How to Support Parents Post ASD Diagnosis - VAC 2014

It is always a privilege being invited to speak at the Victorian Autism Conference. Having worked with the brilliant staff at Amaze previously it was good to see friendly faces again. 

Lia Castorina, Manager of Advisory & Counseling Services at Amaze, requested a presentation on how to support parents after a diagnosis of Autism Spectrum Disorder (ASD). In an effort to provide the best possible care for the child with autism, the parents are often forgotten and are the unsung heroes. 

As a Psychologist supporting children and families with autism at Psychology Melbourne, the following are the three most common areas of difficulty parents report post diagnosis.

Risk of depression
Did you know that there is a significant risk of suffering from depression post diagnosis for your child? A study in Neuroscience (2013) found that depression and anxiety was significantly higher among parents of children with autism when compared with controls. 

Swinburne University had a poster at the conference expo which discovered that fathers experience significant psychological distress after their child is diagnosed with autism. 

To be clear, being a parent of a child with autism does NOT cause depression. But in an effort to provide the best possible care and support for the child it can leave a parent emotionally and psychically exhausted. Even the most capable person struggles. 

Strategies for coping with depression

1. The first step is to identify and acknowledge the signs and symptoms of depression. Speak with your GP or check with reputable websites such as Beyond Blue for signs and symptoms. 
2. See a psychologist. You are entitled to 10 sessions with a Mental Health Care Plan from the GP. 
3. Your psychologist with first and foremost listen to your concerns/thoughts/worries. Never underestimate the power of being heard and listened to. Many clients leave the office saying, 'that felt so much better telling you all the things that I've been bottling up for ages!' 
4. Your psychologist will empower you. Together you will co-construct new ways to at develop coping strategies that will work for you.

Risk of divorce and separation

There was a urban legend that 80% of relationships will end in separation/divorce after a child is diagnosed with autism. However, recent research has shown that it is not this high (Hartley et al 2010). Although it is recongised that having a child with autism does add extra strains on a relationship. 

Please check out Raising Children Network for a short clip of parents speaking about how a diagnosis impacted their relationship with their partner. 

Strategies for supporting your relationship with your partner:

1. Open lines of communication. You may be at a different stages of the grief cycle to your partner but suffering in silence only makes it worse. 
2. Avoid negative feedback loops that start with the accusatory "you" word -  'You always shout at me'. And replace it with an "I" statement. "I experience this shouting as upsetting and I'd like us to..."
3. Establish new role. Often one parent has to give up full time work post diagnosis. How is this going to be managed? How can you work together as a team to adapt to this new way of being?
4. Money is one of the top 5 reasons for separation and divorce regardless of whether a parent has a child with autism. The BBC recently reported that it cost the UK £32bn a year in terms of treatment, lost earnings, and care and support for children and adults with ASD. Amaze is there to help ease those financial burdens via the Helping Children with Autism Package. You are entitled to this money so please access this support. 

Risk of social isolation

It is often reported in the clinic by parents that family members not understand their child's autism, or friends have stopped coming over after a diagnosis. 

This is a shame because this is the time when you most need support, care and understanding. 

Strategies for gaining social support:

1. Start with something easy like a online forum. Dr Julie Green, Executive Director from Raising Children Network commented that parents have reported using online forums as a great way to 'dip your toe' into a new community and seek support while at the same time feel safe. Parents have reported to Julie how humbled they have felt by other parents good will and words of support and kindness on online forums.
2. The next level would be to access support groups face to face. This is a good way to share thoughts and ideas with other parents going through the same issue. Parents often report that it normalises what they are going through by knowing someone who is experiencing a similar situation. Lyndell Kennedy, Director of Aspergers Victoria has reported great successes for parents joining Support Groups run by Aspergers Victoria. 

Having a  child diagnosed with autism is a life changing event. And all life changing events can bring stress and anxiety. But, it can also bring hope for a new way of being. When you are ready, build up the courage and access that support that is out there for you. 

Best wishes, 
Christina 

References:

Almansour MA1, Alateeq MA, Alzahrani MK, Algeffari MA, Alhomaidan HT (2013) Depression and anxiety among parents and caregivers of autistic spectral disorder children. Neurosciences, Jan;18(1):58-63.

