A Journey In Therapeutic Care

By Patrick Tomlinson.
A Note from the author

In 2012 Dr. Hisayo Kaihara (Child Psychiatrist, Tokyo, Japan) invited me to Japan to look at the development of Therapeutic Residential and Foster Care in Japan.
She is leading a 3 year research project set up by the Ministry of Health, Labour and Welfare to examine worldwide models of Therapeutic Residential and Foster Care services for potential implementation in Japan.
Hisayo asked if I would talk about my career to various groups – she felt this would be particularly interesting as the concept of therapeutic care is a new development in Japan and therefore no-one has a career in it. So, I have tried to tell the story of my own career in a way that illustrates some important points. This was written for a PowerPoint presentation, hence the use of short sections with headings.

As John was ultimately responsible for offering me my first job working with traumatized children in what has become a 28 year career (so far!), I am very pleased that he felt this presentation was worth sharing on his website.

The Cotswold Community.

Beginning and the Cotswold Community

In 1984 I was returning to England after spending 6 months working as a volunteer on a Kibbutz in Israel. In Israel people would always be interested in asking what you planned to do next. I had a degree in Social Administration and had done some voluntary work with children, so not really having a plan I always used to say, “I’m going to work with children”. However, I really had no idea what kind of work. So, when I got back to England I started applying for jobs I saw in the newspaper.

I got invited to an interview at the Cotswold Community. As this was in the days before the internet there was little I could find out about the Cotswold Community. Unbeknown to me it was one of the most important organizations working with children traumatized by abuse and neglect. It had been set up in 1967 by the Home Office as a therapeutic community, and an experiment in replacing the ‘Approved School’ system. Approved schools were in many ways, like prisons for juvenile delinquents. They were often brutal places for children to live in and 85% who left the Cotswold Approved School did indeed end up in prison as adults.

When I went to the Community, 17 years after its beginnings it had established itself as a nationally and internationally renowned centre for treating these severely damaged children (actually it was a place for boys only). During my time there over the next 14 years, we would have many visitors and volunteers, from all over the world, America, Europe, Russia and I remember a large group from Japan.

Leadership and Consultancy

Barbara Dockar-Drysdale.

The success was in no small part due to the leadership of the Principal Richard Balbernie, John Whitwell who followed him, the clinical consultancy provided by Barbara Dockar-Drysdale who implemented an approach based on the theories of child psychoanalyst and paediatrician Donald Winnicott, and the Tavistock Institute of Human Relations who provided organizational consultancy. Interestingly, these 3 areas are critical to how well we work with traumatized children – leadership and a strong clinical approach, within an organization that fully understands the task and ensures that it is organized in a way that supports this. I understand all of this now, though I understood little of it then.

Interview Process

Before my interview I was asked to write a short letter about my own childhood and how it might be relevant to the work at the Community. While this was an unusual thing to be asked it made sense to me. My first interview went sufficiently well for me to be invited back for a 3 day visit. This was an opportunity to get a full experience of the work before a decision would be made, by the Community or the applicant.

Numbers of Children and Staff in a Home

The Community was like a small village on a farm. It was in the countryside, 5 miles from the nearest town. The boys lived in 4 different houses with up to 10 boys in each. The staff and their families lived in the Community in their own houses. Each house of 10 boys had a team of 5 carers working with them, normally with 3 working at any particular time. We worked about 70-80 hours per week, 7.30am – 11pm 5 days, 1 day off and another ½ day off. Often we would be working until, midnight or into the early hours if there were difficulties, and if anyone was sick we often worked on our day off! It was a vocation or way of life rather than a job.

Group Holiday at the Seaside.


The boys also had their Education at the Community in small schools. Teachers would also spend some time working in the houses during the evenings and weekends. The close work between the teachers and carers helped to create a small and tightly knit team. In some ways this was good for the children, though at times the boundary between education and care became blurred in ways that would be unhelpful. Over the years the tasks of therapeutic care and education became more distinct.

