The ‘failure’ of a therapeutic care strategy to achieve the desired outcome on first administration does not necessarily mean that it will not or that it is a worthless strategy. Children and young people who are recovering from a tough start to life spend too much time approaching life and relationships under the influence of beliefs that caregivers are unresponsive and uncaring and they, themselves, are bad and undeserving. A therapeutic caregiving strategy takes time to exert it’s influence over the attachment beliefs that influence responses to caregiving endeavours. At first, it may not be noticed by the child or young person who is selectively attending to behaviours that reflect their beliefs. If it is noticed, it may be experienced as inconsistent with their expectations of caregiver behaviour and responsiveness and difficult to trust. Further, as inconsistency is a central nervous system irritant, the implementation of a therapeutic care strategy may, in the first or early stages, give rise to a heightened response. Hence, the adage that behaviour often gets worse before it gets better.
Notwithstanding the above, in my experience therapeutic care strategies can and do ‘work’, with some being quite powerful.
In order for a therapeutic care strategy to achieve a desired outcome, it has to live up to its name. A therapeutic care strategy is a strategy that is intended to address some aspect of the way in which the child or young person approaches life and relationships that is maladaptive. It has to target something. In my view, a therapeutic care strategy addresses a maladaptive coping or survival strategy (and the beliefs that support them) that developed and was adaptive in an inadequate care environment but which is no longer adaptive, such as when it precipitates exasperation and overwhelm in the contemporary caregiver. A therapeutic care strategy supports functional beliefs about life and relationships, and a functional approach to life and relationships.
This takes time; time to understand on some level that old ways of thinking and doing are no longer necessary or helpful, and to develop new ways of thinking and doing. Remember, I am talking about children and young people. This can be difficult for adults too.
A related factor that influences success in applying therapeutic care strategies is the nature of the strategy. Is it derived from psychological science and what we know about child development, or some other source? In my experience, the strategies most likely to achieve desired therapeutic outcomes are those that have a strong scientific and developmental basis to them.
Finally, in consideration of my earlier point that children and young people can be heightened by caregiver behaviours that are inconsistent with their beliefs and expectations, it is important to choose your strategy carefully and only implement it at a rate that you can sustain over time. It is better to not do anything than to start implementing a strategy, only to revert back to previous caregiving practices. This only reinforces the belief that caregivers are unpredictable and cannot be relied upon. Rather, start with something simple, something that can easily be sustained over time and, inevitably, in the face of questions about whether the strategy is or will be successful. After a while, add another strategy. In my opinion, the simple things are not as foreign to children and young people who are recovering from a tough start to life as you might think. I am talking here about simple routines, checking in proactively with the child, communicating understanding of their experience and proactively responding to their needs, and being attuned to their emotional state. The majority of children and young people who are recovering from a tough start to life are familiar with, and have experienced some level of, these conventional aspects of care.
If you would like to know and learn more about how conventional approaches to caregiving and relating can be therapeutic, I would refer you to my books (click the images below) and The CARE Curriculum.