IT’S THE LITTLE THINGS

 

 

Thank you for being my client.

 

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The month has gotten away from me, so I’ll just slip this photo in under the wire and keep writing for next month. I’m deeply grateful for my readers, and in 2018, I’d love to reach more! If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. Thank you, and best wishes.

 

THE NUMBERS GAME, PART TWO (OR, MY SO-CALLED THERAPEUTIC LIFE)

One of the many challenging aspects of working in community mental health is that you are, de facto, expected to practice as a generalist. In Youth & Family work, this means taking any client between preschool and 21, with pretty much any kind of issue. It doesn’t matter if you have little to no training or skill with a particular developmental age or diagnostic picture. You learn as you go, or not. At least within the session itself, your clients sink or swim with you; elsewhere, other factors can and often do play the determining role in outcomes.

Of course, any profession will involve on-the-job learning. Still, upon reflection, does working without expertise or even affinity, in some highly sensitive cases, seem therapeutic? We have supervision, but not in vivo; we have training opportunities, but not often or intensively enough. As regards this lack of choice, I’m reminded of an obnoxious rhyme I heard while volunteering in a kindergarten, summoned on such occasions as the passing out of birthday lollipops: “You get what you get, and you don’t get upset.” Yes, in fact, you do get upset! And clients may get upset—rightly so, if they’re not adequately helped where such help might be possible but wasn’t in the roll of the dice. A prohibition against feelings and preferences helps exactly no one.

But back to generalist practice. Let’s say I have a caseload of 25 (again, as mentioned before, that’s on the most absurdly, luxuriously modest end of the community mental health spectrum). Let’s say the work week begins, and maybe I get lucky with an easy sort of Monday, six clients back-to-back but all doing relatively well. I may leave work feeling buoyant and thinking, optimistically, “It’s time I got around to reading more about blended families!” But then I remember that I started a book, some time back, on post-traumatic play, which is still relevant and likely ought to take priority. I decide that I should focus on that.

Tuesday, though, is rougher and brings fresh urgency to the need to research conflict resolution and nonviolent communication, to provide a distillation of resources to a weary and worried single parent who is hungry to learn how to talk to her teenage son before he slips away from her care and into a life of delinquency; she wants more than the basic guidelines I’ve already offered. I plan to assemble some things in the morning… Wednesday finds me, however, scrambling to photocopy materials on fight-flight-freeze and executive function, in order to best and most clearly explain brain processes to some guardians at their wit’s end and contemplating giving up a child, already abandoned multiple times, to the custody of the state. Her fate isn’t in my hands, but my success with the guardians feels as important as if it were.

Then Thursday? Thursday brings a mandated client who would probably rather chew glass or walk across hot coals than engage in therapy. I’m often successful building rapport in such cases, and even look forward to them, but this one’s giving me a run for my money, and my thoughts turn, yearning, to the book on motivational interviewing that I love but never have time to reread from beginning to end. Friday, my lightest day, nonetheless may remind me that if I had more expressive activities up my sleeve, I might better assist a boy in foster care who appears to lack the words for what he may feel.

I have hesitated over the subtitle, “My So-Called Therapeutic Life,” because to some extent it feels self-indulgent. First of all, yes, these are first-world problems. Second, I’ve had some truly amazing therapeutic experiences, and have been in awe of many of my clients and the challenges they overcome. I’m grateful for the chance I’ve had to start where I started and do the work that I’ve done. But I decided to include the subtitle because, as my colleagues and anyone who has ever worked in an agency all seem to agree, the pressures are such that there is little sense of grounded, focused, therapeutic practice. To summon the energy to try and create that experience for clients from hour to hour, can be exhausting and sometimes unrealistic.

I love reading. I love learning. I love doing good work. But, as it happens, I couldn’t live much better than hand-to-mouth on what I’m paid, in the part of the country where I currently live, and the stress of that is too much for me. So, when I leave my agency, it’s not to go home and read, but to race to another job, where I spend evenings and weekends. I average 65 hours a week, and it’s sometimes been up to 80. Additionally, in this milieu, we are buried in avalanches of paperwork, so I’m often working from home to try, in vain, to catch up. When I have free time, which is rare, I almost don’t know what to do with myself, despite a healthy number of outside interests. But I’ll tell you this: lately I spend most spare minutes dreaming of the day when I can leave my job(s) and start living another, more fulfilling kind of therapeutic life: one in which I can rest, nourish my spirit, and educate myself to better serve clients who are not stuck with me by lottery, but who elect to see me week by week. A life, for me and for clients, of choosing and making.

