Having a Say, Doing Things Their Way
Mentally, young people are at a sensitive stage where they are developing the capacity to reflect introspectively, and are starting to be able to consider their own way of thinking. 15 and 16 year olds especially, are often feeling the relief of less self-consciousness and shyness, and instead are becoming more sociable, helping to reinforce their unique expression. What is most important here is that they’ll be able to craft their own voices and their own discernment and resiliency, at a pace that’s right for them.
For this reason, it’s a time when opportunity and expression have particular importance, and wards can offer an excellent chance for young people to benefit from them. Young people usually have different views from adults about what matters in their care; so it’s important they’re able to speak freely and openly in a safe and nurturing environment.
Everyone can benefit from tapping into a creative outlet (creative in the widest sense of the word, that doesn’t have to mean artistic). Young people tend to be naturally imaginative and can reap wonderful rewards when they have the space and encouragement to express themselves through creative means.
So this theme is about involvement, influence and promoting self-expression: the creative communication of one’s personality, feelings, thoughts and ideas. It’s about treating young people as competent individuals who deserve attention and understanding, and who should be continually encouraged to make choices. Encouraging young people to make decisions about what’s important to them and supporting them to get a fuller sense of self are crucial. Ultimately, any therapeutic work is restricted unless the young person is engaged in it. Likewise, options shouldn’t represent (subtly or overtly) one choice as a punishment.
“When we try to see life from our teenagers' viewpoint, negotiate the boundaries with them, appear reasonable, remain flexible, have conversations rather than give lectures and keep a sense of humour, they will increasingly see us as advisers who are on their side. And, when they feel listened to rather than criticised and disapproved of, they may even begin to ask our advice.”
Lee N and Lee S. 2009
The Parenting Book
Lee N and Lee S. 2009
The Parenting Book
Decisions, decisions, decisions
CAMHS staff are highly skilled at promoting emotional and behavioural development, through encouraging the young people on the ward to take the lead as far as possible. As mentioned in the Understanding theme, ‘shared decision making’ is the exchange that takes place between young people and ward staff, which aims to reach a collaborative decision. It’s about having a constant focus on boosting the development of personal responsibility and self-direction.
Some young people might be used to making choices that they think others (especially parents) will approve of, rather than those that feel most congruent for them. This can feel really disorienting and can create varying degrees of identity crises and low self-esteem. Parents want to protect their children from making a ‘wrong choice’ and to safeguard them against painful outcomes. While this is perfectly natural, it denies their child opportunities to learn. Making choices for young people may give them the message they’re incapable of making their own decisions (Dr Sal Severe
, 2004)
Part of growing up includes learning how to make decisions, how to compromise, how to negotiate and how to work as part of a team. They need others (especially parents and staff) to listen to their point of view, and they need to know that their opinions area valued. These and other essential life skills are learned when young people sense that their feelings are taken seriously, that there is an effort made to understand their opinions, that adults around them are genuinely compassionate, open-minded, and curious about them.
A great way to help teach young people these life skills is by getting them involved in ward decisions. They’re much more likely to cooperate with decisions if they've had a hand in making them, especially if they can understand why they’ve been made. Asking a young person what they think your intentions are is very different from questioning their intentions! Also, when adults talk over and under and around a young person - when they talk too much - there’s less space for their thoughts, for what they have to say (Payne & Ross 2009).
A great way to help teach young people these life skills is by getting them involved in ward decisions. They’re much more likely to cooperate with decisions if they've had a hand in making them, especially if they can understand why they’ve been made. Asking a young person what they think your intentions are is very different from questioning their intentions! Also, when adults talk over and under and around a young person - when they talk too much - there’s less space for their thoughts, for what they have to say (Payne & Ross 2009
).
Young people like to chat about things that might affect them or their friends. “They need to be consulted on decisions that affect them, just as you’d expect to be…” says bestselling author Richard Templar
. “As kids get older they need to practise making decisions, to be consulted, and to be treated more like adults.” Likewise, there are also times when they definitely need to be related to as young people. A ward stay can support young people in beginning to think independently (and interdependently) and make their own decisions.
