ISSUE 141 NOVEMBER 2010 BACK

Therapeutic insights


Constrained, Contained or Falling to Pieces?

Laura Steckley

 I’ve been thinking, reading, writing and talking about containment for a good while now, but I haven’t written about it in my column. I’m not sure why that is, but because I think it’s such an important concept, and because I’m always having to cut bits out of my other writing on containment (in order to meet the requirements of word counts), I thought I'd write a series of columns on containment theory here. I hope it is useful.

Containment is a term you are likely to hear in residential child care in Scotland, from time to time anyway. Unfortunately, it’s often used pejoratively to describe a simple warehousing of kids or keeping a lid on things, without actually doing anything that helps to bring about more meaningful change. I can vividly remember a colleague sitting on the bed in the staff office/sleeping overnight room declaring, with a good bit of frustration, “All we really do in here is containment!”  If only”

Theoretical containment, on the other hand, was first developed by Bion (1962) and is about processes that help people and bring about profound change. Notions of therapeutic containment offer a way to understand our work that resonates with our tacit knowledge and also deepens it, enabling us to better meet the needs of some of our most troubled kids. According to Bion, the process of the mother hearing her infant’s distressed cries and responding with nourishment, a nappy change, holding, rocking or whatever is needed “but most importantly, a response that is soothing and provides comfort “is fundamental to development. Essentially, he claimed that the mother absorbed the anxiety, distress and other uncomfortable feelings, and gave them back to the infant in a more manageable form. Interestingly, neuroscience has confirmed what Bion and others knew all along, as it can chart this process using brain scanning technology.

Now if you’re familiar with attachment theory, you are likely to recognise these early processes as fundamental to the development of trust and the ability to form and maintain relationships. And Bion is essentially talking about the exact same processes (the Arousal/Relaxation Cycle highlighted by attachment theory beautifully captures these processes in an accessible, meaningful way). However, while he is talking about the same thing, his emphasis is on different dimensions of what is happening.

Looking at these early processes from a containment perspective, the infant goes from a state of unbearable pain, discomfort, fear or confusion to a state of comfort and of everything being manageable again. The parent “takes away” the unbearable, or uncontainable, and replaces it with more manageable feelings and experience. Through this process, which starts at birth and happens again and again, over days and weeks, months and years, the infant develops the ability to think in order to make sense of and manage raw experience and emotion.

It is important to remember here that when we are first in this world, we have no way of distinguishing ourselves from the world around us and no way of understanding our own emotions and experiences. The ability to think about these things, and for this to help us make our way in life, comes about as a result of those early processes of containment. This is so fundamental and necessary to human development, yet we easily take it for granted.

Many of the children (and families) we work with have faced difficult circumstances and experienced significant disruptions to these early processes of containment. As a result, their development of thinking, particularly the thinking that enables them to manage and make sense of things, may have been limited. For some, the impact can be profound. You can probably identify kids you–ve worked with who cannot recognise their own emotions, let alone identify themselves as having them rather than being them. While the term “contained” elicits the above mentioned misinterpretation that would be better called “constrained”, the notion of a completely uncontained child is easier to grasp. These are the kids that, when they’re struggling, seem about to come screaming out of their own skin. We may refer to them as “coming apart at the seams” or “falling to pieces” and our instinct may be to want to help hold them together “literally or metaphorically (interestingly, Winnicott’s notions of “holding” are extremely similar to Bion's of containment).

For kids who–ve not had good enough experiences of containment, when negative feelings get triggered, they can be more intense due to the pain of “unsoothed”, unresolved feelings that also get triggered “similar to the pain of prodding an infected wound that hasn’t healed properly. In addition, they will have an underdeveloped ability to manage these more intense feelings.

And while original processes of containment occur between caregiver and infant, residential child care has been identified as a space where therapeutic containment can be provided that is reparative and enhances development. Basic therapeutic containment resonates with teaching kids to “talk it out rather than acting it out”. Providing a safe environment where kids can begin make sense of painful emotions and experiences may also resonate with the way you think about your practice.

Containment work, however, is complex and demanding. It is not a free for all, where any and all behaviour is accepted because of the pain that underlies it. It also is not about creating a constricting environment in order to keep behaviour under control. Sometimes to provide containment means to poultice out rather than to dampen down. How different from the “lid on things” way this word is normally used “and how different from always thinking a good shift is a settled shift.

It is also important to highlight that therapeutic containment is an ongoing process, rather than an aim that is achieved. The processes of containment happen primarily within the context of relationships. While some individual relationships may have the power to hold in such a way that fosters the kinds of development related to containment, it is the network of relationships that provide the overall containing function.

Even the way we hold kids in mind when we’re not in their presence is therapeutically relevant. Bringing in a clipping from the paper about something that is of interest, telling a kid we wondered how they got on with something they were challenged by or letting a kid know we thought of them when we heard their favourite song on the radio are all ways that we naturally convey this holding in mind.

Therapeutic containment is also provided through the physical environment, rituals, routines, clear expectations, predictable structures and use of activities. For these components to actually be containing, consideration must be given to how they contribute to a safe environment “one that isn’t too tight, and isn’t too loose; one where the structure is established and evolved to nurture and to hold boundaries; one where practitioners are emotionally available and resilient, where they can convey the sense, “We can deal with what you throw at as and give it back to you in a form you–ll be more able to handle.”

As I’ve already mentioned, this is complex and demanding work. For staff to be able to create therapeutically containing environments, for them to deal with what’s thrown at them and give it back in a more manageable form, they also need containment. This will be the subject of my column next month.


References

Bion, W. R. (1962) Learning from Experience, London, Karnac.

 

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