Connection online….really?

Kia ora from lockdown Level 3 – not as bad as Level 4 but still seemingly taking it’s toll somewhat.

I find myself getting annoyed at the advertising about connecting with others through the use of screens and devices and I am aware of how contradictory I am going to sound as I work my way through this post. I do not want to envision a future where it is acceptable to conduct relational psychotherapy through technology – and hopefully in my professional lifespan, that won’t have to happen again. I say hope, because no one knows! No one has a crystal ball, so there is part of me resigned to the fact that I a glad I have gotten my head around HOW to use technology to sustain therapeutic relationships should the time come again. For now I am feeling grateful for what seems to be something intangible and something that cannot be communicated through a screen, that I offer in my therapeutic space. I always wondered when I was training, about these clinicians talking about what happens in that moment BETWEEN the therapist and client – what on earth did they mean? And oh my goodness I know that place so well – I miss that place being co-created in the moment with each of my clients. It feels more than a sense of trust and more than a sense of knowing someone…. it has such a rich quality to it that is only created when the meeting of the two of us occurs. In this moment, in this between moment, the felt need of being seen, heard, validated and belonging is met… finally. These needs are evident in childhood and exist even earlier when in a mother’s womb. Bruce Perry speaks of this in his work and acknowledges the importance of these relational needs and in Eric Berne’s Transactional Analysis Psychotherapy, the emphasis is on attending to these early, archaic needs. Needs that are not necessarily met online… in an authentic, safe and sincere way. We use going online to find ways of getting these needs met for sure – Facebook and other platforms to be seen, heard, validated and ‘liked’. And sadly, this can make it easier for online predators. If our needs are not met when we are young – for whatever reason – then as adults, these needs remain. They remain and they come out in behaviours, relationship choices, friendships, employment and social connections. And still as adults, we go looking online to have these needs met…. but what are we really looking for? Why do we need to know we are liked, we belong, we are approved of, we are good-enough and we are wanted? If you have a think, if these needs remain then something was missing from when you were younger…. not that YOU did anything wrong, they were simply needs you had that were not met.

If this passage strikes a cord with you, drop me a line or better still – come and see me when time allows.

Trauma-Informed?

Working within a trauma-informed approach (TIA), gives rise to necessary consideration of the environment or service ‘umbrella’ under which one is expected to deliver such a framework. Research evidences the cumulative burden of adversity on increasing risk for many negative outcomes, such as mental illness and a response in many service sectors has been to consider invoking concepts of trauma and adversities in policy and practice.  In my career as an Occupational Therapist, I predominantly worked in Child and Adolescent Mental Health and Forensics in the public health system.  In more recent years, I gained qualifications as a Psychotherapist and I now work mainly with ACC Sensitive Claims individuals.  I want to discuss the response and extent to which I have experienced these services to work within overarching principles of TIA firstly as an Occupational Therapist, and secondly as a Psychotherapist within what can be regarded as an insurance-based model to trauma care.  Briefly, it is important to outline the principles that a TIA is based (for more information see Te Pou Te Pou o te Wakaaro Nui: Trauma informed care, 2018).  TIA aims at creating a culture that embodies the following –  

safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and understanding cultural, historical and gender issues

Perhaps simple concepts, however the filtering of these concepts into the workplace setting is perhaps where things become more complex.  These principles have parallels with what I see as humanistic and existential perspectives as oppose to ground-breaking, innovative research. They are highly relevant when considering the disintegration and fracturing impact of experiencing trauma and what is needed for the healing and the repair of the individual.  These principles are not referring to behaviour or labels imposed, stereotypes, definitions, or other preconceived categories that individuals are sometimes expected to subjectively ‘fit’.  I believe it is asking for the authenticity of connecting with the other.  Curiously, this is a big expectation for those working in mental health it would seem.

