The therapeutic approaches, or therapy, put in place are tailored to each child and family and guided by the results of the child’s assessments and brain map. In providing therapy, we follow a sequential, phase-based approach that is either provided for a medium to long-term, or short-term.
Medium to long-term therapy
Medium to long-term therapy involves a full, intensive, wrap-around service. It includes three phases.
Phase 1: Safety and stabilisation
In phase 1, the child often feels unsure about things happening around them, like the stability of their placement, possible restoration or emergency care. This uncertainty can cause extremes in their behaviour driven by fear.
At this point, the child is using their ‘survival brain’ and will struggle to access higher parts of their brain needed to help them in their therapy, such as thinking, talking and reflecting. The focus therefore in phase 1 is about stabilising the system around the child, rather than direct therapy.
Key aims of phase 1 are to:
- advocate and secure a safe and stable placement for the child
- build a therapeutic network around the child, enlisting multiple healthy adult attachment figures to improve the child’s connection with others (relational health) – this can buffer the impact of adverse experiences
- provide education to the child’s Care Team on the neurobiology of trauma and its impacts, helping the team to understand the child’s behaviour through a trauma-informed lens
- help the Care Team reduce the child’s fear and anxiety by developing predictable schedules and routines
- build relationships with the child and carer through play
- work with the child’s home and school to ensure the environment is therapeutic and meets the child’s developmental needs, which are often different to their chronological age
- work with the carer and school to co-regulate the child using sensory modulation and emotional regulation strategies – this helps the child to be able to understand and manage their emotions
- connect the child with their wider community and engage in activities that have therapeutic intent – for example, cultural groups, dance, drama, sports, music, gymnastics, guides, art, drumming.
Phase 2: Attachment and trauma processing
Once the child’s environment is more stable and their emotions can be co-regulated, a variety of methods will be used to help the child heal from their early life experiences. These may include any combination of the following:
- Circle of Security Parenting Program™: This program offers carers an understanding of the complexity of the attachment system and how it contributes to young children being able to develop a sense of security and competence. Once completed, carers can use the Circle as a roadmap to understand attachment patterns with the child in their care.
- Theraplay®-informed: This is an engaging, fun, interactive and relationship-focused form of therapy. The emphasis is on the child and carer playing together in a way that encourages and strengthens a healthy and secure attachment between them. Through play, the carer builds the child’s sense of security, regulation and comfort that lead to safety and trust.
- Dyadic Developmental Psychotherapy-informed: This therapy focuses on building a trusting relationship between the child and their carer. It involves a therapist guiding conversations and interactions between the child and carer using the PACE model (playfulness, acceptance, curiosity and empathy) to increase the child’s sense of trust and helping them to turn to their carer for comfort and security. It also helps the child develop a more coherent narrative of their life. In this way the child experiences healing of past trauma and achieves safety within current relationships.
- Eye Movement Desensitisation and Reprocessing: Originally designed to alleviate distress associated with traumatic memories, this therapy can help the child access and process traumatic memories to replace the negative and dysfunctional thoughts and behaviours associated with them with more functional and appropriate ones. After successful treatment, emotional distress is relieved, negative beliefs are reformulated, and harmful physical responses to the memories (like increased heart rate) are reduced.
- Expressive therapies: This form of therapy helps the child to express and process their thoughts and feelings in a way different to strictly verbal means, and can be easier and gentler for them to engage with. For example, it could involve using sand tray work, art, music, drama, movement, play or other creative techniques. Often the expressions drawn out reflect the child’s own life, which gives them the opportunity to address their feelings, resolve conflicts, remove obstacles and gain self-acceptance.
- Trauma-Focused Cognitive Behavioural Therapy: This is a skills-based therapy that can help the child (and carer) learn how to manage difficult emotions in a healthier way. It helps the child confront memories and reminders of the trauma they experienced and to change the way they think and feel about it. It involves the child and carer working through core areas for each of them to develop the skills needed to support the child to heal and to move forward in a positive and productive way.
Phase 3: Reconnection and integration
Phase 3 is about supporting the child’s ongoing recovery and helping them to explore who they are and regain their self-worth and emotional stability so they can continue to achieve and function well once therapy ends.
There are two main components of Phase 3:
- Life story work/identity building: Life story work supports the child to make significant changes through them developing a far deeper understanding and awareness of how their history has negatively impacted on their present. Often, children in care have not had the opportunity to hear their stories, to share memories with those close to them or to make sense of who they are. Life story work helps them to do this.
- Facilitate continuity of care: Histories of betrayal and abandonment can make any person (regardless of age) vulnerable to feelings of rejection. As a child’s involvement with us comes to an end it is important for this to happen gradually so they can experience a healthy goodbye. The focus is on providing a sense of continuity for the child and includes transitioning them to less intensive therapy providers and community-based services as needed to support them to sustain what they have already achieved at Melaleuca Place.
Short-term therapy is when a child's safety and stability (as described in phase 1 earlier) has already been achieved through work with another service provider, and Melaleuca Place becomes involved afterward to provide the child and carer certain therapeutic supports for a limited time. This typically happens when the outcome of their phase 1 work determines some additional support is needed for the child, but the full intensive wrap-around service we provide in medium to long-term therapy is not.
The short-term therapy we provide at Melaleuca Place may include:
- a one-off brain map assessment and recommendations
- a one-off speech pathology/occupational therapy assessment and recommendations
- time-limited Theraplay®-informed work or Dyadic Developmental Psychotherapy-informed work with the child and carer (for example, one term).