S3E3 – Navigating the grief and loss of separation for care-experienced children and young people, with Ciara McClelland

W: Hi everyone, it’s Will here. Welcome back to Lively Minds, the mental health podcast. And I’m excited to share that this month we’re doing a feed swap with the Creative Life Story Work podcast, which I produce for the UK charity Blue Cabin.

 

Creative Life Story Work is all about helping care experienced children and young people make sense of their past and create a brighter future through engagement with art, artists and creative activity.

 

In this episode, host Dawn sits down with Drama Therapist and Associate at Trauma-Informed Consultancy Services, Keira McClelland, to talk about how to best support children dealing with the grief and loss that comes with being separated from their birth parents.

 

So without further ado, let me hand you over to the wonderful Dawn Williams as she begins her chat with Keira.

 

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D: A huge, warm welcome to you today, Keira. Lovely to see you again.

 

C: Lovely to see you again, Dawn. Thanks for having me.

 

D: I know we were saying before nearly a year ago since we spoke.

 

C: It’s crazy, isn’t it?

 

D: Can’t believe it.

 

C: Yeah, I can’t believe it. Time just flies by, flies by.

 

D: What does grief and loss mean in the context of the conversation that we’re having today.

 

C: So grief and loss Dawn for children and young people in care or care experience can mean a number of things, but one of the main losses that they would have experienced is the separation from the mother. So that in itself will be a profound loss that, that children and young people will be grieving. And as we know, grief can have a profound impact on the brain and the body.

 

D: So I was looking up some of the definitions around for grief. Well I’ve got one here from the Oxford English Dictionary. Intense sorrow, especially caused by someone’s death. And I was just struck that lots of the definitions that I was coming up with were always linked to bereavement.

 

C: mmm

 

D: But actually that’s often not the case when you’re working with a child who has had experience of the care system.

 

C: The tricky one, isn’t it? So even though children in care or care experience might not have

actually experienced an actual death, a bereavement, although I’m sure a lot of them have, sometimes one could argue that it can feel like a death, a loss of a main attachment. Usually we have children who will have lost an attachment to their main caregiver, their mum or their dad, and really that can sometimes feel like a death to children and young people. So I think in ways they will be grieving it as if it is a death, I would argue.

 

D: What behaviours might a foster carer notice in a child that they’re bringing into their home, what behaviours might they see that have been caused by loss of an attachment?

 

C: I imagine they might see a number of kind of behaviours and it’s different for every child and young person isn’t it, but we’re born in connection to our mum and we have that bond so there will be a withdrawal that they’re going through and so we might see isolation, we might see low mood, we might see irritability, anger, sadness. We’ll probably see extreme ends of different emotions. So a very angry child or a very depressed child or a people pleaser, controlling their food, not eating enough, eating too much.

 

We might see children and young people having some real difficulties around relationships, given that that is the original wounding, the loss of the secure attachment. So you might have someone who then becomes overly attached to a certain friend or a certain teacher, adult, or, and they might get over attached to people who might not be any good for them as well, and then you might have someone who just doesn’t want to attach to anyone because there’s a fear of, actually and this is a big theme for our children and young people, is that they are too scared to get close to anyone because the fear that it might be taken away, that they might lose that attachment. So you find that then there’s that dance between, ‘Oh, can I get close?’, ‘Oh, no, that’s too close’.And that can cause all sorts of challenges as well.

 

D: At Blue Cabin in some projects, we’re working with tiny babies, a couple of weeks old and others working with care leavers at the age of 18. And I’m wondering, does that make a difference at those different ages as to how they might behave when responding to grief and loss.

 

C: Yeah, I think it’s different for different ages, isn’t it? And especially for a baby who’s just developing, especially a baby in his first three years, there’s research that points to that the first three to five years are the most important years for a baby because they are still growing, still developing, still trying to understand who they are in relation to their mother. And there’s some research that points to the first few years that they actually still, they feel like they are part of their mother. They are their mother. There’s limited sense of self. So those years are crucial, and especially for a baby to lose the bond and the connection with the mother in those first few years will have a profound impact on their growth, their development and their relationships further down the line.

 

For different ages it will be different and we might see children, young people overly attached to people or not attached at all so we might see lots of different attachment kind of difficulties that can come through from that. You know, relational trauma, which is what a loss of the bond with the mother would be, also requires relational healing. So what we’ll see is children, young people trying to navigate their relationships because that’s where the original wounding is. And they’re trying to kind of make sense of who they are to other people. And that’s where we find a lot of the challenges are. But also where a lot of the healing comes from, to quote Karen Treisman, she talks about “relational trauma needs relational healing”.

 

W: We are going to duck out of the conversation just for a moment, go to a short break and

we’ll be right back.

