CREATING A THERAPEUTIC HOME ENVIRONMENT
Date added: 26/08/23
In our book,
Barton, S., Gonzalez, R. and Tomlinson, P. (2012) Therapeutic Residential Care for Children and Young People: An Attachment and Trauma-informed Model for Practice, London and Philadelphia: Jessica Kingsley Publishers
Chapter 5 was on the Home Environment. In Therapeutic Care for children and young people who have suffered complex trauma this is the centre of therapeutic work and healing. The power of the environment as this chapter describes has been recognized for many decades and it is vital to any therapeutic service. Since we wrote this chapter authors and researchers such as Stephen Porges (2017) and Karen Tresiman (2021) have affirmed and added to our understanding on the potential of our environments to provide safety, healing, and healthy spaces or ones that may exacerbate trauma and ill health.
CHAPTER FIVE - THE HOME ENVIRONMENT
When we talk of ending homelessness for children, we don’t just mean putting a roof over their heads. We mean ensuring that children live in a place that is the kind of home we will describe in this chapter. A place that feels cared for; a comfortable, loving, and nurturing place to be. A place that the child feels part of, where they belong, and where their uniqueness as an individual is reflected in the environment around them.
Historically, people working in therapeutic homes or communities for traumatized children have understood the importance of the environment in the therapeutic process (Rose, 1990, Bettleheim, 1950). This is so fundamental that the understanding almost feels intuitive and instinctive. We expect it is related to the same way that a parent knows how important the environment is for a young infant. It should be clean, soothing, not too noisy, at the right temperature, etc. Unfortunately, the traumatized children we work with are often deprived of these basic needs. Therefore, providing the right type of environment can be the beginning of the recovery process.
A healthy home environment reflects a family’s values and mutual care for each other. Normally a home will be reasonably clean, and safe and reflect the interests of those living in it. It will also give some sense of the family’s history with mementos and photos of their time together. In this sense, the home can be seen as reflecting to everyone in it, the way they are valued and cared for. For example, when a baby is born a space may be created for the baby that feels warm and nurturing. As the baby develops into a young child, playthings will be provided, and hazards will be kept out of the way or made safe. The home environment evolves to meet the needs of everyone living in it. As Prilleltensky and Nelson (2000) stated,
Family wellness can be considered a state of affairs in which everybody’s needs in the family are met. This requires that people reach a balance between pursuing personal aspirations, such as careers and studies, and contributing to the well-being of other family members.
For this to happen, the parents need to be attuned to the needs of their children. As the children grow up, they also begin to value and care for their environment.
While parents do most of the giving during the children’s early years, children gradually develop the ability to reciprocate and contribute to family well-being in many ways (ibid).
Child abuse and trauma often happen within a wider context of neglect, where the environment the child lives in reflects the parent’s lack of attunement to their needs. The home is often uncared for, unstimulating, chaotic, and sometimes unsafe. Some children who are severely deprived have no concept of play and have never been provided with the kind of emotional interaction and stimulation necessary for play to develop. Additionally, because of the fear these children constantly live in, they become hyper-vigilant of everything around them, which also leaves little emotional space for any kind of relaxed, playful activity.
In the case of homeless children, they have no expectation of a ‘home’ that respects and values them as individuals. These children often believe that the ‘streets’ are safer than any home. Whilst we aim to care directly for the child, every aspect of the environment we provide for the child will give a message of how we feel about them. For some children, the mere fact that they can observe the environment we provide gives the first indication of whether we understand their needs. One child who was unable to trust the carers in her home and let them care for her in an intimate way told us it took over a year before she could trust someone. But from the beginning the way the home was cared for made her think that the adults really cared. The way adults looked after children’s bedrooms, made their beds, made sure their clothes were clean, helped them personalize their space, and looked after the home. A child might make a mess and see how much care is taken in cleaning it up or break something and see how it gets repaired. Children who have never had these things done for them in a reliable and caring way will need to experience being cared for in this way before they can begin to look after and care for their own space. This is a very important point in working with traumatized children.
Because of the mistrust these children rightfully have of all adults, due to how they have been neglected, deprived, let down, and often abused they will keep adults at a distance. Before a child might let an adult directly care for him in a way that feels personal and special, the child might begin to let the adult take care of an object of theirs, like a teddy or looking after a plant together.
