Healthy Attachments and Neuro-Dramatic-Play (Arts Therapies)

‘This heartfelt book offers practitioners and parents exceptional guidance about how to engage a baby or child in vital dramatic play as soon as it makes its presence known. Its pages brim with fun activities, sound reflections on their rationale, and above all, with authoritative optimism.’ – Dr. Alida Gersie, dramatherapist, organisational consultant and author ‘In NDP, Sue Jennings explores  the little understood process of the early shaping of the brain on the primitive, unconscious and nonverbal stage of mother-child interactions.  On this  journey, she brings to bear her considerable experience, solid intuition, and large heart. While most theoreticians tend to become too theoretical in the face of the unknown, Sue Jennings stays grounded in the body, intimate relationships, and moment-to-moment experience –  a methodology sorely needed in the synthesis of neuroscience, human development and adult life. I recommend that you take this journey with Dr. Jennings.’ – Louis Cozolino, Ph.D., professor of clinical psychology and author of The Neuroscience of Psychotherapy ‘Sue Jennings emphasises playfulness as a critical component in the early stages of developing attachment relationships and she highlights its contribution to neurological development. She provides a useful introduction to an important area; this book will entice and provide guidance to a range of practitioners, and parents, to engage in creative care of young infants and vulnerable others’ – Eileen Prendiville, Director and Core Trainer of Children’s Therapy Centre, Ireland ‘Another fascinating book by Dr Sue Jennings which gives an insight into the importance of a mother’s relationship with her unborn child and their interactions during the first six months. NDP builds the foundation for healthy attachment play and compliments the EPR paradigm. Examples of NDP enable the reader to identify what usually comes naturally in the development of healthy attachments. The extensive list of activities, games and interactions suggested by Sue will be invaluable for my therapeutic work in the future.’ – Sharon Morgan, Senior Social Work Practitioner and Play Therapist

by the same author Introduction to Developmental Playtherapy Playing and Health

Sue Jennings Foreword by Mooli Lahad ISBN 978 1 85302 635 5

Introduction to Dramatherapy Theatre and Healing - Ariadne’s Ball of Thread

Sue Jennings Foreword by Clare Higgins ISBN 978 1 85302 115 2

Art Therapy and Dramatherapy Masks of the Soul

Sue Jennings and Ase Minde ISBN 978 1 85302 181 7

Healthy Attachments and NeuroDramaticPlay Sue Jennings Foreword by Dennis McCarthy Afterword by Mooli Lahad Illustrated by Chloe Gerhardt

Jessica Kingsley Publishers London and Philadelphia

Extract from Wisdom and Hall on p.98 is reproduced with permission from the Random House Group.

First published in 2011 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Sue Jennings 2011 Illustrations copyright © TBC 2011 Foreword copyright © Dennis McCarthy 2011 Afterword copyright © Mooli Lahad 2011 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Every effort has been made to trace copyright owners and anyone claiming copyright should contact the publishers. Library of Congress Cataloging in Publication Data Jennings, Sue, 1938Neuro-dramatic-play and healthy attachments / Sue Jennings ; foreword by Dennis McCarthy ; afterword by Mooli Lahad. p. cm. Includes bibliographical references and index. ISBN 978-1-84905-014-2 (alk. paper) 1. Play--Psychological aspects. 2. Attachment behavior in infants. 3. Infants-Development. 4. Attachment behavior. 5. Play therapy. 6. Child development. I. Title. BF720.P56J46 2011 155.4’18--dc22 2010020288 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 978 1 84905 014 2 ISBN pdf eBook 978 0 85700 492 5

Dedication

Eileen Prendiville, Child Psychotherapist and Play Therapist, is a dear friend and colleague. This book is dedicated to her in appreciation.

Acknowledgements

I appreciate all the help I have received from pregnant colleagues, clients and friends. So many colleagues gave me time to discuss and challenge the ideas in this book and I appreciate their interest and thank them for their time. My children and grandchildren are always stimulating and stretching. Sue Hall is forever patient with my writings and muddles – thank you. Jessica Kingsley has believed in the project from the beginning and been so much help. And dear Peter, my husband, has supported me throughout the writing period despite some antisocial times. Sue Jennings (Susan Stein), Glastonbury, 2010

Contents

Foreword

Introduction Neuro-Dramatic-Play – Its Roots in Attachment and Play, Theatre and Ritual

9 11

╇1 NDP – Definitions and Theories

28

╇2 NDP and Attachment

46

╇3 NDP – Play and Play Therapy

63

╇4 NDP, Pregnancy and Birth

81

╇5 NDP, Childbirth and the First Six Months

98

╇6 NDP and Resilience and Empathy

115

╇7 NDP and Children with Attachment Needs

130

╇8 NDP in Fostering and Adoption

147

╇9 NDP with Teenagers and Young Adults

167

10 NDP and Children on the Autistic Spectrum

190

11 NDP and Children with Learning Difficulties

208

12 NDP for Practitioners

225

Appendix 1â•… NDP – 6 Months Before and After Play

240

Appendix 2â•…Embodiment-Projection-Role (0–7 years)

247

Afterwordâ•… NDP –the Wonders of Play and Playfulness in

Securing the Lives of Children

255

References

259

Subject Index

267

Author Index

271

Foreword

I am convinced that practitioners who work with children and with the adults these children become, are sorely in need of a basic introduction or reintroduction to the power and necessity of play, and the profound impact that play, or the lack of it, can have on children. There is much in our culture that denies this necessity, despite the contribution of theorists such as Winnicott, Erickson and many others who, though still read in schools and training programmes, seem not to make an impact on the ways we parent, teach and provide therapeutic help for our children. We have moved ever further into a dehumanised state of functioning and care providing, and thus we need to be reminded of what should seem obvious, which is that playing with children from their prenatal existence into infancy and childhood is intrinsic to emotional and physical health, the capacity for empathy and the development of a healthy ego. Sue Jennings does just this in her wonderful book, and in addition she adds to what is already known about attachment, empathy and resilience with new ideas from the field of neuroscience and her own ongoing work that deepens our understanding of play’s primacy. That the child is a consciousness in need of communication, interaction and play from early on is a revelation despite the obviousness of this, because we are all affected by a world that moves too fast for us to engage in relationships which afford both us, and our children, this type of connection. We must resist the impulse to ignore and bypass the rudiments of healthy development, and speak loudly in a language that affirms it. There is mercifully a movement afoot to correct the dearth of play in our current thinking and practising, and this book is at the forefront 9

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of this movement. Rather than attempting to convince those who cannot, or will not, see the full-blown consciousness in the eyes of a newborn child, this book celebrates this consciousness by describing ways of relating to it as parents, and helping children who have not had the good fortune to have been related to in such ways, and have suffered because of it. Mothers intuitively play with their baby, even in utero, if they are not too emotionally damaged to do so, and often even if they are. They sing, touch, dramatise and engage in many forms of sensory playfulness, which will help the child develop a healthy body sense. We can learn much about what is needed for health by watching what mothers and babies innately do. There is a wonderful ancient Nordic chant in the book that says it all: And did you sing as I came into the world? As you opened the door for me to come into the light? Sing at my birth and for all babies as they start their journey on this earth. Dennis McCarthy Dennis McCarthy has practised psychotherapy with children and adults for 35 years, and has developed a unique approach to play therapy, documented in his book If You Turned into a Monster… Transformation through Play, published by Jessica Kingsley Publishers. He is the director of Metamorfos Institute in New York State.

Introduction

Neuro-Dramatic-Play – Its Roots in Attachment and Play, Theatre and Ritual Franz Kafka once noted in his diary that a writer must cling to his desk ‘by his teeth’ in order to avoid the madness that would overtake him if he stopped writing. I suppose the same could be said of every creative activity that somehow permits us to come to grips with the demons of our past, to give form to a chaos within us and thereby master our anxiety. (Miller 1995, p.15)

Alice Miller really puts us in touch with the fact that we all have personal demons, and that creative activity is one way of ‘giving form to chaos’. This book maintains that many of our demons could be prevented if we become more aware of the emotional damage done to children at a very early age, through lack of attachment awareness. Neuro-Dramatic-Play is one way of both presenting the demons but also dealing with them.

Introduction This book is about the importance of Neuro-Dramatic-Play (NDP) with all children, unborn, newborn, and beyond, but especially with those children who are ‘at risk’. They may be at risk because they have been neglected, abandoned, abused or misused, but in all cases because their most basic needs have not been met. They have not had a good enough attachment relationship with their mothers or other primary carers. In subsequent chapters there is a description of the theories that underlie NDP, in particular an understanding of attachment and play, pregnancy and early months. The book then moves on to describe 11

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how NDP can be helpful for children with attachment needs, ‘looked after children’, teenagers and young adults, and children on the autistic spectrum and those with learning difficulties. The final chapter is for those people who are involved in the care of children: foster carers, adoptive parents, teachers, social workers, doctors, nurses and therapists. The appendices provide a wealth of ideas and techniques that can be applied with children, teenagers and adults.

The Theatre of Life Our lives are like a piece of theatre that unfolds in several stages and many stories. The seven stages of man (or woman), as described by Jacques in As You Like It, are a powerful statement of our progress through life, written by William Shakespeare in one of his most enduring plays. He says: All the world’s a stage, And all the men and women merely players: They have their exits and their entrances; And one man in his time plays many parts, His acts being seven ages. At first the infant, Mewling and puking in the nurse’s arms. And then the whining schoolboy, with his satchel And shining morning face, creeping like snail Unwillingly to school. And then the lover, Sighing like furnace, with a woeful ballad Made to his mistress’ eyebrow. Then a soldier Full of strange oaths and bearded like a pard Jealous in his honour, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon’s mouth. And then the justice, In fair round belly with good capon lined With eyes severe and beard of formal cut,

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Full of wise saws and modern instances And so he plays his part. The sixth age shifts Into the lean and slipper’d pantaloon, With spectacle on nose and pouch on side, His youthful hose, well saved, a world too wide For his shrunk shank; and his big manly voice, Turning again toward childish treble, pipes And whistles in his sound. Last scene of all, That ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans every thing. ( Jacques, As You Like It 2.vii: 139–167) However, although acknowledging the dramatic development of the whole person, this book will focus much more on the time of ‘mewling and puking’ and especially the time even before, when the infant is growing in the womb and experiencing its whole sensory system: temperature, sound, rhythm, touch and emotional changes of mood and energy. Mothers have a profound effect on the infant’s wellbeing through their own sensory experience. The telling of soothing stories and the playing of calming music can influence the state of trust and tranquillity for the mother and her unborn child. In the few weeks before birth, infants are already turning their heads from side to side, rehearsing their movements ready for feeding. After birth there is mirroring and the development of a playful attachment with the mother, which is an extension of the pre-birth attachment. We can represent this process in another way.

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Primary circles The circle of containment The circle of containment is established pre-birth as the infant is contained within the womb, the first circle full of safe waters (see Figure I.1). As the infant begins to make an impact on the mother, as she grows rounder and rounder, the mother is interacting with the infant in the circle.

The circle of care The circle of care is developing pre-birth as the baby stimulates an increasing awareness from the mother, and continues after the baby is born. It is symbolised by the mother encircling the baby in her arms. This will form the basis of the attachment between mother and baby.

The circle of attachment In the circle of attachment, the baby is now established within the care and containment of the mother, and develops a reciprocal playful relationship. There are sensory experiences, rhythmic games and ‘dramatised’ interactions.

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Attachment

Containment

Care

Figure I.1: Primary circles

What I have described through these circles is the basis of NeuroDramatic-Play which will be elaborated upon throughout this book. As a metaphor these circles are like a primary ‘theatre in the round’ between two performers, mother and unborn or newborn child. Neuro-Dramatic-Play is the crucial developmental process that progresses from conception to the first six months of life. This book also demonstrates that if NDP has not been established during this critical time, it is possible to intervene, through appropriate sensory, rhythmic and dramatic processes later in life, and still be able to make changes. It is never too late to play, and that makes all the difference. This feeling of optimism will continue throughout this book, and demonstrate, I hope, that we should never give up on children or teenagers. It is never too late to bring about changes and enable children and young people to be happier or more content. NDP needs to be placed within several frameworks in relation to child development and the primacy of drama in a child’s growth. First, it is relevant to re-establish the developmental paradigm of EmbodimentProgression-Role (EPR) that I have developed continuously since the mid-1980s, and established in Dramatherapy with Families, Groups and Individuals (Jennings 1990). EPR charts the child’s ‘dramatic’ development from birth to seven years and can be said to be the progenitor of NDP (see Jones 2010). EPR and NDP are both understood within the bigger overarching frame

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of Theatre of Body (ToB), which I have further developed since 2005. This leads into Theatre of Life from the age of eight years. If Theatre of Body and Theatre of Life can be understood as preventative, Theatre of Resilience (ToR: 2007a) is therapeutic (Figures 1.2 and 1.3). ToR is an important means of addressing NDP difficulties and attachment needs in older children and teenagers. THEATRE OF BODY/THEATRE OF LIFE (PREVENTATIVE)

Neuto-Dramatic-Play Conception – six months

Embodiment-Projection-Role Birth – seven years

Creative dance and drama Theatre in education Storytelling, music, art and theatre Eight – eighteen years

Figure I.2: Stages of dramatic development

THEATRE OF RESILIENCE (THERAPEUTIC)

Neuro-Dramatic-Play Therapy during pregnancy and first six months

Embodiment-Projection-Role Play and dramatherapy from birth to seven years

Social and therapeutic theatre Figure I.3 Re-staging of dramatic development

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Embodiment-Projection-Role EPR is a developmental paradigm that uniquely charts the progression of dramatic play from birth to seven years. Based on extended observations with babies, young children, and pregnant women, it provides a parallel progression alongside other developmental processes such as physical, cognitive, emotional and social. EPR is ‘value free’: it does not rely on a particular school of psychological theory; indeed it can be integrated into any psychological model or therapeutic or educational practice. EPR charts the ‘dramatic development’ of children, which is the basis of the child being able to enter the world of imagination and symbol, of storytelling and poetry, the world of dramatic play and drama. The early sensory attachment between mother and infant has a strong physical, rhythmic and dramatic component through playfulness and role reversal. Even in pregnancy the mother is forming a dramatic relationship with her unborn child (see NDP above). Competence in EPR is essential for a child’s maturation: • It creates the core of playful attachment between mother and infant. • It promotes sensory, embodied, rhythmic and dramatic playing. • It supports the child in creating images through clay and art materials. • It establishes the ‘dramatised body’, i.e. the body which can create. • It encourages the structures of storytelling and their interactive potential. • It is the basis of developing empathy through echo play and mimicry. • It gives a child the experience and skills to be part of the social world. Therefore EPR is a means of being able to work with children and teenagers to re-establish normative dramatic development. Increasingly I have discovered that the Embodiment stage is of primary importance:

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the experience of all forms of sensory interaction, rhythmic movement songs and games contribute to children feeling secure in their own bodies, and enable them to communicate with other bodies. For the older child, NDP techniques will need to be integrated within the EPR paradigm in age-appropriate ways. Not all tough teenagers will want to play with modelling clay and blow bubbles: nevertheless the examples in Chapter 9 challenge my assumptions. Winnicott (1982) himself describes the importance of the ‘play space’, the creative space between therapist and child. He also emphasised the importance of the mother–child relationship. NDP shows that the space between mother and unborn/newborn child is a playful one. These two developmental paradigms, Neuro-Dramatic-Play and Embodiment-Projection-Role, together form the bigger picture of Theatre of Body.

Theatre of Body: integrated circles Attachment is among other things a visceral, sensory and physical experience and the physical proximity between mother and child is of the utmost importance. However it is essential to remember that every culture produces its own movement, dance and rhythms and children can be disturbed by the imposition of other cultural forms until they have become embedded in their own. People can be cut adrift from their own roots unless they have been established in them. In ‘The Collective Body’ Adler (1999) says we were all born with a tribal body but also belong to an earth body. She proposes a movement approach called ‘Authentic Movement’ (derived from Mary Starks Whitehouse 1970), that gives us the opportunity to rediscover this process that has been influenced by the rapid move away from tribal living. Authentic Movement bridges many beliefs and practices: therapy, meditation, ritual, improvisation, individual and community group process. Adler (1999) also suggests that the loss of the community, the loss of the circle, ‘a sacred circle has contributed significantly to the creation of unbearable rage, isolation and despair’(p.192).

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Our embodied experience from conception and continuing through our early lives sets a marker on how we will develop: self-confidence, resilience, communication, generosity, empathy, trust and hope all have their early roots in our bodily experience in the pregnancy and attachment processes. ‘Thinking with the body’, ‘body intelligence’, ‘body memory’ are just some of the concepts used in therapeutic understanding of our physicality. The body is a primary means of learning (Jennings 1998) and early somatic experiences influence later physical and cognitive growth. An infant needs to develop a ‘body self ’ before he or she can have a ‘body image’ (Jennings 1998–1999a). The body self means that the person feels they inhabit their own body with confidence: the livedin body. Early attachment experience is strongly influenced by our body experience. Through the physical attachment to our caregiver we are able, later, to let go and explore independently. The body of another person holds and contains, and allows us to experience body boundaries. Embodiment is the first stage of our dramatic development (Jennings 1987, 1990, 1998, 1999a, 2003, 2004). The Theatre of Body is being enacted from the moment of conception to the time of collaboration (around six months), and from ‘birth-playing’ until ‘drama for real’ (around seven years). It contains the development paradigms of Neuro-Dramatic-Play and

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Embodiment-Projection-Role (see above). NDP addresses the dramatic basis of attachment, from conception to the first six months of life; EPR charts the dramatic development from birth to seven years as a child moves from the physicality of the first twelve months to the mastery and exploration of substances and objects during the projective stage. By four years old, the child is playing roles, inventing scripts, telling stories and improvising dramas from their own life or from books. But there are initially only two players in this dance and drama of life. Through basic enough attachment in the early days and months, the child experiences trust, affirmation and unconditional positive regard (Maslow 1968). This experience is embodied and it is playful, and it has elements of mimicry. This is Theatre of Body.

Dramatic development Play and therefore ritual, theatre and drama, all have a biological basis (Cozolino 2002; Jennings 1999a; Schechner 1991; Turner 1982; Whitehead 2003), and much is now written of the impact of healthy attachment and play on the growth of the brain. The need to dramatise is a primary drive, which is necessary for survival. We can recall children who failed to thrive because no one played with them and there was no social interaction. A spectacular example was when Western European people first saw the pictures from the Romanian orphanages after the revolution, in the early

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1990s. Babies and young children were depressed and dying, not because they had no food, but because there was no sensory play and no social interaction. This bears out the research by Harlow (1958: see Chapter 2) with rhesus monkeys that found that physical affection took priority over feeding. Even a soft cloth to cling to was better than no softness at all. The roles we play in everyday life and theatre are ‘embodied’; we understand our roles through our bodily experience. As infants develop, they are able to separate out the difference between ‘let’s pretend’ (dramatic reality) and everyday life. They have already experienced the ‘as if ’ of dramatic playfulness in their early playful relationship. Actors also work with ‘as if ’ and the concept of ‘emotional memory’ (Stanislavsky 1950) in order to find the authentic role or character. In order to understand roles and characters we need to look at concepts of ‘role’ and ‘performance’. However, we need to make a clear differentiation between the idea of playing a role as if I am this other person, the enacted situation, and the ‘as if body loop’ that is described by neuroscientists (Damasio 2000, 2003; Le Doux 1998), which is an imagined situation. The ‘imagined situation’ refers to the brain processes that are involved when we imagine something rather than actually doing it physically, or witnessing it in others. In the following examples, both Le Doux and Damasio talk about the imagined or ‘as if ’ bodily states: In certain situations, it may be possible to imagine what bodily feedback would feel like if it occurred. This ‘as if ’ feedback then becomes cognitively represented in working memory and can influence feelings and decisions. (Le Doux 1998, p.295) There are thus neural devices that help us feel ‘as if ’ we were having an emotional state, as if the body were being activated and modified. (Demasio 2003, p.155) Mirror neurons fire when an infant observes certain actions being performed by someone else. It is thought that mirror neurons contribute to social functions such as rituals and dancing, and ‘setting a good example’; (for an elaboration on this theme see Whitehead 2001, 2003).

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However, dramatic development must also include the theme of performance, and in certain educational circles performance was seen as a negative experience, with small children being made to perform for the entertainment of adults or an attitude of performance being more important than process. Slade (1995) suggests that it interferes with the absorption of the children: You will help the work and the children if, in the infant school, you try to avoid all playing to parents, use of formal stage and script plays, and use only a little dressing up. These things interfere with the absorption, and thus the sincerity, if they are experienced too soon. (Slade 1995, p.63) Dramatherapists have mainly shunned the idea of performance being in any way therapeutic, which is something I challenge. Theatre of Resilience culminates in a shared performance (see Chapter 12). Moore (2009) has written extensively on the Theatre of Attachment, and sees her therapeutic work as an opportunity to close old scripts and write new ones. She says about her play and dramatherapy practice: Here, play is performance when carried out publicly, performative when it is more private (Schechner 2006). When we enact one another’s social dramas, through awareness of original settings, we gain new perspectives. Since, in life history work, we benefit from the presence of others to assist our understanding I am drawn to Turner’s etymology of the word performance, from the old French, ‘parfournir’ meaning the ‘proper finale of an experience’ (Turner 1982) and not to do with ‘form’. This interpretation permits ‘performance’ to be more private, valuable for participants confronting intense pain and shame in the process of discovering their true strengths. (Moore 2009, p. 204) Moore (2009) sees her scripted performances as a means of creating bridges between the past, present and future life of looked after children, and their attachments and relationships. She integrates the foster and adoptive parents into these performances, which she terms ‘Theatre of Attachment’ (Moore 2009). Schinina (2004) writes: ‘Theatre has to be understood here as a means of developing relationships, communication, and expression

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that concentrates on the construction of roles’ (p.37). Everyone is playing differentiated roles in everyday life, and they are also playing imaginative roles when they play or perform in the theatre. There will be comments as to whether the performances are as good as expected. Together with Whitehead (2003) I would suggest that dramatic action, rather than language, is the foundation of culture and therefore individuals need to be socialised both into social groups as well as into their cultural forms. This means that the dramatic developmental process has a unique function in the socialisation of individuals and groups within different cultures. Furthermore it has major implications for resources for infants and young children as well as community initiatives. In every sense of the word we have a ‘Theatre for Life’ that grows out of Theatre of Body. It emphasises even more the importance of the dramatic nature of early attachment experience. Not only are we laying the foundation for the healthy development of the individual child, but also we are ensuring that the embedding of the child’s culture is available through a continuation of the dramatic development and process within social groups. Several theorists from theatre, social psychology and social anthropology have developed contrasting theories of roles and performance, which are relevant in this context. A brief mention will have to suffice within this complex frame of references. George Herbert Mead (1934), founder of Symbolic Interactionism, describes how people actually create reality by the way they act towards the world, and he contributed the following important concepts: • Self: Mead’s concept explains our ability to see ourselves as both actor and subject. The self is reflexive, meaning we can see ourselves as others see us. Mead (1934) suggests that the self is developed into a play stage and a game stage in childhood. • Play stage: this involves learning to take the attitude of a particularised other (a specific person such as the child’s mother). • Game stage: this involves learning to take the attitude of everyone else, and therefore learn how to function in organised groups.