Although we sometimes wish we could, it’s not merely about fixing all young people’s problems for them, as that might constrain their ability to develop true resilience. Sometimes it’s about planting in them the notion ‘The quality of my life depends on the decisions I make.’ When a young person is encouraged, through exploring likely consequences, to make considered choices and constructive decisions, a positive self-image can flower. So they need opportunities to make choices where, if things end up going crappy (in the young person’s eyes), it’s still okay, it’s safe. Living with the impact of their own decisions can inspire them to be responsible for the choices they make. Shared decision-making encourages young people to continue to behave responsibly and make healthy choices, while boosting their confidence and building their confidence in others.
. “As kids get older they need to practise making decisions, to be consulted, and to be treated more like adults.” Likewise, there are also times when they definitely need to be related to as young people. A ward stay can support young people in beginning to think independently (and interdependently) and make their own decisions.Although we sometimes wish we could, it’s not merely about fixing all young people’s problems for them, as that might constrain their ability to develop true resilience. Sometimes it’s about planting in them the notion ‘The quality of my life depends on the decisions I make.’ When a young person is encouraged, through exploring likely consequences, to make considered choices and constructive decisions, a positive self-image can flower. So they need opportunities to make choices where, if things end up going crappy (in the young person’s eyes), it’s still okay, it’s safe. Living with the impact of their own decisions can inspire them to be responsible for the choices they make. Shared decision-making encourages young people to continue to behave responsibly and make healthy choices, while boosting their confidence and building their confidence in others.
Some examples of how staff successfully achieve this include giving young people a choice of treatment, a say in their care plan or the opportunity to help shape a service with new, innovative ideas. For young people to become mindful, confident, caring adults, they need to know they can effect change, and that they can have a positive influence on other people’s lives, as well as their own (Susan Stiffelman 2015 - see Parenting with Presence: Practices for Raising Conscious, Confident, Caring Kids
).
It can be difficult to engage with young people to begin with, but presenting them with a selection of choices encourages them to take responsibility and influence their care. Young people who grow in responsibility also grow in self-worth. Each young person’s recovery journey is unique and deeply personal, and freedom is very, very important to young people. “Choice means doing something in accordance with one’s personal volition (rather than external control),” says Dr Ilona Boniwell, “aligning our actions with something we value... Once they feel that the responsibility is real... they are very likely to rise to the occasion.”
).It can be difficult to engage with young people to begin with, but presenting them with a selection of choices encourages them to take responsibility and influence their care. Young people who grow in responsibility also grow in self-worth. Each young person’s recovery journey is unique and deeply personal, and freedom is very, very important to young people. “Choice means doing something in accordance with one’s personal volition (rather than external control),” says Dr Ilona Boniwell, “aligning our actions with something we value... Once they feel that the responsibility is real... they are very likely to rise to the occasion.”
“One of the most important skills we can teach our kids is to make good decisions in high-emotion situations.”
Siegal & Bryson, 2012 (From The Whole-Brain Child: 12 Proven Strategies to Nurture Your Childs Developing Mind
)
Siegal & Bryson, 2012 (From The Whole-Brain Child: 12 Proven Strategies to Nurture Your Childs Developing Mind
)
Shared decision making focuses on the detail of interactions between individual staff members and the young people they work with. These interactions underpin young people’s capacity to take control and include five key stages:
Young People Friendly Services
There needs to be sufficient provision to help young people in dire circumstances. Children, young people and families frequently say that well-timed, accessible and non-stigmatising support is one of the fundamental features of an effective CAMHS service.
YoungMinds have compiled the following list of the characteristics of an ideal service based on young people’s views:
Express It
Preliminary research in Canada reveals how parenting interventions strengthen their value by paying more attention to children’s choices, initiative taking and sense of autonomy. A team of Montreal-based psychologists note how ‘autonomy support’ is a crucial dimension which is often overlooked (Read more).
