives assume that all women will want pain relief during childbirth. However research shows that certain painkillers given during birth can dull the attachment process: Infants who are exposed to epidurals can have behaviour difficulties in the first few days after birth. They can be more irritable and hard to console and may be less responsive. Additionally the bonding between parents and the baby can be disturbed, which has life-long consequences for the parentchild relationship. (McCormick 1997)

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Parents often feel that all decision making has been taken out of their hands, especially since childbirth is seen as a medical condition rather than a natural process. When I have asked parents about home births the most frequent answer is ‘What if anything went wrong?’ Hospitals, despite their reputation, are perceived as some kind of sanctuary, a safe place. As professionals we have a duty to give pregnant women the facts about home births or GP units with birthing pools. This will encourage parents to make informed decisions about their birthing arrangements and to develop some autonomy. Parents need to feel that they are in charge of their own and their child’s destiny with support from others. Parents who have the opportunity to prepare for the birth, and have some knowledge of gestation and childbirth itself, will feel more equipped to deal with the challenges from specialists, from GP to consultant. However, too often they feel they are dictated to by authoritarian doctors and nurses and there is generally a lack of affirmation by the professionals. Many women feel they are being treated like children as the nurse says ‘Good girl, well done’. Is it surprising that new parents feel undermined and lacking in confidence? We can encourage parents to belong to a supportive network, especially when they are feeling down. Some mothers who are on their own often struggle to ‘get it right’ and end up feeling failures. All of these feelings are communicated to the infant. A mother who feels depressed or inadequate will discover that her child is likely to experience similar feelings. We need to find more ways of being supportive during childbirth and afterwards, and that includes pregnancy and birthing workshops. This kind of information in traditional societies is usually passed on by the village midwife or at least the mother’s mother. Many of the traditional kin networks have been broken so we have to create new streams of knowledge. Parents need to know the facts of physical development, psychological development and playful attachment (as described in Chapter 4). Yet these will be big steps for authorities to commit themselves to; new classes will mean new money, despite the fact that long-term benefits could be shown to save money! It seems easier to maintain the status quo, that is, with ‘patients’ being dependent on ‘specialists’.

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It is common to blame everything on hormones: whether teenagers or menstruating girls or pregnant women or mothers of newborn infants, it can all be attributed to raging hormones! Thus, there is an attitude that emotions get in the way of serious thought – thinking is prized over feeling – logic over intuition. This is the received wisdom that we have lived with for centuries. Women have been stereotyped as ‘all feelings’, especially during pregnancy, young motherhood and menstruation. Medically, life should be pain free so we are programmed to feel we should ask for strong painkillers, but as we know these can become addictive. Prescription and non-prescription tablets not only dumb down physical pain, but also suppress emotional pain. When we are anxious or bereft or frightened or angry, there is a pill to take it away. And if not pills then we have psychotherapy that interprets the pain for us and can often blame us and our experiences for the pain. Physical and emotional pain are both real for us and need to be addressed through a supportive relationship. That may or may not be a therapist or counsellor. However, I have found that both play and bodywork will often get to the heart of the matter without us regressing and losing both our adulthood and parental feelings. The more we reinforce the notion that women are all feeling and men are all thinking, the more we maintain the stereotype which makes a huge impact on the pregnancy. Although a woman’s feelings are certainly heightened during childbirth, she is still capable of thought

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and decision making; similarly her partner, although perhaps planning the immediate arrangements, needs to feel wanted in his own right, not just as a support for the mother. Men have a crucial role to play at childbirth and need to be able to express their powerful feelings of fatherhood.

We must remember not to reinforce the stereotype of men being the strong ones, and women ‘the weaker sex’; both men and women can have playful and emotional attachments with their children; the more they can establish the inclusive family with overlapping roles and responsibilities, the more balanced will be the environment for the children. Another culture

When I lived with the Temiars (Jennings 1994) fathers and indeed all men were kept well away from the delivery room. There is a range of taboos that are followed by the more traditional men but it did not mean they were down the ‘pub’! They have to bring logs from the rain forest and chop them as the delivery room has a huge fire that is kept high at all times. They have to fetch water from the river ready for boiling on the fire, and generally be around for running errands. The birth is presided over by the experienced village midwife with usually an assistant (often me!) and other older women who would sit around and chat. Births usually took place in the kitchen next to the fire, the mother leaning against a back rest at an angle of 45 degrees. During the first stages of labour the midwife would massage the mother with coconut oil and give her plenty of water to drink which had a bitter herb (one I could not identify). From time to time the midwife would give an internal examination and discuss how many fingers the cervix was dilated. All the attention was focused on the mother. As the birth becomes imminent, the midwife starts chanting and speaking to the spirit of the river for the baby to be born quickly – everyone

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else nearby, usually older women and younger women seeking to learn, would take notice and sit with their knees wide open. As the baby is about to be born, the women open anything that happens to be around: fishing nets, saucepans, suitcases… A grand opening ceremony culminates in the baby being ejected onto the bamboo floor of the stilt house! The midwife then presses firmly on the woman’s stomach for the placenta to come away and leaves the baby attached to the placenta while she looks after the mother. The mother is seen to be at greater risk than the baby and is washed and then ritually bathed by the midwife, before being dressed in a clean but not new sarong. The attention is then given to the baby who is still lying on the floor attached to the placenta. The midwife cuts the cord with a sharp piece of bamboo, washes and wipes the baby, wraps it in a cloth and immediately tells the mother to let it suckle. One midwife said sharply, ‘Give him the breast or he will forget.’ The father and siblings put their heads round and catch a glimpse of the newborn, but for the most part, mother, baby and midwife are left alone, while everyone else looks after the house, hunting, cooking and general organisation. The father will be careful to keep any taboos that will ensure the health of the baby. The midwife stays with the mother, sleeping in the same room and giving both the mother and the baby regular massage. Other people do visit after the first few days and stay a while but it is looked upon as a quiet and private time with constant support from the midwife. No newly delivered mother feels lonely or inept! The important theme of the Temiars’ delivery is that a group of experienced women were giving constant support to the mother and baby. I noticed that sometimes younger children would hide near the house to see what was going on, and teenagers might be allowed to stay, well in the background. It was all right for them to learn about the mysteries of childbirth but it was the older women who had the practical knowledge and who would play the dominant role during and after the delivery.

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The newborn baby needs contact In our highly technological and automated society it is easy to forget the very basics of human communication. It is not for nothing that we say ‘stay in touch’ although these days it can often mean a text message or email. People are also scared of the litigious domination of our social and education systems so that many people such as teachers and care workers are scared to touch children. No wonder that mothers forget that human contact is the very basis of the word ‘attachment’. We discussed the importance of ‘bonding and attachment’ in Chapter 1 when we saw how it affects a baby’s brain and social development. However, I want to re-emphasise that it has a physical basis. Literally a baby needs to be physically attached to its mother or carer and the images of baby monkeys clinging to their mothers both front and back show us what the small infant needs. Although many people are very critical of Harry Harlow (1958), feeling that he caused unnecessary cruelty to monkeys, nevertheless what he discovered is crucially relevant to this topic. Baby massage is very important and it should continue after the baby is born: there are many cultures that promote massage immediately the cord is cut (Jennings 1994). Stoppard (2008) draws on research with premature babies and discovered that massage played an important role in promoting weight gain, alertness, better circulation and digestion. She believes that the benefits to the premature baby can be given to all unborn children, as described in the following advice to expectant mothers: Continue massaging your newborn baby: research from the University of Warwick says babies who are massaged sleep better, cry less and are more contented. If your partner massaging your bump soothes you, it soothes your baby too and that promotes growth of the frontal lobes of your baby’s brain which determine your baby’s intellectual capacity. It also tips your baby into a group of children who will be resistant to developing asthma, arthritis, allergies, ulcerative colitis, fatigue and ME. (Stoppard 2008, pp.102–3) Healthcare professionals can support mothers to physically stay with their babies and encourage them to find ways, for example by using slings or carriers, that the body contact can be maintained.

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The newborn needs company Babies are born with immediate social needs; they enjoy being with their mothers, and would prefer their mothers’ company day and night. Many professionals discourage and even frown on mothers sleeping with their babies, scaring them with talk of smothering in their sleep. It was not so very long ago that whole families slept in the same bed together or at least in the same room. It is a very modern fashion that children should have their own rooms, and from a very young age. There are still clinicians who advise mothers to let their babies ‘cry it out’ at night so that they eventually fall asleep. It seems that mothers are set up to do battle royal with their children from the beginning, and are advised ‘Don’t give in or your baby will have the upper hand.’ Babies are stereotyped into being monsters that will make monstrous demands on their mothers. The reality is that small babies are very frightened of being left alone, especially at night, and there is no reason why they should not sleep with their parents, and later in a crib at the bedside. There is absolutely no evidence to suggest that babies can be ‘spoilt’ by being nurtured or co-sleeping or being fed on demand. In Western Europe, especially England, there is more emphasis on the ‘couple’ rather than the extended family. And it is difficult for mothers to cope if they do not have a supportive extended family. It can feel desperate if one believes there is a battle to be fought. Deborah Jackson’s important book Three in a Bed: The Benefits of Sleeping with Your Baby is immensely reassuring for professionals and parents alike. She points out so eloquently: When you put your newborn baby down to sleep in his cradle and tiptoe out of the room, he thinks a part of himself has gone – the part that sustains life and gives him comfort. He does not have many resources to cope with this separation. Whether he protests or not, he needs you. It is such an obvious explanation for infant misery that medical handbooks tend to overlook it. Experts keep telling us to put the baby down, because (apparently) it is easier, and mothers should not be subject to the whims of their children. They are missing the point altogether. (Jackson 2003, p.40)

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Newborn babies want to feel warm and close but they also want their mothers’ company. They are not happy being wrapped up and placed in a separate room from their mothers and physical contact. One midwife said to me that babies needed to get over ‘the shock of being born’ as if childbirth was somehow abnormal. Babies who are abandoned away from their mothers may well become depressed or fearful. It is usually mothers who need support to get their energy back because they are very tired, hormones are chaotic for a while, and bodies feel stretched and bruised, which of course they are. At this time it is very important that mothers have support so that they do not fret about the washing or the household routine.

The newborn needs communication Contact with the mother’s physical body, and company for the social newborn are both shown to be essential and needed. However neither contact nor company are static; newborn babies need communication. Communication is interactive (otherwise it is just expression), and dramatic play and storytelling enable babies and their mothers to communicate from the very beginning. Communication with persons is possible from birth, and we should not be surprised at this. It is the nature of human consciousness to experience being experienced: to be an actor who can act in relation to other conscious sources of agency, and to be a source of emotions while accepting emotional qualities of vitality. (Trevarthen 1993/2006, p.121)

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Trevarthen reminds us that above all babies are able and also need to communicate from birth. He also suggests that the infant is ‘an actor’, which reinforces everything that I have said about interactive and dramatic playing. The bonding or attachment between mother and newborn baby is of primary importance, and many professionals will make sure that babies are given straight to their mothers to hold. Professionals can encourage the contact, company and communication between mother and newborn. This strong attachment is the basis for brain development, and for all future relationships. Professionals and other family members and friends need to gently understand this fact.

When therapy is indicated There are still some situations that despite all the support systems in place that we have talked about can cause great distress to mothers and potentially their child. Raphael-Leff (2001) suggests that for some women childbirth creates ‘postnatal distress’ (rather than postnatal depression) that may well need psychotherapy for the benefit of the mother and safety of the child. She writes: Perinatal psychotherapy offers a lifeline for the expectant/ new parent to cling to while making sense of the intense emotional experience. The baby’s welfare is crucial as, as even with help, it can take many months of painstaking effort, with occasional frightening slippages and sudden backslides, threats of flooding and ‘going under’, before released from its grip, they suddenly climb up out of the dark psychic depth. (Raphael-Leff 2001, p.60) Raphael-Leff (2001) says that it is estimated that 50 per cent of all mothers suffer some form of postnatal distress during the first two years, such as sleeplessness, tearfulness and social withdrawal, and that 10–20 per cent experience severe disturbance. Here is not the place to discuss this at length, but it is important to acknowledge that not all feelings post-birth are positive. Most of Raphael-Leff’s examples are taken out of the cultural and contextual setting of the mother and child. I am not underestimating the depths of postnatal distress that

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many women experience, but it is important to consider also whether lack of extended support contributes to the process. As readers will have already grasped I am not an advocate of the psychoanalytic approach and therefore not necessarily in agreement with the interpretations about postnatal distress. However intervention can be necessary and again I return to the framework that allows women and men to tell their own attachment stories through an NDP approach that will address most situations. The sharing of stories and the reassurances that support systems can provide, plus the skills of a therapeutic play worker, can usually be sufficient. Post-partum psychosis is a reality in a very small number of situations that will need medical intervention together with the support system that is already in place. As we saw above, with the Temiar peoples (Jennings 1994), newly delivered mothers are given primary attention and support from their midwives as well as the extended family.

Breastfeeding? The milk is there, it is rare for the supply to run out, it builds the baby’s immune system and it helps the mother’s uterus to shrink back, so why is there a debate between the benefits of breast or bottle? I believe it is a multifaceted subject that we could debate endlessly but much of it is tied up in new ideas about dependency and independence. It feels a big responsibility for mothers to be the feeders of their children and some women talk about there being not enough milk or about it being thin and watery. They feel very inadequate as the provider of sustenance. How much more reassuring to give formula milk that states the vitamins and can be measured, even though bottle feeding is much more time consuming and much more expensive, and does not provide the immunity of breast milk. Breastfeeding does require the presence of the mother, and the so-called freedom that bottle feeding gives has other implications such as the interruption of the attachment process. If small babies are bottle fed by a variety of adults, there can be a confusion of the bonding process. The primary relationship is not being formed with any one person. Odent (2001) points out that there are other issues at stake and discusses two hormones in particular, oxytocin and prolactin. He says

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that oxytocin is ‘the hormone of love’ and that love can be directed in several ways. When there is a high level of prolactin, the tendency is to direct the effects of the love hormone towards babies. Prolactin is well known as the hormone necessary to initiate and sustain lactation. In fact it is an ancient hormone on the evolutionary scale, serving multiple roles in mediating the care of the offspring, from nest building, for example, up to the aggressive defensive behaviour typical of lactating mothers. (Odent 2001, p.38) So these hormones are promoting the attachment process, stimulating lactation so there will be milk for the baby, but also allowing the mother to feel defensive and protective of her newborn baby. Mammals are noted for their protection of their dependent young throughout the animal kingdom. Odent (2001) goes on to say: ‘prolactin is not only a “mothering hormone”, it also acts as a contraceptive: we know that if mothers breast feed “on demand” and not “on schedule” there is sufficient prolactin to inhibit conception’ (Odent 2001, p.38). So it is not an ‘old wives’ tale’ that breastfeeding acts as a contraceptive, providing we do not try to sleep through the night and therefore have too long a gap between feeds. The other fact about prolactin is that it inhibits sexual desire, in order that the mother can focus on the baby to the exclusion of all else and this is common with other mammals. The choice to stop breastfeeding and use the bottle could have various issues embedded in the decision, especially a wish to return to normal sexual relationships.

Birth fathers? There is a lot of debate about fathers being involved in the birth process, being present at the actual birth and providing strong attachment right from the beginning. Stoppard (2008) suggests that the father’s role is crucial if the mother is having a Caesarean birth: Dads come into their own however if mums need a Caesarean. Paternal instincts can be as strong as maternal instincts and really

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play their part when newborn babies cannot have immediate contact with their mum immediately after a Caesarean. Ideally a newborn baby would be held close by mum and put on her breast to feed. But research has shown that dad can do almost as good a job with skin-to-skin contact if this is not possible. (Stoppard 2008, p.163) Odent (2001) is not in agreement, and suggests that in the immediate time after birth, attachment to the father could endanger the primary maternal attachment. He suggests that there is a crucial time following the birth which should not be interrupted with rushing the cordcutting, bathing, rubbing, ear piercing or any other seemingly ‘necessary’ things that need to be done that separates the baby from its mother. He continues: I am convinced that most cases of post-partum haemorrhage and difficult deliveries of the placenta occur because the mother has been distracted at a time when she should have nothing else to do other than look at her baby and feel the baby’s skin close to her body. (Odent 2001, p. 42) Whichever direction we follow, whether Stoppard’s or Odent’s, it is important that fathers feel they have a defined role in the birth process. For the Temiars it was very clear that they had a practical and supportive role but had no actual involvement in the birth or the times immediately following (Jennings 1994).

Neuro-Dramatic-Playing The birth has taken place and the afterbirth or placenta has also become detached, now comes the move forward into a playful life. It is worth saying at this juncture how most societies value the placenta and different belief systems regard it as the twin of the baby or possessing magical powers. The Temiars would tie the placenta in a piece of cloth and the father would go deep into the forest and tie it to a tree. This was like a burial ‘above the ground’ which was also accorded to stillborn babies. Many people eat the placenta at a special feast not only because it is very nutritious but also because it is believed to carry magical strength.

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The breastfeeding experience allows for the playful sharing of caressing and patting, teasing and mimicry, and it can provide an opportunity for messy playing. A range of facial expressions pass between mother and baby during a positive breastfeeding experience, so it is time to ask the question, is this all playing? Many people are surprised to know that babies need to play almost immediately they are born. As we have said, within hours of birth babies are trying to imitate adult expressions (Field et al. 1982) and can differentiate facial expressions within two days. Babies want to interact and need someone to interact with them! They will recognise their mother’s face within hours and spend more time gazing at her than at other people’s faces. Babies will turn away when they are not engaged with what they see and they find faces more interesting than dangly toys. Initially mothers will interact with their babies during feeding, bathing and nursing and much of the activity is similar to the prebirth play described in Chapter 4. Stroking and rocking, singing and humming seem natural ways to communicate and strengthen ties with the baby. If a mother has a positive expression as she is feeding, the baby will focus on this and absorb not only the milk but also the positive affirmation. Mothers continue to talk to their babies as they did before they were born, making observations about how they look and the colour of their eyes or hair. They will tell them stories and have private conversations and be silly and child-like. Mothers and babies alike enjoy entertaining each other and the laughter and giggles usually continue for as long as there is energy.

The first six months The development of Neuro-Dramatic-Play during the first six months lays the foundation for all future development of the child. Once the excitement and highs and lows of the birth have settled, mothers will try to find a routine that not only accommodates their own needs but also allows for sufficient attachment play with the baby. No two mothers are alike in how they want to plan their time, and there will be occasions of great exhaustion and feelings of ‘not getting it right’.

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Many mothers feel that their babies are completely overwhelming, and not the nice cosy little bundles that they first imagined! The real child is replacing the imagined child, and many women need time to adjust. One little piece of wisdom that mothers can learn is this: Never play victim to your baby even if he or she does feel monstrous sometimes! ‘Hold tight’ is a very good motto when mothers feel like giving up: I use this phrase both as a metaphor and in reality. The baby that is held tightly will feel secure and contained, as I described in Chapter 4 when I referred to the ‘Circle of Containment – Circle of Care – Circle of Attachment’. The baby has been safely contained in one circle, the womb, for nine months, he or she now needs to feel contained in another circle while making the transition into the outside world. It is important that mothers are encouraged to continue to play any pregnancy or birthing music, and to make use of classical music as either a stimulus or a soother for their children. Mozart is a great favourite and very good for the brain!

The first week The baby alternates long periods of sleep with short wakes for feeding, and there may be fretfulness and crying. The baby is already establishing eye contact with the mother and trying to imitate her expression. Babies are rooting and sucking during feeding, and enjoying stroking. It is important the storytelling continues throughout, along with sensory play when feeding and washing; consonant play mainly through rocking, humming and singing; responding ‘as if ’ with imitation. All of these processes are part of the NDP interaction between mother and baby.

The first month The baby is increasingly alert to facial expressions and mother’s voice; the baby makes cooing and guttural noises that mothers will imitate.

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NDP: as for the first week but more focus from baby on following face, voice and a moving toy; consonant play will slowly lead to echo play; sensory play with soft toy, caressing and patting.

The second month The baby notices certain toys placed close by; increase of arm movements; follows person round the room; with his or her eyes starts to grasp; more sounds. NDP: start of dramatic play with imitation of sounds and expressions; peek-a-boo (gradually); continuation of massage and sensory play; rhythmic songs and rhymes; telling short stories with expression.

The third month The baby anticipates sounds, door opening, footsteps, bathwater; develops gaze to some object or body part; sustains eye contact when feeding; finger play and clapping hands. NDP: developing finger play and hand claps with songs or stories; ‘surprise’ with toy hidden/visible; more play with bath time, bubbles and splashing.

The fourth month The baby sometimes sits up or rolls over from front to back; new perceptions of space; enjoys caring routines, especially sensory ones; curious about sounds. NDP: songs of fingers and toes; ‘little piggy went to market’; whole body massage while exercising arms and legs; imitates sounds back and forth, ‘raspberries’.

The fifth month The baby starts to grasp feet and hold toys; responds to colours, music and other sensory stimulation. NDP: body games with arms and feet while singing; holding up brightly coloured toys including safe puppets and allowing baby to grasp them; ‘dance’ on your lap; songs with refrains more stories.

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The sixth month The baby laughs and chuckles and has obvious enjoyment of playing; will play alone as well as with adults; intense concentration on light patches or moving shadows; possible variation in foods provides new stimuli. NDP: laughing games with tickles and kisses; rolling from front to back and back to front as a game; variation of voices with toys and puppets; rolling ball with bright colours; singing and chanting; lots of stories. These are NDP techniques that can be developed during the first six months and taught to parents. There are more in the appendices, and many people will be able to invent their own after the initial experiments. Because all babies develop at different rates, some activities will be welcome earlier or later than others. Mothers will be able to follow the clues from their babies’ responses. Now that we have laid the foundations for Neuro-Dramatic-Play, Chapter 6 will explore NDP in relation to that all important quality, that of resilience.

Chapter 6

NDP and Resilience and Empathy I had a baby you know – I was raped by a priest and they took the baby away and gave me shock treatment. If I ask for my baby they tell me not to be silly, so I am learning to be good. I am good and do what they say, (whispers) but I am telling you – there is a baby and one day I will find her – I know I have a daughter. (Jennings 1999b, p.2)

Introduction There have been many attempts to define the word ‘resilience’ and it does not easily translate into many other languages. The resilient child is one who is able to deal with the ups and downs of life, and to cope with adversity in age-appropriate ways. It has been demonstrated repeatedly that the resilient child will have had good enough attachment as a baby, and when small will have a strong enough parent to manage any trauma without being overwhelmed (Cyrulnik 2009; Erikson 1965/1995; Hughes 2006; Rutter 1997). Cyrulnik (2009) tells us that the word ‘resilience’ was first used in physics and referred to a body’s ability to absorb an impact, but he thinks this places too much emphasis on the body’s substance. He quotes a social science definition of resilience from Vanistendael (1998); resilience is the ‘ability to succeed, to live and to develop in a positive and socially acceptable way, despite the stress or adversity that would normally involve the real possibility of a negative outcome’ (Cyrulnik 2009, p.5). This social science definition implies that resilience deals with major impacts whereas I tend to think that someone who is resilient 115

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also deals with the smaller ups and downs of living; however, for many people the small nuisances become big obstacles. part of Jenny’s story

Nothing is more poignant than the severely obese woman who has a history of childhood sexual abuse, self-harming and eating disorders, crying like a six-year-old and saying, ‘They haven’t collected the rubbish’ – and following it by saying, ‘and I know they missed me on purpose’. The actual event of the rubbish has become mountainous and completely preoccupies her thoughts and feelings; she also feels there is a personal motive in all this. What does this symbol of rubbish mean for her and her life story? How has she maintained this ‘world is out to get me’ feeling for 20 years? Are we surprised that she is not coping in a resilient way when we learn that she was severely sexually abused within the family by her parents’ paedophile ring, shut down her feelings and became dissociated? When she was taken into care and placed with a loving foster family, they expected her to forget all about ‘those nasty people’ and enjoy being with her new family. There was no acknowledgement of her rage about what had happened to her or her feelings of self-loathing regarding her body or even that there must be some vestiges of goodness that came from her own parents to her. As a result she only takes on the negative images from her parents (loathsome, monstrous, evil, hateful) because she was born of them. How can we help her to feel positive about herself when there has been no acknowledgement of the actual processes she has been through? And although she hates her parents and has fantasies about what form her revenge will take, essentially she is still this little girl for whom nobody will take away this dreadful mess and pain, and who was made to feel that it is all her fault, so a little girl with feelings of shame, blame and helplessness.

As an adult Jenny needs the equivalent of Neuro-Dramatic-Play where she can feel nurtured and contained; where she can feel better about her body through sensory play and more confident about herself and

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the rest of the world through dramatic play. Instead of experiencing the containing circle of attachment as an infant, she became caught in a repetitive cycle of disorganised and insecure attachment from her multiple abusers. The abuse that she experienced is being repeated against herself and in desperation her abused body is subject to her efforts both to produce feelings (from cutting herself ) as well as to deny them (from her obesity). Emotionally I suggest she is still five years old and struggling to make sense of this confusing and hostile world, where there is no nurture or ‘good enough attachment’ from either parent, no hint that there could be any hope for her. So she continues to cry out in the dark for someone to take away the rubbish.

Rainbows for resilience The theme of rainbows is in many of my writings, from stories about rainbow silk to a rainbow massage in ‘The Weather Map’ (see Chapter 8). I use the physical sensation of creating the rainbow on a child’s back, the drawing or painting of rainbows, the use of coloured clothes to create rainbows in stories. This can lead to the dancing or enactment of rainbow themes. One group of adults with severe learning difficulties each drew a picture of what they would like to find on the other side of the rainbow. The staff had said they would find it too difficult and they would all copy each other. This was not the case: all 25 people drew something different, from the highly personal, ‘I want to find my father,’ to the natural, ‘I found a red flower.’ The only two people who drew the same thing were two friends who had some discussion and then decided that they would find water. I do not claim any exclusivity to the idea of rainbows as a motif for both grounding and stimulating. A woman who had suffered multiple losses in her family developed what she called ‘rainbow remedies’ (Siebert 2005); several appeared to me very important when we are addressing trauma and resilience. One is the power of choices, and it is important to remember that we always have choice; another was emphasising the positive, no matter how powerful the loss; and a third was that in helping other people we are able to keep our own trauma in perspective.

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Resilience and trauma Trauma at a very young age can have a permanent effect on the emotional life of the child. No one expects the small infant to deal with trauma without the care and nurture of an adult who can protect the child. Babies and toddlers do not have the mental apparatus to deal with trauma on their own, and many orphans, child soldiers and victims of abuse have been left to cope with their nightmares alone. Much is being written about resilience and how it develops in children despite traumatic situations or crises. Children respond to different stresses in significantly different ways; however the younger the child, the more vulnerable they are to stress reaction. Resilient children are able to manage stresses in their lives especially if they live in stable and supportive families where there is trust, optimism and nurture. This includes adults who will listen to fears and anxieties and help children express and understand them. However, as McCarthy (2007) describes, not all parents are so understanding: Monsters are after all our first creative acts as humans. From early on we dream them and imagine them. They dwell under our beds or behind our bedroom doors. They peek in through our windows. They are often right at the edge of our developing consciousness, part instinctual urge and part deity. We wake our parents in the middle of the night because of them, and our parents try ineffectually to dispel them by saying things like ‘There’s no such thing as monsters’ or ‘It was just a dream’. (McCarthy 2007, p.19) It was thought that children would grow up able to deal with the world if we made them ‘tough’, which meant no ‘namby-pamby’ cuddling, especially for boys. Some of the extreme cruelty in the Romanian orphanages happened because the untrained staff believed that by not cuddling the children, they would grow up as survivors in a harsh world. ‘Don’t make them soft,’ as one caregiver said to me (I was struck by the irony of the word ‘caregiver’). Many children ran away from these institutions at a young age, as life on the streets was preferable to the brutality and hunger in the homes. Many of them experience a dichotomy between longing for love, affection and attachment to a significant individual on the one hand, and the fear of settling in one

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place on the other. There are numerous attempts to ‘settle’ children and teenagers who live on the streets and railway stations in Romania. However, many of them will try it for a few weeks and then disappear again; they often come back for a few more weeks but they need ‘to go walk-about’, sleeping rough and begging in the supermarkets for out-of-date food. They have child-like attachments to adults who offer shelter, classes, outings, clean clothes and food but for them it seems that the attachment to a place is too scary. When I use the technique of drawing their self-portraits, they are often baby or child-like figures and almost always there is an idealised house drawn with the portrait.

As Masten has pointed out, ‘Resilience does not mean “invulnerable” or “unscathed’!” (Masten 2000). Children who seem unscathed by their past neglect or abuse may well have just shut down their emotional life because it is unbearable. Lahad (2000) identified the dominant ways that children deal with stress, through the ways they ‘meet the world’: belief, affect, social, imagination, cognition and physical. Through observation of children in bomb-shelters and community centres, he found that children dealt with the events and shocks in their own way. Some played sport or danced (physical), others talked logically and rationally (cognition), others showed and shared their feelings (affect), others prayed or in some way acknowledged a higher power (belief ),

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many children shared and played with their friends (social) and yet others told stories and developed creative activities (imagination). All of these children had a different way of ‘meeting the world’ and it is important that we as therapists are able to be as flexible in our resilience work in order to meet the child on their terms.

