by Guy Shahar
Published: 15th October, 2016
Containment is, without doubt, the single most important concept I have come across for the support of autistic children. We have used it extensively in the transformation of my own son’s quality of life, and it is key to how we work with families to bring about similar transformations.
What is Containment?
Essentially, containment is creating an environment around an autistic child (or around anybody, for that matter) to give them a feeling of safety and security. Anxiety is so prevalent in autism and I believe this is the primary cause of the difficulties that autistic children face. When it is consistently soothed by an approach based on containment, this is when the child has the chance to grow and to show what is really inside them.
I have written in several posts about the nature of this anxiety and where is comes from (perhaps the clearest is in the article, What is Autism, Really?) and it will be a key component of my TED talk next month. I have become convinced that, at its root, the autistic condition is not one of inherent difficulties, but one of idealism, softness (in the best possible sense), sensitivity and goodwill. The “difficulties” and “symptoms” that we observe in autistic children result from their acute sensitivity to the harshness of the world around them and the way we automatically behave to each other and to them (which are nothing remarkable to us, but which they experience differently). If we had always lived in a world that was similarly intolerable to us, we too would resort to such coping strategies.
Containment is a way of providing the autistic child with surroundings that conform to their expectations and deep needs; where they can feel safe and protected from constant sensory overload and, even more importantly, from the constant risk of what they experience to be sudden, arbitrary and unwarranted emotional negativity, which we may not even register, but which can be devastating to them.
Once they are free from these destabilising factors and contained in an environment that feels safe, there is the real opportunity for them to consolidate their strength and press on with their cognitive, social and emotional development, which is impossible when they are constantly assailed by excessive sensory stimulus and less than charitable social influences that can so easily knock them off balance so that they need to channel all their resources into coping with them, rather than into their maturing.
We learnt to do this with our son when we visited the Mifne Centre for the treatment that turned out to be the turning point in our family’s life. Part of the creation of this environment was in a dedicated room, where he could play one-on-one with a therapist for around 6 hours each day. It was set up to be a wholly positive experience for him, and to give him the space to develop his natural interest in exploring his surroundings – including, eventually, his social surroundings – and allowing his readiness to engage with the world to grow.
Eventually, this built up his inner-resources and strength, so that he was able to venture outside this protected environment for increasing periods of time, returning to it regularly to be recharged, until there is no need for such a formal protected environment apart from in times of difficulty.
However, this can only happen if the parents/carers bring as much as possible of the sense of safety that the child feels in the room, permanently into the rest of life as well – as a constant soothing factor. At its heart, the message that containment gives to an autistic child is, “Everything’s okay.” They are reassured that they are understood and that the adult knows how to look after them and their needs will be safeguarded. They can trust us. Of course, this can only happen if the adult can manage themselves and actually carry within them this conviction that there is nothing to worry about and everything can be coped with. The child will effortlessly imbibe this conviction and be reassured by it.
Who is it for?
While containment is particularly important when working with our autistic children, it is actually a basic and central need that we all have. None of us can function at our best if we feel overwhelmed by bright lights or loud noises, or if we feel that we are not valued or if we fear we could be treated arbitrarily or if we feel surrounded by what feels to us to be negativity and aggression and injustice. Anybody in such a situation will be functioning at a level far from their best, and will eventually develop unusual behaviours as a means of trying to cope. If that person is lucky enough to be somehow convincingly reassured that everything will be fine, and the anxiety is given the chance to recede, then they can begin to draw on their inner resources to eventually contain themselves and start to realise their true potential, free from the debilitating worry about what will happen next.
Because of the anxiety inherent in autism, containing an autistic person is the most valuable and the most empowering thing we can do for them.
But the person containing them also needs to be contained – else we will not be able to manage the task.
When we first arrived at the Mifne Centre, the 2 most senior therapists immediately came to visit us in the house where we were being put up, and offered us the warmest welcome we could have imagined. Right through our stay there, they bent over backwards to make sure we were comfortable, we each had opportunities to take time out alone and together, and they even arranged a day out for us in the middle of the programme, while they treated our son without us. I’m sure the thinking was that if we didn’t feel relaxed and looked after, we were not going to be able to project a feeling of calm and reassurance to our son.