An autonomy-supportive, motivating style involves staff being willing to embrace the young person’s perspective during interventions, including their needs, interests and preferences, and to deeply value, understand and appreciate that perspective. When doing so, staff focus on identifying, nurturing and building young people’s inner motivational resources.
We have loads of admiration for those who are committed to empowering young people to speak their minds and hearts and to trust their feelings and instincts. Of course, structure and boundaries must first be made cystal clear. Young people should be encouraged (but not forced!) to express themselves through creativity - for example, through art, dance, music, drama, gardening etc. Wards can help young people to express themselves, verbally, non-verbally or symbolically, through games and creativity, as well as through advocacy, and offer emotional security so young people can progress emotionally, socially and educationally. Your perceived availability is a major factor that predicts how likely young people are to express what’s going on for them. If they think you’re too busy to spend time with them or just unavailable in some way, it’ll probably feel hard for them to reach out to you (Greenberg & Powell-Lunder, 2010
).
Acknowledging
Acknowledgement isn’t necessarily about agreeing with or condoning young people’s behaviours; it’s about validating the feelings behind them. It’s a straightforward, yet effective way to reflect a young person’s experience and inner world, including their thoughts, feelings, desires and motivations, and show them that they’re acceptable. Acknowledgement is about giving the young person the space and time to express painful feelings, without trying to censor or even make them feel better with a solution. Acknowledging, instead of judging or ‘fixing’, nurtures trust and encourages young people to keep sharing their feelings and to gain clarity (Lansbury, 2014 - see Elevating Child Care: A Guide to Respectful Parenting
). For example, acknowledging what you’re picking up from them by saying something like: “You’re feeling overwhelmed right now” or “I recognise that your relationship with your mum is difficult”. Acknowledging their difficulty might be all the encouragement a young person needs to move forward a few more steps.
In 2007, a University of California, Los Angeles (UCLA) brain-imaging study revealed that verbalising feelings makes sadness, anger and pain less intense and has a therapeutic effect. Naming it to tame it, if you like. When staff acknowledge a young person’s feelings with words, not only does it help alleviate distress, it also helps the young person to build their confidence and a language with which to describe and think about how they feel. Fostering empowerment instead of powerlessness. One example is displaying emotional vocabulary posters on the ward, which everyone can refer to, and using this language in groups and individual sessions. A shared vocabulary is one facet of fruitful communication.
It’s also useful for staff to have an understanding of what kinds of feelings and emotions young people are able to express at different developmental stages, and of how boys and girls differ in how they experience and express their internal worlds (Weissbourd, 2010 - see The Parents We Mean to Be: How Well-Intentioned Adults Undermine Children's Moral and Emotional Development
).
It’s also useful for staff to have an understanding of what kinds of feelings and emotions young people are able to express at different developmental stages, and of how boys and girls differ in how they experience and express their internal worlds (Weissbourd, 2010 - see The Parents We Mean to Be: How Well-Intentioned Adults Undermine Children's Moral and Emotional Development
).
Young people between the ages of 11 and 14 often have a strong sense of justice, but tend to see issues in black and white and from their own point of view. 15 and 16 year olds are less suggestible and less eager to conform compared to younger children, which can be tricky for staff and parents but highly liberating for young people! However, they are,more able to tell good choices apart from not so good choices. But, they may still find it hard to describe their worries about their symptoms, past traumas, school and relationships. By giving them a new language, they’re more able to express their concerns and views, perhaps for the first time, and also to see things from different perspectives.
Using or finding words isn’t always easy. Many young people have difficulty using words to describe how they feel. So they might want to try expressing themselves with drawings or pointing to images. This helps young people get started. Once they have a picture, you can ask about events, thoughts and feelings. Some may benefit from using a diary to help reflect on emotions such as anger. You can teach them to write down what happened, how they got angry (or whatever feeling they’re experiencing) and what they did after they got angry. This helps young people see patterns to triggers and reactions (Severe 2004).
To be taken seriously is very satisfying to a young person. Advocacy helps, and it plays an important role in making services accessible and meaningful. Advocates help young people to navigate what’s on offer. They do this by speaking up for them, and empowering them to make sure that their rights are respected and their views and wishes heard at all times. Young people need to feel that their take on things has been given full consideration, before they feel willing and able to consider alternative suggestions presented to them.
