Transcript for
Overcoming adversity in work with mothers and children – part one

Narrator (00:02): Welcome to the Emerging Minds Podcast.

Gill Munro (00:08): Welcome, everyone. My name is Gill Munro from Emerging Minds. This episode explores the impacts of adversity on children and families. And what’s helpful for practitioners to keep in mind that will be helpful in supporting parents to support their children’s social and emotional wellbeing and resilience. So we’re joined by Christine Watson from Kamira Alcohol and Other Drug Treatment Services in New South Wales. Welcome, Chris.

Christine Watson (00:34): Thanks, Gill.

Gill Munro (00:35): It would be lovely to start off just by finding out a little about your role there at Kamira.

Christine Watson (00:40): As you said, I’m the clinical director at Kamira Alcohol and Other Drug Treatment Services. And I’m responsible, basically, for the ongoing development and implementation of our residential rehabilitation service for women with their accompanying children to address issues of substance dependency.

Gill Munro (00:59): I imagine the families that you work with obviously experienced a lot of significant adversity.

Christine Watson (01:05): Yes. So most of our clients have experienced complex trauma, whether that be childhood interpersonal trauma or neglect. And most also have histories of family and domestic violence relationships as adults. Our Aboriginal clients, who make up between 30 and 60% of our admissions through the year, they have a whole other dimension of trauma in areas of culture, institutional and social discrimination. We currently also have about 30% pregnant women, and they have also their trauma stories to tell. And most of our women actually have had multiple children removed from their care. And each time that happens, it’s another successive trauma for them.

Christine Watson (01:52): And it speaks to that whole problem of intergenerational trauma that happens with families where there’s this history of children being removed. And then those children having their own difficulties growing up. And then they again become parents who are at risk of having their own children removed, and that cycle just goes on and on. At our current cohort, apart from our pregnant ladies, the other women are all engaged in processes to have at least one of their children returned to their care. So that’s a really common, I guess, motivation for women to seek treatment. So they’re very keen to overcome all the life obstacles that they’ve had in order to cherish that little one that they are trying to get back.

Gill Munro (02:39): Amazing work. Can you just talk to us a little about what you’ve noticed about the impacts of adversity on children in the families that you see?

Christine Watson (02:47): Yeah. So the children that have remained in the care of their parents who have been substance using. They’ve often missed out on a really close emotional connection with mum. Mum has her own trauma history. So she’s perhaps been emotionally disconnected anyway. But when we layer in the substance use, which takes them then even a greater emotional distance from their children. So that’s if the children are in mum’s care. But if the kids have already been taken from mum’s care, well, then that’s another rupture in their lives. And so the children are coping then with being taken out of a familiar circumstance. Being put into sometimes a number of successive temporary placements. And so what we see is these little children have problems with connection. Problems with emotional expression. Problems with regulating their emotions. But huge issues around trust.

Gill Munro (03:49): So pretty important for practitioners to think about these impacts of adversity on children in the family. I imagine you would say. And to have some idea how to work with parents in ways that will support children’s resilience and social and emotional wellbeing.

Christine Watson (04:04): Yes, we have children presenting as anxious or depressed. They could be really clingy with mum or at the other end of the spectrum. They ahm, I would say offer indiscriminate affection because they haven’t got that close attachment with mum. And so it’s really so important to work with the parents and the children to improve their relationship to really help with that attachment. And as practitioners, we need to be aware of that fundamental ruptures that have occurred for whatever reason and work with that. Because a mum who is attached to her child in a really secure way is going to keep that child safe. And a child who feels safe and supported and connected to mum is going to be more resilient in overcoming life’s challenges. So it is really important, as you say, to be aware of that. But also we need to be aware that people who’ve experienced severe adversity throughout their life have so many horror outcomes in life than most people would appreciate.

Christine Watson (05:17): So they actually have a lot more physical illnesses, much more likely to die early. They’re more likely to have a high suicide rate. More likely to have complex mental health issues. More likely to have problems with concentration or learning. And so, therefore they don’t do well in the education system, which affects their ability for employment and then financial security. And so all of this, if we don’t address all of that, it just perpetuates into lives that people don’t see any improvement. We can throw different supports that people, but if we can’t really work with these fundamental things, we’re not really going to support them at a level that’ll make a difference in their life.

Christine Watson (06:06): And what we want to do is change the whole trajectory of that child’s life by doing the intervention with them and with the parents. And we have to engage with women in a way that they’re able to feel supported but not lack agency. We need to value and respect their knowledge and experience. And we have to give them hope that there is a way out of their current circumstances. And there’s a clear pathway, and it’s supported and having like a web network to catch them if they’re struggling. So that really old saying of, “You need a community to raise a family. You need a community to lift families out of poverty and disadvantage.”

