Georgina Sturmer: Hello and welcome to Attach Together, the podcast where we explore attachment theory and what it really means in practice for counsellors, psychotherapists and psychologists. The podcast is created by the team at Optima who deliver the level five and level seven diplomas in attachment-based psychotherapy. It's a space designed to help you deepen your understanding, reflect on your clinical work and stay connected to the heart of attachment-informed practice. I'm Georgina, an attachment-based psychotherapist and supervisor working in private practice. And alongside hosting this podcast, I also teach on the Level 5 courses at Optima. And before we begin, just a quick note, our episodes now include a CPD certificate. If you'd like to access it, you can visit our website or check the show notes if you're listening on Spotify, and I'll share the website at the end of the episode. Now joining me today is Alex Hearn. Alex has over 14 years experience working with children, young people and families across different settings. Her work brings together attachment theory, child development, systemic thinking and also environmental perspectives. And she's an author too. Alex has recently published an amazing read for anyone who's interested in attachment called Places of Safety, How Attachment Shapes Our Parenting. So Alex. We're gonna be really delving into attachment today, but also something I know that you and I have talked about a lot, which is how attachment fits into the wider systems that we live in. So where should we start with this?

Alix Hearn: It's a very good question. Hi Georgina, it's lovely to see you again. Thank you for your time. Yes, I I think the main thing for me is to, and I say this as a child and adolescent psychotherapist, is really broaden, I suppose to go back to the roots of what attachment theory is really about in terms of it being about the environment and our relationship to the environment. And when I say the environment, I also mean the environment. And we obviously sitting here very hot, thinking about climate change and actually how this affects both physical and mental health. So I'm really keen for attachment to be, go back to the basics or the roots of it in a way around thinking it being around systems and our relationship to each other, to everyone that we are all connected with and around. So not just the child or the parent child dyad but also not just the child's attachment, which I see a lot in my work. That's kind of really where my thinking is at the moment.

Georgina Sturmer: And so tell me more about that. So in my work, I see a lot of people talking about the child's attachment, what's the kind of undercurrent there? Is this more about looking at parenting and families more widely?

Alix Hearn: Yeah, I really think so and I think it's, we all have attachment ways of being or attachment patterns. I don't really like to go into sort of the binary, in my mind anyway, thinking sort of attachment styles with this or with that because I think sometimes that can sort of shut down thinking and I think I saw something that you had posted about that on a similar sort of kind of level as well that... So we all have attachment ways of being and yet in my experience and seems to be increasingly so in the world of sort of child mental health, child therapy interventions and child counselling, there still seems to be a focus on the child's behaviour and... what's happening for them, whilst not considering what's happening around them, but also what is every adult who interacts with a child or young person bringing to that relationship, if you see what I mean. The bi-directionality of relationships that we all have. So, yeah, I guess I'm... really wanting to de-pathologise child mental health, to de-colonise it, to really start to question the way we're doing things, interventions, what's helpful, what's not, what's effective, what's not. And for me, attachment is just at the heart and core of that, because that is at the heart of, in my mind anyway, relationship building. And therapy is all about relationship building. So that's really where, yeah.

Georgina Sturmer: Absolutely. And so I guess there's something here about when we're working with parents or with children and young people in different settings, it's about taking into account all the relationships that they have in their life and not just the person who's sitting in front of us in the therapy room.

Alix Hearn: Yeah, exactly. you know, I wrote about this in the book, and this was a while ago, but I used to do kind of what they call state of mind assessments, where you are assessing a child to sort of understand what they're experiencing, how they are, thinking about their attachment. But was only until fairly recently, I was like, huh, okay, well, this is interesting. Because by doing that, I'm not thinking about the parent or the carer or the foster carer or whoever the child or the grandparent, whoever the child is being looked after. I'm not. I'm not taking into account their attachment ways of being. I'm not assessing their attachment or their relationship to others. And therefore I'm not then thinking about intergenerational patterns of attachment, intergenerational trauma. It's all about the child and what the child is doing or what the child isn't doing. And so I'm really struck by that whenever we're doing sort of... clinical formulations, which we're encouraged to do in many settings, which I'm a big believer in. But actually, it's not just about clinically formulating what's happening for the child. It's also thinking about what's happening for the family. Because children don't exist in a vacuum. They exist as multiple systems. Bronfenbrenner's work is fantastic in that kind of area around thinking about all the sort of circles around the child, all the different environments that they're in. Yeah, and that's why it can be quite complicated.

