Wednesday, September 7, 2016

Neuroscience and Bullying.

Last year I attended a training looking at a brain-based understanding of adolescent issues. It was presented by Professor Pieter Rossouw of Mediros Associates and it has given me food for thought ever since.

This is a brief review of neuropsychotherapy to deal with bullying from the 'bottom up. It is based on understanding the way the brain develops. In the world of psychology, psychotherapy and counselling, a 'top down' approach works from the understanding that we can harness the abilities of our intellect to develop higher order thinking habits and through this, we develop better mental health. However the top down approach does not account for the fact that when our brains are exposed to fear inducing or non-nurturing environments, we are not able to access higher order thinking abilities. In fact if exposure to stress goes on for long enough, and particularly if it happens early in life, our brains do not develop enough connection between primitive survival areas and higher thinking areas and so we tend to operate in survival oriented, emotionally impoverished ways. This is not just  a wilful refusal to think about things more clearly. The brain has not developed to be able to think clearly. Some neuroscience influenced mental health practitioners are advocating that unless we work from the bottom up and teach people, particularly children to better regulate their primitive brain responses(which luckily is entirely possible), we have little hope of bringing about significant changes in behaviour.

Here are some of the key points in the article (you can read the whole thing by following the above link):

Young adolescents are particularly vulnerable in fear inducing environments (such as when exposed to bullying) because their brains are undergoing a great deal of intense modification at this stage. The brain can be wired at this stage in negative or positive ways that have consequences extending into later in life.

Most bullying programmes in schools have relied on 'top down' interventions, attempting to harness kids cognitive abilities to help them learn to behave in more pro-social ways.

If distress is not dealt with at the level of the survival oriented brain, the authors state (this is fairly dense bit of academic-speak):

Experiences of bullying up-regulates the fear system, (emotional and primitive brain) resulting in heightened activation and hypervigilance of the amygdala. Subsequently, stimuli that would not normally be perceived as threatening may be activated in the amygdala due to their ambiguous nature. The function of the hippocampus particularly relates to short-term memory, the application of context, and neural plasticity. Overproduction of stress chemicals can lead to impaired functioning of the hippocampus (Thomas, Hotsenpiller, & Peterson, 2007), compromising the capacity to form new memories and hinder academic learning (Rossouw, 2012). Similar to the effect bullying has on the amygdala, ongoing exposure to this trauma and damage to the hippocampus can result in an overgeneralisation of threatening stimuli. Subsequently, the victim may be unable to appropriately apply context to situations and respond to non-threatening stimuli as if they were a threat. Furthermore, damage to the hippocampus through continual stress activation further compromises the individuals capacity to form new memory connections (Rossouw, 2012), which can also play a role in academic learning. Third, the neomammalian brain consists of the large frontal cortical systems of the brain, and is known as the ‘smart brain’ due to its executive functions. The prefrontal cortex (especially the right) significantly contributes to the development of social functioning. Therefore, the social well-being of a victim can be significantly impaired to the up-regulation of the emotional brain and hindered neural proliferation of the smart brain. It is clear to see the significant impact trauma associated with bullying can have on the young developing brain, particularly relating to neural architecture and functionality. 

So - in short, your memory, ability to discriminate between genuine and imagined threat  and your ability to learn are affected by long term stress. This article is looking at bullying, but long-term stress could come from other factors such as problems in the family, poverty, social unrest or illness.

What can be done to counteract the effects of a negative and fear inducing environment? The brain based approach uses principles of neuroscience to define an 'enriched environment'. In their words: An enriched environment is one which enables an individual to feel safe and facilitates the fulfilment of three basic needs; 

  • the need for attachment, 
  • the need for control and orientation, 
  • and the need for pleasure maximisation and pain minimisation. 

The culmination and satisfaction these three basic needs then lead to the growth of the individual’s sense of self. An enriched environment facilitates neural proliferation, allowing for growth of the frontal cortical systems (i.e., smart brain) and its capacity to down-regulate over-activation of the emotional brain. 

At HPSS, we are developing a dispositional curriculum, which takes place primarily in the context of the hub. Our philosophy is that the need for attachment and safety can potentially be met in the hub. This context can also generate opportunities for students to experience taking control of their environment with the mentoring of their coach, learning to be organised, responsible and assertive. Because the hub is an informal and more intimate environment, there should be opportunities for the students to learn in ways that are pleasurable; food can be included, games, music, anything that involves healthy pleasure.

