HAIL-MARY SWISH

There’s a basketball rim behind the agency that stands several feet below regulation. It’s supported by a plastic base that tends to fill with water, broken glass, and cigarette butts. The court is smaller than your kitchen, unless your kitchen is a galley on a boat; it’s made of brick and weeds and bordered by abandoned patio furniture. Beyond that, the miracle of grass.

It’s good for little but playing H-O-R-S-E, which I’ve done in blazing sun, swarms of gnats, and even cold, though not lately—it’s probably been twelve months or more since I’ve taken clients there. Different clients, different interests. My basketball, bought four years ago for work, sits deflating under the desk where I sit typing copious notes, community mental health’s Sisyphean task.

I don’t miss those outside sessions, which always made me feel like I was in the wrong place, wishing I were in the right one. I’m still working out to this day where exactly that place will prove to be, ultimately. I do sometimes, though, think about a middle school boy I saw early in my employment. He was my first truly mandated client and engaged in selective mutism in protest of his mother’s insistence that he attend therapy. The substance of her concern was his childish behaviors at home. I would not be of help, it soon became clear.

Our therapeutic relationship didn’t start strong. The boy complied with an expressive activity straight from a textbook, to choose an animal figure from a jar to represent each member of his family and place them in a constellation of sorts on a labeled paper; but his reasons for choosing each, he kept to himself.

It didn’t finish strong, either; our last visits, as I recall, surpassed mere silence and exceeded recalcitrance to enter territory beyond. While now I might recommend more co-parenting work, at that point on my learning curve, I was advocating to end services, expressing privately to my client’s mom that I would rather he feel supported in his preference than be turned off to therapy for the rest of his life. By then, she and I had had a few one-on-one talks, and I believe the most difficult piece about closing, from her perspective, may have been the loss of someone to hear her own challenges and frustrations with the whole family.

Formal activities work for some kids, but it didn’t take long before my focus shifted, for the duration of the middle phase, to attempting rapport by joining my client in whatever fun could be had. We played War (for the record, the most tedious card game I know) and UNO. There may have been an occasion of popping matchbox cars in a wordless contest; that’s a bit foggy now. Sometimes we went out back to the sorry court described above, clouds passing overhead. I had the idea that if I could impress him with my hoop-shooting skills, the energy of our visits overall might shift. Well, you already know that didn’t happen. But there was one glorious afternoon that lives in my memory…

His younger brother had come along that day, and the decision was made to head for the grass with a small finned foam football that was meant to have good spin, though not when thrown by my hands. My client was animated with unusual verve, in the role of leader. He talked! Mostly to his brother, but still! In a spirit of inspiration and delight, I proposed rules. Instead of just passing and catching or fumbling, whoever dropped the ball would run prescribed laps and then throw the football through the basketball hoop. If a basket was made, play could resume. If not, more laps.

He wasn’t just game, he showed gusto, and the three of us ran around the broken picnic tables until I literally, if dramatically, fell down panting. I think of that day, and the neon-green torpedo catching net, as my Hail-Mary Swish. I gave it my all, and my all was both grounded and free. If my client remembers anything from our time together—ancient history now, in kid years—I hope that’s it. We salvaged something, I think, however small. Not in that case, but in the very best cases, salvage can be salvation.

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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. 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’m deeply grateful for my readers, and as always, 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.

 

 

MISSING PIECES

 

It was a cold, rainy November day in community mental health. I was stood up for the third week in a row by a parent who nonetheless makes no move to end services, meaning that I have to send a letter that indicates concern (without getting too personal) and points up my outreach efforts (without sounding overbearing). Despite a background in writing, such communications are grueling for me.

I spent 25 minutes on the phone with a juvenile probation officer, discussing a client’s obsession with his ex and his legal situation related thereto; then hung up and promptly wondered whether I’d betrayed his confidentiality in the little bit of talking I’d done, something that will likely nag at me long after my supervisor reviews it with me. I was beset and nuzzled by a hand-puppet seeking affection-by-proxy on behalf of a child I have frequently had to remind about personal space.