Awareness around the stigma and the negative attitudes held by mental health staff towards those who experience mental illness, is increasing (Martensson, Jacobsson & Engstrom, 2014).  Criticism, assumptions, opinions and judgement from clinicians was common, when I was working in various Child and Adolescent Mental Health settings.  The attitudes of staff towards the families with adversity, peppering most clinical presentations, felt almost like an inconvenience.  A familiar theme in their research, Berliner & Kolko (2016:169) offer –

instead of characterizing children with problems as intentionally misbehaving, it is important to consider that the behaviours may be adaptive or understandable responses to adversity or other historical influences

Another consideration highly relevant to child and adolescent services, is the support necessary not only to the person the referral to services concerns, but the supporting persons of that individual who are also often impacted by trauma experiences themselves.  This is intergenerational trauma or trauma repeated over generations.  This is seen often when working with families and the clinical thinking necessary is more systemic.  This was emphasised by Figley & Figley (2009:174) who recognised the pervasive nature of trauma whereby –

the traumatised person who has a good result from linear treatment is surrounded by supporters who are still traumatised (secondarily) themselves, and who remain ordered around the traumatised person without benefit of reconstructing and processing through the traumatic experience

It is therefore seen that a certain level of disconnection exists between the needs of traumatised individuals and their families and implementing TIA within overall constraints of service provisions, expectations and budgets.  Time is required by the clinician seeing the individual referred, to gather the personal information from all family members concerned, with a gentle, inquisitive manner.  This requires often, considerable time that services are often faced as not having the luxury of providing.  It can often feel as though services repeatedly attend to individuals when in crisis, rather than providing an overall ethos of care and healing – or the ‘ambulance at the bottom of the cliff’ approach (Figley & Figley, 2009). 

Not only are services responsible for constraints and limitations to implementing TIA, so are individual clinicians. The overall culture of a working environment is implicitly instrumental in incorporating TIA into policies for positive change. Aaron and colleagues (2006) note that the workplace culture and climate will influence clinician’s attitudes and further add that a “more positive organizational climate is associated with better organizational process, work attitudes, and outcomes of mental health services” (Aaron, et al., 2006, p. 2-3). Of interest but of no surprise, Baker et al., (2016) found that staff attitudes can effectively act as a roadblock to the implementation of new approaches to mental health care.  For all staff involved within TIA services, Clark, et al. (2015) reminds us as the importance in recognising transference and countertransference within the relationship.  Perhaps this offers a reason for the staff who show unwillingness or inability to adopt a TIA perspective.  Given the prevalence of childhood adversity, such as childhood sexual abuse (Ministry of Justice, 2015), it would stand to reason that a number of employees in the field of mental health, are likely to have their own journey or know of a close friend/family member perhaps yet to embark on their journey and acknowledged their own therapeutic needs.  I see transference and countertransference as highly relevant for staff and their relationships with clients in mental health settings, although it is an intangible concept that is perhaps not easily ‘taught’.  Martensson et al., (2014:787) state that –

staff do not only need knowledge, information and education, but also to be involved in supervision and processes that actively highlight and challenge their own beliefs and attitudes

 

Horsfall et al. (2010:453) offer that “avoiding discussions of shame or stigma could relate to the professionals’ own views about mental illnesses”.  This has been supported in the literature with Hansson et al., (2013) findings revealed that staff who were treating patients with a psychosis or working in inpatient settings presented with the most negative attitudes. Clark, et al., (2015:6) reiterates that –

acknowledging the impact of trauma requires that the trauma-informed provider adjusts how care is delivered in order to accommodate what the trauma survivor needs—and to deliver it in such a way that the survivor’s sense of safety is prioritized

When consideration is given to the implementation of trauma-informed approaches into mental health care – and perhaps along with other settings – the staff that this is directed at, needs to be a part of the ‘package’ of delivery. 

Sweeny, et al., (2016:177) again thoughtfully offers –

Staff who experience conflicts between job duties and their moral code are under chronic stress for which they must learn to cope and adapt. Those coping strategies may include “shutting off” the ability to empathise, and viewing people receiving services as “other” thereby disqualifying their humanity and basic human rights

It has to be said though also, that encouragingly, literature has revealed that by providing training on trauma informed initiatives, not only does this build staff knowledge, it can also influence change in attitude, develop compassion and positive practices reflecting TIA (Schiff, et al., 2017; Brown, Baker, & Wilcox, 2012).  I would hasten to add that because we are talking about layers of complexities within most individuals including staff working in mental health, I would expect this to vary considerably dependent on each unique setting.

