Hello and welcome to the first of the Compassionate Nature posts for 2024, which takes a look at two papers from last year around the use of compassion based programmes to support young people in care and those who work to support them.
Childhood is often portrayed as a period of idyllic long summers, with an open curiosity towards the world which fades through adolescence and as adulthood beckons. Childhood is a key developmental stage, both physically and psychologically, where a safe and secure environment supported by caring relationships can help foster the positive development that lays down strong foundations for adulthood.
Attachment is the psychological concept of the emotional bond between child and caregivers. Perhaps one of the most well-known developmental psychological theories of attachment is the ethological attachment theory of John Bowlby and the research of secure bases by Mary Ainsworth. Across a series of papers and books in the 60’s and 70’s Bowlby (1982) theorised that infants and children behaviour is driven by an evolved instinct that encourages attention from a caregiver, which forms an attachment, with the nature of that attachment derived from the quality of care provided. This early attachment helps to inform our relationships with others. Ainsworth (1979) developed an assessment of attachment styles using the “strange situation” assessment, which involves observing reactions to caregivers and strangers from a child, leading to the attachment being categorised as either secure, insecure-resistant or insecure-avoidant. Work by Mary Main and Judith Young (1986) added insecure-disorganised attachment to cover those children who did not easily meet those three categories, with a large percentage of children in this category having experienced maltreatment (abuse or neglect).
And sadly not all children do experience a safe and secure environment within which to grow. The NSPCC in 2022 estimated that around half a million children in the UK suffer maltreatment annually In 2023 the Children’s Commissioner for the UK reported that there were nearly 84,000 children in care, accounting for around 1 in every 140 of children, with the main reason for being taken in to care as a result of maltreatment.
Supporting those in care
In a recent paper, Alex Lau-Zhu and Lydia Vella (2023) highlight evidence that children in care are more likely to experience psychological issues, which may develop earlier, be more severe and be more persistent than their peers, alongside social and behavioural challenges that impact on daily functioning. Low level of self-confidence and high levels of shame are often present, coupled with maladaptive emotional regulation.
They considered the potential of Compassion Focused Therapy (CFT) in supporting a group of 8 young people, all female and aged 12-16 years old (mean age of 14). They were invited to attend a programme, “Building Your Self-Confidence”, consisting of 8 in-person group sessions, using adapted CFT materials that were age appropriate. CFT was selected given its evidence base for addressing high levels of shame and self-criticism while improving self-compassion and emotional regulation, although the evidence for use with children and adolescents is limited. The sessions included looking at aspects of CFT such as the three system model of emotion (drive, threat and soothing), the three flows of compassion and exploring the fears and blockers to compassion.
Measures were taken at the start and end of the programme. Both a caregiver and the young person completed a measure of mental wellbeing, with the young person also completing measures of general functioning and self-compassion levels, plus providing feedback on the sessions. Nearly all the young people attended all of the 8 sessions and provided positive feedback on them, with most reporting the sessions were helpful, enjoyable and the material used was understandable. Most also reported improvements in their self-confidence with 3 reporting improved levels of self-compassion.
Perhaps the most interesting result was the difference reported in mental wellbeing. The caregivers data suggested that 5 of the young people would meet clinical thresholds for mental health conditions at the start of the programme which had decreased to 2 at the end. Based on the young people’s responses however, 6 met clinical threshold at the start which had not changed at the end. The authors suggest this may be a result of the wellbeing measure used (the young people used a shortened version of the one the caregivers used) or that the 8 sessions did not provide enough time for them to notice the benefits from the intervention, which the caregivers may have noticed more from an external perspective.
It is a small scale case study, so further studies of CFT to support those in care are required to expand on this promising work. This would include using an RCT design with a control group, more formal measures with suitably sized samples, and considering the delivery methodology of the programme eg group or individual, blend of online and in person. Exploring which aspects of CFT were most useful is also required and some of the CFT exercises used were more challenging for the young people than others, for example safe imagery.