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I’m deeply grateful for my readers, and in 2018, I’d love to reach more! If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. Thank you, and best wishes for (finally!) Spring.

DON’TS AND DON’TS

 

A significant part of working with children involves working with family systems, and in community mental health, that often means contending with inter-generational trauma. I don’t think anything could have prepared me for the reality of that; I, under excellent supervision, expend a lot of mental energy trying to factor caregivers’ own personal issues into their choices with kids, adapting my message to what they can hear and take in at any given time. After all, if caregivers feel criticized, the likelihood of their support for therapy drops significantly, and change is unlikely to happen. Sometimes that means trading no change at all for painful slivers of increments. And sometimes, let me tell you, that trade becomes deeply sad and demoralizing. Like this month. Like this in-like-a-lion-and-the-lion-keeps-roaring March. I’m feeling spent by the effort of starting over every bloody session, and I just want to be mad and let it out. Indulge me?

If you are caring for a child who was born in withdrawal from drugs, abandoned, passed around, and abused in every possible way, and as a result lacks a sense of appropriateness and has a bottomless need for attention, please observe the following don’ts, in no particular order:

Don’t refuse to tuck her in because she hasn’t made her bed. Don’t deny her a birthday because you don’t like her behavior. Don’t send her to her room when she’s having a meltdown; don’t film her while she melts down further, desperate not to be rejected and alone. Don’t show the video to people and shame her. Don’t show the video to a therapist and expect sympathy for YOU, the person impassively holding your smartphone up while her struggle plays out. Don’t claim you’ve tried everything, because you haven’t if you haven’t rocked and cuddled her. Don’t expect her to act her age when that’s developmentally impossible. Don’t automatically take others’ word against hers, every time, not even teachers’; teachers see a lot, but not everything, and they aren’t always right. Don’t condemn her for craving electronics when you yourself bury your head in “Candy Crush” and other less important things when she’s trying to make eye contact with you. Don’t justify that by saying that she always wants attention. Don’t reject the games she likes to play with you. And speaking of games, don’t show mercy to other players but gloat (“Ha-ha!”) when you get her out, thinking you’re teaching her a lesson about fair play because, you say, that’s something she’s done. Don’t tell her it serves her right if she falls because she sat on a chair the wrong way. Don’t tell her she can’t have friends because she doesn’t know how to behave. Don’t tell her teachers, in front of her, that she’ll try to manipulate their sympathy. Don’t say, “We love you, but.” Don’t say you’re thinking you might not be able to keep her. Don’t say 100 no’s for every yes. Don’t miss every single chance to validate what she’s feeling, even when her therapist has explained quite clearly, with relatable examples, that validation isn’t agreement. Don’t take her to therapy, an hour a week, no matter for how many years, and expect the therapist to undo the damage of life in an unloving home. Don’t blame the therapist for failing, when the therapist is working hard to help the child feel like she matters. Don’t tell the child in your care that your life is shitty because you’re caring for her.

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Sympathetic readers might appreciate the haunting song “Nearly Midnight, Honolulu,” by Neko Case. Thank you, Neko Case, for your vision and your songs. // I’m deeply grateful for my readers, and in 2018, I’d love to reach more. If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017), now long delayed, will be continued in a future post, when I have more stamina for the topic. Thank you wholeheartedly for reading.

USE WORDS.

 

So I work with kids. I work with people who work with kids. In my free time, I read books about working with kids. I don’t, however, always drink the Kool-Aid. For example…

There are few phrases I find more inherently condescending than “Use your words.” This expression, all too common in English, is intended as a prompt to children to choose prosocial ways to communicate their wants and needs. At the best of times (which is by no means all the time) I think it’s meant to be empowering, a kind of “Go, you!” coaching. Even where the aim is worthy, though, the method makes me wince.

No caregiver enjoys tantrums. Kicking, flailing, screaming, wailing—that’s misery for all concerned, including children themselves. Just as newborns feel safer when swaddled, children are significantly happier when they’re regulated, i.e., in control of themselves.

In community mental health—where so many of the kiddos we see start their lives already burdened with trauma—tantrums can be even scarier, leading to assaults and destruction of property. One little boy I know, in the midst of a recent fit, climbed to the top of a fridge to grab the butcher knife kept there and threaten his family.