Gill Munro (06:50): Wow, that really speaks to things like the intergenerationality of adversity as well. Doesn’t it? What you’ve just said there. I was going to ask you. You mentioned something about the importance of that parent-child relationship, Chris. So, could you tell us just a little bit more about the ways in which you work to sort of strengthen that relationship and build a bit of parenting confidence?

Christine Watson (07:14): We try to always be very respectful with a woman when we’re working with her around parenting because it is such a sensitive area. People feel so judged in that area, and we normalise their experience. Like we would say, “Given the history, how could we expect things to be very much different to that? And we can see how things have gotten to where they are.” But also to let them see that it’s never too late to make changes. And by coming to Kamira, they’re exactly doing what they need to do. They’re making a positive choice by choosing recovery. And we also try and foster development of compassion. Compassion for themselves because there’s so much guilt and shame that goes along with substance use when you’re a parent or when you’re pregnant and also having compassion for their child. So we use a lot of humour when we can, and we just really help reframe circumstances so that mum’s able to see that beautiful little child in front of them, rather than the behaviours that might be happening at the moment.

Christine Watson (08:20): So working with a mum’s values and her parenting strengths, we’re then able to really support that relationship between them, and it all centres around having that really strong attachment with their child. If things are going well there, then mum’s able to focus on these other areas that are going to make her life and her child’s life better. So we do a lot of work with building trust. Trust building in the relationship between the parent and the child, because that’s often been affected by mum maybe being inconsistent or emotionally distant. So we do trust-building and also educating mums and helping them see the value of child-led play. Unfortunately, most people don’t really know how to be a parent until they’re suddenly a parent and expected to know everything. And so there’s a huge educational component of our programme, and we run attachment-based groups for the women.

Christine Watson (09:22): And that is such a great learning opportunity for the women because it’s women experiencing similar challenges. Being able to support each other and shared experiences without judgement , and that’s so important. People will shut down if they feel judged. And so being able to work with them in that group way as well as the one-on-one support. We actually have a dedicated parenting team to deliver that programme. But also a dedicated attachment specialist who uses theraplay to work with the mum and the child around, really working on that attachment that might need some repair there.

Christine Watson (10:04): And really working on strengthening the relationship and building enjoyment in the shared activities because that enjoyment is something that when women have been in addiction, that ability of them to experience joy in the simple things of life becomes diminished. And so we’re really working to build that. Finding joy in the interaction with your child and taking away some of the fears that they have about not being the good enough parent that’s coming out of their shame from the past. And then what we see with the children then is when they’re more secure, behaviorally, they want to please mum, and they also much more settled if mum’s not as available. If mum has to do something, the child’s not so anxious. And so life becomes easier for mum.

Gill Munro (10:52): I love the way you speak. So sort of joyfully, almost Chris. So it’s such a strengths, hope-filled kind of optimistic approach that you take. And I think that’s probably at odds with how many people would actually consider this kind of work to be. So it’s lovely to hear that coming through in the way that you talk and the importance of it in finding that optimistic approach.

Christine Watson (11:15): Yes. And I think your comment comes out of this whole stigma that goes along with people who have challenges in parenting. So for our clients, it’s around drug and alcohol. But it’s not just drug and alcohol because there’s all that other stuff that goes with it. But every mum wants to be the best mum they can. And every mum loves her child. They might be frightened of their child’s emotions. Or they may feel that they don’t have the skills, and they may feel insecure. But that’s all coming out of their own past experience. And so if we can bring them together, it’s just so wonderful to see the changes. And to see mum change from someone who is barely managing her own mood, let alone trying to calm her child.

Christine Watson (12:03): Because what we see at first is we have the child become dysregulated, and mum can’t cope. So she dysregulates along with the child. And that leads to all sorts of problems for both mum and the child. But with the work that we do, we’re able to see a child become dysregulated and mum be able to manage to stay calm herself and offer that secure hands to hold the space for the child. And then the child’s able to then feel safe and secure and calm down. And it’s just lovely to see that. And just seeing the relationship grow.

Gill Munro (12:41): That is lovely. Eventually, I was going to ask you more about emotions and we know that parents can be so triggered by children’s behaviours and emotions. Also, I think it’s difficult for many practitioners to sort of ask parents about their children’s behaviours and how they manage behaviours. It’s something that I think perhaps practitioners that don’t work as directly as you do with parents and children would find difficult to kind of approach or broach that subject. So I’m just wondering if you can talk to us just a little bit more about how you work with parents around building their understanding of their children’s emotions and behaviours.

