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Development supportive dialogue with children

        Inge Nordhaug & Dag Nordanger




                         Dag Ø. Nordanger
                RVTS West, Bergen, Norway
                  Norwegian TENTS partner
                      www.tentsproject.eu
Focus for these days
Children in particularly difficult circumstances:
  Exposed to violence
  Witnessing violence
  Sexual abuse
  Drug abuse in families
  Orphaned

                     www.rvts.no
What is developed in these children?
Not the ”Learning brain” …
  Exploration, curiousness, interest
  Balance between the the safe/known and the new
  The ”attaching brain”

…But the Survival brain”
  Defensiveness, supsiciousness, identification of danger
  Mobilisation of resources for protecting onselfskyttelse
  The ”detaching brain”

                       www.rvts.no
The ”alarm centre” of the brain
                                              is kept a state of constant alert
                                              Releases stress hormones
                                              which stimulate instinctive
                                              reactions and inhibits more
                                              higher cognitive processing



Underdeveloped connections                              Inhibited:
between limbic system and
                                              Affect regulation and ability
prefrontal cortex (which runs
reasoning, self reflection,                      to learn and integrate
contextualising – cognitive                          new information
control)

                                www.rvts.no
Different kinds of conversations

  To explore
  To understand
  To disclose
  To help


            www.tentsproject.eu
Disclosure versus therapy

Therapy has much to learn from the
directness and exposure in disclosure
conversations
Therapy can be ”anti-therapeutic” if
central stressors in children’s lives are
not disclosed

              www.tentsproject.eu
Some communication theory
All behaviour is communication
One cannot ”Not communicate”
Communication concepts:
– Synchronised communication
– Counter communication
– Uneven power relation between adult and child
– Message sent – Message received


                www.tentsproject.eu
Centrals aspects in dialogue with children
  Congruence
  Position
  Eye contact
  Voice tone
  Body posture and movements
  Mimics and facial expressions
  Emphasising sounds

              www.tentsproject.eu
Frame factors
The adults’ preparation
  Information about the child

Physical arrangements
 Furniture
 Tools
 Presence

              www.tentsproject.eu
Facilitating/inhibiting communication
Facilitating:                              Inhibiting:
Open questions                             Closed questions
  Imperative form                             Yes/no questions
  Descriptive form                            Causal form
                                              Wide, general form
Non leading                                Leading
  Key questions, and                         Leading questions to
  references to what has                     expected answers
  the child has told                         Choice questions
  before
                                             Projections

                     www.tentsproject.eu
What facilitates and what inhibits?
Active listening                          Passive listening
   Repetition                               Ignore
   Confirmation                             Doubt or deny
   Sum up                                   Switch of topic
                                            Pressure/negotiation
Clarification
   Exploring questions                    Blurring, making it wage
   Personal form                             Interviewing
   Child language                            ”You” form
   Metacommunication/mirroring               Adult language
   Pauses                                    More questions

                    www.tentsproject.eu
Disclosure conversations




       www.tentsproject.eu
General principles of disclosure conversations
  Show interest, receptivity and neutrality
  Invite to dialogue based on the child’s own
  signals
  Be present, close, and have time
  Do not push, but make a ”room” for children to
  talk
  Remember; It is the child who discloses, not the
  adult

                 www.tentsproject.eu
Methodical approach
The conversation focuses on the child’s reality
The conversation is in the form of dialogue
The purpose is to get qualitative and descriptive
information through free speech
The conversation is a interpersonal interaction
The conversation is focused
The conversation is non-leading


                 www.tentsproject.eu
The phase structure

Establishing contact
Opening procedures
Introduction of the topic
Free speech
In depth exploration
Closure

               www.tentsproject.eu
When do we need disclosure conversations?

 When children in different ways signal that
 they are not ok
 When these signals make us worry
 When we want children to tell about concrete
 events they have experienced


               www.tentsproject.eu
Worries can be based signals from:

Something the child has said
Something the child has shown:
– Aggressive behaviour
– Withdrawal
– Sexualised behaviour


            www.tentsproject.eu
Sexualised behaviour
Stop it, and ask:
- Where did you learn that?
- Have you seen someone else do that?
- Have someone done such a thing to you?
- Who?
...when it happened, how was it like to be you?


               www.tentsproject.eu
Why do we not talk to kids about difficult
           experiences?
  Our view of children’s credibility
  Ethical reasons
  Adults protect themselves
  We may think we protect children that way
  Cultural taboos
  We are afraid that of being wrong
  Afraid of parents’ reaction
  Afraid of spoiling possible investigations

                www.tentsproject.eu
And why do not children talk about it?
Memories about it are unreal and ”split off”
Fair of adults’ reactions
Fair of consequences and punishment
Fair of not being believed, understood and helped
Shame, guild and feeling dirty
Being threatened to keep quiet
Children intuitively understand they must not tell
Taboos
Nothing happened

                 www.tentsproject.eu
What does it take for children to tell?