Georgina Sturmer: Can you tell us more about that, the circles around the child? What do you mean by that?

Alix Hearn: So Bronfenbrenner talks about, so you have things like school or college or university. So some sort of educational establishment, for example, but that could also be, you know, proves or where children get excluded from school and get sent to alternative provision. That could be home. That could be homeschooling for some. So sort of the educational kind of learning aspect. And then we think about other maybe systems, social workers, psychiatrists, occupational therapists, nurses, residential units, children's homes. So there's lots of then other different therapeutic medical kind of systems around the child. But then also there's something around developmental kind of systems as well that children and young people are, they're changing like every day, you you see them, they literally grow up in front of you and you know, they come in with pink hair one minute and then purple hair the next and you know, so it's very dynamic work. So there's a sense of time and things changing. But. And then of course you have religion and culture and cultural heritage and faith which can be hugely important for some families and a real resource. So lots of different systems and thinking about the sort of nesting dolls, know, actually how much we exist. Yeah, we're not in isolation. We are all interconnected and interdependent and wired for connection ultimately. Yeah.

Georgina Sturmer: Yeah, absolutely we are. you know, because I work with adults, I don't work with children and young people. And I was thinking about how much we know about things like intergenerational heritage and how much we think about culture and all of these other things that have such an impact on who we are as people and adverse childhood experiences and everything. And then I guess I'm wondering from your work, is it sometimes the case that when we're working with children and young people, there's an expectation that those things are stripped away, they don't exist somehow?

Alix Hearn: Yeah, do think, and I really don't want to sound like I'm sort of denigrating other professionals, other colleagues or anything like that, but I do think there is still a focus on the child and what they're doing or what they're not doing. And children generally get referred for therapy because... their behaviours are quite challenging to the adults around them and they can in some systems, not in all systems, but in some systems there can be a sort of pressure or an agenda kind of coming in to make that child better, to stop those challenging behaviours. And so as a child therapist who really wants to work... in collaboration with everyone around the child or the young person because that is where I think ultimately the healing and the work takes place is when we're thinking about what's happening in the child's life or young person's life, what's happening in their parents life, what's happened before they've even been born which is what I was talking about in the book around you know pre-birth and epigenetics and so this idea of like the reason for referral in my mind can sometimes be a red herring because there's so much else to consider. that might not even be the child's experience, if you see what I mean. And we now know so much more about epigenetics and the impact of trauma, as well as good things, not just always, you know, difficult things, the capacity to be resilient and all of that. But it feels quite narrow minded, narrow kind of focused if we're only thinking about why has this child been referred and how am I going to sort that out? when I just think there's so many other things to consider that's in the kind of matrix, it were, the ecosystemic matrix, not the other matrix.

Georgina Sturmer: And so Alex, when you're working with children and young people, how much are you able to learn about the epigenetic impact, I suppose, that intergenerational stuff? Again, I'm talking about this from a I suppose, constrained lens of working with adults, where I will invite them to talk about their history, about what they know about when they were born, about what they know about their families. How much are you able to have those kinds of really important conversations with the young people that you work with?

Alix Hearn: think, yeah, can be difficult sometimes because I think, as we know, relationship building takes time and it takes trust and that building of trust with parents, with carers, you know, who... whoever you might be working with or teachers or teaching staff or anyone around the child, it can take time to build trust. And for some families, they have every reason and right to maybe feel a bit mistrustful or hypervigilant around professionals because they've had some negative experiences in the past. and or if there's cultural difference, for example, you know, it can really take time to build trust. So I think it's not you don't always have access to parents. So therefore we don't always have access to history or background or birth experiences and I think if we think about attachment kind of lens, know, maybe someone who's more avoidantly attached may say it was all fine, everything was great, it was, you know, an okay pregnancy or but there's so much more to sort of unpack underneath the words I think and I think that can take time to sort of... As child therapists, also have to be an ally to the parent or to the carer. is about being supportive and not in rivalry with or... Do you know what I mean? I think it's really important to build a therapeutic alliance with other adults around the child or young person. But that can take time, in my experience.