“Find some common ground - it’s no good approaching this child from your own point of view, you need to approach them from a place that they can communicate from, something that they understand, be it music, popular culture, TV, whatever it is, find some common ground.”
Newton, 2012 - see The Teen Years - Don't Get Mad - Get Through It
Newton, 2012 - see The Teen Years - Don't Get Mad - Get Through It
Creative Common ground
Here’s what bestselling author Richard Templar says: “…take an interest in the things that they enjoy. They may not show it, but actually they’ll think that’s pretty cool… You don’t have to pretend to be a huge fan of their music or clothes style, but you don’t have to put it down either. And actually, you might even discover all sorts of new things to enjoy. [They’re] close enough to adulthood to have some pretty sophisticated interests, and you can learn a lot from them if you’re broad-minded enough.”
Psychotherapist Susan Stiffelman (2012) suggests another way of creating an unshakeable connection with young people is to ask them their view on something (for example, a celebrity story or news headline), and then invite them to elaborate. “Stop and reflect on what they’ve said, demonstrating your sincere desire to understand life from their vantage point. Show them you really want to know what they think about a piece of music or an issue in the news, or why they think chocolate ice cream is better than vanilla. Be hungry to discover more of who they are, and let them know what a delight it is to get to know them as they blossom into their true selves.” - see Parenting Without Power Struggles: Raising Joyful, Resilient Kids While Staying Cool, Calm and Collected
Young people need to be helped to pursue whatever they love, whatever makes them feel good. They must learn through their own exploration where their passions will take them. By supporting this dynamic exploration staff can help them uncover the value of their uniqueness. Mindfulness is the key (as with all the COLOURFUL themes). Mindful therapeutic relationships help foster a deeper openness and awareness, allowing communication to flow successfully.
Young people need to be helped to pursue whatever they love, whatever makes them feel good. They must learn through their own exploration where their passions will take them. By supporting this dynamic exploration staff can help them uncover the value of their uniqueness. Mindfulness is the key (as with all the COLOURFUL themes). Mindful therapeutic relationships help foster a deeper openness and awareness, allowing communication to flow successfully.
‘Creative Teaching and Learning Toolkit
’ by Brin Best and Will Thomas (2007) is an awesome spiral-bound gift. The book aims to help teachers become more effective through a new teaching and learning framework which centres on the key role of creativity. What follows is a list of key principles of this framework. Whether you’re a teacher, Occupational Therapist or part of the nursing team, we’re sure these principles will inspire and challenge you:
Read more here
’ by Brin Best and Will Thomas (2007) is an awesome spiral-bound gift. The book aims to help teachers become more effective through a new teaching and learning framework which centres on the key role of creativity. What follows is a list of key principles of this framework. Whether you’re a teacher, Occupational Therapist or part of the nursing team, we’re sure these principles will inspire and challenge you:- Change is essential for us to grow, but that change needs to come from within by making appropriate choices.
- Positive changes can be challenging and will require high levels of commitment and much determination.
- Values and vision underpin everything we do, but they're frequently not articulated.
- We possess within us the resources to find solutions to many of the questions or problems that we set ourselves — but we sometimes need an external influence to help us to see a situation differently and to find an alternative preferred future.
- One of the keys to making positive change is the ability and willingness to pose yourself challenging and thought-provoking questions.
- Effective learning is fun — for both teachers and students. Effective learning happens when teachers and learners work together in partnership (not when teachers ’deliver’ a curriculum to learners).
- Be the change you want to see in your classroom — when we model the behaviours we want in our students we get them more of the time.
- Taking calculated risks leads to invention and growth — encourage this whenever you can.
Read more here
Two Ears One Mouth and Loads of Mindfulness
As you’ll know, the crucial ingredient when spending time with young people is listening; not only hearing what they say but also how they say it, how they express themselves. Listening to young people makes them feel that what they have to say counts, and that you're doing your best to see things from their viewpoint and appreciate whatever they’re going through.