Hartley SL1, Barker ET, Seltzer MM, Floyd F, Greenberg J, Orsmond G, Bolt D (2010) The relative risk and timing of divorce in families of children with an autism spectrum disorder. Journal of Family Psychology Aug;24(4):449-57

Boosting your Brain Power

Boosting your Brain Power - the Hype and the Hope was a sold out public lecture held at the Melbourne Neuroscience Institute (28.05.13). ABC’s Hilary Harper skillfully chaired the evening and we heard from three leading experts: Professor Nicola Lautenschlager, Dr Bob Wood, Dr Damian Birney and Dr Jee Hyan Kim.

Context of the brain

Prof. Lautenschlager introduced the context of the brain. Studies show that by the age of 25 the majority of people have reached our cognitive peak. The knowledge, that brain function declines from in our twenties has peaked people’s interest.

Brain training industry

This could also explain why there is an exponential growth in the brain ‘training’ industry in the last five years (just google ‘brain training’ and you will see a plethora of companies). We have an aging population who want to preserve their well-being as much as possible. It is predicted that the younger generations will be retiring later in life, therefore being mentally (and physically) in  ‘good shape’ is essential for the potential demands of later life. Doing brain training exercises (for some people) is akin to going to the gym.

Prof. Wood reviewed the recent research into the brain training programs in the market. The main message was that these brain training activities are based on scientific research, but are over-stretching the claims made by the neuroscientists. He explained that although these programs are ‘evidence based’ they have not undergone the rigorous research protocols of academic research.

Criticism of brain training programs

One main criticism Prof. Wood put forward was that most brain training exercises do not account for motivation and attention, and lack thereof. In principle these brain training techniques might work, but people lack the motivation to engage in them for X amount of minutes every day.

Prof. Wood also postulated that the brain training exercises lack real life applicability. For example, how can doing Sudoku be generalised to everyday life? There may well be parallels but this needs to be studied further to understand the implications.

Active memory

Interestingly, Melbourne University, the Florey Institute and ABC have collaborated to create a brain training program that is a cut above the rest - Active Memory. As all good researchers know they are building on existing memory programs and learning from past mistakes. 

For example, they are using expert developers to create a program that is tantalizing and engaging to users. From professional experience one child (who had working memory difficulties) reported that he disliked his brain training program because ‘it doesn’t look any where near as good as my Xbox games! Why would I bother?!’ Using expert developers is important because the biggest criticism from children and adults who try to engage with existing brain training programs in the market are immediately turned off because it looks rudimentary in its design.

If you are interested in improving or sharpening your memory take a look at Active Memory. If you sign up you will secure exclusive and first time access to the program. It is currently in beta version and your participation will help improve and develop the program for the future.  

Parents' experiences of obtaining a diagnosis of autism: Training Amaze (Autism Victoria)

My experience meeting the team from Amaze 
Last week I had the pleasure of meeting and training the team at Amaze. Amaze (previously known at Autism Victoria) is a not-for-profit organisation dedicated to "improve the quality of life for people affected by Autism Spectrum Disorders (ASD), their family and carers." 

You would be forgiven thinking that Amaze had a staff of 100. Not only do they support

thousands of people in Victoria with autism, they run many fund raising events. This includes the successful World Autism Awareness Day in Melbourne which was attended by an estimated 4000 people in April 2013! This day also involved the Light It Up Blue International campaign. Fed Square, AAMI Park, Crown Casino, The Eureka Tower, The Arts Centre Tower and Hamer Hall were lit up blue blue to generate awareness about Autism Spectrum Disorder.

Are there 100 staff to accomplish all this great work? No, there are 26 people. So kudos to all the staff at Amaze who do a wonderful job supporting people with Autism in Victoria. 

A shared understanding

Amongst other topics covered within the morning training session, two issues in particular where addressed: 1. Parents' milestones obtaining an ASD diagnosis and 2. Solution Focused thinking. This blog post will focus on the former, and the latter will be a blog post written at a later date. 

Firstly, The team were encouraged to share their thoughts and feelings about their first experience with autism. This was an opportunity to engage in what parents are feeling when they telephone Amaze for advice and support. 

This activity evoked emotions ranging from: fear, worry, wonderment, anger, helplessness, laughter, anxiety relief to sadness. This mirrored the range of emotions parents experience when receiving a diagnosis of autism. 

Parents' experiences of the ASD diagnostic process: the milestones

At this juncture it was an opportunity to share my research on parents' experiences of the ASD diagnostic process in the UK. A mixed methods design was used comprising of collecting and analysing quantitative data on 800 children and qualitative data from interviewing parents who had experienced the diagnostic process. 

