Case studies

Peter’s story*
(*name changed to protect the child’s identity)

On arrival, Peter presented as mature and highly capable, however, his intellectual and emotional development had been severely impacted and at school, he was assessed as functioning at foundation level (3–5-year-old ability). The disparity between his age, actual academic ability, and superior representation of himself meant that Peter found school extremely difficult, and his behaviour included absconding and physically assaulting others. Another aspect of Peter’s behaviour that was significant was his negative and aggressive treatment and perception of women which impacted the staff team across the community.

The behaviours displayed Peter’s previous experiences and his consequential negative sense of the world. He revealed that he felt very alone and had unbearable levels of anxiety which he had to enact. Peter feared becoming a victim again so instead tried to hurt and control others. Some of his traits included a lack of empathy and remorse at times, alongside charm and competency. These complex behaviours, anxiety, and emotional needs required high levels of intervention, expertise, and staffing to manage; this was to enable Peter to feel secure and to be able to challenge some of these defences.

The therapeutic care and education team created an individual and specialised routine for Peter, this was highly managed and staffed due to the level of threat and concern around his behaviour. Peter was given a prolonged period of close care and attention by a small group of well-known adults, with routines adapted to his individual needs at home and school. This was similar to primary care given to a small infant by its mother, however, this care had been exploited by adults around Peter and was missed by him.

Peter found this type of care and attention a struggle as it made him feel extremely exposed and too vulnerable – hence it was often fought against and demeaned. Adults were constantly trying to tentatively help him think about his antisocial behaviour and what it meant (his violence, stealing, deceitfulness, and manipulation of others). Gradually Peter was helped to make links with his past experiences and his internalised perceptions and beliefs about himself/others as unsafe, contaminated, and not to be trusted.

The close and consistent individual work and intervention from adults at home and school over the first year meant that Peter began to show a glimmer of hope that there may be a different way of being and that some adults/people in the world may be able to genuinely ‘care’ about (love) him. Through repeated experiences, reflections, and discussions, Peter made progress in learning that his fears and anxieties did not always come true, and he learnt to be a little more vulnerable and trusting.

Through the development of appropriate adult relationships, Peter began to feel secure, and he was able to start taking some risks, and the home and school saw him trying harder in his lessons and with his routines. Ground-breaking moments with Peter, in the first year, included him accepting care on offer without having to demean it and starting to show in small gestures and moments that he too cared for some people in the community.

Between years one and two Peter made historical disclosures about his abuse, which showed he had found somewhere to think and to potentially move on from his early experiences. He began to explore his past increasingly with adults in the community in more appropriate ways. With Peter processing his traumas and feeling more secure in himself through his relation- ships with people he trusted, his anxiety levels lessened somewhat (though did not disappear) and the community saw real achievements happening.
By the end of his second year, Peter had started to catch up with his education and was now working at Key Stage 2 level (7-11 years). He also started being able to spend time by himself – something that before this had felt too overwhelming, given his perceived threat of what could happen.

The ability for Peter to experience an interrelated and consistent approach at home and school was key to his treatment and recovery. This allowed for him to feel emotionally held and understood in both spheres, with information shared clearly and systematically on every transition to update staff teams of his emotional state and help him to feel seen and contained by all those looking after him in the community. This helped staff in both settings to plan appropriate routines and lessons for Peter, assessing what was required to support him, without allowing him to hide from his experiences or behaviour in either setting which had been a frequent occurrence in previous placements.

The school’s tripartite curriculum which links up the National Curriculum, the Therapeutic Input, and the Enhanced Curriculum, allowed for a more creative means of teaching Peter, which took into account his individual needs and made learning feel less threatening for him. This focus began on Emotional Literacy and used his preferred subjects (such as Art, Drama, and Sport) to help him engage with learning and being taught.

Family work, through supervised contacts and planned meetings, was undertaken to help support and repair relationships that had been badly damaged by his early abusive experiences. Provisions were made to assist not only Peter, but his siblings, mother, and adults around them, to build healthy, thinking relationships that could enable the family members to be together in less damaging ways and to work through complexities and traumas from the past. This means that Peter will have a better chance of having a ‘good enough’ network when he leaves care.

Peter began to work at an age-appropriate level of Key Stage 3 level (11–14-years) and he completed his entry-level 3, which allowed him to progress to Level 1 at college, working to an equivalent GCSE level. He attends college on a day release, which he travels to independently.

Peter is a member of various clubs and can make friends, though finds it hard to maintain friendships and trust them. He has also attended various courses which have required some overnight stays away from the community which he has been sup- ported to manage. Peter has completed training to help as an Instructor in the Physical Education lessons for the younger pupils at Amicus, indicating his growing ability to lead others in appropriate ways without coercion or aggression. These experiences, alongside the therapeutic input, help Peter to have a sense of self-worth and pride appropriate to his age and abilities.

Peter attends weekly psychotherapy, which would have been much harder to achieve without the earlier intensive therapeutic groundwork on his anxiety and stress levels. This gives him a private space to further explore and work through his emotional disturbance and the darker parts of his personality and the internal world that affect his daily life and the relationships in it. As Peter approaches adulthood, there is hope that by acknowledging these parts of his internal world he will not deny them, hide them away, or act them out, which would be more harmful to himself and others.