 

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D: How does your role as a drama therapist, your therapeutic practice, how does that support

those children and young people to deal with the disconnect and start to heal? What is it that’s happening in those creative sessions that you’re running with those children and their carers or the, the special people in their lives?

 

C: So when we’re working with children and young people who have experienced relational trauma, we’re in many ways trying to relationally repair that, okay? So if a child comes to me or a young person on their own for an individual session, my main objective is to try to relationally repair any kind of relational trauma they’ve experienced. So that might look like … trying to create a safe space for them, similar to what they might experience in the mother’s womb. Okay, so everything’s about safety and nurture and trying to offer as much holding and containing and nurturing as possible, because they might not have always experienced that, especially if there was a rupture at birth. So it’s about trying to repair that rupture through offering the opposite.

 

If I was work, working with the foster carer or the adopter and the child, again, it’s about trying to repair that relational trauma by going back almost to those early developmental moments that the child might have missed. So my practice would draw on models such as TheraPlay or DDP* and we might be doing things like what a mother and child might do in the first few years. So it might be like mirroring, when the baby moves and makes a sound, then the mum moves

and makes a sound, serve and return, hide and seek, all of those really early developmental

exchanges that our children, young people might have missed out on. So that’s a lot of the kind

of repair work that I would do with, with the parent and child.

 

D: I’m interested in that developing and strengthening the relationship between the child and the adult in there. And you’ve described a space where they’re safe enough to tell their own story, to have that space where they can tell their story but there’s also something there about the foster carer or the adoptive parent witnessing that, and hearing that, and the shift that that takes in developing that relationship.  So seeing that child with a different set of eyes I guess is what we often see in some of the workshops that we do at Blue Cabin. You know the foster carer seeing something new about that child and I’m wondering if that’s what’s happening in your sessions as well?

 

C: Yeah. So it’s both ends. So it’s, it’s around trying to support the parent and child to, to strengthen their bond through drama therapy, therapy play techniques, who strengthen their bond, their attunement, their reciprocity, all of that kind of stuff, but also to witness each other. And it’s in that witnessing where the insight comes and the change. So I can give you some examples. So sand play or role play or puppet play is sometimes the mediums that are most popular. So we might have a child who uses some puppets to tell a story that they aren’t able to tell in real life because it’s too difficult. And then the parent or parents will be able to witness that in the session. And then as a therapist, I would invite some kind of reflections on that, or we might think about who the puppet reminds the parent of, and that can open up some conversation about other things. So yeah, so it’s about allowing both to witness each other and, and realise things that they might not realise in everyday life about each other.

 

D: And I wondered what the impacts might be that you see in your sessions about multiple moves that those, some of those children might have had or different places that they’re going on. So it’s almost like a repetition of those beginnings and endings that are needing to be dealt with and how your practice as the therapist supports what those multiple impacts might be.

 

C: It’s difficult isn’t it because as you know the system sometimes can unfortunately cause more trauma essentially to children and young people because of the continuous moves that they can

experience. So, so really my practice really again is about really coming back to that sense of how can I ensure that I keep a safe container for the child or young person. So if they’ve experienced lots of different moves then it’s super super important that I am consistent so that the therapy is in the same room at the same place at the same time, starts at this time it’s meant to start and ends at that time as well. Especially coming into the room and leaving the room, those transition points are really quite difficult for some children I work with. So it’s about being mindful of those and reflecting in my clinical supervision, about how I can support those transitions as well. So it’s about being mindful of those transition points and how we can name those and support those points. And also in the room around exploring those moves, I’ve had young people who might use the room in a creative way to think about all of those moves. You know, I’ve had some children who’ve actually used the whole room, like put out a big piece of paper, and they’ve put different objects or postcards or creative things in different points along their kind of, their lifeline, we call it a continuum lifeline. And then they’re able to step back and witness that and the parent can witness it, the therapist can witness it and that can open up a conversation around, wow, you’ve had a lot of moves and etc, etc.

 

So, so that would be a real life connection example, but also there’s a space for story and metaphor and sound play. I see a lot of play from children around lots of different houses in the sand, lots of different structures, moving around a lot, that kind of stuff. So the therapy space allows them to explore, like what it means to have all of those moves, but they can only really explore all of those moves and the chaos of all that moving in a safe container, in a safe space. So if we don’t provide that then, you know, we’re not going to provide enough safety for them to tell their story really.

 

D: And because you’ve got the foster carers or perhaps a social worker or adoptive parent in there as well, do you have to do a separate piece of work with them, to get to support them to understand what it is that’s happening in that space?