Case Example - Craig One fourteen-year-old boy, Craig, we were looking after seemed to be completely unconcerned about turning his bedroom into an extremely chaotic and dirty environment. The extent of this was beyond the kind of mess we might ordinarily expect of a teenager. This was demanding for the adults working with him and sometimes they felt that he should be able to take better care of his room. Working with the adults and exploring his life history we could see that he had grown up in an extremely chaotic and unhygienic environment. It was clear that he had no opportunity to internalize a sense of an ordered and cared-for environment. It could also be hypothesized that he was re-creating the familiarity of the only kind of environment he knew. It was meaningless for us to try and persuade him how he should look after his room or to take a punitive stance about the issue. He needed us to take responsibility for his environment and look after it in much the same way a parent would for an infant. We needed to continually, tidy up and clean the mess he made. This kind of repetitive cleaning up is normally something that goes on for the first few years of childhood and parents do it without expecting anything different.
So, we adopted a similar approach and after a few months, it was clear that Craig began to enjoy the benefits of his cared-for environment. The repetitive cleaning and tidying of the adults also enabled him to feel that adults could be relied upon, and this basic level of care wasn’t stopped because of his difficult behavior or the mood of the adults. Once Craig began to feel these things, he also began to help take care of things. Before Craig left us, he had internalized a sense of being cared for and how this is reflected in the environment – not only did he value his own space, but this extended to the whole home. He would help with jobs around the house and took a particular interest in looking after the garden.
This approach to work in a therapeutic environment means that many of the everyday and what can often seem like mundane things are crucially important in the therapeutic process. House cleaning, laundry, and cooking are all central to this. As in infancy, these processes have huge symbolic as well as practical meaning. For instance, tidying up can feel like making order out of chaos, cleaning and taking care of a mess can feel like taking care of overwhelming feelings, and mending something can feel like repairing a feeling that is hurt or damaged. In these respects, it is particularly important that a child’s carer takes direct responsibility for as much of this as possible. It might take a while for a new worker to grasp the importance of this. It is not just that these things are done to a good standard, as it would be easy to create a clean and cared-for home if that’s all we wanted to do. It’s that these things are done in a personal way with each child in mind. The carers who get to know how each child likes things, make little adaptations to ordinary things that reflect their attunement to each child. For example, one child might like all their clean clothes put away and another might like a few left out ready for the next day.
We like to use the acronym (P.L.A.C.E) to describe the type of home environment we try to create. This means the home is a playful, loving, accepting, curious, and empathetic, therapeutic environment. Where children and carers can develop positive supportive relationships (Becker-Weidman and Shell, 2005). It is a place where children can take comfort and respite from their daily challenges; a place where they can feel that their individual needs are recognized.
The home is a secure base that enables children to grow, to try new things, and to address their problems. All the while knowing that whatever challenges life may bring, they can always seek refuge in their home. For example, after a difficult day at school, the child knows he will be able to go home, be welcomed and accepted for who he is, relax, and be taken care of. The home is a constant factor in the children’s lives, providing them with a sense of permanence and stability. It forms part of a child’s identity - a place where they feel connected to and belong. The sense of belonging is demonstrated in the way the home reflects their needs and interests as a person. It is a place where children feel welcome and are regularly reminded that their presence alone makes the home special.
The environment is warm, friendly, nurturing, calming, and aesthetically pleasing. It contains facilities that can support and enrich a child’s life. The home is a place for growth, and development, and a means of balancing the need for being sociable with privacy. It is a place where positive memories can be made, and life-long relationships are established. Most importantly, the home is a safe place and sanctuary.
A central component of the Therapeutic Family Model of Care is that we don’t have any locks on bedroom doors. The intentions of this are to emulate a ‘normal’ family home, to create opportunities for children to build trust, and to demonstrate to the children that they can be trusted. This is an important symbolic demonstration of trust. Many of the children have previously lived in institutional settings with internal security systems. This reinforces a belief that those living in the home cannot be trusted. The absence of locks on bedroom doors and the message that the home is a safe place, slowly de-conditions children out of their hyper-vigilance. Allowing them to relax and engage with fellow children in a trusting way.