Georgina Sturmer: Yes, yeah, because I suppose it's that really delicate balance of, you you are there for your client, for the child, but actually if the adults around them are not on board, then the therapy simply won't happen. And I guess I was really curious about your work with families and what it's like having more than one person in the room, that kind of family system.

Alix Hearn: Yeah, I think the more people you get in the room, the more complicated it gets. I mean, I've done some work with... without sort going into too much sort of disclosing anything, but I suppose, you know, parent and child or parent and teenager, adoptive family, sometimes it can be really helpful to have the whole family in the room, for example, just to start to have conversations. And I suppose sometimes my job is to mediate difficult conversations to facilitate to midwife. to a conduit, suppose, to they could talk to me rather than to each other or how I can facilitate something that can be really hard. And I think generally parents are really doing their best and it's hard to see a child or young person in distress, isn't it? So I think that's really where it's coming from is wanting to help someone. But sometimes that can look like wanting to get rid of feelings, for example. And I think that's part of our work is, you know. Yeah, we've got good at bearing difficult feelings, but we've had to because we've trained for a long time to do so.

Georgina Sturmer: Yeah, and so actually we're often faced with children, with young people, with adults who don't want to share their difficult feelings, don't want to voice them. And so

Alix Hearn: Yeah, absolutely.

Georgina Sturmer: I know that in your work with children and young people as well, you do a lot around play. Can you tell us a bit more about that?

Alix Hearn: when I maybe get a new referral, I'm quite clear that if I'm working with a younger child, for example, or even primary age child, most of the work, unless the child wants to talk, is play-based, so it's non-verbal. And it's my job to understand, to translate, to make sense of, and to feed that back in a way. But it's not the job of the child necessarily to make it easy for me. So it's all through play and relationships. building is through play. It's one of our earliest building blocks of attachments, of joyfulness, of companionship, of exploring the world, exploring the world, exploring self and other. But it's difficult, I think many child therapists would say, you know, we look like we're just playing and we're having fun or, you know, we're painting. that is the world of the child and that is also their language. And I think sometimes it can be difficult for some adults to understand that we're not just saying, right, what's the problem? We're going to sit and talk about the problem, but that's not how emotions are processed and that's not how they're felt or expressed.

Georgina Sturmer: Yes and I actually think, you know, when we think about working with adults there's a lot of playfulness in there as well. It might not always look the same as it might look like with a child but actually there is often playfulness in creativity or in using words differently or I know that I will often sit with a client and say, should we just play with this for a moment? Should we just think about this differently here?

Alix Hearn: you're so right and I I think playfulness ultimately and being being in relationship to play is about what you're embodying within yourself. And I consider myself a very playful person, which I think is just inherent in me. I don't think I was ever taught that. But humor, jokes, making a fool of myself, not being the expert, because that's a dangerous position to be with a child or a young person, you know, and I think you're absolutely right. Play can come in many forms. And I think that's partly why I'm also a clinical supervisor and that's why I love being a supervisor because you play with the material. You come at it and think about it from different angles. Yeah, so I think you're absolutely right. But it's such a key component of attachment formation is the importance of play. Yeah.

Georgina Sturmer: Yeah, yeah, it's so important, isn't it? And I just wanted to come back to something else that you mentioned, I think, when we began today, which is about, that you think a lot about the systems that we are within and you use the phrase decolonizing. And I wanted to ask you to expand a bit more about, I suppose, what that means for you in terms of your therapeutic work.

