(pronounced de-escalate)


De-escalation Blog covering De-escalation and Positive Behaviour Support in health and social care. Developing Positive Relationships with Individuals in Distress rather than Managing Challenging Behaviour


The De-escalation Blog



Attachment Trauma & Relationships

Recently I was lucky enough to attend the latest BILD seminar entitled

Attachment Trauma & Relationships

D.ESCAL8 has, from its inception, focused on attachment, trauma and resilience in relationships and in our main course titled – “Developing Positive Relationships with Individuals in Distress”. I was therefore interested in this seminar in particular and was able to swing my timetable to go in the last few days prior to the event.

Brodie Patterson was the host and first speaker, having not met Brodie before I was interested in the content he would cover as he is well known in the industry.

Brodie Patterson

Integrative Practice

In terms of best practice Brodie gave a broad spectrum talk, covering all the basics needed to engage in the discussion at hand.

we are collections of emotions and relationships

Brodie discussed:

  • PBS and the relationship or lack of relationship to ABA.
  • How relationships should be part of any PBS approach.
  • An overview of PBS through the 10 points of PBS.
  • An interesting example of procedural memory and scripts.
  • A discussion about integrative vrs isolated thinking
    • empathy, compassion, value and social roles must take into account attachment

you cannot respect an individual and not take into account their relationships (therefore acknowledge their attachment)

  • Social ecological model by Bronfenbrenner, highlighted how interconnected within those systems we are and how we need to take into account the influences when working with an individual.
  • Many links back across the subject relating to attunement and attachment
  • As a concept, what has the person not learned, was a nice shift in thought relating to this subject.

Brodie prefers behavioural distress and as per my post last year on why challenging behaviour is an outdated term, I explain my view there and agree we need to have some better terminology

Jake Lukas – Novalis Trust

attachment based trauma – informed care, finding sanctuary

I was glad to experience this talk as I have completed a MSc in Psychology and so the other talks were interesting but not, for me, ground breaking. Jake Lukas gave me lots of new thoughts on the subject, its implementation with staff and those they care for in the real world.

Jake is the CEO at a school in the Cotswolds. He gave a frank account of the issues the school has gone through with the local community. This led to discussing trauma as an organisation and on to attachment and trauma work in the real world.

It was great to hear how an organisation had worked through or were on a path to managing the issues that the children and organisation were experiencing.

We were entertained with stories of the progress the school had made using the sanctuary model of recovery and about meeting Sandra Bloom who has written books on the subject. This for me was very interesting and leads me to want to look further at this subject.

Jake explained about the school following the Rudolf Steiner system and provided an overview of that system.


The most interesting part of the day for me was the research on the Adverse Childhood Experiences Study ACES. I knew, of course, that trauma can effect long term health, however I was not aware of this research on this subject and the replication in the UK. It was great information and the ability to bring it into staff support and staff understanding of the people we care for was superb. I am always looking for information like this that backs up the subject D.ESCAL8TM is focussed on.

This talk was mentioned on the subject.

staff support

Jake basically had too much content for the allocated time, I would be interested in more information on the areas of real world supporting and working with staff. D.ESCAL8TM has always promoted that, to assist carers in supporting those they care for who display their distress, we must support staff to build and maintain those important relationships. I was therefore left wanting more from this talk.

We (humans) seem to have a default setting when we come into care, meaning a lot of D.ESCAL8TM’s work is challenging those staff perceptions around the work and opening their eyes to the fact they are carers and not parents controlling naughty children. I would have therefore enjoyed more time to hear about how they had worked with carers around supporting development of those relationships with individuals in distress.

if you don’t train your staff – they will make it up on the day. Staff need a model.

He spoke around discussions to have with new staff, this gave me another discussion linking with ACES.

since often the way we work with children has been influenced by the way we were brought up, I wonder what growing up was like for you?

Alan Morris

A carers perspective on attachment and supporting a child with challenging behaviour

Alan gave us a frank conversation about some interesting very personal real world situations, which I feel I should not discuss here. Thank you for sharing.

Dr Allan Skelly

staff training and the conditions for security

While Brodie had mentioned Bowlby in the discussion, Allan mentioned Ainsworth which was another person embedded in my memory of my MSc.

Allan discussed:

  • attachment hostility
  • disorganised attachment
  • integrating assessment and treatment

Relational Risk Questions

The set of risk related questions were a useful resource and starts with a question that was relevant to a relationship an individual has with their carer whom I am supporting. Sometimes it is up to us to be the adult in the relationship and take an objective questioning longer view. It is great to have a list of questions around the relationship that focusses us on seeing the risks.

Quoted at the start of the day by Brodie, Allan finished with

They have behaviour, we have relationships?

Beth Greenhill 2011

Nigel Beail – relationships at work and integrative approaches to realising positive behaviour support

to examine the role of relationships in PBS

Nigel took us back through some history covering Freud and the morphing from hypnosis to talking therapy. It was funny to think of the patients asking Freud to “shut up and let me talk”.

He discussed:

  • what PBS is
  • qualities at the heart of PBS
  • concept of the working alliance
  • counter transference, which I remembered about from CBT training.

Nigel discussed the fact that the major therapies listed by the British Psychological Society and the Royal College of Psychiatrists, which were on a slide, are all complimentary to PBS.

In CBT etc the main factor in effectiveness is the relationship between the person and their therapist – why should it be different in PBS – it is not the therapist – it is the relationship that is key.

All of them have the relationship with the therapist at their core. Therefore we can use these complimentary therapies in PBS.

It is clear that the relationship with the therapist is more important than the therapist or therapy. Therefore we have another banner for the relationship being core to the work we have in PBS.

By far the most interesting part of Nigel’s talk for me was the conversations about staff emotional understanding and support. Again this is so complimentary to the D.ESCAL8TM model that I was re-assured that we are on the same path.

issues relating to feelings

  • we need to be open and not ignored
  • we need an open and honest culture
  • how much of our feelings should we use in our work?
  • who is at the point of maximum anxiety (client or us)?
  • how do we monitor the impact over time?
  • who is supporting us?

PBS needs explicit recognition about relationships in all 10 areas

without that recognition barriers get in the way

end of day

the day was finished off with Brodie giving a great example of how to explain trauma using something most of us can relate to at some point in our lives – Alcohol

Thank you BILD for putting on the day.

Author Des Cooke.

Des Cooke