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• Generalised other: the generalised other develops out of the game stage: it is a collective attitude of the community or society; persons can see themselves as belonging to their society by engaging in shared meanings of others. • I and Me: Mead suggests that the self is a social process – the ‘I’ is the immediate response of the individual to others; the ‘Me’ is the adoption of the generalised other. Therefore the human being is an acting organism. When we role take we are able to understand how our own actions will be perceived and interpreted by others, as well as understand how others perceive and feel themselves (Mead 1934). Through taking the role of the other, we are ensuring that empathy and a conscience are able to develop. Mead’s observations enable us to grasp the basic fundamentals of the dramatised self and other, both specifically and generally. Erving Goffman (1969) expanded Mead’s ideas and he developed a dramaturgical perspective to show how social reality is created through interactions and performances. Lemert, writing on Goffman, says that: It is our ability to carry off a convincing performance, to make people believe that we are who we say we are, we mean what we intend, and that the definition of the situation is what we have claimed by implication, is the means to impressing ourselves and others. (Lemert and Branaman 1997). Victor Turner’s important writings on ritual and ritual symbols, and the relationship between ritual and theatre have shaped the way anthropologists, theatre theorists and theatre therapists think about their work (Turner 1967, 1974; Turner and Bruner 1986). Turner developed some of the earliest ideas on theatre and anthropology, drawing on his own life: his mother was in the theatre and his father was a bankrupt engineer who divorced when he was only 11 years old. He was brought up by grandparents, living far away from his estranged parents. For me the anthropology of performance is an essential part of the anthropology of experience. In a sense, every type of cultural performance, including ritual, ceremony, carnival,

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theatre, and poetry is explanation and explication of life itself, as Dilthey often argues. Through the performance process itself, what is normally sealed up, inaccessible to everyday observation and reasoning, in the depth of sociocultural life, is drawn forth. (Turner 1982, p.13) Turner also says: My training for fieldwork roused the scientist in me – the paternal heritage. My field experience revitalised the maternal gift of theatre. I compromised by inventing a unit of description and analysis which I called ‘social drama’. (Turner 1982, p.9) I cannot help but identify with Victor Turner, being born of a medical doctor and a dancing mother, and I have seen how I have moved (sometimes lurched) between the polarities of medicine and art, even though my parents were together for over 60 years. Dramatherapy and play therapy continue to evolve in my thinking and practice, but even so I seek to free myself from those very terms, and move into playful encounters and theatre experiences. I invent structures and paradigms that are meant to contain but not restrict; I seek out variations on themes rather than fixed compositions. The Theatre of Life is started by the developmental and attachment theorists and is then continued by the ritual and performance theorists, weaving together a rich and vibrant tapestry. But it is theatre! Let us just recap our dramatic development, and see how we can emerge into empathic social beings. First, there is consonant play, where mother and baby do the same movements and sounds, singing and movements. Then the newborn infant usually echoes simple sound phrases or movement of the mother; this is followed by mimicry that is a reciprocal drama: the baby imitates the mother and then the mother imitates the baby. This develops into the dramatic act of mirroring; then even more complex dramas emerge when the infant begins to imitate both actions and sounds, as well an initiating them.

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The repetition of ‘ritualised’ actions that can include singing games and stories with sounds becomes a secure base from which creativity and improvisation can grow. Through the first social relationship and secure attachment, the infant feels secure within his or her body identity, to begin to explore dramatic playing. This dramatic development of infants is essential not only for healthy attachment and resilience but also for identity and self-esteem and the process of social integration into culture. The child needs to belong to the fabric of a social network with his or her own roles and expectations, rules and norms. Culture will include rites, rituals, dance, art, music, drama, theatre and of course storytelling. Trevarthen (1993/2006) suggests that infants from birth are able to communicate: It is the nature of human consciousness to experience being experienced: to be an actor who can act in relation to other conscious sources of agency, and to be a source of emotions while accepting emotional qualities of vitality and feeling from other persons by instantaneous empathy. (Trevarthen 1993/2006, p.121) However, he does say later that the focus of communication is marked by babies of six weeks or older: they still their movement, pause for breath, and everything is aimed to gain information about their mothers’ presence. Trevarthen has done extensive observational and laboratory research with babies and I am hesitant to challenge Trevarthen’s findings, but in my own work I put the start of this intensity much earlier, from birth, rather than six weeks old. The child is part of the rituals of a family and social group through which the embodied ideas and values of the culture are transmitted and embedded. Trevarthen has written extensively on the early development of babies, especially in relation to musicality and rhythm. He infers that even at an early age, a small infant is making sense of other people’s behaviour:

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Babies are born to find meaning in intense participation with the imagings and ambitions of older minds. They have a musical sense of time, and a language of emotions that matches that of the wisest adult, including sensitive feelings about the contingent appropriateness of other persons’ behaviours. And they soon build a ‘personal narrative history’ that connects moments of the present to an imagined future as well as a remembered past. (Gratier and Trevarthen 2008, p.122) There is an increase in studies of newborn babies and their development, but apart from Trevarthen, there is less attention paid to the minutiae of the communication of babies, and their playfulness. However, it is important that we keep both mothers and babies within the frame and look more closely at the qualitative communication that happens in the play space between mother and baby. We shall now commence our playful journey through this book and find new ideas, old images in new perspectives, refreshing approaches for working in difficult situations, and, I hope, some optimism for creative change.

Chapter 1

NDP Definition and Theories When I was seven I had a weird experience. I had my new football and I kept on playing, even though it had got dark and all the other kids had gone home. As I was walking home on my own, I looked up at the stars and thought, how long do stars go on for? Then wondered, how long is life? How long will I live? How long will I be dead? Will it be OK when I’m dead or will I feel different? Suddenly I was scared, and I ran all the way home, screaming and crying. I got into bed with me mam and dad, squeezed in beside them, cuddled close. I didn’t tell them why I’d been screaming. I just sort of hid it in my head. (Gascoigne 2004)

Introduction Neuro-Dramatic-Play is a new synthesis of several approaches to child development that include our greater understanding through neuroscience of the complexity of early brain development, the contemporary thinking on childhood attachment, and the emergence of play therapy and dramatherapy as a primary intervention with children and teenagers with emotional and behavioural difficulties. It is also influenced by the more recent synthesis that both nature and nurture are necessary for healthy child development. Whereas historically nature and nurture were seen as opposing factors in understanding human thought, feeling and behaviour, recent research by neuroscientists shows that nature and nurture are in fact doing the same thing. They are both building the human brain and its capacity to function. The brain of the baby is not built before he or 28

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she is born; the newborn infant will develop most of the higher brain after birth. Nature gives the brain its potential but it is the quality of the nurture (or the neglect) that will determine the eventual growth of the brain and its capacities. Much of what we now know about brain development and nurture has grown from ‘living research’ into the effect of deprivation on thousands of orphans from Eastern Europe. There is a joint irony that we understand much more about attachment behaviour from the work of Harlow (1958) and his cruel experiments on rhesus monkeys (see Chapter 2), and from the results of years of cruelty, neglect and abuse of babies and children under a politically repressive regime (see Chapter 2 and also discussed below). Neuroscientists have contributed to our greater understanding of the brain and how it functions. Le Doux writes about new perspectives on the relationship between nature and nurture, and Cozolino, a neuroscientific psychotherapist, puts forward his ideas linking social networks and neural networks: …the stuggle between thought and emotion may ultimately be resolved, not simply by the dominance of neocortical cognitions over emotional systems, but by a more harmonious integration of reason and passion in the brain… (LeDoux 1998, p.21) From the first moments of our lives, we exist within a complex matrix of social relationships. This elaborate social relatedness is organised and controlled by neural networks of bonding and attachment, play, predicting others intentions and being able to see the world through others eyes. (Cozolino 2002, p.172)

Background Although my own work with teenagers living on the streets in Romania and India has helped me to understand more fully my thinking behind Neuro-Dramatic-Play, it was my earlier research and writing that created the foundation for these more recent developments. Much of my early writing and teaching (Jennings 1983–2007) on dramatherapy and play therapy has focused on the developmental paradigm

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‘Embodiment-Projection-Role’ (EPR), which charts the ‘dramatic development’ of children from birth to seven years of age. These three stages of EPR and their appropriate transitions are essential for healthy development and maturation. They influence the development of both the right and left hemispheres of the brain as well as encouraging resilience and self-confidence. If children do not navigate the EPR stages, it can have serious consequences in later life. Indeed a child who has not been able to go through an appropriate embodied stage (E) may have a distorted body image and potential eating disorders. A child who struggles with hand–eye coordination and literacy, and maybe has little confidence in their own artistic abilities, may well have never been through the projective stage (P). There are many children who are unable to ‘pretend’, i.e. to take on the role of another (be it animal or person), because they have not been through the role stage (R), who will then play out destructive or isolated roles in everyday life. These children have missed out not only the role stage of EPR, but also the time of dramatic playing during the early weeks and months (see Chapter 3). They are unable to dramatise their roles but continue life in a series of day-to-day destructive encounters where they often play out roles of aggressors or victims. I have worked with children who will happily play at physical games or movement exercises (Sherborne 2001) or will create collage or self-portraits or intricate clay models, but they have been quite unable to play a role, i.e. to become someone other than themselves. To play a role means that we are able to play ‘as if ’ we are the other person (or creature). This is what I term ‘the dramatic response’ (Jennings 2005a), and it is only through being able to play dramatically, to take on roles in thought or action, that we are able to consider the feelings and experiences of somebody else. This is how we develop empathy and the child who cannot engage in dramatic playing will have great difficulty with understanding ‘the other’. Baron-Cohen and Chakrabarti (2008) have a very useful definition of empathy which is pertinent here: Empathy is a defining feature of human relationships. Empathy stops you doing things that would hurt another person’s feelings. Empathy also stops you inflicting pain on a person or animal. Empathy allows you to tune into someone else’s world, setting aside your own world – your perception, knowledge, assumptions or feelings. (p. 317)

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As a therapist, mother and grandmother, I am increasingly concerned by the lack of empathy shown by many children and adults, seemingly endorsed on TV shows: We are living in times where empathy seems to be absent in one or two generations of children; lack of empathy means that not only do we not understand how others feel, we are capable of inflicting enormous pain on them with no remorse or conscience. (Jennings 2007b)

The fertility clinic It was only in 1988, when I began to work in a clinic for people who had difficulties in conceiving, that I became far more aware of how EPR actually starts before birth in the sensory, projective and dramatised relationship between mother and unborn child. Indeed, there has been a burgeoning literature on the life of the unborn child and the fierce and often violent debate between the pro-life advocates and those who support abortion. Very tough questions have been asked concerning our reactions if we knew we were giving birth to a child with disabilities or a pregnancy that followed rape. This book does not enter this debate but acknowledges the increase in research on pre-birth development and external influences on the baby before he or she is born. Embodiment-Projection-Role are broad-based categories that encompass a wide range of behaviours and actions (for a detailed breakdown of these, see Jennings 1998), so I began to focus on the more minute detail of mother–unborn-baby and mother–newbornbaby interactions and playfulness (Jennings 1999a, 2003a, 2003b 2009a, 2009c) and discovered that EPR needed refining for these early months in a child’s life. It was some time before I found a description that could focus on this period between conception and the first six months of life, and decided that ‘Neuro-Dramatic-Play’ was probably as accurate a description as any. I am convinced that this is the critical time for NDP to make an impact on the future development of any child. Neuro-Dramatic-Play means that it is connected to the infant’s brain development; it also involves the dramatic response ‘as if ’, and it is connected to our capacity to play. Playfulness is a motif that permeates this book.

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The importance of women When I say NDP starts from ‘conception’, it may not be the actual moment of conception, although I firmly believe that a child conceived in violence, or without regard, can be affected by the immediate feelings engendered by the encounter, especially if these feelings persist throughout the pregnancy. Certainly when the mother is aware of her wished-for pregnancy (or is pleasantly surprised) and starts to react to the presence of another being, there are positive changes in herself and her unborn child (see Chapter 12 for discussion of McCarthy 2007). For many women this is when the baby first begins to move, and playful thoughts, dream states and emotional changes become more prominent. Despite early discomfort of morning sickness and exhaustion, and later feelings of grossness and exhaustion, pregnancy can be a playful and creative time. It is very sad when women feel under so much pressure that they feel they must work during pregnancy: there are not only economic demands but also societal expectations. The role of mother can be looked down upon and equated with being ‘just a housewife’. I think this is very confusing because in many ways mothers are valued highly, they are the carriers of the next generation and therefore they need time and attention to be mothers, but this is not always borne out with how mothers are treated, as if they cannot think for themselves or make a decision. And certainly as if they do not know better than the doctor! Furthermore, women are not supported adequately financially, whether or not they are married or single. Women have struggled for their rights for hundreds of years but things are slow to change. The rights of mothers to have a say over their own destiny and that of their unborn child is still a long time in coming, especially in western cultures. Historically women have been punished and killed for being midwives and attending to childbirth; their knowledge was thought to be from the devil and their perceived frailty meant that they were subject to wrong influences. It was a long time before women were allowed to deliver babies ‘officially’; when forceps were first invented, it was kept secret and only male doctors were allowed to use them. Things are different now but there still pervades the idea of the frail woman who needs to be cared for and who cannot think for herself.

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Most pregnant women I know are strong and feisty and capable of delivering their own babies if necessary! It is difficult for women who are able to manage their own births in a trance-like state to be prodded by ‘specialists’ who do not have the working understanding of the processes of labour. Childbirth is a private occasion, rather than a public display under the glare of bright lights and chrome. It can be compared with the difference between dreams and theatre. Dreams are our individual private experience, rather like a theatre in our heads, whereas theatre is very much a public and group event with spotlights and heightened effects. Childbirth is very private, personal, and indeed natural. It does not have to take place in a surgical space with costumed and masked attendants in starched white uniforms, under bright lights. So we know that the period of time from conception through the three trimesters to when the infant is six months old is the time for the basis of attachment to be formed. The period before birth is as important as the period afterwards (see Chapters 4 and 5). It is important to realise that neuroscientists have discovered not only psychological processes but also chemical secretions that are underlying the emotional attachment between mother and child. It is the interactions between mother and baby that are influenced by neurochemicals, so there is a constant flow of nature and nurture that eventually establishes ‘positive attachment’: ‘The internalisation of the mother involves an intricate network of visceral, motor, sensory, and emotional memories that can be involved in times of stress and can support the ability to regulate affect’ (Cozolina 2002, p.177).

The brain and the body Having identified the critical period for Neuro-Dramatic-Play (NDP) to take place, let us now look at what it actually is and what it actually does. Definition of NDP Neuro-Dramatic-Play is the sensory, rhythmic and dramatic playfulness that takes place between a mother and her unborn baby and mother and newborn from conception to six months.

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What does NDP do? Neuro-Dramatic-Play has a profound effect on the growth of the brain, the chemical balance of the body and the healthy attachment between infant and parents. It influences the future emotional and social maturation of the child.

Neuro-Dramatic-Play is the term I use to describe the play processes of ‘sensory play, rhythmic play and dramatic play’ because they make a direct impact on the neural pathways and the developing brain of the infant, as well as forming the basis of playful attachments through games and storytelling. The body is the primary means of learning, as we shall see in all the situations later described in this book. NDP makes an impact on several parts of the brain that at one time were referred to collectively as the ‘triune brain’ (Maclean 1985). Not all neuroscientists now believe in the layered brain theory of the reptilian, mammalian and executive layers, but nevertheless still make use of the analogy as a way of talking about the evolutionary brain functions. Cozolino (2006) suggests that Maclean’s model is very useful for therapists and teachers since it connects with both Darwinian and Freudian theories. He comments that: The triune brain presents an evolutionary explanation that may account for some of the contradictions, discontinuities and pathologies of human behaviours (Maclean 1990). Maclean described the human brain as a three-part phylogenetic system reflecting our evolutionary connections to both reptiles and lower mammals… Think of it as a brain within a brain within a brain, each successive layer devoting itself to increasingly complex functions and abilities. (Cozolino 2006, p.24) It is useful to consider that the instinctual brain (reptilian) that includes the amygdala is where fears both inherited and acquired are stored. The emotional brain (mammalian) is concerned with nurture and feeding. It is shared by all mammals, and probably contributes to attachment and care of small infants. The rational brain (executive function) is also referred

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to as the higher brain; it is where our lived and conscious experience is located, together with our informed decision making and reflection. NDP addresses all these areas of the brain through therapeutic play: predictable play that reassures the instinctual brain, sensory and rhythmic play that influences the emotional brain, and dramatic playing and stories that make an impact on the development of the rational brain. The reassurance through constancy and predictability is very important for the child who has become locked in fear and is unable to move out of their instinctual responses. Sensory and rhythmic playing are important ingredients of attachment playfulness. Dramatic playing and stories encourage both structure and curiosity. Research demonstrates (Sunderland 2006) that the growth of our early brain is dependent on the quality of our social interaction with our mothers (or primary carer): ‘Much of the infant brain is developed after birth, so it is very open to being sculpted by both negative and positive parent interactions. At birth your child’s higher brain, in particular, is very unfinished’ (Sunderland 2006, p.20). The reptilian brain is the most ancient part of our brains and is necessary for survival. It reminds us to take food, to keep warm or sheltered, and especially it warns us of danger and whether to ‘fight, freeze or take flight’. How many damaged children do we know who live their lives around food and fear; they seem to live only through survival mode. Deft attempts to bring about change through a new family or intensive therapy are not necessarily successful, especially when the attachment needs of the carer or parent or therapist become intertwined with those of the child (see Chapter 8). The emotional brain is located in the limbic system and as its name suggests is involved with the emotions as well as learning and memory. The higher brain is within the neo-cortex. Because at birth it is still ‘soft-wired’, i.e. not all the synaptic connections have been formed, it will be influenced by external influences in parenting and care. Loving interactions, affirmation and playfulness will have a strong influence on the growth of the higher brain and its functions. It is responsible not only for empathy but also for imagination and problem-solving, and the capacity to reflect. The rational brain needs to work in collaboration with other parts of the brain and not separated from the ‘emotional brain’ or the ‘instinctive brain’.

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Erik Erikson’s eight stages of maturation commence with ‘Hope: Trust versus Mistrust’ 0–12/18 months although there are variations (Erikson 1965/1995). He focuses on the quality of interactions between parents and children and says that if the small infant experiences ‘warmth, regularity and dependable affection’, their view of the world will be one of trust and thus hope. He is describing the basic qualities of a ‘good enough’ attachment. However, for many of the damaged children, the basic ‘Trust versus Mistrust’ stage has not taken place. A host of other fearful experiences have entered the amygdala, creating a self-perpetuating situation of Reactive Attachment Condition (Hughes 2006). The lower brain or the emotional brain is also called mammalian because it is shared with other mammals. All mammals appear to care for their young and also share with humans the capacity to be playful and social.

Whereas sensory play through touch and massage, soothing sounds and loving gestures and words strengthens the emotional areas of the brain including the thalamus and the hypothalamus, dramatic play helps to develop the potential for empathy that belongs to the higher brain areas. Empathy is also linked to the developing of a conscience. Our moral sense and our values are linked to how we should treat other people. Empathy is the ability to stand in someone else’s shoes and understand how they feel. We cannot empathise unless we can ‘take on the role of the other’ (Mead 1934) (see the Introduction for further elaboration of Mead’s ideas).

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Dramatic play and role play promote the capacity to step out of my own reality and enter someone else’s. It belongs to the higher brain area: We can only develop empathy if we are able to feel ‘as if ’ we are the other person. Therefore the early mimicry between mother and baby is enabling the possibility of acknowledging and feeling for ‘the other’. (Jennings 2007a, p.8) Much of what we have learned about the brain since the early 1990s has come about because of the exposure of the appalling cruelties in some Eastern European orphanages (Gerhardt 2004; Sunderland 2006). Large institutions with untrained staff meant that thousands of abandoned, disabled or orphaned infants received the most rudimentary ‘care’. Babies were abandoned in cots and fed with propped feeding bottles, with no physical nurture of any kind. Many small children were tied to their beds for long periods of time so that their limbs grew back-to-front or disproportionately. In some places children were fed alternate days which led to ‘scoffing, sicking-up, slow-eating’. Children snatched and scoffed as much food as they were able, then sicked it up again in order to eat it more slowly. This way they would not feel such hunger pains while waiting one or two days for the next food to arrive. We can see that these children were forced into their survival brains with little opportunity to develop their positive emotional lives or their capacity to play or empathise. Observation of these orphans has shown that the emotional and social neglect actually caused parts of the brain not to develop, especially the neo-cortex. The social function of the brain does not develop until after we are born: we have the potential but it develops through our interactions with others. It depends on the quality of these interactions whether we develop positive social relations that include trust and empathy. Since the orphans did not have social interactions at any meaningful level, it is not surprising that their capacity to create trust was severely impaired. Stressful experiences, such as separation from the person who feeds us and the food itself, increase the release of the ‘fear-chemical’ cortisol in the brain, which makes the infant wary and distressed. Many of these neglected children escaped from the institutions when they became older and spent their lives on the streets, railway stations

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or under bridges. Many children as young as seven years learned how to fend for themselves, rather than continuing to tolerate the cruelty and frequent physical and sexual abuse of the orphanages. There was no feeling of safety or security in the orphanages, and children chose to break free rather than stay as institutionalised victims. Gerhardt (2004) uses the phrase ‘emotional immunity’ to describe the positive affective development of babies and infants: ‘Good emotional “immunity” comes out of the experience of feeling safely held, touched, seen and helped to recover from stress, whilst the stress response is undermined by separation, uncertainty, lack of contact and lack of regulation’ (Gerhardt 2004, p.84) The development of our brains and the maturation of our emotions are therefore dependent on our early playful attachment. This loving interaction is a two-way communication, at first through touch, sound and gaze. The social interaction influences the development of the social brain, and without this interaction, the brain will not fully develop. Certain innate responses to fear, usually through freezing, are processed. Just as parents can reproduce their own attachment history with their children, carers and therapists can also get sucked into a destructive dynamic that can be addressed only with careful supervision and sometimes personal therapy (see Chapter 12).

Theatre of Body and Theatre of Mind Whitehead (2001) developed his ‘Theatre of Mind’ from ‘Theory of Mind’ – the capacity to ‘read’ other people’s minds (Baron-Cohen 2003). He says that Theatre of Mind develops at the higher levels of social intelligence. Humans are committed to living and experiencing through others: gossip, jokes, news, television – and of course theatre. Theatre of Mind happens both through our imagination and through performance. Whitehead (2001) suggests: • Mimicry is a reflex; it is copying. • Imitation is insightful; it is goal copying. • Mimesis has intentionality, voluntary simulation to represent actions, things, and people. (p.11)

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Very importantly, Whitehead suggests that mimesis includes pretend play, and that pretend play is necessary for ‘Theatre of Mind’. The study of pretend play reported here represents a collaboration between neuroscientists and social anthropologists. Our aim is to contribute to the knowledge base necessary for further theorizing and research, particularly in relation to autism and theory of mind, but also to answer some more general questions relating to the social brain. We assume that human culture must depend on implicit displays (such as dance) and mimetic displays (such as pretend play), and that these are the necessary precursors of the conventional displays that characterise and constitute human culture. (Whitehead et al. 2009, p.1) Baron-Cohen (2003) also says that pretend play is important. He suggests that ‘pretending’ is the first epistemological mental state that is understood by children. Autistic people are trapped in a here and now without insight into the past or future. He describes how an autistic boy said that he had to speak his thoughts out loud in order to know what they were; this is because he had no ‘mirror in his mind’. He therefore had to create a mirror ‘out there’. Again we are talking about the importance of ‘the dramatic response’ or the ‘as if ’ or indeed the capacity to make ‘pretend play’. This leads us into a further discovery from neuroscience which is the identification of ‘mirror neurons’. Their effect, especially on the growing infant is profound especially in relation to their development as social and cultural beings. Whitehead, integrating the work of Dilthey, Baldwin, Cooley and Mead, argues that ‘self awareness depends on social mirrors and shared experiential worlds’ (Whitehead 2001, p.1). Mirror neurons in the brain fire when humans and other animals perform specific actions and when they see another perform the same action. Babies at 36 hours old can differentiate between happy, sad and surprised human facial expressions. Within the first few hours of birth, newborn babies can imitate their mother’s expression and even stick out their tongue. Mirror neurons and their networks within the social brain link brains and bodies which may stimulate sharing and turn taking. Mirror neurons help to explain and justify theories of ‘role modelling’ and ‘setting an example’ that is talked about as a moral imperative, i.e. that

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this is a ‘good thing’. However, the underlying neurobiological basis cannot be ignored. Mirror neurons may also play a dominant part in organised group activity: dancing, hunting and other collaborative endeavours. Mother and unborn child anticipate the social mirroring that will take place after birth. Whitehead’s ideas influenced me when I began to re-examine my observations of mothers and unborn and newborn infants. The dramatic play or pretend play was very clear to me but I had yet to tease out what I was actually seeing in the sensory and embodied playfulness. I noticed that mothers would often rock themselves and their unborn child, and I have noticed that other women will sometimes rock while hugging a cushion without being aware that they are doing this. The encircled arms create a circle of safety, a circle that will soon become the circle of attachment once the baby is born. Almost like a ‘theatre in the round’ that encircles a ritualised containment of two people, one is very much dependent on the other. Perhaps this is another way of understanding playful attachment in the early weeks. A piece of ‘physical theatre’ that maintains the safe borders and guards against danger and intrusion until there is a cue to be a little more adventurous! This led me to explore the notion of ‘Theatre of Body’ which I think precedes Theatre of Mind in a person’s development. The early sensory and embodied play between mother and newborn child as well as being anticipated during the pregnancy has all the qualities of a ‘Duet for One’. Physically mother and baby are living life through each other’s physical proximity and non-verbal communication. The paradox of their closeness will enable the infant to eventually tolerate distance, and once the child is physically secure he or she can also tolerate absence. The early playing, which is physical and consonant between mother and child, is necessary before ‘the echo’: you smile – I smile. The consonance in the circle establishes the security of oneness before it is possible to establish difference. This circle of safety is important to establish before there are any extended absences of the primary carer. If there is prolonged absence before an infant can grasp ‘going away and coming back again’ then the result may be sustained anxiety and potential depression. Theatre of Body enables Theatre of Mind to follow developmentally.