 Christine Watson (13:16): It is a really sensitive thing, as you say, to talk to a mum about how she is with her children. And particularly for our clients who have experienced that children being removed from their care and being put into out-of-home care. So there’s not a lot of trust at first with agencies. But we’re in a pretty unique situation here at Kamira, where we’re spending a great deal of time with our clients. They’re here 24 hours a day for between five and seven months working with their child. So we get the chance to see lots of the challenges, and we’re able to normalise that and take away the shame that goes along with that. Because when the judgment’s not there, it’s just a conversation about normal kid behaviour. And even if it’s not so very normal, we’re able to see that it’s normal in the circumstances.

Christine Watson (14:04): And because there’s such a focus here on mums and kids, the general conversation is often around that. So the women do lots of groups around parenting. And so the conversations, I guess, are easier. So they’re familiar with the circle of security concepts. So we’re able to open up about conversations relating to a child’s behaviours and emotions and relate it to the needs on the circle. So the mum’s not feeling judged. It’s not about what she’s doing or not doing well. It’s about sitting beside the mum, more or less, and we’re looking together, “Where’s my child on the circle at the moment? Are they out exploring? Are they coming in for support?” It’s just such a gift to be able to do the educational component alongside of the practical work with them. Mums often actually are quite disconnected from their own emotion.

Christine Watson (14:59): So we’re able to work with mums disconnection as well so that she’s able to then settle her child. So we could talk to mum about that. We can normalise her own disconnection because of her past trauma and what that’s like for her. And then we can kind of lead the conversation around to, “So you’re feeling this. What do you think that’s like for your child when you’re like that?” And so they get to put themselves in their children’s shoes and look out through their children’s eyes. And that makes a difference to be able to look through a different lens about what’s happening either as a result of what mum’s doing or what the child may be feeling. So mum then learns not to escalate along with the child. She learns to be the hands that hold the child when they’re needed and to help the child deescalate.

Christine Watson (15:56): And we also do a lot of work around helping mum observe, I guess, what I would say, what the messaging is behind the behaviour. So rather than mum thinking, “There’s something wrong with my child because they’re doing that. Or my child doesn’t like me, or they wouldn’t do that.” To seeing, “Okay, there’s an unmet need here. And my child has very few words and very little power, and this is the only way that they can let me know how they’re feeling in the moment. And then they learn, “Okay, well, if my child’s feeling this, I can validate that to my child.” And so we really coach the women in picking up the cues and then verbalising, “Oh, you’re looking really sad at the moment.” Or, “Oh, wow, you’re so excited because we’re going to the park.” So we’re teaching mum all the time to label the emotions in conversation so that the child then learns to identify their own emotions as well.

Christine Watson (16:58): So there’s lots and lots of things we do. But a big part of their programme also is based on sensory perception. So we actually do assessments with the mum for her sensory preferences and also assessments with the children for their sensory preferences. And so, a lot of the work we do with building attachment. But also learning to manage difficult emotions is done from a sensory level. So for one child, pushing around a heavy truck helps them feel better. But another child, it might be touching something that has a soft and fluffy texture. And so, we’re able to tailor the interventions according to sensory preferences of the child as well.

Christine Watson (17:41): For our mums with children in out-of-home care, we are also working with them on how to talk to their children about the situation. Part of the programme of tuning into kids is the emotional identification. But this other programme that we run, which is keeping connected, is about how can mums stay connected to children that aren’t in their care? And how can they have the conversations with them that they want to have with them and that the children need to hear? So it’s such broad work, but it’s so important that each mum recognises that she’s one of many with shared experiences. But she’s also an individual with an individual experience and tailoring a programme to help her respond to her experiences.

Gill Munro (18:30): I mean, it’s just so interesting, Chris, to hear you talk. I don’t even want to interrupt you. I could just keep listening to be honest. But you talked a little bit there about the emotional stuff, which is just fantastic. And helping parents better understand the behaviours as not just acting out or being naughty or something. But these are unmet needs kind of thing.

Christine Watson (18:51): Absolutely.

Gill Munro (18:51): Yeah. So that’s fabulous. And around the communication with children. You touched on that as well. How children can be supported to express how they’re feeling better. And I also wonder how you work with parents around having perhaps those more challenging conversations where things haven’t gone quite right. Where a parent has had a reaction that they feel sorry about. And if you could talk to us a little around that.

