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!

 

 

 

 

 

GORILLA! BANANA!

 

Frank was twelve, and living with grandparents for the reason now so common here: his parents got caught up in drugs and abandoned him. He had a roof over his head when I met him, but still lacked nurturing. One grandparent was an alcoholic whose next bender would crash the family car; the other was a chainsmoker forced to drag an oxygen tank with her everywhere she went. She dragged it into my office, where she proceeded to carp and nag and bicker Frank into oblivion. No wonder his posture had become a slow slink off the chair toward the floor.

Caregivers can be the unwitting designers of psychological stress tests, their children the unfortunate test subjects. Frank’s grandmother had a habit of saying “No” that was so deeply entrenched, I seriously heard her once contradict Frank on whether the sun was shining. The acts of defiance for which he was brought to counseling swiftly came to seem to me like logical expressions of resistance, little signs of patriotic loyalty to his own nascent self. Did they make life harder for her? I’m certain they did. I’m equally certain things weren’t, at bottom, his fault.

When Frank and I spent time alone together, the handful of times they came in, I made it my business to say yes as often as possible, to affirm his playful nature by playing back. Silliness came easily because I felt I could see it nourishing him; even though I believe in the value of play, it’s harder for me to be silly when I don’t feel connected to the deeper reward, just as it’s hard for me in my personal life to make small talk unless I know Big Talk is also an option.

Late one afternoon, Frank threw himself to the carpet. I remember it being dark outside, so we must have hit Daylight Savings, that cold plunge. I don’t why, but instead of telling me about his day, he began calling out the names of fruit: “Apple! Pineapple!” So I also lay down on the carpet, at the little distance my office allowed, and began repeating after him. When he came to “Banana!” he exclaimed it while “jumping” a little, as if popping from a cartoon peel. So I did that, too. He did it again. I did it again. Then, in the middle of trading off, I sat up slightly, beat my chest, and said, “Gorilla!” And the game became Gorilla! Banana!

Thrilled by the sweet, spontaneous fun of it all, I later described the scene to a coworker at my night job. “Sounds like a drinking game,” was his reply. Which sums up quite a lot about quite a lot, including why I write. I need a place to bring my enthusiasms and my earnestness. Everyone does.

Another evening, Frank was in a soberer mood. I invited him to color in a heart with a color for each emotion he was feeling and proportional to it. The heart he filled in was one of overwhelming sadness, with cracks in it, but with love at the center. He shared with me a new prognosis for his grandmother’s health. We discussed it, and he decided to show his heart to her when she came in. What do you think she did?

She told him he was lying—lying, about his heart—and ought to own up to the truth, that he was only sad about losing time on his videogames, a consequence imposed for some misbehavior. What good would counseling do, if he was only going to mislead his counselor? He and his sibling had both had services off and on, with various providers and the same essential refrain. I barely got a word in edgewise; she let me get as far as validating her perceptions as such, but then no further. She rejected utterly the notion of his love.

As they left the session and walked down the hall, I called after him softly. He turned. “Gorilla!” I whispered, and beat my chest. He brightened, and popped like a banana in reply. That was a couple years ago. I haven’t seen him since.

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Out of respect for client privacy, names here are always changed or omitted. 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. ***I’d like to put in a plug for Playful Parenting, by Lawrence J. Cohen, an inspiring book and enjoyable read.*** “The Numbers Game” (July 2017) will be continued in a future post, when I have more stamina for the topic. Thank you for reading!

 

PAPIER-MACHE, IN TWO PARTS

This story starts at my inner-city parochial school, where supplies were so sparse that at one point we were sharing a single box of construction paper amongst grades Pre-K through 8. I can still recall my pride upon being chosen by Mrs. Z to leave my 1st grade classroom and walk down the grand black-tiled hall to request the box from another teacher—head held high in my state of importance, I fervently hoped to be witnessed.

What my school lacked in resources, it made up for amply in spirit, thanks in no small part to the cultural influence of the Spanish-speaking families in our parish. The Sisters who ran things, all Caucasian, embraced those families and honored Our Lady of Guadalupe. Looking back from this distance, in a culturally hostile hour, I admire the welcome offered by administrators who would have first come to know the neighborhood when it was all Polish, before the sugar skulls of the Day of the Dead bedecked the shelves of the shabby nearby bakery. A local woman was brought in to teach us Spanish hymns. Most thrilling were the piñatas.

Preparing for an all-school festival, each class worked together at long tables in the basement, soaking strips of newspaper in gummy flour paste and laying them bubbled and buckling over balloons. Smoothed, dried, painted, and strung up in the school gym—a magical transformation—they bobbed as each member of each class, taking turns, got to leverage one blind-folded swing, until a spill of candy hit the floor.

