MY SMALL, GOOD THING

I had an insatiable hunger as a child, which I tried to feed with chapter books, great stacks that I collected on weekly library trips—cradled below my belly and held in place with my chin, as I carried them to the checkout counter.

That hunger is still present, but fiction often feels insubstantial these days, with so little time to spare and so much to accomplish. That shelf of titles on trauma, addiction, blended families, communication, grief, and more—I need what they contain. I need it all, I need it now. Such is the pressing quality of community mental health.

My intimate contact with the stories of traumatized children leaves me with simultaneous and contradictory incentives. One, to write so vividly of the horrors I hear and the pain I witness, that the general reader looks at the world anew: aghast and called to action. Two, to obscure those horrors so as not to titillate prurient minds or inspire troubled imaginations.

Sitting with memories of trauma is usually manageable; harder by far is to know that a trauma is ongoing—unfolding right before me in my office at times, in the words of caregivers who evidence no care to give, likely having received too little when they themselves were small. Harder is listening to parents, grandparents, and guardians who are overwhelmed and relentlessly negative, who fill the ears and hearts of their charges with every kind of blame and shame, each and every possible iteration of No. Needing to be diplomatic for the umpteenth time, when that is the last thing I feel; turning down the heat lest I, too, boil over.

So it is that I recommend Raymond Carver’s story, “A Small, Good Thing,” a masterful sketch of anguish in the ordinary world, and the humble ways we can assuage it. I reread it not long ago and carry that title within me, a phrase that describes the bird feeder on my window. How it took the birds two weeks to find it, but the first I saw was the male house finch, ardently red from crown to breast and finely patterned white and brown beneath. How the female house finch brings their juveniles to feed them beak to beak, while the punk-rock tufted titmouse busies himself with the sunflower seed.

Whatever else the day brings, there is that.

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The Raymond Carver story mentioned above appears in his great collection Cathedral, as well as numerous anthologies. 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, please 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. Thank you for reading!

THEN, SHE NAMED IT

I’ve written about the Tuesday evening when my thirteen-year-old client Shona shared that she had cut with mortal intent, and a little about how I myself was feeling at the time.

This morning the sun is pouring strong through my easterly window, and a prism hanging there is scattering rainbows hither and yon. It’s more than a week into spring and still below freezing, but the sun promises warmth to come. In climatological pockets, pussy-willows have been tricked into fuzzy bloom and perhaps even the friendly spears of crocuses are pushing up from below, where the snow has cleared. It’s a good time to say a few words more about Shona.

The Wednesday morning following the Tuesday in question, I called Shona’s mom to ask how the night had gone. She sounded tired, from waking several times to check on Shona, but also calm. It had not always been so. Anger had dominated this mom’s emotions in the early days of our meeting, along with a feeling of being held hostage to her daughter’s emotional state. What her anger meant to me was that her own feelings were in need of validation as much as her daughter’s, before she could be more empathetic, and that is how we worked.

I asked how Shona was doing, and her mom said she was sleeping, that she hadn’t woken herself early for school as she usually did, and her mom was just letting her stay home to rest. We agreed that I would call Shona later to check in, and when I did, she sounded rested and happy, on her way with her mom to buy ingredients for cupcakes. They would spend the afternoon baking, an activity she enjoys. I encouraged her to call the Center if she felt the need, and hung up feeling hopeful.

The next week Shona came in smiling. She was having a good day. What’s more, she told me that in the past week, “I didn’t cut, and I didn’t feel like cutting.” I was over the moon. That she hadn’t cut and hadn’t even wanted to, and that she said so.

At that point, we were into the fifth month of our counseling relationship, and the whole time she had avoided using any words for her self-harming. As she narrated her thoughts or actions, she would let her voice trail off as she gestured toward her wrists and arms. I didn’t push, but I let her know at one point that I noticed, and at another point I suggested that it’s helpful to speak neutrally and factually about highly charged things, including self-harm. I tried to model such an approach by making unflinching reference to her painful practice. If she said, “This week I felt like…” I would reflect back, without judgment, “You felt like cutting.”

