Containment as a helping tool

Sharon Bacher

In discussing ways of treating or helping troubled children, the concept of 'containment' is frequently mentioned. We say a child needs to 'be contained'; needs to 'feel contained'. But what is this need, and what can we do to engender in the child the feeling that he is thus contained?

Children who require such help are children who seem somewhat out of control. It is as though their feelings, thoughts, and impulses spill over in ways that create anxiety and tension for themselves and in those around them. Often their behaviour is chaotic. Either the child has not developed a healthy inner control system, or else some severe stress has rendered him temporarily out of balance and unable to cope. Thus containment as a therapeutic tool means that we, as adults, need to create structure through which we temporarily relieve the child of his anxieties and prevent him from harming himself or others.

The word “temporarily" is worth additional comment. We never grow out of the need for some structure in our lives, but the structure implied by containment in this article is something which we “lend" to youngsters, as we help them to internalise it for themselves as they grow their own strengths. There is a tendency for institutions to impose a form of permanent containment as a matter of course, perhaps as a means of control. When this happens, containment can become a strait jacket and ceases to be a therapeutic technique.

Some examples of children needing containment:

Carrie, aged 10 is in crisis after being separated from her mother. She cries a lot. She runs from adult to adult looking for attention and help, but she is thus unable to develop a relationship with one person. As her distress compounds in this way, so she becomes increasingly clingy, whiney, and silly.
Tina, aged 14, is impulsive and rebellious. She acts without thinking, and in so doing she is destructive to herself and to others. The care workers see her as 'asking for punishment'.
Desmond, aged 9 is a mess. He is forgetful. His clothes and possessions are left about. He misses appointments and is never punctual. He seems to be 'all over the show'.

Each of these children is asking for containment. Yet each requires somewhat different handling. The team has a number of resources to provide for this need:

Space manipulation
One child may feel better contained in a room of his own than when sharing. The insecurities and unpredictabilities of the other children may worsen his own fantasies and fears. A child who is tantrumming or displaying irritating attention seeking behaviour, may be calmed by a short period of 'time out' in a quiet, non-punitive place. An anxious young child may feel more contained in a small cosy room within easy reach of his careworker, than in a large hard-to-manage room.

Routine management
Having a structured and predictable routine can be containing and reassuring for an insecure or chaotic child. Routine becomes therapeutic when it organises a child's day, creates dependable behaviour sequences, and helps bridge the time between different kinds of activities. Time structures divide the day into manageable portions. Rituals, when used sensibly, provide a means for quelling children's anxieties.

Teamwork
Co-operation between careworkers provides a supportive framework in which a child can feel secure and contained. It is reassuring to him to know his careworkers agree on the important details of his management. While the ability to play one carewoker off against the other may give the child a temporary sense of his own power and control, it robs him of the secure knowledge that his careworkers are dependable and that they have a rational approach to his care. In addition, playing careworkers off against each other and causing ill feeling between them can leave a child feeling guilty about his own destructiveness. This can feed into his already irrational sense of omnipotence and badness.

A 'key' worker system
A child cannot feel safe and oriented when he has to relate to a whole lot of adults to get his needs met. He needs to be connected to a small number of people who are there to take care of his needs. In addition the child needs to know the authority hierarchy of the home. He needs to know he cannot be exploited and that he has redress for his complaints. Thus he needs to know his accessibility to his 'caseworker' and to the 'director' of the home.

Rules and limits
A clear definition of rules and limits enables a child to know where he stands in the community. Vague, unpredictable or arbitrary limits constitute a dangerous environment: there is no way for the child to be 'safe' and to get on with those in authority over him. The more logical and just the consequences are for his misbehaviours, the more containing they will be for the child. Arbitrary punishments increase anxiety and anger in the child and prevent him from acquiring a sense of personal responsibility.

Physical containment
A child who is upset, or even a child who is tantrumming, may be calmed by physically holding him. Thus it may be reassuring to a crying child when the adult sits quietly with his arm around the child's shoulders. A frightened child may be comforted by being held tightly. A tantrumming child may be reassured that he is not falling apart by being held in a firm, non-punitive but no-nonsense way.

Verbal and behavioural containment
One may calm and 'hold' a child whose feelings and behaviour seem out of control by saying things like: “it's okay, you're alright. This will soon be over.. ." “We'll handle this. These things happen." “You're very angry with me at the moment. Okay, so I also get cross ..." Active listening to a child's feelings with empathy and caring is a most powerful containing response. Who has not felt better and renewed in spirit and hope after the experience of being deeply heard and understood! So powerful and rare is this experience that when it does happen, it may become a turning point in a child's attitude to life, and an experience he remembers for years.

One of the most significant resources we have for containing children is the conscious and therapeutic use of ourselves. When we respond to the child with empathy and maturity we lend him our strength, our faith in him, our greater experience “and the wider perspective that, after all, his world is only temporarily out of balance. When a child perceives that we, his adults, are not overwhelmed as he is by his feelings, his behaviours “or his 'badness' “he is reassured. He cannot but read in our behaviour the inner message that: 'if ever I do feel like I'm falling apart, these adults can hold me together and will prevent me from doing harm to myself, to them, or to the others around me'.