Christine Watson (19:17): Yes. And we always say to the mums. The conversations need to be age-appropriate. So for a young child, mum can model to that child, “Oh, we all make mistakes. I’m really sorry. I was so cranky. Mum didn’t sleep very well last night. And it’s not your fault that mum’s feeling this way,” And just really normal. And it helps the child realise that all emotions are normal. But it gives a context where the child might experience mums communication in a negative or upsetting way. But then mum’s able to come back and repair the rupture by saying, “Hey, look, it wasn’t you. It wasn’t really your fault. Mum’s having a bad time around this or that.” And mum taking the responsibility. So the child is not bearing the burden. For older children, they can give a bit more detail and context to it. But it’s great modelling for the little ones because they learn then to own that they have emotions. But also that sometimes they might be sorry about what their emotions led them to do or say.

Gill Munro (20:22): I’m just thinking of practitioners who work in more mainstream settings. And one of the areas that I thought might be easier is around routines and rituals. We know that that can be a real sort of stabilising factor to help children feel more secure. And I’m just wondering if you do much work around that. And if so, what you can tell us about that.

Christine Watson (20:43): Routine is king, or as we would say here at Kamira, queen because it is so important. Our mums have come from usually fairly chaotic backgrounds. They’ve had a lot of adverse experiences, and often they haven’t had very secure lives. They may have been couch surfing. That’s all the problems that come along with substance use. So particularly for intergenerational trauma, maybe mom has never had a really good routine at any time in her life. And the children haven’t had a routine either. But if they have had a routine that has worked with them, we try and keep that going in a modified version at Kamira. We don’t want to reinvent the wheel for something that’s already working. However, as a residential facility, there’s this bigger structure around routine, just so that we can function as an agency that the women obviously need to fit into.

Christine Watson (21:38): But within that, the parenting team meets with the mum and comes up with a daily routine. And that might include getting the child ready and taking them to daycare in the morning and picking them up in the afternoon. Or, if the child is younger, what they would do during the day. How they would plan that out. How they would get to and from appointments. What food they’re going to cook or serve and all of those sorts of things. And we try and keep it fairly consistent. Children feel more secure when there is consistency. But also anyone who has experienced trauma also finds reassurance through consistency. So routine is a really important support for the women.

Christine Watson (22:22): And it’s quite common for them to say, “Oh, I really didn’t like being told how I had to do something when I first came in. That I actually had to have breakfast at a set time, but now I can really see how freeing it is to have a routine and how well the children adapt to that.” So I guess part of our ongoing treatment with the women is planning for a workable routine for when they leave Kamira. And it needs to have enough structure that is going to work for them, but enough flexibility that they’re able to adapt to the challenges to that routine that will come up. We’re very collaborative around our routines because we need to rely on the expertise of the mums about what their needs are and what works best for them. And they know their children better than we do.

Gill Munro (23:15): And I guess routines can also be those more simple things such as every Tuesday afternoon we take the dog to the park, or whatever. So those more simple routines for birthdays where you always have a chocolate cake or something.

Christine Watson (23:31): Absolutely. And kids just love it, and they’ll pull us up on it if we’re going out of routine. They let us know, “Oh, no, this is when we do this.”

Gill Munro (23:42): Lovely. And you’ve talked a lot about the importance of peer groups there and support groups. And just how powerful that can be for women to realise that they are not alone in feeling the way that they feel. And some of the experiences that they’ve had maybe common across these groups. So I’d just be interested in hearing a little bit more about the importance of these sorts of supports in women’s lives, but also in children’s lives.

Christine Watson (24:07): One of the main things about the groups is we’re able to deliver a whole lot of information that the women would not have known. But obviously, what they get from the group apart from the knowledge is acceptance, and shared experience and they’re not judged. And so it’s women supporting women, and there’s that real sense of solidarity that they can get from working in a group. And also, they get to brainstorm, and I guess they get to see other perspectives. And that’s a really important thing in life to be able to see beyond one’s own perspective. And so they also learn to cultivate more empathy for themself because they’re hearing other people’s stories. But also growing empathy for others. So it helps with the building of empathy and compassion so that they get their knowledge base and then they get support. And it’s often the beginning of ongoing support past treatment where they’re able to keep in contact with these women out in the community later to be able to have that ongoing support, which is often missing in women’s life.

Gill Munro (25:21): And I guess many women, as you’ve mentioned, they haven’t really had that. They haven’t really got a strong network of support at all.