Below is an overview of the six milestones parents experience when obtaining a diagnosis. 

01. Pre-diagnosis phase

The initial milestone for parents is the pre-diagnosis phase. This is accompanied by parents not knowing what is 'wrong' and feelings of helpless and powerlessness. Parents also reported that co-morbidities (like language difficulties, sensory processing difficulties, developmental delays) clouded the issue and in some cases prolonged the diagnosis. This often caused frustrations for parents. 

02. Mixed emotions 

Parents described their mixed emotions once they received the diagnosis. On the one hand the diagnosis brought a sense of relief, but also feelings of fear and sadness. In some cases the experience of obtaining a diagnosis was traumatic for parents. 

03. Aspects of parenting

Parents spoke about the difficulty of parenting a child with autism. Many parents reflected that they needed to become a 'different' parent to their autistic child. Parents reported difficult emotions associated with parenting included guilt and anger. Some parents suffered from depression. Other parents found that family members freely gave advice and criticism of their parenting with little understanding of what is involved in bringing up a child with autism. 

04. Concerns for the future
It is true that many parents are worried about their child's future. However different types of concerns occupied a the mind of a parent with autism. Some parents worried if their child would be able to hold down a job, move out of home, have relationships. Interestingly, during periods of transition (a new year level, a different school, a new teacher, applying for exam dispensation) parents had to re-visit difficult emotions because they were reminded of their child's limitations. This suggests that there is a long term impact beyond the initial diagnosis. 

Summary
The general consensus amongst the staff at Amaze, is that they are dealing with much more than 'just' autism. Parents who have obtained a diagnosis of autism are feeling a range of difficult emotions. Some parents experience the diagnosis as a relief, others find it traumatic and upsetting. 

According to the statistics from the Australian Society for Autism Research the national average autism prevalence in school age children was 1 in 62.5 (date from June 2012). This highlights the importance of organisations like Amaze who provide support, knowledge and training for parents, schools and organisations. It also highlights the need for a better understanding of autism in schools, within families and society as a whole. 

To come....next blog post will be on Solution Focused Thinking: tools for tough conversations.  

National Psychology Week : Show full list of events

National Psychology Week : Show full list of events

Impact of moving a 3 year old overseas without Dad

Presenting problem

A 3 year old was referred to gain insight into the potential impact of moving overseas with the mother, leaving the father behind in the country of origin. It was made clear that my role as a psychologist was not to decide whether the 3 year old should go overseas, but rather to provide a psychological perspective so parents could make an informed decision about their family’s future. The child’s parents had separated amicably one year ago.

Research

A literature search was carried out to look at the impacts upon children moving overseas. It felt appropriate to look into the impact of divorce/separation as well as an overseas relocation because they both involve a loss, whether that includes the loss of how life used to be, or the loss of not being able to see a main caregiver regularly.

What does the research say about the impact of divorce?

Several common themes have emerged in the divorce literature:

• The immediate aftermath of parental divorce is often a period of emotional distress for both parents and children (Hetherington, 1993; Hetherington & Elmore, 2003). Sometimes emotional problems including anxiety, depression, anger, guilt, and resentment, may be temporarily evidenced (e.g., Amato, 2000; Hetherington & Elmore, 2003; Wallerstein, 1986, 1987, 1989).
• As the family adjusts to the post-divorce situation, parenting ability generally improves with time, thereby improving the overall family dynamic (Hetherington & Elmore, 2003; Richards & Schmiege, 1993).
• Children can sometimes develop behavioural problems following their parents’ divorce/separation, such as aggression, non-compliance, delinquency, low academic performance, and low self-control (e.g., Hetherington, 1993; Hetherington, Bridges, & Insabella, 1998; Hetherington & Elmore, 2003; Wallerstein 1986, 1987, 1989). Although this will depend upon the protective factors afforded to the child.

What are the protective factors?

The healthy adjustment of children, therefore, is contingent upon the existence of protective factors, including:

• Cooperative parenting (Hetherington & Elmore, 2003; Lowery, 1985; Sorenson & Goldman, 1990; Wallerstein, 1991; Warshak, 1992).
• Meaningful relationships with parental figures (e.g., Hetherington & Stanley-Hagan, 2000; Kelly & Lamb, 2003; Wallerstein, 1991a).
• Stable social supports within the home (e.g., Hetherington & Elmore, 2003; Jameson, Ehrenberg, & Hunter, 1997; Wallerstein, 1989, 1991).
• Positive community environments (Hetherington, 1989; Hetherington, 1993; Hetherington et al., 1993; O’Connor, Hetherington, & Reiss, 1998; Rutter, 1979).