In that follow-up, post-cupcake meeting, I refrained from immediate comment on Shona’s radical use of language. We continued to talk about this and that thing having gone well in her week, and we looked forward together to her upcoming birthday and the start of high school the next year. Only toward the end of our hour did I ask, casually, “So, I noticed that you used the word ‘cutting’ today. I think that’s the first time. Can you tell me about that?” She said, “I used to try to avoid talking about it. But I remember you telling me that I should call it what it is. I caught myself about to not say it, so I said it.”

Now, I hadn’t said “should.” That’s not a word for counseling, and especially not a word to say to someone vulnerable. But it sounded like she may have added her own emphasis to the suggestion, which was fine by me. I was over the moon all over again. The strength of speaking truth! The power of relationship! I’ll have to say goodbye to Shona soon, as my internship at the Center ends, and I’m grateful beyond measure to have first heard her name her challenge. I have every faith that she, especially with her mom’s support, can conquer it.

THE POWER OF PRECEDENCE

I last wrote in a state of devastation that my thirteen-year-old client had reached a point where she’d felt she wanted to die, news that was coincident with a bout of uncertainty on my part about the career path I’ve been on. Before I share a positive development, it seems important to say a little more about that Tuesday evening.

It was my first time seeing Shona after her family’s February vacation abroad, and with the month of March came clinic “housekeeping” of various kinds. There was case management to check in on, and a quarterly review of Shona’s treatment plan. Did she still have the same goals for herself as when we began? Did she and her mom feel that progress had been made? What were our next steps?

From the start, our therapeutic pattern had been that Shona and I would spend the first half-hour or so alone, inviting her mom to join us for the time remaining. It was a pattern that paid heed to two needs: for Shona to have a chance to express herself without inhibition, and for the two of them to have space to strengthen their relationship, grappling with challenges in a safe and supportive environment.

Their work had paid off in a number of ways, from my perspective as observer, and we had had an outwardly positive, productive last visit, when we played with an experiential metaphor following an adventure therapy model. I felt good about where we had left things and was delighted, as always, to greet them in the waiting room. With the exigencies of paperwork in mind, I invited them back together.

The timing of that departure from precedent couldn’t have been worse. Because my attention was, from the first moment of session, divided—respectfully attentive to her mother, who speaks more assertively than Shona—and because there was “business” to see to, I gave insufficient consideration to Shona’s affect, registering that her spirits and energy seemed low but attributing that to the conflicts they described encountering upon their return home from the tropics.

They let me know that Shona had cut again a few days before, and we talked through that: what her trigger had been; whether she had tried other coping strategies and, if so, why they hadn’t worked; how she might move forward from there. We discussed the things that we usually discuss, but again, it wasn’t exactly the same. I neglected to ask the all-important question. Shona, thankfully, answered anyway.

Just as we were standing and confirming for the next week, Shona requested that her mom leave the room. Her mom seemed surprised, but unperturbed. “You want to talk to me alone?” I asked, redundantly. She did. After I escorted her mom out, I returned and focused on Shona. “You know how you always ask me my intent?” she said, without preamble. “This time I wanted to…” and she gestured to her wrists, her sign language for meaning to do real harm.

This moment contained more than words can relay. She would not have shared the difficult truth with me if she didn’t trust me, I know that—and I know that trust is built and sustained largely through reliability, which is a vital aspect of the therapeutic relationship. I am where my clients expect me to be, when they expect it; that simple, symbolic fact means a lot. I ask familiar questions that link each visit. I make myself as steady as I can, so clients can vary and change.

I think what I want to say here is that it doesn’t take long for rituals to root themselves. And unacknowledged changes in rituals can be upsetting, a private disappointment and source of confusion eroding trust in insidious ways. In daily life, this can be hard to address, but good therapy offers an opportunity to get one’s emotional needs met, if only within the bounds of that one relationship—and a good therapist pays attention for signs of those needs.