All secondary schools have initiatives and programmes designed to foster pro-social attitudes and behaviours but they tend to be co-curricular and extra curricular ( i.e. Duke of Edinburgh, Peer Mediation etc) This school is putting the dispositional curriculum right in the centre, alongside the academic curriculum. Perhaps this seems more akin to the way primary schools operate and we should be expecting students of secondary age to have mastered these basic skills. Well look at the world! How many adults are in control of their stress, fear and threat reactions all the time? I personally work at it every day. As far as I can see from my own life and those I work with, developing a healthy brain is a lifelong endeavour.

My hope as counsellor, is that students and staff really get that the enriched environment promotes healthy brain development and a healthy brain makes us both happy and smart.

Monday, September 5, 2016

Tewhare Tapa Wha – The house of wellbeing

This concept of wellbeing draws from the wisdom of our indigenous Maori. It was conceptualised by psychiatrist Mason Durie and translates as ‘the house of wellbeing’. The house is a metaphor of the self and is held up by four pillars, all of which are crucial to overall wellbeing. Here is a power point that explains the significance of the four pillars:
Over the years I have been a mental health professional, it has become a foundation of the philosophy with which I approach counselling. Serendipitously, it is also a foundation of the approach to wellbeing at Hobsonville Point Secondary School. Using this model of wellbeing allows one to work with both children and adults in ways that help understand them and find ways through their struggles. 
Using Tewhare Tapa Wha as a mapping and scaling exercise. 

Imagining that they are looking down on the house from above,  people draw four quadrants on a piece of paper and label them with each aspect of wellbeing. They then scale their current state of wellbeing in each area. Its important to make it current, a snapshot. They then use the four boxes to draw or write about the things that influenced where they placed themselves on the scale. After a while, we have a talk about what they have drawn or written.
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We can see links between the different areas, for example in the one above that I did for myself today to illustrate this page, I was struck by how important to my whole sense of wellbeing it is that I am sleeping well at the moment (Tinana/Physical). Wairau/spiritual health is clearly represented by my drawing of holding a paintbrush. Artistic expression is a deeply soulful activity and makes me feel open-hearted and generous. This has a link to my generally positive feelings about work today. Things are often revealed that might not come out in the open so easily without this tool. For example another thing that struck me about my own drawing today was the hands. Spirituality for me is ‘hands on’, directly felt, not an abstract thing.
Another thing I find useful is the indigenous philosophy behind Tewhare Tapa Wha (as far as I understand it). These ideas are unique to Maori and whether or not we are Maori ourselves, the Maori world view comes from this place underneath our own feet. I like the way this grounds the exercise right here and right now. When we experience the quadrants of wellbeing, most people can think through their current physical, mental and relational health. Spiritual health is more challenging for most people in the modern Western world, even those who belong to religions. This idea of Wairua seems to contain within it a sense of connectedness to the earth and living beings and to meaning beyond what the conscious, logical mind perceives. For me and I think many people with whom I work as a therapist, wellbeing in the Wairua quadrant helps to make sense of lives and challenges in the deepest way. I think traditional Western conceptions of mental health miss out Wairua. They are often focussed on problems and pathologies  and because of this can be inadequate in helping make sense of existential issues like making meaning of the suffering that happens in all lives. 
Online Screening Tool:
I developed this google form to be used as a simple check for wellbeing amongst students at Hobsonville Point Secondary School.  Approximately once each month, each hub completes the form below. These screens are seen by the counsellors, the coach and the learning community leader.
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Online Hauora/Wellbeing screen
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Online Hauora/Wellbeing Screen
Google forms automatically displays the responses on a spread sheet. Here is an example:
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Section of spreadsheet showing Hauroa/Wellbeing Screen responses
How it is working. 
This screen gives us a way of regularly checking on students wellbeing. Most of the time, students will say that they do not need any help, even if they indicate that some things are difficult in their lives. I find this interesting and am not sure how to interpret it. Is it a sign of resilience that they don’t feel they need help? Is it unfamiliarity with the help services that we offer here at this school? Or do young people just struggle along in their lives quite often not realising that they can get help, even if they are clearly given the option? I do not know the answers to these questions yet and further refinements to the screen may give more information.
Coaches have indicated that when they scan the responses of the students in their hubs, it is useful for them to note what students are saying. The responses can be a way to open conversation with students about things that are difficult to raise. The screen also gives coaches information that they can add to the mix of other observations they are making of students on a day to day level. Our coaches have a closer and more wide-ranging role in students lives than many teachers do in more traditional secondary schools. Because of this, they sometimes need a little mentoring about dealing with the more pastoral side of the role. Coaches also sometimes need to discuss the point at which the specialist skills of the counsellor are needed with a student.