When children have facility with words, not only are they better able to make themselves understood by others, but they are also better equipped to make sense of events and form lasting memories. Thus the importance of reading to and with children, and talking over events both before they take place (in preparation) and after (to create narratives).

It has been demonstrated through studies that children from variously disadvantaged backgrounds typically hear far fewer words a day than their more secure counterparts—yet another way that inequality is perpetuated, making social strata more difficult for some to climb. Literacy programs seek to work against that pernicious trend.

“Use your words” is meant to work against the trend of tantrums, storms of tears, sullen silences. Does it? I haven’t seen the evidence. I know I have a contrary, independent streak and tend to want to kick over any traces that harness me to someone else’s direction or notion of labor; but from my perspective, the expression feels more like an impatient, insensitive dictum from on high than like a loving and truly attuned and listening encouragement.

Anything can be co-opted; but think of the ease with which grown people say “Use your words” to one another, with the explicit intent of being snide. If I were still a child, I wouldn’t have the words to say how I felt about hearing that from an adult, but I know it would make me feel as though the person speaking were asserting an unwelcome and invasive authority over me. How do you know what words are my words? What does it mean that you know, when I apparently don’t?

Another way to think about it is that in saying “Use your words,” the adult is often (and often unknowingly) simply outsourcing the hard work of relating, to the person least qualified to do it. “Use your words, as I wash my hands of this.” If words themselves are the point, why not just leave it at that? Would that not suffice as a reminder? “Use words” says much better, “Remember there’s a tool at your disposal.” Adding that possessive pronoun just raises questions about what the hell is meant, and who really owns what.

From a neuroscientific perspective, a child in a tantrum state or weeping fit needs first and foremost to calm down physiologically; the brain is not capable of cool reason and logic in a heated HPA cascade. And the way to calm a child is to love that child in ways the child can feel—to be patient; to touch if touch is welcome (or required for safety) and give near and supportive space if it is not; to offer sympathy for the strong emotions, via reflective statements. Not only does this demonstrate concern, but it models the exact behavior that’s desired: the positive use of words to communicate during a difficult time. When adults use their own words in prosocial ways, children are more likely to do the same.

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Two excellent resources on working effectively with children are The Whole-Brain Child by Dan Siegel and Tina Payne Bryson, and How to Talk So Little Kids Will Listen by Joanna Faber and Julie King. I can’t recommend them enough!

Now: I’m deeply grateful for my readers, and in 2018, I’d love to reach more! If you enjoyed this piece, please consider sharing it with anyone you feel might like it, too, by linking to it in whatever way works for you. I typically post once a month, so no barrage.

Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017), now long delayed, will be continued in a future post, when I have more stamina for the topic. Thank you wholeheartedly for reading!

 

 

 

 

 

META ON METTA

 

The end of any year brings seemingly innumerable invitations to make financial pledges. This is not one such! It is a contemplation, rather, on the merits of taking the whole process of New Year’s resolutions one step further, by creating or adopting a meaningful philosophical pledge, for the coming year and beyond—a pledge that, like metta meditation, moves you to consider your own life and the life of the world through the same lens—then post it somewhere prominent where you won’t fail to see it. A dashboard could work, for those idle moments in traffic. The back of a smart-phone case, as a tactile reminder on an abstract medium. A few valuable inches on your fridge.

I do my damnedest, in this writing, to maintain a positive approach to the subject at hand; I could opine all day long, but the virtual world is full of tirades already. I also try to be simple and straightforward; there’s an overabundance of glib commentary. With the conscious effort that my approach can require, I help reorient myself toward my own higher ideals—of which I not infrequently lose sight in my day-to-day interactions. I mostly write about my therapeutic work; but I’m no plaster saint, to use an old expression. As a child, I was asked to suppress my anger, and it’s still coming out now—mostly in the form of outrage over this and that aspect of culture, all the grievous injustices of which I’m aware, but also things that hit close to home and close to the bone, failures of friendship and emotional betrayals.

So: New Year’s resolutions are all well and good—my default is “Write more; swear less”—but I also need something bigger, deeper, stronger. Something to help me face the daily challenge of living, above and beyond a singular achievement, however important. My very first client, at my first internship, helped me to realize this. Whereas I had grown up in a broken-down neighborhood in a broken-down city, she lived a semi-rural life and loved her chickens with every fiber of her beautiful being—knew their personalities and followed events in the pecking order like a telenovela. Together we worked on validating her negative feelings, so that instead of being suppressed, they might transform themselves and empower her.