Te Pou o te Whakaaro Nui is a national centre of evidence-based workforce development for the mental health, addiction and disability sectors in New Zealand.  The work of Te Pou within trauma-informed care, amongst other areas, has provided rationale, recommendations and a framework designed to be integrated into mental health delivery in New Zealand.  It is evidenced and echoes other leading sources of trauma-informed care and research, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) in America, with careful adaptation to ensure it is culturally respectful to Maori. One may want to therefore question the ethics surrounding resistance to implementing trauma-informed care within such vastness of research, evidence and current efforts. Continuing to not meet the individual needs within our services effectively mirrors, repeats and reinforces the unmet needs of the individuals seeking care.  Bryson and colleagues (2017) importantly describe an emerging theme of change needing to occur at a deeper level within an organisational culture, for implementation of TIA to be successful.  Somewhat of a parallel process could be seen here in regards to how change is also to also be successful in an individual who has experienced trauma.  Conscious and unconscious processes that make up each and every one of us brings perhaps a not so obvious challenge in anticipating TIA being a pragmatic process of simply increasing knowledge amongst staff.  What little change was occurring felt like a token response.  A solution for me, it seemed at the time, was to specifically work with clients through ACC Sensitive Claims.  The fact that clients have experienced sexual trauma, is an overt understanding.  This alone, it turns out, is not enough and challenges have filtered through creating an undesirable conflicting undertone.

Accident Compensation Corporation or ACC, is a government-administered organisation established in 1974, with the overall aim being to compensate those who had suffered accidental injury.  At the time, this mainly meant compensation for personal physical injury from accidents such as in the workplace, sports arena, home and motor vehicle accidents.  Consequently, this meant that the right to sue for compensatory damages was surrendered (Forster & Parkinson, 2000).   In 2002, revisions to the Injury Prevention, Rehabilitation and Compensation Act effectively meant that individuals could make a claim of mental injury as a result of sexual abuse, known as a ‘sensitive claim’.  After an initial assessment following filing an application to ACC, funding is ‘approved’ for multiple sessions of counselling by ‘approved’ ACC therapists. 

The conflict here largely seems to be around the fact that money is involved and individuals are required to go through processes in order to meet funding ‘approval’ – to be ‘approved of’ one could interpret.  In actual fact, for long-term intervention ACC has the requirement that in order to access intervention such as talking therapies, a proven DSM-V diagnosis must be provided.  Therefore, accessing funding for sexual abuse is ‘conditional’.  It assumes that one would have a DSM-V diagnosis, if they were requiring intervention as the result of sexual abuse – not exactly what I would see as fitting with the principles of TIA (ie. transparency, empowerment, collaboration). Forster & Parkinson (2000:186) state that by “insisting on proof of psychological injury, understood in conventional terms, is that some victims show no demonstrable long-term effects at all” – which statistically speaking alone (Ministry of Justice, 2015), is entirely likely. 

The conditional relationship with ACC is reminding of attachment theory and the adverse histories of most clients who present to ACC Sensitive claims.  The risk here is the provocation of early relational schema’s or working models with attachment figures and the processes of being ‘approved’ by ACC. The decision to approve funding solely lies at the discretion of ACC. This may be best described as a “power-over” (Sweeny et al. 2016:177) relationship or ‘three-cornered contract’ framework (English, 1975) in order to access therapeutic professions. Again, this may and can actually prove counterproductive to one’s therapeutic process.  It has the potential to evoke a client’s early script, replay archaic injunctions (Berne, 1961) and replicate earlier experiences for the individual where they had not been heard, believed or assisted to safety (Fallot, et al., 2011). Sweeny, et al., (2016:177) recaps –

In a trauma-informed service, it is assumed that people have experienced trauma and may consequently find it difficult to develop trusting relationships with providers and feel safe within services. Accordingly, services are structured, organised and delivered in ways that engender safety and trust and do not retraumatise.

Beyond the therapeutic bilateral model of contracting (Berne, 1966), is the model introduced by English in 1975 (Fig. 1), within the context of facilitating training workshops.

                                             Great Powers

 
  

 

 

   Your contract                                                     My contract

 

                              You                                      Me

                                      Now our contract

  Figure 1

This model effectively implies an equal working relationship between all parties – ACC, client and therapy professional for example.  From this model, further models have been developed, illustrated by an uneven triangular relationship showing greater alliance between client and therapist, while the organisation (the paying party for example such as ACC or a parent) holds a more distant yet powerful relationship.  Within the complexities of this model, I see possible ethical and moral concerns, bias, external expectations and conflicts.