“The brain works four times faster than the mouth, so the good listener will use this time delay to ask questions of themselves about what is being presented.”
Phil Beadle, Secondary Teacher of the Year 2004
Could Do Better!: Help Your Kid Shine At School
Phil Beadle, Secondary Teacher of the Year 2004
Could Do Better!: Help Your Kid Shine At School
No one wants to see a young person feel bad. But when painful experiences are unavoidable, the next best thing is to be fully there with them, helping them through the process by letting them feel their unhappiness and distress, or whatever difficulty they’re facing. Showing real appreciation for their world is huge. Sometimes the best help we can give is our clarity and accepting presence, our inherent empathy. For so many young people, being sincerely listened to is such an unusual thing. As we said in the Caring Relationships theme, to be heard by a tuned-in and committed person is in itself a therapeutic experience.
Provide stability amidst a young person’s chaos by being fully present throughout their crisis, to help them be fully present too. Your immediacy and patience say more than words ever could. A mindful ward staff member has the capacity to be fully focused on what’s being experienced in the moment. This allows you to listen, comprehend, accept and creatively interact with the young person while appreciating their unique character. Be as ‘awake’ as you can with them and give them your profound listening; listen with all your senses, your whole being. Their despair most likely needs no lectures or wise words; only a compassionate presence in which it can gradually unravel and dissolve.
Lots of one-to-one time helps young people manage their very intense feelings. It helps them to ‘sublimate’ - to direct and express their rage, and other primitive impulses, into activities that are healthier, more constructive and socially acceptable. As young people struggle to work out who they are, staff can provide a supportive framework that they can bounce off. Finding a good balance requires staff to provide appropriate limits while not being too rigid and restrictive. Choices and consequences activate young people’s thinking brain and provide opportunities to form their identity, instead of triggering fear and rage in their lower brain, which can be destructive. Young people can also learn to extend the gap between having an impulse to say or do something and acting on that impulse. From coping with impulsivity to taming emotional regulation, modelling how to slow down and reconnect to the here-and-now (through mindfulness practice, for example) gives them a massive boost in terms of leading a happier life as they develop.
How to teach young people to talk it over:
- Acknowledge the young person’s feelings, and give them time to talk through what worries them, rather than immediately offering solutions or opinions.
- Be a good role model: always try to talk through issues to be sure you understand their point of view. This does not mean allowing yourself to be drawn into an argument.
- Model how to listen, and to repeat back what someone else has said to be sure you've understood.
(Adapted from Palmer, S 2006)
Toxic Childhood: How The Modern World Is Damaging Our Children And What We Can Do About It
Fluid, Tricky, Sticky Labels
Identity formation is believed to be the most important developmental task of adolescence. It involves young people working out what chimes with their emerging sense of self, including their self-perception, abilities, self-image, values, religion and spirituality, gender, sense of belonging, interests, friendships, aspirations and sexuality.
“Achieving one’s own identity often involves serious pitfalls and may lead one to make false starts and turns. It is a process that requires one to retrace one’s steps, and it is also a path strewn with uncertainties as to which direction to follow.”
Bruno Bettelheim, 1988
A Good Enough Parent: A Book on Child-rearing
Bruno Bettelheim, 1988
A Good Enough Parent: A Book on Child-rearing
Younger adolescents start to experiment with things like dress, speech and manners in an attempt to find a separate identity of their own. 15 and 16 year olds invariably change these things frequently, as you’ll know if you have teenagers of your own! Parents may take alternating and often bizarre changes of image too seriously, and worry they may be permanent or a sign of something emerging that they should be concerned about. This age group typically wants to fit in as much as possible with their mates, by having the ‘right’ clothes, hairstyle or listening to the same music. Parents may be irritated by what they see as conformity and its associated financial demands on them. 17 to 18 year olds, on the other hand, usually try to find a social or political cause, and might explore religious or spiritual ideas and movements which light them up. This can also be terrifying (or even dangerous) for parents whose kids end up rejecting their own religion or beliefs.
