The Solihull Approach Dr Hazel Douglas

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The Solihull ApproachDr Hazel Douglas
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The Solihull ApproachThe power of parentingis
in the relationship!
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The relationship

• Video (scenebrain development, The First Years
  Last Forever)

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Plan for today

• Solihull Approach and parenting
• Quick look at the SA model and how concepts
  relate to parenting
• Underpinning attachment
• Parenting, anxiety and performance

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Parenting and the Solihull Approach

• 11 work with parents
• Group work with parents the Solihull Approach
  Parenting Group.in Solihull called
  Understanding your childs behaviour

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Solihull parenting strategy

• Solihull Approach Parenting Group for universal
  upto those in moderate difficulty
• Mellow Parenting for those in severe difficulty
• Solihull population 200,000
• Aiming for a population effect, increasing SAP
  groups from 12 per year to 120 per year. Mellow
  Parenting from 3 to 9 a year.

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More parenting support from Solihull Approach

• Peer support for breastfeeding training (training
  for parents to support other parents, using the
  Solihull Approach model). Completed.
• Antenatal parenting group (bringing the
  relationship into midwives parentcraft classes).
  In development.
• Antenatal resource pack for antenatal team
  (supporting parents from conception). Half done.
• Early Years Foundation Stage training now
  integrated with SA model to support parents
  through good childcare. Completed.

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Solihull Approach and attachment

• Solihull Approach is a vehicle for changing
  relationships and attachment.
• Containment and reciprocity underpin attachment

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Solihull Approach model

• Containment psychoanalytic concept (Bion 1959)
• Reciprocity child development concept
  (Brazelton, 1974)
• Behaviour management behaviourism (Skinner,
  1938)

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Containment

• Containment is where a person receives and
  understands the emotional communication of an
  other without being overwhelmed by it and
  communicates this back to the other person.

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Containment and the brain
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Containment and the brain

• Received/understood

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Containment and the brain

• Head full

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Containment and the brain

• Parallel process

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Containment and parenting

• Helps the parent to think about their child
• Helps parents and their child to relate
• Helps the parent to help their child cope with
  anxiety and emotion so that the child is free to
  relate
• Helps the parent process some old emotions so
  that the parent can relate to the actual child in
  front of them, not a projection of a child

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Reciprocity

• Describes the sophisticated interaction between a
  baby and an adult where both the baby and the
  adult are involved in the initiation, regulation
  and termination of the interaction. Reciprocity
  also applies to the interaction between adults.

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Dance of reciprocity

• Initiation
• Orientation
• State of attention
• Acceleration
• Peak of excitement
• Deceleration
• Look away

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Reciprocity and parenting

• Helps parents and their child to relate
• Tunes in the parent to think about their baby
• Increases the parents awareness of their childs
  needs
• Provides a focus and a language for feeding back
  to the parents about the interaction

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More on reciprocity

• Rupture and repair
• Chase and dodge

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Attachment

• Video 2 (scene Bonding and attachment, The First
  Years Last Forever)

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Attachment and the Solihull Approach

• Attachment is a descriptive theory
• Describes the attachment secure, insecure,
  disorganised
• Doesnt tell you how to change the quality of an
  attachment
• As recently as 1999 no interventions based on
  attachment theory (Lieberman and Zeanah, 1999)

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Attachment and the Solihull Approach 2

• Containment and reciprocity are the building
  blocks underpinning attachment
• Robert Marvins Circle of Security (Marvin et al,
  2002) explicitly cites reciprocity and object
  relations theory

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Circle of Security rupture and repair

• The idea that smooth interactions between
  children and their caregivers are often disrupted
  and need repair.it is this ability to repair a
  disruption that is the essence of a secure
  attachment, not the lack of disruptions. This
  repair requires clear cues from each other, and
  clear understanding of, and responsiveness to,
  each others signals (Marvin et al, 2002 pg 109)

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Circle of Security containment

• Each caregiver is guided at her or his own pace
  toward increasing skill in reading the childs
  cues, reflecting on the childs (inferred)
  thoughts and feelings, and reflecting on her or
  his own feelings, plans and behaviour (pg 116).

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Neurobiological evidence

• The right hemisphere contributes to the
  development of reciprocal interactions within the
  mother-infant regulatory system and mediates the
  capacity for biological synchronicity, the
  regulatory mechanism of attachment Schore, 2001
  pg 23.