Stories or events? Lahad’s (2000) Six-Part Story (BASICPh) method described above that he used to elucidate the coping strategies of children under stress is a very useful starting point for all age groups. However, I have found that it cannot be applied with some children. Conceptually they struggle with the sequencing and a single event is all they can communicate. ‘I ran away from the orphanage’ is not yet a story; it is an event. Many street children and teenagers have great difficulty in ‘holding a story’, where one thing leads to another and there is some resolution or outcome, or there are consequences. Life seems much more a collection of events: ‘trains arrived – leftover food’. We were able to persuade one group in Mumbai to attend a workshop because they would have a copious amount of food and not miss out on the scraps they foraged from the trains. According to Garmezy and Rutter (1983), children will be more resilient if they have strong parents who are able to deal with poverty or violence in the community. Gabarino et al. (1992) also make the point that children need to have resilient or ‘coping’ parents. Parents need to manage their own stress in order to support their children. Maston (2000) has identified resilience in those children and young adults ‘who have the capacity to “hold onto meaning,” to give the events in their lives an emotional framework that somehow lets them cope more effectively’. She asks what the ‘ordinary magic’ is – those factors that provide at least part of what is needed to help children survive acute life events and move on to healthy adulthood. It is estimated that for 80 per cent of all children exposed to powerful stressors there is no developmental damage (Rutter 1979; Werner 1990). There are certain factors that contribute to this resilience: the child’s physical and social environment; a stable, emotional relationship with at least one parent or other significant adult; a supportive educational environment. Parents act as an

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emotional ‘buffer’ for the child who is developing coping strengths and resilience. According to Garbarino et al. (1992), ‘Most children are able to cope with dangerous environments and maintain resilience as long as their parents are not stressed beyond their capacity to cope’. Community and schools programmes can provide crucial support systems for parents and children to enable greater resilience to develop. Authorities need to be aware of the impact of violence and poverty on the coping strengths of parents and therefore the resilience of their children. Children who grow up in a violent environment are most at risk of developing psychiatric or behavioural disorders. Erikson (1965/1995) maintains that learning to trust is the most important task for the infant (see Chapter 1). Learning ‘Basic Trust versus Mistrust’ is the first of Erikson’s eight stages of social and emotional development. This occurs during the first two years and is based on the way a child is nurtured and loved, whether he or she has formed a ‘secure attachment’. Trust and security allow resilience and optimism to develop. If trust does not develop, a child is insecure, mistrustful and fearful. Children who have not learned to trust through their primary attachment relationship not only have difficulties in their social relationships in later life, such as suspicion and lack of trust, but also have difficulty with resilience: coping with adversity. The more secure the child, the more resilient they will become, and the more able to manage changes and difficulties as they grow up. It is within close attachment relationships that children learn to make sense of themselves, other people and social interactions. They begin to develop mental representations of how to view the self and others: their internal working models contain expectations and beliefs about themselves and others. The young child is unable to carry a mental representation and only draws on stimulus reaction. The stimulus in Jenny’s situation was inappropriate sexual arousal, prolonged pain, and threats of punishment if she said anything to anyone else. There was not a significant adult with whom she could share what was happening, even if she ignored the threats, as the extended family were also caught up in schedule 1 offences involving minors. She liked the social worker who removed her into care; however, she was leaving the district and going to another job. Jenny was now thoroughly confused

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with her yo-yo feelings: disgust at the abuse, but sudden loss of her family, the affection from the foster carers but her own self-loathing. The foster carers in the end could not cope, it was affecting the couple’s relationship, and amongst everything else they expected her to be grateful. ‘And gratitude wouldn’t come amiss young lady’, the foster father shouted as the girl and social worker left to find yet another home. In the end she spent the rest of her child and teenage life in a series of children’s homes without any significant attachment figures. Her friendships were brief because she expected so much of them or she backed off suddenly as though anticipating abuse. She is permanently in despair.

The differentiation of feelings The child who is not resilient is less able to differentiate different feelings either in themselves or in others. They become socially confused and feel incompetent and that often results in aggression, withdrawal or both. When I have tried to work on a scale of feelings, say from ‘annoyance’ to ‘rage’, they have found this very difficult. ‘I am just angry, very angry’ is often the response. One approach that is very useful in this situation is working with feeling cards (Hickson 2005); each card portrays a character showing a different feeling and one is able to play card games, charades and mimes in a light-hearted way. Many children cannot ‘finetune’ their feelings and one suspects that they did not experience a finely tuned attachment with their mothers.

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Some children are able to overcome the adversity and find coping strengths to see themselves through to a more hopeful state of being. I am reminded of one prisoner group at a maximum security hospital. They were making masks in four groups of three or four people, and each groups produced a very different mask, almost mirroring the variations in attachment disorder. I use large masks made in small groups as a means of working ‘larger than life’, and as a way of making the mask safer for expressing feelings. The following were all ‘masks of attachment’ when I look back on them: • Disorganised: hypodermic eyebrows, beer-can ear-rings, condom nose, bank-note teeth. • Ambivalent: question marks on the mask, tears, exclamation marks and a vertical divide with horns on one side and halo on the other. • Insecure: grey colouring with ‘boil of badness’ and ‘scar of life’; one new member insisted on a ray of hope – a yellow circle in the eye. • Anxious: journey of life mask going through different states from dark to light, chaos to order – always through difficulty. The mask with the condom produced gales of laughter during the making but when a woman from the Salvation Army came on a visit, the group immediately hid it and covered it up with their arms until she had gone. The horns and halo mask was interesting because it did create two aspects of the self but they were oppositional: no question of a journey from one to the other or any movement. It was stuck with question and exclamation marks. The one man who had insisted on the ray of hope amidst this grim grey mask seemed likely to be the one who would survive. The group who produced the ‘journey of life’ mask showed a level of understanding of what was needed for change and the possibility that they might complete that journey. In an earlier session with this group one of the men said to me, ‘The trouble is, Sue, being good is so boring.’ So far we have been looking at ideas of resilience and how they are obviously connected with early attachment experiences. We have seen how some children can survive the most horrendous abuses through

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having resilient parents or through their own coping strengths, and how some children and adults do not manage to cope.

Resilience and empathy I have great concerns about the impact on society of a seeming increase of teenagers and adults without resilience, with no empathy and perhaps with little sense of adventure. I describe in Chapters 1 and 2 the importance of the playful attachment; how sensory, rhythmic and dramatic play give the child their first ‘dramatic experience’ – the ‘as if ’ response. Mother and infant imitate each other and take on gestures, sounds and expressions as if they were the other. I maintain that the development of being able to be ‘the other’ enables the development of empathy: of being able to feel as the other person feels and thereby to have some idea of the consequences of our behaviour or actions on the other person. Therefore good enough attachment not only makes an impact on the healthy growth of the individual and their ability to form satisfactory relationships, but also affects the individual’s capacity to relate to others in a more general sense, with empathy. The child who is not resilient is likely to have great difficulties feeling empathy. There is a great vogue for ‘reality’ TV shows that illustrate how people do not get on together whether as neighbours, families, in chat shows or in contrived settings. The entertainment value is supposed to be in the conflicts, violence and ridicule being expressed and experienced. People’s discomfort, pain, shame and humiliation have become the entertainment of others. People being ridiculed is supposed to be funny; a new television commercial as I write this book shows a child falling down a hole on the beach that was covered by a towel and the parents think this is very funny. Historically, live theatre provided both our entertainment and learning. We were able to explore the dilemmas of royalty and peasant, the implications of cruelty and the effects of unrequited love. The word ‘theatre’, coming from the same root as theory, meant we learnt something when we went to the theatre. The ancient Greeks believed that it would keep society stable because people could witness the extreme crimes and violence (although always off stage – we heard about it from the messenger) without committing these acts themselves. We could bear witness to Pentheus being torn limb from

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limb in Euripides’ The Bacchae rather than tearing each other apart on the streets. When theatre was central to society it created what we call ‘dramatic distance’ between observers and the play. This distance enabled us to come closer to the great and often uncomfortable themes that were being expressed. There would be structure and usually resolution to the enacted story. However, we now have far less live theatre and much of it is commercial theatre such as musicals because theatre subsidy decreases every year: it is seen as a minority luxury rather than as a necessity for the nation’s mental health.

Collapsing of time and space and training Traditionally it would be trained or experienced actors who would carry this responsibility of expressing important truths to the audiences. Now we have people being chosen without experience ‘from the streets’ and their auditions and misery become another piece of painful entertainment on television. All of this is supposed to be more real – yet we all know that it is not real at all. It is like saying that Chit Chat magazine is a true reflection of people’s lives. I think the following examples illustrate how there is no ‘as if ’ between thought and action. There is no empathy that regulates this behaviour either in the media or in the streets. • A culture of ridicule, where television reality programmes, panel games and advertisements show role models of adults putting each other down: we also see this with TV chefs, quiz shows and chat shows. • A culture of selfishness, where adults are shown wanting to keep food or chocolates for themselves, or children don’t share their favourite cheese spread. • A culture of violence which starts with language: in the supermarket we are told to ‘grab and go’ at a food counter; certain crisps are called ‘grab bags’; stain remover is called ‘Shout’ and there are also ‘grab and fly’ for sale meals at airports. • The culture of violence against the self is increasing with eating disorders, self-harming and other addictive behaviours.

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• There is a culture of avoidance, where a child or adult cannot tolerate touch or sees it as a threat. An accidental bump in the street or playground has a threatening response: ‘I’ll get you for that.’ • Many schools do not allow teachers to touch pupils – even a reassuring hand on the shoulder or putting a plaster on a cut. • Everything has to be now: whether it is food or possessions or academic prizes. What do all these things share? A collapsing of time into the now – no one can wait either for food or to think – a collapsing of space such that anything can happen anywhere – a collapsing of social relationships where there was mutual respect and generosity – a collapse of trust and sharing because things should be grabbed and kept. We appear to be talking about survival rather than resilience. What is interesting is that we live in a reasonably affluent society and we have a highly sophisticated system of health, social services and education, yet it produces people who behave as if they are only just surviving. Perhaps people are not surviving emotionally? The stuffing of food outside a baker’s or take-away looks like a response to famine or deprivation, yet there is always jam tomorrow in most of Western Europe. What therefore is the real hunger? What is being enacted on the streets by children, teenagers and adults? Surely we need to look again at the question of emotional hunger? For the child who has never been held or supported or who has been abused or neglected, there will be a permanent hunger that will never go away. There will be attempts to assuage it with food stuffing, drugs, alcohol, a whole range of substances; bodily stuff to replace emotional stuff. The circle of attachment was broken or never strongly in place and there is an attempt to ameliorate the pain through food, drugs and drink. It seems that social relationships have been replaced by the cult of the individual, seen at its most extreme by the teenager who selfharms to convince him or herself they have feelings. Or we have the identity of the gang or herd who will tear others apart either through physical violence or through verbal bullying or ridicule. Gang identity provides a sense of belonging and attachment, and in many ways the gang becomes like a replacement family.

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It seems that we have lost the closeness that trusting relationships can maintain and paradoxically we have lost the distance that theatre can create around extreme behaviour and violence. We are out of touch with our social rituals that help us to function as social groups by setting limits – and we are terrified of our imagination because it might just go out of control! I have often said in this context that perhaps Freud had got things back to front. It isn’t that people are frightened of sex and therefore sublimate it in theatre and the arts – it is that people are terrified of theatre and sublimate it in sex. A performance of the flesh is easier to deal with than a performance on the stage. The closeness and trust for the infant is expressed physically between carer and child – and distance is expressed through the symbolic rituals and theatre performances that address the culture, beliefs and values of the social group. The more we examine the very fabric of our society, the more we can see that it is built around theatre, ritual and dramatic acts of play and performance. We have the dramatic response of the newborn infant, the development of mimicry and imitation leading into pretend play. Pretend play is necessary for ‘Theatre of Mind’ (Whitehead 2003), but before we can have Theatre of Mind, we have to have Theatre of Body (Jennings 2005a), which is the physicalisation of experience and feelings that usually starts with pregnancy, as discussed in detail in Chapters 1 and 5. Perhaps we should call Theatre of Body, the Theatre of Pregnancy and Birth. The very visceral and dramatic components are the necessities for living. McCarthy (2007) talks about ‘a body-centred approach to play therapy’, yet most play therapy does not involve and even discourages touch and body work. Why do we avoid so much physical communication? It seems to be a contemporary issue that keeps bodies apart for the wrong reasons. Sensory and embodied play are part of NDP, together with rhythmic and dramatic playing. Part of our dramatic interactions between mother and baby is unconditional positive regard (Maslow 2007), the transmission of hope

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and trust (Erikson 1965/1995) and the sensory, rhythmic and dramatic playfulness that forms our primary attachment (Jennings 2007a). This beginning then quickly grows into symbolic play because the infant is already practising the use of the dramatic imagination within the first social relationship – that of mother and baby. Neuro-DramaticPlay has a continuum (see also Chapter 1) that is physicalised or embodied, from pregnancy play to social play that includes consonant play, echo play, mimicry and symbolic play. If that were not enough in terms of the child’s healthy development, he or she is part of the rituals of family and social groups through which the embodied ideas and values of the culture are transmitted and embedded. We are committed to living together as social groups and experience life through each other (Whitehead 2003); we share jokes, memories, gossip, adventures, stories, illnesses. But now this is under threat as damaged young people are being made to go back to work when they have had a baby; there are some strong voices who regard therapy as ‘the soft option’ and say we should bring back the boot camp; the arts generally and theatre in particular are at the margins. The irony is that they return quickly as arts therapies! We are more concerned with mending the pieces than with preventing the cracks: it is time to focus on a preventative approach, rather than a curative reaction. Contemporary social situations have made an impact on a child’s capacity to be resilient. The trust that is born from the primary attachment is being undermined and sabotaged with new expectations being put on individuals, families and groups. The capacity to love and be loved is surely the basis from which resilience and empathy can develop and grow.

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Neuro-Dramatic-Play is central to developing resilience and empathy in growing infants. This is even more urgent as we live in a society where there is an increase of raw violence that often goes unpunished. It is also necessary to relearn that an ‘instant’ society is not necessarily contented as it leads only to more need and greed. Neuro-Dramatic-Play can be applied to address some of these issues: • The language of society is changing: there is more violence and selfishness. • Bullying is on the increase despite anti-bullying programmes in many schools and the compulsory training of teachers (Hickson 2009). • Media portrayals in advertisements communicate selfishness instead of sharing. • There is a lack of understanding of empathy and how it develops from the attachment with the mother. • Through establishing the ‘as if ’ concept, it is possible to change the existing lack of empathy in young people. • Stories for peace and theatre for empowerment are ways in which we can begin to challenge the status quo. This chapter establishes the theory and practice of Neuro-DramaticPlay. We will now see how Neuro-Dramatic-Play can be applied in a wide variety of situations where there are attachment needs, learning difficulties and the perennial stress of teenagers who we feel we cannot reach.

Chapter 7

NDP and Children with Attachment Needs I look his way, wishing he would look mine, Wondering, dreaming what it would be like if he would only look my way. I stare deep into his eyes and I seem to fall, Yet no pain will come when I hit the bottom of this endless pit. (Rabisa 2008)

Introduction The early chapters of this book laid out a framework for the theory and definition of NDP and how it is essential for the development of the child. In this chapter I develop in more detail the evidence for the concept of NDP and show how it can be understood by practitioners in the fields of neuroscience, biology, gynaecology and psychology and by child development theories.

NDP and EPR progressions The focus for NDP is from conception to the first six months of the child’s life, with a focus on the immediate post-birth time. Some authors (e.g. Odent 2001) suggest that the critical time in a child’s development is the first twelve months. I would like to clarify that I maintain that up to six months is the specific NDP time of sensory, rhythmic and dramatic play. I think that the first two years are very important but different: for example, there is a shift from the NDP progression to

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the EPR (Embodiment-Projection-Role) at around six months, which is discussed in more detail in Chapter 1. There are specific changes happening at six to seven months, which involve infants being more aware of the wider world and others in their universe. Later chapters in this book look at the various contexts for applying NDP with children and teenagers, and where new training needs to be available for teachers, therapists and carers, including foster carers. It is not just a question of addressing attachment issues in some form of therapy, it is more fundamental than that: it is an understanding of the basic concepts that underpin attachment: that it is playful and involves very specific forms of play that both shape the brain as well as shaping relationships.

The real needs of the child Many therapists do not ‘do’ sensory, rhythmic and dramatic play. They would be horrified at the idea of using a child’s heartbeat as a means of getting into rhythms and drumming. They usually work from a ‘follow the child’ perspective, and regard other forms of intervention as ‘directive’. However, a child-centred approach, in my view, has to address the real needs of the child, which will then need to take a multimodel approach in therapy. The arts therapies provide a form of active involvement where child and play worker or therapist can co-create together, as well as establishing an appropriate ‘attachment role-modelling’. I cannot reconcile in my own thinking the fact that therapists who call themselves non-directive are extremely controlling in terms of time and space, and also very imposing because they make interpretations which are based on a formula from their own ‘closed circuit’ training. Alice Miller (1992) allows her mind to create different associations and she is mindful of the impact of child rearing on every child: Every human being is born into the world without bad intentions. And with the clear, strong, and unambivalent need to maintain life, to love and to be loved. But if a child encounters hatred and lies instead of love and truth; if, instead of being cared for and protected, it is beaten, then it should

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be able to shout and rage to defend itself against idiocy and wickedness. (1992 p.155) John Bowlby addressed the actual attachment experience of the child, rather than the child’s fantasy, and he was particularly concerned about children who had been put in institutions. He looked at a study on early childhood sounds comparing children brought up in families and those in institutions: A very careful study of infants’ babbling and crying showed that babies from birth to six months in an orphanage were always less vocal than those in families, the difference being clearly noticeable before two months of age. This backwardness in ‘talking’ is especially characteristic of the institution children of all ages. (Bowlby 1965, p.23) I am concerned about the real attachment needs in relation to the deprivation of the play experience of the newborn child and how that might be remedied through play intervention, including ‘echo play’. Echo play starts during the pregnancy when the mother is trying to sense what her baby is doing and tries to mirror it through movement or sound. Pregnancy is like a rehearsal that moves towards the theatre of birth on which the real dramas of attachment will be staged: there will be two characters, the mother and the baby.

Therapists need to be flexible in their approach to children with attachment needs, rather than adhering to a dogma of one psychological belief system. Children who are trapped, for example, in a cycle of self-destruction, including eating disorders, will usually continue their cycle if left without intervention. Many therapists refuse to work with people with eating disorders because they think the prognosis is poor. Art therapist Åse Minde (Jennings and Minde1993) is one of the few people I know who has been able to maintain people with eating disorders in long-term therapy. Arts and play therapies can integrate

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techniques and processes that can allow transformation and change. It is still a child-centred approach but needs a fine sensitivity, the fine-tuning of the early attachment relationship. This enables an understanding of the ‘guide–companion–follower’ relationship. The empathic approach of the teacher, carer and therapist is necessary to facilitate positive changes. This is developed in more detail in Chapter 12. We also need to take into account the attitudes of our society which is not always supportive of prime attention being paid to the nurture of children; as long ago as 1969 John Bowlby stated: Over the years, the belief that experiences of early childhood are of much consequence for the development of psychiatric illness has grown in strength. Nevertheless, the basic hypothesis has always been a subject of sharp controversy. Some have contended that the hypothesis is mistaken – that psychiatric illness has its roots elsewhere than in early childhood; whilst those who believe the hypothesis to be fruitful are still at sixes and sevens regarding precisely what experiences are relevant. (Bowlby 1989/2005, p.97) Bowlby was writing well before the surge of interest and research by neuroscientists into the importance of nurture for the growth and development of the infant brain. His approach is based on biology and ethnology and he comments that all mammals have a bonding mechanism with their offspring, not just humans. Bowlby made several films showing the distress of children being separated from their parents when they went into hospital (discussed more fully in Holmes 1993); indeed he talks of his own distress when separated from beloved adults. Bowlby in his early writings caused a furore not only among the psychoanalysts who rejected his writings about the real experiences of the child rather than the child fantasy life, but also among the early feminists who saw his emphasis on the quality of mothering as an affront to the emancipation of women. Many women as a result felt guilty at the necessity of their working and leaving their babies in childcare.

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The dance attachment Winnicott’s (1965) writing also makes a significant contribution to the understanding of attachment (see Chapter 2), and he coined the phrase ‘good enough mothering’, which certainly helped many mothers to assuage their feelings of incompetence because they were not perfect mothers. Winnicott also talked about ‘primary maternal preoccupation’ and its importance for the healthy development of the child. I have likened these early interactions to a dance between mother and baby: The mother is engaged with her newborn baby and dances their dance. Mother and baby then take turns to lead the dance, as they respond to each other in a playful way.

The relationship between mother and baby is not one way in its dependency, it is interactive and soon there is turn taking. Mother and baby are dependent on each other, and enjoy repeating sensory, rhythmic and dramatic games together. Gradually they both innovate new interactions and elaborations of their playing together. There are favourite stories that can be repeated over and over again. All this creates some predictability for the child on the one hand, and exciting new stimulus on the other. I do not see this playfulness as the regression of the mother as suggested by some theorists (Raphael-Leff 2001); far from it, the mother is attuning to the needs and playfulness of the child and her own playfulness is guiding her, which in turn allows the baby’s growing playfulness to guide the mother as well. This mother and baby dance has an enormous impact on the child’s developing brain and body as well as influencing future social relationships. Neuroscience has helped us understand that not only does the mother–child dyad profoundly influence the brain development, but also the biology of attachment and the chemicals that are being released all contribute to an integrated model of attachment. In a section called ‘The neurochemistry of bonding’, Cozolino describes very poetically this complex process:

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The neurochemistry underlying mother–child bonding is very complex: The warm and happy feelings; the desire to hold, touch and nurse; the pain of separation and the joy and excitement of reunion all have neurochemical correlates that allow us to experience these wonderful feelings. Through a bio-chemical cascade, mother–child interactions stimulate the secretion of oxytocin, prolactin, endorphins, and dopamine, which create positive and rewarding feelings. (Cozolino 2002, p.176)

Toxic effects of stress and anxiety If these positive ‘feel-good’ chemicals are not released, and there is stress and anxiety in the mother–baby relationship, there will be other ‘feel-bad’ chemicals such as cortisol that increase, and over time become toxic if they are present in large quantities (also see Chapter 4). A situation can develop whereby instead of mother and baby feeding their playfulness together, they start a negative spiral of interactions. The baby does not respond how the mother would like, so the mother feels rejected and gives up trying; the baby is confused and is distressed if eye contact is withdrawn and may start to cry so mother puts the baby in his or her cot. The mother feels baby as monstrous; she really needs help to reinforce the positive feelings and her own skills. The first six months is a critical time and the distressed mother needs some empowerment through skilled adults. If the first six months becomes an assault course, it will take a long time to effect any repair.

It is suggested that babies who are adopted before four months old, i.e. within the critical time, will be able to adjust to a new attachment relationship, providing of course that the adoptive parents are able to provide a consistent and supportive environment. Their cortisol levels significantly reduce in the new attachment relationship. This research was done with Romanian orphans (Chisholm et al. 1995); the

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researchers looked at the developmental pathways in children from the orphanages. One group had been adopted as very small babies and the other group had been adopted later. In her book for parents and carers, Sunderland (2006) points out that a child’s brain is unfinished when they are born and therefore can be ‘sculpted’ in both positive and negative ways. She discusses how we need to ‘parent the brain’ and draws people’s attention to the enormous influence parents have on their child’s development: Everything your baby experiences with you as his parent will forge connections between the cells in his higher brain. The human brain is specifically designed this way so that it can be wired up to adapt to the particular environment in which it finds itself. The adaptability works for or against the well-being of the child. If, for example, a child has bullying parents, he can start to adapt to living in a bullying world, with all manner of changes in brain structure and brain chemical systems, which may result in hyper vigilance, heightened aggression or fear reactions, or heightened attack/defence impulses in the reptilian part of his brain. (Sunderland 2006, p.22) Contemporary developmental theories of how children thrive, whether they are based in neuroscience or biology or play or psychology, all draw attention to the critical period that follows the birth of the child. No longer do we have to split nature and nurture; one influences and stimulates the other. At last we are beginning to integrate our approaches in order to fine tune our work with children who are at risk because of their attachment needs.

Is it possible to reattach? So what are these attachment needs? And is it possible to reattach? And do we feel that the agent of change is a therapist or a teacher or a new foster mother? The issues of fostering and adoption are dealt with in Chapter 8. Here we will look at the day-to-day needs that could make a difference for the mental health of the child; how can we apply Neuro-Dramatic-Play in ordinary life with families who are angry or fearful or depressed or who just don’t get it?

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If we have the opportunity to talk with the parent(s) we will often find that their early life experience also had difficulties with relationships or succeeding at school and making friends, or feeling loved and cared for. They will make comparisons with themselves and say, ‘Well, I was always a shy child,’ or ‘His dad was a bit of a lad so I am not surprised.’ It is often difficult for them to hear that life could be different. In many families, outsiders are seen as interfering and judgemental: everyone is either a teacher or a social worker or from the police. A therapeutic play worker or just play worker, for example, perhaps could make a difference through working out of the doctor’s surgery, which could be less of a stigma than going to a psychiatric clinic. Alternatively there may be opportunities to work within the school or kindergarten or nursery. I would hope that it would be possible to have a preliminary session with the mother; then work with the mother and child together; then with the mother, then with the child and then a final session together. Individual situations would try to integrate the father as well, perhaps at the beginning and end, or more if he is available. With attention being focused on mother’s needs initially, we may find a shift in perspective. This way everyone’s needs are being met rather than mothers becoming jealous because of all the attention that is being showered on the baby. These ideas are elaborated in more detail in later chapters. It is really crucial to engage with mother or carer as an equal adult or equal parent. The mother who feels a failure needs a huge boost and the mother who does not care is probably masking feelings about never having got things right. We are not talking about therapy here, it is more mentoring or befriending. Talking can go from the general life to the baby specifically and then if appropriate touching on the mother’s or carer’s own childhood. Very often parents who have difficulties with attachment with their children have had similar experiences in their own childhoods. Attachment difficulties can sometimes be traced back through several generations. It is generally assumed, too, that we choose our partners, to some degree, to satisfy unmet attachment needs, and that we sometimes choose to have children in order to meet our current attachment needs. Neither of these situations is necessarily damaging unless they are taken to extremes.

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Part of Penny’s story

Penny had longed for a baby of her own ever since she could remember. Her own experience was of ‘distant’ mothering where her birth mother worked as a professional writer and her father was always away. She was an only child and felt very isolated. She was sent to boarding school at 11 years old, a private high status school. She rarely spoke for most of her time there. She would read in the library, offer to help in the kindergarten attached to the school, avoid sports whenever she could and generally got through things. Her parents were pleased when she met Keith, a junior doctor, and they were married. They both wanted children but nothing happened and Penny became distraught and insisted they had fertility treatment. It took over a year for conception to be successful and during that time Penny could think of nothing else, counting days and cycles, taking temperatures and slowly Keith lost interest. Although he was pleased at the pregnancy, it was more a question of relief from Penny’s preoccupation. Throughout the pregnancy and then birth Penny was only aware of one thing, having her baby safely. Her anxiety level that something could go wrong after her daughter was born finally drove Keith away. However she appeared not to notice too much. Her child whom she named Polly became the sole focus of her life. Fortunately because Penny had a vigilant GP, her baby was referred for developmental assessment and found to be functioning far behind her normal milestones. Penny continued to baby her daughter as if she was still a few months rather than approaching her first birthday. A smothering attachment was literally stunting her growth. Attachment work for Penny and her baby with a highly sensitive dramatherapist enabled Penny to look at her own attachment needs and the importance of allowing Polly to develop socially and also to widen her frame of reference. Penny became very good at playing make-believe, just as she had at boarding school. Later there was some kind of conciliation between Keith and Penny and he was an important figure in her growing freedom.

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This situation is an interesting one and we can see how Penny is so identified with her baby that she gives her a similar name; it is as if the Polly became Penny which in the very early stages of life gave the baby all the necessary attention; however she was unable to allow it to be the other way round. There was no echo play. The difficulties really started when Penny would not allow her baby to develop beyond ‘delightful babyhood’. She had been terrified of losing the pregnancy, she had been terrified that she might die at birth, and now she was terrified of her child growing up and eventually leaving her, as she had been left while she was a baby. This terror at abandonment and loss parallels Penny’s own upbringing which had involved a series of au-pairs, an after-school child minder and then boarding school. Once she became pregnant her feelings for the future baby took over from her relationship. The situation turned into a one-to-one, parent–child dyad, that had no room for another adult. There was no room for a mutually adult relationship between Penny and Keith. She alternated between being mother and baby and it was sometimes difficult to recognise who was the most grown-up, Penny or Polly. Penny’s terror was very real and it became apparent that the constant feelings of abandonment that she had as a young child would now be finally enacted. She would be rejected as a mother and as a child: her internalised mother and child were both very fragile. She had had no ‘role model’ of good enough mothering and any sense of developmental progression. Furthermore her internalised child was in constant fear and full of unresolved conflict that she would never be good enough to be loved and cared for.

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Immediately after birth In Neuro-Dramatic-Play I am concerned with the time before birth and the six months afterwards; I am particularly interested in the time immediately following the birth. This time would be when nurses would remove babies and say that mothers needed a rest! In more recent years in many centres, mothers cradle their babies immediately and stay with them in close proximity. Attachment theorists and neuroscientists all discuss the importance of early attachment, but what about the minute-by-minute, hour-by-hour activities that are happening immediately after birth? There are many contrasting theories and traditional practices that do not necessarily concur. Odent (2001) discusses how many cultures (not just western ones) disrupt the early attachment time, and he suggests that this is in order to produce children and therefore adults who are more aggressive. In most known societies, until now, it has been an advantage to moderate and control the different aspects of the capacity to love, including love of nature, and to develop the human potential for aggressiveness. The greater the need to develop aggression and destroy life, the more intrusive the rituals and cultural beliefs in the period around birth have become. (Odent 2001, p.28)

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Odent cites the example that many people believe that the colostrum is harmful to the baby, whereas actually the baby is instinctively rooting for the breast often within an hour of being born. Biologically we know that colostrum is precious and healthy, yet historically it was coupled with post-partum blood and considered dangerous and contaminating. Mothers would not be allowed to start breastfeeding until they had been ‘purified’ and these bodily fluids had stopped secreting. There are many other interruptions such as insistence on complete washing, taking the baby away to be weighed and examined. Hospital births themselves are intrusive and carried out in an environment that potentially has a concentration of infections. Yet many mothers would not dream of a home birth: ‘What would happen if something went wrong?’, ‘I feel safer in hospital,’ ‘I would never forgive myself if anything happened’! I have written about the doctor– patient dependency elsewhere, particularly in relation to childbirth and fertility treatment (Jennings 2004). For the purpose of this book, I wish to focus on the sometime obstacle course for the mother who is trying to allow the attachment process to proceed. Bearing in mind the influence that specialists have on people who are vulnerable, is it any wonder that mothers give up the idea of breastfeeding, hand their babies over to others to care for and generally feel undermined in their role as ‘good enough mothers’?