An occasion must be created
There must be a purpose
There must be a thematic connection
An inner feeling of “permission”

             www.tentsproject.eu
These phrases are the model in a “nutshell”!


       You look so sad to day...
       What happened?
       Tell me ….


               www.tentsproject.eu
Drawings and other products
Keep them. Comment when they are unusual:
 What did you draw?
 Tell me about this drawing…
 What is this?
 Who did you draw?
 What does he/she do?
 What does he/she think?


                 www.tentsproject.eu
Opening of disclosure conversation
Start with the child’s signals …
Generalise: ”I know many children who tell/do/draw
just like you, and they have experienced things they do
not dare to talk about. I have wondered if there are
things in your life you have not dared to tell anybody?
Talk to the child about good and bad secrets, and
about what typically stops children from telling things.


                  www.tentsproject.eu
Secrets and frights

Talk to kids about good and bad secrets:
  That children are afraid of to telling bad secrets
  They fear nobody will believe them
  They are afraid of threats
  They are afraid of what will happen if they tell it


                  www.tentsproject.eu
Practicing disclosure
conversations in groups




      www.tentsproject.eu
Therapeutic conversations

(With emphasis on affect regulation
     and affect consciousness)




          www.tentsproject.eu
The ”alarm centre” of the brain
                                              is kept a state of constant alert
                                              Releases stress hormones
                                              which stimulate instinctive
                                              reactions and inhibits more
                                              higher cognitive processing



Underdeveloped connections                              Inhibited:
between limbic system and
                                              Affect regulation and ability
prefrontal cortex (which runs
reasoning, self reflection,                      to learn and integrate
contextualising – cognitive                          new information
control)

                                www.rvts.no
Identifies the following key challenges:
Help children to regulate affect
Help children to become more conscious about
their affects and bodily states
Help children to make connections between
affect and language

Group work: Ways to help children with this

                www.tentsproject.eu
Some ways we have experience with:
Affect consciousness:
  Being sensitive, intonation: Let the principles of good
  care and healthy early interaction with infants be the
  model
  Comment on signals of affect in the child’s voice tone,
  body posture, mimic, and other
  Ask where in the body the child can feel what he or she
  is telling us

                    www.tentsproject.eu
Ways we have experience with (continued):
Affect control and regulation:
  Identify the pre-warning signals in the child’s body
  Discuss alternative ways to cope with those signals
  (counting techniques, relaxation techniques, and more)
  Stop destructive behaviour, with own affects controlled
  Regulate the child’s affect through own affect
  Use such situation as examples for learning
  Reward changes

                   www.tentsproject.eu
Thank you!
Hope to see you again soon!




       www.tentsproject.eu

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Development supportive dialogue, Timisoara, January 2011