Peter joined our community aged 11 with a lot of anger and physically aggressive behaviour due to past abuse. His educational ability was 6 years below his yearly age and his behaviour was particularly challenging in the classroom. As part of his therapeutic input, Peter was given a high level of close care and attention by a small group of staff and although this primary type of care was uncomfortable for Peter, it did eventually make him feel more secure and able to trust and disclose past experiences and begin to accept help with this.

By the end of the second year at Amicus he had caught up with his education and was working at a similar level to his age group. He joined several clubs and completed training as an Instructor in sport, so he could support lessons with the younger pupils. With the intense therapeutic support of the community, Peter has been able to build healthier relationships with his family, go to a local college and attend weekly psychotherapy sessions.

Michelle’s story*
(*name changed to protect the child’s identity)

Michelle came to the community aged 10, following a failed fostering placement after the removal of both her and her siblings from the family home, due to experiencing abuse in the family.

Michelle had been attending mainstream school and was upset to leave it, to attend the special school in the community. She was relatively proficient and able in most lessons and in terms of learning Michelle was comparatively on target, working in Key Stage 2, level 3, in line with her age bracket (8-11 years). Her behaviour could be controlling, disruptive and frightening to others alongside her. Her social skills and emotional literacy were incredibly poor, and this was most noticeable in situations where she felt anxious or out of control.

Michelle was often involved in conflicts and was unable to develop or maintain friendships; she was reported to frequently be at the centre of bullying and intimidating behaviour, with occasional violence towards her peers and adults looking after her also. Her hypervigilance, unpredictability, and internal state of paranoia made being with her, teaching her, or helping her in general terms, very difficult as she was so guarded and volatile that reaching her emotionally was challenging.

Michelle’s damaging experiences at home had left her in a traumatised state, where her illusion of control was the only thing that held her together emotionally. She had sided with her father in the past, which had complex effects on her sense of self, on her sense of ‘other’ and left her unsure of if she fitted in as a child or adult. This led to the development of core defences, such as a false-self ideal to mask her extreme vulnerability, anxiety, and emotional fragility. The therapeutic work began with direct work around this defence, and it helped Michelle to think about and acknowledge her real feelings and to get in touch with her “true self” which had been hidden away and stunted under the layers of defence and anxiety.

Due to her being in a therapeutic, thinking, environment, her normal coping strategies were constantly being challenged and this led to a period of initial regression at home and school, where her learning and development stagnated, and seemingly regressed.

In the later part of her first year and into her second, Michelle’s level of work fell at school, with her now working at Level 2 rather than 3, and spending increasing amounts of time out of lessons, acting out and re-enacting the brutal and unpleasant the relationships she had had with others in her formative years.

Being faced with her feelings of rage, anxiety, and hate was incredibly overwhelming for Michelle, but it led to her experiencing the safety, containment, and care that had been missing earlier in her life. While her educational levels may have fallen, she had meaningful emotional growth and Michelle began to reform her ideas of self/other/world in a place where she felt safe for the first time.

Michelle joined Guides towards the middle of her first year at the community. This was an important group for Michelle, and she was keen to go each week. However, it was also filled with anxieties and complications for her, mainly around making and keeping friends and she was given a lot of support to help her join in and attend any trips that were planned.

Alongside Guides Michelle attended a dance group, where she found she could take more risks in these relationships and experiences. She required support and help to think about her interactions with others and to learn about appropriate behaviour and social skills, but these groups played an increasingly important part in her connection with the external world.

Towards the end of her second year at the community, she felt safer and able to engage in her education. This was because she did not feel the need to impose her anxieties and fears of “not knowing” on others around her. Michelle became more aware of her strengths and weaknesses and could be more accepting of support from well-known adults surrounding her in the community.

After two years therapeutic work at the community, Michelle began to attend weekly psychotherapy. At first, this was unbearable for her, but with support from the Head Teacher, who came into the sessions with her and playing with some of the toys, Michelle’s communication with her therapist developed. She was eventually able to attend the sessions by herself every week and could share and discuss thoughts without the strong feelings of persecution she once had. This was a huge development for Michelle emotionally and meant she had more trust in other people. This was achieved through many hours and weeks of long-term intervention through experiencing care and nurture even at times when she was attacking it, proving to her that others were not as abusive or useless as she feared they were.

At the start of her placement Michelle would only ever talk about her parents in positive terms, but after forming trusting relationships at the community and beginning to make sense of what healthy relationships are, she began to express honest and difficult feelings about these early relationships. This led to disclosures about past treatment, and she began to understand more about her experiences and have different ideas about relationships and wanting healthier ones.

When Michelle left the community, she was less emotionally fragile and had built some sturdier foundations within her internal world structure. There was more work for her to do around processing her past abuse and the impact that this had on her sense of self as she became a young adult. However, she had had an experience of forming meaningful relationships with adults who loved and cared for her and from this point, she could go more confidently into the world to continue her path.

Michelle started at The Amicus Community angry because she had to leave her school and with extreme controlling and disruptive behaviour. Initially, Michelle’s progress at school deteriorated, she struggled with friendships and receiving support due to being guarded and volatile. Her sense of self and sense of other had been affected so that she was not sure where she fitted in, as a child or an adult.

Towards the end of the first year, Michelle joined Guides and this external group proved to be a turning point for her, allowing her to explore friendships with her peer group and attend trips. The therapeutic work with Michelle focused on her core defences and after two years of intervention, care, and nurturing by the team at Amicus she accepted psychotherapy sessions. This turning point in her trust and ability to discuss her feelings meant that when Michelle left the community, she had a stronger sense of self and had experienced loving, healthier relationships.