Patterns of attachment behaviour and NDP interventions We have seen in earlier chapters how there are several patterns of attachment behaviour that need our attention: they are attachments that are avoidant, ambivalent or disorganised; we can place these all under the general umbrella of ‘insecure attachments’. When we speak of ‘good enough attachment’, what we are hoping is that the attachment with the mother or primary carer is secure. When secure attachments have been disrupted or have not taken place we need to consider just how far repair is possible. There are also various schools of thought who have differing views on how this repair could be achieved. The psychoanalytic approach promotes the idea of the transference

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relationship, where the child projects onto the therapist the range of fantasy emotions that are felt about the birth parents. However, I agree with Miller (1990) that this process can be haphazard or even dangerous. She states with clarity: Patients and adepts at psychoanalysis, who in their circles are cut off almost hermetically from advances in knowledge, do not know, just as for years I did not know, there is already a means of access to one’s own childhood that is not (as is unfortunately very often the case) dangerous, confusing, haphazard, fragmentary, and irresponsible, but on the contrary, comprehensive, systematic, clarifying, helpful, and committed solely to the truth. (Miller 1990, p.viii)

My concern is that a long-term dependency relationship does not necessarily move the child on. As someone who interacts with children rather than sitting and reflecting, I feel that interactive play can not only get to the heart of the dynamics but also build opportunities for repair through the play activity itself. Neuro-Dramatic-Play principles can actually address in a direct way the processes that were not addressed in infancy. Many children have very messy feelings: life is a mess, they are a mess and continuing the mess seems the only option. They create havoc at school and home, nothing is contained or held and it is as if they were spilling out all over the place.

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The child who expresses their chaotic and messy experiences may do so physically or projectively or dramatically: for example through physical destruction or bodily aggression or self-harm (Embodiment), or through daubing, graffiti or fire-raising or physically destroying his or her picture (Projection), or through playing the part of the bully or the victim or the destroyer (Role) (Jennings 1998). They lock into one aspect of their EPR development and use it destructively. These children may have had inconsistent parenting, pendulum swings between loving and ignoring; lack of ‘holding’ (that gives body boundaries); over-rough play as babies with pinching cheeks or fingers; very loud ‘widdly, widdly woo’; poking and prodding. They often play in a very chaotic way in the play room. It is possible within the playing to transform the negative play into new play activities (developed from Landreth 2002), through an ‘echo play’ approach; as we know echo play occurs in the early days between mother and newborn baby. For example:

Embodiment: • Echo a similar physical activity (‘Throw the ball to me and I will throw it back’). • Set the limits (‘You can play ball but not to hurt other children’). • Transform into new body activity (‘I’ll be goalie and you kick the ball’). Projection: • Echo a similar projective activity (slosh paint around in an acceptable place). • Set the limits for the paper or space (‘This wall is the graffiti wall, the other wall belongs to the church’). • Transform into new projective or art activity (‘Have you ever tried playing the squiggle game with large paint brushes?’).

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Role: • Echo a similar role activity (‘If you are the angry king, I will be the queen who never speaks’). • Set the limits for the role activities (‘It’s fine to be king but hitting the palace servants for real is not allowed’). • Transform into new role or drama activity (‘What does the king think about when he is on his own?’). Give as much opportunity as you can for the children to have sensory elements in their playing: simple massage can be included in embodiment work; finger paints can be used for projective work; costumes for role work can include velvet and other tactile fabrics. We have addressed the issue of how damaged children express messy feelings in very chaotic ways. We also considered the relationship between chaotic and messy feelings and attachments that are invasive or neglectful or disorganised. There are also damaged children who are unable to make a mess and who spend a lot of time making sure there is no chaos or mess. They may well be watchful and often less noticeable because their behaviour is compliant rather than disruptive. They can be very helpful around the house or teacher’s helper in the classroom. There is often an avoidance of attachment and one becomes aware that feelings are ‘shut down’ as if they may be dangerous if they overflow. The ‘shut-down’ child may well result from the following situations: the child is left unattended for long periods of time or witnesses unpredictable behaviour from adults or takes on an adult role in the family. Sexually abused children will often shut down their feelings as a way of coping and because they have been told to keep it a secret. Children also shut down when they blame themselves for death or disorder, or the break-up of parents. The child who is shut down and keeps all chaos at bay will take time to respond to anything less that the most formal of play experience. He or she may well be mistaken for a child with possible Asperger syndrome or autism conditions. Formal play and artistic activities, perhaps puzzles and rule-based games, may enable a trusting attachment to begin. The child may want to be directed and patiently await instructions, but will also make it clear the types of activities that are ‘no-go’ areas.

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Embodiment: • Touch is unlikely to be accepted initially but you can still create contact: use ribbons, long scarves, hoops and balls to contact each other. • Keep open the possibilities for it to lead into more sensory play with water and hand massage cream. • Encourage the transformation into more sensory play as well as rhythmic movement. Projection: • Drawing and painting are likely to be formal but you can gently role-model other possibilities. • Keep more messy resources such as collage in the play room. • Encourage pictures such as self-portraits, monsters, safe places. Role: • This will be the most difficult area: a shut-down child usually will hold on to the ‘here and now’. • Have around simple role materials such as an assortment of hats, caps, half-masks, shawls. • Encourage games, for example with ‘role cards’ or guessing expressions. Sensory, rhythmic and dramatic play are important as an intervention for children who have suffered trauma or disrupted attachments. The play can help to re-establish those creative processes that are at the heart of ‘good enough attachment’ and later resilience in the growing infant. We can observe children whose responses are either chaotic or shut down and both need nurturing playful intervention to help them ‘make sense’ of their experiences. Although we need to develop all the activities, it is important to include as much sensory play as possible. Young children who have been neglected, abandoned or abused without the care of a ‘resilient adult’ are likely to grow up unable to form relationships or deal with the various roles in life that society

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demands of them (Jennings 2008). However, society does not always support an understanding of attachment needs and consequences. Neuro-Dramatic-Play is placed within a context of other theories of attachment and child development, and the importance of the attachment immediately post-birth. Neuro-Dramatic-Play addresses the attachment needs of children whose lives have been disrupted or distorted. Some children will have suffered early disruption through being abandoned or neglected. Others will have had their lives distorted through sexual abuse or emotional or physical abuse. Embodiment-Projection-Role can be applied when there has been a lack of NDP in the early weeks, months and years. We can also encourage: • focused play to encourage parents to explore their childhood patterns • echo intervention with children who are either chaotic or shut down in their playing • role modelling by the teacher or therapist of the possible alternatives to destructive patterns of playing. Chapter 8 will discuss the application of NDP with looked after children.

Chapter 8

NDP in Fostering and Adoption ‘Looked after children’ My name is Rhiannon, I have a mother somewhere - they say terrible things about her – she must be a prostitute and dirty, so that I am dirty too – that is what they say - when they are abusing me – at the home – him – and his son. (Jennings 1999b, p.8)

Introduction Previous chapters have discussed the broad area of attachment needs in children whose attachments have been unsatisfactory for a variety of reasons. For the most part, these were situations where many children were still within their birth families and extended family settings. This chapter looks at the need for NDP where a child has been taken into care and is being looked after by foster carers or has been adopted into a new family. We have already acknowledged that most infants pass through the stages of sensory, rhythmic and dramatic play within the family that provides adequate attachment (Bowlby 1969) and parenting. We know that these three playful processes commence during pregnancy and continue in their most intense form until the infant is six months old. The dynamic quality of interaction between a mother and a young baby can be predictive of the emotional attachment relationship between them many months later (Jaffe et al. 2001; Trevarthen 2005). Furthermore, the time immediately following birth has been shown by scientists to have a critical function in predicting the future development 147

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of the child (Odent 2001). He emphasises that the influence of the ‘birth hormones’ and ‘opiates’ that are present in mother and baby will encourage the primary attachment between them. I re-emphasise this here as sometimes the birth process has been influenced by other factors, such as drug and alcohol misuse, that can lead to the child being taken into care. Alice Miller as early as 1992 described the importance of understanding the impact of parental influences in early childhood: It is in no way exaggerated to say that every tyrant, without exception, prefers to see thousands and thousands and even millions of people killed and tortured rather than undo the repression of his childhood mistreatment and humiliation, to feel his rage and helplessness in the face of his parents, to call them to account and condemn their actions. (Miller 1992, p.viii) The emphasis in NDP is the playful, rhythmic and dramatic essence of the mother and child attachment that forms the core of the attachment relationship (Jennings 2003a, 2003b). If, as I maintain, these early months (from conception ‘awareness’ to six months after birth) are so crucial to the healthy development of children, how much more so is it necessary in interventions with children who have been taken into care and are looked after by people other than their birth parents?

Looked after parents? I think the term ‘looked after children’ (usually abbreviated to LAC) is also relevant to the foster or adoptive parents themselves. Many people who decide to foster children have no idea what to expect when faced with a child who has had a very traumatic past. Not all local authorities have time or resources to prepare foster carers and adoptive parents, and although every child should have a social worker, there is often a very rapid turnover so that neither child nor family quite know whom they will deal with next. There are few resources for foster parents to help them understand attachment issues, a noteworthy exception being Nurturing Attachments (Golding 2008). This is an excellent book that gives a total schema for supporting looked after children.

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One of the biggest dilemmas that I have come across in fostering is the question of whether one is creating a family or whether one is in fact maintaining a small children’s home. It isn’t just a question of local authority and societal policy in finding families for children rather than institutions. It is also an attitude of what ‘this family’ is about, what it believes, and how integrated the foster children will be into an existing family framework. Will the family decide to have a ‘family holiday’ while the foster children go into respite care for two weeks? Is fostering a job, and an important one too, or is it a way of life? Many ‘homes’ that I have visited still have uniform bedcovers and no pictures on the walls. The following is an outstanding example of possible change: A remarkable change from a small children’s home to a large family happened in the North West of England. The home had an institutional framework with a head and deputy head, night staff and rotas. The eight children in long-term care each had their own locked cupboard for their personal possessions in the sitting room and there was another locked filing cabinet with their backgrounds and histories. To call it a home in the sense of it being a family home would be a misnomer. The children’s diet was ordinary and bland, they had little adventurousness in their hobbies or entertainment and were often referred to as ‘you boys’ or ‘you girls’ rather than by their individual names. When a new head of home took over, her mission was to create a family home rather than an institution. Many of the children’s behaviours and attitudes were already formed but it was extraordinary to see the shift in achievement and expectation as the family slowly developed. They enjoyed food from many cultures including their own: there were five racial groups represented in the family. Their bedrooms reflected their own interests and hobbies; gone were the days when eight face cloths had to hang in the bathroom nine inches apart! Life became playful and fun in this family. Most of them have become achievers in jobs and relationships and fulfilling ambitions that were unheard of for many children who have been contained in institutional settings. The qualities of the foster mother and her love and belief for all the children made these successful outcomes possible.

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Not every foster parent has the vision to follow through like this exceptional example illustrated above. Nevertheless there are some important issues to be considered. According to the British Agency for Adoption and Fostering (BAAF), in March 2008 there were 59,000 children in the care of the local authority; 20 per cent of these were under five years and 71 per cent were with foster parents. In a survey carried out by the Fostering Network (www.fostering. net) over half of all foster carers felt they were not given enough information in order to care for a child safely and appropriately. The following topics were highlighted as being inadequate: insufficient information concerning medical conditions; a lack of any history of abuse; little information about general behaviours. Foster parents felt that if they were not given the appropriate facts, they could not address the children’s needs as they should. It has been suggested that there should be a special category of foster placement known as ‘therapeutic foster care’; these would be placements for very challenging behaviour where foster parents would work alongside the other professionals involved in order to meet the attachment and therapeutic needs of the child. This approach is being successfully developed by Daniel Hughes in the USA, eloquently described in Hughes (2006). The subtitle of his book is ‘Awakening Love in Deeply Troubled Children’. Archer and Gordon (2006) suggest that parents really need support to understand the violent responses that many looked after children show to foster or adoptive parents. They describe what they call the ‘attachment based re-parenting approach’, and that it needs to include both nurture and structure. They suggest that it is necessary to help a child do things differently by understanding the child’s behaviour as his or her language and therefore a means of understanding the history of maltreatment. The blending of structure and nurture stems from an understanding that, at heart, children who act violently are not in control of themselves or their feelings, despite their ‘controlling’ behaviour. This apparent contradiction deserves further explanation. While specific incidents of violence may give the child a feeling of mastery and control, at that moment, it simultaneously perpetuates his deepest fears: that

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he cannot control himself and that the adults charged with parenting him are unable to contain him. It is overwhelmingly distressing to a child to feel both uncontained and helpless. (Archer and Gordon 2006, p.33–34) The above description will be familiar to everyone involved in the care of looked after children, and I do wonder whether some basic understanding of attachment needs together with appropriate support systems should be the right of every foster parent. The double trauma of a placement breaking down will only exacerbate the trauma for the child.

Always we are left with the question: are the abusive or neglectful effects of a dysfunctional family more damaging than the trauma of separation, often in sudden ways, where the child is given little information about what is happening? Many children who are taken into care report that no one told them anything about what was going on and they felt bewildered, confused and disorientated. When we make decisions about whether a child is safe or not (and how often as a society do we fail to make this decision?), we do not recognise that however unsatisfactory the setting, a child has some settled routines, some attachments, and is usually reconciled to a way of life. To disrupt this without explanation and subsequent therapeutic intervention is to exacerbate the trauma that the child will suffer. Many children will remember the aggression of the rescuers rather than the abuse of their families. It is hard to differentiate between the harm done by absence and the toxicity of a destructive environment. In situations of parental failing, any evaluation is hard. When a couple keep on abusing their child, when an adult cheats a child out of his sexuality, when neglect shuts a child up alone in a closet, the developmental problems are so

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important that the child has to be removed for his own protection. Thus agonising decisions lead child-welfare workers to ask for reassuring recipes. I know of only two: 1. Separation protects the child but does not provide treatment for his trauma. A protection factor is not a resilience factor. 2. When separation removes a child for his protection, this is an additional trauma. The child already traumatised by his parents retains the memory that those who wanted to protect him only attacked him all over again. So he puts the parental mistreatment in a perspective that enables him to preserve the image of parents who were kind in spite of everything, and he overemphasises the memory on the part of those who protected him. This defence mechanism, dreadfully unjust as it is, is nevertheless habitual. (Cyrulnik 2005, p.18)

Attachment patterns in looked after children Nothing is more daunting for new foster parents than to provide all the conditions for a happy, accepting and loving home, and then to be rejected by the child. It is understandable that some foster parents want to create a kind of children’s home where there are rules, predictability and sanctions, rather than providing a family where there are also rules, predictability and sanctions; the difference is that the foster parents are part of the family. Any family takes on board the value system for the whole family and is also able to recognise the family dynamic that is part of the ebb and flow of all families as they voyage through both safe and perilous waters. For some families who have already established their way of life, to make changes through the arrival of new members, especially those who can be disruptive, is to risk everything they have already achieved. Children who have been in homes where their parents were unavailable emotionally often develop an avoidant attachment. They shut down their feelings as a way of coping and therefore will be

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very cautious of establishing new relationships. These children often show little emotional distress because they have learnt to cope by not showing their feelings since their needs will never be met. Sometimes this can be interpreted that everything is fine because the child is not showing any distress. When it comes to showing affection or appreciation, the child is not showing those feelings either and there can be a growing resentment on the behalf of carers that there is no two-way warmth of communication. However, these children have already built up their internal model of adults from the earlier experience and they continue to avoid close involvement. They also believe that they must be unlovable or they would have been loved in the first place. Children with ambivalent attachment behaviour are usually responding to the inconsistency of the parent’s capacity to form good enough attachments. Teachers and foster carers will describe their behaviour as ‘He’s only seeking attention, ignore it!’ Of course the child is seeking attention because they are never certain when they might receive it so they display the need all the time. They are often clingy, very needy and difficult to sooth. They also have an internal model of themselves as unlovable, but unlike the avoidant children, they are determined to maintain an attachment at all costs, in case the adult might disappear. Their increased distress at being removed from one situation and put in another will heighten all these behaviours; their prediction came true that the parent finally was not there for them. Golding (2008) suggests that there are some children with whom the attachment system tends to be inhibited. She describes how in the type of attachment that is disorganised, parents can be frightening to the child but can also be frightened: A disorganised attachment pattern therefore develops where parents are frightened or frightening to the child. This frightened/frightening behaviour of the parent activates the child’s attachment system. This motivates him to seek protection and comfort, but the source of this is the very person who is being frightening. The child is unable to organise his behaviour at times of stress in order to receive emotional support because the parent is both the source of

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fear and the potential for safety. For the young child times of fear or stress lead to disorganised behaviour. This behaviour is bizarre or ineffective, as the child expresses ‘I don’t know what to do here’. (Golding 2008, p.27) Many of these children are extremely angry and display controlling and defiant behaviour. Their internal model is also that they are unlovable but in addition that they are bad – somehow all this is their fault so it can be bound up with feelings of guilt and shame.

In all instances of avoidant, ambivalent and disorganised attachment, we know that this is caused by the very early attachment process. The good enough attachment that focuses on the reciprocal relationship between mother and baby ensures that a child will develop hope, trust and resilience, and will be able to manage their social relationships in the future and also the ups and downs that life brings. We can observe that there are many adults who feel hopeless, who do not trust the others or the world, who do not maintain stable relationships and who are over-affected by slight mishaps in the world. Sceptics are prone to be critical in the tabloid responses blaming it all on mummy being nice to you – what you need is a healthy dose of boot camp – bring back national service – that is where it all went wrong – we are too soft – a clip round the ear never hurt anyone – I had beating when I was at school and it did me no harm. Of course we know that it does do harm, in a sense. Sue Gerhardt (2004) sums it up in the title of her book Why Love Matters; she describes eloquently and convincingly the importance of love:

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The first sources of pleasure are smell, touch and sound. Babies can recognise their parents’ voices from the start, and prefer them to any other. Being lovingly held is the greatest spur to development, more so even than breast-feeding. (Gerhardt 2004, p.40, my emphasis) She goes on to say: In mother’s or father’s arms, where it is safe and warm, muscles can relax and breathing can deepen, as tensions are dispersed by gentle stroking or calm rocking. The baby’s heart rate has been found to synchronise with the parent’s heart rate; if she is relaxed and in a coherent state, so will the baby be. (Gerhardt 2004, p.40) Gerhardt is effectively describing the ‘Circle of Attachment’ that I discuss in Chapters 1 and 2. It is not without significance that she also refers to the mother’s state as being not only relaxed but also coherent. Mothers who are anxious, fearful, depressed, distracted or detached will be communicating other messages to the child. If a mother rocks her child when she is on her mobile phone, it means she is putting the focus of her attention elsewhere than the baby. She is not looking after herself and relaxing. Mother’s coherence is affected by her financial situation, the support she has and whether she has worries about being a mother. If she can rock and be emotionally available to the changing moods of her baby, this will communicate itself in a coherent way, even if there may be worries that preoccupy her from time to time. So foster carers may be faced with clinging or shut down or aggressive children who are coming into their care. The reality of the child who arrives may bear no resemblance to the child they were hoping for, and were willing to nurture and cherish. It is comparable to the disillusion experienced by parents who have fantasies about their unborn child, and do not adjust to the real baby once he or she is born. Foster parents are often faced with a child who demonstrates they do not want affection from a new family when they have been deprived of their family of origin. Sometimes they try to control the foster family by being controlling or manipulative. So how can we work with NDP in these situations? We have talked about the importance of early sensory play and experiences involving

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touch and holding, textures and smells, visual movement and colours, sucking and taste, voice and music. We have also recommended massage as one approach to calming and establishing contact, and how this intensive time of ‘attunement and play’ makes an impact on the child’s brain development and will influence how they manage their emotions and social relationships as they grow older. And we know that disrupted attachment may be followed by trauma if the child does not have at least one parent who can manage the disruption and hold on to safety (Rutter 1997). Often the parents themselves can suffer trauma and the infant is left floating in a chaotic mess of feelings and unpredictability.

The safe haven for the newborn The most important thing for the child arriving in a new and unfamiliar environment is to feel safe and wanted. Their arrival may be sudden and unexpected, and may be after traumatic events. Bombardment with questions is just not appropriate in the early days. Foster parents could be encouraged to implement the ‘Circle of Containment – Circle of Care – Circle of Attachment’. Here is a safe haven that will ‘hold’ them, even if they are not ready for physical touch or affectionate gestures. And within this safe haven they need to feel they are noticed, that they are ‘seen’ and of course welcomed.

The child needs to know very quickly the basics of the new home: where is the loo, their bedroom, when are meal-times, are there any pets, and are they staying here for a short time or a long time? Will it be a temporary foster placement until they are chosen to go elsewhere or is this where it will be for an indefinite period of time? Are we truly able to welcome and hold, and not have such a host of expectations that we cannot see the needs of the child in front of us? The child did not ask to be placed in our care and protection. It is of great benefit if we know in advance some information about the child

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and can adequately prepare for their arrival, even if they do arrive with their worldly possessions in a black bin liner. This is a slight improvement on a situation in Romania where a child had been in hospital because of neglect, and the hospital rang the aid worker to say that the child could now be fetched. They omitted to tell her that the child was in fact dead and she was to pick up the child’s remains in a bin liner. Usually the child will be very confused and cut off from their experience; they may just be numb and not be able to respond to very much. The nurturing needs to be very gentle and foster carers need to be vigilant for clues as to ‘where the child is at’. Have they been the subject of a dawn raid or experienced many years of abuse or been so neglected they have no social skills at all? We can only infer from observation; this is not the time for cross-examination. The children are likely to have been questioned by a host of people as part of their ‘investigations’ and asked to put into words things they have not been able to voice even to themselves. Now is the time for containment and boundaries and as much NDP as possible. It is also useful to see where the child is in relation to their EPR development (Jennings 1990, 1998, 1999a, 2003a, 2004, 2005a, 2005b, 2006, 2008). The EPR development can be an observational assessment in relation to the three stages that every child goes through from birth to seven years. It is something that can easily be taught to foster and adoptive parents: 1. Embodiment: between birth and 13 months, everything is experienced through the body: sensory play, rhythmic play, dramatic play. This stage is important for the establishment of the first stage of Erikson: Trust versus Mistrust (see Chapter 1). 2. Projection: between 13 months and 3 years (with variations), the child is more interested in things beyond the body – playing with toys, although initially the play materials are very sensory: sand and water, finger paints, messy play of various sorts. Towards the end of the projective stage infants are playing with puppets and doll’s house figures, gradually taking on roles in their stories.

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3. Role: between 4 and 7 years, the child will take on roles in dramas and scenes, will play several parts in a story and will be able to sustain a role for the duration of the piece. Unlike the dramatic play in the early attachment period where there is echo and imitation, role work involves the drama itself, and is important for the further development of empathy. Foster parents can begin to realise at which stage of EPR the child is at, as many children will not be at their chronological age in the way they behave or express their feelings. However, all children need to go through EPR in order to function as an adult. There is an observation chart in the Jennings 1998 and 1999a. We have found that if children do not navigate embodiment, they are unable to deal with projective activities, and if they have not dealt with projection in its several forms, they are unable to engage in role playing. They may be able to mimic someone they saw on the street or a teacher, but mimicry belongs to a much earlier stage of development. The role stage means that the child can sustain a role and interact with others. Figure 8.1 represents typical activities that occur in the three stages. For more elaboration see Jennings 2009a.

Figure 8.1: Typical activities in the three stages of EPR

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Foster carers can use assessment diagrams in Jennings 2006 to chart the different activities that their children will play at and can encourage areas where there seems to be deficits. Different activities can be made into playful games and shared between members of the family, although there is a purpose with the choice of games in order to improve attachment. What we are doing is finding ways for the principles of NDP to be appropriate for older children and at the same time allow them to do ‘baby play’ if they choose (see Chapter 9). Chaotic and angry children often need a lot of embodiment work through adult-supported swimming and games as well as through nurture play at bed and bath time, and opportunities for messy play with sand and water, flour and water, seaside play. One very popular massage exercise is called ‘The Weather Map’ (see box) and children seem to be less threatened by it than ordinary massage. If the child is at all anxious, they can do it to the parent or carer and then allow it to be done to themselves. Do a gentle warm-up called ‘The Rain Man’: first of all rub your hands together for a few seconds; then use two fingers to smack the palm of the other hand; then slap your thighs, alternately and loudly; it really begins to sound like rain! The Weather Map (using the safe zone: shoulders to waist) One person sits behind the other and starts to tell the story of the weather: ‘It is raining just a little, hardly at all’ (fingers lightly touching the back), ‘then it grows stronger’ (stronger fingers on the back), ‘and then STRONGER!’ (much stronger fingers), ‘and now the thunder starts’ (using flat of hand on back), ‘and now lightning’ (using side of hands across the back diagonally); alternate the rain and thunder interspersed with some rain a few times; then let the thunder die away, and then the rain, until it stops; ‘then the sun comes out’ (two hands make a circle), ‘and then there is a rainbow’ (one hand makes a large arc).

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The Weather Map embodiment exercise includes light and heavy touch, has a sequential pattern and a structure that can be repeated. It could lead into a projective exercise of drawing or painting a rainbow. It also emphasises which parts of the body are safe for touch. The ‘shut-down’ child rarely initiates any play but waits for adults to tell her what to do. There is often a reluctance to create any mess and a preference for more formal projective work such as colouring in pictures or joining dots. Activities need to be safe and contained without spilling over any borders. It takes time for the shut-down child to be able to play spontaneously and she is happier with simple games where the rules are clear. Therefore embodiment can be achieved through physical games and dance, although sensory play will take much longer. There are also damaged children who are unable to make a mess and who spend a lot of time making sure there is no chaos or mess. They may well be watchful and often less noticeable because their behaviour is compliant rather than disruptive. They can be very helpful around the house or teacher’s helper in the classroom. There is often an avoidance of attachment and one becomes aware that feelings are ‘shut down’ because they may be dangerous if they overflow. Clingy and fearful children will initiate embodiment play especially if it allows touch. Sensory play is enjoyed to the full and most of the NDP activities are enjoyed and repeated. The embodiment play also needs structure so that it can be contained and then security can be established. Exercises that involve breathing and voice are helpful such as the Luft Balon exercise (see opposite). This type of exercise involves not only the body but also the imagination; it has safe touch (you blow the child up on the shoulder) and an element of surprise. The child is beginning to learn to control their body in a fun and playful way.

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The Luft Balon exercise Blow up an imaginary balloon and then tie the balloon with imaginary string, count 1, 2, 3 and pop the balloon while saying a loud ‘bang’. Then blow the child up as a balloon: the child crouches on the floor and slowly stands up as you blow more and more; once he or she is expanded as much as possible, tie the top, find an imaginary pin and ‘BANG’! The child lets all the air out and lies flat on the floor. This exercise can be practised so that the air comes out very slowly, and the child learns to relax. The child can then blow up the adult in a similar way. This is one of the most popular embodiment exercises we do and it has been shown across several continents with every age group. Another progression is to blow up an imaginary balloon, tie on the imaginary string and then go for a walk with it. This is quite a complex exercise and means that the child has to focus on not muddling up the string or catching the balloon on anything sharp. Walking an imaginary dog is another similar exercise.

Messy lives and messy play When a child’s life is messy and chaotic, it may be necessary for them to play in messy ways (see also Chapter 7). Playing messily with earth, sand, water, dough, clay and finger paint is a very necessary, physical and sensory experience. It involves the touch and feel of the substances, but there is also the sound as it squelches or oozes, and the sight of it making formless shapes and melting one into another, and the blending of colours to make a marble effect before it all goes brown! Messy substances also have distinctive smells; they appeal on a multisensorial level. Cornflour and water, custard powder and water, starch and water can also be used. Cooked spaghetti and other pasta can make interesting messy shapes. But best of all has to be jumping in puddles and splashing oneself and playing in real mud after it has been raining. It is important to

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have contact with nature and for damaged children, it can be a very healing experience. If there are limited resources, a wet sandtray and a water trough together with sieves, scoops and funnels gives a lot of scope. This way there will be endless opportunities for messy play – messy play develops its own order once a child is ready to move on. I have found the following verse from the songs of Ralph McTell very reassuring to me when I have been working in the most desperate of settings. I have also shared it with teenage groups

… I have made my bow I take only what I need I am the maker of fire And the planter of seed I have found an order in things And I teach my children To each seed there is a star And to each son a generation.

From ‘First and Last Man’, Ralph McTell

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An intergrative therapeutic story Finally in this chapter I would like to share a therapeutic story that is beloved by children with attachment needs, especially those in foster care.