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Most infants pass through the stages of sensory, rhythmic and dramatic play within the family that provides adequate attachment (Bowlby 1969/1971) and secure parenting. These three playful processes commence during pregnancy when mothers have playful interactions through movement and enactment (see Chapter 4) and continue in their most intense form until the infant is six months old (see Chapter 5). The dynamic quality of interaction between a mother and a young baby can be predictive of the emotional attachment relationship between them many months later (Jaffe et al. 2001; Trevarthen 2005). The emphasis in NDP is the sensory, rhythmic and dramatic essence of the mother–child attachment that forms the core of the playful attachment relationship (Jennings 2003a). Neuro-Dramatic-Play is the basis or foundation from which Theatre of Body grows. Many other brain processes are also being developed: this is the physical basis of trust, care, awareness, self-confidence, self-esteem and self-image, which need to be kept balanced.

Sensory play, rhythmic and dramatic play Making sense of the world around us happens through our senses and commences before we are born. We can sense temperature, sound, rhythm, touch and emotional changes while we are still in the womb and our mothers have a profound effect on our well-being through their own sensory experience. We are aware of our mother’s heartbeat and will synchronise it with our own heartbeat. Women who avoid sensory experiences, and perhaps find touch or stickiness distasteful, have difficulty in providing any sensory stimulus for their small children. Early sensory play experiences involve touch and holding, textures and smells, visual movement and colours, sucking and taste, voice and music. It can be messy as well as magical! Plastic bibs are no substitute for skin-to-skin contact. We can encourage pregnant women to create massage times while they sing songs to their unborn child. The telling of soothing stories and the playing of calming music can all influence the state of trust and tranquillity for mother and her unborn child. Most women rock rhythmically without being prompted, thus establishing the secure patterning of regular rhythms.

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Many women report that they tell stories and confidences to their unborn child and sometimes have a conversation in which they answer themselves as if they are the child. This process continues after the child is born when the mother takes on the imagined child’s voice in answering her own question. Mother and infant start to take turns in a non-verbal conversation that is very private and often very funny (see Chapter 5).

Throughout history we have needed to make sense of the world around us: we discover the rules of the universe and the need for the social group. So we tell stories (Storylore, in Jennings 2003a, 2003b) and imitate through ritual, rhythm, drama and dance our view of the world and our shared place within it. However this starts much earlier when we start to make sense of our world a few months after conception. Play and creativity in our relationship with our unborn child commences at the beginning, it is like a life rehearsal. There is a continuum that develops from the playful pregnancy, to playful consonance to playful echo and playful mimicry. This continuum is usually completed within the first three months of life. Not only are we rehearsing life while in the womb, but also we are making connections between the world outside the womb and ourselves. Babies do recognise birthing songs and music once they are born; they

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will shy away from harsh voices they heard before they were born, and they begin to have a sense of who they are in relation to their mothers in the way they are picked up and held as soon as possible after birth: ‘And did you sing as I came into the world? As you opened the door for me to come into the light? Sing at my birth and for all babies as they start their journey on this earth’ (Jennings 2003b, p.6). This ancient chant from the Nordic goddess of birthing, Uks Akka, reminds us of the ritual, rhythm and creativity that should be present at childbirth. Odent (1984) draws our attention to the enormity of the birth experience: Birth, like death, is a universal experience. It may be the most powerful creative experience in many women’s lives. It can either be a disruption in the flow of human existence, a fragment having nothing to do with the passionate longing that created the baby, or it can be lived with beauty and dignity, and labour itself can be a celebration of joy. (Odent 1984, p.xxii)

The early days and months The baby begins to make sense of the world through the sensory experience with the mother. The physical and emotional surge, which is the focus of the early weeks and months, creates the joyousness and excitement of primary play through the senses, especially through smell and touch. These sensory experiences, a kind of proto-play, create the primary attachment between mother and child but they also have a biological basis (see Chapter 2). This sensory proto-play is necessary for the development of healthy attachments and the expansion of the child’s place in the social world. The singing and the storytelling that started during pregnancy continues in the early weeks. Playfulness is always an important way of strengthening attachment. Infants, as we have said, notice faces and their expressions within hours of being born and quickly recognise the face of their mothers, detecting moods and times of being ‘switched off’. Faces smile at newborns and very soon the infant smiles back. The primal gaze between mother and infant of love and acceptance not only makes a

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social impact, but also contributes to the growth of the brain. Although babies are initially responding through smell, touch and sound, sight becomes increasingly significant, in their social development as well as in their brain development. Perhaps the old saying ‘Out of sight, out of mind’ takes on a new significance for us. An interesting sequence of therapeutic play is initiated by Aanand Chabukswar (see Kashyap 2005) in India. He talks about the three significant stages: ‘Intend – Pretend – Attend’. Through these stages participants first of all understand the aims of what they will do, in a safe playing space with a whole range of physical movements, games and dance (Intend); then they go into dramatisation, role plays and other experiences that can enhance their well-being and also address difficulties that will stop them moving on (Pretend); then through reflection and sharing and various means of carrying their experiences forward, participants take from the session changes to integrate into their lives away from the sessions (Attend). I see parallels between this way of working and the sequencing of NDP, where, we hope, the early sensory and dramatic experiences will be internalised by the infant and become a part of their lives as they grow and develop. We always need to remember that our brains are still forming after we are born, and that the creativity and security established during pregnancy will continue after we are born. We shall then complete the cycle of consonant play to echo play, followed at three months by another series of play stages: Embodiment–Projection–Role (EPR), which are all very physical. Neuro-Dramatic-Play is the basis for the healthy attachment relationship between mother and child during pregnancy and labour, and it makes an impact on the healthy growth of the infant. NeuroDramatic-Play influences the powerful connection between social development and brain development. The early positive regard between infant and mother helps to build the brain both before and after the birth. It is important that this first relationship is playful, rhythmic and dramatised and it needs to involve the whole range of sensory experiences: touch, sound, taste, smell and sight. Neuro-Dramatic-Play is epitomised in the loving interactive gaze between the parent and the infant. Especially in the early weeks, it

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reinforces everything the baby has come to expect. Before any social skills can develop, we have to have a basic system of reflexes: smiling, following others and imitating facial expressions. These patterns of interactions in turn lead to our capacity to regulate and tolerate our emotions, often mediated through the ‘echo gaze’. Neuro-Dramatic-Play allows us to be safely held within the ‘Circle of Containment–Circle of Care–Circle of Attachment’ or ‘Theatre of Body’ until we are ready to face new stimuli or risk-taking. If we are held, we are contained and we feel both safe and secure within the physical and emotional circle of attachment. This leads to the basic trust of ourselves, our carer and the world around us. Having established the basis of NDP, in Chapter 2 we shall look in greater detail at the relationship between NDP and attachment theory and application.

Chapter 2

NDP and Attachment ‘My mother is the most important person in my life,’ sobbed Charlie, ‘You can say what you like, but I’m not drawing toys and birthday cakes; I shall draw my mum as she was kind. She made us picnics and we went for walks.’ Charlie was in an adult group for survivors of abuse and despite being neglected and ‘lent’ to various relatives, still maintained his ideas of his fantasy mother.

Introduction I described in Chapter 1 the significance of Neuro-Dramatic-Play in the development of healthy ‘good enough attachments’ in unborn children and babies up to six months of age. I emphasised the importance of understanding this critical developmental time for the emergence of empathy and healthy social relationships. In this chapter we look at our understanding of attachment and how it relates to the subject of Neuro-Dramatic-Play. We shall see how NDP can ‘repair’ damaged attachments through therapeutic intervention (see also Chapter 7) and can help build resilience in children and teenagers (see also Chapters 6 and 9). I will also describe my assertion that attachment is present from birth rather than some months after the baby is born. There is extensive literature written on attachment from many viewpoints; suffice it here to summarise some important pointers in our understanding of attachment theory and then see its relevance to NDP’s therapeutic effectiveness.

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Early attachment theorists Spitz, Bowlby and Harlow There seem to be two significant articles concerned with our initial understanding of attachment theory, which came about in very different circumstances but at the same time. In 1958 John Bowlby (1907–90) published ‘The nature of the child’s tie to his mother’, which is a forerunner of his later thinking on attachment observation and theory. In the same year Harry Harlow (1906–81) published ‘The nature of love’, in which he demonstrated that infant monkeys preferred emotional attachment to food. Both articles created controversy in different spheres. There were angry reactions at Bowlby’s assertion that mothers were responsible for unhealthy emotional development in their children, and many people were appalled at the cruelty involved in Harlow’s experiments with laboratory animals. The former later modified his views in regard to mothers, and we now have the phrase ‘good enough mother’ or ‘good enough attachment’. There is less blame on mothers and greater understanding of the process of attachment. Before Bowlby came to the fore in his attachment work, René Spitz undertook a study of infants in institutions and made a film Grief – A Peril in Infancy (1947), which is a study of the sadness and isolation of infants with no attachment figures. His study is mirrored by the more recent exposure of the neglect and abuse in some Eastern European orphanages where babies were fed with propped bottles and left without nurturing care. Many children were tied to their beds for long periods of time, and now look as if they have cerebral palsy rather than having distorted limbs from their early cruel treatment. I will say more about the Eastern European situation in Chapter 6. The importance of John Bowlby’s thinking and writing and his persistence for his work to be heard and read, cannot be underestimated in the field of attachment. There has obviously been a reappraisal of his thinking in contemporary childcare and therapeutic practice but his basic tenets still hold. There are challenges to his attachment theories such as those from Harris (1998), who suggests that children learn more from their peers than they do from their parents. However I find her propositions rely more on values and skills that can be passed on

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from parents or peers, rather than the attachment foundation that will form the healthy basis for security, trust, empathy and relationships. Bowlby’s early work is based on observations of refugee children and children in hospitals and residential nurseries (Bowlby 1951). Bowlby became sceptical of the psychoanalytic focus on the ‘inner life of the child’ while neglecting actual events in the child’s real life. He observed that separation resulted in ‘protest, detachment and despair’, and this is the basis of what he terms ‘separation anxiety’. Bowlby was trained both as a medical doctor and as a psychoanalyst, but he became increasingly preoccupied with the effects of early childhood experiences on the later emotional and social development of the child. No doubt influenced by his own difficult childhood (loss of a beloved nanny at four years old and being sent to boarding school at seven years), his main preoccupation was with the impact on infants of separation and loss. For a long period of time his ideas were rejected by the psychoanalytic field who thought (and mainly still think) that a child’s inner world or the inner world of the adult was the most important object of study. They even considered that paying attention to the impact of the child’s external world was an avoidance of the real issues! Bowlby stuck fast to his theories and research despite this rejection, and continued to research and write. It has been suggested by at least one author (see Mooney 2010) that one reason for the dismissal of the relevance of Bowlby’s theories was that they caused extreme discomfort to others. Perhaps the analysts fall victim to their own interpretations that it is less painful to stay within fantasy life than face up to the discomfort and guilt of real life. Maybe we should do an attachment study of the psychoanalysts who leave their infants with child minders! It is interesting to note how many of the writers on the early lives of children (Bowlby and Erikson for example) had damaging and difficult experiences themselves during their early lives.

Ainsworth and the Strange Situation Another significant figure in early attachment work is Mary Ainsworth (1913–99), who was an American developmental psychologist working at the Tavistock Clinic in London. When she moved to London in 1954, she answered an advertisement by John Bowlby for

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a research assistant. She worked for him for several years in what was the beginning of a lifelong collaboration on writing and research on attachment. She investigated the effects of maternal separation on child development and then did research in Africa. In the 1960s Ainsworth developed a procedure, ‘The Strange Situation’ in order to observe attachments between a child and his or her caregiver. The Strange Situation is used to observe the amount of exploration the child engages in throughout the session and the child’s reactions when the caregiver leaves and returns. A child is observed playing in the room with the mother close by, a stranger enters, after a brief time the mother leaves and then returns a while later. Ainsworth maintained that the securely attached child will manage this situation whereas the insecurely attached child will become anxious (Ainsworth et al. 1978). Ainsworth used the following specific terms to describe different attachment patterns in children: ‘secure attachment’, ‘anxious ambivalent insecure attachment’ and ‘anxious avoidant insecure attachment’. These terms have since been elaborated and there is a comprehensive list in Prior and Glaser (2006). Although she is perhaps best known for the development of ‘The Strange Situation’, Ainsworth also completed much needed cross-cultural research when she lived in Uganda for two years. She observed Ugandan mothers and their children in their homes and recorded patterns of behaviour when the children and their mothers were separated. Children became concerned at the whereabouts of their mothers, and welcomed them when they returned. Ainsworth observed the increase of independence in babies once they could crawl but it was always necessary for the mother to be present as the lap to go back to if anything was scary (in EPR terms this is the transition to ‘the world beyond’ from the Embodiment play to the Projective play: Jennings 2007a). There is a significant lack of cross-cultural research in therapy and child development, but then many theorists claim that their westernbased models are applicable across cultures. In my own research (Jennings 1994) with the Temiars in Malaysia, their ‘total attachment’ produces infants that have greater hand–eye coordination, earlier walking and greater independence than their western counterparts. However, these infants are breastfed until four years old, discouraged from crawling and are carried in a sling until they can walk independently.

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Ainsworth and Bowlby jointly published Child Care and the Growth of Love (Ainsworth and Bowlby 1965). There is an excellent description of Bowlby and Ainsworth’s work in Prior and Glaser (2006).

Harry Harlow The American psychologist Harry Harlow is acknowledged as having provided important research in our understanding of attachment, but only the most hard-hearted behaviourist would condone his cruel methods and exploitation of animals. Indeed his experiments have paved the way for greater ethical rules in animal research. He is remembered for his research with rhesus monkeys and ‘surrogate mothers’. His interests focused on affection and child development. In his experiments he used ‘surrogate mothers’ that were made either from wire or from soft terry towelling. The monkeys were offered choices between the two ‘mothers’, the wire one having feeding sources whereas the towelling one had no food. Harlow (1958) demonstrated that the monkeys would spend most of their time clinging to the towelling mother whether or not there was any food. Furthermore if there was a frightening stimulus or the monkeys went to a new place, they would cling to the cloth mother and would only gradually explore their unfamiliar surroundings. Harlow (1958) claims that this demonstrates the child’s need for affection and emotional nurture from mother figures.

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Although there is continued criticism of his research methods, Harlow’s observations are still used in current attachment theories. Whereas the psychoanalysts had claimed that the feeding of the baby was the most significant event in the baby’s development, Harlow (1958) demonstrated repeatedly that comfort was far more important. Freud’s insistence on the primacy of the oral stage of infant development has in fact led to neglect or perhaps avoidance of the primary significance of comfort and safety for the small infant’s healthy development. As we shall see below, Erik Erikson emphasised the importance of the development of trust during the first year of life, and the predictability of feeding is only one aspect of a trustful attachment. The great forerunners of attachment theories, Spitz, Bowlby and Ainsworth, communicated and shared ideas with each other. They also had in common the fact that their ideas were ignored or rejected out of hand for many years. Together with Harlow, they laid the early basis of attachment understanding which is still relevant today, although there has been some modification and development of their original ideas. Attachment theory is based on a fundamental human (and animal) need of a baby for close proximity with an adult: ‘a baby human has a need to establish an emotional bond with a care giving adult’ (Laschinger 2004, p.xviii–xix). It is important to emphasise that it is not only the nearness of the adult but also it being a significant adult that is crucial. When this does not take place, then such children will have difficulties in communicating appropriately, feeling empathy and forming relationships. They often experience loss and grief for the attachment or bond that they never had. These feelings can often be expressed in antisocial ways including a lack of trust in a new caregiver (see Chapter 8). It seems as if the child has lost hope. Small infants lack the verbal skills to express their distress at the loss of an attachment figure or object and we have to infer their feelings from forms of crying, rage or withdrawal. It is suggested by many (for example Sunderland 2004), that we are pre-programmed to attach and lack or loss of attachment can trigger these emotional responses from our primitive brain, the amygdala.

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Attachment and mourning We know that early traumatic life experiences suffered by some children seriously impair their ability to form positive reciprocal relationships. Children who have been neglected, abandoned or physically or sexually abused will have difficulties in their emotional and social well-being unless there is appropriate intervention or a significant lifechanging event. Bowlby in his later writings spoke of the wider context of attachment: ‘Attachment behaviour is any form of behaviour that results in a person attaining or maintaining proximity to some other preferred and differentiated individual’ (1979, p.154). Bowlby also helps us understand the importance of mourning in trauma and loss and the effect of the disrupted attachment, in our work as therapists. There are serious consequences from disturbed and unresolved mourning processes (Murray Parkes 1998). Often we do not recognise how deeply children experience loss, not only of close relatives and friends but also pets, homes, special toys or schools. Small children are often kept away from funerals because ‘they wouldn’t understand’ or because ‘they are too young to know anything’. Yet small children form very powerful attachments to their friends and relatives, pets and possessions, places and routines. Sudden disruption or death, or the confusion of situations that are not explained to them, will create an emotional impact on a child that needs to be acknowledged and worked through. Mikey Walsh’s description of his own traumatic childhood well illustrates the importance of all attachment figures – even those are brief and transitory: I came to love Mrs Kerr. She was the only person who showed me tenderness and affection. To have one person believe in me and encourage me to be whatever I wanted to be was the most wonderful thing that ever happened to me. (Walsh 2010, p.114) Unresolved feelings of loss of the loved one can affect people throughout their lives and impair their capacity to form trusting relationships. We trust someone not to go away or disappear or get run over. We have learned to trust our environment and the security of our bedrooms

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and the compass in our heads that locates everything under our roofs. If we move to a new locality or are suddenly taken into care or have our house repossessed, our roots have been torn apart, often with no preparation. Small children feel very helpless with these losses, and severe disruption or separation can become a permanent way of life. Therapeutic intervention is necessary as early as possible in the child’s life unless the parents have done very adequate preparation work and ‘hold’ the child for the duration of the experience of loss.

Winnicott and Erikson Donald Winnicott (1896–1971) contributes much to our understanding of attachment, and he continually talks about play and playful spaces: to him, psychotherapy is about two people playing. Although some of his writing may seem a little archaic to modern practitioners, such as talking about infant deprivation in relation to loss or death of mothers and never to financial insecurity or impoverished environments, nevertheless he is a creative pioneer in the field of ‘transitional objects’ and ‘transitional phenomena’. He named the soft cloth or soft toy that represents the absent mother, the child’s first symbol, as the transitional object. He suggests that great harm is done if children are deprived of their objects with which they form very powerful attachments. He also names masturbation as being a part of ‘transitional phenomena’ and that children should not be stopped from auto-erotic activity.

It is unfortunate that many so-called care staff believe that masturbation is wicked, and I find, certainly in Eastern Europe, that staff are shocked when I teach the importance of allowing masturbatory activity, providing

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that it is done in private. In one day centre for children of working parents, a member of staff told a seven-year-old boy to put his hands on top of the blanket when he was having his afternoon rest. She placed a pair of scissors on the bedside chest as a reminder to him that she would cut off his penis if he touched himself again. The worst orphanages in some countries may have been closed down, but the attitudes of the staff do not necessarily change. The ‘Creative Care’ training programme in Romania, for example, which I designed and have run since 2003, is reaching only a small minority of staff. Winnicott (1965) tells us that: Perhaps the most common disorder of masturbation is its suppression, or its disappearance from a child’s repertoire of self-managed defences against intolerable anxiety or sense of deprivation or loss. (p.157) And, ‘From a study of what normal children enjoy, we can learn what these deprived children absolutely need’. Winnicott, although trained and practising as a psychoanalyst and for several years president of the British Psychoanalytic Society, nevertheless discreetly and indirectly developed his own approach to understanding children. In my view one of his most important contributions to understanding attachment is his belief in the creative impact between mother and child: creativity is a primary drive, presexual and forming the basis of the reciprocal relationship between mother and baby. I will return to this in more detail when we discuss playful and creative attachments in Neuro-Dramatic-Play. Erik Erikson (1902–94) is probably best remembered for the phrase ‘identity crisis’. If Bowlby had events in his own life that triggered his interest in attachment, there is no doubt that Erikson had much in his life to fuel his interest in the subject of identity. He was born from an extramarital affair and the circumstances were kept from him. He was given the name of his mother’s husband; this changed on his mother’s second marriage when he was adopted by his stepfather. His birth father was Scandinavian and Erik was blue-eyed and blond, but brought up as Jewish. Apparently he was teased at the Jewish classes for looking Scandinavian and the boys at his secondary school mocked him for being Jewish.

Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion

Generativity vs. stagnation Ego integrity vs. despair

3 to 6 years

6 to 12 years

12 to 18 years

19 to 40 years

40 to 65 years

65 to death

5. Adolescence

6.Young Adulthood

7. Middle Adulthood

8. Maturity

4. Latency

3. Locomotor

Intimacy vs. isolation

Autonomy vs. shame/doubt

2. MuscularAnal

18 months to 3 years

Basic conflict

Trust vs. mistrust

Ages

Birth to 12– 18 months

1. OralSensory

Stage

Reflection on and acceptance of one’s life

Parenting

Love relationships

Peer relationships

School

Independence

Toilet training

Feeding

Important event

Table 2.1: Eight stages of psychosocial development (Erikson 1968)

A sense of fulfilment and peace with others, or despair

Adults find ways to support the next generation or may feel alienated

The young adult develops close relationships or feels isolated

Teenager develops sense and identity, for example in gender role, politics and so on, or becomes confused

Child deals with demands to learn new skills or risk sense of inferiority/failure

Development of assertion and initiative, but possible guilt feelings

Development of physical skills and coordination. Child may develop shame/doubt if punitive care given.