Extreme Behaviour

It didn’t take me long to understand that these children were some of the most traumatized and needed a very special kind of therapeutic care to help them recover and develop. To begin with, some things I saw were shocking to me. For example, 10 to 14 year old boys in out of control panics, needing to be physically restrained by 2 adults – the boy screaming, shouting, spitting, trying to kick and hit. I never knew that children like this existed. The boys could also be good fun and many of them had positive qualities, but all of a sudden things could turn from calm to chaos. And for someone new like me, there usually appeared to be no particular reason as to what caused things to change so quickly.

Why do we do this Difficult Work?

Thinking back I wonder what I found so interesting as to commit myself to working such long hours in such difficult work. There are a number of things I can think of,

I learnt about the histories of the boys at the Community. Mostly, they had all suffered terrible levels of abuse and neglect often from their own parents, beginning in the first years of life. From a young age I had always felt concern towards children who were disadvantaged by their circumstances. I’m not sure why this would be. A psychoanalytic interpretation might be that I was identified with the children due to some aspect of deprivation, maybe not obvious on the surface, but possibly related to a lack of parental attunement.

Unconscious Reparation, Personal Motivation and Emotional Resilience

Another possibility might be that I grew up in an extended family, where there was an emphasis on being thankful for what we had and being aware of those worse off than ourselves. It has been suggested that those who choose work trying to fix or mend things for people, are possibly trying to fix something in themselves, or making unconscious reparation for damage felt to be done by themselves towards parents. In some ways it doesn’t matter that we know what drives us to do this work.

However, I do think that having a deep personal motivation makes a big difference. Some people come into the work with a slightly sentimental view of wanting to do something good, maybe to give these ‘poor’ children some love. There is nothing wrong with that but it is unlikely to last long without a deeper motivation. Trying to love children who ignore you, say they hate you, try to hurt you, reject everything you offer and do this day after day, is not easy. You might be able to tell your own level of motivation by considering how determined do you feel? I felt a huge level of determination, like I wouldn’t allow anything to stop me however difficult. I needed this determination during my first few years to keep me going or hanging on, at times when I felt completely drained and hopeless.

As well as determination one also needs to be resilient. Some people are not suited to the work due to a lack of emotional resilience. The only way you can consider whether you are suitably resilient is by thinking over your life and how you have responded to difficult situations. Having strong feelings, such as anger, distress, sadness can be healthy but if these feelings easily become overwhelming, working with these children might be too much.

Fish and Chips by the Sea.

Seeing Children Grow and Develop

I remember that during my visit I also enjoyed my time with the children. With 10 children in one home, there would be children at different stages of development, some that were easy to get on with and some that weren’t. It was good to see how well the children could develop. Some of them would enjoy as much attention as they could get, so it was easy to find at least one child who wanted to play a game with a visitor. I found some of the children to be interesting, amusing and good fun to spend time with.

Personal Growth of the Workers – the Importance of Supervision, Consultancy and Training

Most of the staff I talked with on my first visit said how the work would change me. They said that the work would get me in touch with things to do with my own childhood and personality and while this might be difficult it could also lead to my growth as a person. I was interested in this idea. The Community did seem to me like the kind of place and work where I would grow and change. So rather than the long hours and giving up a ‘normal’ social life being a problem, I could see that the intensity of the work might be beneficial not only to the children but also to me. At the time I thought I could manage this for 2-3 years.

Nearly all of the staff I met, who were mostly between the ages of 22 and 50 were very positive about the work. It became clear that this was an unusual place, paying a huge amount of attention to helping these most troubled children. I had the sense that the staff were doing something very important that required special training and understanding.

I didn’t realize at the time how experienced and exceptional the consultants were at the Cotswold Community – Barbara Dockar-Drysdale, Isobel Menzies-Lyth and Eric Miller. Whilst these individuals were crucial to the community’s work, even more important was the culture and systems that they helped create to sustain the work. There was a Manager’s meeting everyday to discuss what was happening in the Community, think about and respond to it. Each carer would have individual supervision every week, either with their team manager or another senior person in the team who would oversee the clinical therapeutic work. We had a weekly team meeting to discuss everything about our work. We had a weekly team consultancy to discuss our therapeutic work with the boys. We would have individual meetings with the same consultant every other week.