The Child who Disappeared It is a very stormy night, the rain is lashing and there is thunder and lightning echoing across the forest. The forest family are warm and cosy in their house with the shutters. There is a warm fire in the kitchen stove and the family are sitting round the kitchen table peeling mushrooms that they picked that day. ‘What a night,’ says Mama, ‘You wouldn’t want to go out on a night like this.’ However, there is a knock at the door. ‘Goodness me,’ says Mama, ‘who would want to be out on a night like this?’ She goes to open the door and there in the rain is her cousin, wearing a bright yellow mackintosh and a yellow waterproof hat. ‘Come in quickly,’ said Mama, ‘What brings you here on such a night?’ She comes into the kitchen dripping wet and says, ‘I have brought you the child who disappeared; she has been living with her aunt who was so sarcastic that the child disappears so in order to know where she was, she tied a bell around the child’s neck.’ And everyone heard the ‘tinkle, tinkle, tinkle’ as the child went closer to the fire, leaving big wet footprints on the floor. ‘So you see,’ said the cousin, ‘If anyone can make her visible again, then you can, which is why I am bringing her to you. I must be going, I have things to do,’ and she disappears into the stormy night. The two children stand open mouthed and Papa looks at Mama with raised eyebrows. ‘Right,’ said Mama, ‘It is time for everyone to go to bed. Papa, you see to the two children and I will take our new visitor and show her to her room.’ Everyone races up the stairs and Mama says towards the kitchen stove, ‘Why don’t you follow me upstairs and I will show you to your bedroom?’ Mama is relieved when she hears the tinkle of the bell following her. Mama shows her her bedroom, which

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has a comfy bed and cosy duvet, and tells the child she is going to fetch her a bedtime drink. Mama goes to the stove and heats up some milk, then she stirs in some honey and some soothing herbs and takes it upstairs. She notices with pleasure the bump under the duvet and she places the mug of warm milk by the bed. Downstairs Mama reaches up on the shelves and takes down Grandmother’s Recipe Book. She wraps her shawl around her, sits by the stove and looks down the index to see if there is a recipe to make children visible. ‘Aha,’ says Mama. ‘So that is what I need to do.’ She takes off her red woollen petticoat and cuts out a little red dress and a red bow, and sews long into the night. When she has finished, she puts the dress and the bow at the end of the child’s bed. The next morning the two children come hurtling down the stairs. ‘Where is she, can we see her?’ they say excitedly. They sit down to breakfast and then one of them says, ‘Look, we can see her feet.’ Sure enough, down the stairs comes a small pair of feet topped by a little red dress and a red bow. Nothing else can be seen. Mama says that they are all going to the orchard to pick apples to store for the winter, so they all troop out with boxes and buckets. The children climb up the trees and Papa brings his ladder and Mama sits in the middle of the orchard, lights a small fire and places her cooking pot on it in order to make apple jam. The child who disappeared is so excited as she runs from tree to tree looking at everything that is going on. She then runs to Mama and accidently tips over the cooking pot and all the apple jam soaks into the grass. Immediately she becomes completely invisible again. ‘If you take something from the earth, you need to give it a present,’ says Mama, and as she watches out of the corner of her eye, she notices the child’s feet and now legs, slowly become visible again. ‘So that is what it takes,’ said Mama quietly to herself. Soon it was time to pack up and go inside the house, with lots of apples and jam, ready to store in the larder. The next morning they notice that the child who disappeared now has visible legs and arms but still she has no face or

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head. After breakfast Mama says they can go and play outside while she and Papa get a picnic ready as they are all going to the seaside. The Child watches them as they chase each other round the garden, and the boy says, ‘The trouble with you is that you do not know how to play.’ Just then Papa calls them as it is time to go. They all pile into the roomy old car, and put buckets and spades and food and drinks into the back. The car bounces along the forest road until they reach the seashore. The two children leap out and start playing games on the sand. Mama decides to sit by the water and cool her feet. The Child sits not too far away so she can keep an eye on Mama. To her horror she sees Papa creeping up behind Mama as if he is going to push her in the water. She flies at him and bites him, and Papa is so surprised that he topples over backwards into the water and his hat floats away on a wave! At that moment they can all see the very angry little face of the child who disappeared. Mama says, ‘Papa was only pretending to push me in the water, it was a game’. And everyone laughs together and the Visible Child smiles for the first time… (Inspired by Jansson 1962) This story contains all the elements of nurturing attachment and NDP. The setting is the turbulent storm, familiar to most looked after children, and the kind and efficient cousin brings the child to the new family. She is welcomed but not questioned and is made warm and cosy in her new bedroom, with a duvet like a nest and hot drink. Mama takes her petticoat, the garment that is next to her skin, made from material that is red and warm in order to make the dress. The child is obviously waiting for criticism as she goes invisible again when she spills the jam, but Mama’s philosophical statement is very reassuring. The children are right when they say that the root of the troubles is that the child does not know how to play, and again Mama has to reassure the child that Papa was pretending. At last the anger of the child is safely shown as she becomes visible again. The story takes place in several nurturing environments: the safe

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house where they are peeling mushrooms; the orchard where there is harvest and fruitfulness; the seashore where there is sand and water. Each scene is in a sensory place. Children love to draw this story, enact it as a play and ask lots of questions. The story can be used to go through all the stages of EPR (Embodiment-Projection-Role). Neuro-Dramatic-Play can be developed with ‘looked after children’ as it particularly addresses their attachment needs; especially if the children are clingy, shut down or chaotic in their relationships. NeuroDramatic-Play can be supportive to foster carers and adoptive parents in understanding some of the children’s ways of communicating in their angry dance of life. Neuro-Dramatic-Play techniques with looked after children can encourage and enable: • sensory play and rhythmic play • the developmental paradigm of Embodiment-Projection-Role • containment and reassurance for children who are out of control • therapeutic storytelling that mirrors the child’s situation • affection and affirmation through sensory methods.

Chapter 9

NDP with Teenagers and Young Adults I was a messed up boy and he was a dossa; both of us outcasts. But Kenny treated me like a human being, he cared what I thought. And spoke about things other than fights and money. He made me feel as if, just for a moment, I mattered, and for that I loved him. (Walsh 2010, p.162)

Introduction This chapter is concerned with how NDP can be adapted to working with teenagers who have not had therapy that has addressed their issues, and have sometimes been rejected by therapists who themselves may feel despondent and deskilled. It is my belief that much of the therapy offered to young people is what we feel they should have rather than what they know will help them. Adults do not always know what is in the best interests of the teenager in question. Interventions are likely to take longer, because early patterns of distress, anger and ‘acting out’ will have become set for many years. NDP will be shown to be an appropriate model, especially since it is able to focus on non-verbal and client led approaches. There are references to working with teenagers in previous chapters, especially when discussing resilience and ‘looked after’ children. I have expressed concern at the number of children who grow into adolescence without the capacity to express empathy and whose limited capacity to express emotion is through rage, depression and boredom. Often the underlying feeling is one of fear, and fear

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comes from the insecure attachment during those crucial early months: Erikson’s stage of ‘Trust versus Mistrust’. When we cannot trust others we can develop a cavalier attitude towards everyone and believe that only ‘myself can look after myself ’.

Attachment deficit for the teenager Without the boundaries and limits that are set within the early months for the infant, together with affirmation and constancy, older children and teenagers find ways of developing their own ways of being. Without a secure attachment they find destructive ways to be in control and to assert power over younger children and adults. Many of them will become bullies or will be victims of bullies. Cyrulnik (2005) talks about adults who allow themselves to be controlled by their teenagers ‘because they have not asserted their role in the shaping of their children’s early development’ (p.128). He emphasises that the violence of ‘hyperactive and unstable young people between the ages of 13 and 18’ (p.128) is not the teenage rebellion that we see in most young people. He says that we are witnessing ‘a discharging of violence that was not structured by the environment’ (p.128). Cyrulnik goes on to say: This ‘violence of proximity’ is learned in the first years of life as little boys insult those around them at a stage of development when they are not yet able to understand the psychological damage they are inflicting on others. As early as three years of age they hit their mother, who starts crying because ‘no one tells him how to behave’. (Cyrulnik 2005, p.128) Cyrulnik suggests that because the child is allowed to practise violence without restraint when small, they will then take on children and other adults in their lives, including teachers, as they interact only ‘through words and blows that cause pain’ (p.128).

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One very distressed therapist who came to see me for supervision said that she had a very confused 12-year-old in therapy whose father would pay him every time he spat at his mother. The therapist said that she was having to deal with an impossible situation, where her practice was one of non-directive play, yet finding herself with a situation where the parents persisted in presenting a continuing conflict that exacerbated the therapeutic needs of the boy. Intervention was needed at the family level rather than with the individual adolescent. This is only one example of how parents manipulate their children for their own conflicts rather than the best interest of the child. It is an important consideration whether the parents themselves need therapeutic help with their own attachment experiences, especially bearing in mind that spitting is a very infantile activity.

Teenage communication and socialisation One of the biggest concerns with both teenagers and children is that not only are there primary attachment difficulties but also communication and relationship deficits that teachers and other professionals are unable to remedy. It seems that less and less time is being spent within the family, learning how to communicate, to compromise, give and take and to learn matters of respect. There appear to be attachment difficulties not only with infants but also with teenagers, as reported in an interview with Mary Bousted general secretary, Association of Teachers and Lecturers, in the Guardian in 2010: Middle-class parents are fuelling bad behaviour in the classroom by ‘buying off’ their children with computers and

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televisions rather than teaching them basic social skills… Children were living in ‘isolation’, glued to computer games and TV shows in their bedrooms, and in many cases it was relatively wealthy parents who were encouraging such solitary behaviour. ‘They are not learning about give and take within the family’, she said. Children and teenagers are usually socialised into the norms and expectations of what it is to be an adult through their family interactions. However, more and more time is being spent either watching television or using the Internet so that teenagers are becoming more and more lonely. Watching a screen is a very isolating activity, and virtual realities are no substitute for real life and real interaction between people. We are no longer just dealing with groups of teenagers who refuse to communicate: the newest phenomenon is those who do not know how to because they have never learned.

Images of neglect We are used to seeing pictures of abandoned children, orphans in cots and scavenging children on rubbish tips. These are our received images of what neglect is about, and we are appreciative that in our society most people have enough to eat and drink, a roof over their heads and the right of education, free healthcare and welfare support. Emotional and social neglect is harder to pinpoint and to understand when it happens in modern western families. What I term ‘urban neglect through technology’ is what we are having to face up to, where many children have televisions and computers in their bedrooms and spend many hours there on their own. It seems clear that social intelligence cannot be adequately learned before emotional intelligence. Daniel Goleman has written extensively on emotional and social intelligence, and says: There is a dangerous paradox at work, however: As children grow ever smarter in IQ , their emotional intelligence is on the decline. Perhaps the most disturbing single piece of data comes from a massive survey of parents and teachers shows that the present generation of children to be more emotionally troubled than the last. On average children are growing more

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lonely and depressed, more angry and unruly, more nervous and prone to worry, more impulsive and aggressive. (Goleman 1998, p.11) Goleman 1998 discusses at length the importance of ‘emotional competence’ in terms of how we handle ourselves (for example selfawareness, self-regulation and motivation) and ‘social competence’ in terms of how we handle relationships (including empathy and social skills). Considering this from an attachment perspective we could say that one is dependent on the other: if the primary emotional and social relationship is good enough, then social intelligence will follow. In his later book, Goleman (2006) suggests that EQ (Emotional Quotient) and SQ (Spiritual Quotient) should not be conflated together: ‘But as I have come to see, simply lumping social intelligence within the emotional sort stunts fresh thinking about the human aptitude for relationship, ignoring what transpires as we interact’ (Goleman 2006, p.83). He suggests that social intelligence is composed of two aspects: social awareness (1. primal empathy, 2. attunement, 3. empathic accuracy, 4. social cognition) and social facility (5. synchrony, 6. self-presentation, 7. influence, 8. concern). However, I would maintain that aspects 1, 2 and 3 of social awareness and aspect 6 of social facility have their roots in early attachment development. And it is the aspects of empathic awareness that most concern us once children become teenagers. De Waal (2009) emphasises that despite Western Europe’s focus on individual freedom and liberty, empathy and sympathy develop from shared experience: Shared laughter is just one example of our primate sensitivity to others. Instead of being Robinson Crusoe sitting on separate islands, we’re all interconnected both bodily and emotionally… This is precisely where empathy and sympathy start – not in the higher regions of imagination, or the ability to consciously reconstruct how we would feel if we were in someone else’s situation. It began much simpler, with the synchronisation of bodies: running when others run, laughing when others laugh, crying when others cry, yawning when others yawn. (De Waal 2009, p.46)

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De Waal is describing in other words what I discuss in Chapters 1 and 2; there is ‘consonant play’ where mother and her newborn baby do things at the same time, especially rocking together. Consonant play precedes ‘echo play’ when mother and infant copy each other. In an earlier publication (Jennings 1990) I describe working with a young man in a psychiatric hospital by initially mirroring his movements, until he felt secure enough for us to echo each other’s movements. Although he was described as having an ‘unascertainable IQ’, he was able to progress through consonant play to echo play and eventually to working in a small group with music and movement.

Is it too late? When children with emotional and developmental needs become teenagers, there is always the question, ‘Is it too late?’ Many practitioners believe that if early intervention does not take place then at most a young person’s behaviour and life role can only be modified. There is pessimism about profound change once children reach double figures. However I have heard many stories of major changes in teenagers and young adults when there has been an appropriate intervention. Gerhardt is optimistic about the potential for change: In making the case for the importance of infancy, it is easy to lose sight of the subtleties of human development over the life span. Babyhood is an intense, concentrated moment of development that can have a disproportionate impact on our lives, but it is not the whole story by any means. Important pathways continue to be established through childhood, especially up to the age of 7. Then in early adolescence there is another intense moment of brain re-organisation, until the brain is fully fledged at 15 years old. But even after that, change and development continue because life is a process of continual adaptation. (Gerhardt 2004, p195, my emphasis) However, our interventions can be piecemeal and the teenagers who get most attention are those whose behaviour ‘makes the headlines’. There are always media reactions to children and teenagers who are violent to other children and teenagers. We appear to have a greater need to punish youngsters who commit violent crimes than adults who

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do something similar. We feel intimidated by groups of young people who may be forming some kind of group attachment and searching for a group identity during the turbulence of teen years. We need to remind ourselves that during puberty there is enormous activity in the brain as well as in the body; often extreme behaviour is dismissed as ‘only the hormones’. Neuroscience has shown us that at the beginning of puberty there is a huge increase in brain cells that promptly decreases throughout puberty. We seem to shed those cells that we do not need or that are not exercised. This makes it even more important that young people have sufficient physical and mental activity. They need to discover points of contact and involvement in order to use the increasing brain cells. Even so teenagers generally do need lots more sleep – that we understand – usually they are not being lazy but are genuinely exhausted. There are also many suffering young people on the verge of psychosis or who have chronic eating disorders or self-harm who often go unnoticed. The power of theatre cannot be ignored here; for example Somers (2009) points out that a number of audience members attending his interactive play On the Edge subsequently sought help for mental ill-health. This piece of applied theatre raises awareness of teenage psychosis, and the ‘distancing’ of theatre enabled young people to come closer to their own issues and recognise them: what I term the paradox of theatre (Jennings 1998). Teenagers can often allow themselves to come closer to their own issues through the enactment by others: either through theatre or through TV soaps.

Attachment for teens Sensory play and dramatic play within a context of nurture may well be helpful to many troubled teenagers. However for most of them, these activities would seem childish and demeaning. They would seem like another shameful experience on top of the shame that so many young people experience: shame that their parents are substance dependent, separated, in prison, promiscuous, or favour other siblings; shame that they cannot read or write or succeed at sports or gymnastics; shame that they cannot make friends or sustain them.

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Teenagers above all cannot afford to ‘fail’ yet again and will shore up against our intrusion into their fragile inner lives. Teenagers or ‘between agers’ are in between the dependency of childhood and the expectations that go with adult life. And their destructive behaviours against themselves or others seem to be an ultimate ‘breaking out’ of all the stored up feelings that have accumulated over time. When children who have had ‘good enough’ attachments grow into teenagers their type of attachments will change radically. They will usually have recourse to parental support from time to time, especially concerning issues in the bigger picture of the world beyond school and family. However, their immediate attachments will be towards their peers, other teenagers often of the same sex but not always, who are roughly in the same age set. Usually they will form peer groups with others who have similar interests or hobbies, rather than the intense ‘best friend’ relationship of the junior school. Children who have had a satisfying attachment experience in their early lives will be able to make this transition, usually coinciding with transfer to secondary school, in a relatively unscathed manner. Those teenagers who are still functioning at a younger age emotionally will have enormous difficulties and either form no peer relationships or will band together with others who are not ‘coping’ and become a group of teenagers who cannot deal with the expectations of school and society. They will often engage in highly dangerous behaviour either not realising or not caring how dangerous it is.

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Tools have very talkative personalities The following story is of a troubled teenager, Rami, where the therapist had the foresight to be as silent as the boy himself and to occupy himself with a similar activity but being available if needed. The setting is a special school for teenagers with emotional and behavioural difficulties, but who have an IQ within the normal range. Rami was special, he would be idling in the school yard, grinning to himself and absorbed in the other children’s activities, always watchful with his big brown eyes. He never shared a single reaction or impression with anybody. When he was discussed at regular staff meetings, they all had variations in their observations: he would rock backwards and forwards lazily, sometimes humming an expressionless tune to himself, as though utterly detached from the teachers, the lesson and the other five children in the class. At random he seemed to be able to fire a very intelligent word, answering the teacher’s question or adding something to what she said, without being addressed. Sometimes he would stand up and start wandering and stop at something that caught his attention. If anyone tried to stop or interrupt him, he would often just spit in their faces, grinning. Rami loved working in the art room, and would occasionally come and grab some crayons, draw some abstract figures and then vanish. It was at a weekly teachers’ meeting that I said, why I did not know, that perhaps Rami could work with me individually, in the carpentry workshop. Usually the participants in the workshop have a short first meeting with me where I explain about the space and its goals; then during four or five sessions individuals explore the tools through a structured journey of trial and error, as well as brainstorming ideas. Having gained some mastery over the tools they then decide on a project. I knew I would have to be very straight and goal orientated with Rami; he looked round for two minutes and then I asked him what he would like to create. ‘…Parrot,’ he mumbled, and that was the only word he said to me for several weeks. We went to the library where he chose a picture, and he traced it from the photocopy onto his piece of wood.

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I suggested to him that he could use a carving knife and his eyes lit up; ignoring any of my instructions he chose his own way of carving the parrot and I got on with my own carving in another part of the room. Suddenly he said, ‘How is it going to come out?’ – seven words having only ever spoken one! It took me a few moments to realise that he did not want to carve a picture, he wants to remove the carving, and he stood there, clenching the handle, and stirring the knife blade backwards and forwards. I quickly explained about the use of the saw and the pressures you have to moderate in order to cut and he immediately understood. He worked away at cutting out his parrot, finishing when it was time without shouting or spitting. He attended the workshop twice a week for 45 minutes each time. From time to time I would make a comment such as ‘long strokes’ or ‘just pat the parrot’ and only the tools responded. After about two months the parrot was finally out of the wood(s), a beautiful and finely polished wooden creature. Rami said, ‘I want him to be coated’ – ‘With what?’ I asked – ‘With feathers,’ he said. His teachers had already reported that he was talking with a few words in a fragmentary way, and that he was becoming more gentle towards others. I brought in some feathers although I hated the idea; I thought it was a beautiful parrot but I knew that Rami knew better. He delicately stuck the feathers on his carving and it became a very beautiful parrot indeed. Rami held the parrot close to him; he embraced it gently with both hands close to his heart, his eyes closed. Before I could say anything, apart from taking a photo which he had previously agreed, Rami tore the parrot away from his clasp and started to tear out the feathers. I had to bite back my own distress at the destruction of his beautiful creation. He did not attend the workshop again and then it was the summer holidays. I heard from his father, after a chance meeting in the street, that Rami is now in ordinary school in an ordinary class; he is doing very well. (From professional communication with Dori Tabachnikov, family therapist)

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I don’t pretend to have any answers or interpretations. Working at ‘separating’ with the carving knife was obviously important, and the cradling of his creation before stripping it bare seemed to be the point of major transformation, otherwise I would not presume to say. There are obviously issues on the theme of attachment in this story, and the relationship between Rami and his parrot is very moving. I agree with Dori that one could speculate on many explanations and debate all the symbolism; the important thing is that this young man was able to turn his life around and knew what he needed to do to achieve that. The presence of a silent supportive person in the room seemed the basis for the possibility of change. His attachment with the wood and his creation also needed a non-intrusive attachment figure. We can note that his work was very sensory and progressed to the creation of a ‘character’, who needed to be clothed: a successful variation of NDP for a troubled teenager. It is also possible to look at it within the EPR developmental paradigm: the physicality of the material, the creation of an image, and the transformation into a role.

Ways of working with teenagers There are different opinions about working with teenagers; Emunah (1994) says that in her own experience, adolescents generally will respond to ‘real’ situations rather than imagined scenes and stories: Adolescents are best engaged by realistic enactments about issues directly pertaining to their life stage (conflicts with parents, peer pressure, drug abuse, dating etc.), and yet in their struggle for peer identification and peer acceptance, they are often threatened by more personal self-disclosure. (Emunah 1994, p.20) She therefore advocates the use of sociodrama rather than psychodrama, but points out that role playing and role reversal lie at the heart of all psychodrama, sociodrama and dramatherapy. Whereas psychodrama is playing out roles immediately appertaining to one’s own life, sociodrama and dramatherapy allow some ‘distance’ to be created between the self and the role.

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Emunah (1994) has five main concepts for her dramatherapy work which are integrated into what she sees as the five sequential phases that her groups will progress through (see box). Table 9.1: Emunah’s five sequential phases of her five main concepts

Phases

Concepts

1. Dramatic play

most influenced by

Dramatic play

2. Scenework

most influenced by

Theatre

3. Role play

most influenced by

Role play

4. Culminating enactment

most influenced by

Psychodrama

5. Dramatic ritual

most influenced by

Dramatic ritual

Emunah (1994) stresses that teenagers will feel most comfortable in the reality base of these stages on the one hand, but would shy away from making personal disclosures on the other. Herein often lies the dilemma if one comes too close to the actual life scenario of the young person concerned. There seems to be a transition where the ‘let’s pretend’ of younger children becomes the ‘you must be joking’ of the teenager. Teenagers need to know in concrete terms where they are at, and imaginary work can make them feel ill at ease, mainly because they do not want to look foolish in front of their peers. Loss of face is a huge issue for the insecure individual, especially in adult-led activities. It is extremely important for teenagers to feel comfortable, and I think that perhaps teenager-hood could be described as ‘discomfort time’ when facing what seems to be a strange and hostile world. There seems to be a difference between working one-to-one, where more risk taking seems possible, and working with a group where peer pressure puts limits on what many teenagers are prepared to do. Any drama work could be difficult for those young people who have not been through the dramatic response (the ‘as if ’), and the sensory and dramatic play of early weeks and months, described in Chapters 1 and 2. It is made more difficult if there has not been drama

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and other creative activities in some form of ‘repair work’ during childhood. Cossa (2005) describes his own understanding of teenagers in his sociolodramatic work: During adolescence, there is a unique opportunity for therapeutic intervention that exists at no other time in the life cycle. As young people move into this period of their lives, the revisit the developmental challenges of childhood, with the peer group assuming a role of support and influence parallel to that held by the family during childhood (Cossa 2005, p.21) Cossa (2005) describes an archetypal sociodrama that he terms ‘DragoDrama’™ in which individuals or groups embark on a quest to confront an obstacle, symbolised by their Dragon, and reclaim their goal, symbolised by their Jewel of Great Worth. He describes a remarkable method that guides the participants through a range of challenges, feelings and experiences that are parallel to the life experience of many young people. This is an interesting example of where it has been possible to work through the imaginative approach, and perhaps we should always keep that possibility open. There are various ways that we can make some activities accessible for older groups, and in the following example, the group’s choice to make masks allowed them to unwittingly participate in sensory and dramatic play. Adolescent group project: the sensory and dramatic mask

The adolescent group were from a boarding hostel and they had no experience of drama. They had lived in the hostel from childhood, and some of them went to their parents for part of the holidays. The workshop was intended to develop storytelling and enable them to become storytellers for younger children in the hostel. However as soon as they saw the masks that another group were making, those who were hovering hesitantly near the door asked if they could make masks. We were able to provide two adults to each teenager to facilitate the mask-making which proved an ideal opportunity for sensory play.

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The adults took time to apply the cream that was necessary on the face in order to place the strips of plaster-bandage and create the mask. This was the equivalent of a face massage, and the total attention of two adults. As the masks dried, then touch was needed again to safely remove the masks and leave them to dry for painting. Every young person had a look of joy when they ‘saw themselves’ in the mask. The following session they wanted to decorate the masks with their own ideas but were able then to adapt them to the characters of the people in a story. They decided they wanted to tell the story of Sinbad which they had seen on television, complete with monsters and slayers. They were then able to develop stage fight techniques safely and without any loss of control. The mask-making had allowed for sensory play and appropriate and acceptable touch, and the ancient story had both contained their anger and stimulated their dramatic playing.

Additionally we can see that the sensory experience of the mask creates an embodied (E) experience, the painting of the mask is a projective (P) activity and the enactment of the story develops roles (R). The developmental progression through embodied, projective and roleplay process is integrated into the creating, painting and wearing of the mask. Mask work was involved again when I was facilitating support for teenagers who had been bullied. The young people were attending a huge conference on the theme of bullying and there was access to counselling support. However, the teenagers did not want this; they were anxious at the idea of being away on their own in a room with a stranger. So we created a graffiti table with long pieces of strong wallpaper on refectory tables; a team of six of us stayed nearby and we provided lots of felt pens and coloured pencils. The table became an immediate magnet and the young people sat and talked about their experiences of being bullied, of self-harming and the ‘front’ they felt they had to put on at school and at home. They went on to create masks that expressed this duality of the hidden tears and despair, and the outward glittery face that their friends and family could see. It was only very close friends to whom they could sometimes confide.

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Working with sand and water is a very fundamental sensory experience and again we can see that it also integrates the ‘Embodiment-ProjectionRole’ development: the sand and water is sensory and physical; creating the images moves into projective play; and dramatising the sandtray stories becomes a transition role. The following description of individual work also with an adolescent involves the opportunity for sensory play with sand and water and dramatic playing in the sandtray. ‘Hitting the watershed’

Kirk is a 13-year-old boy in residential care. He was chronically abused as a young child by a male relative in his extended family, who also coerced Kirk into being sexually inappropriate with his two younger sisters. He became addicted to watching porn and has been sexually inappropriate with other young people. Four months ago, Kirk moved into his present residential home, which he shares with a 15-year-old boy, and three weeks later started his play therapy. Initially he was shy and wary and was accompanied by two carers whom he requested stay with him. He is tall and slim with a high, piping voice which is

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sometimes difficult to understand – perhaps a metaphor for his voice not being heard? The various play materials were all set out and Kirk slowly explored them but he was hesitant to touch anything or engage with the therapy. By week 3 he allowed one of the carers to remain in the waiting room while he went upstairs to the sandtrays. He was intrigued by the empty water trough and he asked if he could have some water to pour into it and said he would like that. He spent this session calmly pouring in water and then started to slide marbles and glass beads down the sloping sides of the trough and watched the shapes form and change. He sat in a chair by the water trough and he seemed mesmerised by the fluid movements and beautiful shapes that were formed – like a beautiful coral reef that was taking shape from within him.

After this breakthrough session Kirk felt safe enough to be on his own with me. In sessions 4 and 5 Kirk went straight to the sandtrays. He particularly liked the sand wheel and seeing the moving sand turning the various wheels in an ordered and regular pattern. In week 5 he built around the sand wheel and placed walls and fences along the perimeter of the tray. He included an assortment of trees and a few animals, and in the centre on a raised platform he placed a wounded soldier on a stretcher. As he worked on his sandtray he told me about his cousin abusing him and making him hurt his young sisters. He then went on to tell me that he had recently watched some porn films

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in his bedroom and that he had allowed his 15-year-old house mate to be sexually inappropriate with him. Having presented himself as a ‘wounded soldier’ in the safety of the therapeutic relationship, Kirk was able to feel safe enough to share sensitive information, knowing that I would act on this to ensure his safety within his home environment. Kirk was able to express his inner turmoil and need for safe boundaries through his sandtray. (All the information given in this session was corroborated. Kirk’s 15-year-old house mate was moved to a different house and a Child Protection Investigation took place.) Source: based on Galloway 2010

What is interesting in this piece of work is that the elements of the sandplay are both sensory as well as dramatic. There is also a rhythmic and ritualistic quality as Kirk allows water to flow and the wheel to turn: both of which are archetypal images with many resonances. I wonder what else began to flow, and did the wheel move anything forward? Did the repetition allow some grounded security? Did the possibility of the beautiful lagoon provide enough reassurance for Kirk to talk about his ugly experiences? No interpretation took place with this therapeutic work: the creative process moved Kirk’s experience forward and allowed him to

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admit to being ‘the wounded soldier’. He was able to trust his therapist enough to see her alone and to share his burdens. Saying the unsayable through play

Anya is almost 17 and has been attending play therapy sessions for two and a quarter years. As a young child she was neglected and seriously sexually abused by her uncle, who is now serving a custodial sentence for these offences. She has attachment issues and her speech is very indistinct so it has been difficult for her to tell her story and be heard. Although Anya had never seen a sandtray before, she was immediately drawn to them and each week would spend the whole session working on one or more trays. There is a ritual to her work whereby she removes every grain of sand from the tray and sifts it before she recreates her story in the sandtray; this may give Anya a much needed sense of control over her environment. In her third session she removed the sand from the tray and then she built ‘The Ruined Room’. She used furniture from the doll’s house and placed a female baby in a chair with another female doll trapped behind a deckchair some distance away. She then poured wet sand over this domestic scene.

This tray powerfully shows how easily a family scene can be ruined.

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As Anya grew in confidence she became more curious about the play materials and was prepared to take more risks in her work. In session 85 she found four wooden frames, some soft wire and a bag of plaster. She worked intuitively, binding the wooden frames together with the wire and then pouring in the plaster, filling up five of the created spaces. The plaster started to set quickly and she decided to carve initials into the plaster of the people or things that she wanted to imprison. The middle box had the initial of her abusing uncle and ‘AP’ stands for ‘all paedophiles’.

Anya likes the immediacy of plaster and recently made a plaster cast of her hand to give to her mum on Mother’s Day. The following session when her work was set, she very roughly turned out her cast and the hand broke into three pieces. She reverted to the voice of a young child, saying it was ‘ruined’ and that she could no longer give it to her mum. Had she wanted it to break? Using a metal pick she wrote down both sides ‘Help me’ and on the palm she wrote ‘P**s off now’. Was Anya seeking my help? Was her other sentiment to me or Mum? Was Anya using transference to safely express her feelings about Mum through me? All this was achieved without Anya relying on words.

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The plaster cast is a sensory way of playing that allows not only for sensory experience but also for model making. The cast on the hand reinforces body image and enables a move from messy to structured playing.

The importance of peers As children journey towards their teens, there is a growing energy that is put into peer relationships and a decrease of dependency on parents and other significant adults. As is often quoted, teenagers spend twice as much time with their peers than they do with their parents and other adults, and that is discounting the time spent in school (see for example Gordon and Grant 1997; Luxmoore 2000). There is therefore a strong case to be made in some settings for peer counsellors or peer educators to work with their contemporaries. In a programme called ‘Respect and Protect’, peers facilitated workshops on negotiating sexual intimacy, while at the same time providing appropriate role models (Evans, Ackerman and Tripp 2009). Peers could make new experiences less anxiety-making for pupils going to a new club or school. Many schools now have a ‘buddy system’ to support new pupils or befriend those who have suffered loss or are being bullied. However, when individuals are suffering from developmental delay, peers can find it difficult to deal with their immaturity, and are really in need of peer counselling training.

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Cyrulnik (2005) discusses at length the possibilities for young people to overcome their attachment difficulties. He suggests that young people who have been bullied or victimised may well be experiencing silent suffering and depression; they employ what he terms ‘constructive defences’. These include daydreaming, activism and so on. He says that: If an adult is willing to act as a support for resilience in order to mobilize their hidden abilities, these children will come back to life to the point where the silent depression will give way under the influence of emotional, intellectual and social efforts. (Cyrulnik 2005, p.63) Cyrulnik suggests that victims who fight back often end up feeling just as helpless with fewer reserves to draw on and are less likely to form an attachment relationship. He describes almost a cyclic process whereby if victims behave like their bullies, eventually they have to start all over again.

The importance of adult support Teenagers who have not been able to trust any adults in the past are unlikely to trust their teachers if no intervention has taken place. Teachers with a specific pastoral role may well be able to address attachment difficulties by presenting as a robust and accepting adult who cares. Perhaps we need to pay more attention to the transition from primary to secondary schools, especially when some young people are the only individuals going to the new school. Going to the new school as a group is a much more satisfactory experience. We have already described several methods in the above examples of client work including: masks, sociodrama, quest stories, sandtray, wood carving and drama games; that can be integrated into both NDP and EPR ways of working. All of the examples involve attachment work together with creative methods that use plenty of sensory play and dramatic play in the presence of a supportive adult(s) who does not intrude on the client’s process.