Careful consideration needs to be given to sensitive claims applications in New Zealand, for Maori clients accessing therapy.  Whilst this appears to have been accounted for ‘on paper’, translation of TIA principles into the expected processes, appear to become lost.  My experience is that culturally this process has felt intrusive, with little flexibility in the time allowed for introductions, establishing connections, and removal of restrictions (tapu).  These are considered important aspects of the work for my clients.  The initial stages of ACC sensitive claims work, if not done well, transference experienced can be retraumatising and replaying intergenerational trauma.  ACC processes not aligning with kaupapa Maori values to allow fair access to intervention, is perhaps is reflected in the number of Maori clients who access counselling/therapy compared with Pakeha/European (Paton, 1999; Jansen, et al., 2008).  While Jansen, et al., (2008) found the main issue was with communication of entitlements and lack of Maori staff within the organisation, their study of Maori experiences with ACC was not solely focussed on Sensitive Claims.

Despite best attempts, aligning TIA with ACC – effectively what is seen as an insurance company – seems paradoxical at best. The ACC pathway to access and obtain trauma responsive care and funded intervention is unique and potentially invaluable.  The few studies cited above however, do not allow for generalisation of findings.  This would highlight the obvious need to evaluate and obtain viewpoints from clinicians contracted to ACC Sensitive Claims, for perceived concerns in implementing trauma informed care in practice. Such systems as the government administered organisation of ACC, could be tarnished with the very same brush that Frewin et al., (2009:44) frankly concludes with –

The identity and development of sexual abuse victims are negatively impacted by the sexual assault and by the systems, such as law enforcement and the courts, designed to support those damaged through such heinous events

 

 

Summary

Implementation of TIA is without question, a necessary evolution of how we approach mental health and wellbeing globally.  Obvious, as well as elusive resistance is emerging as attempts are made in absorbing what could be seen as a humanistic perspective to mental health care, with the more ingrained medical model approaches to mental health.  Continued enquiry of barriers, such as attitudes of clinicians and staff is needed the context of implementing TIA in health care settings.

In recognising the ongoing challenges to implementing TIA within existing mental health settings, Berliner & Kolko (2016:171) offer –

It is a desirable goal that all trauma exposed children receive a warm and caring response from knowledgeable professionals, but the most important needed change is creating systems that identify traumatized children and ensure that they get effective care

 

We know that statistically New Zealand (Ministry of Justice, 2015) could do with taking a good hard look at how to approach mental health matters differently reflecting the abundance of trauma research and basic humanism.  Te Pou o te Whakaaro Nui – Trauma-Informed Care: Literature Scan (2018) is a thorough document, suggesting particular areas and common features to ensure efficient translation of their research, into mental health services in NZ.  Research continues for Maori specific approaches which will need to be assimilated nationwide as well as into the likes of ACC Sensitive Claims units.

Overall, the research demonstrates how best to respond clinically to those individuals with trauma histories.  Promisingly, this is further argued in the literature of the relevant application to multiple settings, illustrating the pervasive nature of adverse childhood experiences. These include settings that are not solely set up for mental health problems such as schools (Walkley & Cox, 2013; Overstreet & Chafouleas, 2016; Chafouleas, et al., 2016), government agencies, maternity services (Seng, et al., 2014) and A&E departments (Hall, et al., 2016). 

The principles of trauma-informed care describe the essence of being in human relationships with the other in my opinion.  The ideal is for this to become a part of the very make-up of mental health professionals amongst others, working in various settings in our communities.  The challenge perhaps lies with the simple fact that these principles – or human qualities – cannot always be ‘taught’ per se from manuals, text books or workshops. But how else do you do it?

 

References

Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological services3(1), 61.

Baker, C. N., Brown, S. M., Wilcox, P. D., Overstreet, S., & Arora, P. (2016). Development and psychometric evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) scale. School Mental Health8(1), 61-76.

Berliner, L. & Kolko, D. J. (2016). Trauma Informed Care: A Commentary and Critique. Child Maltreatment, 21(2): 168 – 172.

Berne, E. (1961). Transactional analysis in psychotherapy. New York: Grove Press.

Brown, S. M., Baker, C. N., & Wilcox, P. (2012). Risking connection trauma training: A pathway toward trauma-informed care in child congregate care settings. Psychological Trauma: Theory, Research, Practice, and Policy4(5), 507.

Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., … & Burke, S. (2017). What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International journal of mental health systems, 11(1), 36.

 

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 1, Trauma-Informed Care: A Sociocultural Perspective. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207195/

 

Chafouleas, S. M., Johnson, A. H., Overstreet, S., & Santos, N. M. (2016). Toward a blueprint for trauma-informed service delivery in schools. School Mental Health8(1), 144-162.

Clark, C., Classen, C. C., Fourt, A. & Shetty, M. (2015). Treating the trauma survivor an essential guide to trauma-informed care. New York: Routledge.

 

Cloitre, M., Courtois, C., Charuvastra, A., Carapezza, R, Stolbach, B. C. & Green. B. L. (2011). Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress, 24(6), 615-27.

 

English, F. (1975). The three-cornered contract. Transactional Analysis Journal.

 

Fallot, R. D., McHugo, G. J., Harris, M., & Xie, H. (2011). The trauma recovery and empowerment model: A quasi-experimental effectiveness study. Journal of Dual Diagnosis7(1-2), 74-89.

 

Figley, C. R., & Figley, K. R. (2009). Stemming the tide of trauma systemically: The role of family therapy. Australian and New Zealand Journal of Family Therapy30(3), 173-183.

 

Forster, C., & Parkinson, P. (2000). Compensating child sexual assault victims within statutory schemes: imagining a more effective compensatory framework. UNSWLJ23, 172.

Frewin, K., Pond, R., & Tuffin, K. (2009). Sexual abuse, counselling and compensation: discourses in New Zealand newspapers. Feminism & Psychology19(1), 29-47.

 

Hansson, L, Jormfeldt, H, Svedberg, P. & Svensson, B. (2013). Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? International Journal of Social Psychiatry, 59(1), 48 – 54.  

 

Hall, A., McKenna, B., Dearie, V., Maguire, T., Charleston, R., & Furness, T. (2016). Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: A pilot study. BMC nursing15(1), 21.

 

Horsfall J., Cleary M. & Hunt G.E. (2010). Stigma in mental health: clients and professionals. Issues in Mental Health Nursing 31, 450–455.

 

Jansen, P., Bacal, K., & Crengle, S. (2008). He Ritenga Whakaaro: Māori experiences of health services. Hospital200, 30-7.

 

Jennings, A. (2008). Models for Developing Trauma-Informed Behavioural Health Services and Trauma-Specific Services. Available from: URL: http://www. theannainstitute.org/MDT.pdf

Martensson, G., Jacobsson, J. W. & Engstrom, M. (2014). Mental health nursing staff’s attitudes towards mental illness: an analysis of related factors. Journal of Psychiatric and Mental Health Nursing, 21(9), 782 – 788.

Ministry of Justice. (2015). New Zealand Crime and Safety Survey: Main Findings. Wellington: Ministry of Justice.

Overstreet, S., & Chafouleas, S. M. (2016). Trauma-informed schools: Introduction to the special issue.

Paton, I. (1999). The nature and experience of private practice counselling in New Zealandº. nature20(1), 1-23.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Schiff, D. M., Zuckerman, B., Hutton, E., Genatossio, C., Michelson, C. & Bair-Merritt, M. (2017). Development and Pilot Implementation of a Trauma-Informed Care Curriculum for Pediatric Residents. Academic Pediatrics, 17(7), 794-796.

Seng, J. S., D’andrea, W., & Ford, J. D. (2014). Complex mental health sequelae of psychological trauma among women in prenatal care. Psychological Trauma: Theory, Research, Practice, and Policy6(1), 41.

Sweeny, A., Clement, S., Filson, B. & Kennedy, A. (2016). Trauma-informed mental healthcare in the UK: what is it and how can we further its development? Mental Health Review Journal. 21(3), 174 – 192.

Te Pou o te Wakaaro Nui: Trauma informed care. Retrieved from

https://www.tepou.co.nz/uploads/files/resource-assets/Trauma informed%20Care%20Literature%20Scan%20Final.pdf

 

Walkley, M., & Cox, T. L. (2013). Building trauma-informed schools and communities. Children & Schools35(2), 123-126.