Through her, I came to be aware of the 4-H pledge: “I pledge my head to clearer thinking, my heart to greater loyalty, my hands to larger service, and my health to better living, for my club, my community, my country, and my world.” I saw her living out those values in continuing to love those who had hurt her, despite looking with clear eyes at their flaws, and rising above the chaos she’d known at home. The first four assertions have spoken to me ever since, like a nondenominational statement of grace. (I have mixed feelings about that string of possessive mys, and those feelings amplify as the picture gets bigger. Whose world? Our world.) An even simpler distillation of values, which for me is supremely grounding, is posted above my desk at work, a reminder to me and my clients: Be curious.

In 2018 and thereafter, I hope that ecosystems will be protected and valued as sacred, and that workers will be fairly paid and treated. I hope the humble honeybee, with its staggering commitment to fructifying the earth, will survive colony collapse. I hope that the rights of women, and various vulnerable populations, will be recognized and upheld. I hope that buzz words like “slow food” and “slow fashion” will build up to full-on movements, and that the doomed cultures of Agribusiness and Big Pharma will fall. Food doesn’t come from factories, and answers don’t come in pills. I hope that we collectively will have the resilience to develop the patience to labor on toward real answers—many of which can be found in traditions whose caretakers are indigenous peoples. And, of course, I hope children grow up feeling safe, loved, and respected. So many visions and wishes for our planet. I’ll be doing my part as best I can. I share these thoughts today, in this quiet corner of the internet—deliberately free from the commercial intrusions of ads—as an act of loving-kindness: I wish good things for me, and I wish them for you.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. If you enjoyed this piece, I hope you’ll consider sharing it. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017), now long delayed, will be continued in a future post, when I have more stamina for the topic. Thank you for reading!

 

INVISIBLE INK

 

We were walking together alongside the building when he veered away from me to climb the perimeter of an unused loading dock. He had done that before, on another walk, and appeared cheerfully confident of my discomfort as he placed one foot before the other on the concrete edge, tightrope-style. Dismissing my worries about his safety, he compared me to his granny, who was his guardian and whom he described as “your standard, everyday grandmother.”

Well, I didn’t correct him on that point; for a kid with his background, being able to take a caregiver for granted is a hard-won luxury. However, I can tell you, she was anything but ordinary. For one thing, she was actually his great-grandmother; her early life unfolded against a backdrop of WWII, yet she was still working full-time and ferrying kids to after-school activities when I started seeing them.

Before she obtained custody, she drove to Jason’s house each day—never knowing what she would find—to take him to school. Without her, he wouldn’t have gotten there, neglected among adults whose lives were given over to pills and needles. Now she was raising him. On a rainy afternoon, as she and I were chatting, I glanced down and noticed matching holes, big as silver dollars, worn into the top of each shoe; she laughed as she admitted she was too busy to try on new ones.

It’s thanks in no small part to her, I’m thinking, that Jason was able to hold his own in the world. His bravado on the loading dock notwithstanding, he had at least one quotidian fear that could send him into a panic. Perhaps that’s why it was tempting for him to show off a bit of fearlessness with me—it was probably empowering for him to scare me in that little way.

Someone had given him a pen that wrote in invisible ink. He brought it to show me once, and was writing secret hieroglyphs on the waiting room walls when I walked out to greet him. They would only be visible in purple light, he said. I think about that, and I think about his history, which he wasn’t inclined or equipped to discuss. Hopefully that exploration would happen one day. So much of our lives are written in invisible ink; it takes the right kind of light, shone in the right places, to reveal what is hidden in plain sight. At its best, counseling can shine a soft violet beam—which is, in fact, a careful reflection of a client’s own light.

Late November is meant, in my part of the world, to be a season of gratitude. This year I feel grateful on Jason’s behalf for the care I saw him receive—for the memory of his great-grandmother’s hand ruffling his red hair as she said, when I asked how his week had been, “He’s a good boy.” And I’m grateful for the invisible heart he drew on my hand. Despite innumerable washings since, it’s still there.

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Out of respect for client privacy, names here are always changed or omitted, and details may be altered in fact while relevant in spirit. Text and image copyrights held by me. If you enjoyed this piece, I hope you’ll consider sharing it. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017), now long delayed, will be continued in a future post, when I have more stamina for the topic. Thank you for reading!