Relationship renaissance: the use of attachment-based narrative and metaphor in life story work

Background

Katie was 16 years old and had experienced considerable rejection, loss, trauma and abuse during childhood. She is one of five siblings whose birth parents were highly vulnerable and unable to care for and protect their offspring. She has experienced 10 foster placement disruptions and has little sense of meaningful trust in adults. Her early history includes being emotionally and sexually abused within her extended birth family, an experience also suffered by her parents as children.

This context of inter-generational abuse led Katie to develop a profound sense of worthlessness and a faulty internal relational template dominated by anxiety, fear and insecurity. This became more established as one rejection followed another and placements broke down without any reasons that she could comprehend.

To counter this, Katie constructed layers of emotional protection to avoid further emotional haemorrhaging and hurt. She was, therefore, a typically well-defended youngster who was difficult to communicate with at an emotional level. She presented as being vulnerable with low self-esteem, often expressed in self-harming, particularly cutting. She expected and anticipated rejection from those involved in her care and handled this by avoiding closeness, rejecting overtures of help and abandoning relationships before (as she perceived) they excluded her.

Therapeutic plan

The core of the therapeutic plan for Katie is to establish a meaningful narrative while at the same time providing suitable guidance and direction to the carer. The aim is to give her some insight into Katie’s world, especially the experiences that have profoundly affected her ability to make, sustain and benefit from relationships. Helping Katie’s carer in this way enables her to fulfil an influential role throughout and beyond the therapeutic life story process.

Early on in the work, sessions are dedicated to the carer’s preparation and attunement to the child’s attachment history and early life history. Also at this stage, the carer is helped to become familiar with her role and to appreciate the concept of therapeutic life story work, the importance of continued interpretation and reinterpretation of the narrative and the use of metaphors. Work is then undertaken to gradually write and rewrite the child’s script, including an emotional dialogue that weaves itself simultaneously within chronological events. The order, sequence and, most importantly, the meaning of emotional experiences are constructed collaboratively.

Time is taken over identifying suitable metaphors and a narrative that the child understands. This has the effect of igniting and fuelling the therapeutic story that gives it meaning and understanding for both parties.

In each story there is a centrally embracing metaphor; in Katie’s case it is the ‘cave of physical safety’. At the epicentre of this work is the child’s emotional turmoil and need to avoid further traumatisation. However, the narratives are expressed in the third person to provide sufficient psychological distance for the child, allowing her or him to make connections with the story without re-experiencing stress. A by-product of the widening of the carer role that arises from this approach is that the carer–child relationship shifts from one that is ostensibly behavioural to one that is attachment based.

Therapeutic narrative and key metaphor: ‘Beyond the cave of physical safety’

The story ‘Beyond the cave of physical safety’ has its origins in rebuilding trust, acceptance and reducing feelings of rejection. It explores the young person’s pervading emotions, such as insecurity, fear and anxiety, which often serve as foundations for emotional and physical barriers that make it difficult for such children to engage in emotional communication (Siegel, 2001). They prevent children from accepting invitations to form new attachments as these may be perceived as scary and threatening. Such children adapt to a world where, for them, there is a critical absence of emotional safety.

The critical absence of emotional safety

The cave of physical safety was described as a special place constructed by Katie to provide her with her own version of care and protection – a compensatory legacy from her time with her birth family. It was a difficult place to reach, an appropriate metaphor for well-defended children like her. In its introduction, the narrative recognises that some children remain emotionally isolated and at times overwhelmed by their past maltreatment.

The cave stopped children learning how to make relationships. It was a lonely and emotionally cold place and because it was so high up on ‘the hill of relationship mistrust’, it was exposed to ‘the wind of trauma and hail’, which often overwhelmed children, blowing them off their feet and pushing them back into memories and worries of their earlier life and even deeper into the cave.

The beginning of therapeutic recovery and healing

In this context, the young person’s therapeutic friend is ‘Paula the pilot’, who attempts to engage the child and carer and moves at the emotional and attachment rhythm of the child. She is perceptive and patient, familiar with the perils of the hill of relationship mistrust and aware of an antidote to neglect, abuse and rejection: empathy.