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The story continues with Cybil, 14, who was hospitalized several times for suicidality before she came to the agency seeking services. I liked her instantly, which made it relatively easy to build the rapport that is crucial with any client, but perhaps especially with teens; she had a mordant wit and a sensitive heart, both of which provided points of connection. One evening early on she interrupted herself and looked up from her mandala, colored pencil poised, and asked, tremulously, “You know I’m not doing this for attention, right?” It was already clear she had heard that accusation many times before.

Thanks to Cybil’s engagement in session and commitment to her therapeutic homework, within several months, she had stopped cutting—then, later, purging. Much of our work, though, still lay ahead. Ahead, and below.

In ways beyond my ken, I’m sure the speculated hard inner core and molten outer core of the Earth make all life possible; but the hard inner core of pain and molten outer core of anger, beneath a crust of scars and mantle of “behaviors,” almost cost Cybil hers. She told me that it wasn’t so much that she didn’t want to talk about things, as that she didn’t know where to start.

Reception at the agency had a vestigial practice of printing visit slips, despite the transition to computerized record-keeping. Several clients were aware, when they turned them over to me, that I put them in a file marked “To Shred.” As she and her mother prepared to leave one night, Cybil handed me hers: “Oh, here, do you want this for your file?”

“Sure,” I replied, “unless you’d like to keep it for yours.”

“I’ll be able to wallpaper my room with them pretty soon.”

Her mother and I exchanged quick looks; she seemed to hear what I did. All that stigma, writ large in Cybil’s life. “Why wallpaper?” asked her mother. “How about papier-mâché?”

“Yes!”—I seized on that. “What about a piñata?” Cybil liked candy, and she deserved a celebration. Transformation for transformation. “You could fill it with sweet things and baubles!” I imagined—I hope we three collectively imagined—a jaunty silk scarf tied above her fine nose and wide smile.

“I like that,” she said. Her mom agreed.

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THE SMARTOVATOR

Fidget toys

 

“I’m making a machine,” Riley said, on our second visit. It was a sunny Tuesday noon hour, and his kindergarten teacher had presumably been glad enough to see him go, given his predilection for throwing furniture when distressed. His mom, fed up with what she perceived as the school’s maladroit interventions, was presumably equally glad to take him out of his classroom and bring him to me. Little did she know how inexpert I felt, with behaviors such as his.

So far I’d seen no physical outbursts from Riley—just an air of self-possession and a serious imagination, which he used to endow himself with every power convenient to his ends. Like his machine: my rectangular wooden fidget toy manipulated into a new configuration, which he pointed at me while declaring, from his mother’s lap, “I’m shrinking you!”

Instinctively, I drew my arms and legs tight to my chest, balancing back on my tailbone, and exclaimed in a pipsqueak voice, “Oh my goodness, what has happened to me? I’ve become so tiny that I’m almost disappearing! Whatever will I do?!

Seeming a little smug—not terribly surprised by his success—he rearranged the toy a second time. “I’ll make you bigger,” he promised slyly. “You’re a GIANT!” I flung my arms and legs out and sprawled all over my chair: “Oh no, this is even worse,” I boomed in my best basso profundo. I saw myself growing too big for the building, soon wearing the roof for a cap.

Growing even faster than me-as-giant was my sense of progress in our play; it, too, was exceeding reasonable bounds, although I didn’t know that at the time. I didn’t know that as weeks became months, my presence in the landscape of Riley’s world would require that I see and hear nothing of his actual life. It was like I was wearing a blindfold, and anytime I made as if to remove it, Riley’s hands would dart up to hold it in place and cover my ears as well. His imagination would come to seem to me as much defense as diversion. But defense against what?

One challenge in working with “conduct” kids is to maintain a therapeutic approach in the face of serious integration problems. How to help a kid fit into the systems around him? To function socially within the culture? I’m reminded of the Japanese proverb, “The nail that sticks out gets hammered down.” The word “socialization” sounds relatively benign, but that hammer tells some hard truths about how it can happen. And the philosophical questions and quandaries about who decides what counts as what—well, they appear endless.

Philosophy aside, though, teachers don’t care to be punched while doing their work, and who can blame them? Furthermore, other students have a right to safety in their school. A therapist can easily feel an urgent pressure, self-imposed or otherwise, to help “fix” things ASAP, and a premature sense of success with a child can lead to frustration and impatience further on down the line. Frustration and impatience are common, of course, and can be admitted in the company of sympathetic colleagues. But they have no place in therapy itself.

Q: Instead of using an apparently strong start to measure disappointment thereafter, can I learn to see it as a source for replenishment? A font of inspiration? A reason for hope?

“You better fix her,” Riley’s mom told him, with unintentional irony, as my sprawling reached its awkward limits. “If only you had a normalizer,” I lamented. Riley paused. “I do have a normalizer,” he said, notably setting down the rectangular toy and reaching for the round one. He spun it in his hands and then released me: “Now you’re normal,” he said.

