Saturday, June 18, 2016

Treatment points for "delinquent" boys


In 2006, I was the first and sole therapist for a start-up Residential Treatment Center – a therapeutic home for delinquent adolescent boys – in rural Ohio. I wrote the following guide* for the support staff whose job featured relating in a personable way to the boys and preventing and stopping their violent behaviors. (I forget what this staff’s title was at this center; in other places they’ve been called “crisis techs” or MHA’s – mental health associates. It wouldn’t be unfair to call them kindly bouncers.) Though the guide was quite psych- and theory-heavy, I wanted these workers to understand something of the inner natures of these boys, beneath the stigma and tendency to see them as corrupt or simply immature. With some built-in embarrassment, the material was titled –

The Deepy-Weepy, Huggy-Wuggy
Side of Treatment
Brief introduction to psychological and counseling concepts
that will apply to residential adolescents


Main psychological concepts (applying to both adults and children)

“Everything is psychological.”  Some clinical professionals differentiate between children’s actions that are “mental health”-related and those that are merely “behav­ioral.”  This differentiation is sometimes used to determine if a child should go to counseling or the crisis center, or to court or jail.  But . . . everything is psychological.  Behavior always has deeper meaning, and it is valid to say it always has a darned good reason.  This includes negative behavior, positive, language use, how you walk, talk, eat, groom, breathe.
*****
“People are dysfunctional not because they think wrong or behave wrong, or (in general) have unbalanced chemicals or flawed genes.  People – including children – are psycholog­ically dysfunc­tional because they’ve been hurt and haven’t been given the chance or means to heal.  The primary source of psychological pain in childhood (and derivatively, in adulthood) is the pain of unmet needs for love, bonding, visibility (“mirror­ing”), touch, attention, communication.  Otherwise put, we may love our children, but not necessarily in a way that reaches them.
*****
“Everything is behavior.”  That means: emotional/mental/tension states of the person manifest in the body and its actions.  This could be over-sleeping from depression, trembling from anxiety, restricting respiration in response to abuse or anger; over-working or over-exercising to channel away tension or feelings of emptiness; passively accepting abuse; it could be whatever brain processes are involved in dissociation (numbing out, daydreaming, “leaving one’s body”); it could be irritable bowel syndrome or ovarian cysts in response to sex abuse, and a constricted blood vessel and high blood pressure in response to stress.  Therefore, a child who appears healthy and mentally positive may still exper­ience symptoms of mental/emo­tional problems that are not apparent to him or to us.  Lessons: (a) The overt behaviors of our clients are the tip of the tip of the iceberg; (b) Don’t assume that things are fine just because they appear that way; (c) Don’t assume that positive behaviors are actually positive – they may be repressively self-medicative (self-soothing) behaviors.
*****
“The brain hates pain.”  For psychologically wounded people (most of us), the self is in conflict.  Pain “wants” to be expressed (i.e., the body wants to heal): outletted to the light and air of healing.  But the brain, averse to pain, wants to bury (repress, minimize, distract) it through the various defense mechanisms.  In many adults, everything you see may be a defense against psychic pain: TV watching, sleeping, workahol­ism, belief systems/atti­tudes, raging, destructive­ness, niceness, narcissism, silliness/immaturity, pseudo-matur­ity/indepen­dence, etc.  Therefore, promoting “positive” behavior and attitude, while good and essential in many ways, may hide the underlying “splinter in the soul.”  Note that in the Ron Clark story, when Mr. Clark found Taeshon injured and traumatized, he first consoled, nurtured, bonded, empathized with him before accentuating the positive (his artistic talent).
*****
“We must feel to heal.”  And, “We can only heal where we’ve been wounded.”  If you break your arm, you don’t bandage your leg.  If your heart is broken, you don’t “think” the pain away.  Psychological pain is imbedded in the holistic system – it’s not just “feelings” but nerves, chem­istry, muscles – body and soul.  We must acknowledge and express it – let it out.  We can’t think, act, talk or “positive attitude” it away – though these things may temporarily cover it up.
*****
From the concept that psychological pain must be outletted to be healed (a grieving-related process), that to bury and ignore our hurt (to put on a smile and soldier on) is to disown and harm our self, we realize that:
Sometimes the most self-caring, justice-giving thing the child can do is fail, rage, decline, drop out, crash-and-burn.  The child who is in overwhelming distress because of incest or other abuse at home, should act up in school, fail to maintain his high GPA, mutter, growl, whimper, refuse to attend, get sick, get depressed, get scared.  These behaviors are his language of self-affirmation: “I hurt!  I can’t go on like this.”  Adults need to hear this language and respond with understanding, compassion and help.
*****
One of the greatest and most elemental needs is for the child to be seen for who he is.  This is related to his need to be accepted (by the mother) for the exact, specific child he is, rather than be forced to warp his natural inclinations to satisfy the needs and expectations of his parents (“You will be silent; you will be lady-like; you will be an athlete; you will get straight A’s; you will play the piano; you will be impressive to make me look good.”)  In therapy, this gift of acceptance and deep visibility is, essentially, life-giving and curative.