Can Katie escape from the cave and start to trust people again? Before this can happen, the narrative invites Katie’s carer to travel down ‘the runway of acceptance’ before the child–caregiver relationship can take off on a journey in which Paula takes Katie’s carer through to ‘the pool of empathy’. Paula then sets course on a bearing of exploration, curiosity and learning – qualities that improve the prospects of a ‘sustainable attachment flight’ or empathic attuned care, an attribute that remains integral to the carer’s nurturing and insightful parenting, particularly in the future as the effects of earlier neglect and trauma continue to unravel.

The story emphasises that Katie’s carer kept going through cloud, rain and thunderstorms and eventually landed the aircraft near the cave of physical safety. This is a metaphor for caring to help Katie, who so far has resisted an emotional connection with carers, offering them little reciprocity. These are very difficult journeys for carers to sustain over long periods without an attachment crash and placement disruption.

At a critical point in the story, and central to this approach, the carer is invited to reflect upon how the child may be feeling about living with pervasive anxiety, hyper-vigilance and fear. On their way into the cave, Katie’s carer needs to cross ‘the ridge of anxiety’ and keep the balance of commitment and unconditional love towards her, despite being repeatedly buffeted by the wind of trauma and hail. The ridge of anxiety is a place where most children like Katie live; it is on the edge, precarious and insecure and children feel frightened and ready to jump off before being pushed. Here, children anticipate rejection while defending themselves from further harm and rejecting the kindness of others in a vain attempt to control their emotional world.

As the carer becomes increasingly emotionally connected to the child, her or his history and the way the world is experienced, she is challenged to expand her approach from one that is focused on behaviour management and containment to one marked by relational sensitivity. This significant change is expressed via the metaphor ‘the cave’s entrance of doubt’, which represents the carer’s uncertainty about looking beyond children’s presenting behaviours. It becomes smaller and narrower when carers question the importance of relationships but grows larger, wider and more welcoming once they appreciate that relationships are more significant than behaviour. When the carers first reach the entrance of doubt, they do not know what to do or how to react. They have to visit and revisit the pool of empathy in order to understand how Katie might be feeling before they can gain entry to the cave.

Once inside the cave, Katie’s carers see some wonderful things starting to happen. Relationships become more important than ever before and new trust starts to build. Katie begins to feel less anxious and lonely. ‘What is this place?’ Katie asks her friend Paula who explains that this is the ‘attachment cave’ and that once empathy, understanding and acceptance can live inside the cave, new, more emotionally warm relationships can flourish.

If the carers take empathy, understanding and acceptance into the cave it transforms into the attachment cave. Conversely, if empathy, understanding and acceptance were to leave the cave, it reverts to the cave of physical safety. When this happens, it can lead to the embryonic attachment being lost at a cost of further layers of emotional defensiveness becoming built in the cave’s deeper chambers.

The narrative strengthens its therapeutic effect by revisiting (with the carer) the child’s early experiences, exploring the past in a curious way and seeking to learn more about it. It can naturally uncover parental indifference and a lack of love, conversation, guidance and nurture. At the same time, it can introduce the carer to Katie’s desire to belong, despite not knowing what love, joy and happiness consistently feel like. The narrative also highlights Katie’s emotional, social and relational delay. The healing process began when Katie felt the touch of her carer’s acceptance, although this was a complex juxtaposition of subtle action and counter-action taking place within their relationship.

At first, Katie played around with her carer’s acceptance because she wanted to protect herself from being repeatedly hurt. She pulled away and tried to avoid her carer’s kind actions, and soon her web of adaptive behaviours entangled her carer into a state of confusion, and she even started blowing up her own ‘wind of trauma and hail’ to see if her carers really had visited the ‘pool of empathy’. But by this stage, the carer was more attuned to Katie’s particular experiences and was able to demonstrate the necessary acceptance, understanding, commitment and unconditional love for Katie that soothed and ameliorated her anxieties.