Loving, trusting relationship with caregiver, or child develops fear and mistrust

Summary

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Initially he was a teacher of the arts in Vienna. He met Anna Freud, and decided to become an analyst and also a Montessori expert because of its emphasis on child development. When he emigrated to the USA he became the first child psychoanalyst in Boston with an outstanding reputation. Like Ainsworth, he was interested in cross-cultural studies and researched child development with the Yurok Native American tribe. His most useful contribution to our understanding of child development and attachment is his eight stages of the growth of the child, adolescent, adult and elderly person, rather than the five stages of ego development that Freud claimed (see Table 2.1). Erikson postulates that people who are able to survive the ‘crisis of adolescence’ are those who can deal with the transition into adulthood, and we will look at this more closely in Chapter 9. For this current discussion, his most interesting statement is regarding the notion of hope. Hope, according to Erikson, derives from the conflict between ‘basic trust and mistrust’ during the infant stage. We know that the child without hope is the child who is in despair; the child without hope does not thrive. There are children who just fade away and die because of their hopeless situation. I wonder how many of us can remember a teacher saying to us that we were hopeless, or that our skills or knowledge were hopeless. People who have been kidnapped and who have hopeful personalities usually survive their capture more effectively than those for whom there is a feeling of no hope and no solution. The child who can hope is the child who can trust the person who gives them care and nurture and is predictable in their attention. Hope grows out of trust and if there is basic trust in the early attachment, the infant is more likely to be hopeful and often optimistic. How many people do we know with the belief that if you think the worst then there is no disappointment? There are many others who have contributed to our understanding of attachment and who are constantly relooking at attachment processes and refining them within a contemporary context. Howe (2005) gives an excellent description of a contemporary approach to attachment, in particular focusing on neglect. A selection of work by authors and researchers is included in Gerhardt (2004). The literature is also

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burgeoning with our greater understanding of neuroscience and the impact on the development of the brain of the early attachment relationship. Although there is disagreement between attachment specialists as to significant times the primary attachment figure needs to be available to the infant, there is no dispute that the first six months are crucial for the baby’s welfare. Hence there is an increase in the number of projects for pregnant women and mothers of newborn babies to increase the positive attachments as a basis for later development. Again I emphasise that the critical time for NDP is during pregnancy until six months old.

What actually is attachment? Despite the extensive research and literature about the importance of attachment, and there is little dispute that good enough attachments influence positive social and intimate relationships, there is far less information available on the nature of the attachment itself. Writers describe the necessary ‘emotional availability’ of the primary attachment figure to the infant and their capacity to ‘fine tune’ to the infant’s needs. What does this actually mean in the reality of child rearing? Attunement and reciprocity are qualitative aspects of bonding that reflect mutual awareness, emotional resonance, and turn taking. The mother’s ability to resonate with the infant’s internal states, and translate them into actions and words appropriate to the child’s stage of development, will eventually lead to the child’s ability to connect internal states with words. (Cozolino 2002, p.191) I think it is important to state very clearly that the primary attachment figure needs to be able to play! Attachments are playful and from conception women are usually playing with their infants and through play are establishing the attachment. We know that there is a biological drive too, what is termed the neurochemistry of bonding, as described by Cozolino (2002): The neurochemistry of mother–child bonding is very complex: The warm and happy feelings; the desire to hold, touch, and nurse; the pain of separation and the joy and excitement of reunion all have neurochemical correlates that

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allow us to experience these wonderful feelings… Through a bio-chemical cascade, mother–child interactions stimulate the secretion of oxytocin, prolactin, endorphins, and dopamine. (Cozolino 2002, pp.176–7) The holding, touching and nursing between mother and infant need also to be understood in relation to playfulness. The mother needs to be able to play in a sensory way because that is how we develop our own senses and our senses are the most important aspect of our early embodied experience. It is through our sensory play of touch such as massage, stroking, finger-tipping, bathing and warm towelling that the infant develops a body-self (Jennings 1998). As Cyrulnik (2005) put it, ‘When the sensory developmental supports in the child’s environment are missing, the world no longer has an outline’ (p.13). The other senses – sight, hearing, taste and smell – are all part of the playful relationship as mothers look at their babies and pull faces and the babies do the same (the beginning of echo play); little sounds in toys, musical boxes and bells as well as the crooning and songs of the mother stimulate the hearing; and babies soon know if their mother has eaten something bitter or acidic as the taste of the breast milk is different! The smell sense in some ways is the most important as it is the way babies recognise their own mother compared with any other mothers. And we can observe the snuggling and snoozeling that the baby makes at the breast before actually feeding. NDP focuses on sensory play in a therapeutic setting if there are difficulties with attachment relationships. Many sensory experiences can be reproduced together with the rhythmic play that gives a basis for security. Rhythms of heartbeats, clapping, rocking and simple drum beats enable infants to be grounded in their bodies and in the sounds. As I said in Chapter 1, a crucial aspect of the attachment relationship is ‘as if ’ play – the dramatic play that includes imitating each other, echo play – mother playing as if she is the baby – baby playing as if she or he is the mother. NDP emphasises the dramatic response in early play and in NDP therapy. Storytelling is also important in NDP and can be very simple, autobiographical or the retelling of a favourite tale with expression and cadence. It has been suggested that mothers need to regress in order to play and I wonder whether this is just another psychoanalytic straitjacket.

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Maybe the mother has to relearn how to play, or to learn to play for the first time if she did not play as a child. However, I do not see this as regression. Playfulness needs to be a part of our lives ‘from cradle to coffin’ and so we need creative environments to try to make sure that it is possible. The importance of NDP very much belongs to the infant’s world at the very beginning. This is the critical time when babies need their mother’s presence, when absence cannot be held in the experience that she will come back. Small babies do not yet have that mental apparatus – when she is gone, she is gone. Once we are able to hold a symbol such as Winnicott’s (1965) transitional object, or the ‘representation of an event’, there is the increasing belief that the absence will be brief and soon there will be a joyous reunion. Even so, the small infant is as yet unable to have a representation of an event; he or she cannot yet hold on to a concept, and is left with the feeling ‘I have been abandoned.’ If this too early separation happens repeatedly, it will become set in some kind of maladaptive behaviour. Babies and toddlers eventually do acquire the capacity to hold a representation or image of a person or event, but it cannot be forced or hurried. The small infant is not yet equipped biologically or emotionally to deal with significant absences. When a loved person isn’t there and a child is too young to understand, it can be extremely painful. You can’t just say to a child who is missing his Mommy, ‘Look, don’t feel like that,’ yet adults often give that sort of message to small children. When we pry a distressed child away from his parent and urge him not to be ‘silly,’ we entirely underestimate the power of the massive hormonal reactions in his brain and body. (Sunderland 2006, p.51) Professionals need to assist parents to understand the trauma of sudden separation or early loss. It is not just a question of acknowledging and managing emotions, it is also an understanding of the chemical reactions in the body to undue stress. When small children are separated too early or for too long, their cortisol levels rise and can flood the brain. Cyrulnik says that once we can hold a ‘representation of an event’ (or symbol), it can be a turning point in dealing with our traumas. But for the very small infant, separation trauma feels sudden and permanent:

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Every trauma shakes us up and sets us on the path to tragedy. But the representations of the event enable us to make it a turning point of our personal history, a kind of dark guiding star showing us the way. (Cyrulnik 2005, p.12) If there is the possibility of caregiving responses to the traumatised child, the damage may be ameliorated in time. For example, the sudden death of one parent may be contained for the child by the support of the remaining parent, providing he or she is emotionally ‘available’. For some people, their grief is so overwhelming that they cannot attune to their child’s emotional needs. Nevertheless attachment distress generally provokes a protective caregiving response by those adults involved with the child.

Attachment distress is triggered by physical discomfort (illness, hunger, pain), feeling frightened or sudden separation from the attachment figure: not only physical separation but also psychological separation. Some mothers or caregivers are not available emotionally for the infant. This may be because of their personal attachment needs or sudden loss or trauma. It is easy to observe the outgoing nature and sociability of most small infants. They invite reciprocity; they seek dialogue through gestures and expressions, sounds and rhythms from a very early age, usually days and weeks rather than months. It is within close attachment relationships that children learn to make sense of themselves, other people and social interactions. They

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begin to develop mental representations of how to view the self and others: their internal working models contain expectations and beliefs about their own and other people’s behaviours. Babies begin to experience that they are lovable and accepted and that others, especially their mothers, are emotionally available to them with interest and concern. Bowlby (1969/1971) emphasises the dimension of protection and security and suggests that the ‘enduring affectional bond’ is rooted in biology. This is where we can see the need for NDP where there is an impoverished attachment or where a child’s most basic playful needs are not being met. Ideally we should seek to implement an NDP programme with mothers and their babies in order to enhance their attachment relationship. If mothers are unavailable, it is possible to enable carers to create the NDP potential with babies and infants. This is discussed further in Chapter 8. There have been several pioneers in the field of attachment, particularly John Bowlby, and we now have an understanding of the inability of infants to thrive if they do not have at least an adequate attachment with their primary carer. Neuro-Dramatic-Play is particularly indebted to attachment theory because it highlights those crucial early months in a baby’s development where a playful attachment needs to be developed. Neuro-Dramatic-Play consists of sensory, rhythmic and dramatic play that forms the basis of the playful attachment relationship. It is important that NDP can be structured within storytelling. Neuro-Dramatic-Play enables the development of trust and hope, and the capacity to empathise with others. It forms the foundation for the potential of future social relationships. Neuro-Dramatic-Play and attachment empower the continuing story.

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Chapter 3

NDP Play and Play Therapy In my father’s lap everything was yellow and blue, I longed to swim like the boys. ‘Of course not’ said Father I should’ve run from him, leapt off the wall. I should’ve said ‘No’ to him! But I sweated on his lap in my blue woollen dress. I’ve always longed to go back to Acre… (Zuabi 2010, p.43)

Introduction In the previous chapters we have established a working definition of Neuro-Dramatic-Play and how it develops in normal child development during a critical time from conception to six months of age. We have also seen how NDP is central to the establishment of a good enough attachment relationship between mother (or other primary carer) and the newborn child. I have mentioned the major pioneers in attachment theory and practice so they will not be repeated here, apart from reminding the reader that so much of our work is about relationships, and play is one means of relating to someone else. In that context of course it is Winnicott who had such a profound understanding of children, mothers and playfulness: I suppose that everyone has a paramount interest, a deep, driving propulsion towards something. If one’s life lasts long enough, so that looking back becomes allowable, one discerns an urgent tendency that has integrated all the various and varied activities of one’s private life and one’s professional

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career. As for I can already see what a big part has been played in my work by the urge to find and appreciate the ordinary good mother…for me it has been to mothers that I have so deeply needed to speak. (Winnicott 1957) It is now time to consider the relationship between play and play therapy, and make the links between NDP and Neuro-Dramatic-PlayTherapy (NDPT). There are many publications on both play and play therapy (see the References), and a single chapter cannot possibly do them all justice. It must suffice for me to give some brief comments on both fields and their connectedness, on the ‘play to play therapy’ continuum where playing can be considered a ‘preventative’ activity and play therapy a ‘curative’ activity. There is a large overlap in the middle where children are able to generate their own play to help themselves; this often does not need the intervention of play therapists. Teachers also have an important role to play (see Chapter 12) in maintaining the status of play within the educational framework, as a source of selfdiscovery, learning and development. Play and play therapy are the means through which we can contextualise Neuro-Dramatic-Play, and see how it can be developed for infants, children and teenagers where it has not taken place in early life. In Chapters 1 and 2 we saw that playfulness is the central core through which mother and baby are able to establish a healthy attachment during pregnancy and the first six months of life. As I emphasised, primary playfulness between mother and baby includes sensory play, ritual play and dramatic play. Playfulness is not only the means by which a mother expresses her care and concern, it is the care and concern, it is the relationship.

Play and playing Theorists going back into the mists of time have debated the importance or otherwise of children’s play. Whereas Plato (1974) was adamant that child play was ‘the biggest menace that can ever afflict a state’

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(similarly he wrote about the dangers of the actor), Aristotle was more positive in his ideas about play being important for the socialisation of children. He also believed that children’s play was the origin of poetry (these ideas are developed in Goldman 1998). Cattanach (1992/2008) gives an overview of the interest in play and the attempt to study it scientifically from the Victorian age. Play has also been linked to studies in education and as early as 1917, Caldwell Cook was emphasising the importance of play as a natural means of study. It is interesting that significant writers such as Caldwell Cook (1917), Peter Slade (1954), Brian Way (1967) and Richard Courtney (1968) have all emphasised the importance of play and drama, and the child as a natural actor. However, both in ancient and more modern times, actors have been despised, vilified and not treated as ‘true artistes’. Classed with tinkers and other itinerants, they were unable to have a status within western society. So difficult was it for them to obtain any sort of insurance that the actor’s union, Equity, eventually created its own insurance company. In contemporary media, actors are asked to endorse products, have their private lives examined and generally stay in the public eye through events in their day-to-day lives, rather than their acting. Play, acting, pretence and dissembling all seem to be enmeshed in our thinking as being untrue, lies and even psychopathic: it is the conman on the doorstep who is able to convince us to part with money because he is a good liar. It is the politician who covers up the corruption with lies that shocks us; ‘If only we had known’ or ‘truth will out’, or as Polonius advises his son Laertes in Hamlet: This above all – To thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man. (Hamlet 3.i: 78–80) We also need to remember that one word for the actor in Greek is hipokcritiki, which is the word from which we get hypocrite and hypocrisy. It would be easy at this point to get into the realms of philosophy and the nature of ‘truth’; let us stay with the idea of pretend play and

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why it is disturbing for some people to accept. Of course when we are working with people on the autistic spectrum we know that ‘let’s pretend’ is very difficult because in the main they are concrete thinkers (see Chapter 10). There seems to be confusion in the differences between ‘everyday reality’ and ‘dramatic reality’ (Jennings 1998). Mothers will play at pretend games with babies, but then become concerned at their children lying when they report a more romantic notion of school than the harsh reality (Jennings 1999a). Play is dismissed as being silly, a waste of time and not important when compared with the necessary world of work. A group of local fund-raisers in the mid 80s said that they would not raise money for a play group for the children ‘to waste their time scribbling’! It is only recently that anthropologists have been starting to take an interest in children’s play in its own right, and a lot of time is being spent in definition and observation. Goldman (1998) states that anthropological monographs about child play, including make-believe play, are extremely thin on the ground: Play analysts have suggested that such neglect is an outcome of the way academia itself, a quintessentially adult pursuit, perpetuates and embraces a socio-historical legacy which devalues infant interaction. Thus the most conspicuous facet of children’s behaviour – their indulgence in ‘play’ – has often been typified as irrational, trivial, non-productive and decidedly something other than work. (Goldman 1998, p.xv) Goldman (1998) also suggests that: And yet the topic of ‘as if ’ play is, I believe, an area of potential and consequential effect for anthropology. Such lucid phenomena provide a unique window onto current interests about human imagination, about images of modernity, about how roles are imbued with distinct ‘voicings’, and about how these in turn get translated and transformed into mythic texts. Amongst the myriad of ways in which anthropology has sought to locate itself in respect to understandings about the ‘imagination’, pretend play offers a unique and

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ethnographically grounded tangent along which to pursue such quests. (Goldman 1998, p.xvi It is encouraging that the Convention on the Rights of the Child was adopted on 20 November 1989 by the United Nations General Assembly. Article 31 states: ‘Every child has the right to rest and leisure, to engage in play and to participate in recreational, cultural and artistic activities.’ Moyles (1989) points out that there are three more or less accepted benefits for play within education, and its essential inclusion within the curriculum: • the acquisition of language • the capacity to problem solve • the development of creativity. Parents and teachers alike can more or less accept the first two premises, but often have great difficulty with the third; creativity can be seen as ‘arty’ and not relevant for a modern school syllabus. Moyles (1989) goes on to say: If we accept that being able to express oneself effectively is a ‘good’ outcome of education then nowhere is this more likely to happen for younger children than in creative activities associated with play. The child as ‘creator’ appears in a majority of play contexts… Children constantly create and re-create ideas and images which enable them to represent and come to terms with themselves and their views of reality. These can be captured within children’s talk, drawing and painting, craft, design, music, dance, drama and, of course, play. (Moyles 1989, p.70) Although intellectually there appears to be a greater acceptance of the importance of play, especially in the early years settings, play groups are now facing stringent financial cutbacks and nursery places are more and more limited. We value the importance of physical play and games, and a direct link has been demonstrated between physical play and alertness and effective learning. As playing fields are sold off to developers, there is less and less room to play, and swimming and other outdoor activities such as conker games are so beset by health and safety procedures that

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schools may give up. In 2010 snow storms in the UK led to many schools being closed in case children got hurt. How many of us can remember the wonderful school days in winter when we were allowed to play outdoors and throw snowballs, build snowmen and women, create a slide or build an igloo? We could indulge our bodies and imagination to the full with little need for adults. Perhaps the award-winning film The Snowman (1982) from the story by Raymond Briggs touches our ancient snow memories. It has music, cartoons and lyrics by Howard Blake and the one song, ‘Walking in the Air’, is sung by a St Paul’s Cathedral chorister. It is a story about a developing relationship between a small boy and the snowman he has built. The snowman comes into his house, fiddles with all the technology and then boy and snowman go off on a motorbike, scaring many animals as they go. The song starts as they fly through the air to the land of the snowman where the boy is the only human. Eventually returning to earth, the snowman melts in the morning sun and the boy wonders if he has dreamed everything, but he finds the scarf that the snowman gave him and he knows what happened is true. Maybe the fact that it was voted into fourth place in UKTV’s greatest TV Christmas moments in 2000 shows its wide appeal, not only in the UK. What is the appeal for old and young people alike? It is also a story that can be shown and read to children or an individual child that can stimulate their imagination, take them into a fantasy land where they can understand things differently. And of course at some level there is an acknowledgement of loneliness in both of the characters, an exploration of strange objects and situations and an experience of the temporary nature of some encounters.

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Karen Stagnitti is one of the most important current practitioners and theorists of play as a therapy. In her book Play as Therapy she says with co-editor Rodney Cooper (2009): Play not only affects a child’s development and inner world, but contributes to his or her development as an active, dynamic and open ended process that continually challenges and facilitates growth, development and individual competence. How children play, where they play and what they play, largely reflects their culture and environment. (Stagnitti and Cooper 2009, p.16) A cross-cultural understanding of play is very important or we can get into a mind-set that stays with a generalist view that ‘play is good for you’; there is no point in starting cultural conflicts by, for example, suggesting to a group of Gypsy children that they all sit on the floor, when they have been socialised into a strong ethic that floors are dirty and fit only for animals. Similarly, the idea of rough and tumble play would be quite out of place for some families from India. In an East Indian study, Roopnarine et al. (1994) comment that unlike their western counterparts, parents rarely engage in rough stimulating activities. In a culture that values physical closeness, fathers show their affection through physical holding. Parents engage their children in a wide variety of games and physically close play. These occur during massage, during informal sessions when the mother is resting with the baby, or when the mother is engaged in routine caregiving. Although the games vary from region to region and across age groups, there are common elements mirrored in them: physical closeness, their high tactile nature, social messages about the culture, and their rich linguistic content. (Muralidharam et al. 1981, p.15) The writers continue with descriptions of play interactions that involve not only tactile stimulation but also singing. A delightful example is given of a game from Bengal called ‘Kan, Dol, Dol’, where the mother and child sit facing each other and holding each other’s ears. The mother rocks her baby and sings:

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Kan do, dol, du luo ni, Ran ga ma thae chiruni, Bar ash be ek hu ni Ni ye ju be ta knu mi. Which translated means: The bride is decked and waiting The bridegroom will come just now And take her away. (Muralidharan et al. 1981, p.15) Play observation across cultural groups will yield ideas about identity, values, relationships and myth making. It will illustrate not only how children learn important adult skills, but also how the imagination will create narratives and rituals that are congruent with the beliefs of the people themselves.

Play can be messy Many children go through a stage of messy play before they become more ordered in their playing. I want to draw a distinction between chaos and mess! Most of us have memories of puddle-jumping or swishing through leaves when we were young. Beckerleg (2009) says in a delightful beginning to her book that is all about messy play: How I came to discover messy play. I don’t think I discovered it, more it discovered me. I have always been messy. From an early age I was in the garden cooking with weeds and earth; filling the sandpit with water; digging a muddy hole to find water or Australia, whichever came first; making perfume from stagnating rose petals; and making ice-cream from milk and butter and leaving it by the fire to set! As a child – there is no doubt – I enjoyed being messy. I have continued this theme into my adult life and have enjoyed a great deal of messy play with my own children. (Beckerleg 2009, p.17) Mess making is an important time in sensory play where children are discovering all their senses in a variety of media from bubble to finger paint to sand and water play. In the early sensory play in attachment

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development, there is dribbling of milk at feeding time, discovery of saliva as mothers suck their baby’s fingers, lotions and potions at bath time and nappy changing. Children return to their own messy play as they explore food and saliva, often irritating parents when they are sticky. Messy play is a means of discovering order: by making a mess I can learn limits, containment and borders. It is also a means of developing sensory play, and may continue in some form into adult life. For example, gardeners and farmers create and work with lots of mess; nursery and infant school teachers have mess as part of their working day; cooks and caterers mix lots of ingredients by hand, and know that their hand-mixed baking gives better results than that done with mixers. They are sensitive to, and creative with, the ingredients. There are some occupations where perhaps there is less pleasant mess to be dealt with, such as doctors or nurses or vets. Mess-making sensory play is an important stage in the embodiment process for the infant.

Messy play is not chaotic play Messy play can sometimes be mistakenly confused with chaotic playing: play that has lost its boundaries and is literally out of control. A mother will cry out in desperation, ‘What a mess!’ when perhaps she means, ‘I can’t live with this chaos.’ We all recognise the moment when a child ‘loses it’; often there are two heightened red marks on the cheeks, a burst of uncontrollable energy and all the toys are swept to the floor, jumped on or wrecked in some other way. It is important to observe the ‘chaos cues’ and remind children of the contract (things are not broken or destroyed in the play room). The therapeutic use of the therapist’s voice can create a stability through rhythmic cadence (music therapists are superb at this). In the basic principles of NDP, rhythmic playing is an essential means of grounding and stabilising. This can be achieved through songs, drum beats and physical games that involve rhythmic movement. There are more NDP therapy ideas in the appendices that address more difficult situations that teachers and therapists dread in their caring work. I also describe very practical methods such as worksheets and therapeutic stories about mess and chaos in Creative Play with Children at Risk (Jennings 2005b).

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We all know families who seem to live in a perpetual state of chaos, where all cupboards and surfaces melt into one jumble: junk is pushed to one side while food is consumed from the packet and the milk bottle. And this is how they live and meet the world, unless someone in the family decides that ‘enough is enough’. I know one such family where the daughter has decided that she cannot live in such disarray and has transformed her own bedroom into a model of cleanliness and tidiness; she is studying Korean language and culture, which is an extremely organised way of life. There are situations where the chaos has become destructive. Take, for example, the family who live with the extremes of a parent with bipolar disorder, where often the normal organisational limits have been dissolved: night and day merge into one another; meals are eaten in the middle of the night; the house is in turmoil from energetic bouts of creativity and then total despair. There is also the chaos and confusion that comes from an abusive family where the norms and values are turned upside down. In some situations children are made to engage in inappropriate sexual behaviour; for others they become the carers of their parents who abuse alcohol or drugs. Some of these children may well be taken into care, and some of them may be referred for play therapy.

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Playfulness and play In NDP I refer frequently to primary attachment being a playful interaction between mother and small baby (Jennings 2009a, 2009c): playful has been defined as ‘fond of or inclined to play; done in fun’ (Concise Oxford Dictionary: Allen 1990). In order to play we must have an inclination to be playful. Playfulness is defined by Cordier and Bundy (2009) as a web with four quadrants – intrinsic motivation, internal control, freedom to suspend reality, and framing – and playfulness at the centre, and that playing varies in balance between these quadrants. Heathcote talks about ‘the suspension of disbelief ’ (Heathcote and Bolton 1995) that is necessary for drama work with children. When we pretend and enter ‘dramatic reality’, our everyday ideas are suspended in order for the imaginative processes to have their own life. If we have an inclination to be playful, then we will play in some form or other.