Alix Hearn: Yeah, sure. It's obviously not my phrase. But I suppose it's thinking more about intersectionality. It's thinking about systemic violence, again, which is not my phrase. But I feel I've become increasingly more aware, probably increasingly more angry, actually, and more passionate about this area of what systems are doing, organisations, settings, different contexts, are sort of reenacting something, re-traumatising a child or young person basically and this is really difficult things to think about but that could be for example social care making a child have contact with a parent that has abused them or abused their other parent. Now that could potentially be quite re-traumatising for a child but the child's voice sometimes gets lost in that. That's just one example or in children's homes sort of these children have already had very difficult attachment histories probably experience a lot of aces and difficult experiences and then they get moved on and it's like well okay but then we're reenacting a sort of attachment trauma so It's hard, it's painful. It's painful to think about these things. But I think we have to really think about what unconsciously we're perpetuating and unconsciously what we're doing and why young people get referred and what's considered okay, what's considered not okay. And I think deconstructing assumptions are really challenging. I encourage my supervisees to challenge referrals, to challenge when they're told to end sessions. and the child might not be ready to end. So to be able to have a voice on behalf of the child, that's like, that's not okay. And they need more work. And this is my clinical formulation and this is my clinical thinking as to why they need to continue. so it feels like it's in all areas, systemic violence can be perpetuated and recreated.

Georgina Sturmer: I'm also translating this into an adult context and I'm thinking a bit about a client who might be sent for therapy by a system or by a family or by someone who tells them that they are the problem. And obviously that's not to say that that's the reason why most people are sent to therapy, but I think often in our rooms we might come across someone where actually... Yes, therapy will be of enormous benefit to them, but there's also a question around is this more here? Is there more here? Is this actually about the family or the system that you are within? Where there's something that is happening here that is violent or unbalanced in terms of power?

Alix Hearn: You're absolutely right and I think particularly with I work with some adults but my training wasn't child therapy and so I predominantly work with children and young people. So children and young people are generally sent for therapy and sometimes they do request it or they self-refer obviously in some schools young people can self-refer and their parents might not even know that they're coming for therapy but generally children young people are sent for therapy and it's a really good question of do you want to be here and is what you want and what do want to get out of this space? You know these are questions that we can ask children and young people and to listen to them when they're like no I don't want to be here, I don't want therapy and I don't want to come and to really respect that, to really respect their sense of agency and autonomy and sovereignty and their rights you know that then it's not going to work if they don't want to be there and I'm not going to enforce it on or make anyone you know engage in something they really don't want. to do and sometimes it is about, well actually maybe it's not the child or the young person, like you said, maybe it is about family therapy or maybe it's not even about therapy. Therapy is not always, it's not the panacea is it, it's not always the intervention so there are other things that also could be put into place.

Georgina Sturmer: But I'm just thinking about how empowering it is for that client, for that young person or for that adult, for someone to actually say, well, what is it that you want? know, yes, you're here in my room, but what is it that you want? How can your needs be met? And often that might be the first time someone's asked in that question. But I'm just

Alix Hearn: Yeah.

Georgina Sturmer: thinking as well about something else that I wanted to bring in today, which is I know that when you talk about the systems that we're in, you are often thinking about the wider environment that... that ecology, that landscape around us, what you term in your book, the more than human world. And so I wondered

Alix Hearn: Thank

Georgina Sturmer: if you could share a bit with us about, suppose, maybe your relationship with that part of the world and how that influences our clients.

Alix Hearn: Yeah, thank you for sort of bringing that in because I think this is the bit that maybe gets lost and I feel particularly passionate about around in terms of place attachments, which is a very real thing that we all have relationships to where we're at, whether we have access to, and this particularly came up during COVID, do we have access to an outside space even or, you know, what's our environment like and how impactful that can be on our wellbeing. And that's really what it comes down to for me is our relationship with mental health, with creativity, with ourselves, with our bodies and how nature connection, the connection with the more than human world, the natural world for me has been so key to my own child development. My parents were, you know, keen gardeners and knew all the names of plants and flowers and I was very, very lucky. It was very privileged that that was just encouraged. I would be out all day on my bike and come back. was, you know, that was my making mud pies and just messing about in the garden and So for me the connection with the more than human world is so sort of deep and personal and part of who I am. And I know how helpful it can be to come into relationship with nature for us to feel connected, to feel part of something. And I think many young people feel so disenfranchised and don't feel a sense of belonging. And they start to seek belonging in other places. So, for example, like gangs, because they don't have a sense of belonging elsewhere. And being part of something gives them a sense of belonging. And I think there is a real severance and disconnection with the natural world. and it makes me sad. I feel very sad about that because it's so vital. It's vital. It can keep us alive and make us feel alive. And yeah, so it's, you know, I could talk about that forever. It's very deep.