Resilience

Resilience is a key factor in a child’s ability to adapt to the separation and divorce of their parents and research has placed attention on positive factors that will enhance children’s resiliency and decrease maladaptive and negative outcomes (Chen and George, 2005).

Children’s resilience can be developed and cultivated by the positive action of the adults, and by the reduction of risk factors (Pedro-Carroll, 2005). Factors that support children's adjustment include parental cooperation (Whiteside, 2000), parents' adjustment and mental health (Kelly, 2000), stable financial circumstances (Amato, 2000), and a supportive social and familial safety net (Buchanan, Maccoby, and Dornbusch, 1996).

Attachment theory

According to attachment theory, children need continued interaction with parental figures to form meaningful emotional relationships, which have considerable impact on a child’s long-term development.

What is a secure attachment?

Children who are positively attached are confident in the responsiveness of their parents’ care, and are able to explore their world knowing the parent is available when needed (DeHart, Sroufe, & Cooper, 2000). Such relationships are promoted through periods of interaction whereby feelings of closeness result in stronger emotional involvements between parent and child (Furstenberg & Nord, 1985). The formation of parent-child attachment, however, is considerably dependent upon the child’s age and stage of development.

After 2 years of age

• Children may engage in meaningful communication with parental figures and refer to internalized images when caregivers are absent (Kelly & Lamb, 2003).      
• Older children tolerate more extended separations with less stress than younger children, provided meaningful contact is regularly maintained (Maccoby et al., 1993).
• Short-term visitation with the father does not harm attachment relationships with the mother (Bray, 1991).

The research suggests that early emotional bonds have considerable impact on subsequent social adjustment, regardless of whether the child lives in a single or two-parent home.

Why are paternal relationships so important?

Fatherly involvement is strongly correlated with children’s psychological and behavioural adjustment in the short and long term (Pruett, Williams, Insabella, & Little, 2003; Rohner & Veneziano, 2001). Active involvement by fathers in their children’s lives fosters positive psychological development by helping protect against:

•  Social withdrawal
•  Aggression
•  Conduct problems
•  Anxiety
•  Depression (Rohner & Veneziano, 2001)

In addition to the buffering influence fathers may have on their young and adolescent children (Amato & Rivera, 1999), paternal involvement offers unique benefits to children that only a positive father-child relationship may provide. Such important fatherly contributions include:

•  Academic achievement
•  Higher self-esteem
•  Improved socialization (Amato & Gilbreth, 1999)

It is important to note, however, that only those fathers who actively engage meaningfully in their children’s live exert a positive developmental influence (Amato & Gilbreth, 1999).

Impact of Parental Absence

Research indicates that children who do not see their parents on a frequent or regular basis may feel intensely disconnected and rejected (Emery, 2004; Grief, 1997; Wallerstein, 1987), which increases these children’s risk for developing a variety of psychological and behavioural problems following divorce (Hetherington et al., 1998; Kelly & Lamb, 2000; Ross, Roberts, & Scott, 1998b; Whiteside & Becker, 2000).

How do children of different ages respond to parental absence?

• Infants may cry, fuss, or pull away once reunited with an absent parent, while toddlers may demand more personal attention by exhibiting clinging or regressive behaviour (Anasuri, 2001)
• Older children are more likely to feel guilty or anxious about their parent’s absence, perhaps angry that the parent has been away while at the same time afraid that the parent will never return (Anasuri, 2001)
• Teenagers may tend to pull away from the absent parent, preferring to spend time with friends, or may challenge that parent’s authority and limits (Anasuri, 2001)

However, it is the quality rather than the frequency of contact that is considered most important (Hetherington et al., 1998). A study conducted by Maccoby et al. (1993) confirms this assertion, indicating that while closeness with a parent depends upon face-to-face interaction (Hetherington & Stanley-Hagan, 2000; Warshak, 1992), “even a fairly small amount of contact [appears] sufficient to maintain close relationships” (p. 32).

How can the impact be reduced?