Play therapy The British Association of Play Therapists uses the following definition of play therapy: Play therapy is the dynamic process between child and play therapist in which the child explores, at his or her own pace and with his or her own agenda, those issues past and current, conscious or unconscious, that are affecting the child’s life in the present. The child’s inner resources are enabled by the therapeutic alliance to bring about growth and change. Play therapy is child-centred, play being the primary medium and speech the secondary medium (www.bapt.info). There are many different systems of play therapy that have grown and defined themselves with their own set of core practices since the early 1990s; there is now ‘approved’ training for play therapists with codes of practice and ethics. There is now a comprehensive training in ‘Playwork’ (Brown 2006) and several play therapy training approaches (McMahon 1992; West 1992). There were some significant early pioneers in the field of play and therapy who paved the way for others to follow. Margaret Lowenfeld (1979) developed her ‘Make a World Technique’ using a sandtray and

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small toys; she had an enormous collection of little figures and produced lists for therapists of toys to acquire so that the child would have plenty of choices. Sandplay as a therapy has been developed by Jungian child therapists as a discipline in its own right (Ammann 1991; Kalff 1980; Weinrib 1983). Other play therapists incorporate sandplay into their wider range of techniques (Jennings 1999a, 2005b), the difference being whether the sandtray is central to the therapy or whether a child or adult has a choice of the sandtray and other play materials. In my own work I use a circular sandtray as another means of containment within the safe circle. The influence of Carl Rogers (1951/1961) has been profound in the exegesis of child-centred and non-directive play therapy. Virginia Axline with her book Dibs in Search of Self (1964) made a profound impression on many people working with children, and her early text, Play Therapy (1947/1989), paved the way for many future play therapists. My abbreviated summary of Axline’s (1947/1989) eight basic principles which ‘guide the therapist in all non-directive therapeutic contact’ is simple (p.73): 1. The therapist must develop a warm, friendly rapport. 2. The therapist accepts the child exactly as he is. 3. The therapist establishes a situation where the child feels free to express his feelings completely. 4. The therapist recognises the feelings in the child so these may be fed back for the child to gain insight. 5. The therapist maintains a deep respect for the child’s ability to solve his own problems. 6. The therapist does not attempt to direct the child’s actions or conversations in any manner. The child leads, the therapist follows. 7. The therapist does not attempt to hurry the therapy along. 8. The therapist establishes the anchor of the therapy in the. real world, and makes the child aware of his responsibilities in the relationship.

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Non-directive play therapy in skilled and experienced hands can make enormous differences in the life of troubled children. Many children who are ‘out of control’ find a means of developing their own inner control through this method. Some non-directive play therapists use this approach but with interpretations based on Freudian or Kleinian principles, so possibly Axline’s tenets numbers 5 and 6 would not apply to them. Violet Oaklander developed an influential approach drawn from the theories of Fritz Perls and Gestalt therapy. Her book Windows to Our Children (1978) is still a delight to read. Gestalt play therapy is founded on the basic tenets of Gestalt theory where individuals are perceived as more than the sum of their parts, and where all behaviour is regulated by a process of homeostasis. According to Blom (2006): Integration as an objective of gestalt play therapy requires that children as a holistic entity, must be helped to integrate their cognition, emotions, body and senses in order to complete unfinished business on their fore-ground. All of these aspects of the child’s holistic entity should be attended to during assistance-rendering. (p.54) By complete contrast there is a school of cognitive and behavioural play therapy that is task centred and goal orientated, which works through a structured programme of play therapy to deal with specific issues (for a discussion of directive/non-directive play therapy, see Carroll 1998). Some directive play therapy is used to prepare children for, say, hospitalisation and treatment; it is also used for addressing chronic nightmares in children (Marner 2000). Cattanach (1992/2008) has devised A Model of Play Therapy to Heal the Hurt Child which is based on a narrative approach and social construction theory. She says that it is based on the stories we tell about ourselves and the stories that other people tell about us. She continues: Abused children often have dominant stories told to them by the perpetrators of their abuse and through their behaviour and talk seek to have these opinions reinforced by those around them. They constantly set up situations to prove the dominant story that they were ‘naughty’ or ‘bad’ or ‘sexy’. In

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Play Therapy the themes the children present in their social world also appear in the imaginative stories they express. In therapy we play together with these imaginary stories, expanding themes, changing and shifting meanings, exploring alternative plots and solutions until the stories develop in ways that can support the child and not lead to further exploitation. (Cattanach 1992/2008, p.51) We have also had innovations in approaches called ‘filial therapy’ and ‘theraplay’, which are briefly described below.

Filial therapy The goal of filial therapy is to enhance the parent–child relationship (Landreth 1991/2002). It was first developed by the Guerney couple in the 1960s, and since the early 1990s has been refined and defined by Landreth (1991/2002). Landreth combines instructions to the family, role playing of difficult situations, and supervision of play situations between parents and children. Landreth suggests that professionals collaborate in this approach, for example by having counselling and filial therapy with a parent, and someone else seeing the child for play therapy. Landreth acknowledges that it is a short-term intervention. Sue Bratton in collaboration with Landreth, Kellam and Blackard have produced a workbook of a tenweek programme that can be used by parents, teachers and therapists.

Theraplay From its beginnings (Jernberg 1976), Theraplay is clear that it is an ‘attachment based therapy’. Theraplay has four dimensions that are modelled on a healthy parent–child relationship: 1. Structuring: Parents are trustworthy and predictable, and they help define and clarify the child’s experience. 2. Engaging: Parents provide excitement, surprise, and stimulation in order to maintain a maximal level of alertness and engagement.

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3. Nurturing: Parents are warm, tender, soothing, calming, and comforting. 4. Challenging: Parents encourage the child to move ahead, to strive a bit, and to become more independent. ( Jernberg and Booth 2001, p.17) They are clear that it is not for all children and families, and there may be occasions where longer-term insight-focused play therapy could be needed.

Play therapy dimensions model This approach to play therapy has been developed by Yasenik and Gardner (2004) as an organising framework for therapists, and as a means of making decisions regarding interventions. It is based on four quadrants: conscious/unconscious on a vertical axis and directive/ non-directive on a horizontal axis. The dimensions are created by a vertical axis from conciousness to unconsciousness, and a horizontal axis from non-directive to directive; this creates four quadrants and the therapist is free to choose a quadrant that best serves the interest of the individual child. It is extremely useful for considering starting

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points for children in therapy and the ensuing development into the appropriate mode of intervention.

Neuro-Dramatic-Play and play therapy In Chapters 1 and 2 we saw how NDP is a means of more fully understanding the relationship between mother and baby during pregnancy and the first six months of life. We considered the basic components that enhanced the attachment relationships of: • sensory play and messiness • rhythmic play and ritual • dramatic play and mimicry. The application of NDP principles in a wide variety of situations is described throughout the book, and there is a long list of NDP techniques and materials in the appendices. In this chapter on play and play therapy, I give a precise description of how NDP principles can be used as a structured intervention in play therapy with children of all ages.

Sensory play Many children will not have had the primary experience of sensory play while they were growing or when they were born. Indeed many people find birth a messy experience and one they do not want to remember. However, the slipperiness and holding, warm washing and towels, warm breast, food and massage are just some of the important sensations of the early hours and days after being born.

Rhythmic play There are children who have not developed and internalised a sense of repetition and predictability; there was no awareness of mother’s and infant’s heartbeats; there was no rocking or clapping, no phrases and chants; and there may well have been unpredictable outbursts of physical abuse or shouting. Rhythmic play is also vocal through humming, chants and songs, and NDP intervention includes singing and drumming.

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Dramatic play When you are very small this needs two people but many children have not been given the time or the patience from a significant adult to establish this playful activity: mimicry and funny faces, copying and changing, building up to a happening…1, 2, 3 – here it is! All these forms of playing are primarily embodied activities that serve different functions in the baby’s neurological, emotional and social development.

Sensory, rhythmic and dramatic elements in play therapy Neuro-Dramatic-Play therapy can now be applied as a discrete model of attachment based intervention for children, teenagers and adults. NDP therapy is appropriate for children and teenagers with attachment difficulties and where playfulness is absent in primary relationships. There may be emotional or behavioural difficulties, disassociation, and abuse in all its forms, including self-harm. It is also appropriate in situations of loss and bereavement, family break-up, trauma and learning difficulty. NDP therapy is applied as a short-term intervention: initially 12 weeks that has boundaries and is contained in time and space. Further blocks of 12 weeks can be put in place if necessary, after careful consideration, but the staff will consider the developing skills of the parents and other family members in continuing the NDP. Support is given to families to continue the play but also allowing it to mature into new stages of development. NDP therapy is unique in that it is usually conducted in small groups with a one-to-one ratio of adult and child, with one or two facilitators. Depending on the severity of the situation, the one-to-one will be another professional, volunteer or student in training. As soon as possible another member of the family needs to become part of the dynamic so that each child has two adults, one family member and one professional. Eventually the progression will lead to the professional (apart from the facilitator(s)) withdrawing from the situation and the parent continuing the playing with their child.

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Therefore it can be seen that NDP re-creates the early attachment dynamic and allows the opportunity for re-parenting a child within a group context. The group can all be involved in the rhythmic and dramatic playing. As far as I know this is a unique approach because it takes place with in a group setting rather than individually. NDP therapy moves on to another major life stage after the satisfactory completion of the essential sensory, rhythmic and dramatic playing stages, which is called the Theatre of Resilience; described in Chapter 12. Chapter 4 addresses Neuro-Dramatic-Play development during pregnancy and childbirth.

Chapter 4

NDP, Pregnancy and Birth

As I was laid in my mother’s arms, Granny Ivy with her dyed black bouffant hair, mouthful of gold teeth and physique of that of a child said ‘that is the fattest child that I have ever seen in my life, Bettie! A little pig boy’… the night Bettie Walsh gave birth to a pig has gone down in family folklore. (Walsh 2010, pp.15–18, 22–3)

Introduction The words ‘playful’ and ‘pregnancy’ do not usually go together. The subject of pregnancy usually becomes serious with lots of things that potential parents must pay attention to: appointments, scans, diets, exercises and a host of decisions regarding location of the birth and the support and economic systems that need to be in place. My contention is that whatever the circumstances and whether the baby was planned or even wanted, the overriding quality of playfulness could make a very big difference to the worries, doubts and possible despairs. Unfortunately, therapists and counsellors become involved only when there are issues around extreme anxiety or difficulties with fertility, and not always then. Selwyn well describes the mixed feelings that women experience once they know they are pregnant: Motherhood is commonly discussed as though it involves only pleasurable feelings. When faced with the reality of pregnancy, many mothers have a mixture of feelings: disgust at changes in body shape, joy if the pregnancy is wanted, or terror at the forthcoming labour. (Selwyn 2000, p.21) 81

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This chapter focuses on the importance of the NDP processes that usually start during pregnancy and suggests a programme of NDP that can be a part of preparation both for the birth and for life outside the womb. It also provides some developmental pathways that can heighten understanding of the gradual development of pre-birth attachment. This chapter emphasises that the NDP process is not exclusive: it needs to be a part of all the pre-birth preparation and antenatal checkups and classes. NDP needs to be within the ‘pregnancy circle of care’ that focuses on biological development, physical preparation and playful preparation (Figure 4.1). • The biological development is usually addressed in the antenatal clinic through examinations and scans. Medical staff will monitor the healthy stages and growth milestones of the unborn. • The physical preparation is for the mother for the good of herself and for her unborn. The antenatal clinic usually has classes that include breathing and posture, as well as general advice about pregnancy. • The playful preparation can happen in a class or can be practised by the woman with her partner or alone, throughout the pregnancy.

Developmental

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Figure 4.1: Circle of care

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Within the circle of care approach, I am focusing mainly on the playful segment for the development of NDP. The ‘Circle of Containment – Circle of Care – Circle of Attachment’ (Jennings 2009a) is being developed in a new book, Playful Pregnancy – Positive Children (Jennings, in preparation). We consider the other aspects of pregnancy that interweave with the playful. For example when a woman is feeling horrendous because of early morning sickness, she will not be feeling very playful! Nevertheless if her body is tired and feels misshapen, there are relaxation exercises she can do with her imagination that will restore the playful mind-set and act as a calming agent. Many of the techniques that are suggested for pregnancy play will be already practised by many women; here they are developed and expanded, and placed within an attachment context. This will then have a coherence that can be understood within the 40 weeks of the pregnancy.

The growing relationship A mother’s relationship with her baby usually starts during pregnancy when a small flutter occurs which indicates the beginning of movement. That butterfly wing sensation is often referred to as ‘quickening’, meaning that the baby is a living being. Sometimes women are not sure it is happening and it can take a few flutters to convince them that the baby is really there. The earliest movement that can be sensed by the mother starts at around 16 weeks, although the foetus has already been moving around for several weeks. Now that it is felt to exist in reality, the relationship between mother and baby can begin to develop in playful ways. This relationship, if supported and encouraged, will create the roots for a healthy attachment once the baby is born. Selwyn also makes the point that parents are affected by the opinions and trends around them, and by their own mental and physical health as well as their family and social relationships: Parents are affected by dominant discourses, by changes in their own physical and psychological health and changes in relationships with extended family and friends. In turn, foetal development is affected by these changes and by the wider environment. Understanding the interaction of these

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systems is important, as professionals involved at this point in development are often concerned with only one aspect. As we learn more about foetal development it is becoming clearer that professionals will have to be more aware of the impact of all these systems on the mother and foetus to ensure better outcomes for all. (Selwyn 2000, p.21) For some women and men too there is also a heightened awareness of a potential baby when they have difficulties in conceiving. Once a couple have made a decision to have a baby, the longer it takes, often the more desperate they become. After a year of trying, followed by the visits and the checkups, there are often feelings of inadequacy and blame; conception becomes the focus of the relationship and sometimes it puts too much stress on the potential parents. I will not discuss further issues around fertility, as I have written about them elsewhere (Jennings 1994); there is no doubt that the more stressed people become, usually the less chance they have of conceiving. People do challenge this idea and ask what about the child conceived from violence such as rape? This is a different situation from the prolonged anxiety, often over years that can affect the balance of the entire hormonal system. Generally speaking, stress is not helpful for conception, pregnancy, birth or babyhood!

Important milestones during pregnancy The growth stages during pregnancy indicate when there is a growing awareness of the new life and the potential for playing (Figure 4.2). We can see that during the first trimester there is physical development, but very importantly, by the end of this trimester the brain structure is complete.

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First Trimester 4 weeks

Layers of cells multiplying and dividing very rapidly; outer layer becomes brain, skin, hair; middle layer becomes muscles, bones, blood vessels, genitalia; inner layer becomes lungs, liver, digestive system and bladder. 8 weeks

‘Baby shape’ with curved spine (slowly changes in next two weeks); central nervous system developing quickly, heart begins beating, has four chambers; limbs and digits recognisable; brain developing, bones hardening; webbed feet. 12 weeks

Heart almost fully developed, brain structure complete; facial features emerge, hand and foot webbing changed; circulation working, bones getting harder; digestive system works, respiratory system stimulated by breathing practice.

End of First Trimester 16 weeks

Mothers usually experience quickening, beginning to move; end of fourth month baby beginning to look ‘human’; variety of facial expressions, may yawn, suck thumb; finger and toe nails growing; thyroid producing hormones. 20 weeks

Lungs formed, kidneys fully formed and working, tooth buds appeared, heartbeat is stronger; immune system developing alongside digestion and lungs; senses are developing: taste, smell, hearing, sight and touch. 24 weeks

Very rapid brain growth; breathing amniotic fluid in and out of the lungs; a lot of movement, almost as much as newborn; aware of sounds and bright lights; memory may be starting, organs developing; eyes still closed. Twenty-four weeks is the time in most countries when a baby is thought to be viable and capable of living independently from the mother, although of course premature. 28 weeks

Eyelids open, nervous system maturing; everything growing and strengthening; responds to mother’s changing moods especially if stressed; cortisol can enter placenta from mother and affects baby; increased awareness of baby.

End of Second Trimester 32 weeks

Baby has less room to move than before when floating in amniotic fluid; eyes can focus and blink, hearing attuned to outside world; important development of lungs to enable breathing outside the womb; hair growing and overall baby is plumper. 36 weeks

Hair is thickening and eyebrows formed; all major organs are mature but lungs continue to develop; lots of movement means muscles have grown stronger; baby has filled out and overall is chubbier; still considered premature if born at 36 weeks.

40 weeks

Baby is ‘rehearsing’ feeding, turning head from side to side and trying to suck; ready to be born; heart and lungs ready for changes; mother’s antibodies passed to baby; the newborn baby dependent on mother for protection from infection; bones of skull still soft for the delivery.

Figure 4.2: Important stages throughout the pregnancy

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Figure 4.2 shows the important stages of development during the 40 weeks of the growth of an embryo into a baby, ready to be born. What is extraordinary is how the many complex pieces all fit together and start working. With the discovery of ultrasound and other imaging techniques, it is possible to see far more inside the baby than before. Many things are happening including slight movements before we are even aware of it. The progress from a cluster of cells to a fully formed baby is still a wonder. If we look at Figure 4.3, we can see that there are several bursts of energy that are crucial for the understanding and practice of NDP.

Important birth stages in more detail It is significant for our discussion that the earliest sensory responses take place at 20 weeks (although taste appears even earlier, at 14 weeks), even before a baby is considered officially a ‘baby-person’. This demonstrates how important the sensory system is and how gradually it is developing during the nine months of pregnancy. We know that babies experience smell and taste, can see changes of light and can recognise music while still in the womb. They are also capable of a lot of movement, but individual babies vary. Isadora Duncan (Daly 1995) used to say that she danced in her mother’s womb! During the first trimester of pregnancy, women are usually feeling anything from slightly unwell to awful if there is constant sickness. Life and pregnancy suddenly take on a less rosy view, but fortunately for only a few months. Even before the quickening, the baby responds to the food eaten by the mother as the sense of taste becomes very strong indeed. One study showed that after birth babies had a preference for some of the foods that their mothers ate during pregnancy (Stoppard 2008). At 24 weeks babies react to the shining of a bright light and they are aware of their mother’s voice. The mother’s voice sounds louder in the womb than it does to anyone else and the unborn child becomes very much aware of the whole lilt, the cadences and rhythm and flow; the baby will recognise its mother’s voice over any other once he or she is born. Shouting and harsh sounds make an impact on the baby and it may jump at a sudden noise.

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20 weeks The area of the brain where the senses are located has become active and the baby is able to experience taste, smell, hearing, sight and touch.

24 weeks Very rapid brain growth; breathing amniotic fluid in and out of the lungs in preparation for independent breathing; a lot of movement, almost as much as a newborn baby; aware of sounds and bright lights; memory may be starting; eyes are still closed.

28 weeks Eyelids open; responds to mother’s changing moods especially if stressed; cortisol is able to enter the wall of the placenta; mother more aware of the baby’s presence.

32 weeks Eyes can focus and the baby’s hearing is attuned to sounds from the outside, especially mother’s voice, aware of tension in voices; remembers music.

40 weeks Baby is ‘rehearsing’ feeding, turning head from side to side and trying to suck, ready to meet the world. Figure 4.3: Important birth stages for sensory, rhythmic and dramatic development

Music being played during pregnancy will be recognised later and babies do make a choice about the music they like to hear. Often a favourite piece of music heard during pregnancy will be played at the birth and will then be a calming influence after the baby is born.

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At 28 weeks the baby is certainly affected by the mother’s moods; many specialists think this happens earlier and encourage positive feelings and non-violent language right from the beginning of the pregnancy. If the baby cannot yet hear the raised voices, he or she can certainly sense the tension in the mother’s body; the baby can become wary, scared or depressed in the womb as well as after birth. At 32 weeks the hearing is fine-tuned to hear things outside the womb and the eyes have begun to focus and are functioning; the hearing also is more alert. At 40 weeks the most amazing things are happening: a fine-tuned little role play is taking place: the baby is rehearsing the movements needed for feeding. The baby is moving its head from side to side, just as it will when searching for the breast to feed on, and is also practising sucking movements. A ‘rehearsal of living’ takes place in the womb of the skills that the baby needs for survival: a drama is being played out before we even see the world!

Imposition or attachment? Unfortunately the downside of this knowledge is that some parents become competitive and impose learning of the unborn child leading to overstimulation, in the hope that the baby will be born with a greater intelligence or be more successful in life. Mothers will walk around with cassettes taped to their bellies in order to programme their baby’s thinking. We can see families in all walks of life not only wanting the best for their child but also wanting the child to be the best. This is the difference: to be the best means an extraordinary level of competition and pressure on the as yet unborn child. And we know that many children who have to ‘perform’ to their parents’ wishes may well have difficulties as teenagers or young adults. The development of an eating disorder is one way of gaining control over one’s destiny, and that can have alarming consequences. Our society still has not got the mix right of being able to inform parents on the one hand, but not dictating rigid child-rearing rules on the other. It is fortunate that the philosophy of children being empty vessels

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that are filled with appropriate beliefs and knowledge by religious institutions, schools and parents is generally a thing of the past. We know that the primary relationship where there is reciprocity between mother, carer or infant provides the best foundation for learning, whether it is emotional, social or academic learning. What is important is not the stimulation but the development of the relationship and the more we can focus on the prebirth attachment, the more the transition to mother and babyhood will be both beneficial and pleasurable. Being aware of the various developments during the three trimesters can help plan a progression of exercises to gradually increase the bonding between mother and unborn baby, which will encourage the attachment process and lead into the playfulness that lies ahead.

Playful pregnancy We know that generally mothers experience their baby being more active at night and more still during the day. When the mother is moving around she is lulling her baby to sleep in the cradle of the placenta. Perhaps the vigorous movement of the baby at night is a rehearsal for her, preparing the new patterns of brief and interrupted bouts of sleep! Babies do need attention in the night but the calmer the child, the less demanding they will be. Nothing is more distressing than a cycle of deprivation where a mother will feel exhausted with constant nightwaking; her exhaustion is then communicated to her baby, who makes even more demands. One outcome is that sometimes mothers give up breastfeeding so that fathers can bottle feed in the night and mothers can get more sleep. A more satisfying alternative could be to ensure that mothers get the opportunity for sleep and rest in the daytime in order to restore their energy. Once women know that they are pregnant then playfulness can begin, and some of it will be quite spontaneous. If people already have a playful nature and perhaps the child was conceived in a playful way, then already the seedbed for the creative development is being prepared.

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The balance of the ‘Circles of Containment – Circle of Care’ during the three trimesters The first trimester is the time for all the developmental stages to be put in place and to begin to interconnect (Figure 4.4).

Playful

Figure 4.4: First trimester

During the first trimester the developmental aspect overrides both of the others: they are important but are not in the foreground. Considerations of the mother’s physical state with constant sickness take over and the baby can be seen as a monstrous being! However, it is important to encourage playful and creative thinking. During the second trimester everything is becoming more balanced (Figure 4.5).

Playful Developmental

Physical

Figure 4.5: Second trimester

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Obviously there is a strong focus on the developmental but with the surge of energy that usually comes in the second trimester, a range of creative activities can start between mother and baby, and the beginning of the physical preparation will take place, with classes and opportunities for sharing with other pregnant women. During the third trimester, all the processes that encourage attachment will outweigh the others, if the physical and developmental stages are progressing without concerns (Figure 4.6).

Developmental

Physical

Playful

Figure 4.6: Third trimester

The importance of massage and rhythm During the first trimester it is important that women do only very gentle strokes of their belly. However, a head and neck massage is very soothing, reassuring and calming. It is important not to massage the rest of the body while the pregnancy is settling down: there will be plenty of opportunities in the third trimester.