We had a weekly training group for 1 hour, where we would meet with staff from different houses and teachers to discuss a particular subject, related to some reading we would be given the week before. The papers were normally, fairly complex, written by such people as Donald Winnicott. Due to the fact that the work was considered intellectually as well as emotionally demanding, the Community only employed people who had University Degrees.

The Influence of a Boy

Writing this has reminded me of something I had forgotten about, that had an influence on my decision to work at the Community. When I caught the train home after my 3 day visit, I saw one of the boys, Vincent, who was 17 and having been at the Community for 5-6 years was ready to leave. I sat next to him and we talked for ½ an hour or so before he got off the train. He felt that the Community had helped him reach a position where he could look forward to his life ahead. Without it he said he would be in trouble and probably end up in prison. He asked me if I was going to work at the Community. I said I wasn’t sure and asked him what he thought about it – he said he thought I should work there and that I would get on well.

Important Early Lessons – Being Tested and Surviving!

When I started work it didn’t take long to learn some important lessons. The team member who I was replacing had left suddenly and without notice. This meant that the boys were especially mistrustful of a new person. The difficult but positive thing about this was that I didn’t have to wait through a ‘honeymoon’ period where the boys were nice to me. They were pretty hostile and rejecting straight away. The team explained that the boys were testing me to see if I would also leave and they needed to do this before they could trust me. The team did challenge the boys’ behaviour and were supportive towards me, but it was a process that had to be worked through.

During the first couple of months one of the boys became aggressive to me, during the night when I was sleeping in the house. I think I didn’t manage it all that well and ended up with a broken nose in the early hours of the morning. I was taken to hospital and the x-ray revealed a break that would heal on its own. Being determined to show the boy that he hadn’t finished me off, I came into work the next morning as usual at 7.30am. I looked a bit like a boxer with a squashed nose. The Team Manager appropriately sent me home to get some rest and let the swelling go down.

Emotional Demands of the Work and Dealing with Powerful Negative Feelings

Getting physically hurt obviously was not pleasant but it was not as hard as the emotional challenges. Being constantly rejected and treated in a hostile manner can be exhausting and demoralizing. There were many times when I just felt wiped out. One day I was telling our consultant Barbara Dockar-Drysdale how awful I felt. She told me that sometimes the most important thing you can do is just survive and be there the next morning. This seemed manageable to me and by saying this she was empathizing with exactly how difficult it was for me. It was one of the most helpful things ever said to me.

One of the hardest things to discover was emotions within oneself that were unfamiliar, such as extreme levels of anger and even hatred towards the children. Donald Winnicott wrote about the reality and importance of this in his groundbreaking paper of 1956, Hate in the Countertransference. I remember one boy in particular who tormented me relentlessly – he found my vulnerable points and constantly pushed all the buttons. I had to work hard not to react. There was a period where I would hold my hands behind my back to resist the urge to push him away from me when he was trying to wind me up. He seemed to find all of this highly amusing. Many adults who come into the work, wanting to do good for these children and who see themselves as caring people do find it shocking to discover such powerful negative feelings within themselves.

Anti-Social Behaviour as a Sign of Hope

But as Winnicott pointed out it is not feeling these things that is the problem, but it is essential to not act out the feelings by rejecting or hurting the child. The children actually want you to feel these emotions to see what you will do when you are feeling at your worst – will you still care for them or will you give up, or even worse hurt them as they have experienced in the past. Talking of Winnicott, another important concept I learnt was that the child’s anti-social behaviour can also be a sign of hope. The child’s difficult behaviour can be a sign that they are looking for something they need. The child who is being difficult might be more hopeful than one who is completely withdrawn.

A Community Play.