Wilson, R. (1998). ACC 1997: A fairer scheme or a breach of the social contract? New Zealand Journal of Industrial Relations, 22/23(3), 301-310. Retrieved from https://search-proquest-com.cmezproxy.chmeds.ac.nz/docview/213508201?accountid=14700

Could I be a better parent?

Positive Parenting seems to be a phrase I hear often, as a way to encourage what I imagine to be warm, thoughtful interactions with our children.  The bit that doesn’t quite align for me is that there are times when parenting doesn’t feel positive at all – not because the opposite of positive parenting is neglect or abuse – it’s simply because there are good days and there are days. The truth is, there is room for both.  We won’t and we don’t get it right every time.  If I’m honest, ever since I was given my baby daughter to hold, I critiqued my parenting skills.  And I did so even more when told my 8-year-old daughter is anxious.  I promptly blamed my husband’s family genes for the anxiety whilst feeling I had done something to my daughter.  And with the prevalence of social media today, everyone’s opinion is more apparent than ever!

Neuroscience gives strong emphasis to early childhood preverbal relational experiences.  We want the input ‘message’ that will effectively shape the neurophysiology of our child (no pressure…) to be “you belong, you are loved and you are safe”.  This is fundamentally vital and occurs very early on. It is seen as a pre-requisite for other psychosocial developmental milestones such as empathy, compassion, tolerance, persistence, humility and a sense of one’s autonomy (again, no pressure).

But how do I know if I am doing a good enough job as a parent?

The phrase “good enough mother” was first coined in 1953 by Donald Winnicott, a British Paediatrician and Psychoanalyst.  Winnicott’s research involved observing thousands of babies and their mothers.  From this, he learnt that babies and children actually profit when their mothers (and I hasten to include fathers/caregivers) fail them in ways that are physiologically tolerable (excluding abuse and neglect obviously). This in turn strengthens your child’s ability to tolerate the ‘not-so-comfortable’ emotions in life, such as feeling disappointment.

Decades on from Winnicott, the ability to be ‘good enough’ parents, I see largely being reflective of one’s own sense of self as ‘good enough’Being good enough, isn’t so much about the doing interestingly enough.  It is more so about authentically coming from your own sense of being “good-enough” as a platform to parent from.  We are often overwhelmed with how we “should” be parenting and flooded with the ‘ideals’ about getting it ‘right’ or ‘wrong’, when we didn’t send children home with ‘party bags’ after our child’s 8th birthday party (for example say…). Social media, the world wide web, magazine, marketing, Dr. Phil – it all contributes to our internal dialogue, our voice inside of ourselves.  This dialogue comes with a felt sense of pressure, making it a lot harder to be authentic and to trust one’s own intuition, to attune and to relate with our children, as we parent. 

Covert and not-so-subtle influences feed into our internal dialogue of voices that can be heard almost constantly evaluating whether we are actually good enough or if we need to try harder?!  To do more, have more, give more, be more….!  It can and will suck the breath out of you.  The good news of course, is that this incessant internal dialogue is actually within oneself – it can therefore, be changed.  Again, its not so much about the doing, but becoming aware of one’s dialogue within oneself.  Is it familiar? Is it relevant to here and now? Is it harsh or nurturing? Bringing this into one’s own awareness is the beginning of integration, of becoming whole and being in the here and now.

We all have our own experiences and upbringings that shape our internal world and our sense of who we are – or our ‘script’ as Eric Berne (1961) termed it.  Our script is our blueprint for how to be in this world and how others view us.  Intertwined often, in one’s sense of I’m ‘not good-enough’, are the painful unattended aspects of oneself or perhaps a concealed feeling of shame.  Despite being siblings in the family of feelings, there is a clear distinction between shame and guilt. Guilt is feeling bad about something you have done, while shame is feeling bad about who you are or a part of you. As a way of managing all of the above, we may lose sight of what is fundamental, to be ‘good-enough’ parents.  Parenting is a journey with your child…… take a moment to be in the moment with your child, to laugh with and laugh at oneself! To sometimes get it ‘wrong’, acknowledge the rupture in relationship, repair with care and model that this is how we all learn.  Be authentically with our children, rather than do parenting to our children.  You won’t be a better parent by making yourself feel worse about how you’re already doing – you already are a better parent by wondering, “could I be a better parent”?  If you think about it, ‘good-enough’ parenting is actually hard-enough…..!