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The importance of rhythm and ritual To end this chapter I want to describe the importance of including rhythmic and ritualistic work when we are working with teenagers. To this end we can encourage poetry and ritualistic storytelling, rap words and music. Be sure to have a rhyming dictionary to hand: an ideal one is Chambers Rhyming Dictionary with a preface by Benjamin Zephaniah (2008), who says: Chambers already have a reputation for producing great conventional dictionaries, but here they have adopted a completely new approach. Rhymes are grouped by the stressed syllables; phrases are given as well as individual words, and thousands of proper names have been included. So it’s now official, you can rhyme Johnny Cash with balderdash, or Ben Nevis with crevice. The future is bright; it’s a rapper’s delight. (Zephaniah 2008, p.v)

A teenage rap Don’t touch me Don’t talk to me I don’t need your empathy Just leave me alone Just let me be angry You don’t know what it’s like to be me You don’t know the red mist I see You don’t know the clenched fist when your head’s a mess You don’t know what to do when there are no words left My mouth can’t speak But my body roars It’s a weapon of mass destruction It’s a raging inner war (Becky from the Actionwork Project)

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Chapter 10

NDP and Children on the Autistic Spectrum I discovered the air was full of spots. If you looked into nothingness, there were spots. People would walk by obstructing my magical view of nothingness. I’d move past them.They’d gabble. My attention would be firmly set on losing myself in the spots, and I’d ignore the gabble, looking straight through this obstruction with a calm expression, soothed by being lost in the spots. Slap. I was learning about ‘the world.’ (Williams 1992, p.11)

Introduction Research into the nature and causes of autism has gone through a whole series of hypotheses since the beginning of the twentieth century including notions that it is a childhood psychosis (Bleuler 1911), a deep psychological disorder (Kanner 1943), or a result of uncaring mothers (Bettelheim 1967). Kanner himself had observed towards the end of his work that autistic children came from highly intelligent parents and that few of the parents were warm-hearted. During this period of time there was a major influence of psychoanalytic thinking which pervaded explanations of autism. In fact it delayed further research into causation for perhaps 20 years, and resulted in much distress for parents and their children. Some children were removed and put with foster families who were thought to be warm and caring; however, there was no change in the children’s capacity to respond to this affection in an interactive way. The early 1960s saw the beginnings of a shift in perspective. Rimland (1964) challenged earlier ideas of ‘refrigerator mothers’ (it

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is not clear who actually coined this phrase, but Kanner (1943) and Bettelheim (1967) both supported the idea that mothers who were cold and rejecting were responsible for autism in their children) and developed his own ideas of a biological basis for autism. Currently it is generally accepted in Western Europe that autism is a spectrum condition because of the wide range of capabilities of individuals and that it is multicausal. Autism has a biological basis where there are brain abnormalities and additional physical factors such as birth difficulties. Approaches to ‘treatment’ and education are many and varied, but broadly fall into two main categories: those who believe in repetitive rote learning such as the ABA (Applied Behavioural Analysis) system, and those who develop an approach based on interaction and relationships within a context of playfulness. The difficulty with the rote learning approach is that most children are unable to generalise from this experience to other experiences. The relationship approach supports the development of symbolic play and language so that meaning can generalise to other situations. Most authors and practitioners refer to ‘the triad of impairment’ that typifies the autistic spectrum condition: 1. Difficulties with social relationships. 2. Difficulties with social communication. 3. Difficulties with the use of the imagination. Although the same in essence, I prefer the accessibility of Greenspan’s description of the three primary themes (or core problems) that characterise autism: 1. Establishing closeness. 2. Exchanging emotional gestures in a continuous way. 3. Using emerging words or symbols with emotional intent. And this is how he and his team address the issues with parents: 1. Is the child having trouble with establishing intimacy and warmth? Does the child seek out those adults he is really comfortable with, such as a parent or key caregiver? If so, does he show enjoyment of closeness in that relationship?

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2. Does the child communicate with gestures and emotional expressions? Does she engage in a continuous flow of backand-forth emotional signalling with smiles, frowns, head nods and other interactive gestures? 3. When the child begins using words, does he use them meaningfully? Are the words or symbols invested with emotion or desire, such as ‘Mommy, I love you’ or ‘I want that juice’ rather than ‘This is a table’ or ‘This is a chair?’. (Greenspan and Wieder 2006, p.5) Greenspan and Wieder (2006) suggest that if these are not present at an age-appropriate time, then it is likely to indicate a degree of autism. They also very firmly state that there are secondary symptoms that can be present in autism but that these also are found in other conditions such as learning disability and therefore should not be the basis of the diagnosis. The secondary symptoms include spinning, repetitive actions, lining up objects. Greenspan and Wieder (2006) are advocates of starting work with babies and small children who may be on the spectrum. This way we are providing the opportunity for achieving developmental milestones, rather than waiting until the child is older and having a formal diagnosis. In this chapter we address the developmental needs of children who are likely to be given the label Autistic Spectrum Condition (ASC). Baron-Cohen (2008) suggests that referring to autism as a condition is less pejorative than the term Autistic Spectrum Disorder (ASD). I do not propose to go into all the theories or all the diagnostic criteria; these are well covered in many books including Fuge and Berry (2004), Morton-Cooper (2004) and Wolfberg (1999). I am moving forward in the discussion and looking at what children with ASC can do, rather than what they cannot do. I have always referred to creative processes and interventions, such as dramatherapy in particular, as optimistic (Jennings 1999a) and the whole range of play activities in themselves are optimistic and engender optimism (see Introduction). We shall look at the triad of impairment as a process to be addressed rather than a diagnosis that is mainly static.

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Communication is interactive When a mother talks to her unborn child or a child tells secrets to an imaginary friend, even without the presence of another person, the communication is still two way. The mother imagines what her baby might be saying in reply and may even voice it; the child knows what her imaginary friend is feeling and thinking. If something is communicated then it has to be interactive. You cannot have communication unless at some level it is interactive. The person who talked to themselves would often be teased: ‘first sign of madness’, others would say! But we do talk ‘as if ’ someone else is listening or answering, even if it is another aspect of ourselves. The Concise Oxford Dictionary (Allen 1990) has several definitions of communication but they all imply being understood, to ‘succeed in conveying information, evoking understanding; share a feeling; relate socially…’ Communication is being understood by another and it is usually reciprocal: we communicate and the child responds to what we have said, verbally or non-verbally. The child is making connections between what we show and how they respond. For example: A child was looking through a picture book and naming the animals to his sister and mother. Every one was accurate until he came to a picture of a polar bear, and he pointed to it and said ‘cockerel’. His sister and mother laughed and although he knew it was ‘polar bear’ he would always say ‘cockerel’ to this particular picture because he knew it made others laugh. He understood the humour of the situation at three years old.

A child with ASC would not grasp the humour in this situation as it requires a quick reciprocity between child and listeners, and the child grasping the entertainment value in what they have said. They have understood the basic principle of a joke and that it is a ‘back and forth’ communication. 1. Child makes initial mistake. 2. Listeners laugh. 3. Child knows he or she has made a mistake. 4. Child enjoys the laughter.

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5. Child now makes the mistake deliberately because it will ellicit laughter. 6. It does elicit laughter until the listeners tire of the ‘joke’. One of the frequent difficulties with children with ASC is that they do not grasp what is being communicated to them and furthermore we do not understand what they are trying to communicate to us.

Because NDP is interactive through sensory, rhythmic and dramatic play, it will encourage the ‘reciprocity’ between adult and child that is necessary for the development of communication. The role of NDP in the development of children with ASC addresses the following areas of difficulty: • sensory play, consonant play and sensory integration • rhythmic play and sound • echo play leading to interaction • interactive play and reciprocity • dramatic play, role taking and storytelling • symbolic play and the development of the imagination • theory of Mind and the capacity to empathise. Diana Seach says: The primary role of interactive play is in the development of reciprocal communication and socio-affective relationships rather than the improvement of play skills. However, changes in play behaviour and symbolic understanding are more likely to occur as a consequence of the child’s altered perspective of playing within an interactive sequence that is providing the motivation to explore the environment in more complex and enjoyable ways. (Seach 2007, p.25)

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Sensory play and sensory integration We have talked earlier about the importance of pre-birth play and attachment and how in the early stages play develops both before and after the baby is born. I have emphasised how playful pregnancy already influences the unborn child and how the playful relationship can continue once the baby is born. Most of this early play is sensory and gradually explores all the senses: sight, touch, hearing, smell and taste. Since formal diagnosis of ASC does not usually happen until the child is of school age, there may be clues that the child’s development is not progressing as expected. For example, usually a baby will follow the sound of the mother’s voice and turn their head when she comes into view. Often a child with ASC will not seek out another person and may well look through you instead of establishing eye contact. Now some of the reactions to this seeming avoidance can cause an unfortunate chain of events. The mother or primary carer feels hurt at the lack of attention and begins to withdraw their availability and playfulness. This then becomes a destructive cycle, rather like a twister storm where things can spiral up or spiral down. If things are spiralling down, there is a non-interactive response and the relationship becomes more distanced. If the response is an interactive one, the relationship spirals up and becomes closer. There are fairly predictable age stages during the first six months in the growing relationship between mother and baby: • From birth to three months: early attempts to imitate mother’s expression (dramatic response); follows sound and moving light; snuggles and holds finger; accepts foot massage while feeding; enjoys bath time and trickling water from sponge; calms with lullabies; coos noises of pleasure; consonant and echo play (see Introduction); waves hands and feet. • From three to six months: growing engagement and interaction with mother; playfulness; sensory games involving singing (pat-a-cake), stroking and tickling; private ‘jokes’, ‘peep-bo’ and simple ‘where’s it gone?’; reading mother’s signals of attention, depression, displeasure; echo play and imitation move on to reciprocal play and ‘to and fro’ communication; movements and sounds increase.

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If very few of the above activities are engaged with, it could be that the child has signs of ASC. It is too soon for a definitive diagnosis but not too soon to address some of the issues, rather than wait for later assessment. Babies thrive on the attempts to have an interactive conversation through playing and will sustain contact usually far longer than the mother has resources for. However, when there is little reaction or lack of sustained interest or repetitive self-stimulating movements, mothers become very disenchanted and may switch off. Mothers need to keep the switch on and will often need lots of support because at times it seems a thankless task. When babies respond with smiles and delight, mothers are amply rewarded for their efforts and are quite prepared to go on playing and communicating. When there seems to be no response it feels very daunting and then rejecting and finally punishing. Non-responding babies can take on quite monstrous roles in the mother’s imagination and she can feel punished and controlled by this monstrous entity. Some of the switching off is an act of self-preservation which may also be to prevent potential anger being vented on the child. Mothers are usually exhausted at this point and all the powerful feelings of pregnancy and giving birth have resulted in a child with special needs; this is indeed a shock. It feels like a powerful anti-climax, as if somehow they have been given a punishment. Mothers can be punished in reality, not just in their fantasy. I know of women being beaten up by their husbands for giving birth to sons with special needs such as autism; I listened with great sadness to the following story. Marianna is a woman in her forties but she looks much older; her hair has turned grey and she has huge bags under her eyes; she nervously winds her scarf around her hand as she talks to me. She was quite appalled at the idea of sensory play being useful for her son; she said that is the last thing that he needs. ‘He already has plenty of sensory stimulation – too much in fact.’ Her family is disintegrating because of the ‘inappropriate behaviour’ of her teenage son who has ARC. His younger sister had been sent to live with grandma because ‘she shouldn’t have to witness this [masturbation in public]’, and the husband has withdrawn all engagement with his wife and autistic son: ‘He just can’t cope

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with it and is drinking heavily. I don’t want to lose him’. She is desperate and now talking of either brain or genital surgery (castration) to change her son’s behaviour and ‘calm him down: he won’t have sexual feelings after that’, and she sobbed and sobbed. ‘I have no other choices now – I have tried everything.’ I suggested that her son had become monstrous to her and she immediately agreed, ‘He is a monster – he is spoiling everything – he has broken up the family and I don’t know what to do next.’

This story was told in the midst of a training workshop in Eastern Europe for parents of children with ASC and the group leader told me this was not an unusual situation. There were very few resources and still less availability of counsellors and specialist teachers. We proposed a multidimensional approach. • Mother needs counselling support to address all her feelings of resentment, distress and abandonment. She is probably feeling very guilty. • Father needs counselling support, either on his own or jointly with his wife to address issues of failure, guilt and shame. He is probably feeling very lonely. • The son needs an adult ‘friend’ or ‘buddy’ who will take him out and role model appropriate behaviour as well as befriending him. He is probably quite bewildered at the disintegration of his family around him which can lead to even more self-stimulating behaviour. • The younger sister needs reintegrating into the family and shown lots of affection and love. • The parents need some respite care so that they can have time together. • The teenager also needs interest and hobbies and a limit put on television programmes. • The whole family need to find an interest that they can all be involved in, whether it is an outing or a hobby or a sport. Now that this child is well into his teens, therapeutic intervention and ‘relearning’ appropriate behaviours will take longer and will have to be

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reinformed on a regular basis. I firmly believe that the role of buddy volunteers for children from nine years upwards can be very helpful in these difficult situations, although in many families there are members of the family who are prepared to take on this role. The advantage of the buddy is that they are less emotionally involved than the parents, less subject to the despair and disappointments of mothers and fathers who really do need some relief from the demands. Buddies need some basic training into the needs of children and teenagers with ASC and lots of patience and resilience. We need to be able to explain to parents and mothers in particular that newborn babies sometimes behave as if they are still in the womb: they do not noticeably react to our touch and sound nor seek out our faces. We need to enable greater contact and not think that the baby needs less, just because he or she does not respond. Again I have heard mothers say, ‘He doesn’t need me so I am not bothering any more.’ The usual dependency of the small baby on the mother has reversed into the mother feeling deprived by the baby: unwanted and uncared for, and becoming either aloof or baby-like herself. It is sometimes believed that babies who are ‘no trouble at all’ and who ‘never cry’ or make demands are ‘good babies’. Trouble-free babies are the dream of every mother, especially when she has more than one child. However, babies who are good can be depressed and have ‘shut down’ all feelings and responses. Similarly they can have signs of ASC and therefore need a lot of attention rather than being left on their own. Mothers may indeed welcome the fact that they have a good baby, especially if they are very tired. There are certain NDP exercises that are specifically appropriate for mothers who are exhausted and need to snatch what rest times they can. The following ideas are ideal for keeping contact with an ASC child who is not responding. • Mum can lie down and have the baby resting on her chest, placing her near to her heartbeats. This reinforces closeness, touch and the first rhythm the baby will have experienced. • Calming music can be played during this relaxation, especially if there is music that was played during pregnancy and birth. The advantage of doing this is that it will calm both mother and baby.

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• The baby’s back can be slowly stroked which reinforces touch, rhythm and closeness and helps mother to feel that she is doing something right for her baby. It will also help her to get into a rhythm again, especially if she has been feeling very stressed. • Mum can also sing to her baby, a lullaby or nursery rhyme or a made-up song. The baby will experience the vibrations of the mother’s voice, especially if she sings in a lower key. All these ideas are part of NDP development but are particularly important for children who are thought to be on the autistic spectrum, and they take in to account the needs of mothers who need rest and reassurance. There are other restful exercises that are more interactive but can still be undertaken when mother is lying down. Mother and baby can both lie on the floor, making sure there is no draught, and that there is something comfortable to lie on, such as a yoga mat and a blanket to be cosy. • Lie down side by side and cuddle closely. • Trace the baby’s eyebrows, round the eyes, nose and mouth with a forefinger. • Stroke the baby’s back and sing or hum. • Hold a hand of the baby and hum or talk ‘beautiful talk’. • Hold a hand and just tell the baby the story about the events of the day, what we call ‘diary talk’. • If mothers prefer to relax in a sitting position with their back firmly supported, most of the above exercises can be adapted; rocking and swaying can be added. • For a bit of fun, mothers can try ‘talking toes’ by lying flat on their backs and placing their baby ‘feet to feet’ (though obviously not with tiny babies).

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There are more NDP sensory exercises in the appendices that can be developed specifically for children who are thought to be on the autistic spectrum. I cannot emphasise enough the importance of early intervention. Basically mothers are doing more of what they usually do with small babies to assist the catch-up of developmental milestones. Greenspan and Wieder (2006) poetically describe this process: …infants who can’t connect sensory to emotional and motor experiences are unable to engage with others as richly and fully as infants without these problems. They may feel pleasure and experience a deep sense of intimacy, but demonstrating these feelings with joyous smiles and facial expressions and focused, pleasurable interest in their caregivers is difficult. Caregivers, without the magic of the baby’s smile and joyful sounds, may be less drawn in and motivated to keep engaging and playing with him or her. However, if they can intuitively sense the baby’s underlying delight (in spite of his difficulty in showing it), they may be able to woo the infant and sustain intimacy. (Greenspan and Wieder 2006, p.31) With an emphasis on the sensory play and the consonant play (playing at the same time, such as rocking together), it is hoped that gradually the child with ASC will move on to the echo stage of play. The child will echo the sound or the movement or the gesture that the mother initiates, and it leads into the mother echoing the baby’s sounds or movement. Once the child can echo, we have the basis for reciprocity or an interactive relationship. The echo response precedes imitation

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or mimicry, which is an elaboration of copying that carries a degree of meaning (Whitehead 2003). When people say of a child with special needs ‘she is only copying’, they are failing to understand the developmental sequencing in which echo play precedes ‘copying with meaning’, i.e. mimicry. It is vitally important that as far as possible the mother allows the baby to lead and initiate rather than always direct the baby to copy her. As Seach (2007) also suggests: Child-led interactive approaches focus on the developmental needs of the child with the major emphasis on communication and social and emotional growth. The child’s repertoire of behaviours is seen as having s specific function in terms of what is being communicated, and through appropriately cued responses by the adult these behaviours are supported and adapted. (Seach 2007, p.25) Many readers will remember that extraordinarily touching moment in David Lynch’s film The Elephant Man (1980) when the examining doctor Carr Gomm comes to meet John Merrick. Dr Treves has helped him prepare for the interview, and Merrick repeats what he has been taught. Although he is asked other questions, he does not elaborate so Carr Gomm thinks he has just mouthed Treves’ words. As the two doctors turn to go, Merrick recites the 23rd Psalm, including verses that he had not been taught. That is the turning point in accepting that he is intelligent enough to learn with meaning, rather than ‘only copying’. It is then that Merrick admits that he did as he was told because he did not want to cause any trouble. This is a familiar theme when children in many different situations will comply with our expectations or instructions, in case they might get into trouble or be ‘found out’ if they speak ‘out of turn’. The big step for the child with ASC is to attach meaning to communication. It becomes evident once the child starts to initiate playful interaction. However, it is important to keep stating that it begins in an early playful relationship with the mother and later other close relatives.

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Rhythmic play If we observe the ritualistic and repetitive play of many children with autism we can see that it is usually rhythmic. Persistent rocking or flicking or spinning all have their own rhythm which the child has perfected. The issue that needs addressing is that it is usually an isolated activity that a child will repeat for hours on end. Children get very agitated if we interrupt their playing or try to change it in other directions or make attempts to divert them. Baron-Cohen (2008) is famous for saying to parents that perhaps the child is perfecting their flicking or spinning, and that no one else could do it with such accuracy! We need to consider whether the child is in fact repeating the joys of rhythm and repetition that occur in much earlier stages of playing, but they are not shared activities. We have talked in several chapters but especially in the Introduction of the importance of consonant play, such as mother and baby rocking together or swaying to music or repeating songs and sounds. I am suggesting that we could be observing an extension of that in the rocking child with ASC. My own approach has been to work with the rocking and to echo what the child is doing but in a meaningful and absorbed way (see below). It is important that the child does not feel mocked. Sometimes it will mean that we need to move further away from the child so we are not ‘in their face’ which can otherwise be quite overwhelming to them. By positioning oneself at a comfortable distance and just mirroring what the child does, there will come a point where it is noticed, and there may well be eye contact and recognition. Then it is possible for it to become a shared movement and eventually to incorporate variations, such as moving more slowly or moving faster. Mothers can try to initiate and see if the child follows, then maybe he or she will initiate and it becomes an exchange. I was working in a large institution for people with severe learning disabilities. One young man stayed in a corner and was a ‘rocker’ – he would spring backwards and forwards from one foot to the other, bending almost double as he did so; one arm was held so that his elbow almost reached his ear, and the other hand had two fingers very close to his eyes. He would continue doing this

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for hour after hour and the staff left him alone because he wasn’t causing any trouble. His chronological age was 19 years and the staff said he had an unascertainable IQ and he was autistic. They said not to bother working with him as it was not worth it. I was intrigued that this young man had rocked for most of his life and apart from being led to meals, toileting, walks in the grounds and bed, he stayed in his corner. Any attempt to interrupt the rocking made him react angrily and he would go away to another corner and continue the rocking. I arranged to have short sessions with him every day. Initially I established the distance where he would tolerate my presence without moving away, which was about 60 feet. I established a routine of coming into the room, greeting him and then trying to do what he was doing at the same time (consonant play); I did this for 15 minutes, said goodbye and left. I repeated this each morning and slowly went a few feet nearer to him, which he accepted. After a week he accepted me standing next to him doing the same as he was doing, and at that moment he made eye contact and smiled. At that point I tried to make a change to see what would happen: I continued the same movement but I slowed it down. He copied me! We were doing echo play. He then gave me a wicked grin and started doing it twice as fast! This was the beginning of ‘to and fro’ playing as I changed something and went side to side, and then he changed something and used alternating shoulders. The essence of the movement was the same but we discovered together variations on doing it. He relaxed and allowed himself to join a small group with two other men and a helper who played the guitar. We now were able to accomplish simple swaying and rocking movements together as a group to rhythmic music. If ever he became agitated he would scamper back to the corner and start his rocking.

By approaching this young man through NDP and focusing on his rhythmic repetitive playing, I was able to move this on in the following terms: 1. It became a shared activity rather than a lonesome repetition.

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2. He was able to establish eye contact and smile. 3. He progressed to consonant play (the beginning of a relationship). 4. He accepted variation and initiated it himself. 5. He progressed to echo play. 6. He relaxed and notice my arrival. 7. He was able to join a small group. 8. He was able to move in more complex ways. 9. He accepted music and movement. I feel this was quite an achievement for him in the space of two weeks and he had already caught up by several developmental stages. He was a young adult.; what could happen if we had been able to start much earlier? Most of the movements made by children on the autistic spectrum and those with other special needs are movements that everybody does, but we do them with less intensity and for shorter periods of time. Music therapy as well as dramatherapy and NDP have all proved effective in working with children on the autistic spectrum, especially in relation to developing rhythms, and expanding them. However, it is the primary rhythm of life that we need to start with; this develops from the heartbeat of the mother to the heartbeat of the child.

Dramatic play and enactment We considered the dramatic response that takes place between mother and newborn child at the beginning of NDP development, when the baby begins to imitate the mother’s expression. I maintain that these dramatic interactions eventually enable the child to ‘take the role of the other’ and to understand how other people are feeling. I discussed in Chapter 1 the ‘Theatre of Mind’ (Whitehead 2001, 2003), an

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important area to understand in relation to children on the autistic spectrum. Many such children are unable to read social cues, either verbal or non-verbal, and to grasp ‘what is going on’. Whereas other children can pick up these cues fairly rapidly, for a child with ASC we need to unpack the whole area of emotional literacy and create much smaller stages. It is no good expecting a child to empathise with someone else when they have not developed any connection between feeling and expression. The very early attachment play includes lots of facial expressions, playing silly faces and exaggerating responses. The use of puppets to express primary emotions and link them to events is a very important part of social learning.

By emphasising these links we stand a chance of helping the brain to actually make the connections, at least partially, for example by using a puppet: ‘Ducky is sad, Ducky is feeling sad.’ The next step is playing at expressions and feelings, linking causes to feeling such as: ‘Ducky is sad because he’s lost his toy.’ Then being able to find the toy and Ducky being happy creates an actual scene of changes of emotion. The next step would be that Bear helps Ducky find his toy, which brings in the social domain. Finally, Ducky being able to appreciate that Bear has helped him find the toy brings the scene to a resolution. Before closing this chapter I want to draw attention to our reluctance to accept drama as a crucial and unique way of developing our life and social skills, and our artistic and aesthetic pleasure. Just

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as some would say ‘It is only copying,’ they would also say ‘It is only acting,’ meaning somehow that it is not real. However, let’s look at the following sequence: ‘act – react – interact’ We can see that ‘only acting’ takes on another perspective when it relates to the developmental stages of attachment and the imagination. What we hope will happen is that children not only react (often seemingly absent in children on the autistic spectrum) but that they also interact. That is the beginning of social play, which is also described by Seach (2007): Interactive play, like the creative arts therapies, emphasizes the role of non-verbal communication in supporting socioaffective functioning. In the same way that music, movement and art function as a catalyst for creative expression, so play also stimulates and supports impulses and feelings in the child that are not dependent on verbal communication. The model… shows that interaction is at the core of the development of communication and social understanding. The experience of interacting in positive and meaningful ways leads to a range of competencies that impact on motivation, thinking and behaviour, that will bring about significant changes in children’s emotional and cognitive growth. (Seach 2007, p.25) The importance of this early interaction is emphasised by all recent writers on how to support children on the autistic spectrum (see Greenspan and Wieder (2006), Jennings (2008), Seach (2007), Wolfbert (1999)). Therapists, mothers and teachers alike are seeing that there is a positive alternative to the repetition approach, ‘put that brick in that hole’, which is solely leader directed rather than child led. The work of Greenspan and Wieder (2006) and their longitudinal studies with children on the autistic spectrum is an excellent demonstration of the efficacy of the interactive approach. They describe very succinctly an approach to encouraging primary interaction: To facilitate purposeful emotional interactions, be very animated as you exchange facial expressions, sounds and gestures, as well as words and pretend dramas with the child. Go for the twinkle in the child’s eye that lets you know she’s alert and

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enjoying the exchange. Treat the child’s behaviour – even if it seems random – as purposeful. For instance, if she flaps her hands in excitement, you might use this as a basis for a ‘flap your hands’ dance move. (Greenspan and Wieder 2006, p.60; origianal emphasis) They go on to describe the playing of brief interactive scenes in games and social situations with the emphasis always on the interaction. Neuro-Dramatic-Play has an important part to play in the parenting and teaching of children and young people on the autistic spectrum. Neuro-Dramatic-Play is also important with babies and toddlers who are thought to be at risk of being on the spectrum. Neuro-Dramatic-Play reinforces the developmental simplified milestones through the developmental stages. The key play stages are: • consonant play • echo play • imitative play • interactive play. The content of these stages includes sensory play, rhythmic play dramatic play and storytelling, all of which address the ages birth to six months, but may have to be repeated at a later age, especially if there has been neglect or institutionalisation. Some of this chapter will also be useful to read in conjunction with Chapter 11, on working with children with learning difficulties.

Chapter 11

NDP and Children with Learning Difficulties Please come again – nice things happened today – I liked the story about the Golden Fish – I liked being the fish – I was a net. (Feedback from young adults with learning difficulties attending an NDP workshop)

Introduction Children with learning difficulties are often diagnosed during pregnancy when parents are faced with the difficult decision of whether to proceed with the pregnancy. Indeed there are some doctors who will not give certain tests (such as for Down’s syndrome or spina bifida) unless the parents have already agreed to termination if a test is positive. For other parents the birth of a child with a learning disability comes as a great shock. This chapter addresses the importance of play, especially Neuro-Dramatic-Play, with children with learning difficulties or learning needs, and gives practical examples of early and later interventions.

Disability and difference: the context Some parents have difficulty with the appearance of their child and if the child ‘stands out’ as looking or behaving differently, they may well put the child in an institution or give him or her up for longterm fostering. Our society does not easily tolerate difference and we know that the double tragedy in 2009 of a mother killing herself and her daughter with disabilities was brought about because of persistent bullying and harassment. 208

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There can be instant rejection and abandonment or an overbearing compensatory focus as if to assuage the guilt at having formed a child who is not ‘normal’. Many parents need support after the birth while they are making adjustments to their ‘special child’. People may remember the storyline in EastEnders when a baby was born with Down’s syndrome: the excellent portrayal by the actor playing the mother going through all the processes of denial and rejection, even to giving the baby another name rather than the chosen name she wanted for her ‘normal’ baby. The programme also included the typical reactions from neighbours and friends who either commiserated or pretended that they had not noticed, and then commented behind her back. A play specialist is often the person who can offer very practical assistance in helping the parents to play with their child and to demonstrate that play is such an important part of any child’s development. The contribution of play workers or therapeutic play and drama workers is becoming more important in this area of acknowledging and demonstrating play possibilities with children with special needs. Just as the child needs to be shown how to play, often the parents or carers need the same. The following example, in particular, shows how children with Down’s syndrome are often regarded as very funny or good mimics or great entertainers. Their range of emotional needs, longings and desires can be overlooked or underestimated. Freddie was eight years old when he came to our special NDP project for children with attachment needs. He has Down’s syndrome, he is bright, lively and very energetic. He wanted to be our entertainer and any exercise he tried to do was in a funny way: walking or conducting or ball throwing or dancing. When the adults in the programme refused to laugh at him he became very angry and aggressive: shouting, attacking people and destroying his art work. The project included plenty of sensory play including massage, which he would tolerate only if he could massage someone else’s hands: this he took very seriously. The sensory room was too static for him and he stayed restless the whole time. He calmed down as he achieved some physical and coordination milestones including being able to

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balance on someone else’s back, and throwing a ball to someone else and calling out their name. His great love was the large drum on which he wanted to entertain us with rhythms. However Freddie was learning that by having an attachment partner who would set boundaries, engage him with play, allow him to go beyond his limits and take his work seriously, he could keep our attention in different ways. He was, we discovered, very scared of balancing exercises, and his humour masked some very deep fears. Parents of most of the children came to visit the project and the children could choose what activity they wanted to share or show. All of them wanted to massage their parents’ hands with specially chosen essential oils. Most of the parents were very touched by this activity and some even had tears in their eyes. However, Freddie’s mother found all this highly amusing and giggled throughout the massage activity. Once again Freddie became the entertainer for his family.