The Relevance of Early Child Development

During my first few months it became very clear to me that the Community had a well defined method of working both from a clinical and organizational point of view, and that it worked. We were given plenty of reading and guidance as part of our training. Sometimes during training groups we would watch videos of mothers with their babies. Whilst this seemed a little odd to me at the time, it was however, very relevant to the work we were doing. In many ways the boys, although being 7-14 years old had needs much more in common with babies and infants. They also had reactions and rages commonly seen in infants.

The Importance of a Clearly Defined Therapeutic Approach – Making Sense of our Feelings

Having a way of working that is supported by theory and evidence is very important. It is also important that this is an evolving rather than fixed thing. The different forums in the Community, such as supervision, consultancy and training were always exploring our experience and looking for improvements in the way we did things. During my first few months I realized the importance of these forums.

If the staff are going to deal with all the difficulty thrown at them they need spaces to receive support, digest and make sense of their experiences. Without this the work can soon seem to be completely bewildering, overwhelming and impossible. I am sure this is a reflection of how the children see the world and their own lives. By the carers making sense of their experience they also help the children to gradually make sense theirs. An important concept here is that all behaviour has meaning. Often it just needs time, space and attention to find the meaning.

Becoming a Carer

Once I had gone through the first few months I was given an individual child to be carer for. This meant that I would take care of his day-to-day needs and pay special attention to him, especially his emotional state of mind, so that an attachment could develop. Working long hours really helped in this role as a carer. If we think of these children being in many ways similar to young infants, it is clearly helpful that the child can have a focused relationship with one person and supportive relationships with others.

Me and the Boys!

The Importance of Consistency and Time

For example, being settled at night, perhaps with a bedtime story and being woken up by the same person is a normal part of what many infants experience. This level of consistency and reliability helped the boys to experience the world around them as a nurturing, predicable and safe place. Naturally, if the child has never experienced this and even worse, may have been hurt or abused, it takes time, persistence and patience from us for the child to realize that we will provide care and won’t give up.

The first boy I looked after would never ask me for anything and would regularly reject or spoil what I did offer. I remember after a year or so when he was beginning to enjoy some of what was on offer, he told me that he never asked for anything because his parents told him he was greedy and bad. However, he said that he had noticed when he arrived that some children took food, such as a biscuit when they wanted it and they weren’t told off. He thought this was a good thing, though it took him over a year before he could ask for and enjoy something as simple as a biscuit.

Getting Better Can Make Things Worse

An important lesson that I learnt in caring for traumatized children is that getting better can make things worse. As a child begins to trust and feel hopeful his behaviour might become more difficult as a way of testing the reliability of the positive care he is experiencing. Also, as a child begins to become less defended and more in touch with his feelings, he may begin to feel strong feelings about his previous experiences. For example, the child might feel depressed or angry about the losses in his life. Things might feel worse though the child is getting better. The road towards recovery is very much 2 steps forward and 1 step back.

Symbolic Communication – Freddie and Freakie the Frog

Another boy I looked after helped me learn the meaning of symbolic communication. Traumatized children will often not be able to use words to tell you how they are feeling. They may however, use symbols through play and other means such as drawing. You have to be observant to notice this as the child may not draw attention to their communication. For example, if a child is playing you might notice the violence taking place between the toy animals or people he is playing with.

Freakie the Frog.

This child, Freddie, asked me one day if I would make him a stuffed toy frog, using fabric. Many of the children had stuffed teddy bears and other such animals. Rather than letting you look after them, some children felt safer asking you to look after their teddy. A child might tell you that his teddy bear isn’t feeling very well and ask if you could tuck him up in bed and give him a nice warm drink. If you asked why the teddy was feeling unwell, the child might say something like he’s sad because his mummy has gone away. The child might also use the teddy as a ‘transitional object’ to bridge the gap between him and his carer, especially during the carer’s absence. Anyway, I managed to find a ‘make your own’ stuffed frog kit and I made the frog and gave it to Freddie, who named the frog, Freakie (in English Freakie can mean a little strange or odd, which Freddie was).