Parents need to plan for maintaining relationships with their children in light of potential relocation (Weissman, 1994), including how to engage meaningfully with their child through:

•     Telephone/Skype calls
•      E-mail
•      Hand-written letters
•      Pictures
•      Audio and video recordings
•      Send postcards from a smart phone using apps like: http://www.touchnote.com/

Absent parents may also stay in touch with their children by:

• Sending token presents that say, “I’m thinking of you”
• Completing crafts that are sent back and forth
• Engaging in a distance ritual at the same time, such as reading a book over the phone
• Anything that brings parent and child closer together on an emotional level.

How a child responds to parental separation also depends on the at-home parent’s response to the situation (Anasuri, 2001). If the residential parent is eager to assist both parent and child maintain active involvement with each other, relocation may be a more viable option. If, however, the custodial parent is hesitant to facilitate, it may be far more difficult to assume meaningful contact would continue following a change of geographic residence, and thus more difficult to recommend that moving is in the child’s best interests.

Families needs to think about:

• How important is this move to the parents?
• Are there pros as well as cons for the child?
• How can the child maintain a relationship with parent, family left at home?
• What is the child's personality like; in particular how do they cope with change?

Clinical summary

Relocating with children is stressful and invariably involves an adjustment. However, in cases where there are no extenuating circumstances, most children who relocate do well after an initial transition. In fact, more often than not, moving becomes an opportunity for growth rather than a burden once the original adjustment is made. 

For families where parents are separated or divorced, however, relocation can be traumatic for both child and parents. The loss involved in moving always is profound when it means losing not only extended family but also a parent. The two main questions that parents need to consider are 1) how can we minimising the disturbance to the child and 2) is this relocation in the child’s best interest? Ultimately the decision needs to be made by parents themselves but it is hoped that the above information can help to inform their decision making process.

References

Contact me for full reference list – it’s too long for a blog.

UK Psychologist working in Australia

UK Psychologist working in Australia - tips I wished someone shared with me

Before I moved to Australia some people were unsure if I could practice as a psychologist in Australia having trained in the UK. The good news is, yes you can. The not so good news is, it requires a lot of patience and money!

Below is the process required to practice as a psychologist in Australia and a few tips that I wish someone would have shared with me before I arrived.

Stage 1. Assessment of Psychology Qualifications:
The first form to complete is the Assessment of Psychology Qualifications which is carried out by the Australian Psychological Society (APS): http://www.psychology.org.au/Assets/Files/Assessment-of-Quals-Migration-form.pdf
This is an 8 page form which requires certified* copies of:

• certificates
• academic transcripts
• evidence of your thesis (title page, abstract and contents page)
• registration with HPC and membership with bodies such as the BPS

*Certified copies means someone signs that it is the true copy of an original. This can include people like a notary public or Justice of the Peace (this can be a rather expensive exercise if they charge per document and I needed at least 12 documents signed). Alternatively you can obtain a ‘statutory declaration’ from the Police Station. I’m not sure if the Police offer this service in the UK, but in Australia you can go to the Police station and ask for a ‘stat dec.’ and they do it for free.

Question j) of the form requires you to think back to your training years and provide information on the following:

What was the name of the practice/institution where the compulsory practical experience/supervised internship was undertaken?

What was your role?

Provide details of your supervisor(s) including name(s), profession(s) and academic credentials(s).

How many clients did you work with?

What were the start and end dates for your compulsory practical experience?

How many hours per week did you attend your compulsory practical experience?

What was the total number of hours you attended your compulsory practical experience?

How many hours of face-to-face supervision did you receive?

Tips:

• I had lost my academic transcripts but the UK universities were more than happy to post me a copy free of charge.
• The APS require copies of your undergraduate and masters/doctorate thesis, but just the title page, abstract and contents page. I did my undergraduate degree nearly a decade ago but luckily my parents still had a copy of it in the attic! You also need to remember the name of your supervisor.
• Once you have compiled all this information the APS inform you it will take up to 8 weeks. In my case it took 6 weeks.
• This will cost you $920 for the privilege.

Stage 2. Applying to become a member of the Australian Psychological Society (APS):
The next process is to become a member of the APS. This is a much shorter application form, and I suggest you apply soon after your qualifications have been recognised because they still have all your original documents.

• The 4 page membership document and can be found on the APS website: http://www.psychology.org.au/Assets/Files/2012_MemberApplication_FEB.pdf
• To become a member you are required to find two psychologists from the UK to nominate you. The pro form can be accessed via: http://www.psychology.org.au/Assets/Files/Pro-Forma-Reference.pdf

• Membership costs $505 and this include a variety of benefits such as: online CPD logging system (their website is pretty good), access to journals, online CPD, etc.