What do I mean about being steady so clients can change? From a biological perspective, no one is exactly the same from one minute to the next. We are all organic and constantly mortal, constantly a little deeper into our mortality, the conscious or subconscious fact of which can separate as well as unite us. But ritual matters. When I failed our precedent, it showed its strength. When I lacked awareness, Shona expressed herself—she sought the thing that was missing. She demonstrated that she had been actively present for our relationship, and she was courageous with me. In the midst of everything, I thanked her for that.

 

ONE BELL, FIVE BREATHS

In my last post, I proposed a collection of ideas for incorporating mindfulness into the school day. To begin at the beginning, here’s one about breath.

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All the kindergarten teachers I know seem to have bells or meditation chimes to summon students to attention, and it strikes me that these could be appropriate for any age group. (Having sat through some faculty meetings, where order was called vocally, I think a bell would have been much more effective!)

A particular kindergarten teacher of my acquaintance often follows the ringing of her meditation chime with directions given in a library-quiet voice—a strategy for engaging more active listening. The pure tone and near-whisper strike a peaceful chord that seems to benefit everyone. But there may be still more opportunity in those resonant moments. What if every bell were the signal to take five good, deep breaths and then listen to instructions?

An online course in trauma-focused therapy (through the Medical University of South Carolina) takes what I feel is an excellent approach to teaching deep breathing to kids. Children are taught to lay one hand on their chests (in the manner of the Pledge of Allegiance) and the other hand on their bellies so that the pinky lies above their bellybuttons. They are asked to keep the chest still while swelling and deflating the belly.

I find this technique remarkably calming. Having one hand over my heart and one on my abdomen seems to complete a circuit of comfort. I think we are so much more aware of the touch of others—like a hand on a shoulder—that we often don’t realize how powerful the effect of our own can be. I haven’t yet had time to look this up, but if there isn’t research on this already, I hope that there will be. An “intra” variation on the fascinating subject of interpersonal neurobiology.

A natural question here might be, “Why five breaths, and not three?” Three often feels like a magic number, but my inclination is that while three good breaths can connect us to the value of deep breathing, three can also be done expediently, whereas five breaths seem to require a genuine slowing down, which serves to ground the experience. All this is hypothetical on my part…

There is abundant room for variation in the mindful-bell concept, allowing for developmental differences and energetic needs. I have less experience with older kids at this point, for example, and those savvier about preteens and teens might well approach the breathing differently.

My instinct is that with younger kids, such an activity can be part of rapport-building, while with older kids, some rapport might need to come first and through other means? And that with younger kids, the breathing prompt could be signaled as needed, while with older kids, it might need to be more formally a part of beginnings and endings?

Closed eyes might enhance the practice, if the classroom atmosphere supports that. Standing in a circle facing out, away from others, might help as well. A significant aspect of mindfulness is being truly grounded in one’s own reality, and in group situations, that might require some structured support to deal with self-consciousness, comparisons, and other distractions.

Again, there is room here to experiment. Creativity has an important role to play in mindfulness activities, especially with younger kids. I would only encourage attentiveness to whether a particular creative idea truly supports the desired outcome. If there’s a metaphor involved, is it apt? I recognize the visual appeal of the prompt to children to “smell flowers and blow out candles,” which Jenna mentioned in our interview and which is commonly taught, but I don’t use it because I feel some concern that the direction to smell flowers encourages a fairly shallow form of upper-chest breathing. When I smell things, the action doesn’t tend to reach all the way to my belly, and depth of breath impacts its value.

In closing, thinking about proposing a bell-prompt reminded me of classical conditioning, and I wondered whether more independent-minded thinkers might object to the Pavlovian notion of that. It seems to me that informal conditioning occurs in our lives all the time, however, and that peaceful feelings and enhanced self-regulation are gifts we can give to children that will not only allow for, but also encourage, greater freedom and autonomy.

 

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P.S. It seems there are computer programs and applications that can be programmed to ring a bell periodically. For those who have lots of computer work to do, that might be a nice tool for remembering to take breaks, rest the eyes, and breathe.