social pharmacy d-pharm 1st year by Pragati K. Mahajan
Development supportive dialogue, Timisoara, January 2011
1. Development supportive dialogue with children
Inge Nordhaug & Dag Nordanger
Dag Ø. Nordanger
RVTS West, Bergen, Norway
Norwegian TENTS partner
www.tentsproject.eu
2. Focus for these days
Children in particularly difficult circumstances:
Exposed to violence
Witnessing violence
Sexual abuse
Drug abuse in families
Orphaned
www.rvts.no
3. What is developed in these children?
Not the ”Learning brain” …
Exploration, curiousness, interest
Balance between the the safe/known and the new
The ”attaching brain”
…But the Survival brain”
Defensiveness, supsiciousness, identification of danger
Mobilisation of resources for protecting onselfskyttelse
The ”detaching brain”
www.rvts.no
4. The ”alarm centre” of the brain
is kept a state of constant alert
Releases stress hormones
which stimulate instinctive
reactions and inhibits more
higher cognitive processing
Underdeveloped connections Inhibited:
between limbic system and
Affect regulation and ability
prefrontal cortex (which runs
reasoning, self reflection, to learn and integrate
contextualising – cognitive new information
control)
www.rvts.no
5. Different kinds of conversations
To explore
To understand
To disclose
To help
www.tentsproject.eu
6. Disclosure versus therapy
Therapy has much to learn from the
directness and exposure in disclosure
conversations
Therapy can be ”anti-therapeutic” if
central stressors in children’s lives are
not disclosed
www.tentsproject.eu
7. Some communication theory
All behaviour is communication
One cannot ”Not communicate”
Communication concepts:
– Synchronised communication
– Counter communication
– Uneven power relation between adult and child
– Message sent – Message received
www.tentsproject.eu
8. Centrals aspects in dialogue with children
Congruence
Position
Eye contact
Voice tone
Body posture and movements
Mimics and facial expressions
Emphasising sounds
www.tentsproject.eu
9. Frame factors
The adults’ preparation
Information about the child
Physical arrangements
Furniture
Tools
Presence
www.tentsproject.eu
10. Facilitating/inhibiting communication
Facilitating: Inhibiting:
Open questions Closed questions
Imperative form Yes/no questions
Descriptive form Causal form
Wide, general form
Non leading Leading
Key questions, and Leading questions to
references to what has expected answers
the child has told Choice questions
before
Projections
www.tentsproject.eu
11. What facilitates and what inhibits?
Active listening Passive listening
Repetition Ignore
Confirmation Doubt or deny
Sum up Switch of topic
Pressure/negotiation
Clarification
Exploring questions Blurring, making it wage
Personal form Interviewing
Child language ”You” form
Metacommunication/mirroring Adult language
Pauses More questions
www.tentsproject.eu
13. General principles of disclosure conversations
Show interest, receptivity and neutrality
Invite to dialogue based on the child’s own
signals
Be present, close, and have time
Do not push, but make a ”room” for children to
talk
Remember; It is the child who discloses, not the
adult
www.tentsproject.eu
14. Methodical approach
The conversation focuses on the child’s reality
The conversation is in the form of dialogue
The purpose is to get qualitative and descriptive
information through free speech
The conversation is a interpersonal interaction
The conversation is focused
The conversation is non-leading
www.tentsproject.eu
15. The phase structure
Establishing contact
Opening procedures
Introduction of the topic
Free speech
In depth exploration
Closure
www.tentsproject.eu
16. When do we need disclosure conversations?
When children in different ways signal that
they are not ok
When these signals make us worry
When we want children to tell about concrete
events they have experienced
www.tentsproject.eu
17. Worries can be based signals from:
Something the child has said
Something the child has shown:
– Aggressive behaviour
– Withdrawal
– Sexualised behaviour
www.tentsproject.eu
18. Sexualised behaviour
Stop it, and ask:
- Where did you learn that?
- Have you seen someone else do that?
- Have someone done such a thing to you?
- Who?
...when it happened, how was it like to be you?
www.tentsproject.eu
19. Why do we not talk to kids about difficult
experiences?
Our view of children’s credibility
Ethical reasons
Adults protect themselves
We may think we protect children that way
Cultural taboos
We are afraid that of being wrong
Afraid of parents’ reaction
Afraid of spoiling possible investigations
www.tentsproject.eu
20. And why do not children talk about it?
Memories about it are unreal and ”split off”
Fair of adults’ reactions
Fair of consequences and punishment
Fair of not being believed, understood and helped
Shame, guild and feeling dirty
Being threatened to keep quiet
Children intuitively understand they must not tell
Taboos
Nothing happened
www.tentsproject.eu
21. What does it take for children to tell?
An occasion must be created
There must be a purpose
There must be a thematic connection
An inner feeling of “permission”
www.tentsproject.eu
22. These phrases are the model in a “nutshell”!
You look so sad to day...
What happened?
Tell me ….
www.tentsproject.eu
23. Drawings and other products
Keep them. Comment when they are unusual:
What did you draw?
Tell me about this drawing…
What is this?
Who did you draw?
What does he/she do?
What does he/she think?
www.tentsproject.eu
24. Opening of disclosure conversation
Start with the child’s signals …
Generalise: ”I know many children who tell/do/draw
just like you, and they have experienced things they do
not dare to talk about. I have wondered if there are
things in your life you have not dared to tell anybody?
Talk to the child about good and bad secrets, and
about what typically stops children from telling things.
www.tentsproject.eu
25. Secrets and frights
Talk to kids about good and bad secrets:
That children are afraid of to telling bad secrets
They fear nobody will believe them
They are afraid of threats
They are afraid of what will happen if they tell it
www.tentsproject.eu
28. The ”alarm centre” of the brain
is kept a state of constant alert
Releases stress hormones
which stimulate instinctive
reactions and inhibits more
higher cognitive processing
Underdeveloped connections Inhibited:
between limbic system and
Affect regulation and ability
prefrontal cortex (which runs
reasoning, self reflection, to learn and integrate
contextualising – cognitive new information
control)
www.rvts.no
29. Identifies the following key challenges:
Help children to regulate affect
Help children to become more conscious about
their affects and bodily states
Help children to make connections between
affect and language
Group work: Ways to help children with this
www.tentsproject.eu
30. Some ways we have experience with:
Affect consciousness:
Being sensitive, intonation: Let the principles of good
care and healthy early interaction with infants be the
model
Comment on signals of affect in the child’s voice tone,
body posture, mimic, and other
Ask where in the body the child can feel what he or she
is telling us
www.tentsproject.eu
31. Ways we have experience with (continued):
Affect control and regulation:
Identify the pre-warning signals in the child’s body
Discuss alternative ways to cope with those signals
(counting techniques, relaxation techniques, and more)
Stop destructive behaviour, with own affects controlled
Regulate the child’s affect through own affect
Use such situation as examples for learning
Reward changes
www.tentsproject.eu