Holding respectful silence, I supported a young adult in the process of contemplating how much of her sexual trauma she needs and wants to share. I stepped with a mother and daughter into the furnace of long-fueled resentments. At one point, an adult psychiatric patient crunched through the snow to look in my window before continuing next door to pound on the glass of the doc, cursing and threatening him till police were called. Come to think of it, that’s what started the day.

Two client visits were easy and joyful and kept the lights bright in my brain after too many hours spent doing paperwork and hearing disappointing news. But the part of this Monday that I’ll remember most clearly is the call from Sue, a foster mother, to tell me about a question posed by my kindergarten client on the drive to school. Removed from her biological mother for gross medical neglect as well as alleged abuse, my client asked from the backseat, “Do you think you can love a person without liking them?” Six years old.

Every clinician I know has favorite clients and heartbreak clients, often one and the same. This girl stole my heart from the moment we met, and although I behave with the same playful professionalism I would with any client her age, I wish in a very real way that I could adopt her. That I can’t is one of a short-list of aches that descend from metaphor to dwell in my core.

I’d gone in early to finish an annual review, so the day felt extra-long. When I got home, my bootlaces wouldn’t loosen fast enough. Yanking, tugging, heaving, I got the right boot off, taking my sock with it. Stuck to the bottom of the sock, and hence to the bottom of my foot, the bottom of my day, the bottom of my ache, was a small puzzle piece. The crackled glaze on the curve of the Mona Lisa’s mysterious smile.

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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.

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’m deeply grateful for my readers, and as always, 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! Thank you for your visit.

WORK-LIFE RESONANCE

 

I recently sat in on my first Aikido class. Afterward, I was pleased to tell acquaintances that I now know how to throw a grown man to the ground. That was just silly bravado for my own amusement, however, and not at all reflective of the discipline. What you learn in Aikido, as the sensei put it, is how to help someone fall.

That concept speaks to my sense of the work I do.

Vulnerability tops nobody’s list of favorite mammalian sensations; certainly it doesn’t top my own. For me, the experience of vulnerability can evoke fight, flight, and freeze simultaneously, an anti-trifecta. So I empathize with those who are ambivalent about therapy, instinctively resistant to the deeper conversations.

My faith in the depths is firm; my compass points inward. But the “fall” into therapy has to be taken with great care and companionship, and one of the best ways to achieve that—in addition to active listening and the sensitive use of silence—is through reflective statements. Not a flurry of questions, chop-chop-chop like karate. Minimal use of questions, maximal use of restatement, summary, and gentle extrapolation, always open to correction.

This approach is beautifully described and detailed in Miller and Rollnick’s Motivational Interviewing, one of the most inspiring texts of my education. MI is the Aikido of therapy! It’s rewarding to work in such an intentional way, to assist the fall—and the standing back up.

I was sitting with a traumatized tween girl on the floor in my office. Her chaotic life experiences were poignantly evoked by the careful way she organized my dollhouse, visit after visit, arranging everything just so. One particular afternoon, she was highly escalated from the car ride to the appointment; she had shared information about her trauma with her mother, and her mother had gotten angry.

My dollhouse is an eco-friendly Scandinavian wooden “chalet” that can be separated into two parts. For the first time, the girl separated them and set one part off at a distance: “This needs to be its own house.” Sometimes that’s what’s needed, I said.

She described to me the conversation in the car as she worked on one house. I continued to reflect and validate what I heard her say. After a while, I asked her permission to share a thought I had. She granted it, and I proposed that her mother may have been too upset to give her the response she needed, but that we could try again to talk all three together when things were calmer.

She reached for the “other” house, saying, “I guess this actually belongs here,” and put them back together again, making a new space of the whole. And she started, for the first time, to tell me the story of her trauma, using the dolls and furniture as props to her narration. When her mother joined us, they were calm together. The work continued, and the work began.

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Monday I had my four-year anniversary with this site! 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.

 

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.

 

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!

 

 

 

 

 

JANUARY 20, 2018 / MARCH

 

 

I overheard this in the crowd today:

Mother: Do you want me to put you on my shoulders?

Daughter: You can’t pick me up!

Mother: Yes, I can.

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Please excuse the brief departure from my once-a-month posting routine! Please also excuse the unedited collage; I’m still learning WordPress. 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. Represent!