Introversion, Extraversion, Privacy, Hierarchy

Recently I was reading ‘Quiet’ by Susan Cain. More about this book at The concepts of extraversion and introversion as basic temperament ‘sets’ were first conceptualised by Carl Jung, the famous contemporary of psychoanalyst Sigmund  Freud. Introversion and extraversion  are considered the two most strongly defining characteristics of temperament. Organisations that I’ve been involved with have sometimes put staff through the Myers Briggs personality screen which is derived from Jungs categories of personality, extraversion and introversion being the most powerful. The main point in ‘Quiet’ is that the Western world (specifically the North American business world), has come to value the qualities of extraversion much more than introversion and that in the process, the many positives that introverts bring can be overlooked.
This has made me think about my work environment and culture at Hobsonville Point Secondary School. HPSS is a huge, high- ceilinged building full of open plan, flexible spaces. It is nothing like any high school that most people have been in before. The concepts behind learning space design are to foster collaborative teaching and learning and to break down traditional silos of learning. Ultimately this should foster the ability of students to take charge of their own learning in a way that is much less achievable than the traditional high school setting. The flexibility and openness of spaces has the effect of breaking down barriers in relationships. Everything is visible, there is little in the way of territorial space. I find this also has an effect of blurring hierarchies. Its a lot to get used to!  My mind goes back to the very first taste of HPSS I had when I was approached by Maurie Abraham the principal after sending in a job application for the position of counsellor. Here is an anecdotal account:
Maurie called me to ask me in for a ‘chat’. OK, I thought, he must want to talk to me informally before deciding whether to formally interview me (mental image of board room, BOT members, sheets of pre-agreed questions). Maurie appeared at the door to meet me wearing a bright coloured shirt and a clashing sequined bow tie. Later I noticed that he was also wearing striped socks with more than a passing resemblance to those you would see on a clown.
We sat down at a table in the midst of much people traffic. Because I perceived it as a chat, I was less nervous than I would have been if I thought it was an interview. Funny isn’t it? Anyway at the end of the chat, Maurie said that there would be a decision about the guidance position within a few days. It was then that I realised that I had just been interviewed!
I went away intrigued and with my head spinning somewhat. My heart immediately sang at the fluidity of the space and the gentle humour of Maurie taking the mickey out of formal principal attire. At the same time I felt a nervousness in my fingers and toes as I contemplated the possibility of no corner of space to call my own, no door to close, no privacy… All my work spaces in school have been my islands, accumulating special pictures and poems and definitely with doors that could close, even lock. When I later read Susan Cain’s book, this nervousness made more sense and raised many questions that I have no answers for yet. How do you have private space in an environment like this? Does this culture value the qualities of introversion?
What about the counselling space itself? When dealing with people’s inner stuff that they are exposing, sometimes for the first time,  features of security, predictability, privacy are really important, partly for the person being counselled, but for the counsellor too. This can be lighting, the exact placement of the chairs, the box of tissues, the sound levels around the place.
Its one thing for the students to be able to move a few beanbags around and snuggle up in a nest behind some library books. The staff spaces are open at HPSS. Even the senior managers sit in a large space, their desks against the walls, their computer screens visible to all who walk through. There have been many times I have gone into their space to talk to one of them, usually Maurie. There he is, busy. Do I interrupt him? Well the space invites this. There is no polite door knocking going on here.
Everyone can hear the conversation, unless you make a point of saying can we go somewhere to talk in private, which makes a point of the need for privacy. As I write this, I can see how much of my own self-consciousness is involved. I have hated the feeling of schools and institutions where the administration and senior management block consists of a row of intimidatingly closed doors. But it is familiar, so you know where you stand (cap in hand, on the back foot in my experience). When you don’t have this hierarchy embedded into the physical spaces, you wonder where it is. Well I do. To me it is difficult to conceive that there is no hierarchy.

