Centre of Knowledge
The Model in Practice:
Understanding the Lighthouse
Therapeutic Family Model of Care™
Theoretical Underpinnings of TIP
Attachment
Theory
Object
Relations
Theory
Trauma
Neurobiology
Psychological
Wellness
Theory
The Lighthouse Experience
Overview of the Model
Home
Individualised
Care
PLACE
Playful, Loving, Accepting,
Caring, Empathetic
Individual
Professional
Development
Plan
Development Plan
Staff
Therapeutic/
Recovery
Oriented
Family
Developmentally
Focussed
Not Chronologically
Sense of
Community
Primary
Experience
Time/Holding
Space
Recovery Process
Psychologists
Care Team
Carers
Young
Person
Intake
Process
Presenting Issues
Referrals
Identify
Intake interview
Confusion/diffusion
Consultation
Mental health issues
Psycho-social screening
Drug & alcohol issues
Placement meetings
Disconnected
Immediate gratification
Induction
Process
Presenting Issues
Visit homes
Attachment difficulties
Dinners
Cold feet
Family meetings
Culture shock
Community events
Guarded
Meet carers and young people
Debrief with intake worker and carer
Holding Environment
Process
Presenting Issues
Primary experience
Reactive attachment
Attachment with carer
Traumatic experiences surface
Relationship building
Resistance to boundaries
Trust, safety, stability and security
Substance issues may resurface
Home
Mental health issues
Develop confidence and self esteem
Family conflict
Window to future
Transference and counter-transference
Transition to Autonomy/Independence
Process
Presenting Issues
Coping skills
Resistance to change/separation anxiety
Skills development
Regression
Support networks
Cold feet
Established healthy attachments
Internal conflict
Community networks
Grief & loss
Transitional object
Excitement vs. anxiety
Transitional planning
After Care
Process
Presenting Issues
Assertive outreach
Financial issues
Transitional development planning
Accommodation/housing
Carer relationships
Mental health support
Ongoing relationships with young person
Separation anxiety
Inter-dependent living
Community support
The Recovery Process
Elements of Recovery
• Therapeutic Relationships
• Group Experience
• Physical Environment
• Sense of Community
• Organisational Culture
Therapeutic Relationships
A central aim of the therapeutic relationship is to provide a safe relationship in which
the child can then work through and integrate unresolved aspects of their traumatic
experiences.
From the position of being engaged in a positive attachment relationship and
through observing other healthy relationships, the young person can then acquire
experience and skills to develop and manage other relationships in their life.
Barton, Gonzalez & Tomlinson (2012)
Therapeutic Relationships
…evidence is accumulating that human beings of all ages are happiest and able to
deploy their talents to best advantage when they are confident that, standing behind
them, there are one or more trusted persons who will come to their aid should
difficulties arise. The person trusted, also known as an attachment figure, can be
considered as providing his or her companion with a secure base from which to
operate.
Bowlby in Barton, Gonzalez & Tomlinson (2012)
The Group Experience
Traumatized young people need a healthy community to buffer the pain, distress
and loss caused by their earlier trauma. What works to heal the young person is
opportunities to increase the number and quality of relationships. If we don’t give
children time to learn how to be with others, to connect, to deal with conflict and to
negotiate complex social hierarchies, those areas of their brains will
be underdeveloped.
Perry and Szalavitz (2006)
The Group Experience
The group processes provide an opportunity to observe group dynamics and
where it is helpful to intervene in a way that disrupts destructive dynamics
that may be developing
For example, difficulties within the group may be projected onto one person
who could then become a scapegoat for the group’s difficulties
An opportunity for everyone involved to establish their sense of self by
making their own unique contribution. For everyone to reflect on what is
happening for themselves, for others and the whole group. This enables the
members of the group to learn about their own feelings, thoughts and
relationships and to consider this alongside other people’s experiences
Therapeutic Environment
Traumatised people benefit from caring
environments that are attuned to their
emotional states.
…where workers can adjust the
environment to support emotional
regulation, and can provide predictable
responses and routines that assist in
reducing hyper-arousal.
(Tucci, Mitchell and Goddard, 2010)
Physical Environment
Child abuse and trauma often
happens within a wider
context of neglect, where the
environment the child lives in
reflects the parent’s lack of
attunement to their needs.
The home is often uncared
for, unstimulating, chaotic and
sometimes unsafe.
Barton, Gonzalez & Tomlinson (2011)
The environment is warm, friendly, nurturing,
calming and aesthetically pleasing. It contains
facilities that can support and enrich a child’s
life. The home is a place for growth,
development and a means of balancing the
need for being sociable with privacy. It is a place
where positive memories can be made and lifelong relationships established. Most importantly,
the home is a safe place and sanctuary.
The Community
Sense of community:
The feeling that one is part of a readily
available supportive and dependable
structure. Sense of community
transcends individualism in that to
maintain such an interdependent
relationship one does for others what
one expects from others.
Sarason (1974)
Sense of Community
Ideally, children are raised by their family and extended family within the
context of a supportive wider community. Many of the children that we
work with have been alienated and disconnected from their local
community. Many of the children’s lives are transient, due to running
away from unsafe relationships, or being moved around by the system
from placement to placement.
Barton, Gonzalez & Tomlinson (2012)
Therapeutic Circle of Care
Organisational Culture
Traumatized children cannot heal within traumatizing - or
traumatized - organisations, and instead such
organizations can make children’s problems worse.
Bloom (2005)
Organisational Culture
• Organisational wide understanding child development and impact of
trauma
• Consistent trauma informed approach incorporated across systems and
processes
• Clarity as an organisation of the primary task
• Young people are provided a holding environment - feel safe & protected
• Opportunity to learn to deal with grief & loss in a healthy way
• Long term consistent and repetitive work
Organisational Culture
• Opportunity for the child to develop healthy attachment
• Promote the direct expression of feelings
• Systems that support staff to manage complex nature of the work
• Enhance motivation for growth and future success
• Provide opportunity for connections with wider community
Organisational Parenting
All staff role
model a
healthy sense
of
community
Internalised
by the child
Provides a
therapeutic
milieu
Operations/
relationships
attuned to the
therapeutic
task
Organisation
The Organisation as Therapist
Relationships,
language,
communication,
leadership and
authority =
Environment
experienced by
child
Variety of
relationships
& circle of
care
TFMC Process of Recovery
Individual
Development
Plan
Learning
Physical development
Emotional development
Attachment
Identity
Social development
Autonomy / life skills
Relational and community
Connectedness
Fun / play / recreation
Transition planning
Psychological
Healing
Process
Identity confusion
Attachment difficulties
Holding space
Trauma work
Dealing with loss and rejection
Developing insight and awareness
Building trust in relationships
Internal working models
Developing autonomy
New skills consolidation
Confidence in relationship building
Lighthouse
Process
Time-frame
Intake
Induction
Weeks / Months
Lighthouse Home
Months / Years
Transition
After Care
Months / Years
Feedback and Evaluation