Yep, opportunity and expression are massive for young people and wards can play a part in helping them safely explore themselves and the world around them.
Yep, opportunity and expression are massive for young people and wards can play a part in helping them safely explore themselves and the world around them.
Here are some of the ways being on a CAMHS ward can help young people continue to develop and express their identity:
(Adapted from Tomlinson 2004, cited by Rymaszewska and Philpot, 2005 - see Reaching the Vulnerable Child: Therapy with Traumatized Children (Delivering Recovery)
)
- General interaction in the care setting.
- Considering their own and others’ experiences and opinions.
- Receiving feedback about themselves from others.
- Making positive contributions to others.
- Being acknowledged and thought about by others.
- Making choices and negotiating with others.
- Working through what they’ve experienced.
(Adapted from Tomlinson 2004, cited by Rymaszewska and Philpot, 2005 - see Reaching the Vulnerable Child: Therapy with Traumatized Children (Delivering Recovery)
)
The Same Boat
We’re delighted that Trusts are providing ways for patients and families to get involved and have their say on matters that affect them and their peers. As with all of the COLOURFUL theme pages, you’ll find some tried-and-tested ideas listed below, as well as some quotes by people who’ve had stays on wards. Within the staff-young person relationship, as in all relationships, it’s the mutual influence that each one has on the other that adds to the relationship’s success.
What young people say and why it matters
- The views of young people must be sought and taken into account when planning, improving and evaluating services.
- The available research on participation and involvement shows that young people, their parents and healthcare providers often have different views and expectations of services.
- Young people want access to better information about services. This should be offered in a range of formats and help enable greater involvement in care and treatment decisions.
- Young people want help from professionals who are non-judgemental, empathetic, respectful, open-minded, informed, competent and respecting of their privacy and confidentiality.
- Young people in hospital want access to a range of individual and group-based activities alongside support with their education. They also want help with developing the skills they need to leave hospital and get on with their lives.
Adapted from Street in McDougall & Cotgrove, 2013 - see Specialist Mental Healthcare for Children and Adolescents: Hospital, Intensive Community and Home Based Services
When a ward team encourages a young person to have an input into the decisions that affect them, staff are more able to tune into what they need and want. This enables the intervention to be both valuable in the given circumstances, and advantageous to the developing relationship. The most fruitful therapy is young person-focused, which means that the young person leads (Rymaszewska & Philpot 2006).
It’s our view that the most therapeutic wards are those that nurture a culture of ‘interdependency’. This is a healthy dynamic where everyone (staff, patients and parents/carers) works together to benefit the ward as a community - it’s the whole ‘all in the same boat’ thing. Everyone works towards individual goals, but generously; also go the extra mile to help others do the same. In this sense, CAMHS wards have the potential to be egalitarian and participative, so that everyone is positively energised, engaged and finds a bit more happiness.
It’s our view that the most therapeutic wards are those that nurture a culture of ‘interdependency’. This is a healthy dynamic where everyone (staff, patients and parents/carers) works together to benefit the ward as a community - it’s the whole ‘all in the same boat’ thing. Everyone works towards individual goals, but generously; also go the extra mile to help others do the same. In this sense, CAMHS wards have the potential to be egalitarian and participative, so that everyone is positively energised, engaged and finds a bit more happiness.
Care to Help / Help to Care
Caring about other people, as staff or patients, is fundamental to our happiness. Action for Happiness has got it sussed. On their website you’ll find their brilliant ‘10 Keys for Happier Living’, which includes (way up the list) helping others: “Helping others is not only good for them and a good thing to do, it also makes us happier and healthier too. Giving also connects us to others, creating stronger communities and helping to build a happier society for everyone.” The ward culture (as with any culture) influences the way young people express themselves and how they express, talk about and manage their emotions. Furthermore, most young people believe the things they think and feel are unique to them, and so being able to relate to one another can be reassuring and normalising in itself.
Search
A Random Idea:
Tell young people that if they start talking about a small problem with someone, they can stop it from becoming a big problem.
COLOURFUL Themes Menu