Children who have learning difficulties are in great need of all the activities that constitute NDP in order to maximise all learning potential. There is a tendency by specialists to underestimate the possibilities of learning for children with disabilities and some may recommend placing the child in an institution. Doctors themselves may have difficulty with dealing with disability and often there is the question for them too of whether they were culpable or not (this is especially the case with assisted conception), or whether they should have ‘known’ and therefore advised the parents earlier. The emotional and attachment needs of the child with learning difficulties have to be addressed through appropriate sensory, social and dramatic play activities that can be modified where necessary in relation to intellectual understanding. As we said in Chapter 10 when discussing the autistic spectrum, all the activities and stages are required: some may need simplifying or breaking down into smaller stages. The following ideas are for children with learning difficulties who have missed out on the early NDP development through avoidance or abandonment or neglect.

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Some practical guidelines Certain children will need physical support during exercises and advice should be sought from the nurse or physiotherapist in relation to physical games and play. Play needs to start in a very simple way with the child having lots of reassurance. We need to build the progressive stages designed for children who have not played as babies. There may be excess dribbling and other bodily fluids that need to be managed calmly in order to progress to the play. It is important not to use plastic bibs and overalls as they really do not help the sensory process. Towelling bibs can be used if necessary and they are easily washed, but remember that there is bound to be lots of mess: you cannot do sensory play without mess making! The following example of three-year-old Tommy illustrates many of the issues in regard to sensory play: Tommy was three years old when he came to the special nursery and had a constant preoccupation with his body orifices; he especially enjoyed picking his nose and eating what he retrieved. Staff had kept saying ‘No’ and putting him in gloves (which he managed to chew and suck off). My guess was that he was demonstrating a real sensory need. We made use of finger paints,

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Plasticine, and sticking paper (including textured paper such as sandpaper) with white glue stick. Staff thought he would promptly eat the materials, but he didn’t. We made sure he had crunchy snacks at break time (celery and crispbread). We fed this back to Tommy’s parents, who said they had been feeding him on a bland diet: mashed potatoes, rice pudding, custard and baby cereals. They thought he might choke on other foods but also added that they were so used to giving him baby food, they had not thought to vary it. No wonder Tommy had such a sensory need! The preoccupation with orifices soon stopped and the staff relaxed a little more (there was one carer who was pregnant and every time that Tommy ate a bogie she rushed out and threw up!).

In the example of Tommy it was very important not to make either staff or parents feel undermined or humiliated. We always made a point of asking their advice regarding the children’s play and saying things like: ‘I wonder what would happen if we tried such and such.’ It was also important for us to provide information sheets for parents and staff to understand what we do and why.

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Practical NDP: suggestions for carers and parents The following suggestions for sensory and physical activities need to start as early as possible and reinforced through repetition if a child has missed out on pre- and post-birth NDP. Readers of this book are now familiar with the developmental sequence for NDP (see Introduction and Figure 1.3) and can refer to it as they plan their activities. Remember that there is no fixed stage for anything to be achieved, and that one thing will lead to another. Some activities will be more appropriate at an earlier age, such as the whole body massage that is discussed below. Just remember some things you did not learn until you were adult and suddenly realised, ‘This is what they mean or that is how it is done.’ In my own experience I had great difficulty with understanding certain instructions and set my hair alight in a science lab, for example.

Sensory and physical activities As well as being fed and washed, these children need lots of attention to their body-self both through fine and gross movement. Children need help to orientate themselves in space, to find balance and to coordinate their limbs. The more sensory play is developed, the more a child will be able to orientate and balance: literally the child is ‘making sense of the world’. All the senses need focus in as many ways as possible.

Food Food is often seen as separate from sensory activity but perhaps think about the sensory variety at meal times. We all like a variation in colours and textures: liquidised soup is fine but even better with rough rye bread! We enjoy a combination of savoury and sweet and the look of food is also important, although we might feel that ‘designer food’ has gone a little overboard! Working lives are very busy but it is important to try to plan one time in the day when the family sits down together and shares food and conversation. Parents complain that children with learning difficulties don’t know how to eat or behave in an acceptable

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manner, but then expect the child to learn by instruction rather than example. This is demonstrated in the following example: Isabella came on a training course for care staff. She worked in a children’s home where all the children had special needs of varying severity. She enjoyed all the play work and then said that there was just no time because of the demands of her daily routine. She said that meal times took ages and she had to line up the children in their chairs and feed them a spoonful at a time. We suggested that she try to incorporate some of the activities into the meal time. If she and her assistant and the eight children could all sit round a table, then initially the children could feed themselves with their fingers and then learn to use a spoon and so on. The children would learn by watching her and her assistant eat and chew, and maybe they could also have a song to sing during the meal to help focus the children’s attention. She looked very sceptical and we invited her to give it a try. Well, when she came to the follow-up course she was beaming. The children responded to being more independent; out of the eight there was only one who could not feed himself but at least he was sucking his fingers! It was not a perfect situation but the children were allowed the sensory experience of their food and were beginning to be able to feed themselves. It had not crossed the minds of the staff that developmentally this might be possible.

Food needs to be varied and balanced in colour, taste and texture. The eating of food should be pleasurable and not rushed. Food can be named and talked about in order to facilitate language development and social relationships. A meal table is one of the best places to have a social discussion rather than a war-zone. Television does need to be switched off so that children focus on the people around them rather than the flickering screen. It is the same with all children: if food becomes a war-zone then children realise they can wield power through food refusal or smearing. Mothers and care workers are emotionally linked through food to giving care, so the rejecting of food becomes a rejection of the person. I watched with fascination outside an infant school in a Mediterranean town as several mothers

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called their children to the fence in the break time and fed them a boiled egg through the fence: apparently the daily egg is all important! In time, simple food mixing and cookery can be undertaken by the children and again it will be a sensory experience and not just a functional one. Mixing flour and water requires a fine coordination and kneading dough even more so. It is important for the learning process to differentiate clearly when dough is made for playing and painting and when it is made for cooking and eating. If it can be organised, the more that children can help with making the food, the more it becomes not only a sensory and learning experience, but also a social experience where you are doing something together. Again it can have stages: once hands are washed, children can feel the texture of the rice or the sound of the pasta before they are cooked. My own personal magic is watching the custard powder turn bright yellow once you add the milk. I still buy a well-known custard powder and do not use custard in tins or cartons – no magic! Food in fact is a sensory experience throughout our lives and involves most of our senses: the smell, taste, texture, feel and sight. Occasionally it involves sound but usually more in the preparation than in the serving. So many sounds in the preparation of food: bubbling, sizzling, whisking, splashing, whirring, slapping, kneading, dripping, slicing, chopping, grating, grinding… Food is a cultural marker for celebrations: we have special food for feasts; different food for birthdays, naming days, religious ceremonies, seasonal rites, fasts, funerals and memorials. In so many ways, food is a group celebration that is both a sensory and social occasion. Very sadly a woman was not allowed to bring a home-made cake for a celebration of her mother’s birthday in a care home; she had made a large enough cake for all the residents to share. The manager told her that it was a health and safety risk, but she was very welcome to bring a wrapped cake from the local supermarket!

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Massage Whole body massage at bed or bath time is helpful while the child is still small but obviously it needs to be modified as the child gets older. Baby lotion or oil are ideal for massage ‘top to toe’, and conversations and stories can develop during the massage time. The more massage that can be developed in the early months and years, the greater ‘whole body’ experience the child can integrate. Many children with learning difficulties struggle with experiencing their body as a whole and instead relate to certain limbs. Massage reinforces our body-self, which is an essential part of our development before we are able to have a body-image (Jennings 1999a). The ‘Weather Map’ or ‘Cooking Time’ (Jennings 2005a; see also Chapter 8) are fun; they are massage exercises that can be done with pre-teens and they do not involve intimate touch. For example in the Weather Map, the child is sitting and the adult is creating different sorts of weather on the child’s back: light rain drops, heavy showers, thunder and lightning… It takes place on what we call ‘the safe zone’, i.e. shoulders to waist. Unless massage is undertaken by parents or a designated carer, then we should use only the safe zone or the hands for all massage. Older children will usually shy away from massage that is too intimate anyway. I think we need to do as much touch work as possible during the early years, and then slowly transform it into more mature touching, holding hands etc. Children also need to learn about the appropriateness of who they may touch and who they may not.

Bath time As well as massage there are lots of sensory bath play techniques for fun experiences. Bath puppets made either of sponge or towelling are now available and they can create interactive games and stories; sponges themselves are wonderful for squirting and squeezing; bubbles from liquid or soap can create wonder and visual stimulus; splashing and trickling, filling and pouring are all important learning stages; finger and toe games can also be done in the bath (‘This little piggy went to market…’ ‘Round and round the garden…’). Small children also need to learn how to balance in the bath; it is very scary if they topple over sideways or slip under the water unexpectedly. A firm hand behind

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the back, just as one would do for a small baby, is enough for them to slowly build up their confidence. Some children then want to stay in the bath and it is a shame to make it an issue: use a game, even counting, to start the getting out of the bath stage (for example: ‘One two three and I close my eyes, one, two three and I wave my hand, one two three and I stroke your hair but one two three four and it is out of the bath!’). Another idea that also teaches structure and sequencing allows time for putting things away on the edge or squeezing surplus water (for example: ‘First we squeeze the flannels, then we find the soap, then we count the toys and then – out we go’). Towels that have been warmed on the radiator continue the sensory process, especially for the small child who can be enveloped in a large bath towel: this again reinforces the whole body and is a holding and containing experience. The warm and playful bath time then needs another transition to bedtime, which again is all the more calming if it can be a gradual process. Fleecy pyjamas are cuddly and soothing and can be put on with a game and therefore a minimum of fuss. Duvets are like nests and children feel contained and wrapped. Everyone has different routines for bedtime but a predictable sequence of events that a child can anticipate with pleasure usually ensures that bedtime is trouble free and that the child goes to sleep. A story being told or read, some cuddle time and tucking in, placing of special toy and some words of affirmation of how much the child is loved and wanted should enable the settling down and sleep. If children have difficulties in settling at night, occasionally back rubbing will help to calm if needed and a night light should be provided if the child is anxious about the dark. The child who has been neglected or avoided will take time to accept and trust these new routines. The calming bath and duvet nest will work only if a child is able to wind down from the day. They may have lots of excess energy that needs to be worked off, or they could still be high from a very energetic game. We all need time to cool off from activities that have stimulated us either mentally or physically. In the following section we will look at games and other structured activities that can both express and organise physical energy.

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Movement There are many movement exercises that can be made fun by putting them in an imaginative context. All of the exercises pioneered by Veronica Sherborne (2001) are excellent for children with learning difficulties. They develop the capacity to work with a partner (cooperation and collaboration) as well as working against your partner (standing your ground, withstanding bullying); there is a very good section on trust and balance, and understanding bodily feedback about body image. Over the years I have added to these ideas, for example everyone rolls over and over as if they are logs; everyone stands very tall as if they are a tree; everyone stands very wide as if they are riding an elephant; everyone stands very narrow as if they have to get through a small space; everyone stands in a round shape like a ball, in a twisty shape like a screw, a thin shape like wire, a flat shape like a pancake. You can keep adding to these movements and shapes, working first of all individually, then with children working with a partner and then in small groups. Note how although we are doing movement, we are still doing it ‘as if’; already the dramatic elements are expanding.

Games Many conventional games are very daunting for the child with learning difficulties. They will long to join in and be like others but often end up being rejected or laughed at because they can be clumsy, uncoordinated and quite literally do not understand the rules. They may well tell you the rules but do not apply them to what they actually do, as a link between instruction and application has not been forged. Sharing and turn taking has its roots in early NDP where mother and baby take it in turns to make sounds and then copy or make movements that are shared. We need to discover new ways for making this possible with older children who literally ‘do not understand’; it’s not that they can’t understand, but they have not had the early experience which forms the foundation for this kind of learning. Many of the sensory and physical exercises in the earlier sections will help to build a basis for more coordinated physical activity. These can lead on to simple ball games. Examples are throwing the ball to each other; throwing the ball and saying our name; using balloons and together keeping one up in the air so it does not touch the floor; using

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hoops and when the music stops standing in a hoop, or sitting in a chair, or standing on a piece of newspaper. We now realise that so many of the early playground games, such as those involving skipping, ball play, jumping and hop-scotch, are forms of play to heighten our skills in preparation for more complicated games. They all need concentration and attention as well as coordination. Some people believe that if a child is not born ‘normal’, they cannot play in a normal way! They can but we need to break the learning down into more stages, especially if there has been a play deficit in the early months and years. Children with development delay can catch up much of the lost ground. Even children who have profound learning difficulties can expand their potential and go beyond their expected level of functioning.

Dramatic play As I described in the earlier chapters of this book, dramatic play with babies is an essential stage that accompanies and follows on from sensory play. When the baby first gazes at the mother’s expression and tries to imitate it, the drama is already beginning. Sadly the mother who turns away or cannot bear to look at her child, or who is in gross pain or fear, does not pick up on this early interaction. Children removed from their parents, as we saw in Chapter 8, often have the dramatic response disrupted and it may never be captured again. When we are working with children with learning difficulties, we need to capture this imitative stage as soon as possible because it will help the later development of social roles and feelings of empathy. Small children enjoy and seem to search for and gaze at faces; they will even respond to a simple piece of card with facial features drawn

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on it rather than a blank or non-facial picture. They are requesting our response. When we gaze back it may indicate a gaze of love, total acceptance and inclusion or it may indicate that movement or sound is required. If we pull a face, the chances are that the baby will copy us. So we need to create dramatic playing that can be used with the older child, especially when they are able to move around and are not just in a shawl and cradled in our arms. Create interactions with imitation of expressions: start with a simple pout or wrinkled nose or wiggly tongue and give time for the child to respond; repeat after a few moments and see if they will pick up the cue to copy; don’t rush on to something else. If the child does copy, then wait to see if they will give an expression to copy. This is the beginning of turn taking; it might need lots of imitation before the child can initiate an expression. The innovator of Child Drama, Peter Slade (1954, 1995) gives many interactive techniques for working with children. Always give an indication when moving on to something else: ‘We’ve played faces, let us do sounds’; try imitation of simple noises, typical baby noises at the beginning. Again wait to see if the child imitates and then whether they offer a sound to copy. Eventually this can develop into a whole sound and movement echo play and probably lots of laughter can ensue as well. A baby mirror can be used to augment the process with the child following their own expressions in the mirror, and mothers can do the same. Part of dramatic playing is also the expression of a range of feelings: ‘Teddy is feeling sad because he has lost his friend.’ ‘Teddy is feeling happy because he has found his friend.’ ‘Teddy is feeling scared because the dog is barking loudly.’ ‘Teddy is feeling cross because there is no one to play with today.’ These basic emotions are being expressed through Teddy (or it could be a special puppet that is the ‘feelings puppet’). It is another step to move from expressing how Teddy is or the puppet is feeling, to be able to see how I am feeling. Many children use their own name to express themselves: ‘Sarah wants to go for walk.’ ‘Robert feels hungry.’ Another step is made when the child can say I; again it needs to be role-modelled by the adult. If the adult is also using the third person, the child will copy as in ‘Mummy is tired now so she will finish the story.’ ‘I am feeling scared of the big dog but

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Mummy looked after me.’ ‘I am feeling sad because Teddy has gone.’ ‘I am feeling happy because Teddy has come home again’ (after getting lost on the floor). These very simple imitative games are the start of the development of emotional literacy if they are done in a playful way through dramatic playing. If adult and child then move on to being interactive when the child initiates the feelings, we are moving forward in our degrees of competence with the ‘dramatic response’. Taking turns to imitate and initiate is a very important step in dramatic development. The dramatic playing has gone from imitation and echo, to interaction, to initiation. The child is beginning to respond in a variety of ways with a change in emotions. And he or she is also able to project emotions on to others such as the toys or another player in the game, e.g. Mummy.

Interactive storytelling The dramatic playing can lead into interactive storytelling where the children provide the necessary sounds or visual effects. The following story is a great favourite with children and teenagers with learning difficulties. It contains many actions and reactions and has lots of humour. The children readily understand the ‘rough justice’ that greets the king at the end. Some of the actions can be practised, especially being able to be a stick that hits without actually hurting: learning how to pretend. The Magic Bag (Hungarian Roma)

There was once a poor Roma family who often went hungry because there was not enough food. Their father worked so hard to look after his family but no matter how hard he worked, there was still not enough to care for his wife and children. One day he decided to find a solution so he took his axe and went into the forest. He was very angry indeed and his face looked like thunder. There was an old man in the forest with a long white beard who said to the man: ‘There is something wrong, please tell me and maybe I could help you’. The father told the old man all about his situation and said just how angry he was that he could not look after his family. The old man went

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away and came back and he handed the father a bag: ‘What is inside here will help you – just give it an instruction when you need help.’ The father was very grateful and rushed back to show the bag to his family. His wife looked very disbelieving and said, ‘Magic bag – what nonsense – it won’t feed the children will it?’ The father said to the bag, ‘Put food on the table for my children – please.’ He and his wife could not believe their eyes; wonderful food appeared from the bag until their table was covered. They all sat down and ate a huge meal. And so it went on each day, the bag provided as much food as they could possibly eat. The man and the woman were sitting down talking one evening and she said, ‘The King should come and visit us now that life is treating us a bit better.’ The man said, ‘Why on earth would he want to come to us?’ ‘Don’t forget that he is godfather to our eldest son, of course he will come and visit,’ she replied. So the next day she put on her best blouse and skirt and walked to the palace. At the beginning the guard would not let her in and said, ‘What would the King want with the likes of you? Go away and stop bothering me.’ ‘Please let me through, I have some very important information to tell him and he will be very pleased,’ she said in her persuasive voice. In the end the guard let her through and she went into the King’s chamber in the palace where he was talking with his courtiers and drinking a lot of fine wine and eating a lot of fine food. She made a low curtsey. ‘Hello your Majesty, I have come to bring you to our house. You have not seen your godson for a long time and he is such a fine boy. We would like to invite you to a meal,’ she told him. The King really did not want to leave the palace but in the end he was persuaded and two of the palace guards came with him. When they all reached the house and the King entered, the poor man said to the magic bag, ‘Provide a meal fit for a king,’ and immediately the most rich and wonderful food appeared on the table. It was even better food than the King ate at home. After he had eaten as much as he could, the King said to the poor man, ‘I want that bag and my guards will take it back to the

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palace. Thank you for this visit, I have learnt a lot.’ The family just stood with their mouths open as the King and his guards took the bag and went back home. And sure enough, there was only a small amount of food left and the children soon became hungry again. Their father took up his axe again and went to the forest in a very angry mood. He saw the old man again and told him what had happened so the old man said to him, ‘I will give you another bag, but you must look after it and use it wisely. The bag will obey your commands.’ The poor man thanked him and started his journey home, but he was so curious that he sat down on a bank and looked inside the bag. Immediately two sticks jumped out and began to beat him most cruelly until he was able to say the magic word to make them stop. He picked up the bag and ran home as fast as he could. He put the bag on the table and immediately the sticks jumped out and started to beat everyone: mother, father and all the children and they were crying out and shouting. The poor man had an idea and said to his wife, ‘I am going to the palace; if we don’t have food by lunch time then life is a riddle.’ He took the bag and went to the palace, where there was no trouble getting in to see the King. The King greeted him and said how wonderful the bag was. The man said, ‘Well that is just what I am here for; you see I have obtained a much richer bag, very beautiful and lined with silk. Much more fit for a King I think.’ The King was very flattered and immediately wanted the new bag that was lined with silk and he gave the old bag to the poor man. Just as he was leaving he called out, ‘Bag do your stuff,’ and then disappeared out of the palace gates. The sticks jumped out of the bag and began to beat the King and the courtiers and the man could hear everyone squealing and shouting. He ran home as fast as he could and put the bag on the table and asked it to feed his family. There was food on the table once more and the children stopped crying. The poor man learned a big lesson that day that was, ‘Never obey a king who is just being greedy, especially if you are poor yourself.’ (© Sue Jennings 2005)

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Neuro-Dramatic-Play is important when children and teenagers with learning difficulties need to reclaim stages of their development. Neuro-Dramatic-Play practice can support the child who needs: • sensory variation through food textures and tastes • sensory play through whole body massage and story massage • bath and bedtime calming routines • movements and differentiation of body shapes • basic skills of games for coordination • dramatic play for emotional and social literacy • storytelling for structure and surprises.

Chapter 12

NDP for Practitioners I think my mother is a clock! And he took a sharp tool and stuck it Into his mother’s stomach And the knife ran red with blood oil he said and twisted the knife he heard screams ticking he said and pulled out the knife full of guts Ah cogs and wheels he said now I know how this thing works and he started taking apart the clock that was his mother… to see what she was made of. (Lavery 1987, p.81) Ceausescu not only drove Rumanian children into the same misery as was once his own: lovelessness, hunger, cold, total control, and all pervasive hypocrisy.With the help of the women of Rumania he also sought to take unconscious revenge on his mother. Consciously he never ceased to glorify her, but by forcing millions of Rumanian women to become mothers, he could reinforce his repression. He would never have to feel what he had repressed as a child: that he was nothing but a burden to his mother and that she literally forgot – and this can be verified – that he even existed. (Miller 1992, p.103) 225

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Winnicott (1986) emphasises that the mother’s importance in the beginning is often denied, as if physical care was enough for healthy development: At present, the importance of the mother at the start is often denied, and instead it is said that in the early months it is only a question of bodily care that is needed, and that therefore a good nurse will do just as well. (Winnicott 1982, p.203)

However Odent (2001) is far more radical and suggests that there is a conscious disruption of the early contact between mother and her baby: Most cultures disturb the first contact between mother and baby.The most universal and intriguing way is to simply promote the belief that colostrum is tainted or harmful to the baby – even a substance to be expressed and discarded. Let us recall that, according to modern biological sciences, the colostrum available immediately after birth is precious. Let us also recall the newborn baby’s ability to search for the nipple and to find it as early as the first hour following birth.The first contact between mother and baby can also be disturbed through rituals: rushing to cut the cord, bathing, rubbing, tight swaddling, foot binding, ‘smoking’ the baby, piercing the ears of little girls, opening the doors in cold countries. (Odent 2001, p.21)

Introduction In the first six chapters of this book we placed NDP within a context of theories of attachment, play and resilience, and contextualised the theories within the development of infants from conception to six months of age. The next three chapters showed how applied NDP can make a difference with children and teenagers who have attachment difficulties, those who are ‘looked after’, and troubled teenagers. Finally we considered the direct application of NDP with children and young people on the autistic spectrum as well as those with learning difficulties. This final chapter describes how NDP can assist professionals in their therapeutic and educational choices. Additionally we shall discuss the effects of current aggressive and reactive attitudes

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and that we need to support collaborative and peaceful approaches to living The quotations above by Miller, Winnicott and Odent all emphasise the importance of the mother–child attachment and the negative or even catastrophic results if this attachment is absent or toxic.

Choices about change The ideal situation would be that we are all aware enough of the perils of parenthood that we will ensure our babies and infants are safe to grow up into resilient adults, perhaps with a few rough patches on the way. There is so much that we can learn from unhappy children and teenagers, single mothers under stress, and the frequent acceptance of bullying and intimidation. How much do we listen to these groups rather than making decisions on their behalf, which are often driven by media headlines? There appears to be an increasing number of people who cannot cope with the stresses of modern living, who have not had the heritage of good enough attachment parenting and the experience of unconditional love. We all know people who still talk to us like infants but inside a big adult body, we regularly meet adults who want to spar with us rather than hold a debate. And we have to ask, what role models do we as a society provide with the examples being set by ‘political experts’, ‘medical specialists’ and ‘media and entertainment icons’ (including sports people). As adults we ourselves have also had our share of abuse and exploitation, of cycles of depression or deep loneliness. What echoes must there be around us? Nevertheless, most of the time we do manage to cope, but is coping enough? Do we want more than that? If we are able to develop the secure base for healthy relationships to flourish, maybe we can communicate that to others so that our meetings with other souls will be creative and fulfilling. How much better is it if we can work with a preventative model rather than a curative one; if we can find ways to support others in our neighbourhoods and communities so that there is not the breakdown or the domestic violence or the interminable fight over custody of children? McCarthy (2007) says that one of the issues in contemporary society is that few

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parents actually value their roles as parents (I discuss this is some detail for mothers in Chapters 5 and 6). He continues: I find that very few parents value their role as mothers and fathers enough if at all. Psychoanalytic literature in many ways did a disservice to parents. First it focused almost exclusively on the role of the mother, laying the onus of responsibility for emotional disturbances on women. The reaction to this burden was initially guilt and fear but has ultimately been replaced by the outright rejection of the value, primariness and beauty of motherhood. (McCarthy 2007, p.140) McCarthy (2007) goes on to say that it is similar for fathers, that they feel disempowered and insignificant because they have not been given responsibility by therapists. He suggests that many fathers had inadequate fathering themselves and end up not understanding the power they have over their children’s lives.

Instant emotions People will have noticed that in all my writings I make reference to theatre as a way of life, a therapy, as a model for change, as a means of education and as a form of healing. Yet the very institution of theatre is marginalised, supplanted, starved of resources, so that it ends up being poisoned or gratuitously violent or else sexualised. Much modern theatre and television is in fact toxic, without merit or coherence. It becomes like a distorted attachment disorder that cries out and clings onto us, limpet like. A good example of this on television is The X Factor: people cry when they win, cry when they leave, the judges cry, the audience cries. People cannot get on or off stage without the group hugs: everyone in sight cries and hugs. Grief also used to be a private matter but now the cameras want to see your emotional moment when your eyes well up and you cannot hold back the tears. Community tears are shed for soldiers returning home in coffins, which is a good way of keeping the public’s interest in the war as a ‘good thing’ as it produces plenty of heroes. As Odent (2001) discusses (see his previous quote), societies have a vested interest in making sure we continue to support wars. With unlimited tears for joy and sadness,

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do tears have meaning for us any more if we can produce them so readily? Alice Miller (1992) wrote about the abusive childhood of Friedrich Nietzsche: In the meantime, the body seeks to express its terrible distress in other ways than tears and screams. It produces an endless catalogue of symptoms, the hope that someone will finally sit up and take notice and perhaps ask the questions: ‘What is causing you such distress? Why were you sick more than one hundred times in one school year?’ But no one asks such questions. Instead, doctors continue to prescribe their drugs. Not one of them comes up with the idea that, perhaps, Friedrich’s chronic throat infections are a way of compensating for the screams he is forbidden to scream. (Miller 1992, p.28) If tears are the norm, is it surprising that we miss the very deep grief of the children with whom we work? Maybe they are children who have learned, like Nietzsche, not to cry. The most toxic statement that can be said to a child is ‘If you don’t stop that crying I will give you something to cry about,’ and if the crying does not stop, then whack or slap. This could be described as an ambivalent attachment disorder. As well as other people’s deep distress creating good box office, so does gratuitous violence, bullying and out of control behaviour. We want to see vicarious emotions that will get us in touch with our own instant emotions. Stage plays now show torture, murder, explicit scenes of violence and sex that at one time would be communicated with some subtlety. Much of our theatre and television has become sexualised and many scenes that at one time would have been shown after 9 o’clock are even shown in the afternoon (the same with the violence). We no longer just hear about the sexually abusive relationship or the violent rapes, we are shown them. I think that probably theatre feels it has to compete with television and therefore has become more explicit in sexualised scenes. Sex is good for ratings and children are exposed to it far in advance of their years of understanding. Many of these programmes are sexually abusive both to the actors and to the audiences. We are really losing the plot between reality and imagination and being able to hold the

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difference. We know the drastic effect of sexual abuse on attachment relationships, and I think the same is happening with abusive media. We watch documentaries about neighbours who ride roughshod over their community or gangs who terrorise the streets: it is strange that we have gone overboard preventing the foreign terrorist with extreme security measures yet we ignore the terrorist on our streets. This violence is a disorganised attachment disorder in the way it splatters over our lives and tabloids. If we have attachment disorders in society that are distorted (sexualised media), ambivalent (being hit for crying) or disorganised (street violence), these are being established as a norm. Children and their parents are receiving role models that will reinforce inappropriate attitudes, behaviours and relationships. These examples seem to point to the fact that we have a milieu where the human shadow is presented to us for entertainment: not for reflection, not for warnings, not for learning. People are meant to be enthralled by the sight of families out of control, but unfortunately not only are they being entertained in this distorted way, but also the mirror neurons in the brain allow it to be established as normal behaviour. Neuroscientists have demonstrated that from birth the mirror neurons in the brain reflect the immediate world, and it becomes internalised. For example the infant who is born into a violent family will have violent language and gestures reflected internally into their brain system. Many adults assume that children ‘are not old enough to understand’ when there is grief and loss for example, or a family crisis. Whether or not infants understand the words being spoken, they will internalise the gestural language and atmosphere that is being generated. Many children have unresolved grief issues because there was no resolution for them at the time they had understood that something had happened. Mirror neurons influence group activity such as celebrations and rituals; they enable us to ‘know what is going on’. Most people attending a wedding celebration know more or less what to do, unless it happens to be from a very different culture. We pick up the gestural signals, and the space that we should inhabit. People who are kept in isolation, or children who spend a long time in institutions, do not have the reflective mirrors reinforcing appropriate behaviours. We know that some victims of kidnapping begin to adopt

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the beliefs of their captors, and that many institutionalised children internalise the projections of their ‘carers’. If attitudes and beliefs are to change, it is crucial that teachers, foster carers and therapists understand that the reinforcement of new mirror information will need intensive and lengthy intervention. Structured NDP both for the child as well as the carers is a central means of intervening in an ‘ill-mirrored’ situation. It will take time to recreate a ‘well-mirrored’ ambience. There is now lengthy research on the mirror neurons and a greater understanding of the contribution of collaborative therapies that involve both body work and action: principally I would include play therapy, dance therapy and dramatherapy as ‘mirror therapies’ for children as well as adults. It is because of their privileged position that mirror neurons are able to bridge observation and action. Mirror systems have helped us to understand how our brains link together in the synchronisation of such group behaviours such as hunting, dancing, and emotional attunement. They are most likely involved in the learning of manual skills, the evolution of gestural communication, spoken language, group cohesion, and empathy. (Cozolino 2006, p.187) We need role models and examples, we need mentors and consultants; we need people who can set an example to young people or provide an appropriate role model to children or can be a support to someone in distress. They will all contribute to a more caring society, where people are people rather than patients. Yet that must seem like a dream beyond attainment. We continue to find entertainment from distressed children. The ‘child-mascots’ who are found in every orphanage are a good example. Although they are very distressed, they make us laugh. Although they are very sad, they write poems and give them to us when no one is looking. Although they have been quite abandoned they weave a network of little friends, and try to support them. These defensive constructs provide emotional bridges in a world that is in ruins. Thanks to their inner defences, these distressed children can preserve a little island of beauty. Taking refuge in day-dreams gives them a few hours of the happiness that desperate children seek. (Cyrulnik 2007, p.45)

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A child mascot with Down’s syndrome

Brian was a child with Down’s syndrome who attended an intensive NDP project that was structured around sensory, rhythmic and dramatic playing with opportunities for developing art and role work. Brian was used to being the clown in his family, and made funny walks and funny talks and turned everything into something that could be laughed at. We worked as a team to try not to collude with his need to entertain us. He was restless and unable to settle in the sensory room but he enjoyed the rhythms of the giant drum. Nevertheless he still tried to make us laugh. Our non-laughter was making him get angry and he shouted and gesticulated as if to say ‘laugh, laugh…’ His anger culminated in him trying to wipe his adult partner’s face with soiled nappies; literally ‘rubbing his face in it’. His anger was contained and he adhered to the limits, taking some delight in pounding the modelling clay with heightened energy. However he could not forget his laughter hunger and began to disrupt other children by tickling them or making funny sounds in a whisper. Brian needed very intensive one-to-one work in the group to demonstrate that he was valued as himself and not as our entertainer or ‘mascot’.

