Love and Hope | Supporting Child Caregivers

My observations in India – just as my much longer experience in El Salvador – have led me to question the idea that the way to heal attachment disorders is either by the establishment of a potentially secure attachment relationship through adoption or foster parenting, or through intensive and lengthy psychotherapy. That is not to say that I saw uniformly effective healing in either place, but just that I observed alternative healing methods that seemed to me to have promise.

In each children’s home, for example, there are multiple caregivers, at least one central parental figure, and (when all is going well) a secure environment. The secure environment is not only associated with the person of the caregiver but is also related to adequate food and shelter and freedom from threat. At Love and Hope, Rachel is the central parental figure, and the children also have important relationships with the tias and tios (female and male caregivers), the cook (as witnessed in the “papusa maker” video), and a social worker and psychologist on staff; the high caregiver-child ratio is one of the strengths of the home. At Deenabandhu, there are two central parental figures – Prajna and Prof. Jayadev – and the important continuity of one (the same) skilled and caring teacher throughout the early years of school. In addition to these strengths in each home there are the important relationships between and among the children – age mates and older-younger pairs. Perhaps the power of the peer relationships is enhanced by aspects of the culture; in El Salvador it is not uncommon to see a young boy carrying a baby on his hip. At any rate, the richness of the interpersonal environment offers many opportunities for finding security in a trusting relationship, contingent social interactions, and the subjective experience of caring and personal recognition.

It is important to recognize the apparently contradictory results of the Romanian orphanage studies that point to the dangers of early institutionalization and the need for a primary caregiving relationship such as through adoption or foster care (Zeanah et al, 2011, Fox et al, 2010). When viewing the films of the children in these orphanages, the caregivers appear to be surprisingly pleasant and sometimes engaging in friendly, even helpful, interactions with the children. The main problem, I guess, is the lack of contingency of caregiver responses, especially in infancy. That is, the children are fed without reference to their cues or initiatives, aggression in the free play situation is not responded to helpfully, and the caregivers do not play with the children. I guess I would suggest that the big difference I observed between what I saw in the films of the Romanian orphanages and what I saw at Love and Hope and Deenabandhu is greater personal involvement of the caregivers and the children so that relationships were encouraged, the children were known for who they were as little individuals, and there was a lot of interaction between caregivers and children – in play and in academic learning. This is related to the idea of “magic moments“, or “lost momentos magicos” of earlier posts.

I am reminded of Bruce Perry’s observations that traumatized children initially do better when allowed to seek out particular caregivers to fill specific personal needs – such as one caregiver to roughhouse with, another to provide food, another for comfort at times of emotional distress, another to help with homework. I am also reminded of Peter Fonagy’s therapeutic model of mentalization. That model avoids directly engaging the attachment system without simultaneously working on building reflective capacity that can guard against what one might call the “regressive pull” to intense destructive relationship patterns that were established in early childhood. Fonagy’s model was originally designed to treat adults with Borderline Personality Disorder, many of whom have experienced early trauma. However, it seems to me to be equally relevant to children – at least those with the cognitive capacity for mentalization – who cannot trust adult caregivers and cannot comfort or care for themselves. None of this means that developing a trusting and loving caregiving relationship with a single person is not healing. It is just to say that – at least now in my thinking – I am leaning towards the idea that there are multiple ways of healing the attachment system of children who have experienced trauma and severe neglect.

I hope my readers can make comments on this posting.

Bos K, Zeanah C, Fox N, Drury S, McLaughlin K, & Nelson C, Psychiatric outcomes in young children with a history of institutionalization, Harvard Review of Psychiatry, January/February, 2011, pp. 15-24; Fox S, Levitt P, & Nelson C, How the timing and quality of early experiences influences the development of brain architecture, Child Development, January/February, 2010, Vol. 81, Number 1, pp. 28-40).

Photograph by Ginger Gregory

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Ginger went to observe in the school with a group of other visitors the first day. When she returned, she had many positive things to say about the school and the teaching. Every classroom they visited had active engagement of almost all the children. The teachers were tolerant of children having conversations with each other while working on projects. There were no desks. The students moved freely from place to place during the classes, while still staying engaged in their work. The teachers maintained a calm, contained environment.

The teachers managed lack of participation and disruption – potential or actual – in an unusually skillful way. In one class on Social Studies, the students made paper lanterns and discussed a topic about profit and loss in an animated and involved way; the students who had trouble actively participating in the discussion, had something not disruptive to do with their hands in a self-regulating way, allowing them to listen and follow along. A little boy in the upper kindergarten who wanted to be part of a puzzle activity during a free choice time had difficulty collaborating with the puzzle doers. The teacher came up and put a hand on his shoulders and to calm him and support his efforts, and when that was not successful, guided him to another activity that had a more sensory basis, sorting seeds. He never sorted the seeds the way everybody else did but sat next to another child and kept scooping up the seeds and letting them fall through his fingers, his way of participating. He tried to take seeds from a little girl, but she set a clear boundary and he stopped.

The teachers consistently displayed a calm and receptive manner, quietly acknowledging individual children’s successes. In the upper kindergarten classroom, each child had to bring the teacher his or her journal when finished with each lesson, so that she could mark it. In that way no child was allowed to fall behind or drop out. The kids seemed to expect it to be a good day. Even at the end of the day, the children did not seem eager to leave.

After the school day was over, Ginger and I gathered in the Resource Room and gave a presentation about helping children learn. In addition to showing some videos of El Salvador that offered an example of adults facilitating learning in an infant, we concentrated on teaching about early developmental problems that can interfere with learning, introducing Dan Siegel’s model of the brain (Siegel, 2012) and Bruce Perry’s Neurosequential Model, and also offered some interventions designed for the “bottom up” healing of developmental problems that affect learning, such as breathing exercises, regulatory breaks of various types, and meditation (which is culturally syntonic here). The teachers were receptive and and stayed late to listen. At the end, Prajna suggested that we continue the next afternoon, so we did that.

After school, Prajna brought over tea and biscuits, and she reflected on how the school had changed over the years that she had known it. She discussed the project-based learning curriculum, a change from the original lecture-based curriculum. They eventually moved to what they called an activity-based instruction method in which they added structure to a project-based model. In that way they “grew” their own curriculum, adding structure to allow for more helpful classroom control. She explained that the teachers remain with their classes through the lower grades, providing a continuity of the caregiving role of the teacher. Prajna also mentioned her belief in the value of practice and structure in learning.

Then I did a little work of my own and later followed her to the dining room where the older children (“standards” 5-8) were doing homework. It was now 7:00, and the children would not eat until 9:00. There were thirty kids, both boys and girls, sitting in two circles on the floor, and Prajna was the only adult in the room besides me. Prajna was leading a lesson on English grammar, and of the twenty children sitting with her, all of them were actively engaged for more than 40 minutes, eagerly offering answers to her prompts. From time to time, a child from the other circle, where the children were working together in small informal groups doing math, would come to ask Prajna to review their work. She always interrupted to do this, and she gave a non-effusive but affirming response to each child. One thing I noticed is that Prajna immediately responded to each child who made a bid for her attention, even if it were for a few seconds; I remember being impressed with Rachel’s habit of doing this at Love and Hope.

Siegel, D. (2012) The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (Second Edition). Guilford Press.

photograph by Ginger Gregory

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