Freakie the Frog

Over the next 2 years Freakie went everywhere with Freddie. If Freddie was feeling bad, he might pull Freakie apart or throw him in a dirty puddle. He did this repeatedly and each time I would repair Freakie, sewing him back together again. Symbolically, I was putting Freddie back together and showing care for him at the times when he felt most worthless. Barbara Dockar-Drysdale would emphasize the importance of doing this over and over again. In the end as Freddie began to feel better about himself, Freakie also enjoyed a more comfortable life!

When Freddie was beginning to recover and we carried out an assessment, Barbara said she thought Freddie was Archipelago, which meant that he had islands of ego or functioning, in a sea of chaos. She said that our job was to help him move from one island to the next without falling into the chaos. During the same time, one day when I went to collect Freddie from the school, he was pleased to show me a new game he had made. He had drawn a round pound with lily pads on it. He said that the game was for Freakie to jump from one pad to the next without falling into the water.

Freddie’s Lily Pad Game.

Freddie’s Lily Pad Game

When Freddie was getting ready to move on from the Home, because he had made a good recovery, Freakie got a job as an airline pilot – clearly linked to Freddie’s sense of his own transition! If we are aware of symbolic communication there are many opportunities for learning things about the child, responding and meetings some of the child’s needs in this way.


After 2 ½ years at the Community, during which time I had not only survived, but become reasonably effective in my work with individual children and in managing groups of children, I became a manager of one of the Homes. The most important quality I took into this role, was a conviction that some things in the work were essential – such as, clear boundaries, reliable daily routines, attunement to children’s needs, good communication within the team, and support to team members through supervision. I had the same level of determination to succeed in this role as I did when I started at the Community as a carer.

The focus for my work was now shared between the children and the team. If the team were to be effective in their work with the children, then I would need to be effective in my work with them. I had observed in the Community, how much difference reliable supervision could make. I saw that in Homes where this was not reliable, there tended to be a higher level of staff turnover and more acting out by the children. However, sometimes it is difficult to know which comes first. High turnover and acting out by the children inevitably can make it difficult to maintain supervision, consultancy and training meetings.

During my first few years as a manager, I was also working as a carer for individual children. Though this went well the demand between meeting the needs of the children and the needs of the team was hugely challenging. After this experience I believed that the manager should not be the carer for individual children, but should focus on the overall management of the Home and its relationship, with the wider community and outside world. This became policy in the Community and as it turned out the increasing amount of administration required of Children’s Homes demanded that the Home Manager could pay full attention to this.

Establishing a Therapeutic Culture – Culture Carrier

The first Home I managed developed a strong therapeutic culture. I expect that part of the reason for this was a high level of commitment by me and the Community towards supporting and developing the team. The team then showed a high level of commitment towards developing themselves, the Home and the children. The children made positive progress in an environment which they experienced as being focused on their needs.

This meant that over time the children became what we called ‘culture carriers’ – they wanted their home to be a good place and contributed towards making it one. For example, rather than break windows and damage things they would help look after and mend things. Then with the money we were saving by not having things always broken and damaged we would let the children choose good things for the home, such as new books or toys.

After 3 years of managing this home, I was asked to manage another home in the Community that had fallen into a state of chaos. The children were seriously acting out and the team was not managing to get on top of it. The children were scared and highly anxious about things being so much out of control. They would do things, like run off together in groups of 4 or 5, climb up on roofs, attack the adults and many individual children would have regular panic rages where they needed to be physically restrained until they were calm and safe. I began the work by applying the same principles I mentioned above. It took about a year to reach a point where the Home was stable and developing a strong culture.

The Size of the Children’s Group

These days in England it would be rare for any Home to have more than 5 children. I can see that this is generally a safer option. However, if you were able to manage a larger group much could be learnt that might not be possible with a smaller group. Large groups can also be beneficial by providing a variety of children, who are at different stages of development. A large group is likely to have 3-4 children who have developed well and as I mentioned are supportive of the culture. This can be helpful to newer children, who also see that others have come to the home like them and now are ready to move on. It provides evidence to all the children that it is possible to recover. Though smaller groups can be a safer option, this is not always the case and groups of 3-5 children can also be very difficult. In a small group if 2 or 3 of the children are going through a very challenging phase it tends to overwhelm the whole group.