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Attachment

• Evidence cited that containment and reciprocity
  underpin attachment .
• Interventions (e.g. Marvins Circle of Security)
• Neurobiological (Schore)

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Parenting, a secure base and containment

• A secure base is established through parenting
• via containment and reciprocity (and other
  concepts)

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Parenting, anxiety and performance

• It may be thought that the concept of containment
  indicates that parents need to be at a low
  anxiety level to be able to contain their own
  children and be in an attuned, reciprocal
  relationship.
• But it is probably more complicated than that.

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Containment and the brain

• I think, therefore I am (Descartes)
• The old anxiety/performance curve

containment
performance
anxiety
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Parenting and anxiety 1

• Marga Thome, Prof Nursing, Iceland. Research on
  the effect of telephone counselling with parents
  (telephone used because of the distances involved
  and remoteness of some communities). Some parents
  anxiety went down but some went up.

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Parenting and anxiety 2

• Solihull Approach Parenting results. Very strong
  correlation with a change in anxiety using BAI.
  But although the trend was down, some parents
  went up.

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Parenting, anxiety and performance

• There are many studies now that show that stress
  in the antenatal period can negatively affect
  child development.
• However, too little stress may also be
  maladaptive. DiPietro et al, 2006 showed that a
  moderate amount of stress is better than too
  little or too much for a childs development.
• DiPietro JA, Novak MF, Costigan KA, Atella LD,
  Reusing SP. (2006) Maternal psychological
  distress during pregnancy in relation to child
  development at age 2. Child Development, 77,
  573-587.

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Zone of optimal functioning

• Research from sport. The zone is different for
  everyone. Some need more anxiety to perform well.
  Some need less.

containment
performance
anxiety
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Zone of optimal functioning for parents

• I think this explains Marga Thomes results,
  Solihull Approach Parenting results and DiPietro
  et al.s results.
• Being in tune with your child may raise your
  anxiety if you werent in tune before

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Conclusion

• The Solihull Approach model is used to support
  parenting
• Containment and reciprocity, concepts within the
  model, can be used to work with the attachment
• Supporting some parents may mean raising their
  anxiety. For others, it is about lowering their
  anxiety.

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• Video (scenebrain development, The First Years
  Last Forever)

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Research Results effect of training 1

• Douglas, H. and Ginty, M. (2001) The Solihull
  Approach changes in health visitor practice.
  Community Practitioner, 74, 222-224.
• Whitehead, R. and Douglas, H. (2005) Health
  visitors' experience of using the Solihull
  Approach. Community Practitioner, 78, 20-23.

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Research Results effect of
training 2

• Lintern, J. (2005, unpublished study) A follow-up
  evaluation of the Solihull Approach training,
  Middlesbrough.
• Lowenhoff, C. (2004) Practice development
  training professionals in primary care to manage
  emotional and behavioural problems in children.
  Work Based Learning in Primary Care, 2, 97-101.

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Research Results effectiveness

• Douglas, H. and Brennan, A. (2004) Containment,
  reciprocity and behaviour management preliminary
  evaluation of a brief early intervention (the
  Solihull Approach) for families with infants and
  young children. International Journal of Infant
  Observation, 7 (1), 89-107.
• Milford, R., Kleve, L., Lea, J. and Greenwood, R.
  (2006) A pilot evaluation study of the Solihull
  Approach. Community Practitioner, 79, 358-362.

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Ghosts from the nursery

• From the waters of the womb to the arms of the
  caregivers to the walls of the family home, when
  the shelters in which we harbour our children are
  inadequate or destructive, the final shelter our
  society provides will often be the cement walls
  of a prison cell Karr-Morse and Wiley, 1997

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Ghosts from the nursery

• Our challenge is to move this information into
  the mainstream to create a critical mass of
  people who know and who care who will over time
  enable this information to move from
  understanding to practice Karr-Morse and Wiley,
  1997.

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Risk Factors child

• Specific learning difficulties
• Communication difficulties
• Specific developmental delay
• Genetic influence
• Difficult temperament
• Chronic physical illness
• Academic failure
• Low self-esteem

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Risk Factors from the family

• Overt parental conflict
• Family breakdown
• Inconsistent or unclear discipline
• Hostile or rejecting relationships
• Failure to adapt to a childs changing needs
• Physical, sexual or emotional abuse
• Parental psychiatric illness
• Parental criminality, alcoholism or personality
  disorder
• Death and loss-including loss of friendship