Gradually, Katie started to feel the warmth of her carer’s acceptance. She began to unravel from her web of adaptive and protective behaviours and soon stepped out of the cave and across the ridge of anxiety and straight into the aeroplane. Paula started up the engine and asked everyone to strap themselves into their new attachment seats. Katie’s carer sat beside her and held her hand. This calmed Katie. She started to have new feelings that she had not experienced before. She began to build new trust and even when the weather became stormy, she was able to take comfort and feel emotionally safe and calm. Feeling part of a family who loved and accepted her, Katie became increasingly less anxious and stressed. As her challenging behaviour diminished, she was free to engage and relate in a new way that generated positive responses, firstly within the foster family and then in her wider social network.

Therapeutic outcome

As the carer had a close involvement in the therapeutic life story work from the outset, she was now able to understand and relate to the complexities in Katie’s life, in particular the significance and meaning of the self-harming. At the core of the work was the emotional dialogue between Katie and the worker, to which the carer now felt connected. Katie was able to reflect on the narrative and how it represented her inner-world experiences and gradually share them with her carer who, in turn, was now attuned to Katie’s experiences, bringing about a new kind of relational experience. The acquired insight into Katie’s precarious inner world of fear, anxiety and vulnerability enabled the carer to support and guide her in a more meaningful way that was in marked contrast to the earlier, albeit caring but predominantly behavioural approach.

Katie’s placement ended after approximately a year. A lot of work had been undertaken in that time. It was a planned ending during which Katie had gained trust in her relationship with her carer and for the first time had had a positive, unique experience of change and transition. As a result, she could approach the next placement in a more positive, accepting way that minimised her feelings of shame, blame and responsibility.

As Katie explained:

When we first had therapeutic conversations about life in the cave of physical safety, I wasn’t even prepared to consider any journey up the hill of relationship mistrust. All I was planning to do was to jump off the ridge of anxiety again, if my latest carer tried to get to close to me. Exploring the storyline with the therapist, I thought perhaps one day I can begin to trust again.

Background

Luke, aged seven, and Anthony, six, were half-brothers placed together after being removed from their mother’s care. Since that time they had experienced four placement disruptions and an unsuccessful return home. The children’s family history was one of chronic neglect, disruption and repeated rejection, mostly due to their mother’s considerable learning difficulties, which compromised her understanding of the children’s developmental needs. There was no significant extended family or other support available and the boys were often abandoned for periods and exploited by their respective fathers who, beyond this, played no significant part in their lives.

The local authority children’s services had tried to support the family but were defeated by a combination of the mother’s limited parenting capacity, a succession of serious safeguarding incidents and overwhelming evidence of the boys' failure to thrive. An attempted rehabilitation to the mother’s care only lasted a few weeks before the boys were again placed in foster care, this time with a single carer. Here they experienced some limited stability for 10 months before being moved to another short-term placement, with a view to being adopted. While a prospective adoptive couple were identified, they very soon withdrew. At this point the foster placement started to break down, with the boys displaying increasingly confused and distressed behaviours. They then moved to their current foster carers, with whom they have been living for five years.

Therapeutic plan

The therapeutic plan for Luke and Anthony is very similar to the one for Katie but differs in the sense that it takes account of the shared experience of two much younger children who are also half-brothers. The key concepts are preparing the carer for her role in the work, rewriting the children’s script in the context of the centrally embracing metaphor – in this case, ‘the attachment line’ – and supporting them in the reinterpretation of their lives.

The therapeutic narrative and key metaphor: ‘the attachment line’

The attachment line is a therapeutic story that provides a vehicle for children to explore, question and ultimately understand their family histories. It helps them to revisit and reinterpret their past from a position of growing emotional safety so that they can begin to make sense of feelings such as shame, self-blame and responsibility for their mother that trouble them.