Children are encouraged to take responsibility for their home and on occasions when there are breaches of trust, there are processes such as ‘family’ meetings where discussions about trust take place. The children are encouraged to decide what their home should be like. Over time, the home becomes a sanctuary and children develop a sense of trust for each other. If children can develop a sense that the home is safe and that they can trust others because of the behaviors that others have demonstrated, they are also more capable of discerning trustworthy relationships in the outside world. We do not encourage children to lock themselves away from the world or lock the world out. The locked doors in institutions can feel quite symbolic of this. The locks on doors are a short-term solution to the internal fear experienced by the child, which affects their interaction with the outside world. We work to assist the child with internalizing a sense of safety instead through their experience of a trusting environment that validates their worth.
Home Aesthetics: The aesthetics of the environment children live in is extremely important for their psychological wellbeing. The children at one time or another can present with any number of psychological states that can be exacerbated by the look and feel of the environment they live in. A therapeutic home environment is created to promote a sense of order, safety, and belonging, as well as a sense of pride. To facilitate a child’s therapeutic development and an attachment to their home as a secure base, the following aesthetic aspects can be very helpful,
- Bright, spacious, and comfortable
- Personalized
- Be positive and respectful (pictures, artifacts, etc., positive and uplifting in nature)
- Good quality furnishings
- A hygienic level of cleanliness
- Mend things immediately
Bright, Spacious, and Comfortable: Ideally the home will be bright, light, and well-ventilated. Carefully chosen decoration, such as pastel colours can help create a sense of space and light. Homes must be bright, as evidence suggests that low-lit and dark environments can exacerbate depressive symptoms. It is important to create a balance between the presence of belongings, decorative items, and furniture and the absence of unnecessary ‘clutter’. Too much ‘clutter’ around the home can be a reminder of a chaotic environment and potentially exacerbate a child’s sense of wellbeing and self-worth. The home should feel comfortable and cozy with furnishings that reflect this.
Personalized Environment: It is important to encourage children and carers to personalize their homes with personal decorative items, photos, and furnishings. Having personal pictures, photos, trophies, and the like can greatly facilitate a child’s attachment and sense of belonging to their home. In emulating a family home, we encourage the abundant display of ‘family photos’ that capture current children and carers. We encourage that family photos be continually updated when new children enter the home. Additionally, we encourage the display of photos of past carers and children, communicating a sense of history and permanent belonging to the home. Photos of past children in particular can ensure that children who have moved on can still feel they belong when returning for visits or respite stays.
Positive and Respectful: When choosing decorative items, toys, games, and books it is important to ensure that all items are positive, respectful, and not offensive to other members of the home. For example, the items,
- Don’t have sexual, alcohol, or drug-related connotations.
- Don’t promote, endorse, or depict violence.
- Are not sexist or discriminating.
- Don’t desecrate specific religious or cultural values.
Encouraging Play and Curiosity:
Play is central to child development and as the anthropologist George Dorsey said, play is the beginning of knowledge.
Especially given the deprivation many traumatized children have experienced, the home should be an enriching environment, with a good selection of books, toys, games, sports equipment, computers, and music, with a focus on learning and fun. Most importantly the children need carers who understand the importance of play and who can encourage playfulness in their interactions with them. As Clifford-Poston (2001) claimed, for children to develop they need a secure base and permission to be curious. Traumatized children are often too fearful to express any curiosity and one of our tasks is to help stimulate their curiosity in appropriate ways.
Therefore, we need to create an environment with interesting things around and where a child can explore and play. We need to allow them to experiment and not inhibit this by being too anxious about a little disorder or muddle. To facilitate curiosity and play, it is also important for the carers to be playful and get alongside children who may have had very little experience of playing with another. During infancy, a child needs someone to be with him while he tries things out, to make it safe, and to help him with the anxieties involved. Through her playful involvement with the infant, the adult reflects the infant’s play back to him. This helps to hold the situation, enabling the infant to sustain, enjoy, and make sense of his experience. Gradually through internalizing this experience, the infant is then able to play alone in the presence of another.
Whilst the home should be a stimulating environment, children who have been traumatized through abuse have often been extremely over-stimulated. Rather than being introduced to the world ‘in small doses’, as Winnicott (1964) advised as being necessary for healthy development, they have often been exposed to things in everyday life long before they were emotionally ready to cope with such experiences. Winnicott described this as an intolerable impingement on the child’s ongoing sense of self. As a result, the child’s stress responses are over-stimulated leading the child to be in a constant state of hyper-arousal. These children need an environment that helps to calm and soothe them.