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The active embodiment of the relationship in a gentle massage can be accompanied by soothing humming or singing, which is culturally sensitive to our own ritual and music. The rhythm of the massage and sound is important too as we remember that the baby is constantly aware of the rhythm of the mother’s heartbeat. Rhythm is the regulator of life, it creates predictable and stable patterns, and it is the container of anything unpredictable that may happen and catch us unawares. Remember how we will rock a baby when he or she is distressed and how we can rock with a cushion to soothe ourselves. Massage and rocking are probably the most important activities to establish the initial attachment. Stoppard takes a positive stance towards activities during pregnancy: If you talk and play music to your unborn baby, and massage her through your bump, you can make her feel calm, tranquil, safe and loved. When she’s feeling this good her brain is bathed in love hormones such as serotonin, which help her develop into a healthy, happy baby. (Stoppard 2008, p.9) Mothers can use gentle music as well as singing during massage and they should be encouraged to dance with their babies. Music needs to be enjoyable – not too vigorous obviously, but rhythmic and fun. The baby will be affected not only by the swaying of the dance but also by the pleasure hormones that are activated when women are

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enjoying something. The baby will be hearing music during the second trimester as well as feeling the rhythms through the mother’s body. More and more is the baby becoming sensitive to moods and tensions and anxieties so the more the mother can exude positive thoughts and feelings, the better. There are also special swimming classes for pregnant women, or the woman can go swiming on her own: she will need to take advice on which swimming forms are best. Women will be swimming in water just as their baby is swimming in its own waters too. Making sense of the world around us happens through our senses and commences well before we are born. We can sense temperature, sound, rhythm, touch and emotional changes while we are still in the womb and our mothers have a profound effect on our well-being through their own sensory experiences. If women do nothing else, the telling of soothing stories and the playing of calming music can influence the state of trust and tranquillity both for them and their babies. As well as the very physical aspects of massage and movement in the playfulness aspect, woman may well be joining a yoga group or special antenatal classes. It is very helpful to be with others who are engaged on the same journey and fellow pregnant women provide a lot of support. It is easy to become isolated during pregnancy and allow fears to build up. Yoga for pregnancy is an excellent movement system and enables women to keep calm and focused and it is also very reassuring for the baby.

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During pregnancy many women do report that they talk to their unborn child, they tell him or her secrets and daydreams, stories and gossip. Mothers will confide in their babies and share all sorts of hopes and fears. The earlier that this communication can take place the better, because it is also part of the attachment process. Usually it begins once we are aware of the baby’s presence, once the quickening has happened. There are many ways to talk with unborn children and it is a matter of what it comfortable for the individual. There is no prescriptive way and many women do it anyway. The following are some suggestions we can make to pregnant women: • Not using words but passing loving and caregiving thoughts. • Whispering a secret or sharing a joke. • Telling a piece of light-hearted gossip. • Making up a story about mother and the baby. • Short pieces of conversation – ‘Hey, what are you doing down there? That was quite a kick!’ • Sharing dreams and waking dreams of life and fantasy futures. • Singing songs, humming and crooning, perhaps with gentle music. Women will, I am sure, think of many other ways of communicating with their unborn child or the communication will just bubble up from their own playfulness. They may feel silly but also they will find it quite enjoyable. Sometimes it is easier to have these conversations in our heads than in reality. Sometimes the stories and conversations will take on another dimension and this is likely to happen more in the third trimester, when the baby is also practising little role plays about life. Mothers will talk to their baby and answer themselves ‘as if ’ they are the baby: a private piece of drama indeed. It often starts just as a conversation, the baby acting as a commentator on what the mother has to say. The mother will also say or think something like, ‘Well, if you could talk, you would be telling me to buck up a bit’; the mother is imagining the dialogue with the child even though she does not speak as the child. It can also become a dialogue with mother expressing her own and

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her baby’s voice. Then she is establishing what I call the ‘dramatised relationship’ (Jennings 1999a), which means that initially the mother takes on fun and playful roles in relation to the unborn child which will then be slowly established between mother and newborn child. This is a very important part of the development and could be termed the crux of what NDP is about. If the mother begins to role play before the baby is born and even ‘role reverses’ with her baby, she is setting the scene for the baby to be able to do this eventually. If we play the role of the other, we then have some idea of how that person is thinking and feeling: we are beginning to be in their shoes. And if I am able to be in someone else’s shoes, I have the capacity to develop empathy and a conscience. If I always stay stuck in my everyday role, I will never have the chance to use my imagination and wonder what it must be like to be this other person. Especially during the last trimester, the mother needs time to daydream and imagine beautiful worlds, to tell or read stories, to create scenes to enact with her baby in which she plays the baby’s role. You will also find fathers entering into the role plays, though less often. Fathers will have conversations about who ‘this special little man might become’; if the father knows it is a boy he will often identify with him so his conversations are more equal. If the baby will be a girl, the father is usually much more protective and keeps his role of looking after his little girl.

The baby is born! During the first few moments of a baby being born there is an overwhelming sense of relief that it is all over! It can often be a long and painful event, with anxiety that everything will be ‘all right’, which ends in this very sticky and wet bundle being placed in your arms. You don’t know whether to laugh or cry, and the staff can be funny as well. I was told after one of my children was delivered: ‘You look after the upstairs department dear and we will take care of everything downstairs!’ This is now a real baby who can be held and seen whereas during the pregnancy it is an imagined child. Mothers have thought what the child might be like when he or she is born and have had imaginary conversations and stories. A lot of time is spent, especially in the last

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three months, focusing on who this child might become. We also idealise this baby – it will be perfect in every way and not create sleepless nights and messy days! Then there is the transition to the real baby with its constant demands and mess and seemingly never ending hunger. Usually this transition is relatively smooth, especially with the biological drive to see our baby as endearing and perfect anyway. Mothers may feel elated or exhausted, or both mixed up together; emotions and hormones will take time to settle down. Fathers will also be adjusting and wonder whether to look at the mother or the baby! New mothers need lots of affirmation! Isn’t that why all the flowers arrive? Flowers of course are symbols of fertility and are making a fertile statement. Fathers have an important role to play immediately after the birth in celebrating the joint creation of the new life and its safe delivery. Mothers and midwives can be encouraged to focus on the NDP stages during the pregnancy and to anticipate the birth. Relaxing showers and baths can be helpful, carefully chosen music that has been played during the pregnancy can be available for birthing. And in my opinion the most relaxed birth will be in a birthing pool. The baby will try to imitate the expression on the mother’s face within hours of being born. I have described this earlier as ‘the dramatic response’, the first step in dramatic playing that is such an important part of the attachment process. The concept of NeuroDramatic-Play both as a natural process and a therapeutic intervention will be developed throughout this book.

Neuro-Dramatic-Play being established during pregnancy and in preparation for the birth During pregnancy, NDP ensures that the infant grows in the three major areas, developmentally, physically and playfully, within the ‘Circle of Containment – Circle of Care – Circle of Attachment’. These three circles have been established during the three trimesters. NDP enables sensory, rhythmic and dramatic play to be developed through the three trimesters, slowly anticipating the birth.

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Sensory play: the stresses during pregnancy are addressed through sensory massage of the mothers’ back, shoulders and feet; babystroking increases. Rhythmic play: Rocking and rhythms (through heartbeats and music) are increasing; mothers will sing spontaneously. Dramatic play: The baby is demonstrating the potential for role play and he or she is practising skills before birth. The gradual growth of mother and baby’s interactive playfulness is happening within the womb and there is the beginning of reciprocity. Chapter 5 continues the birth process and the first six months of life. I think professionals should encourage mothers to consider home births and a birthing pool rather than talking them out of them.

Chapter 5

NDP, Childbirth and the First Six Months I was born in very sorry circumstances. Both my parents were very sorry! That’s an old music hall gag, but in fact it wasn’t very far from the truth.When I talk about my childhood, friends inevitably compare me to Oliver Twist. And that wasn’t so far from the truth either. (Wisdom with Hall 1991, p.11)

Introduction This chapter first of all focuses on the birth itself and all the beliefs and ideas that surround childbirth and the immediate post-partum time. We shall see that there are many attitudes concerning both the physical needs and the emotional ones that come to a climax at the moment of birth. Not all specialists agree on best practice and mothers can be left floundering in conflicting views of the medical professions, as well as family and friends. We shall also look at the continuation of the NDP process for the newborn baby within a context of support and practical assistance that is crucial for calm and creative development.

Hospital or home? Childbirth is a normal process that traditionally is contained within rituals, singing, chanting, massage and a range of cultural norms that herald the safe delivery of the new child. Sadly it must be said that in the UK certainly there is far more emphasis on the sanitised birth in the hospital, and yet hospitals have shown that they cannot deal with the MRSA infections that are often fatal. My late father who was a very 98

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successful general practitioner (GP) always said that childbirth was his most favourite activity in medicine because it was normality rather than illness. He always favoured home deliveries even though there was a marked shift to hospital confinements after World War Two. Although all the indicators suggest that home births are safer and that there is less risk of infection than for hospital births, having a home birth is more difficult in the USA and UK compared with other European countries (Stoppard 2008). Many doctors insist on the first baby being delivered in hospital before there is any consideration of a home birth for the next child. There is now an increase in the use of birthing pools and mothers wanting to give birth at home, which illustrates our desire for a less technological and more human birth experience. The birthing pool creates a continuation of the ‘safe waters’ of the womb; it also helps to alleviate some of the extreme pain, and provides an immediate context for warm bonding through smell, touch and sound. Odent (2001) suggests that the attraction of pregnant women to water has primeval roots; he believes we were created ‘aquatic apes’ and inhabited the coastal plains. He said that this could also account for the need of our brains for fish oils. He also describes how pregnant women are attracted to water once they hear the tap running and have been known to get into the birthing pool with just a little water at the bottom! Some hospitals are now creating birthing units and have pools, facilities for playing music and for father friendly units. However there are still issues around ‘who is in charge’. We have developed a deepseated and historical belief that ‘doctors know best’. Many doctors and midwives assume that all women will want pain relief during childbirth. However research shows that certain painkillers given during birth can dull the attachment process: Infants who are exposed to epidurals can have behaviour difficulties in the first few days after birth. They can be more irritable and hard to console and may be less responsive. Additionally the bonding between parents and the baby can be disturbed, which has life-long consequences for the parentchild relationship. (McCormick 1997)

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Parents often feel that all decision making has been taken out of their hands, especially since childbirth is seen as a medical condition rather than a natural process. When I have asked parents about home births the most frequent answer is ‘What if anything went wrong?’ Hospitals, despite their reputation, are perceived as some kind of sanctuary, a safe place. As professionals we have a duty to give pregnant women the facts about home births or GP units with birthing pools. This will encourage parents to make informed decisions about their birthing arrangements and to develop some autonomy. Parents need to feel that they are in charge of their own and their child’s destiny with support from others. Parents who have the opportunity to prepare for the birth, and have some knowledge of gestation and childbirth itself, will feel more equipped to deal with the challenges from specialists, from GP to consultant. However, too often they feel they are dictated to by authoritarian doctors and nurses and there is generally a lack of affirmation by the professionals. Many women feel they are being treated like children as the nurse says ‘Good girl, well done’. Is it surprising that new parents feel undermined and lacking in confidence? We can encourage parents to belong to a supportive network, especially when they are feeling down. Some mothers who are on their own often struggle to ‘get it right’ and end up feeling failures. All of these feelings are communicated to the infant. A mother who feels depressed or inadequate will discover that her child is likely to experience similar feelings. We need to find more ways of being supportive during childbirth and afterwards, and that includes pregnancy and birthing workshops. This kind of information in traditional societies is usually passed on by the village midwife or at least the mother’s mother. Many of the traditional kin networks have been broken so we have to create new streams of knowledge. Parents need to know the facts of physical development, psychological development and playful attachment (as described in Chapter 4). Yet these will be big steps for authorities to commit themselves to; new classes will mean new money, despite the fact that long-term benefits could be shown to save money! It seems easier to maintain the status quo, that is, with ‘patients’ being dependent on ‘specialists’.

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It is common to blame everything on hormones: whether teenagers or menstruating girls or pregnant women or mothers of newborn infants, it can all be attributed to raging hormones! Thus, there is an attitude that emotions get in the way of serious thought – thinking is prized over feeling – logic over intuition. This is the received wisdom that we have lived with for centuries. Women have been stereotyped as ‘all feelings’, especially during pregnancy, young motherhood and menstruation. Medically, life should be pain free so we are programmed to feel we should ask for strong painkillers, but as we know these can become addictive. Prescription and non-prescription tablets not only dumb down physical pain, but also suppress emotional pain. When we are anxious or bereft or frightened or angry, there is a pill to take it away. And if not pills then we have psychotherapy that interprets the pain for us and can often blame us and our experiences for the pain. Physical and emotional pain are both real for us and need to be addressed through a supportive relationship. That may or may not be a therapist or counsellor. However, I have found that both play and bodywork will often get to the heart of the matter without us regressing and losing both our adulthood and parental feelings. The more we reinforce the notion that women are all feeling and men are all thinking, the more we maintain the stereotype which makes a huge impact on the pregnancy. Although a woman’s feelings are certainly heightened during childbirth, she is still capable of thought

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and decision making; similarly her partner, although perhaps planning the immediate arrangements, needs to feel wanted in his own right, not just as a support for the mother. Men have a crucial role to play at childbirth and need to be able to express their powerful feelings of fatherhood.

We must remember not to reinforce the stereotype of men being the strong ones, and women ‘the weaker sex’; both men and women can have playful and emotional attachments with their children; the more they can establish the inclusive family with overlapping roles and responsibilities, the more balanced will be the environment for the children. Another culture

When I lived with the Temiars (Jennings 1994) fathers and indeed all men were kept well away from the delivery room. There is a range of taboos that are followed by the more traditional men but it did not mean they were down the ‘pub’! They have to bring logs from the rain forest and chop them as the delivery room has a huge fire that is kept high at all times. They have to fetch water from the river ready for boiling on the fire, and generally be around for running errands. The birth is presided over by the experienced village midwife with usually an assistant (often me!) and other older women who would sit around and chat. Births usually took place in the kitchen next to the fire, the mother leaning against a back rest at an angle of 45 degrees. During the first stages of labour the midwife would massage the mother with coconut oil and give her plenty of water to drink which had a bitter herb (one I could not identify). From time to time the midwife would give an internal examination and discuss how many fingers the cervix was dilated. All the attention was focused on the mother. As the birth becomes imminent, the midwife starts chanting and speaking to the spirit of the river for the baby to be born quickly – everyone

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else nearby, usually older women and younger women seeking to learn, would take notice and sit with their knees wide open. As the baby is about to be born, the women open anything that happens to be around: fishing nets, saucepans, suitcases… A grand opening ceremony culminates in the baby being ejected onto the bamboo floor of the stilt house! The midwife then presses firmly on the woman’s stomach for the placenta to come away and leaves the baby attached to the placenta while she looks after the mother. The mother is seen to be at greater risk than the baby and is washed and then ritually bathed by the midwife, before being dressed in a clean but not new sarong. The attention is then given to the baby who is still lying on the floor attached to the placenta. The midwife cuts the cord with a sharp piece of bamboo, washes and wipes the baby, wraps it in a cloth and immediately tells the mother to let it suckle. One midwife said sharply, ‘Give him the breast or he will forget.’ The father and siblings put their heads round and catch a glimpse of the newborn, but for the most part, mother, baby and midwife are left alone, while everyone else looks after the house, hunting, cooking and general organisation. The father will be careful to keep any taboos that will ensure the health of the baby. The midwife stays with the mother, sleeping in the same room and giving both the mother and the baby regular massage. Other people do visit after the first few days and stay a while but it is looked upon as a quiet and private time with constant support from the midwife. No newly delivered mother feels lonely or inept! The important theme of the Temiars’ delivery is that a group of experienced women were giving constant support to the mother and baby. I noticed that sometimes younger children would hide near the house to see what was going on, and teenagers might be allowed to stay, well in the background. It was all right for them to learn about the mysteries of childbirth but it was the older women who had the practical knowledge and who would play the dominant role during and after the delivery.

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The newborn baby needs contact In our highly technological and automated society it is easy to forget the very basics of human communication. It is not for nothing that we say ‘stay in touch’ although these days it can often mean a text message or email. People are also scared of the litigious domination of our social and education systems so that many people such as teachers and care workers are scared to touch children. No wonder that mothers forget that human contact is the very basis of the word ‘attachment’. We discussed the importance of ‘bonding and attachment’ in Chapter 1 when we saw how it affects a baby’s brain and social development. However, I want to re-emphasise that it has a physical basis. Literally a baby needs to be physically attached to its mother or carer and the images of baby monkeys clinging to their mothers both front and back show us what the small infant needs. Although many people are very critical of Harry Harlow (1958), feeling that he caused unnecessary cruelty to monkeys, nevertheless what he discovered is crucially relevant to this topic. Baby massage is very important and it should continue after the baby is born: there are many cultures that promote massage immediately the cord is cut (Jennings 1994). Stoppard (2008) draws on research with premature babies and discovered that massage played an important role in promoting weight gain, alertness, better circulation and digestion. She believes that the benefits to the premature baby can be given to all unborn children, as described in the following advice to expectant mothers: Continue massaging your newborn baby: research from the University of Warwick says babies who are massaged sleep better, cry less and are more contented. If your partner massaging your bump soothes you, it soothes your baby too and that promotes growth of the frontal lobes of your baby’s brain which determine your baby’s intellectual capacity. It also tips your baby into a group of children who will be resistant to developing asthma, arthritis, allergies, ulcerative colitis, fatigue and ME. (Stoppard 2008, pp.102–3) Healthcare professionals can support mothers to physically stay with their babies and encourage them to find ways, for example by using slings or carriers, that the body contact can be maintained.

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The newborn needs company Babies are born with immediate social needs; they enjoy being with their mothers, and would prefer their mothers’ company day and night. Many professionals discourage and even frown on mothers sleeping with their babies, scaring them with talk of smothering in their sleep. It was not so very long ago that whole families slept in the same bed together or at least in the same room. It is a very modern fashion that children should have their own rooms, and from a very young age. There are still clinicians who advise mothers to let their babies ‘cry it out’ at night so that they eventually fall asleep. It seems that mothers are set up to do battle royal with their children from the beginning, and are advised ‘Don’t give in or your baby will have the upper hand.’ Babies are stereotyped into being monsters that will make monstrous demands on their mothers. The reality is that small babies are very frightened of being left alone, especially at night, and there is no reason why they should not sleep with their parents, and later in a crib at the bedside. There is absolutely no evidence to suggest that babies can be ‘spoilt’ by being nurtured or co-sleeping or being fed on demand. In Western Europe, especially England, there is more emphasis on the ‘couple’ rather than the extended family. And it is difficult for mothers to cope if they do not have a supportive extended family. It can feel desperate if one believes there is a battle to be fought. Deborah Jackson’s important book Three in a Bed: The Benefits of Sleeping with Your Baby is immensely reassuring for professionals and parents alike. She points out so eloquently: When you put your newborn baby down to sleep in his cradle and tiptoe out of the room, he thinks a part of himself has gone – the part that sustains life and gives him comfort. He does not have many resources to cope with this separation. Whether he protests or not, he needs you. It is such an obvious explanation for infant misery that medical handbooks tend to overlook it. Experts keep telling us to put the baby down, because (apparently) it is easier, and mothers should not be subject to the whims of their children. They are missing the point altogether. (Jackson 2003, p.40)

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Newborn babies want to feel warm and close but they also want their mothers’ company. They are not happy being wrapped up and placed in a separate room from their mothers and physical contact. One midwife said to me that babies needed to get over ‘the shock of being born’ as if childbirth was somehow abnormal. Babies who are abandoned away from their mothers may well become depressed or fearful. It is usually mothers who need support to get their energy back because they are very tired, hormones are chaotic for a while, and bodies feel stretched and bruised, which of course they are. At this time it is very important that mothers have support so that they do not fret about the washing or the household routine.

The newborn needs communication Contact with the mother’s physical body, and company for the social newborn are both shown to be essential and needed. However neither contact nor company are static; newborn babies need communication. Communication is interactive (otherwise it is just expression), and dramatic play and storytelling enable babies and their mothers to communicate from the very beginning. Communication with persons is possible from birth, and we should not be surprised at this. It is the nature of human consciousness to experience being experienced: to be an actor who can act in relation to other conscious sources of agency, and to be a source of emotions while accepting emotional qualities of vitality. (Trevarthen 1993/2006, p.121)

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Trevarthen reminds us that above all babies are able and also need to communicate from birth. He also suggests that the infant is ‘an actor’, which reinforces everything that I have said about interactive and dramatic playing. The bonding or attachment between mother and newborn baby is of primary importance, and many professionals will make sure that babies are given straight to their mothers to hold. Professionals can encourage the contact, company and communication between mother and newborn. This strong attachment is the basis for brain development, and for all future relationships. Professionals and other family members and friends need to gently understand this fact.

When therapy is indicated There are still some situations that despite all the support systems in place that we have talked about can cause great distress to mothers and potentially their child. Raphael-Leff (2001) suggests that for some women childbirth creates ‘postnatal distress’ (rather than postnatal depression) that may well need psychotherapy for the benefit of the mother and safety of the child. She writes: Perinatal psychotherapy offers a lifeline for the expectant/ new parent to cling to while making sense of the intense emotional experience. The baby’s welfare is crucial as, as even with help, it can take many months of painstaking effort, with occasional frightening slippages and sudden backslides, threats of flooding and ‘going under’, before released from its grip, they suddenly climb up out of the dark psychic depth. (Raphael-Leff 2001, p.60) Raphael-Leff (2001) says that it is estimated that 50 per cent of all mothers suffer some form of postnatal distress during the first two years, such as sleeplessness, tearfulness and social withdrawal, and that 10–20 per cent experience severe disturbance. Here is not the place to discuss this at length, but it is important to acknowledge that not all feelings post-birth are positive. Most of Raphael-Leff’s examples are taken out of the cultural and contextual setting of the mother and child. I am not underestimating the depths of postnatal distress that

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many women experience, but it is important to consider also whether lack of extended support contributes to the process. As readers will have already grasped I am not an advocate of the psychoanalytic approach and therefore not necessarily in agreement with the interpretations about postnatal distress. However intervention can be necessary and again I return to the framework that allows women and men to tell their own attachment stories through an NDP approach that will address most situations. The sharing of stories and the reassurances that support systems can provide, plus the skills of a therapeutic play worker, can usually be sufficient. Post-partum psychosis is a reality in a very small number of situations that will need medical intervention together with the support system that is already in place. As we saw above, with the Temiar peoples (Jennings 1994), newly delivered mothers are given primary attention and support from their midwives as well as the extended family.

Breastfeeding? The milk is there, it is rare for the supply to run out, it builds the baby’s immune system and it helps the mother’s uterus to shrink back, so why is there a debate between the benefits of breast or bottle? I believe it is a multifaceted subject that we could debate endlessly but much of it is tied up in new ideas about dependency and independence. It feels a big responsibility for mothers to be the feeders of their children and some women talk about there being not enough milk or about it being thin and watery. They feel very inadequate as the provider of sustenance. How much more reassuring to give formula milk that states the vitamins and can be measured, even though bottle feeding is much more time consuming and much more expensive, and does not provide the immunity of breast milk. Breastfeeding does require the presence of the mother, and the so-called freedom that bottle feeding gives has other implications such as the interruption of the attachment process. If small babies are bottle fed by a variety of adults, there can be a confusion of the bonding process. The primary relationship is not being formed with any one person. Odent (2001) points out that there are other issues at stake and discusses two hormones in particular, oxytocin and prolactin. He says

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that oxytocin is ‘the hormone of love’ and that love can be directed in several ways. When there is a high level of prolactin, the tendency is to direct the effects of the love hormone towards babies. Prolactin is well known as the hormone necessary to initiate and sustain lactation. In fact it is an ancient hormone on the evolutionary scale, serving multiple roles in mediating the care of the offspring, from nest building, for example, up to the aggressive defensive behaviour typical of lactating mothers. (Odent 2001, p.38) So these hormones are promoting the attachment process, stimulating lactation so there will be milk for the baby, but also allowing the mother to feel defensive and protective of her newborn baby. Mammals are noted for their protection of their dependent young throughout the animal kingdom. Odent (2001) goes on to say: ‘prolactin is not only a “mothering hormone”, it also acts as a contraceptive: we know that if mothers breast feed “on demand” and not “on schedule” there is sufficient prolactin to inhibit conception’ (Odent 2001, p.38). So it is not an ‘old wives’ tale’ that breastfeeding acts as a contraceptive, providing we do not try to sleep through the night and therefore have too long a gap between feeds. The other fact about prolactin is that it inhibits sexual desire, in order that the mother can focus on the baby to the exclusion of all else and this is common with other mammals. The choice to stop breastfeeding and use the bottle could have various issues embedded in the decision, especially a wish to return to normal sexual relationships.