Why stories are important Storytelling has been a continuing thread throughout this book and I have emphasised both the structure and surprises of storytelling. We have favourite stories, and so do the children with whom we work: the enduring nature of stories demonstrates their importance. Alida Gersie (Gersie and King 1990, 1991) has written extensively about her philosophy and method of ‘Storymaking’, and is a world authority on the subject. She uses specific structures to evoke stories both from children and adults, in training as well as therapeutic settings. Both storymaking and storytelling are important approaches that can be integrated into the structure of Theatre of Resilience, especially when exploring new stories from different cultures (see also Crimmens 2006).

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The structure of the story that has a beginning, middle and end allows the listener to experience the security of the resolution of the story. The fact that most of our stories will contain surprises means that our curiosity will be stimulated and we may start to think about things in new ways and from new perspectives. Stories can be for participation (see Gersie and King 1991 for a wealth of ideas), as we saw in Chapter 11. Once the participation becomes enactment, we are then entering the realm of theatre. What is theatre but stories in action: stories that are enacted and dramatised in a cultural form?

Why theatre is important In the plays of the early Greeks, the worst excesses would be off stage, and we would learn about them through messengers or a chorus. We would use our imagination to picture what had happened. Shakespeare portrayed violence through poetic verse and through ‘distanced’ characters: the distance paradoxically enables us to come closer (Jennings 1999a). The stories in Shakespeare’s plays enable us to identify with a range of themes that connect with our own lives, characters that express the feelings that touch us profoundly. This is very different from the instant emotions that we can access through explicit dramas and reality TV. They are like instant food: satisfying in the moment but not lasting; they do not promote change but keep us in the status quo. It is rather like a sugar fix that is fine until the next craving. I have evolved these ideas over many years that now culminate in a form and structure that I call the ‘Theatre of Resilience’ (ToR). I realise that I was developing this concept while still referring to my work as dramatherapy.

Theatre of Resilience I have referred to ToR in earlier chapters, and then in relation to the application of NDP principles with specific groups of children and teenagers. Because ToR integrates all of the previous theory and

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practice, I want now to elaborate it in greater detail and illustrate how it is a unique intervention for children and young teenagers, and with adaptation with older teenagers and some adults. We know that children may grow up without resilience when there has been early childhood neglect, abuse or other types of trauma. Some of these children may well develop survival skills but do not function in a balanced resilient way to deal with all the vicissitudes of modern living. In my extensive educational and therapeutic work with children I felt I was always glimpsing part-pictures of recovery rather than the whole scene on the stage of life. ToR was born of my unwavering belief in the healing energy of theatre together with my early work on child development through play. The words sensory, rhythmic and dramatic as well as embodiment, projection and role came back to haunt me in many configurations, and in dreams and dramatic variations in everyday life and in theatre. I developed Theatre of Body (ToB) as a concept, having been influenced by Whitehead’s (2003) Theatre of Mind (in turn stimulated by Theory of Mind); this integrated into another concept, Theatre of Life (ToL). Theatre of Resilience was given birth to for addressing situations where the Theatre of Body–Theatre of Life continuum had not happened because of early attachment difficulties or trauma. To be effective ToR needed to integrate all the factors in NDP, EPR, ToB and ToL in order to provide a developmental progression towards social and artistic health (see Figure 12.1). What this will mean in reality is that a group of children will all have a one-to-one adult partner (in an ideal setting it could be two adults), who will work with them as co-creators within the group as a whole. This has a twofold benefit for the child: the one-to-one will provide some good enough attachment during the opportunity to recreate the NDP early stages. Furthermore the child will be influenced by the role modelling (therefore influencing their mirror neurons) that takes place both between adult and child and from the group as a whole. From Figure 12.1, the progression is very structured and will take the group through the EPR progression. The group will move forward to the second part of Theatre of Resilience, which can be addressed only once the basic stages have been navigated (Figure 12.2). They then develop a performance based on a story, myth or play from their own culture. This is not an

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enactment of the group’s own stories or improvisations that they have created. This is an artistic and culturally appropriate play where the members of the group are able to take on the roles and narratives and perform them to an audience perhaps in the community. This whole process moves the group from their personal attachment needs, their early play experience and their development into a culmination of an artistic performance to share with others. It may seem that a ToR model is very labour intensive and that there would not necessarily be enough people to carry it out. However in my experience it has worked very well with arts therapy students, carefully trained volunteers and others who are interested in gaining experience of this unique way of working. It can be structured as a once-a-week meeting over several months or as an intensive programme during school breaks. In order to challenge existing brain systems, my belief is that the initial period should be very intensive, and then modulate into a weekly programme, perhaps with an intensive rehearsal period at the end. Perhaps it is time to rethink policies especially in education, and think about ‘education for health’, especially for mental health (Somers 2009). Teachers would need to be specially trained, and with an understanding of attachment work they could see that their ‘acting out’ pupils are trying to communicate distress rather than just being ‘difficult’. Teachers have had to withstand a lot of violence in the classroom, and pupils have had to deal with a lot of bullying in the playground. Teachers need additional resources to turn their work into preventative work rather than being expected to pick up the pieces. Therapists also need further training in prevention rather than always focusing on cures. Unwell beings create income for therapists and it is not unknown for people to be kept in therapy for longer than necessary so that a steady income is assured. People know when it is time to finish therapy and it is rarely a running away or an avoidance that therapists suggest. People usually know how far they have gone and how far is enough. My suggestion is that we find a model of empowerment for people, both adults and children, who have faced trauma in their lives or degradation or abuse. Empowerment leads to resilience which means that people will develop the resources to manage their own lives, within the context of community support.

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Theatre of Resilience (Part 1)

Sensory play

One-to-one within the group

Water, sand, lotions, massage, finger paints, consonant and echo

Rhythmic play

Dramatic play Mimicry, imitation, mime, ‘as if ’, mirroring

Heartbeats, patting, pulsing, jumping, drumming, songs, rhyme

Theatre of Resilience (Stage 2) Clay modelling

Drawing

Threading

Model making

Storytelling

Puppets

(Projection) [outside the body]

Attachment

(Embodiment)

Theatre of Resilience (Stage 1)

Imitation

Movement and gesture

Role play

Masks and props

Figure 12.1: Theatre of Resilience (Part 1)

Scene enactment

Performance to each other

(Role) [integrating embodiment and enactment]

Theatre of Resilience (Stage 3 )

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Warm ups

Repetition and rehearsal

Movement and dance Structure and communication

Improvisation

Text work

Artistry and awareness

Sharing our endeavours with others

Performance

Theatre of Resilience (Part 2)

Figure 12.2: Theatre of Resilience (Part 2)

Long before they can speak, infants begin adapting to the parental culture, learning simple habits of expression, and the family responds, giving objects and actions a clear shareable sense for the learner by offering rhythmic participation in rituals and tasks. Adults, provided they are not stressed and unsure in themselves, are naturally ready to teach their ideas and methods to young children. Indeed, toddlers can assist the infant’s sociocultural learning as the baby and their brother or sister share the rhythms and emotions of communication in affectionate playful ways. (Powers and Trevarthen 2009, p.209) Human dilemmas portrayed through great myths, stories and plays take us on a journey through the highs and lows, and ending in a resolution. Arts projects and theatre groups need priority funding as they are providing an important ‘health model’ in the community. In a deep sense, storytelling is theatre with one man or woman playing several roles. The young princes watch how the characters in the tales, both human and non-human, think, feel and act in situations many of which would be similar to situations that they would find themselves in at one time or another, as rulers. (Sarma 1993, p.xxxiv) Throughout this book I have discussed the embodied experience and the importance of early sensory and rhythmic play; Theatre of Body emphasises the central focus of the body in early infant development.

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The ways in which children’s bodies interact with their mothers influence to a major degree the positive growth of their brains. Mothers are crucially important in this early brain building. Theatre of Resilience makes an important attempt to re-parent, or perhaps re-mother, the child within a social setting and with appropriate playing and creative development. Maybe we are seeking ‘Mirror-Mothers’ who can assist the changes for distressed and lonely children who have been labelled as ‘mad’ or ‘bad’ or ‘sad’. And now a word from Clifford and Herrmann (1999) about coming to the end, both for me as the author and for you as the reader, project maker, teacher or therapist: It is always frightening as well as exciting to reach the end of something significant. There is the pride in having achieved something that you did not know you could, the feelings of relief for having some free time to yourself and the fear of not knowing what you are going to do next. (Clifford and Herrmann 1990, p.231) Theatre of Resilience is a compassionate approach to children and teenagers in distress and seeks to awaken the creative artist that is the birthright of everyone. ToR seeks to address individual and personal areas of distress but enable them to be turned into a cultural sharing of important values through performance. It is very important that by integrating a high ratio of adults to children, we are enabling the adults to have an important role in relation to the children. This does need some basic training in attachment as I discovered in one ToR group where the volunteers took to heart some of the mean criticisms from the children; they sought to assuage their pain by suddenly suggesting, ‘Let’s all swap children’. The volunteers had found the verbal criticism from the children very difficult to deal with, and took it personally.

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Mirror image Father – son – barrel shaped without waist Face each other across the ketchup Dripping onions from their twin burgers Elbows to support the whoppers And bites of sheer ecstasy Huge sighs and hands wipe across mouths Then napkins are remembered and sticky fingers And finally, a huge wink of conspiracy. ( Jennings, in preparation Poems for the Body)

Appendix 1

NDP 6 Months Before and After Birth

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Pregnancy play The most important factor during early pregnancy is the sound of the mother’s voice; her voice is like a guiding principle that influences the slowing of the baby’s heartbeat when she is speaking or singing. Unborn babies can in fact hear from about 16 weeks and all the hearing apparatus is in place by 27 weeks. There is increasing noise in the baby’s external environment, but the mother’s voice is always recognised over all other sounds. It is better not to massage the unborn baby during the early months while everything is settling down physically, but mothers really welcome a massage for their own shoulders or even a back-rub. Mothers can stroke their bellies or do walking fingers, as they are singing or storytelling. Playing classical music, especially Mozart, or gentle rhythmic ballads, is very reassuring for the unborn baby. Singing along with the music, tapping and dancing can all be enjoyable for mother and unborn. The baby responds to both structure and stimulus before birth and recognises the security of structure after being born. Surprises need to be a bit like a sandwich: security on either side and a bit of excitement in the middle. It is important to keep telling stories or reading stories aloud. Encourage mothers to choose stories that they like so it does not become a chore: after a while mothers discover that there are stories that they enjoyed as children and they would like to revisit them, or stories they always meant to read but never got around to it. And the stories don’t just have to be children’s stories, read a chapter of your current novel and the baby will be soothed by the sound of your voice.

First six months Some of these ideas appear in chapters throughout the book. They are all gathered here in chronological order, with additional ideas and sequencing.

The first week The baby alternates long periods of sleep with short wakes for feeding, and there may be fretfulness and crying. However, the baby is already

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establishing eye contact with the mother and trying to imitate her expression. Babies are rooting and sucking during feeding. Many of the following exercises can be done during feeding and bathing. They are grouped developmentally but can be varied and merged. There are several activities that need to be developed consistently, several times a day combined with other activities or on their own. Massage Continue the massage in some form every day, for example: Hold the hands, feet, elbows and knees with a gentle press; hold each arm from shoulder to hand repeatedly with a firm press, and repeat with each leg from thigh to ankle. Stroke, especially the back and head, and then the tummy and bottom; gently stroke the cheeks with the back of the hand. Stories Always tell a simple story, even about the weather that day, with the regular rise and fall of your voice: the baby has become accustomed to it during the pregnancy; stories can be about how the baby looks, how much he or she is loved and how you are feeling today. Types of play Consonant play through rocking and humming; sensory play when feeding and washing; rhythmic play with singing and patting; echo play back and forth with sounds and facial expressions; dramatic play responding to the ‘as if ’ expressions. Consonant and sensory play These types of play gradually develop into more generalised ‘embodiment play’ with consonant and sensory elements. Keep finding ways of being ‘in touch’, including kissing, as part of the embodiment development. Take care Be careful to avoid tickling or invasive playing; allow the baby to indicate pleasure; remember that sudden movements and sounds are likely to cause distress. Neuro-Dramatic-Play from the first week:

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1. Consonant play: rocking while holding the baby close, rock back and forth. 2. Sensory play: trickle water at bath time over the tummy. 3. Rhythmic play: humming or singing gentle rhythmic sounds, pat or rub baby while you are singing. 4. Echo play: mm – mm – mm – baby will attempt to copy. 5. Games: tracing – use index finger to trace the baby’s eyebrows, down their nose and round their mouth. 6. Dramatic play: smile back when the baby seeks out your face. 7. Stories: continue…this is the story of a very special baby. All of the above can be integrated into the following weeks and months, and they can be used as a foundation for the development of more techniques.

The first month The baby is increasingly alert to facial expressions and mother’s voice, and responds to sensory playing while feeding and bathing. Neuro-Dramatic-Play: 1. Consonant play: rocking and humming so that the baby feels the vibrations through the body. 2. Sensory play: with soft toy, caressing, stroking and patting. 3. Rhythmic play: hold the baby on the left-hand side to feel the heartbeat. 4. Echo play: echo back the cooing and guttural sounds the baby starts to make. 5. Games: following and touching mother’s face; following and touching a slow moving toy. 6. Dramatic play: mother gives a soft toy and then holds out her hand to take it back. 7. Stories: tell a story about the toy you are both playing with.

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The second month Baby notices a certain toy placed close by, increase of arm movements, follows person round the room; starts to grasp, makes more sounds. Neuro-Dramatic-Play: 1. Consonant play: add circles as you hold and rock. 2. Sensory play: gently blow hair, palms of hands, back and tummy. 3. Rhythmic play: with songs, clapping (mother claps own hands and also claps baby’s hands). 4. Echo play: ‘Mummy’s nose, Mary’s nose’ as noses are touched with forefinger; then hold the baby’s finger to touch the noses. 5. Games: repetition of ‘Round and round the garden’, and ‘This little piggy went to market’. 6. Dramatic play: imitation of sounds and expressions; peek-aboo (gradually). 7. Stories: vary the stories with more vocal expression and gestures.

The third month The baby anticipates sounds, door opening, footsteps, bathwater; develops gaze to some object or body part; sustains eye contact when feeding. Neuro-Dramatic-Play: 1. Consonant play: wrap both arms around the baby and dance together. 2. Sensory play: extend the playing at bath time: bubbles, splashing, bath ducks. 3. Rhythmic play: hand claps with songs or stories. 4. Echo play: develop finger play back and forth, echo the finger grasp when baby takes finger. 5. Games: hold baby round waist and lift high up and then down again together with an up and a down sound. 6. Dramatic play: create a ‘surprise’ with a toy that is hidden and then visible.

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7. Stories: favourite stories to repeat that have a little surprise.

The fourth month The baby sometimes sits up or rolls over from front to back; new perceptions of space; enjoys caring routines, especially sensory ones; curious about sounds. Neuro-Dramatic-Play: 1. Consonant play: ‘Rock-a-bye baby’. 2. Sensory play: whole body massage while singing. 3. Rhythmic play: ‘Pat-a-cake’ and ‘Hush little baby’. 4. Echo play: blow raspberries, stick tongues out. 5. Game: of exercising legs and arms (say the words, such as ‘up– down’). 6. Dramatic play: pretend to nibble toes or fingers alternately. 7. Stories: show a story book as you tell a story.

The fifth month The baby starts to grasp feet and hold toys; responds to colours, music, and other sensory stimulation. Neuro-Dramatic-Play: 1. Consonant play: dancing/bouncing on your lap while you move and hum. 2. Sensory play: hold up and move brightly coloured objects. 3. Rhythmic play: gentle rhythms on the back and tummy. 4. Echo play: sounds back and forth, expressions back and forth. 5. Games: stretching up, up, up and down, down, down. 6. Dramatic play: have fun with a baby mirror: pull faces and be silly. 7. Stories: tell a simple story with baby-safe puppets.

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The sixth month The baby laughs, chuckles and has obvious enjoyment of playing; will play alone as well as with adults; intense concentration on light patches or moving shadows; possible variation in foods provides new stimulus. Neuro-Dramatic-Play: 1. Consonant play: mutual tickles and kisses. 2. Rhythmic play: singing with a rhythmic chorus. 3. Sensory play: rolling ball with bright colours. 4. Echo play: mother laughs, baby laughs; baby giggles, mother giggles. 5. Games: rolling from front to back and back to front. 6. Dramatic play: variation of voices with puppets. 7. Stories: use the ball and the puppets to tell a story. These Neuro-Dramatic-Play techniques are ones that usually develop during normal pregnancy and development, and the first six months of life. They can be taught to women who are nervous or lacking in confidence in handling their babies, especially if it is a first baby. They can be added to and developed and need to be reviewed if there are more appropriate cross-cultural techniques. Confidence in applying these techniques forms part of the NDP practitioner training.

Equipment Mostly bodies play with bodies and the human frame makes an excellent nest, a swing, a cradle and a climbing frame. You may also add: special organic baby oil for massage; sponge puppets for the bath and a range of bath toys such as yellow ducks (mother and babies); sponges; bath sponges and face cloths; soft blanket for resting and hiding; baby-safe puppets and soft toys; musical mobiles and shakers and rattles with musical sounds rather than noises.

Appendix 2

Embodiment-Projection-Role (0–7 years)

Neuro-Dramatic-Play Embodiment-ProjectionRole techniques with special needs groups The following can be adapted for children with attachment needs as well as those with developmental delay, behavioural and learning difficulties. Many of them can also be applied with children on the autistic spectrum. Some teenagers, surprisingly, will join in some of these exercises; it can often be a question of trial and error. 247

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Consonant play ‘Row, row, row your boat’ is a very good example of playing the same thing: many singing games, marching and dancing, and group exercises allow us to have the pleasure of consonant play.

Sensory and messy play Sand, water, mud, small stones, play-bark, finger paint, dough, custard powder or cornflour: most of these substances can be played with wet or dry and many of them can be mixed together. Making ‘pies’ is always a favourite. Pasta hoops, macaroni, alphabet pasta, wheels, spaghetti and so on, all can be played with dry; or cook some and get ‘wiggly worms’ or ‘soft stars’ or ‘squidgy letters’. Remember that it is not only the touch sensation but also the sounds: slithery, squelchy, oozing, splashing, gritty, splodge, splat (encourage the children to create more sounds). There are also the smells, for example the difference between the smell of mud and dough is very striking. Pasta can be cooked with various herbs such as thyme or sage or rosemary to provide another stimulus. There is also the visual stimulus with different textures and contrasting colours mixed together, as well as shapes and muddles. The Weather Map (using the safe zone: shoulders to waist) One person sits behind the other and starts to tell the story of the weather: ‘it is raining just a little, hardly at all’ (fingers lightly touching the back), ‘then it grows stronger’ (stronger fingers on the back), ‘and then STRONGER!’ (much stronger fingers), ‘and now the thunder starts’ (using flat of hand on back), ‘and now lightning’ (using side of hands across the back diagonally); alternate the rain and thunder interspersed with some rain a few times; then let the thunder die away, and then the rain, until it stops; ‘then the sun comes out’ (two hands make a circle), ‘and then there is a rainbow’ (one hand makes a large arc).

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Rhythmic play Find your heartbeat; find the pulse of a partner; beat a simple rhythm on the floor or by clapping hands; take it in turns to conduct the group while they play pretend instruments. Lots of singing games including stamping feet and clapping your hands; use the back as a drum and play out rhythmic beats; use a very large drum for the whole group to sit around and play rhythms together or send each other drum messages or drum the rhythm of your name.

Games Make use of ordinary playground games: ‘Simon says’, ‘What’s the time Mr Wolf ?’, ‘Oranges and lemons’ and incorporate as many crosscultural games as possible. Include repetitive games to build security and those with a singing or chanting element; others have skills built in, such as walking quietly.

Dramatic play Basic movement and drama games to ease people in: freeze frames where the children have to freeze in a shape, initially on their own and then with a partner; lots of hats for dressing up and then walking as a character. Have a box of props such as a walking stick or brief case or shopping bag, and everyone chooses a prop and turns into the character. Create simple single theme stories that can be mimed without people feeling overwhelmed.

Stories Share stories together: the story of my day or what happened on the way here; favourite TV story; favourite fairy story; discuss what stories can be turned into a play. Compose stories specifically for the group or encourage them to create a story about the group.

Embodiment-Projection-Role techniques for children Techniques for children with behavioural difficulties (inspired by Bratton et al., and developed from his model) comprise a three-stage

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intervention that acknowledges how a child is feeling, sets limits on unacceptable behaviour and suggests an alternative activity.

Embodiment 1. Echo a similar physical activity (‘Throw the ball to me and I will throw it back’). 2. Set the limits (‘You can play ball but not to hurt other children’). 3. Transform into new body activity (‘I’ll be goalie and you kick the ball’).

Projection 1. Echo a similar projective activity (slosh paint around in an acceptable place). 2. Set the limits for the paper or space (‘This wall is the graffiti wall, the other wall belongs to the church’). 3. Transform into new projective or art activity (‘Have you ever tried playing the squiggle game with large paint brushes?’)

Role 1. Echo a similar role activity (‘If you are the angry king, I will be the queen who never speaks’). 2. Set the limits for the role activities (‘It’s fine to be king but hitting the palace servants for real is not allowed’). 3. Transform into new role or drama activity (‘What does the king think about when he is on his own?’) Give as much opportunity as you can for the child/ren to have sensory elements in their playing: costumes can include velvet and other tactile fabrics; fingers paints can be used for projective work; simple massage can be included in embodiment work.

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Embodiment-Projection-Role activities for children who are angry, chaotic or shut down Chaotic and angry children often need a lot of embodiment work through adult-supported swimming and games as well as through nurture play at bedtime and bath time; opportunities for messy play with sand and water, flour and water, seaside play. Clingy and fearful children will often initiate embodiment play especially if it allows touch. Sensory play is enjoyed to the full and most of the NDP activities are enjoyed and repeated. However, the embodiment play also needs structure so that it can be contained and secure. Exercises that involve breathing and voice are helpful, for example, the Luft Balon exercise (see box). The Luft Balon exercise Blow up an imaginary balloon and then tie the balloon with imaginary string, count 1, 2, 3 and pop the balloon while saying a loud ‘bang’. Then blow the child up as a balloon; the child crouches on the floor and slowly stands up as you blow more and more; once he or she is expanded as much as possible, tie the top, find an imaginary pin and ‘BANG’! The child lets all the air out and lies flat on the floor. This exercise can be practised so that the air comes out very slowly, and the child learns to relax. The child can then blow up the adult in a similar way. This is one of the most popular embodiment exercises we do and it has been shown across several continents with every age group. Another progression is to blow up an imaginary balloon, tie on the imaginary string and then go for a walk with it. This is quite a complex exercise and means that the child has to focus on not muddling up the string or catching the balloon on anything sharp. Walking an imaginary dog is another similar exercise.

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Embodiment 1. Touch is unlikely to be accepted initially: use ribbons, long scarves, hoops and balls to contact each other. 2. Keep open the possibilities for it to lead into more sensory play with water and hand massage cream. 3. Encourage the transformation into rhythmic movement and drumming.

Projection 4. Drawing and painting are likely to be formal but you can gently role-model other possibilities. 5. Have a large bead and button box for sorting and matching (this can be very soothing). 6. Encourage pictures such as self-portraits, monsters and safe places.

Role 7. This will be the most difficult area: a shut-down child usually will hold on to the ‘here and now’. 8. Have around simple role materials such as an assortment of hats, caps, half-masks, shawls. 9. Encourage games for example with ‘role cards’ or guessing expressions. Sensory, rhythmic and dramatic playing is important as an intervention for children who have suffered trauma or disrupted attachments. These are just a few ideas of practical NDP activities you can do with special needs groups of children, and specifically children with attachment needs. There are also many books of ideas, some of which are in the Further Reading section at the end of this Appendix.

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Embodiment-Projection-Role techniques with teenagers and young adults Many teenagers cannot bear to seem involved in something like drama; others will be propelled towards it and make full use of the medium (reread the story of Rami in Chapter 9). Teenagers need clear communication and the opportunity to make choices. They may wish to make up dramas about events that are relevant to them, but then find they are too near the bone. Although it isn’t usually possible to go through the seven stages of playing like we can with younger children, nevertheless some of the elements can be built in. For example, teenagers have been involved in ‘sticky’ play when making collages: use a large selection of newspapers and magazines to create individual or group collages on a theme: cut or tear out pictures or headlines to create a story or a poem or a themes picture. Young people have happily allowed Vaseline to be put on their faces, when it was necessary for creating a mask. It enabled their adult co-workers to perform a face massage by smoothing in the Vaseline. The skills needed for jousting with broomsticks required a high degree of physical coordination and control. The textures of materials such as velvet, canvas and sandpaper allow for sensory experiences. I want to emphasise the importance of rhythmic and ritualistic work when we are working with teenagers. To this end we can encourage poetry, ritualistic storytelling, rap words and music. A rhyming dictionary is important as it will open up a whole new world for young people to put their feelings into words and actions such as rap. Chambers Rhyming Dictionary is excellent: in its preface by Benjamin Zephaniah (2008), he says: use this book as a starting point, a source for new ideas, and as a way of finishing those poems that will not be done by head scratching alone, but remember there are no boundaries for the things you can do in poetry. You have my permission to use the words outside the list provided. (Zephaniah 2008, p.vi)

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You could also look at the following books, which contain a lot of surprises: Crystal, B. (2008) Shakespeare on Toast: Getting a Taste for the Bard. Cambridge: Icon. Partridge, E. (1968) Shakespeare’s Bawdy. London: Routledge.

Further reading for ideas Clifford, S. and Herrmann, A. (1997) Making a Leap: Theatre of Empowerment. London: Jessica Kingsley Publishers. Crimmens, P. (2006) Drama Therapy and Storymaking in Special Education. London: Jessica Kingsley Publishers. Jennings, S. (2004) Creative Storytelling with Children at Risk. Milton Keynes: Speechmark. Jennings, S. (2006) Creative Play with Children at Risk. Milton Keynes: Speechmark. Riley, S. (1999) Contemporary Art Therapy with Adolescents. London: Jessica Kingsley Publishers.

Afterword

NDP – the wonders of play and playfulness in securing the lives of children Or Can Peter Pan come home?

In our chaotic world children are not really children any more as they are exposed to technologies much too early (computers, computer games, cellular phones), demanding from them only that they have to push a button and everything is readily rolling, singing, talking… no need for adult mediation, no need for exploration and no need for delay in gratification. Moreover, images and messages much beyond their emotional capacity to digest appear on the screen at home; Mum and Dad may be either very distressed or preoccupied with themselves, thinking the little one does not understand, and in the absence of such adult mediation, leaving a bewildered child to wonder what it means and how to comprehend or react to it. It seems that every adult in the western world knows that this exposure has a significant impact on our lives and the lives of the new generation, but do we take it as yet another ‘Act of God’ or do we look into this reality with open eyes and a positive approach? In this new book, Sue Jennings is certainly working hard to open our eyes, giving us a new paradigm to comprehend the impact that modern western culture is having on our children and furthermore, a very useful and hands-on approach on how to deal with it.

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The emotional neglect of children and the need to mediate the world for them is not new. Recently I was reading again the original story of Peter Pan (Peter Pan in Kensington Gardens, the original novel by James M. Barrie, published in 1906). In hindsight I could see its relevance to NDP in understanding the story. I must admit I did not remember that Peter is a seven-day-old infant who (like all babies in London) came from Kensington Gardens and used to be a bird. Lying in his cradle he hears a disturbing discussion about his adult life and believing in his flying abilities, he escapes out of the window of his London home and returns to Kensington Gardens. There, however, he is shocked to learn from a crow that he is a ‘Betwixt-and-Between’, more like a human and not still a bird. Learning he cannot fly, he is stranded in the Gardens, which he navigates by use of a large thrush’s nest as a boat, which takes him by way of the Serpentine. Peter soon gains favour with the fairies and plays the pan pipes for them at their fairy dances. After some time, Queen Mab grants him his most heartfelt wish, which makes him decide to return home to his mother. The fairies enable him to fly home, where he finds his mother asleep in his old bedroom. As he looks at her, Peter feels guilty for having left her and believes she misses and longs for him. However, before finally returning home, he feels he should go back to the Gardens to say his last farewells. Unfortunately he stays too long, and when he uses his second wish to go home permanently, is devastated to learn that his mother had given birth to another boy she can love. Heartbroken, he returns to Kensington Gardens where he finds comfort with his gang, the lost boys. The lost boys had fallen out of their prams or been abandoned by their nannies. If they were not claimed within seven days they were sent to Neverland. What does it mean by ‘lost’? Who did not want them? Why are they lost and not found, or at least searched for by any adult? Peter does not understand children’s games until a friend, Maimie, explains them to him, and he then discovers he plays all his games incorrectly.