During infancy, a mother will protect the infant from impingement (excessive stimuli), so that the infant experiences a sense of continuing self without intolerable disruption. Infants need protection from excesses of emotional and physical stimulation. Infants that do not have adequate protection will develop reactions to impingement (Tomlinson, 2004, p.158).
Therefore, it is important to pay careful attention to simple things like noise levels, the types of TV programs watched, computer games played, and magazines around the home, and that the home provides a general sense of calm and stability.
Good Quality Furnishings: An environment with good quality furnishings can have an immediate impact on how people feel about being in that environment. As Pughe and Philpot (2007, p.41) have argued, “The physical surrounding needs to be conducive to children’s recovery”. Similarly, Mawson (2008, p.70) talking of his experience as a social entrepreneur involved in the regeneration of a rundown London community, stated,
The environments we live, work, and play in profoundly affect how we are as human beings and how we relate to each other… When we are careful about the way we create a physical environment, when we pay attention to every detail of it, people begin to think of themselves and each other differently.
Conversely, an environment that looks worn out, shabby, and uncared for may imply to people that ‘they’ are broken down or worn out or not worthy of a good quality environment. Homes fitted with good quality furnishings send a message to children that ‘I am worthy’. Additionally, the likelihood that these furnishings will be better cared for and respected by children will increase. As Mawson recognized, this is a fundamental quality of human nature. In the community where he worked, local people helped to turn some wasteland into a park, for the whole community to use and enjoy. Unlike the previous history of vandalism, this area remained remarkably free of such damage. A key component of the Therapeutic Family Model of Care is to show children the importance of nurturing and respecting everything connected to them.
However, it is not the ‘magical’ creation of a positive environment that is most important, but how the individuals, family, and community are also involved in creating the environment. How choices are made and how everyone is involved in that. Adults in a parental role have to take responsibility for key things, but this can be done wherever possible by involving children in the process. For example, how children’s interests, likes, and preferences are taken into consideration. Perry and Szalavitz (2006, p.70) explained the importance of this for children’s development,
To develop a self, one must exercise choice and learn from the consequences of those choices; if the only thing you are taught is to comply, you have little way of knowing what you like and want.
When one of us worked at the Cotswold Community (a therapeutic community for emotionally disturbed boys) in the 1980’s the concept of the ‘X Factor’ emerged (Miller, 1986). We lived in what was like a small village with a working farm as our immediate environment. In the days before many of our present health and safety regulations, there were many farm, building, and maintenance projects for everyone to get involved in. We noticed the difference it made to the therapeutic climate of a home when people were involved in working together on a shared project or X Factor, compared to times when nothing much was going on. An X Factor creates the opportunity for two or more people to work on a shared external factor. This then helps to reduce the intensity and head-on nature of relationships and can be especially helpful in an environment where relationships tend to become highly emotionally charged. There is something deeply satisfying in transforming an environment, which can be seen in the popularity of makeover TV programmes.
Especially for traumatized children, creating something positive, mending, and rejuvenating things can have very significant symbolic meaning. As with trauma, something that has been damaged can be repaired. This kind of work is an important component of a child’s treatment. A therapeutic environment and everything that happens within it can be healing. The importance of this needs to be looked at alongside work that has more to do with verbal communication and talking about a child’s problems. Perry and Szalavitz (2006, p.231) supported this point of view,
But while emerging therapeutic models like the neurosequential approach hold great promise, my experience, as well as the research suggests that the most important healing experiences in the lives of traumatized children do not occur in therapy itself.
They do occur, he goes on to explain, in exactly the situations we have described in this chapter.
Privacy and Security: A starting point for any therapeutic service for traumatized children is that it must provide safety for the children. Only when the children feel safe can they begin to relax, calm their overloaded stress response systems, and begin to engage. So, first and foremost, children in out-of-home care need to be protected from further abuse and exploitation. This standard can be measured by,
- The ways that out-of-home care services implement effective safeguarding children policies and procedure
- The number and scope of abuse in care al
- How allegations of abuse in care are identified, investigated, and responded to (Tucci et al., 2010).