The inventions didn’t end there, though. As his mom tried to fill me in about how things were going with him at home, he interrupted with another incarnation for me: “I’m going to zap you with my smartovator,” he said. “I’ll make you smart like me. I’ll make you think about things like me.”

Briefly but powerfully, I was transported to a cold walk home, late one December night, and a rare conversation with someone important to me. There were years of painful events and much distance between us, but he seemed to evoke a solution: if I could only be him for even a moment, I’d understand things and forgive him. How fervently I wished for such enlightenment! Needless to say, it didn’t come, although the very suggestion at least made it seem possible. We were adults, and might have used words to approach it, given sufficient time and mutual will.

Pulling myself back to the bright space of day, the four white walls around me decorated with children’s art, I found myself unable to enact my new part, even in play. I didn’t know how Riley thought—would that I did. He seemed to sense my limitation almost as fast as I did, and his rescue was, I thought, sensitive. A jumble of colors again, as he swirled the fidget toy: “Now you’re smart like you again.”

That would have to suffice.

 

AND THEN, NOT SO FUNNY

Horses, plants

 

The first thing she did was break my Japanese kaleidoscope—jabbed her finger through the viewing window. From the threshold of my office, she’d homed in on it, as if she’d known it would be there, on my table by the schefflera, awaiting destruction. A pixie with a tornado’s wake, she tore around my office, snatching things up and demanding “What’s this?” before casting them aside and moving on. She was ten, with a three-year-old’s lack of restraint. Her mother did not stir to intervene in any way, just sat heavily and watched me, wearing an inscrutable smile.

I had some information to relay and gather, it being our first visit, although I knew a bit from the intake report and a colleague on the Youth and Family team. The family had been receiving functional support services in their home for some time, to help with behavior management, but the FSS worker felt therapy would be appropriate as well. Danielle, the pixie, was suspicioned to have some trauma in her history. If she did, that might explain her wild energy, although she was being medicated for ADHD, as all too many kids are. The FSS worker had told me she was a sweetheart, if a handful, and would likely want to spend our time playing dolls.

At a certain point, I interrupted my intro to let Danielle know that although there weren’t a lot of rules in my office, there were a few important rules, and one of them had to do with gentleness. “I’m going to show you how I don’t like things to be handled, and how I do like them to be handled.” First, I picked up a toy and threw it on the ground. “You will not see me do that again,” I said, “and I don’t want to see it either. This is how I like things to be handled.” I picked the same toy up and set it down gently. “Can you show me the gentle way to handle things?” And she did—from that moment on, she was careful with everything she touched, and I made sure to thank her and heap praise upon her.

Danielle offered to teach me a card game in vogue called Trash. I accepted, and we arranged ourselves “crisscross applesauce” on the floor. She gave me the rules haphazardly, clarifying as she went along, as in, “Oh, and if that happens, you lose your turn.” It felt as though maybe she was just making up rules to suit her, which, if that was the case, was a) hard to follow, and b) not fun for me. So, again, I asked for what I wanted: “Could you please tell me all the rules first before we play? I’m feeling confused.” And she did! With perfect sense and order! We got on like a house afire then and played cards till the end of our session. I invited her mom to join us, but she just kept smiling and shook her head. Soon enough, our time was up, and I confirmed our next appointment for the same time next week. I was on Cloud 9: attention deficits can be hard for me, but we were off to a good start!

Then, the next week, no Danielle. I made an outreach call and got voicemail. No reply to my message, so I called again later that week, expressing concern. No reply again. I called a week later, then wrote a letter—nothing. Finally, I ran into her FSS worker and asked him to look into it. This is what he came back and told me: the mom didn’t want therapy for her daughter, or at least, not with me. “All she did was play with her,” the mom reportedly said.

Now at the risk of sounding prideful, is that all I did? Danielle and I built rapport. We engaged in behavior modification through clear communication and positive reinforcement. She got the chance to take the lead, and led beautifully, and we started in on addressing unmet needs. (The FSS worker still talks about the time the two of them played Trivial Pursuit—how Danielle didn’t even understand the questions, let alone know the answers, but appeared to be having the time of her life because someone was playing with her.) Perhaps these matters are subtle to the untrained eye. But I didn’t even merit a conversation? The funny story I told recently, about the mom who worried my voice was too calm when we booked our first appointment? That mom gave me a chance, and we got on splendidly.

My supervisor opined that the mother felt uncomfortable seeing Danielle behave like a different child; perhaps I had achieved something that she, as the parent, never had. He felt that she probably saw her daughter through a certain lens and was unwilling to have that lens so radically changed. Indeed, she might not have wanted to feel compelled to look at herself. I can’t profess to know if any of that was the case—but I can say this: I wanted to work with Danielle, and there are few things in life that upset me more than golden opportunities missed, especially when it’s not a matter of chance, but one of willful denial.