I have to say that my overall experience with the APS has been very positive, when you call the staff at the APS they have been very helpful.

Stage 3. Applying to the Australian Health Practitioner Regulation Agency (AHPRA):
Just when you thought it was over, you pretty much have to go through the first stage all over again. You are required to fill in the AGEN-76 form: (http://www.psychologyboard.gov.au/Standards-and-Guidelines/Forms.aspx)

• Start filling in this form while you are waiting for stage 1, so once you get the go ahead from the APS, you can immediately send this off however you cannot apply to AHPRA until you have completed stage 1.
• AHPRA have harsher rules than the APS. Transcripts have to come directly from Universities in the UK. They do not accept copies, and want to see a postmark from the UK. This can take up to 2 week to request the university to do this, and of course the time it takes to post a letter from the UK to Australia.
• You will also need to ask HPC to write a letter to confirm you are a psychologist of ‘good standing’. HPC were more than happy to do this for me and did not charge for the service.
• This whole process will set you back $827 and will take at least 8 weeks to complete once they receive your form. I called up a week after I had posted my form and they claimed they had not received it yet, so factor in another week and a half between you posting it and AHPRA ‘receiving it’.

Other Stages:
There are other stages to go through, but they are not compulsory (i.e. obtaining a Medicare Number - only if you work for a private practice, and the ‘APS Find a Psychologist Service’) but I’ll write a blog post about this another time.  

Summary:
I have found the whole process to be frustrating, tedious, and rather expensive. Patience is the key, and taking lots of deep breaths! I appreciate this process needs to be thorough to maintain the integrity of our profession, however I found the process of obtaining registration with APHRA identical to the initial process of applying to the APS. Why the duplication? It’s a shame they cannot join forces to streamline the process since they require the same information.

I have spoken to Australian colleagues who trained in Australia and they too found APHRA to be a long drawn out process - so it ain’t just cos I’m foreign!  

For me, the process from beginning to end has taken 16 weeks and cost me $2252 (£1445). However, I’m really excited to start my new job in Australia and obtain some international experience...plus living and working near the beach makes up for a lots of things ;)

I realise this post might become outdated over time so please do add comments or links below to any updates that occur.  This post was written in hopes that as more psychologists like myself travel around the world gaining more experience can help each other out.

Therapeutic Story Writing

Therapeutic Story Writing for children with emotional and behavioural difficulties


Presenting problem:
Children are often referred to me for emotional and/or behavioural difficulties. The cause of these difficulties can be wide ranging. It is common for children to find it hard to talk about their difficult emotions and feelings. Some children find an issue is too overwhelming or too painful to talk about. Other children cannot stop talking about an issue and will inappropriately discuss it with anyone. Often children have not reached the linguistic maturity to be able to verbally navigate and process complex issues.


Therapeutic Story Writing is one way of exploring unresolved or troubling issues in a non-confrontational manner. See below for information on Therapeutic Story Writing and two case studies where Therapeutic Story Writing resulted in some some very successful results.


What is Therapeutic Story Writing?
Therapeutic Story Writing was developed by Trisha Waters in 2002. It is an intervention which uses the medium of story writing to support children with emotional and behavioural difficulties.


Trisha Waters (2004) explains that Therapeutic Story Writing works through metaphor that unconsciously emerge within children's own story writing in order to address issues that may be too emotionally overwhelming for children to talk about directly. This approach, which encourages children to write from their core sense of self, can also increase children's motivation to write, and therefore supports the development of both emotional and academic literacy.  


Who is suitable for Therapeutic Story Writing suitable?

• Children attending the Therapeutic Story Writing group need to be able to write independently to some degree (at least a National Curriculum level 2c is recommended).
• Waters suggests that children need to be between the ages of 7 - 12.
• Therapeutic Story Writing is suitable for children with general emotional and/or behavioural difficulties. This can include: children who are having difficulty with a divorce/separation, children who have been abused, bullied, friendship issues, not coping with a bereavement/loss, or suffered trauma of some kind.
• If running a group it is important to be aware of how individual children may affect the group dynamic. The facilitator needs to feel the group will be manageable. Dr. Waters (2004) considers that often children with EBDs will fall into one of the following two categories: 1.) Withdrawn and need encouragement to join in group discussion; 2.) Acting out, attention seeking with difficulty listening to others.  The inclusion of children from both categories created a broader dynamic within the group.