Christine Watson (25:28): Absolutely. Their supports outside when they first come in are often very strained. Like if they’ve come from a family that has had intergenerational substance use, it’s unlikely that the immediate family can offer very much support. Their capacity to support is reduced. But also, even in quite functional families, when a mum has substance problems, there’s a lot of shame that comes along with that and a lot of judgement. And so it really strains the fabric of the families who may be very judgmental of this mum or feel judged themselves because there’s someone in their family with a substance problem. So judgments from family and friends can be very isolating coming from domestic and family violence relationships has really impacted a woman’s faith in herself and her faith in her own reality. Intimate partner violence also often involves isolating women from family support and friend supports.

Christine Watson (26:33): So it is really important for women to either rebuild the relationships that have been damaged that can be supportive or to find a new network of support. And I mean, agencies are great supports, but they will never replace that web in the community of friends. So if we can get mums to a playgroup, that’s great because they’re making new connections. If we can get mums out to the park meeting other mums, that’s great. So there’s a lot of work to be done. There’s the repair work of the mum with her own child that she has here. But there’s that broader repair with their family or the realisation of, “Actually, I need stronger boundaries around certain relationships now. And I do love these people. They have been in my life. But I can see that if I stay close to these people, my life’s not going to improve. And the life of my children aren’t going to improve.”

Christine Watson (27:37): So it’s working with the women around what’s a healthy relationship and how can I develop that for myself and my child? But I think if we’re able to show the women support without judgement and model those healthy boundaries to them, we might be the very first relationship that they’ve had that is perhaps not abusive or negligent in some way. It’s a whole new thing for them to have supportive relationships.

Gill Munro (28:05): Yeah. And that first relationship with the practitioner then can be that sort of springboard into having the confidence to join some of these groups in the wider community then, I guess.

Christine Watson (28:15): Yes. And also being able to have a process where they’re able to connect with those groups in a safe way because they’re in a very supported environment at Kamira, and we don’t want to just push them out the door and say, “Okay, good luck now.” So we start getting them involved with outside groups whilst they’re here. So it’s a transition from the amount of support they get from us. And then the connections that they’re having outside.

Gill Munro (28:45): And you talked about playgroups and parks and so on, Chris because I imagine the support are just as important for the child as well. Particularly when they leave the comfort of Kamira can go out into the big wide world again. That there’s that support for the child, as well as the mother.

Christine Watson (29:01): It’s absolutely fundamental that a child needs supports. That having just one person of a mum that they can rely on makes a big difference in their ability to build resilience. So, having that one person that can offer that praise to them. That person who’s very biased in their favour. Those sorts of connections can really help the resilience. And so, we need our children to be connecting with people in the community that can affirm them and keep them safe. But also they need to be able to learn to relate in healthy ways with other people, and they can start that child to child level.

Gill Munro (29:46): Wow, that has been so interesting hearing you talk, Chris. I mean, we’ve just about finished my questions, really, and you’ve just covered everything and more than I could possibly have asked. But I’m just wondering if there was anything else that you wanted to add or any other thoughts or dilemmas that you think might be interesting for other practitioners to hear when working with parents to support their children and children’s mental health?

Christine Watson (30:09): I think that what’s been implicit in our conversations, but I haven’t actually said is that mum needs to be stable. And that includes her mental health. So everything the mum will do or will fail to do is often dependent on her state. And so if mums mental health can be supported. If she can manage that. Well, then she has a pretty good chance of being able to do everything else that we’ve spoken about today. So particularly with our cohort of women, who’ve used substances quite often to create emotional distance from past events or current challenges that they might have, or people would call that self-medicating perhaps. But these stressors in their life are also the things that could take them back into substance use. That will then, again, affect their quality of life. Affect their relationships with their children and totally destroy their mental health.

Christine Watson (31:10): So we really do need to help mum recognise where her mental health is at and do what she needs to do in order to keep it stable. So for some, it might be a medication review, and for others, it’s learning about self-care. And for everybody, it’s about developing healthy relationships and support. So having that supportive social web can really help mum maintain the mental health that she needs in order to cope. Working in the drug and alcohol field. I would say, people say, “Well, what leads to relapse?” And I would say, “Well, you know what? It’s not being able to handle stress.” And quite often, the stress is related to relationships. But it’s not being able to manage stress. It’s not having that level of resilience to be able to cope with life’s challenges that will lead a woman, perhaps back to using substances to cope. And if she can maintain her mental health, her resilience will be able to kick in and help her manage.

Gill Munro (32:17):Well, that’s really been interesting talking to you, Chris. Can’t thank you enough for spending the time to join us today. And I think there’s just so much food for thought in what you’ve said. So thanks again, Chris. And we will say goodbye for now.

Christine Watson (32:32): Thanks, Gill.

Narrator (32:34): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health, under the national support for child and youth mental health programme.