Birth fathers? There is a lot of debate about fathers being involved in the birth process, being present at the actual birth and providing strong attachment right from the beginning. Stoppard (2008) suggests that the father’s role is crucial if the mother is having a Caesarean birth: Dads come into their own however if mums need a Caesarean. Paternal instincts can be as strong as maternal instincts and really

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play their part when newborn babies cannot have immediate contact with their mum immediately after a Caesarean. Ideally a newborn baby would be held close by mum and put on her breast to feed. But research has shown that dad can do almost as good a job with skin-to-skin contact if this is not possible. (Stoppard 2008, p.163) Odent (2001) is not in agreement, and suggests that in the immediate time after birth, attachment to the father could endanger the primary maternal attachment. He suggests that there is a crucial time following the birth which should not be interrupted with rushing the cordcutting, bathing, rubbing, ear piercing or any other seemingly ‘necessary’ things that need to be done that separates the baby from its mother. He continues: I am convinced that most cases of post-partum haemorrhage and difficult deliveries of the placenta occur because the mother has been distracted at a time when she should have nothing else to do other than look at her baby and feel the baby’s skin close to her body. (Odent 2001, p. 42) Whichever direction we follow, whether Stoppard’s or Odent’s, it is important that fathers feel they have a defined role in the birth process. For the Temiars it was very clear that they had a practical and supportive role but had no actual involvement in the birth or the times immediately following (Jennings 1994).

Neuro-Dramatic-Playing The birth has taken place and the afterbirth or placenta has also become detached, now comes the move forward into a playful life. It is worth saying at this juncture how most societies value the placenta and different belief systems regard it as the twin of the baby or possessing magical powers. The Temiars would tie the placenta in a piece of cloth and the father would go deep into the forest and tie it to a tree. This was like a burial ‘above the ground’ which was also accorded to stillborn babies. Many people eat the placenta at a special feast not only because it is very nutritious but also because it is believed to carry magical strength.

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The breastfeeding experience allows for the playful sharing of caressing and patting, teasing and mimicry, and it can provide an opportunity for messy playing. A range of facial expressions pass between mother and baby during a positive breastfeeding experience, so it is time to ask the question, is this all playing? Many people are surprised to know that babies need to play almost immediately they are born. As we have said, within hours of birth babies are trying to imitate adult expressions (Field et al. 1982) and can differentiate facial expressions within two days. Babies want to interact and need someone to interact with them! They will recognise their mother’s face within hours and spend more time gazing at her than at other people’s faces. Babies will turn away when they are not engaged with what they see and they find faces more interesting than dangly toys. Initially mothers will interact with their babies during feeding, bathing and nursing and much of the activity is similar to the prebirth play described in Chapter 4. Stroking and rocking, singing and humming seem natural ways to communicate and strengthen ties with the baby. If a mother has a positive expression as she is feeding, the baby will focus on this and absorb not only the milk but also the positive affirmation. Mothers continue to talk to their babies as they did before they were born, making observations about how they look and the colour of their eyes or hair. They will tell them stories and have private conversations and be silly and child-like. Mothers and babies alike enjoy entertaining each other and the laughter and giggles usually continue for as long as there is energy.

The first six months The development of Neuro-Dramatic-Play during the first six months lays the foundation for all future development of the child. Once the excitement and highs and lows of the birth have settled, mothers will try to find a routine that not only accommodates their own needs but also allows for sufficient attachment play with the baby. No two mothers are alike in how they want to plan their time, and there will be occasions of great exhaustion and feelings of ‘not getting it right’.

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Many mothers feel that their babies are completely overwhelming, and not the nice cosy little bundles that they first imagined! The real child is replacing the imagined child, and many women need time to adjust. One little piece of wisdom that mothers can learn is this: Never play victim to your baby even if he or she does feel monstrous sometimes! ‘Hold tight’ is a very good motto when mothers feel like giving up: I use this phrase both as a metaphor and in reality. The baby that is held tightly will feel secure and contained, as I described in Chapter 4 when I referred to the ‘Circle of Containment – Circle of Care – Circle of Attachment’. The baby has been safely contained in one circle, the womb, for nine months, he or she now needs to feel contained in another circle while making the transition into the outside world. It is important that mothers are encouraged to continue to play any pregnancy or birthing music, and to make use of classical music as either a stimulus or a soother for their children. Mozart is a great favourite and very good for the brain!

The first week The baby alternates long periods of sleep with short wakes for feeding, and there may be fretfulness and crying. The baby is already establishing eye contact with the mother and trying to imitate her expression. Babies are rooting and sucking during feeding, and enjoying stroking. It is important the storytelling continues throughout, along with sensory play when feeding and washing; consonant play mainly through rocking, humming and singing; responding ‘as if ’ with imitation. All of these processes are part of the NDP interaction between mother and baby.

The first month The baby is increasingly alert to facial expressions and mother’s voice; the baby makes cooing and guttural noises that mothers will imitate.

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NDP: as for the first week but more focus from baby on following face, voice and a moving toy; consonant play will slowly lead to echo play; sensory play with soft toy, caressing and patting.

The second month The baby notices certain toys placed close by; increase of arm movements; follows person round the room; with his or her eyes starts to grasp; more sounds. NDP: start of dramatic play with imitation of sounds and expressions; peek-a-boo (gradually); continuation of massage and sensory play; rhythmic songs and rhymes; telling short stories with expression.

The third month The baby anticipates sounds, door opening, footsteps, bathwater; develops gaze to some object or body part; sustains eye contact when feeding; finger play and clapping hands. NDP: developing finger play and hand claps with songs or stories; ‘surprise’ with toy hidden/visible; more play with bath time, bubbles and splashing.

The fourth month The baby sometimes sits up or rolls over from front to back; new perceptions of space; enjoys caring routines, especially sensory ones; curious about sounds. NDP: songs of fingers and toes; ‘little piggy went to market’; whole body massage while exercising arms and legs; imitates sounds back and forth, ‘raspberries’.

The fifth month The baby starts to grasp feet and hold toys; responds to colours, music and other sensory stimulation. NDP: body games with arms and feet while singing; holding up brightly coloured toys including safe puppets and allowing baby to grasp them; ‘dance’ on your lap; songs with refrains more stories.

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The sixth month The baby laughs and chuckles and has obvious enjoyment of playing; will play alone as well as with adults; intense concentration on light patches or moving shadows; possible variation in foods provides new stimuli. NDP: laughing games with tickles and kisses; rolling from front to back and back to front as a game; variation of voices with toys and puppets; rolling ball with bright colours; singing and chanting; lots of stories. These are NDP techniques that can be developed during the first six months and taught to parents. There are more in the appendices, and many people will be able to invent their own after the initial experiments. Because all babies develop at different rates, some activities will be welcome earlier or later than others. Mothers will be able to follow the clues from their babies’ responses. Now that we have laid the foundations for Neuro-Dramatic-Play, Chapter 6 will explore NDP in relation to that all important quality, that of resilience.

Chapter 6

NDP and Resilience and Empathy I had a baby you know – I was raped by a priest and they took the baby away and gave me shock treatment. If I ask for my baby they tell me not to be silly, so I am learning to be good. I am good and do what they say, (whispers) but I am telling you – there is a baby and one day I will find her – I know I have a daughter. (Jennings 1999b, p.2)

Introduction There have been many attempts to define the word ‘resilience’ and it does not easily translate into many other languages. The resilient child is one who is able to deal with the ups and downs of life, and to cope with adversity in age-appropriate ways. It has been demonstrated repeatedly that the resilient child will have had good enough attachment as a baby, and when small will have a strong enough parent to manage any trauma without being overwhelmed (Cyrulnik 2009; Erikson 1965/1995; Hughes 2006; Rutter 1997). Cyrulnik (2009) tells us that the word ‘resilience’ was first used in physics and referred to a body’s ability to absorb an impact, but he thinks this places too much emphasis on the body’s substance. He quotes a social science definition of resilience from Vanistendael (1998); resilience is the ‘ability to succeed, to live and to develop in a positive and socially acceptable way, despite the stress or adversity that would normally involve the real possibility of a negative outcome’ (Cyrulnik 2009, p.5). This social science definition implies that resilience deals with major impacts whereas I tend to think that someone who is resilient 115

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also deals with the smaller ups and downs of living; however, for many people the small nuisances become big obstacles. part of Jenny’s story

Nothing is more poignant than the severely obese woman who has a history of childhood sexual abuse, self-harming and eating disorders, crying like a six-year-old and saying, ‘They haven’t collected the rubbish’ – and following it by saying, ‘and I know they missed me on purpose’. The actual event of the rubbish has become mountainous and completely preoccupies her thoughts and feelings; she also feels there is a personal motive in all this. What does this symbol of rubbish mean for her and her life story? How has she maintained this ‘world is out to get me’ feeling for 20 years? Are we surprised that she is not coping in a resilient way when we learn that she was severely sexually abused within the family by her parents’ paedophile ring, shut down her feelings and became dissociated? When she was taken into care and placed with a loving foster family, they expected her to forget all about ‘those nasty people’ and enjoy being with her new family. There was no acknowledgement of her rage about what had happened to her or her feelings of self-loathing regarding her body or even that there must be some vestiges of goodness that came from her own parents to her. As a result she only takes on the negative images from her parents (loathsome, monstrous, evil, hateful) because she was born of them. How can we help her to feel positive about herself when there has been no acknowledgement of the actual processes she has been through? And although she hates her parents and has fantasies about what form her revenge will take, essentially she is still this little girl for whom nobody will take away this dreadful mess and pain, and who was made to feel that it is all her fault, so a little girl with feelings of shame, blame and helplessness.

As an adult Jenny needs the equivalent of Neuro-Dramatic-Play where she can feel nurtured and contained; where she can feel better about her body through sensory play and more confident about herself and

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the rest of the world through dramatic play. Instead of experiencing the containing circle of attachment as an infant, she became caught in a repetitive cycle of disorganised and insecure attachment from her multiple abusers. The abuse that she experienced is being repeated against herself and in desperation her abused body is subject to her efforts both to produce feelings (from cutting herself ) as well as to deny them (from her obesity). Emotionally I suggest she is still five years old and struggling to make sense of this confusing and hostile world, where there is no nurture or ‘good enough attachment’ from either parent, no hint that there could be any hope for her. So she continues to cry out in the dark for someone to take away the rubbish.

Rainbows for resilience The theme of rainbows is in many of my writings, from stories about rainbow silk to a rainbow massage in ‘The Weather Map’ (see Chapter 8). I use the physical sensation of creating the rainbow on a child’s back, the drawing or painting of rainbows, the use of coloured clothes to create rainbows in stories. This can lead to the dancing or enactment of rainbow themes. One group of adults with severe learning difficulties each drew a picture of what they would like to find on the other side of the rainbow. The staff had said they would find it too difficult and they would all copy each other. This was not the case: all 25 people drew something different, from the highly personal, ‘I want to find my father,’ to the natural, ‘I found a red flower.’ The only two people who drew the same thing were two friends who had some discussion and then decided that they would find water. I do not claim any exclusivity to the idea of rainbows as a motif for both grounding and stimulating. A woman who had suffered multiple losses in her family developed what she called ‘rainbow remedies’ (Siebert 2005); several appeared to me very important when we are addressing trauma and resilience. One is the power of choices, and it is important to remember that we always have choice; another was emphasising the positive, no matter how powerful the loss; and a third was that in helping other people we are able to keep our own trauma in perspective.

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Resilience and trauma Trauma at a very young age can have a permanent effect on the emotional life of the child. No one expects the small infant to deal with trauma without the care and nurture of an adult who can protect the child. Babies and toddlers do not have the mental apparatus to deal with trauma on their own, and many orphans, child soldiers and victims of abuse have been left to cope with their nightmares alone. Much is being written about resilience and how it develops in children despite traumatic situations or crises. Children respond to different stresses in significantly different ways; however the younger the child, the more vulnerable they are to stress reaction. Resilient children are able to manage stresses in their lives especially if they live in stable and supportive families where there is trust, optimism and nurture. This includes adults who will listen to fears and anxieties and help children express and understand them. However, as McCarthy (2007) describes, not all parents are so understanding: Monsters are after all our first creative acts as humans. From early on we dream them and imagine them. They dwell under our beds or behind our bedroom doors. They peek in through our windows. They are often right at the edge of our developing consciousness, part instinctual urge and part deity. We wake our parents in the middle of the night because of them, and our parents try ineffectually to dispel them by saying things like ‘There’s no such thing as monsters’ or ‘It was just a dream’. (McCarthy 2007, p.19) It was thought that children would grow up able to deal with the world if we made them ‘tough’, which meant no ‘namby-pamby’ cuddling, especially for boys. Some of the extreme cruelty in the Romanian orphanages happened because the untrained staff believed that by not cuddling the children, they would grow up as survivors in a harsh world. ‘Don’t make them soft,’ as one caregiver said to me (I was struck by the irony of the word ‘caregiver’). Many children ran away from these institutions at a young age, as life on the streets was preferable to the brutality and hunger in the homes. Many of them experience a dichotomy between longing for love, affection and attachment to a significant individual on the one hand, and the fear of settling in one

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place on the other. There are numerous attempts to ‘settle’ children and teenagers who live on the streets and railway stations in Romania. However, many of them will try it for a few weeks and then disappear again; they often come back for a few more weeks but they need ‘to go walk-about’, sleeping rough and begging in the supermarkets for out-of-date food. They have child-like attachments to adults who offer shelter, classes, outings, clean clothes and food but for them it seems that the attachment to a place is too scary. When I use the technique of drawing their self-portraits, they are often baby or child-like figures and almost always there is an idealised house drawn with the portrait.

As Masten has pointed out, ‘Resilience does not mean “invulnerable” or “unscathed’!” (Masten 2000). Children who seem unscathed by their past neglect or abuse may well have just shut down their emotional life because it is unbearable. Lahad (2000) identified the dominant ways that children deal with stress, through the ways they ‘meet the world’: belief, affect, social, imagination, cognition and physical. Through observation of children in bomb-shelters and community centres, he found that children dealt with the events and shocks in their own way. Some played sport or danced (physical), others talked logically and rationally (cognition), others showed and shared their feelings (affect), others prayed or in some way acknowledged a higher power (belief ),

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many children shared and played with their friends (social) and yet others told stories and developed creative activities (imagination). All of these children had a different way of ‘meeting the world’ and it is important that we as therapists are able to be as flexible in our resilience work in order to meet the child on their terms.

Stories or events? Lahad’s (2000) Six-Part Story (BASICPh) method described above that he used to elucidate the coping strategies of children under stress is a very useful starting point for all age groups. However, I have found that it cannot be applied with some children. Conceptually they struggle with the sequencing and a single event is all they can communicate. ‘I ran away from the orphanage’ is not yet a story; it is an event. Many street children and teenagers have great difficulty in ‘holding a story’, where one thing leads to another and there is some resolution or outcome, or there are consequences. Life seems much more a collection of events: ‘trains arrived – leftover food’. We were able to persuade one group in Mumbai to attend a workshop because they would have a copious amount of food and not miss out on the scraps they foraged from the trains. According to Garmezy and Rutter (1983), children will be more resilient if they have strong parents who are able to deal with poverty or violence in the community. Gabarino et al. (1992) also make the point that children need to have resilient or ‘coping’ parents. Parents need to manage their own stress in order to support their children. Maston (2000) has identified resilience in those children and young adults ‘who have the capacity to “hold onto meaning,” to give the events in their lives an emotional framework that somehow lets them cope more effectively’. She asks what the ‘ordinary magic’ is – those factors that provide at least part of what is needed to help children survive acute life events and move on to healthy adulthood. It is estimated that for 80 per cent of all children exposed to powerful stressors there is no developmental damage (Rutter 1979; Werner 1990). There are certain factors that contribute to this resilience: the child’s physical and social environment; a stable, emotional relationship with at least one parent or other significant adult; a supportive educational environment. Parents act as an

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emotional ‘buffer’ for the child who is developing coping strengths and resilience. According to Garbarino et al. (1992), ‘Most children are able to cope with dangerous environments and maintain resilience as long as their parents are not stressed beyond their capacity to cope’. Community and schools programmes can provide crucial support systems for parents and children to enable greater resilience to develop. Authorities need to be aware of the impact of violence and poverty on the coping strengths of parents and therefore the resilience of their children. Children who grow up in a violent environment are most at risk of developing psychiatric or behavioural disorders. Erikson (1965/1995) maintains that learning to trust is the most important task for the infant (see Chapter 1). Learning ‘Basic Trust versus Mistrust’ is the first of Erikson’s eight stages of social and emotional development. This occurs during the first two years and is based on the way a child is nurtured and loved, whether he or she has formed a ‘secure attachment’. Trust and security allow resilience and optimism to develop. If trust does not develop, a child is insecure, mistrustful and fearful. Children who have not learned to trust through their primary attachment relationship not only have difficulties in their social relationships in later life, such as suspicion and lack of trust, but also have difficulty with resilience: coping with adversity. The more secure the child, the more resilient they will become, and the more able to manage changes and difficulties as they grow up. It is within close attachment relationships that children learn to make sense of themselves, other people and social interactions. They begin to develop mental representations of how to view the self and others: their internal working models contain expectations and beliefs about themselves and others. The young child is unable to carry a mental representation and only draws on stimulus reaction. The stimulus in Jenny’s situation was inappropriate sexual arousal, prolonged pain, and threats of punishment if she said anything to anyone else. There was not a significant adult with whom she could share what was happening, even if she ignored the threats, as the extended family were also caught up in schedule 1 offences involving minors. She liked the social worker who removed her into care; however, she was leaving the district and going to another job. Jenny was now thoroughly confused

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with her yo-yo feelings: disgust at the abuse, but sudden loss of her family, the affection from the foster carers but her own self-loathing. The foster carers in the end could not cope, it was affecting the couple’s relationship, and amongst everything else they expected her to be grateful. ‘And gratitude wouldn’t come amiss young lady’, the foster father shouted as the girl and social worker left to find yet another home. In the end she spent the rest of her child and teenage life in a series of children’s homes without any significant attachment figures. Her friendships were brief because she expected so much of them or she backed off suddenly as though anticipating abuse. She is permanently in despair.

The differentiation of feelings The child who is not resilient is less able to differentiate different feelings either in themselves or in others. They become socially confused and feel incompetent and that often results in aggression, withdrawal or both. When I have tried to work on a scale of feelings, say from ‘annoyance’ to ‘rage’, they have found this very difficult. ‘I am just angry, very angry’ is often the response. One approach that is very useful in this situation is working with feeling cards (Hickson 2005); each card portrays a character showing a different feeling and one is able to play card games, charades and mimes in a light-hearted way. Many children cannot ‘finetune’ their feelings and one suspects that they did not experience a finely tuned attachment with their mothers.

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Some children are able to overcome the adversity and find coping strengths to see themselves through to a more hopeful state of being. I am reminded of one prisoner group at a maximum security hospital. They were making masks in four groups of three or four people, and each groups produced a very different mask, almost mirroring the variations in attachment disorder. I use large masks made in small groups as a means of working ‘larger than life’, and as a way of making the mask safer for expressing feelings. The following were all ‘masks of attachment’ when I look back on them: • Disorganised: hypodermic eyebrows, beer-can ear-rings, condom nose, bank-note teeth. • Ambivalent: question marks on the mask, tears, exclamation marks and a vertical divide with horns on one side and halo on the other. • Insecure: grey colouring with ‘boil of badness’ and ‘scar of life’; one new member insisted on a ray of hope – a yellow circle in the eye. • Anxious: journey of life mask going through different states from dark to light, chaos to order – always through difficulty. The mask with the condom produced gales of laughter during the making but when a woman from the Salvation Army came on a visit, the group immediately hid it and covered it up with their arms until she had gone. The horns and halo mask was interesting because it did create two aspects of the self but they were oppositional: no question of a journey from one to the other or any movement. It was stuck with question and exclamation marks. The one man who had insisted on the ray of hope amidst this grim grey mask seemed likely to be the one who would survive. The group who produced the ‘journey of life’ mask showed a level of understanding of what was needed for change and the possibility that they might complete that journey. In an earlier session with this group one of the men said to me, ‘The trouble is, Sue, being good is so boring.’ So far we have been looking at ideas of resilience and how they are obviously connected with early attachment experiences. We have seen how some children can survive the most horrendous abuses through

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having resilient parents or through their own coping strengths, and how some children and adults do not manage to cope.

Resilience and empathy I have great concerns about the impact on society of a seeming increase of teenagers and adults without resilience, with no empathy and perhaps with little sense of adventure. I describe in Chapters 1 and 2 the importance of the playful attachment; how sensory, rhythmic and dramatic play give the child their first ‘dramatic experience’ – the ‘as if ’ response. Mother and infant imitate each other and take on gestures, sounds and expressions as if they were the other. I maintain that the development of being able to be ‘the other’ enables the development of empathy: of being able to feel as the other person feels and thereby to have some idea of the consequences of our behaviour or actions on the other person. Therefore good enough attachment not only makes an impact on the healthy growth of the individual and their ability to form satisfactory relationships, but also affects the individual’s capacity to relate to others in a more general sense, with empathy. The child who is not resilient is likely to have great difficulties feeling empathy. There is a great vogue for ‘reality’ TV shows that illustrate how people do not get on together whether as neighbours, families, in chat shows or in contrived settings. The entertainment value is supposed to be in the conflicts, violence and ridicule being expressed and experienced. People’s discomfort, pain, shame and humiliation have become the entertainment of others. People being ridiculed is supposed to be funny; a new television commercial as I write this book shows a child falling down a hole on the beach that was covered by a towel and the parents think this is very funny. Historically, live theatre provided both our entertainment and learning. We were able to explore the dilemmas of royalty and peasant, the implications of cruelty and the effects of unrequited love. The word ‘theatre’, coming from the same root as theory, meant we learnt something when we went to the theatre. The ancient Greeks believed that it would keep society stable because people could witness the extreme crimes and violence (although always off stage – we heard about it from the messenger) without committing these acts themselves. We could bear witness to Pentheus being torn limb from

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limb in Euripides’ The Bacchae rather than tearing each other apart on the streets. When theatre was central to society it created what we call ‘dramatic distance’ between observers and the play. This distance enabled us to come closer to the great and often uncomfortable themes that were being expressed. There would be structure and usually resolution to the enacted story. However, we now have far less live theatre and much of it is commercial theatre such as musicals because theatre subsidy decreases every year: it is seen as a minority luxury rather than as a necessity for the nation’s mental health.

Collapsing of time and space and training Traditionally it would be trained or experienced actors who would carry this responsibility of expressing important truths to the audiences. Now we have people being chosen without experience ‘from the streets’ and their auditions and misery become another piece of painful entertainment on television. All of this is supposed to be more real – yet we all know that it is not real at all. It is like saying that Chit Chat magazine is a true reflection of people’s lives. I think the following examples illustrate how there is no ‘as if ’ between thought and action. There is no empathy that regulates this behaviour either in the media or in the streets. • A culture of ridicule, where television reality programmes, panel games and advertisements show role models of adults putting each other down: we also see this with TV chefs, quiz shows and chat shows. • A culture of selfishness, where adults are shown wanting to keep food or chocolates for themselves, or children don’t share their favourite cheese spread. • A culture of violence which starts with language: in the supermarket we are told to ‘grab and go’ at a food counter; certain crisps are called ‘grab bags’; stain remover is called ‘Shout’ and there are also ‘grab and fly’ for sale meals at airports. • The culture of violence against the self is increasing with eating disorders, self-harming and other addictive behaviours.