Trisha Waters  suggests it is sometimes useful to include one or two children who do not have overt emotional anxieties and are not on the Special Educational Needs register in order to provide positive role models for other group members. This can also help to normalise the group and avoid any possible stigmatising in the minds of other children.


How long are the sessions?
Ideally each session will be in the same room and occur on the same time and day each week. Consistency itself can represent a therapeutic factor for children whose lives have been disrupted. Each session lasts for fifty minutes.


Case Studies:
Olivia - case study 1:  
Olivia was a 9 year old girl in Year 5. Over the summer holidays she was held hostage in her family home. When she returned to school staff described her as a ‘different girl.’ She was displaying signs of anxiety and becoming withdrawn. Olivia completed a 7-week Therapeutic Story Writing group session.


When Olivia first joined the Therapeutic Story Writing group her stories always involved a menacing figure, often in the form of a fairy tale monster-like creature. In the first couple of sessions Olivia found it difficult to conclude her stories. It was as if problem solving an ‘ending’ was too painful or overwhelming for her. I facilitated the other group members to imagine different endings of Olivia’s story. Half way through the sessions Olivia’s stories started to develop an ending, including a fish that could help her breath under water and talk to her about escape routes.


By the 7th week the menacing figures had completely disappeared from Olivia’s stories. Her last story was a touching tale about enjoying Christmas with her family. Pre and post measures on the Behaviour Profile showed a significant improvement in Olivia’s emotional development. Olivia’s mother and class teacher reported that Olivia was happier and ‘back to her old self’.


On reflection the use of Therapeutic Story Writing enabled Olivia to explore a traumatic experience that she was unable to speak to anyone about. Using the metaphors in her stories she was able to work through some very difficult emotions. The supportive presence of the group (although no one else knew of her hostage experience over the summer) also helped Olivia reconnect with her peers in a positive way.


Ben - case study 2
Ben was a twelve year old boy in Year 8 at a mainstream secondary school. Ben lived with his maternal grandparents after Social Services removed him from his mother’s care. Ben was subject to physical abuse and neglect. Ben’s biological father was in prison. Ben presented with emotional and behavioural difficulties at school and was at risk of permanent exclusion.


I encouraged Ben to engage in Therapeutic Story Writing. I was unsure how he would respond and I was also concerned he was too old for this intervention. Ben surprised me by how much he did engage and enjoy writing his stories. On the first one to one session he developed a character called Storm the dog. Every week Storm went on different adventures such as : ‘Storm and the playground bullies’,‘ Storm on the bus’ and ’The day that Storm forgot his homework.’ Ben would happily start writing the beginnings of  the stories (which often reflected everyday incidents in his own school life) but always asked earnestly, ‘but what should Storm do now?!’ He needed help to jointly discuss how Storm could problem solve a way out of these situations.


Ben explained that his character was called ‘Storm’ because he created mayhem wherever he went but he couldn’t help it. When he drew Storm, he had scars on his body. Ben was unable to tell me where Storm got his scars from but it is reasonable to hypothesise that these could represent the scars from Ben’s own physical abuse in his early years. I never made my hypothesis or interpretations explicit to Ben, it felt safer for him to explore his issues through the metaphor of Storm.


Ben avoided permanent exclusion and started to demonstrate more pro-social skills amongst his peers. Although I was worried that Ben was too old for Therapeutic Story Writing, his emotional development was delayed therefore he quite happily worked within the story metaphor. Therefore I suggest looking at the emotional age of a child, and not just the chronological age when deciding to use Therapeutic Story Writing as an intervention. I typed up the stories and along with his drawings we made up a booklet for school and home. When Ben became distressed at school he liked reading the book to himself or reading it through with his trusted Teaching Assistant.


Interested in training or further reading?

• Please visit http://www.therapeuticstorywriting.com/ for information on how to join a 3 day course in Therapeutic Story Writing. I can highly recommend it.
• Waters,T.(2004) The Use of Therapeutic Storywriting to Support pupils with emotional difficulties. Support for Learning·Volume 23·Number4·
• Waters,T.(2004) Therapeutic Storywriting: A Practical Guide to Developing Emotional Literacy in Schools.London:David Fulton.
• Waters,T.(2004) Writing Stories with Feeling:an evaluation of the impact of Therapeutic Storywriting Groups on pupils’ learning, SERSEN Report, Therapeutic Storywriting.com.