 

C: The model that I’m working from, I work with the family, but there’s a sense that we’re led by the child. So if the child just wants sessions on their own, that’s what happens. Okay, so there’s a time and a space, so it might be an individual piece of work with the child, where they need a safe space to explore their story, and it just might sit like that. And we get there through kind of assessment and conversational and social worker and the referrer and that kind of thing. And there’s, there’s a criteria for that kind of piece of work. And then the other model or the way we can work is the child and the parent coming to sessions together. And that’s where we do all that work around building and strengthening the bond and the therapeutic processes. But then there is an offer of a therapeutic parenting space for the parent online. So there’ll be a parent and child session, but also there’ll be a space for parent and therapist or parents and therapists. And that’s, that’s where we think about different processes and what it might’ve meant in the therapy room when they did this and actually how can we then take something from a therapeutic process, say for example the PACE model, how can we take that from the therapy room and apply that at home? So it’s about how we can then transition and strengthen that kind of therapeutic parenting slash thinking at home. The child knows that the parents meet with the therapist online, sometimes they’ll come into the room and say hello. They also have the option just to have a session on their own without the parents as well. So that’s, that’s the model that I work with, with the families I support that, that seems to have the best outcome and best feedback.

 

D: That’s a lovely picture you paint of your sessions with the choice offered for child and adult to think about how they spend their time with you.

 

C: Yeah. So I could give you a quick example of that, how…

 

D: Yes, please.

 

C: I’m supporting a teenager who hates the therapy room, hates it. So we didn’t go into the therapy room. So we started…

 

D: Hurrah!

 

C: Yeah. So we started, we met at the therapy door,  we agreed to meet at the therapy

door the parents would leave her off and then we would go for a walk and get a drink and a snack from a cafe and go to a park and, and most of the kind of talking and getting to know each other happened through walking on the street and this is a young person who lived a lot of her life on the streets and just hated the, any idea of going into a therapy room for many reasons. So once we finished the walking and talking. We’d come back to the therapy door and the parents would pick her up.

 

But after a few sessions she was then intrigued by the therapy room. So she knew it was there, she’d seen it in the first session. So then the third session she decided to come into the therapy room and we had a look around etc etc and we then done a session around her thinking about her relationship with her parents and we used some wooden dolls for that and she draws, she can then place different feelings and emotions on the body and how they make her feel and how they get on. And then from that session, there was an invitation to, well, the parents can, it sounds like you have a lot to say to your parents and a lot that you would like them to hear and there’s always an option for them to come in. And she, she said, oh yeah, we did that years and years ago, but yeah, I love that. And I said, well, I’ll leave it up to you and she’s asked both of them to come in. So that’s an example of how it’s led by a child.

 

She was like, I’m not coming to therapy, I’m not going to the therapy room. I was like, okay, you don’t have to. As long as we’re mindful about it and we, we see clinical supervision around those kind of decisions, then there’s always a way.

 

D: I’m a big fan of a walk and talk

 

C: Yeah definitely

 

D: or actually some of my Irish colleagues refer to it as a wander and a ponder, which made me laugh as well.

 

C: Oh, I love that.

 

D: Yeah, you can have that.

 

C: Yeah.

 

D: Let’s go for a wander and a ponder.

 

D: So you are delivering a live classroom for Blue Cabin in October and I wondered, for

somebody who’s attending your live classroom on grief and loss, what might be some of the

key takeaways? Not giving away the crown jewels, but what might be some of the key insights that somebody attending your live classroom would take away with them?

 

C: Some of the takeaways will be around thinking about how grief can impact the body and the

brain, which can be quite a significant impact. And also thinking about practical ways to support and hold space for children and young people who have experienced grief.

 

We’ll be looking at the power of relationships and safe relationships and how to be a safe anchor for the children you support. We’ll be looking at some stuff around the power of ritual and supporting children, young people around finding a ritual that helps them move through grief and whatever else comes up because I know there’s going to be lots of professionals there and a mix of people all over the range of experience so there’ll also be a space for people to share and all to learn from each other really.

 

D: Fantastic, thank you very much. Thank you Keira and thank you so much for our conversation today and painting such a vivid picture of the work that you’re doing with children and their families.  Thank you very, very much. Lovely to speak to you.

 

C: Thank you. And you. Thanks Dawn.

 

W: And don’t forget to check out and subscribe to the Creative Life Story Work podcast which you can find on all the usual platforms. And if you want to dive deeper into drama therapy be sure to listen to our earlier chat with Ciara in the back catalogue of this podcast.

 

Thank you to the Creative Life Story Work podcast for this feature and thank you to you for listening.

 

Please let us know what you think you can find us on social media at Lively Minds Pod and please note that this show does not constitute medical advice and is not a replacement for

seeking professional help.

 

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Until next month, bye for now.

 

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* DDP (dyadic developmental psychotherapy) is a therapy that was originally developed to help children who had been through developmental trauma, such as neglect, abuse, or chronic trauma. The heart of DDP is to help a child feel safe through relationships.