Staff Training and Development

During my time managing this Home I began training for an MA in Therapeutic Child Care. This would take me 3 years and turned out to be an invaluable experience. The training was provided at a University outside of the Community, so one day each week I joined other students from different organisations in England. The training had a large experiential part to it. We worked in groups all the time, discussing and exploring things, carrying out various projects, etc. This provided an excellent opportunity to step back and get a perspective on my experience at the Community. It also provided new learning experiences about things I hadn’t considered before. During this and my training at the Community, reading was always an important part of it. There is much to be learnt from reading about the work. It also helps to develop a critical mind, reflecting on and evaluating our work and what we have learnt.

After completing my MA I became Assistant Principal at the Community, responsible for Staff Training and Development. In this role, I was also part of the senior management team responsible for the day-to-day running of the Community and for its ongoing development. I supervised each of the 4 home managers and the person in each team who had specific responsibility for clinical work. In this role, I applied what I had learnt about the importance of staff recruitment, supervision, consultancy and training. We developed a 3 year training programme in therapeutic child care and gained University Accreditation for it.

We further developed processes and systems across the whole community. We improved staff recruitment by looking in detail at the whole process and how we could get better at identifying those applicants who had the right qualities, especially the right balance between emotional resilience and sensitivity. We made great progress, for example, improving staff retention by 60% over 4 years.

Developing Therapeutic Practice

The Community had for a long time been running a group, with the 4 senior clinical practitioners and Barbara Dockar-Drysdale – where they would consider important issues related to the therapeutic work with children. Barbara retired and was replaced with child psychotherapist Paul Van Heeswyk. The group continued to meet weekly, with me chairing it. After each meeting we would provide notes for the rest of the Community, giving ideas and opinions for discussion and guidance. Later I developed the work from this group into a book, Therapeutic Approaches in work with Traumatized Children: Theory and Practice.

Therapeutic Principles and Adapting to Change

After 14 years at the Cotswold Community, which was a lot longer than my initial plan of 2 years, I felt ready for a new challenge. The Community was also going through a major change, having been taken over by a large national charity. By this time, as many of the staff predicted during my 3 day visit I had changed a lot!

Positive Outcomes for Children

I had also seen many children, change, grow and develop into healthy young men with hope of a positive future. Today with over 25 years since my beginning and being in contact with some of the boys who are 30 – 40 years old it is clear that many of them have done well and are bringing up their own children in a good way. One boy I had been looking after told me before he left that because of his time at the Community he believed that if he ever had children, he would be able to do it in the way he should have been brought up. He said that he thought he would never hurt his own children. Breaking the cycle of abuse in this way is really what the work is all about.

Setting up New Homes

I found a new position with an organisation that was setting up new Children’s Homes and Schools. My role was to open therapeutic homes and establish the culture. The challenge for me was – how much of what I had learnt at the Community could be transferred to completely different settings? As I have mentioned, the Community was on a farm in the countryside. These new homes were to be ordinary family type homes in small villages or urban settings.

By this time many laws had also changed so staff could no longer work the kind of hours we used to at the Community. 40 hours a week was to be the norm. Regulations imposed by the Government also meant that we could have a maximum of 5 children in one home. These changes meant that we had 5 children being looked after by a team of 10 carers, rather than 10 children being looked after by a team of 5 carers. However, many of the therapeutic principles could still be applied. We just had to work harder to ensure our communication within the team was effective, so we could provide the consistency in approach the children needed. Ensuring that children got enough individual attention also needed careful planning.