  • 1. Development supportive dialogue with children Inge Nordhaug & Dag Nordanger Dag Ø. Nordanger RVTS West, Bergen, Norway Norwegian TENTS partner www.tentsproject.eu
  • 2. Focus for these days Children in particularly difficult circumstances: Exposed to violence Witnessing violence Sexual abuse Drug abuse in families Orphaned www.rvts.no
  • 3. What is developed in these children? Not the ”Learning brain” … Exploration, curiousness, interest Balance between the the safe/known and the new The ”attaching brain” …But the Survival brain” Defensiveness, supsiciousness, identification of danger Mobilisation of resources for protecting onselfskyttelse The ”detaching brain” www.rvts.no
  • 4. The ”alarm centre” of the brain is kept a state of constant alert Releases stress hormones which stimulate instinctive reactions and inhibits more higher cognitive processing Underdeveloped connections Inhibited: between limbic system and Affect regulation and ability prefrontal cortex (which runs reasoning, self reflection, to learn and integrate contextualising – cognitive new information control) www.rvts.no
  • 5. Different kinds of conversations To explore To understand To disclose To help www.tentsproject.eu
  • 6. Disclosure versus therapy Therapy has much to learn from the directness and exposure in disclosure conversations Therapy can be ”anti-therapeutic” if central stressors in children’s lives are not disclosed www.tentsproject.eu
  • 7. Some communication theory All behaviour is communication One cannot ”Not communicate” Communication concepts: – Synchronised communication – Counter communication – Uneven power relation between adult and child – Message sent – Message received www.tentsproject.eu
  • 8. Centrals aspects in dialogue with children Congruence Position Eye contact Voice tone Body posture and movements Mimics and facial expressions Emphasising sounds www.tentsproject.eu
  • 9. Frame factors The adults’ preparation Information about the child Physical arrangements Furniture Tools Presence www.tentsproject.eu
  • 10. Facilitating/inhibiting communication Facilitating: Inhibiting: Open questions Closed questions Imperative form Yes/no questions Descriptive form Causal form Wide, general form Non leading Leading Key questions, and Leading questions to references to what has expected answers the child has told Choice questions before Projections www.tentsproject.eu
  • 11. What facilitates and what inhibits? Active listening Passive listening Repetition Ignore Confirmation Doubt or deny Sum up Switch of topic Pressure/negotiation Clarification Exploring questions Blurring, making it wage Personal form Interviewing Child language ”You” form Metacommunication/mirroring Adult language Pauses More questions www.tentsproject.eu
  • 12. Disclosure conversations www.tentsproject.eu
  • 13. General principles of disclosure conversations Show interest, receptivity and neutrality Invite to dialogue based on the child’s own signals Be present, close, and have time Do not push, but make a ”room” for children to talk Remember; It is the child who discloses, not the adult www.tentsproject.eu
  • 14. Methodical approach The conversation focuses on the child’s reality The conversation is in the form of dialogue The purpose is to get qualitative and descriptive information through free speech The conversation is a interpersonal interaction The conversation is focused The conversation is non-leading www.tentsproject.eu
  • 15. The phase structure Establishing contact Opening procedures Introduction of the topic Free speech In depth exploration Closure www.tentsproject.eu
  • 16. When do we need disclosure conversations? When children in different ways signal that they are not ok When these signals make us worry When we want children to tell about concrete events they have experienced www.tentsproject.eu
  • 17. Worries can be based signals from: Something the child has said Something the child has shown: – Aggressive behaviour – Withdrawal – Sexualised behaviour www.tentsproject.eu
  • 18. Sexualised behaviour Stop it, and ask: - Where did you learn that? - Have you seen someone else do that? - Have someone done such a thing to you? - Who? ...when it happened, how was it like to be you? www.tentsproject.eu
  • 19. Why do we not talk to kids about difficult experiences? Our view of children’s credibility Ethical reasons Adults protect themselves We may think we protect children that way Cultural taboos We are afraid that of being wrong Afraid of parents’ reaction Afraid of spoiling possible investigations www.tentsproject.eu
  • 20. And why do not children talk about it? Memories about it are unreal and ”split off” Fair of adults’ reactions Fair of consequences and punishment Fair of not being believed, understood and helped Shame, guild and feeling dirty Being threatened to keep quiet Children intuitively understand they must not tell Taboos Nothing happened www.tentsproject.eu
  • 21. What does it take for children to tell? An occasion must be created There must be a purpose There must be a thematic connection An inner feeling of “permission” www.tentsproject.eu
  • 22. These phrases are the model in a “nutshell”! You look so sad to day... What happened? Tell me …. www.tentsproject.eu
  • 23. Drawings and other products Keep them. Comment when they are unusual: What did you draw? Tell me about this drawing… What is this? Who did you draw? What does he/she do? What does he/she think? www.tentsproject.eu
  • 24. Opening of disclosure conversation Start with the child’s signals … Generalise: ”I know many children who tell/do/draw just like you, and they have experienced things they do not dare to talk about. I have wondered if there are things in your life you have not dared to tell anybody? Talk to the child about good and bad secrets, and about what typically stops children from telling things. www.tentsproject.eu
  • 25. Secrets and frights Talk to kids about good and bad secrets: That children are afraid of to telling bad secrets They fear nobody will believe them They are afraid of threats They are afraid of what will happen if they tell it www.tentsproject.eu
  • 26. Practicing disclosure conversations in groups www.tentsproject.eu
  • 27. Therapeutic conversations (With emphasis on affect regulation and affect consciousness) www.tentsproject.eu
  • 28. The ”alarm centre” of the brain is kept a state of constant alert Releases stress hormones which stimulate instinctive reactions and inhibits more higher cognitive processing Underdeveloped connections Inhibited: between limbic system and Affect regulation and ability prefrontal cortex (which runs reasoning, self reflection, to learn and integrate contextualising – cognitive new information control) www.rvts.no
  • 29. Identifies the following key challenges: Help children to regulate affect Help children to become more conscious about their affects and bodily states Help children to make connections between affect and language Group work: Ways to help children with this www.tentsproject.eu
  • 30. Some ways we have experience with: Affect consciousness: Being sensitive, intonation: Let the principles of good care and healthy early interaction with infants be the model Comment on signals of affect in the child’s voice tone, body posture, mimic, and other Ask where in the body the child can feel what he or she is telling us www.tentsproject.eu
  • 31. Ways we have experience with (continued): Affect control and regulation: Identify the pre-warning signals in the child’s body Discuss alternative ways to cope with those signals (counting techniques, relaxation techniques, and more) Stop destructive behaviour, with own affects controlled Regulate the child’s affect through own affect Use such situation as examples for learning Reward changes www.tentsproject.eu
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  • 34. Thank you! Hope to see you again soon! www.tentsproject.eu