Burnell and Archer (2003: 67), referring to Schore’s (1994) shame hypothesis, state that:

. . . even the temporary breaking of attachment bonds during socialisation must be immediately repaired by the caregiver if the child temporarily abandoned or rendered helpless and hopeless is to feel comforted, secure and revitalised. Failure to do so leads to an overwhelming stress response, expressed bi-modally, either as cast-down shame or aggressive-shame-rage.

The narrative-based attachment approach uses play to engage children and then revisit their early relationship experiences. The child’s initial emotional response to this, including regression, is accepted and then addressed as part of the therapeutic process. The ‘stations of time’ incrementally layer the child’s significant past and current relationships and placements in a meaningful and coherent way, which is sensitive to their needs in terms of pace, meaning and integration. Involving carers in this process enhances their understanding of the child’s emotional journey and their residual fears and anxieties. In a reference to Jennings (2004), Golding (2014: 31) writes that ‘stories are safe structures to help with anxieties and burdens. As these anxieties are externalised within the narrative construction, the burden can be lightened.’

The carer’s task is highlighted throughout the narrative and consistently invites reflection, insight and empathic and attuned care. The choice of play intervention, a train journey, was made in collaboration with the children and constructed from an attachment perspective using an understandable and developmentally sensitive metaphor to simplify the key emotional concepts.

In the evolving story the railway engine is the therapeutic friend to each child and travels with them on their journey. The experience introduces questions and feelings into the child’s thinking and visits the various stations of time that represent where the children were born and have lived. The railway track is the metaphor for their lives and their relationships with adults. This is then used to explain the different stages of the child’s life and development, often amid changing and confusing circumstances. The identification of specific lines, such as birth, birth family, foster care, adoption, special guardianship or living with relatives at different times, helps the child begin to order and sequence life experiences, thus beginning the process of consciously connecting them to the past, present and future.

Lacher, Nichols and May (2005: 90–91) reflect that children who are ‘trapped in the past do not develop an emotional connection with their current caregivers or the skills to deal with the past events’. So, further metaphors are embedded throughout the narrative as a pathway to enable the child and carer to begin to understand significant perceptions and experiences. For example, the engine maintenance depot/shed represents the special baby care unit where Luke was born prematurely. In his attachment-based life story therapy, the engine visits the depot/shed for repairs at the start of the journey and helps him start to make a connection between his life experience and his own need for emotional repair.

The narrative then introduces the concept of emotions, describing the mother’s love for Luke but her inability to meet his needs; this causes him to fall off the rails with his mother not being able to get him back on track. Child protection concerns, professional worries and readmission to hospital on the hospital line are all available metaphors within the story, allowing a focus on one issue at a time for the child. As a result, the emerging narrative not only connects the children’s individual chronology, but also encourages an exploration of their emotions during various often abrupt, unresolved and confusing transitions and experiences.

A central theme in the narrative is that this should not happen to children and that it was not their fault. In addition, children with attachment difficulties often need to know how to trust and make relationships. With this in mind, the narrative introduces the concept of ‘the hill of relationship mistrust’ used with Katie; this represents a natural place to find many abused and traumatised children. The story reflects that when Luke and Anthony met new people who were going to care for them, they did not know if they could trust them. Hughes (1997: 24), citing Brothers’s (1995) psychoanalytic perspective, proposes that ‘at the core of the effects of trauma on the self is the betrayal of trust that such trauma represents’.

Again quoting Hughes (1997: 8), ‘helping the children to differentiate the old from the new parental figure’ is critical if they are to begin to trust. Trust is also difficult to experience for a child who is full of shame and convinced that he or she is unworthy to receive it. Such children often resist any encounter that would facilitate parent–child trust. So the story then interjects hope and understanding in the form of the pool of empathy where empathy emerges from the images of the pool. Luke said, ‘It would be good if my foster carers and school teachers knew about the pool of empathy so they could understand how I have different feelings each day.’

Hearing this and similar comments enabled the carer to reflect and increasingly see the emotionally driven child behind the presenting behaviours. Another instance occurred when the boys’ developmental trucks became uncoupled and were left several miles behind at different points of the track, illustrating the children’s emotional immaturity. On the journey, they often needed to go backwards (in terms of their behavioural needs) to recover the trucks before moving forwards over the twisty track or through tunnels, up hills and over the bridges of new life events.