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The fact that Peter Pan did not know how to play fits in admirably with Sue Jennings’ contention that playful primary attachment is essential for health development. In Peter and Wendy, J.M. Barrie, 1911, Wendy’s mother cuts off Peter’s shadow, which represents his unconscious. He can’t allow himself to admit that he misses home, his mum, the secure attachment of a caring adult. We all need to own our shadow side if we are to mature psychologically. The fact that Wendy sews his shadow back on re-connects him with his desires to be with a mother-like caring figure, to return to what Sue Jennings describes as the early playful attachment, and in fact the most important virtue of Wendy is that she knows lots of bedtime stories! But is it really up to a child to care for a child? In fact, if one reads the story using NDP vision and adapting the definition given by Jennings for it, “a sensory, rhythmic and dramatic playfulness that takes place between mother and unborn and mother and newborn from conception to six months”, one can see why Peter will forever stay in Neverland. Wendy and her brothers can return to the home where they have a caring and warm mother, bedtime stories and cuddly places, from which they can wander and to which they can return. But as for Peter, as Sue suggests, very early neglect needs a long road to recovery, if at all. I have read the new paradigm that Sue has developed with much amazement, amusement and admiration. Amazement at the new integration of neuroscience, developmental psychology and dramaplay theory, amused by the many great examples of practical use of the paradigm, admiration for Sue’s ability to look at her own work and the work of others afresh and bring such a novel approach which can be so easily understood by both laymen and professionals. In my mind the NDP model, theory and practice, is a very powerful tool that provides new outlooks, and new skills and methods for parents, teachers and mental health professionals; a map and a compass for understanding children as well as the child within. Prof. Mooli Lahad PhD. Professor of Psychology and Dramatherapy Tel Hai College Israel.

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References╇ /╇ 261 Field, T.M., Woodson, R., Greenberg, R. and Cohen, D. (1982) ‘Discrimination and imitation of facial expression by neonates.’ American Association for the Advancement of Science 218, 4568, 179–181. Fuge, G. and Berry, R. (2004) Pathways to Play. New York: Asperger Autism Publishing Company. Galloway, L. (2010) 2 Case presentations in Chapter 9. Professional communication. Garbarino, J., Dubrow, N., Kostelny, K. and Pardo, C. (1992) Children in Danger: Coping with the Effects of Community Violence. San Francisco, CA: Jossey-Bass. Garmezy, N. and Rutter, M. (eds) (1983) Stress, Coping and Development in Children. New York: McGraw-Hill. Gerhardt, S. (2004) Why Love Matters: How Affection Shapes a Baby’s Brain. Hove: BrunnerRoutledge. Gersie, A. (1991) Storymaking in Bereavement. London: Jessica Kingsley Publishers. Gersie, A. and King, N. (1990) Storymaking in Education and Therapy. London: Jessica Kingsley Publishers. Goffman, E. (1969) The Presentation of Self in Everyday Life. Harmondsworth: Pelican. Golding, K. (2008) Nurturing Attachments: Supporting Children who are Fostered or Adopted. London: Jessica Kingsley Publishers. Goldman, L.A. (1998) Child’s Play: Myth, Mimesis and Make-Believe. Oxford: Berg. Goleman, D. (1998) Working with Emotional Intelligence. London: Bloomsbury. Goleman, D. (2005) Emotional Intelligence. New York, NY: Barnes and Noble. Goleman, D. (2006) Social Intelligence: The New Science of Human Relationships. London: Hutchinson. Gordon, J. and Grant, G. (1997) How We Feel: An Insight into the Emotional Worlds of Teenagers. London: Jessica Kingsley Publishers. Gratier, M. and Trevarthen, C. (2008) ‘Musical narrative and motives for culture in mother–infant vocal interaction.’ Journal of Consciousness Studies 15, 122–158. Greenspan, S. and Wieder, S. (2006) Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, MA: Da Capo Press. Guerney, B., Guerney, L and Andronica, M. (1976) The Therapeutic use of Children’s Play. New York, NY: Jason Aronson. Harlow, H. (1958) ‘The nature of love.’ American Psychologist 13, 673–685. Harris, J.R. (1998) The Nurture Assumption: Why Children Turn Out the Way They Do. New York: Free Press. Heathcote, D. and Bolton, G. (1995) Drama for Learning. London: Heinemann. Hickson, A. (2005) Feeling Cards: Card Pack for Group Work. Weston-Super-Mare. Actionwork. Hickson, A. (2009) ‘Social Theatre: A theatre of empowerment to address bullying in school.’ In S. Jennings (ed.) Dramatherapy and Social Theatre: Necessary Dialogues. Hove: Routledge. Holmes, J. (1993) John Bowlby and Attachment Theory. London: Routledge. Howe, D. (2005) Child Abuse and Neglect. Basingstoke: Palgrave Macmillan. Hughes, D. (2006) Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children. Lanham, MD: Jason Aronson.

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Jackson, D. (2003) Three in a Bed: The Benefits of Sleeping with Your Baby. London: Bloomsbury. Jaffe, J., Beebe, B., Felstein, S., Crown, C. and Jasnow, M.D. (2001) Rhythms of Dialogue in Infancy: Coordinated Timing and Social Development. Society of Child Development Monographs Serial No. 265 66 (2).Oxford: Blackwell. Jansson, T. (1962) Tales from Moomin Valley. Harmondsworth: Puffin. Jennings, S. (1983) ‘Play Scripts in Relation to Teaching Psychiatry.’ Seminar for staff at Hertfordshire College of Art and Design. Jennings, S. (1987) ‘Developmental Dramatherapy.’ Presentation to Dramatherapy Course, Tel Hai College, Israel. Jennings, S. (1990) Dramatherapy with Families, Groups and Individuals. London: Jessica Kingsley Publishers. Jennings, S. (1994) Theatre, Ritual and Transformation: The Senoi Temiars. London: Routledge. Jennings, S. (1998) Introduction to Dramatherapy. London: Jessica Kingsley Publishers. Jennings, S. (1999a) Introduction to Developmental Playtherapy: Playing and Health. London: Jessica Kingsley Publishers. Jennings, S. (1999b) ‘Silver Apples of the Moon: A Spiral of Madness.’ Play script (Performed but unpublished.) Jennings, S. (2003a) ‘Playlore: The roots of humanity.’ Play for Life, autumn, p.7–9. Jennings, S. (2003b) ‘The Sensory Foundation.’ Core training for play and dramatherapists, Romania. Jennings, S. (2004) Creative Storytelling with Children at Risk. Milton Keynes: Speechmark. Jennings, S. (2005a) Creative Storytelling with Adults at Risk. Milton Keynes: Speechmark. Jennings, S. (2005b) Creative Play with Children at Risk. Milton Keynes: Speechmark, p.7–9. Jennings, S. (2006) Creative Puppertry with Children and Adults. Milton Keynes: Speechmark. Jennings, S. (2007a) Keynote presentation for Greek Dramatherapy Conference. Jennings, S. (2007b) Theatre of the Body and Neuro-Dramatic-Play. Keynote presentation BADTh conference. York: York University. Jennings, S. (2008) ‘Neuro-Dramatic-Play with excluded children.’ Play for Life, summer, p.3–5. Jennings, S. (2009a) ‘Circle of Containment – Circle of Care – Circle of Attachment.’ Presentation for play therapy students in UK and Romania. February. Jennings, S. (ed.) (2009b) Dramatherapy and Social Theatre: Necessary Dialogues. Hove: Routledge. Jennings, S. (2009c) ‘Neuro-Dramatic-Play and Attachment.’ Workshop presentation for therapists and counsellors, Glastonbury. May. Jennings, S. (2009d) I Just Want to go Home: Working with Trafficked Women. RAPTD. Conference on Child Abuse. Bravov, Romania. September. Jennings, S. (in preparation) Playful Pregnancy – Positive Children. Jennings, S. (in preperation) Poems of the Body. Rowan.

References╇ /╇ 263 Jennings, S. and Minde, A. (1993) Art Therapy and Dramatherapy: Masks of the Soul. London: Jessica Kingsley Publishers. Jernberg, A.M. (1976) ‘Theraplay Techniques.’ In C.E. Schaefer (ed.) Therapeutic Use of Child’s Play. New York: Jason Aronson. Jernberg, A.M. and Booth, P.B. (2001) Theraplay: Helping Parents and Children Build Better Relationships Through Attachment-Based Play. San Francisco, CA: Jossey-Bass. Jones, P. (2010) Drama as Therapy: Volume 2. Hove: Routledge. Joseph, J. (1962) Warning. London: Souvenir Press. Kalff, D. (1980) Sandplay. Santa Monica, CA: Sigo Press. Kanner, L. (1943) ‘Autistic disturbance of affective contact.’ Nervous Child 2, 217–250. Kashyap, T. (2005) My Body, My Wisdom. Delhi: Penguin. Lahad, M. (2000) Creative Supervision. London: Jessica Kingsley Publishers. Landreth, G. (1991/2002) Play Therapy: The Art of the Relationship. New York: Routledge. Laschinger, B. (2004) ‘Attachment Theory and the Bowlby Memorial Lecture – A Short History.’ In K. White (ed.) Touch Attachment and the Body. London: Karnac. Lavery, B. (1987) Origin of the Species. In M. Remnant (ed.) Plays by Women: Volume Six. London: Methuen. Le Doux, J. (1998) The Emotional Brain. New York: Phoenix. Lemert, C. and Branaman, A. (eds) (1997) The Goffman Reader. Oxford: Blackwell. Lowenfeld, M. (1979) Understanding Children’s Sandplay: Lowenfeld’s World Technique. Aylesbury: Margaret Lowenfeld Trust. Luxmoore, N. (2000) Listening to Young People in School: Counselling and Youth Work. London: Jessica Kingsley Publishers. McCarthy, D. (2007) If You Turned into a Monster. London: Jessica Kingsley Publishers. McCormick, S. (1997) Archive on Painkillers and Childbirth. ICS Usenet. McMahon, M. (1992) The Handbook of Play Therapy. London: Routledge McTell, R. (1971) ‘First and Last Man.’ From the album You Well-Meaning Brought Me Here. Famous Label. Maclean, P.D. (1990) The Triune Brain in Evolution: Role of Paleocerobral Functions. New York, NY: Plenum. Marner, T. (2000) Letters to Children in Family Therapy: A Narrative Approach. London: Jessica Kingsley Publishers. Maslow, A. (1968) Toward a Psychology of Being (second edition). (Note: Original Edition 1954 was called Motivation and Personality). Masten, A.E. (2000) Children Who Overcome Adversity to Succeed in Life. University of Minnesota website. Available at www.extension.umn.edu/distribution/ familydevelopment/components/7565_06.html (accessed on 28 May 2010). Masten, A.E. (2001) ‘Ordinary magic: Resilience processes in development.’ American Psychologist 56, 227–239. Masten, A.E. (2006) ‘Developmental psychopathology: Pathways to the future.’ Journal of Behaviour Development 31, 47–54. Mead, G.H. (1934) Mind, Self and Society. Chicago, IL: University of Chicago Press. Miller, A. (1983) For Your Own Good: The Roots of Violence in Child-Rearing. London: Virago.

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Subject Index Actionwork Project 188 angry children 122–3, 154, 170–1, 209 EPR/NDP activities 159–60, 166, 250 ‘as if ’ bodily states 21, 30–1, 37, 39, 58, 112, 124–6, 129 and anthropology 66–7 and communication 94, 193 in games and exercises 218, 242 As You Like It (Shakespeare) 12–13 ASC see Autistic Spectrum Condition (ASC) attachment circle models 14–15 cross-cultural perspectives 49–50 definitions and explanations 57–61 early theorists 47–51 forms and types (Ainsworth) 49 ambivalent 229 disorganised 230 distorted 228–9 and looked-after children 152–6 and mourning 52–3 neurochemistry 134–5, 230–1 theories of Winnicott and Erikson 53–7 within NDP frameworks 58–61 see also children with attachment needs; mother–unborn baby interactions Autistic Spectrum Condition (ASC) 190–207 background studies and perspectives 190–2 core problems and challenges 191 communication issues 193–4 intervention approaches 191–2

intervention exercises 193–207 and communication 193–4 and dramatic play 204–7 and mirroring 39 and rhythmic play 202–4 and sensory play 195–201 bath time activities 216–17 body image, distortion problems 30 ‘body intelligence’ 19 ‘body self ’ 19 Bousted, Mary 169–70 brain development deprivation and trauma studies 135–6 evolutionary perspectives 34–6 importance of playful attachment 33–8 breastfeeding 108–9, 111 bullying 129, 136, 168–9 victims as bullies 187 Ceausescu (Romania) 225 Chabukswar, Aanand 44 ‘chaotic children’ 143, 145, 159 EPR/NDP activities 145–6, 159–60, 161, 251 Child Care and the Growth of Love (Ainsworth and Bowlby) 50 child development and communication 26 first six months 112–14 and music 26–7 see also brain development; dramatic development; psychosocial development child mascots 231–2 childbirth as ‘creative experience’ 43 cultural perspectives 102–3 first post-delivery moments 95–6 home vs. hospital 98–102 indications for therapy 107–8 medicalisation 100–1 and Neuro–Dramatic–Play 110–11

267

post-delivery distress 107–8 privacy concerns 33 role of fathers 101–2, 109–10 self-management 33 singing and chanting 43 children with attachment needs 130–46 identifying ‘real needs’ 131–3 interventions 140–6 post-delivery 140–1 potential outcomes 136–9 specific NDP exercises 141–6 NDP to EPR progressions 130–1 neurochemistry of brain development 135–6 children with attachment needs cont. storytelling activities 163–6 children with learning difficulties 208–24 disability and difference 208–11 guidelines for NDP work 211–12 practical NDP interventions 213–24 Circle of Care–Circle of Containment–Circle of Attachment 14–15, 40–1, 82–3, 90–1, 156 clingy children 153 EPR/NDP activities 160–1, 251 clowning behaviours 231–2 ‘The Collective Body’ (Adler) 18 communication between mother and infant and the child with autism 193–4 during pregnancy 42–3, 92–5 and the newborn baby 106–7 conception and NDP 32 problems 84

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consonant play described 25, 172 therapeutic uses and practices 242–3, 244–6, 248 for children with ASC 194, 200–1, 202–4, 207 copying see mimicry cortisol 37–8, 59, 135 Creative Play and Children at Risk (Jennings) 71 cultural perspectives and attachment 49 and childbirth 102–3 and play 69–70 and psychosocial development 56 role of the media 125–7 development of play and drama see dramatic development developmental paradigms 15–18, 29–31 see also Neuro–Dramatic–Play (NDP) Dibs in Search of Self (Axline) 74 Dimensions Model (play therapy) 77–8 disability and difference 208–11 ‘Drago-Drama’ 179 dramatherapy work with teenagers 177–81 see also dramatic play dramatic development 20–7 developmental paradigms 15–18, 29–31 key phases 25–6 ToB/ToL stages and restaging 16 ‘dramatic distance’ 125 dramatic play 79 during pregnancy 97 for children with ASC 204–7 for children with learning difficulties 219–21 for children with special needs 249 for teenagers 177–81 general considerations 36–7 and mimicry 79 see also Neuro–Dramatic–Play (NDP) dramatic reality 66 ‘dramatic response’ (Jennings) 30 eating disorders 30, 88, 125 ‘echo gaze’ 45 echo play 17, 44, 58, 113, 128 deprivation of 139 described 58, 132 therapeutic uses 132–3, 143, 194, 195, 201, 203 in children with ASC 200, 203–4

and

Neuro-D ramatic-P lay

The Elephant Man (film) 201 Embodiment–Projection–Role (EPR) 15–16, 17–18 concept explained 30 key milestones 240–6 disruption consequences and legacies 30–1 examples of typical activities 158, 240–6 during pregnancy 241 during first six months 241–6 in children with attachment needs 130–1, 143–6 in children with special needs 247–50, 249–50 in children who are angry/ chaotic 251–2 in looked-after children 157–66 in work with teenagers 181–6, 253–4 emotional brain (mammalian) 34, 35–6 emotional competence 171 emotional hunger 126–7 emotional immunity 38 emotional intelligence 170–1 emotional neglect 37–8 see also emotional hunger; trauma empathy 30–1, 36–7 and conscience 36–7 and resilience 124–5 epidural use 99 EPR see Embodiment– Projection–Role (EPR) evolutionary perspectives on brain development 34–6 facial expressions and infants 43–4, 111 and mirroring 39 failure to thrive 20–1 fathers 228 and childbirth 101–2, 109–10 fear responses 38 fearful children 153 EPR/NDP activities 160–1, 251 fearful teenagers 167–8 feeling cards 122–3 fertility problems 84 Filial therapy 76 foetal development 86–8 food activities 213–15 foster caring 148–52 see also looked-after children Freudian theories on sexuality 127 games, for children with learning difficulties 218–19

gang cultures 126 goal copying see imitation ‘good enough’ mothering (Winnicott) 134 Grief - A Peril in Infancy (film 1947) 47 hand–eye coordination problems 30 home births 97, 98–102 hope 56, 127–8, 154 hospital births 98–100 humour and children with ASC 193–4 imagination 21, 30, 39–40 imitation 38, 127, 158, 195, 200–1, 220–1, 236, 244 stages during first six months 111, 112–13 individualism 126–7, 171 instinctual brain (reptilian) 34–5 ‘Intend–Pretend–Attend’ therapeutic play (Chabukswar) 44 interactive play 97, 142, 173, 194 and children with ASC 205–7 Kafka, Franz 11 learning difficulties 208–24 disability and difference 208–11 guidelines for NDP work 211–12 practical NDP interventions 213–24 looked-after children 132, 147–66 key issues for foster carers 148–52 attachment patterns in children 152–6 see also children with attachment needs Luft Balon exercise 160–1, 251 ‘The Magic Bag’ story (Hungarian Roma) 221–3 mammalian brain see emotional brain (mammalian) mask work resilience and attachment work 123 with teenagers 179–81 Maslow’s hierarchy of needs 20, 127–8 massage 41–2, 91–2 for babies 104 for children with learning difficulties 216 masturbation 53–4

S ubject Index╇ /╇ 269

media and cultural influences 125–7 distortion effects 228–30 messy play 70–2, 161–2, 248 midwifery, historical perspectives 32–3 mimesis 38–9 mimicry 17, 20, 25, 37, 38–40, 42, 78–9, 111, 127–8, 158 and child-led interactions 201 and developing resilience 236 and dramatic play 79 Mirror Image (poem) 239 mirror neurons 21, 39–40, 230–4 mirroring and dramatic development 21, 25 neuroscience of 21, 39–40, 230–4 A Model of Play Therapy to Heal a Hurt Child (Cattanach) 75–6 mother–infant attachment circle models of 14–15 cross-cultural perspectives 49–50 definitions and explanations 57–61 early theorists 47–51 forms and types (Ainsworth) 49 ambivalent 229 disorganised 230 distorted 228–9 and looked-after children 152–6 and mourning 52–3 neurochemistry of 134–5, 230–1 theories of Winnicott and Erikson 53–7 within NDP frameworks 58–61 see also children with attachment needs; mother–unborn baby interactions mother–unborn baby interactions 31 neurochemistry 33 sensory and rhythmic play 41–3, 91–5 talking and singing 42–3, 92–5 motherhood historical perspectives 32–3 importance 226–7 quality and competence 134 and work 133 see also mother–infant attachment

mourning 52–3 movement-based activities 218 see also rhythmic play music playing 41 during pregnancy 87, 92–3 NDP see Neuro–Dramatic–Play (NDP) neglect 29, 37–8, 47–8, 51–2, 56–7, 66 coping strategies 119–20 and the ‘shut down’ child 116, 119, 144–6, 152–3, 155, 160, 198, 251, 252 Neuro–Dramatic–Play (NDP) concept origins 31 concept rationale 34–8 critical periods and timeframes 31, 33 definitions 33 developmental models and paradigms 14–15, 15–18 integration of circles 18–20 key play stages 207 during pregnancy 96–7 during first 6 months 110–14 in children with ASC 194, 198–207 in children with attachment needs 130–1, 143–6 key effects and influences 34 and play therapy 78–80 sensory, rhythmic and dramatic elements 79–80 and resilience 127–9, 234–8 and theories of attachment 46–61 neuroscience of dramatic development 21–2 deprivation studies 37–8 evolutionary perspectives 34–6 nature of attachment 57–8, 230–1 nature vs. nurture aspects 29 newborn babies communication needs 106–7 company needs 105–6 contact needs 104 first post-delivery moments 95–6 key milestones and developments 112–14 Nietzsche, Friedrich 229 Nurturing Attachments (Golding) 148 On the Edge (Sommers) 173 pain relief during childbirth 99, 101

parental death 60 peer influences, during adolescence 186–7 ‘performance’ 22 concepts and theories 21–7 and dramatic development 22–3 and play 22 placenta 110 play cultural considerations 69–70 importance and significance by mothers 58–9, 63–4 in child development 64–70 value of creating mess 70–2 see also dramatic play; Neuro– Dramatic–Play (NDP); rhythmic play; sensory play ‘play space’ (Winnicott) 18 play therapy 69, 73–8 basic principles (Axline) 74 innovations 76–7 and Neuro–Dramatic–Play 78–80 new models 77–8 Play Therapy (Axline) 74 playfulness 73 postnatal distress 107–8 pre-birth interactions see mother–unborn baby interactions ‘predictable’ play, importance 35 pregnancy 81–95 circles of care and circles of containment 82–3, 90–1 early infant-mother relationships 83–4 foetal development 85, 86–8 important milestones 84–6 and playfulness 89 see also mother–unborn baby interactions pretend play 30, 39–40 primary circles model of attachment 14–15 psychiatric illness, and early childhood experiences 133 psychodrama, limitations 177 psychosocial development, eight stages (Erikson) 55 puberty 173 ‘rainbow remedies’ 117 rap music 188, 253 rational brain (higher brain / executive function) 34–5 Reactive Attachment Condition (Hughes) 36 reptilian brain see emotional brain (mammalian) research studies, on brain development 29

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resilience 115–29 definitions 115 impact on differentiation of feelings 122–4 empathy 124–5 influencing factors 120–2 interventions mask play 123 and Neuro–Dramatic–Play 127–9 theme of rainbow remedies 117 and trauma 118–20 ‘Respect and Protect’ programme 186 rhythmic play 41–3, 78, 202–4, 249 during pregnancy 92–3, 97 and ritual 78 with ASC children 202–4 with teenagers 188 see also Neuro–Dramatic–Play (NDP) ritual, and rhythmic play 78 rocking 41, 92–3 see also rhythmic play ‘role(s)’ and dramatic development 21, 22–3 EPR concepts and theories 21–7, 30–1 role models 131, 227–8 intervention work with peers 186–7 with therapists 146, 234 role play 30, 37–8 neurological basis 39–40 within the womb 88 Romanian orphans 20–1, 29, 37– 8, 47, 53–4, 118–19, 225 neurochemistry of deprivation 135–6 safe havens 156–60 see also Circle of Care–Circle of Containment–Circle of Attachment sand and water play, with teenagers 181–6 ‘self ’, concepts 23 self harm 126 selfishness, cultural influences 125–6 sensory play 36, 41–3, 78 early stages 41–2 and messiness 78 and pregnancy 97 therapeutic practices and uses 116–17, 145, 155–6, 160, 173 with ASC children 194, 195–201

and

Neuro-D ramatic-P lay

with teenagers and young adults 173, 179–81, 187 see also Neuro–Dramatic–Play (NDP) separation anxiety 37–8, 48–9, 59–60 neurochemistry 57–8 sexual abuse 144–5 sexuality, media distortion 229–30 shared experiences 171–2 ‘shut down’ children 116, 119, 144–6, 152–3, 155, 160, 198, 251, 252 singing to infants, during pregnancy 42–3, 92–5 Six–Part Story (BASICPh) (Lahad) 120 The Snowman (film 1982) 68 social competence 171 social relatedness, neuroscientific basis 29 socialisation deficits, amongst teenagers 170–1 sociodrama 177–81 special needs and NDP/EPR techniques 247–50 see also Autistic Spectrum Condition (ASC); learning difficulties storytelling for children with attachment needs 58, 163–6 for children with learning difficulties 221–4 during pregnancy 42, 94–5 importance 232–3 ‘strange situation’ (Ainsworth) 48–50 stress responses, brain development 37–8 surrogate mothers, early research studies 50–1 survival mode in children 35, 37 talking to infants, during pregnancy 42–3, 92–5 teenagers and young adults 167–88 attachment deficits 168–9 experiences of neglect 170–2 importance of peers 186–7 interventions with and ways of working 173–88, 253–4 drama work 179–81 importance of adult support 187 peer work 186–7 ritual and rhythm work 188 sensory work 181–6 potential to change 172–3

socialisation and communication issues 169–70 television distortive effects 228 and teenagers 169–70 Temiars people (Malaysia) 49, 102–3 ‘theatre’ 124–5 importance 233 Theatre of Attachment (Moore) 22 Theatre of Body/Theatre of Life (ToB/ToL) 16, 23, 25, 127 concept origins 40–1, 234 and integrated circles 18–20 Theatre of Mind (ToM) (Whitehead) 38–40, 127, 204–5, 234 Theatre of Resilience (ToR) 16, 22, 233–8 Part–1 236 Part–2 237 Theory of Mind (Baron-Cohen) 38 Theraplay 76–7 Three in a Bed (Jackson) 105 transitional objects 53 trauma and attachment losses 52, 59–60, 117 and resilience 118–20 ‘triune brain’ (Maclean) 3436 trust, cultural influences 125–7 ‘trust vs. mistrust’ stage of development (Erikson) 36, 121 victims as bullies 187 violence cultural influences 125–6 and teenagers 168–9 water and sand play, with teenagers 181–6 Weather Map activities 159–60, 248 Why Love Matters (Gerhardt) 154–5 Windows to Our Children (Oaklander) 75 working mothers 133 The X Factor (TV program) 228 yoga, during pregnancy 93 young adults see teenagers and young adults Yurok Native Americans 56

Author Index Ackerman, S. 186 Adler, J. 18 Ainsworth, M. 48–50 Allen, R.E. 193 Ammann, R. 74 Archer, C. 150–1 Aristotle 65 Axline, V. 74–5

Erikson, E. 36, 48, 54–6, 115, 121, 128 Evans, D. 186

Baron-Cohen, S. 30, 38–9, 192, 202 Barrie, J.M. 256–7 Beckerleg, T. 70 Berry, R. 192 Bettelheim, B. 190–1 Blackard, S.K. 76 Bleuler, E. 190 Blom, R. 75 Booth, P.B. 76–7 Bousted, Mary 169–70 Bowlby, J. 41, 47–50, 61, 132–3, 147 Branaman, A. 24 Bratton, S.C. 76, 249–50 Briggs, R. 68 British Agency for Adoption and Fostering (BAAF) 150 British Association of Play Therapists 73 Brown, F. 73 Bruner, E. 24

Garbarino, P. 120–1 Gardner, K. 77–8 Gascoigne, P. 28 Gerhardt, S. 37–8, 56, 154–5, 172 Gersie, A. 232–3 Glaser, D. 49–50 Goffman, E. 24 Golding, K. 148, 153–4 Goldman, L.A. 65–7 Goleman, D. 170–1 Gordon, C. 150–1 Gordon, J. 186 Grant, G. 186 Gratier, M. 27 Greenspan, S. 191–2, 200, 206–7

Carroll, J. 75 Cattanach, A. 65, 75–6 Chakrabarti, B. 30 Chisholm, K. 135 Clifford, S. 238 Cook, C. 65 Cooper, R. 69 Cossa, M. 179 Courtney, R. 65 Cozolino, L. 20, 29, 33, 34, 57–8, 134–5, 231 Crimmens, P. 232 Cyrulnik, B. 59–60, 115, 152, 168, 187, 231

Fostering Network 150 Freud, A. 56 Freud, S. 127 Fuge, G. 192

Hall, W. 98 Harlow, H. 21, 29, 47, 50–1, 104 Harris, J.R. 47–8 Herrmann, A. 238 Hickson, A. 122, 129 Holmes, J. 133 Howe, D. 56 Hughes, D. 36, 115, 150

Damasio, A. 21 De Waal, F. 171

Jackson, D. 105 Jaffe, J. 41, 147 Jansson, T. 163–5 Jennings, S. 15, 19–20, 29–31, 37, 41–3, 66, 71–4, 95, 102–4, 108, 115, 127–8, 132–3, 141, 143, 146, 147–8, 156–8, 172–3, 192, 206, 221–3, 233, 239 Jernberg, A.M. 76–7 Jones, P. 15

Emunah, R. 177–8

Kafka, F. 11

Kalff, D. 74 Kanner, L. 190–1 Kashyap, T. 44 Kellam, T. 76 King, N. 232–3 Lahad, M. 119–20, 255–7 Landreth, G. 76, 143 Laschinger, B. 51 Lavery, B. 225 Le Doux, J. 21, 29 Lemert, C. 24 Lowenfield, M. 73–4 Luxmoore, N. 186 Lynch, D. 201 McCarthy, D. 32, 118, 127, 227–8 McCormick, S. 99 McMahon, M. 73 McTell, Ralph 162 Marner, T. 75 Marsten, A.E. 119 Maslow, A. 20, 127–8 Mead, G.H. 23–4, 36 Miller, A. 11, 131–2, 142, 148, 225, 229 Minde, A. 132–3 Mooney, C.G. 48 Moore, J. 22 Morton-Cooper, A. 192 Moyles, J. 67 Muralidharam, R. 69–70 Murray Parkes, C. 52 Oaklander, V. 75 Odent, M. 43, 99, 108–10, 140, 147–8, 226, 228–9 Plato 64 Prior, V. 49–50 Rabisa, T. 130 Raphael-Leff, J. 107–8, 134 Rimland, R. 190–1 Rogers, C. 74 Roopnarine, J.L. 69 Rutter, M. 115, 120 Sarma, V. 237 Schechner, R. 20, 22

271

272╇ \╇ Healthy A ttachments

Schinina, G. 22–3 Seach, D. 194, 201, 206 Selwyn 81, 83–4 Sherborne, V. 30, 218 Siebert, A. 227 Slade, P. 22, 65, 220 Somers, J. 173, 235 Spitz, R. 47 Stagnetti, K. 69 Stanislavsky, C. 21 Stoppard, M. 86, 92, 99, 104, 109–10 Sunderland, M. 35, 37, 51, 59, 136 Tabachnikov, D. 175–6 Trevarthen, C. 26–7, 41, 106, 147, 237 Tripp, J. 186 Turner, V.W. 20, 22–4 Vanistendael, S. 115 Walsh, M. 52, 81, 167 Way, B. 65 Weinrib, E.L. 74 Werner, E.E. 120 West, J. 73 Whitehead, C. 20, 21, 23, 38– 40, 127–8, 201, 204–5 Whitehouse, M.S. 18 Wieder, S. 191–2, 200, 206–7 Williams, D. 190 Winnicott, D. 18, 53–4, 63–4, 134, 226 Wisdom, N. 98 Wolfberg, P.J. 192, 206 Yasenik, L. 77–8 Zephaniah, B. 188, 253 Zuabi, A.N. 63

and

Neuro-D ramatic-P lay