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• There is a culture of avoidance, where a child or adult cannot tolerate touch or sees it as a threat. An accidental bump in the street or playground has a threatening response: ‘I’ll get you for that.’ • Many schools do not allow teachers to touch pupils – even a reassuring hand on the shoulder or putting a plaster on a cut. • Everything has to be now: whether it is food or possessions or academic prizes. What do all these things share? A collapsing of time into the now – no one can wait either for food or to think – a collapsing of space such that anything can happen anywhere – a collapsing of social relationships where there was mutual respect and generosity – a collapse of trust and sharing because things should be grabbed and kept. We appear to be talking about survival rather than resilience. What is interesting is that we live in a reasonably affluent society and we have a highly sophisticated system of health, social services and education, yet it produces people who behave as if they are only just surviving. Perhaps people are not surviving emotionally? The stuffing of food outside a baker’s or take-away looks like a response to famine or deprivation, yet there is always jam tomorrow in most of Western Europe. What therefore is the real hunger? What is being enacted on the streets by children, teenagers and adults? Surely we need to look again at the question of emotional hunger? For the child who has never been held or supported or who has been abused or neglected, there will be a permanent hunger that will never go away. There will be attempts to assuage it with food stuffing, drugs, alcohol, a whole range of substances; bodily stuff to replace emotional stuff. The circle of attachment was broken or never strongly in place and there is an attempt to ameliorate the pain through food, drugs and drink. It seems that social relationships have been replaced by the cult of the individual, seen at its most extreme by the teenager who selfharms to convince him or herself they have feelings. Or we have the identity of the gang or herd who will tear others apart either through physical violence or through verbal bullying or ridicule. Gang identity provides a sense of belonging and attachment, and in many ways the gang becomes like a replacement family.

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It seems that we have lost the closeness that trusting relationships can maintain and paradoxically we have lost the distance that theatre can create around extreme behaviour and violence. We are out of touch with our social rituals that help us to function as social groups by setting limits – and we are terrified of our imagination because it might just go out of control! I have often said in this context that perhaps Freud had got things back to front. It isn’t that people are frightened of sex and therefore sublimate it in theatre and the arts – it is that people are terrified of theatre and sublimate it in sex. A performance of the flesh is easier to deal with than a performance on the stage. The closeness and trust for the infant is expressed physically between carer and child – and distance is expressed through the symbolic rituals and theatre performances that address the culture, beliefs and values of the social group. The more we examine the very fabric of our society, the more we can see that it is built around theatre, ritual and dramatic acts of play and performance. We have the dramatic response of the newborn infant, the development of mimicry and imitation leading into pretend play. Pretend play is necessary for ‘Theatre of Mind’ (Whitehead 2003), but before we can have Theatre of Mind, we have to have Theatre of Body (Jennings 2005a), which is the physicalisation of experience and feelings that usually starts with pregnancy, as discussed in detail in Chapters 1 and 5. Perhaps we should call Theatre of Body, the Theatre of Pregnancy and Birth. The very visceral and dramatic components are the necessities for living. McCarthy (2007) talks about ‘a body-centred approach to play therapy’, yet most play therapy does not involve and even discourages touch and body work. Why do we avoid so much physical communication? It seems to be a contemporary issue that keeps bodies apart for the wrong reasons. Sensory and embodied play are part of NDP, together with rhythmic and dramatic playing. Part of our dramatic interactions between mother and baby is unconditional positive regard (Maslow 2007), the transmission of hope

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and trust (Erikson 1965/1995) and the sensory, rhythmic and dramatic playfulness that forms our primary attachment (Jennings 2007a). This beginning then quickly grows into symbolic play because the infant is already practising the use of the dramatic imagination within the first social relationship – that of mother and baby. Neuro-DramaticPlay has a continuum (see also Chapter 1) that is physicalised or embodied, from pregnancy play to social play that includes consonant play, echo play, mimicry and symbolic play. If that were not enough in terms of the child’s healthy development, he or she is part of the rituals of family and social groups through which the embodied ideas and values of the culture are transmitted and embedded. We are committed to living together as social groups and experience life through each other (Whitehead 2003); we share jokes, memories, gossip, adventures, stories, illnesses. But now this is under threat as damaged young people are being made to go back to work when they have had a baby; there are some strong voices who regard therapy as ‘the soft option’ and say we should bring back the boot camp; the arts generally and theatre in particular are at the margins. The irony is that they return quickly as arts therapies! We are more concerned with mending the pieces than with preventing the cracks: it is time to focus on a preventative approach, rather than a curative reaction. Contemporary social situations have made an impact on a child’s capacity to be resilient. The trust that is born from the primary attachment is being undermined and sabotaged with new expectations being put on individuals, families and groups. The capacity to love and be loved is surely the basis from which resilience and empathy can develop and grow.

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Neuro-Dramatic-Play is central to developing resilience and empathy in growing infants. This is even more urgent as we live in a society where there is an increase of raw violence that often goes unpunished. It is also necessary to relearn that an ‘instant’ society is not necessarily contented as it leads only to more need and greed. Neuro-Dramatic-Play can be applied to address some of these issues: • The language of society is changing: there is more violence and selfishness. • Bullying is on the increase despite anti-bullying programmes in many schools and the compulsory training of teachers (Hickson 2009). • Media portrayals in advertisements communicate selfishness instead of sharing. • There is a lack of understanding of empathy and how it develops from the attachment with the mother. • Through establishing the ‘as if ’ concept, it is possible to change the existing lack of empathy in young people. • Stories for peace and theatre for empowerment are ways in which we can begin to challenge the status quo. This chapter establishes the theory and practice of Neuro-DramaticPlay. We will now see how Neuro-Dramatic-Play can be applied in a wide variety of situations where there are attachment needs, learning difficulties and the perennial stress of teenagers who we feel we cannot reach.

Chapter 7

NDP and Children with Attachment Needs I look his way, wishing he would look mine, Wondering, dreaming what it would be like if he would only look my way. I stare deep into his eyes and I seem to fall, Yet no pain will come when I hit the bottom of this endless pit. (Rabisa 2008)

Introduction The early chapters of this book laid out a framework for the theory and definition of NDP and how it is essential for the development of the child. In this chapter I develop in more detail the evidence for the concept of NDP and show how it can be understood by practitioners in the fields of neuroscience, biology, gynaecology and psychology and by child development theories.

NDP and EPR progressions The focus for NDP is from conception to the first six months of the child’s life, with a focus on the immediate post-birth time. Some authors (e.g. Odent 2001) suggest that the critical time in a child’s development is the first twelve months. I would like to clarify that I maintain that up to six months is the specific NDP time of sensory, rhythmic and dramatic play. I think that the first two years are very important but different: for example, there is a shift from the NDP progression to

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the EPR (Embodiment-Projection-Role) at around six months, which is discussed in more detail in Chapter 1. There are specific changes happening at six to seven months, which involve infants being more aware of the wider world and others in their universe. Later chapters in this book look at the various contexts for applying NDP with children and teenagers, and where new training needs to be available for teachers, therapists and carers, including foster carers. It is not just a question of addressing attachment issues in some form of therapy, it is more fundamental than that: it is an understanding of the basic concepts that underpin attachment: that it is playful and involves very specific forms of play that both shape the brain as well as shaping relationships.

The real needs of the child Many therapists do not ‘do’ sensory, rhythmic and dramatic play. They would be horrified at the idea of using a child’s heartbeat as a means of getting into rhythms and drumming. They usually work from a ‘follow the child’ perspective, and regard other forms of intervention as ‘directive’. However, a child-centred approach, in my view, has to address the real needs of the child, which will then need to take a multimodel approach in therapy. The arts therapies provide a form of active involvement where child and play worker or therapist can co-create together, as well as establishing an appropriate ‘attachment role-modelling’. I cannot reconcile in my own thinking the fact that therapists who call themselves non-directive are extremely controlling in terms of time and space, and also very imposing because they make interpretations which are based on a formula from their own ‘closed circuit’ training. Alice Miller (1992) allows her mind to create different associations and she is mindful of the impact of child rearing on every child: Every human being is born into the world without bad intentions. And with the clear, strong, and unambivalent need to maintain life, to love and to be loved. But if a child encounters hatred and lies instead of love and truth; if, instead of being cared for and protected, it is beaten, then it should

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be able to shout and rage to defend itself against idiocy and wickedness. (1992 p.155) John Bowlby addressed the actual attachment experience of the child, rather than the child’s fantasy, and he was particularly concerned about children who had been put in institutions. He looked at a study on early childhood sounds comparing children brought up in families and those in institutions: A very careful study of infants’ babbling and crying showed that babies from birth to six months in an orphanage were always less vocal than those in families, the difference being clearly noticeable before two months of age. This backwardness in ‘talking’ is especially characteristic of the institution children of all ages. (Bowlby 1965, p.23) I am concerned about the real attachment needs in relation to the deprivation of the play experience of the newborn child and how that might be remedied through play intervention, including ‘echo play’. Echo play starts during the pregnancy when the mother is trying to sense what her baby is doing and tries to mirror it through movement or sound. Pregnancy is like a rehearsal that moves towards the theatre of birth on which the real dramas of attachment will be staged: there will be two characters, the mother and the baby.

Therapists need to be flexible in their approach to children with attachment needs, rather than adhering to a dogma of one psychological belief system. Children who are trapped, for example, in a cycle of self-destruction, including eating disorders, will usually continue their cycle if left without intervention. Many therapists refuse to work with people with eating disorders because they think the prognosis is poor. Art therapist Åse Minde (Jennings and Minde1993) is one of the few people I know who has been able to maintain people with eating disorders in long-term therapy. Arts and play therapies can integrate

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techniques and processes that can allow transformation and change. It is still a child-centred approach but needs a fine sensitivity, the fine-tuning of the early attachment relationship. This enables an understanding of the ‘guide–companion–follower’ relationship. The empathic approach of the teacher, carer and therapist is necessary to facilitate positive changes. This is developed in more detail in Chapter 12. We also need to take into account the attitudes of our society which is not always supportive of prime attention being paid to the nurture of children; as long ago as 1969 John Bowlby stated: Over the years, the belief that experiences of early childhood are of much consequence for the development of psychiatric illness has grown in strength. Nevertheless, the basic hypothesis has always been a subject of sharp controversy. Some have contended that the hypothesis is mistaken – that psychiatric illness has its roots elsewhere than in early childhood; whilst those who believe the hypothesis to be fruitful are still at sixes and sevens regarding precisely what experiences are relevant. (Bowlby 1989/2005, p.97) Bowlby was writing well before the surge of interest and research by neuroscientists into the importance of nurture for the growth and development of the infant brain. His approach is based on biology and ethnology and he comments that all mammals have a bonding mechanism with their offspring, not just humans. Bowlby made several films showing the distress of children being separated from their parents when they went into hospital (discussed more fully in Holmes 1993); indeed he talks of his own distress when separated from beloved adults. Bowlby in his early writings caused a furore not only among the psychoanalysts who rejected his writings about the real experiences of the child rather than the child fantasy life, but also among the early feminists who saw his emphasis on the quality of mothering as an affront to the emancipation of women. Many women as a result felt guilty at the necessity of their working and leaving their babies in childcare.

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The dance attachment Winnicott’s (1965) writing also makes a significant contribution to the understanding of attachment (see Chapter 2), and he coined the phrase ‘good enough mothering’, which certainly helped many mothers to assuage their feelings of incompetence because they were not perfect mothers. Winnicott also talked about ‘primary maternal preoccupation’ and its importance for the healthy development of the child. I have likened these early interactions to a dance between mother and baby: The mother is engaged with her newborn baby and dances their dance. Mother and baby then take turns to lead the dance, as they respond to each other in a playful way.

The relationship between mother and baby is not one way in its dependency, it is interactive and soon there is turn taking. Mother and baby are dependent on each other, and enjoy repeating sensory, rhythmic and dramatic games together. Gradually they both innovate new interactions and elaborations of their playing together. There are favourite stories that can be repeated over and over again. All this creates some predictability for the child on the one hand, and exciting new stimulus on the other. I do not see this playfulness as the regression of the mother as suggested by some theorists (Raphael-Leff 2001); far from it, the mother is attuning to the needs and playfulness of the child and her own playfulness is guiding her, which in turn allows the baby’s growing playfulness to guide the mother as well. This mother and baby dance has an enormous impact on the child’s developing brain and body as well as influencing future social relationships. Neuroscience has helped us understand that not only does the mother–child dyad profoundly influence the brain development, but also the biology of attachment and the chemicals that are being released all contribute to an integrated model of attachment. In a section called ‘The neurochemistry of bonding’, Cozolino describes very poetically this complex process:

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The neurochemistry underlying mother–child bonding is very complex: The warm and happy feelings; the desire to hold, touch and nurse; the pain of separation and the joy and excitement of reunion all have neurochemical correlates that allow us to experience these wonderful feelings. Through a bio-chemical cascade, mother–child interactions stimulate the secretion of oxytocin, prolactin, endorphins, and dopamine, which create positive and rewarding feelings. (Cozolino 2002, p.176)

Toxic effects of stress and anxiety If these positive ‘feel-good’ chemicals are not released, and there is stress and anxiety in the mother–baby relationship, there will be other ‘feel-bad’ chemicals such as cortisol that increase, and over time become toxic if they are present in large quantities (also see Chapter 4). A situation can develop whereby instead of mother and baby feeding their playfulness together, they start a negative spiral of interactions. The baby does not respond how the mother would like, so the mother feels rejected and gives up trying; the baby is confused and is distressed if eye contact is withdrawn and may start to cry so mother puts the baby in his or her cot. The mother feels baby as monstrous; she really needs help to reinforce the positive feelings and her own skills. The first six months is a critical time and the distressed mother needs some empowerment through skilled adults. If the first six months becomes an assault course, it will take a long time to effect any repair.

It is suggested that babies who are adopted before four months old, i.e. within the critical time, will be able to adjust to a new attachment relationship, providing of course that the adoptive parents are able to provide a consistent and supportive environment. Their cortisol levels significantly reduce in the new attachment relationship. This research was done with Romanian orphans (Chisholm et al. 1995); the

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researchers looked at the developmental pathways in children from the orphanages. One group had been adopted as very small babies and the other group had been adopted later. In her book for parents and carers, Sunderland (2006) points out that a child’s brain is unfinished when they are born and therefore can be ‘sculpted’ in both positive and negative ways. She discusses how we need to ‘parent the brain’ and draws people’s attention to the enormous influence parents have on their child’s development: Everything your baby experiences with you as his parent will forge connections between the cells in his higher brain. The human brain is specifically designed this way so that it can be wired up to adapt to the particular environment in which it finds itself. The adaptability works for or against the well-being of the child. If, for example, a child has bullying parents, he can start to adapt to living in a bullying world, with all manner of changes in brain structure and brain chemical systems, which may result in hyper vigilance, heightened aggression or fear reactions, or heightened attack/defence impulses in the reptilian part of his brain. (Sunderland 2006, p.22) Contemporary developmental theories of how children thrive, whether they are based in neuroscience or biology or play or psychology, all draw attention to the critical period that follows the birth of the child. No longer do we have to split nature and nurture; one influences and stimulates the other. At last we are beginning to integrate our approaches in order to fine tune our work with children who are at risk because of their attachment needs.

Is it possible to reattach? So what are these attachment needs? And is it possible to reattach? And do we feel that the agent of change is a therapist or a teacher or a new foster mother? The issues of fostering and adoption are dealt with in Chapter 8. Here we will look at the day-to-day needs that could make a difference for the mental health of the child; how can we apply Neuro-Dramatic-Play in ordinary life with families who are angry or fearful or depressed or who just don’t get it?

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If we have the opportunity to talk with the parent(s) we will often find that their early life experience also had difficulties with relationships or succeeding at school and making friends, or feeling loved and cared for. They will make comparisons with themselves and say, ‘Well, I was always a shy child,’ or ‘His dad was a bit of a lad so I am not surprised.’ It is often difficult for them to hear that life could be different. In many families, outsiders are seen as interfering and judgemental: everyone is either a teacher or a social worker or from the police. A therapeutic play worker or just play worker, for example, perhaps could make a difference through working out of the doctor’s surgery, which could be less of a stigma than going to a psychiatric clinic. Alternatively there may be opportunities to work within the school or kindergarten or nursery. I would hope that it would be possible to have a preliminary session with the mother; then work with the mother and child together; then with the mother, then with the child and then a final session together. Individual situations would try to integrate the father as well, perhaps at the beginning and end, or more if he is available. With attention being focused on mother’s needs initially, we may find a shift in perspective. This way everyone’s needs are being met rather than mothers becoming jealous because of all the attention that is being showered on the baby. These ideas are elaborated in more detail in later chapters. It is really crucial to engage with mother or carer as an equal adult or equal parent. The mother who feels a failure needs a huge boost and the mother who does not care is probably masking feelings about never having got things right. We are not talking about therapy here, it is more mentoring or befriending. Talking can go from the general life to the baby specifically and then if appropriate touching on the mother’s or carer’s own childhood. Very often parents who have difficulties with attachment with their children have had similar experiences in their own childhoods. Attachment difficulties can sometimes be traced back through several generations. It is generally assumed, too, that we choose our partners, to some degree, to satisfy unmet attachment needs, and that we sometimes choose to have children in order to meet our current attachment needs. Neither of these situations is necessarily damaging unless they are taken to extremes.

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Part of Penny’s story

Penny had longed for a baby of her own ever since she could remember. Her own experience was of ‘distant’ mothering where her birth mother worked as a professional writer and her father was always away. She was an only child and felt very isolated. She was sent to boarding school at 11 years old, a private high status school. She rarely spoke for most of her time there. She would read in the library, offer to help in the kindergarten attached to the school, avoid sports whenever she could and generally got through things. Her parents were pleased when she met Keith, a junior doctor, and they were married. They both wanted children but nothing happened and Penny became distraught and insisted they had fertility treatment. It took over a year for conception to be successful and during that time Penny could think of nothing else, counting days and cycles, taking temperatures and slowly Keith lost interest. Although he was pleased at the pregnancy, it was more a question of relief from Penny’s preoccupation. Throughout the pregnancy and then birth Penny was only aware of one thing, having her baby safely. Her anxiety level that something could go wrong after her daughter was born finally drove Keith away. However she appeared not to notice too much. Her child whom she named Polly became the sole focus of her life. Fortunately because Penny had a vigilant GP, her baby was referred for developmental assessment and found to be functioning far behind her normal milestones. Penny continued to baby her daughter as if she was still a few months rather than approaching her first birthday. A smothering attachment was literally stunting her growth. Attachment work for Penny and her baby with a highly sensitive dramatherapist enabled Penny to look at her own attachment needs and the importance of allowing Polly to develop socially and also to widen her frame of reference. Penny became very good at playing make-believe, just as she had at boarding school. Later there was some kind of conciliation between Keith and Penny and he was an important figure in her growing freedom.

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This situation is an interesting one and we can see how Penny is so identified with her baby that she gives her a similar name; it is as if the Polly became Penny which in the very early stages of life gave the baby all the necessary attention; however she was unable to allow it to be the other way round. There was no echo play. The difficulties really started when Penny would not allow her baby to develop beyond ‘delightful babyhood’. She had been terrified of losing the pregnancy, she had been terrified that she might die at birth, and now she was terrified of her child growing up and eventually leaving her, as she had been left while she was a baby. This terror at abandonment and loss parallels Penny’s own upbringing which had involved a series of au-pairs, an after-school child minder and then boarding school. Once she became pregnant her feelings for the future baby took over from her relationship. The situation turned into a one-to-one, parent–child dyad, that had no room for another adult. There was no room for a mutually adult relationship between Penny and Keith. She alternated between being mother and baby and it was sometimes difficult to recognise who was the most grown-up, Penny or Polly. Penny’s terror was very real and it became apparent that the constant feelings of abandonment that she had as a young child would now be finally enacted. She would be rejected as a mother and as a child: her internalised mother and child were both very fragile. She had had no ‘role model’ of good enough mothering and any sense of developmental progression. Furthermore her internalised child was in constant fear and full of unresolved conflict that she would never be good enough to be loved and cared for.

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Immediately after birth In Neuro-Dramatic-Play I am concerned with the time before birth and the six months afterwards; I am particularly interested in the time immediately following the birth. This time would be when nurses would remove babies and say that mothers needed a rest! In more recent years in many centres, mothers cradle their babies immediately and stay with them in close proximity. Attachment theorists and neuroscientists all discuss the importance of early attachment, but what about the minute-by-minute, hour-by-hour activities that are happening immediately after birth? There are many contrasting theories and traditional practices that do not necessarily concur. Odent (2001) discusses how many cultures (not just western ones) disrupt the early attachment time, and he suggests that this is in order to produce children and therefore adults who are more aggressive. In most known societies, until now, it has been an advantage to moderate and control the different aspects of the capacity to love, including love of nature, and to develop the human potential for aggressiveness. The greater the need to develop aggression and destroy life, the more intrusive the rituals and cultural beliefs in the period around birth have become. (Odent 2001, p.28)

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Odent cites the example that many people believe that the colostrum is harmful to the baby, whereas actually the baby is instinctively rooting for the breast often within an hour of being born. Biologically we know that colostrum is precious and healthy, yet historically it was coupled with post-partum blood and considered dangerous and contaminating. Mothers would not be allowed to start breastfeeding until they had been ‘purified’ and these bodily fluids had stopped secreting. There are many other interruptions such as insistence on complete washing, taking the baby away to be weighed and examined. Hospital births themselves are intrusive and carried out in an environment that potentially has a concentration of infections. Yet many mothers would not dream of a home birth: ‘What would happen if something went wrong?’, ‘I feel safer in hospital,’ ‘I would never forgive myself if anything happened’! I have written about the doctor– patient dependency elsewhere, particularly in relation to childbirth and fertility treatment (Jennings 2004). For the purpose of this book, I wish to focus on the sometime obstacle course for the mother who is trying to allow the attachment process to proceed. Bearing in mind the influence that specialists have on people who are vulnerable, is it any wonder that mothers give up the idea of breastfeeding, hand their babies over to others to care for and generally feel undermined in their role as ‘good enough mothers’?

Patterns of attachment behaviour and NDP interventions We have seen in earlier chapters how there are several patterns of attachment behaviour that need our attention: they are attachments that are avoidant, ambivalent or disorganised; we can place these all under the general umbrella of ‘insecure attachments’. When we speak of ‘good enough attachment’, what we are hoping is that the attachment with the mother or primary carer is secure. When secure attachments have been disrupted or have not taken place we need to consider just how far repair is possible. There are also various schools of thought who have differing views on how this repair could be achieved. The psychoanalytic approach promotes the idea of the transference

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relationship, where the child projects onto the therapist the range of fantasy emotions that are felt about the birth parents. However, I agree with Miller (1990) that this process can be haphazard or even dangerous. She states with clarity: Patients and adepts at psychoanalysis, who in their circles are cut off almost hermetically from advances in knowledge, do not know, just as for years I did not know, there is already a means of access to one’s own childhood that is not (as is unfortunately very often the case) dangerous, confusing, haphazard, fragmentary, and irresponsible, but on the contrary, comprehensive, systematic, clarifying, helpful, and committed solely to the truth. (Miller 1990, p.viii)

My concern is that a long-term dependency relationship does not necessarily move the child on. As someone who interacts with children rather than sitting and reflecting, I feel that interactive play can not only get to the heart of the dynamics but also build opportunities for repair through the play activity itself. Neuro-Dramatic-Play principles can actually address in a direct way the processes that were not addressed in infancy. Many children have very messy feelings: life is a mess, they are a mess and continuing the mess seems the only option. They create havoc at school and home, nothing is contained or held and it is as if they were spilling out all over the place.

NDP

and

Children

with

A ttachment Needs╇ /╇ 143

The child who expresses their chaotic and messy experiences may do so physically or projectively or dramatically: for example through physical destruction or bodily aggression or self-harm (Embodiment), or through daubing, graffiti or fire-raising or physically destroying his or her picture (Projection), or through playing the part of the bully or the victim or the destroyer (Role) (Jennings 1998). They lock into one aspect of their EPR development and use it destructively. These children may have had inconsistent parenting, pendulum swings between loving and ignoring; lack of ‘holding’ (that gives body boundaries); over-rough play as babies with pinching cheeks or fingers; very loud ‘widdly, widdly