As the narrative develops, ‘the tunnel of uncertainty and loss’ emerges, reflecting the children’s distress and need for emotional soothing. In the story, the children make their carer hold their hand on entering this dark and scary tunnel. On emerging, their carer thinks the children ‘will not need to hold my hands anymore’.

The narrative then reflects on how the children’s experience of their trauma has affected them differently. Anthony asks his carer, ‘Can I still hold your hand, as some days I feel as if I am going backwards into the tunnel?’ while Luke asserts, ‘I am holding on to your hand forever, I don’t want to go back into that tunnel ever again.’ This represents their respective stages of healing as well as the impact of trauma at different points in their development.

The process continues: around the corner is ‘the transformer bridge’, a metaphor that resonates for both carer and child. This experience is quite profound in that it offers the carer a new perspective on the children’s needs that ultimately leads to attachment-based care. Luke and Anthony are now travelling along the attachment line until they come upon their own attachment station. By this time they are experiencing the early stages of an attachment experience, making gradual progress and travelling on a journey towards a new and more secure relationship.

The narrative method hypothesises that the boys will need a great deal of repair. However, in the station, there was a very special place called the ‘attachment repair shed’ where children’s relationships became more important than behaviour. Here, children’s emotions, adaptive behaviours, emotionally defensive stances, anxieties and fears are all sensitively explored. The story reflects how via this process the children begin to feel physically and emotionally safer. For the caregiver it is also significant as visits and revisits to the pool of empathy provide an attachment- and trauma-based focus, enhancing attunement with the children.

In the context of a developing secure base and evolving attachment, the narrative method opens the possibility of repairing and healing past trauma and minimising the effect of future harm. It highlights how the engine (now with children and carers on board) will continue to come off the track from time to time while still needing to re-couple the ‘trucks of delayed development and absent nurture’. This requires the carer to show acceptance, empathy and unconditional commitment towards the children, who may still face fear and uncertainty. As children embrace the experience of acceptance and commitment from their carers, the hill of relationship mistrust starts to be climbed slowly but with purpose, with expected slips and occasional slides that can be recovered. New attuned caring experiences are gradually accepted by the children who increasingly want to become part of the family. The ‘attachment relationship oil’ embodies this relationship fusion where earlier explosions are recovered and soothed by the carers’ responses to meeting the children’s individual needs. The children’s reinterpretation of their life events gives them back their childhood, slowly helping them emerge from the tunnel of uncertainty and replacing abuse and the silence and darkness of neglect with laughter, fun and play. These experiences are often assimilated slowly and enjoyed for the first time.

The narrative concludes with how important it is to give the children their daily dose of the ‘medicine of nurture’… ‘that’s three teaspoons full each day, one in the morning, one in the afternoon and one again in the night’, reflecting that the ‘tunnel of uncertainty’ is miles back down the track – a distant memory where the wind of past trauma and unresolved loss is now replaced by the more soothing ‘breeze of unconditional love’, which brings emotional connection and congruence to their lives.

Therapeutic outcome

The carer in this case had a close involvement in the therapeutic life story work from the outset and became able to understand and relate to the boys’ emotional lives. This led to increased attunement on her part that enhanced her relationships with them in a highly personalised way. She now understood the complexity in Luke and Anthony’s lives, particularly the turmoil in their inner worlds and how this manifested in night terrors and daily behavioural challenges. As a result, she was able to support and guide them in a more meaningful and mutually satisfying way. Slowly and gradually this led to a more secure attachment experience for the boys and an enhanced caring role for the carer. She also felt more confident in her approach to their daily care, resulting in greater placement stability. When the work commenced, Luke, in particular, was still vulnerable to thoughts of moving to another foster placement. He demonstrated this during play sessions by initially driving his engine to the next ‘station of time’, i.e. a new foster placement. But as the work progressed, Luke’s engine ended its journey in his ‘attachment station’.