Saturday, September 3, 2016

Wellbeing and resilience:

This week I have been to the RTLB Cluster 8 WWW or 'What works for Wellbeing' conference. Most of the presentations were drawn from the field positive psychology.
I'm going tell parts of my own story which were evoked strongly by presenter Lucy Hone, who by her own definition is a 'pracademic', an academic who researches real world applicable practices for every day life.

Reading Lucy's website  100% project  after the conference, I came across her video presentation about accessing positive psychology for the purpose of dealing with grief. Lucy's story is quite well known - she and her husband Trevor lost their youngest daughter in a car crash quite recently. In this heart-achingly dignified presentation, Lucy talks us through a number of resilient approaches to moving through grief. Lucy talked about the experience of this event bringing to her mind the image of a road that suddenly forks and that you are instantly sent down the road less travelled (in Robert Frosts famous words). Life completely changes in an instant and you a person will now always be partially defined by this event. My younger sister died by suicide in 1992 when she was nearly 25. I remember the image in my mind was similar to Lucy's -  an unexpected corner to the road of life, changing the terrain forever. That loss has been intricately woven into my identity. My resilient response has been to strive to find a meaning for my own life in response to my sister's choice. I have not always achieved this and at times I have felt that all my own pre-existing vulnerabilities were made worse.  I have felt angry, abandoned and broken by the blow of her death.

This brings to mind my reading of the famous book 'Man's search for Meaning', by psychiatrist Viktor Frankl, who survived several years in a Nazi concentration camp and went on to create Logotherapy, which is based around our need to find a way to make meaning of events and experiences which are tragic and over which we have no control.

In my work as a counsellor, I encounter people of all ages who are hungry for meaning. The day after I had been reading Viktor Frankl,  two young students came to counselling and both told me hesitantly that they sometimes felt that suicide was a viable option for them. When students open up about this subject (and they do quite frequently), I first of all attempt to assess their safety and build a safety plan, which can include referring them for a mental health assessment and contacting families, depending on the seriousness of the suicidal feelings. To begin our therapeutic conversation, I often talk to them about some statistics: one in six people consider suicide but in New Zealand one in 10000 actually dies by suicide. The message in this is that our consciousness of mortality separates us from any other living creature, as far as we know. This consciousness gives us the ability to stand outside ourselves, to know we are mortal, to project our thinking into the past and the future, and to know that we have the power to end our own existence. Is it surprising then, that one in six of us consider it when life has lost its meaning and joy? Contemplating suicide then is normal, but concerning.

Viktor Frankl encountered many people in the camps that were suicidal. They felt life had nothing more to offer them other than indignity and suffering and that even if they survived the camps, their families quite likely had not. His question to them was "You feel that life has nothing to offer you anymore, but what might it be asking of you?" This of course is the invitation to make meaning out of experience. Being full of reading the book the night before, I told the two young students about Viktor Frankl and his question "What does life ask of you?" They sat there speechless for a while, and I wondered if I had pitched my offering at the wrong level for a couple of 13 or 14 year olds. A week later, we had another counselling session and I brought up the book again, asking how it had affected them. It had clearly sunk in, and although they could not articulate any response at the time, they both understood the relevance to their own problems of Viktor Frankl's story. Time and time again, I have been struck by the depth of need in children and adolescents to find meaning in life. Most have not been struck by terrible tragedy, but possibly the ongoing hurts of everyday life can be even more challenging because the suffering is invisible and cumulative.

The year my sister died was the year New Zealand became infamous for having the highest youth suicide rates in the OECD. There were many discussions in the media and I remember hearing one between Kim Hill and somebody else whose name I've forgotten, postulating that our culture is immature, we have become increasingly materialistic and self- centred, that parents don't help their kids access deeper meaning and culture but instead treat them like projects,  boxes that can be ticked by good academic grades with the ultimate goal of a good job and material independence from the parents.

24 years later, I work at a school that has given 'personal excellence' and 'academic excellence' equal importance. I think that although there might seem to be a groundswell of acknowledgement of the importance of  'personal excellence' and the attributes of wellbeing and character development that this implies, we are still going to have to swim against the current of the main culture we live in for a long time to come. I will be, thats for sure.