It is impossible to project and promote a sense of calm and reassurance if we are ourselves depleted, run down, exhausted and full of stress and unhealthy emotions. This is a challenge. We don’t have anyone looking after us like that in everyday life, and the demands of that life are huge. Additionally, most of us have had the experience of further (and intensively) increased anxiety when dealing with the medical establishment and other services. For whatever reason, the “system” is not set up with containment in mind, and certainly not as a priority. It is a goal of the Transforming Autism Project to change that, but at the moment, this is what we have.
Therefore, we need to provide containment for each other – respect and value each other when we meet in groups, share what we have learnt and find ways to reassure each other and give each other hope and positive inspiration. If we have partners, the temptation is to offload all of our accumulated stress onto them in the absence of any other outlet. That is understandable. However, it also has consequences, and is likely to lead to much more stress in the short, medium and long terms, as we contribute to each other’s sense of unfairness and injustice, and then see that reflected back to us in an endless and self-fulfilling downwards spiral of negativity, which we will automatically and unconsciously then pass on to our children. It can happen so easily when life is so demanding, and it is not surprising that the divorce rate amongst parents of autistic children is so high. It would be a much better investment, if we can manage it, to see each other as real partners in this process – make an effort to show appreciation for each other and make a decision for ourselves that behaviour that could come across as unfair or attacking the other person is not acceptable to us (it’s not who we want to be, whatever our frustrations) and we will always refrain from them, choosing instead to consciously bolster them so that they can do the same for us. If we can actually make an agreement to do this in both directions and to offer and to accept support and tolerance in putting it into practice, and especially when we (inevitably) deviate from it, that would be the most powerful thing of all. It could make our own lives unimaginably lighter and more positive, and would give us the additional energy, strength and inner-resources to remain positive and less anxiety-ridden when we are with our children.
And then how do we use that new condition to help our child?
We have been so fortunate to have had the opportunity to learn to make the principles of effective containment central in how we live our lives, and especially in our interactions with our son.
Essentially, this means holding within ourselves the conviction that whatever is going on, everything will be fine. However difficult any situation is, we will be able to cope with it, and he will come out of it fine. It means trusting in ourselves, trusting in him, and trusting in life generally. Clearly, this cannot be faked. It needs to be genuine.
But it is simple, and deepens with each successful implementation of it. It is often just a reminder to ourselves to revert to what we actually already know deep inside, and what we have decided. We just need to return to the state we were in during that moment of clarity when we made that decision. Pretty soon, he imbibes our confidence and it soothes him down with generic drugs that include generic stromectol. There is no longer any need for him to worry, as he sees that his parents know what they are doing and are not themselves worried, whereas previously, when we were lost in our own uncertainty and fear about what was going to happen and how it would affect him, it was this that he imbibed.
How to learn to implement this?
It is a key goal of the Transforming Autism Project to raise awareness of the principle of containment so that it becomes recognised as a primary strategy in supporting autistic children and enhancing their quality of life. And a key part of this goal is to support parents and carers to be able to understand and use it.
As a starting point, the book, Transforming Autism, contains a very extensive discussion of containment and how it can be implemented to dramatically improve the lives of autistic children. It describes in detail how we learnt to implement it and gives many real examples of how we used it and how we dealt with the initial difficulties we had in applying it and in retaining confidence in it when we were so used to things going wrong. Several people have commented on how much difference a simple reading of this book has made to their ability to support their autistic children.
Beyond this, we offer consultations with parents in order to help them deepen their application of containment in daily life. Unfortunately, these currently need to be charged at full price, but as we attain charity status – hopefully by the end of the year – and can fund-raise and apply for grants, we hope to be able eventually to subsidise these sessions for families on low incomes.
And we hope to be able expand our range of services to this end next year and beyond, including support at home or school from professional therapists to create and help parents and schools to oversee a programme based on the principle of containment to bring out the best in their children. It may take time for us to get there, but this is the goal.
And once we have learnt the principles of containment and how to transform our children’s lives with them, why stop there? The more we can practice containment on as many people as possible who we come into contact with, the more we will be creating a world in which we can all live to our full potential and have much happier and more fulfilled lives. And that can only be a good thing!