When staff are working less hours there is less time for supervision, team meetings, consultancy and training. Creative ways of providing these things need to be found. We would still have a team meeting once a week, supervision fortnightly, consultancy if it was possible and training would tend to be more on the job and through supervision and team meetings. I found that it was possible to establish therapeutic Children’s Homes in these new circumstances, though not without difficulty.

For example, if the children are acting out and upsetting the neighbors this is much harder to manage than if you have a lot of space around the home. On the other hand there are also benefits for children in being part of and connected to a local community. One problem I found in this new job was that the organisation wanted to keep moving quickly onto the next project. I didn’t feel there was enough time to fully establish the culture within the home before moving on. The organization’s leader did not fully appreciate what was needed to create a truly therapeutic environment.


Two years or so later, I met Mary Walsh the founder of SACCS who did fully appreciate what was needed and suggested I apply for a position as a Director. Because Mary had been a social worker and was passionate about her work with children it was clear that SACCS, like the Cotswold Community was a genuinely child centred organization. SACCS had 10 homes for up to 5 children in each, spread around the town of Shrewsbury. As well as providing therapeutic residential care, SACCS also provided the children with individual therapy and life story work.

Life Story work is the process of helping children make sense of their lives and resolve issues to do with their histories, which are either not known, misunderstood or distorted. The aim is for the child to have a realistic and coherent sense of their own history, which is so important to the healthy development of their identity.

The Recovery Team

The carers in the SACCS homes are called therapeutic parents, and along with the therapist and life story worker for each child they formed the recovery team. It was essential that this team was fully integrated, in regular communication and attending meetings together. Whilst the recovery team provides three different but complimentary approaches they share an understanding of the child and what the overall objectives are for each child.

Bessel Van Der Kolk, Bruce Perry and Mary Walsh at a SACCS Conference.

The SACCS Recovery Programme

I worked with Mary and others at SACCS to create the SACCS Recovery Programme. An important part of this was defining the outcomes we aimed to achieve with the children. We came up with 24 outcomes, such as the child: has a sense of self – who they are and where they’ve been; has developed internal controls; is able to make appropriate choices; is able to make appropriate adult and peer relationships; has developed conscience; is no longer hurting themselves or others, etc. Once the outcomes were defined we clarified the work that would then be required in therapeutic parenting, life story and therapy to achieve the outcomes. Finally, we clarified effective ways of how to do this work. Once we knew what the desired outcomes were, the work necessary to achieve them and how to do it, we needed a way of assessing each child’s progress towards these outcomes.

We developed an assessment process that would involve and further integrate the whole recovery team. Following the recovery assessment, the recovery team would then create an Individual Recovery Plan for each child, covering every aspect of their daily life. For example, how different children are put to bed, woken up in the morning, supported in forming attachments with carers, developing relationships with peers, how much nurture is needed, etc.

A Containing Network for the Child

At SACCS I learnt much about areas of work that are a specialty of the SACCS approach, such as working with sexually abused children and the importance of life story work. The integrated team also showed me how a sense of community can be created for the children and staff, without actually all living together in the same place. It is more like a containing network around the child.

Continual Evolution

Since finishing my work with SACCS I have continued to be involved in work with organizations to develop their therapeutic programs and models. I have worked with the Lighthouse Foundation in Australia we published a book together on their therapeutic model of care that I am delighted to hear is being translated into Japanese. One of the valuable things I learnt from Lighthouse was to do with the importance of stories. So it is fitting that I am talking with you about therapeutic care by telling my own story. I am presently working with a UK organization that provides therapeutic care and education to develop their practice model and organization. What I have learnt from this work is that we need to continually evolve. Each situation we are in is unique.

The Development of Therapeutic Approaches in Japan

There are principles that remain relevant over time, because human need doesn’t change that much! However, we learn new things and what we learn has to be applied in the specific cultural context we are living and working in. This way of thinking was very much alive in the Cotswold Community when I started my career and you could say it is the essence of a therapeutic environment. How can we establish this ‘culture of enquiry’ as therapeutic communities have been described, which facilitate growth and development in the children and also in those working with them? There is an excellent opportunity here in Japan to do just that.