However, the general emotional climate of the home is also a good indicator of how safe the children feel. Often traumatized children, pick up the slightest warning sign that there is a potential danger. Rather than talk about this, they display their anxiety through their behavior. Our attunement to this can help us be aware of anything potentially harmful that may be developing. For instance, one child may be covertly bullying or trying to inappropriately involve another child in sexual activity. As many of the children are so familiar with abuse and exploitation that they think it’s normal, we have to continually role model healthy ways of relating to each other. By always treating each other with dignity, respect, and appropriate confidentiality. We need to continually demonstrate our expectation that everyone in the home should consider and respect the safety and security of all children and staff and not involve themselves in behavior likely to endanger others.
Bedrooms as Private Spaces and Sanctuary: Bedrooms are an individual’s personal space. They are a place where children and carers can seek time out from the ebb and flow of normal busy family life. We acknowledge that carer’s and children’s privacy is of the utmost importance in ensuring that all individuals feel comfortable and safe in the home. Particular respect and attention should be paid to entering a child’s bedroom. This can be especially important to children who have been abused, with the abuse often taking place in their bedroom. Child abuse inevitably involves the inappropriate breaking of personal boundaries. Creating clear boundaries in this area can help establish for the child, the sense that they have a personal boundary. This should be supported and respected by adults, rather than crossed.
Affirming Environment: We acknowledge that an individual’s bedroom is their personal space. Children have the freedom to decorate their room to their tastes, within a reasonable range of options and a personally selected standard of order and cleanliness. However, in creating and role modelling an appropriate and hygienic environment for children, it is important to support the child in maintaining this in their own environment. The bedroom can be a reflection of one’s own internal and external world. Children need to be in an environment that is affirming and that promotes a positive sense of self and worldview, a sense of safety and love. We encourage the children to have photos of loved ones, images of positive role models, and any other articles that promote this.
It is especially important that the room looks very well cared for when the child arrives, to give the message that this is what they deserve. Once the child arrives, we should quickly help him settle in. We make sure we help him unpack and personalize his bedroom. We give the clear message that this is a permanent home, rather than somewhere he is going to live temporarily out of a bag.
References Becker-Weidman, A. and Shell, D. (2005) Creating Capacity for Attachment, Oklahoma City: Wood and Barnes
Bettelheim, B. (1950) Love is not Enough: The Treatment of Emotionally Disturbed Children, Glencoe IL: Free Press (reprint)
Clifford-Poston, A. (2001) The Secrets of Successful Parenting: Understand What Your Child’s Behaviour is Really Telling You, Oxford: How To Books
Mawson, A. (2008) The Social Entrepreneur: Making Communities Work, London: Atlantic Books
Miller, E. (1986) The X Factor: The Cotswold Community: A Working Note, London: The Tavistock Institute
https://www.johnwhitwell.co.uk/material-from-the-work-of-the-cotswold-community/the-x-factor/
Perry, B.D. and Szalavitz, M. (2006) The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook, New York, NY: Basic Books
Porges, S.W. (2017) The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe, New York and London: W.W. Norton and Company
Prilleltensky, I. and Nelson, G. (2000) Promoting Child and Family Wellness: Priorities for Psychological and Social Interventions, in, Journal of Community and Applied Social Psychology, 10(2), pp.85-105
Pughe, B. and Philpot, T. (2007) Living Alongside a Child’s Recovery: Therapeutic Parenting with Traumatized Children, London and Philadelphia: Jessica Kingsley Publishers
Rose, M. (1990) Healing Hurt Minds: The Peper Harow Experience, London and New York: Tavistock/Routledge:
Tomlinson, P. (2004) Therapeutic Approaches in Work with Traumatized Children and Young People: Theory and Practice, London and Philadelphia: Jessica Kingsley Publishers
Treisman, K. (2021) A Treasure Box for Creating Trauma-Informed Organizations: Volumes 1 & 2, London: Jessica Kingsley Publishers
Tucci, J., Mitchell, J. and Goddard, C. (2010) Response to National Standards for Out of Home Care, Melbourne: Australian Childhood Foundation
Winnicott, D.W. (1964) The Child, The Family and The Outside World, London: Penguin Books
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