Georgina Sturmer: Well, I guess it's a useful reminder for us, isn't it? know, when we are thinking about the questions that we ask our clients, and as always, I'm thinking about working with adults as well, and we're asking them about the relationships they have with the people in their lives. But also, we should be curious, what relationships do they have with the places in their lives, with their home, the places where they feel safe, the animals that they are surrounded with, all of those things. So I think that's really fascinating for us all to think about, Alex. Thank you so much. We're just going to pause here just for a quick... break and then we're going to come back and have a little chat with Alex about today's ethical dilemma. So I'm back with Alex now. And we thought that for today's dilemma, we thought that we'd talk about the limitations that we're sometimes faced with when we're working within an organization. Now, Alex, I know that in your book and in our discussions, we've explored a little bit around the challenges of working in a short-term way. And I wondered if you could tell us a bit more about that from an ethical perspective.

Alix Hearn: Yes, I think many practitioners, many child therapists and counsellors come across this probably every day and it's something I hear a lot about in supervision where Unfortunately, time limits have been put on therapy intervention where in some services they used to be able to really offer long term work at least a year's worth if not more. And now in some settings it's like down to six sessions. And I suppose the ethical dilemma for me as a practitioner, but also as a supervisor and as a tutor supporting other people's work is, is it safe? And when we think about attachment and safety and beneficence and what will caused the least amount of harm. Is it actually ethical to start to work with a child and young person that you know is maybe severely traumatized, has severe attachment, relational needs, has had a history of loss and grief and disappointment and being let down. Is it ethical to start to form a relationship to invite that child or young person to start to form a therapeutic relationship and then end the work? And I say in the book quite clearly, agree with and I'm aware that this is just my opinion and where I'm coming from but I don't agree with the this idea that something is better than nothing which I do often hear because I'm thinking but then what happens to that child or young person so you've invited them just maybe to start to think about things that have been really difficult or not you just play cards every week for six sessions and that's all you can do because you can't open stuff up. I think it is a real ethical dilemma and I'm not saying I have the answers here but I think again it's thinking well actually what needs doing first is it about stabilising something in the system first is it about is it about maybe working with an adult in that child's life first is it about offering psychoeducation for teaching staff or their TA for example a teaching assistant or or any supportive adult in that in that child's life rather than actually starting therapy and then my question is what's next? Do you know what I mean? So I think it's really important to consider and to think about the reason for referral and triaging and clinical formulations and having a real rooted groundedness in what we're doing and why and what's possible and when. That's what I would say.

Georgina Sturmer: Yeah. And so I guess what we're saying here is it's about being honest and realistic with ourselves about, know, if someone can only have a certain number of sessions and that's what's on offer, then that is what's on offer. But how do we need to work with that? What is going to be the most beneficial way to go forward? So thank you so much, Alex. If people want to learn more about your work and your book, where would they find you?

Alix Hearn: So there's my website so that's www.alixhearn.co.uk and also my book is available at Carnac Books which is the publisher.

Georgina Sturmer: Thank you. So if you've been listening to this and you'd like to learn more about our Level 5 and Level 7 diplomas in attachment-based psychotherapy, you can find the full details at OptimaAttachment.co.uk. That's also where you can download a CPD certificate for the time spent listening to us today, and that's available for all of our episodes. If you're listening on Spotify, there'll be a link in the show notes. So a huge thanks for joining us today on Attach Together. We'll see you next time.