Supporting those working in care
Laura Santos and colleagues (2023) also considered the role of a compassion based programme within a care setting, this time with relation to those who provide the care. Individuals working in care are pivotal to helping address maltreatment through establishing safe relationships, which can often be demanding and stressful work, requiring good emotional regulation skills. This study considered the influence of Compassionate Mind Training (CMT, a version of CFT used in non-clinical settings) to support workers in a number of residential care homes in Portugal. The sample consisted of 17 caregivers who performed different roles and had different levels of experience. They were all female and aged 25-56 years old.
The programme (CMT-Care-Homes) was held across 3 months, consisting of 12 sessions based on the CMT modules, with the first 6 exploring psychoeducation aspects (eg flows of compassion, three system model), 5 sessions on developing competencies and skills, with a final review/revision session. The programme was assessed using the qualitative approach of thematic analysis, which provided four key themes of development, barriers, enablers, and effect of compassion
The development of compassion suggested that the caregivers felt increased motivation to help others, both those in their care and those they work with. They reported feeling less judgmental with increased awareness of others perspective. They also reported feeling more aware of help towards themselves, both from others and especially through greater self-compassion.
While self-compassion was positively reported, many mentioned that it was demanding to do which provided a barrier to some. Other barriers reported included finding the meditative exercises used within CMT difficult and that the sessions were often run alongside their existing shift, adding extra time to the working day.
That said, overall the caregivers were satisfied with the programme, especially finding the support and safety of the group sessions helpful. The reflective and experimental nature of the sessions was seen as a key enabler to deepening compassionate flows. The programme was seen as increasing awareness and ability to be more in the present, which was seen as being beneficial to those in their care and to colleagues.
The effects of the programme were noted in the care workers sense of improved emotional regulation and ability to cope with stress. Increased feelings of self-efficacy and self-confidence were mentioned, alongside reduced negative affect. Greater team cohesion and improved communication were highlighted across the teams.
Perhaps the greatest effect that the care workers perceived was that the programme had improved the overall quality of their care, through increased intentional awareness of how things were done and greater awareness of taking others perspective into account. This appeared to lead to greater engagement and reduced behavioural issues from those in care.
Again, like the other study, it is a promising initial look at the role of a formal compassion based programme within a care setting. It is a qualitative study with a small sample so generalisation is difficult. The participants all volunteered and some had worked with the researchers before so there may be a bias in their responses. Further studies could look at the longitudinal nature of the benefits and consider how the programme could be delivered to address some of the barriers reported.
Compassion in care
Often those in a care have undergone traumatic experiences which can result in high levels of shame and self-criticism, that may lead to psychological distress and maladaptive behaviours. The caregivers who are helping to address those experiences and provide positive care may find their work stressful and require support themselves. Introducing a formal compassion based programme to both those in care and those working in care may be highly beneficial, to help make caring sustainable and of high quality, while also providing young people with the skills to navigate through their experiences and face a future with more confidence and belief in themselves.
And given the start in the life that they may have had, that seems the least we can do.
I would love to hear your thoughts on this or any previous posts, so please feel free to add a comment, send an email to TheCompassionateNatureHub@gmail.com or add a reply if you see it via social media. Please also feel free to share the post on to anyone you think may be interested.
References
Ainsworth, M. S. (1979). Infant–mother attachment. American Psychologist, 34(10), 932–937. https://doi.org/10.1037/0003-066X.34.10.932
Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52(4), 664–678. https://doi.org/10.1111/j.1939-0025.1982.tb01456.x
Lau-Zhu, A., & Vella, L. (2023). A Compassion-Focused Therapy group for young people who live in foster, adoptive or kinship care: Initial development, reflections, and ways forward. Adoption & Fostering, 47(4), 400-414. https://doi.org/10.1177/03085759231207397
Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. In T. B. Brazelton & M. W. Yogman (Eds.), Affective development in infancy (pp. 95–124). Ablex Publishing.
Santos, L.F.S.M., Pinheiro, M.d.R.C.N.M.M. & Rijo, D.M.B. Compassionate Mind Training for caregivers in residential youth care: Investigating their experiences through a thematic analysis. Mindfulness, 14, 2807–2823 (2023). https://doi.org/10.1007/s12671-023-02239-9