*****
By the way . . . mental health diagnoses are not actual entities or disorders – like medical diseases – but are symptoms or groups of symptoms or defenses against, some earlier injury in the person.  While there will assuredly be a biological, or brain, component to the problem, there is no proven reason to assume that the brain is the “culprit” in the problem – life is the culprit.  (Scenario: In a lonely mood, you’re walking along the railroad tracks at midnight, lost in thought.  Suddenly you are immersed in a blinding light, you feel a rumbling under your feet, you hear the shriek of the whistle.  You look behind you to see a locomotive barreling down upon you.  You can guarantee that every chemical in your body [and brain] is going to be very imbalanced.  You can also be sure that you should blame the train, not your brain, for your “chemical imbalance.”)
*****
Anger is a complex emotion, and can often be considered derivative (secondary) to earlier, truer feelings.  A child may think he feels only anger when his father hits him.  Primary to the anger, however, is a transient shock of hurt and betrayal.  He may want (need) to cry.  But the exper­ience of being so open to his pain and being responded to coldly, mockingly or abusively, is intolerable.  (It is like bleeding profusely in front of someone, who then just walks away.)  It is unsustainable and must be killed.  Anger may then rise up from the corpse of hope.
*****
The child acts out negatively because at some point earlier in his life, he com­municated his distress directly and accurately (such as by whining, crying, yelling), and no one grasped the meaning of, or accepted, these expressions.  Transitioning from crying or whining to breaking things and harming siblings is not essentially a matter of conscious choice.  The building blocks of this transition include unconscious processes of loss of hope (desperation and desolation), shutting-in pain, and alienation.  If the child’s true and articulate communication is unheard, he will have the terrible feeling of being isolated and alone even in the presence of other people – even in the presence of those who are supposed to care about him.  He will have, in effect, no rational outlet for his grievance.  Also, the passage of time will solidify his alienation from others, and possibly more significant, from himself.   Because, as we saw in the point above, painful feeling that is not helped and healed is intolerable to contain, and must be split off in oneself.  The child represses and thereby disowns parts of himself.  This self-distancing leads to “distant” communications to others – indirect, apparently incomprehensible yet eloquent messages of pain in the form of destruction and aggression.
*****
A history of being unheard and unhelped may cause the child to grow emotional scar tissue over his hurt, in order to survive.  In order not to be open to pain felt and pain caused, he may become unfeeling, tough, alienated from others.
*****
He will also tend to make his jail into his haven.  That is, he’ll take his negative responses to the world and consider them positive.  (This is a way to experience less pain.)  The anger and disconnect he’s had to cultivate in himself to numb his pain, will now be thought of as tough, manly, “cool.”  The quiet, shy and isolated person will see himself in more romantic terms, as a “loner.”  The incested girl (or boy), now oversensitized to sexuality, may see her/himself as sexy and seductive.  Therefore, you will see children wearing their injuries and self-harmful stances as badges of honor.
*****
Such a child will typically have – despite his show of bravado and big ego – a terribly impaired self-esteem.  It may be excruciating for him to be in environments of love and caring, and (more peer-related), in the presence of other kids’ success and healthy lifestyles.  The contrast with his own state of poor self-value will be too glaring and painful.  A yet more fundamental dynamic is that exposure to health and love – even when offered to him – will trigger feelings of his own long-term, entrenched deprivation and loss, which he will feel compelled to run away from, by running away from the love and kindness offered.  Therefore, while we may work to gradually “win him over” to accepting our care, it is just as likely that whatever success we have may be experienced by him as a crisis of healing – where he must, with tremendous courage, break down his wall of defense and “collapse” into his “un-tough,” younger and needier identity – figuratively to collapse into the arms of loving parent-figures.
*****
Children cannot “grow up too fast.”  Youngsters adopt a pseudo-mature and inde­pendent persona when they haven’t been allowed to be needy and securely dependent on nurtur­ant/authoritative (loving and strong) parents.  (This is sometimes called “reversal of dependency,” where the parents are immature and wanting, and the child may have to parent them.)  It doesn’t always mean these are bad parents.  They may be “depleted” – exhausted – or may have bought into an overly liberal or permissive parenting style.  The child buried beneath the pseudo-adult identity can’t grow beyond itself as its needs have never been met.  Therefore, the individual who “grew up too fast” has actually never grown up, and may be plagued by countless manifestations of immaturity throughout his life.  (An example would be the 15-year-old boy, in youth jail for murder, who was seen lying on the floor, in fetal position, sucking his thumb.)
*****
As a child cannot grow up too fast, so he cannot raise himself and have full psychological integrity.  He will be a young adult with “feet of clay”: adolescent and child fused; teenager and baby combined.  He may both seek parent-figures and defend against his critical need for parent-figures.  He is fighting with himself and consequently, with you.
*****
Final Points
Just as negative behaviors are more than they seem, so positive attitudes and behavior are more than, and sometimes very different from, what they seem.  They may be, of course, consciously manipulative tactics to “pull one over” on authority figures.  But they may also be unconscious “covers” to pain – ways to run away from what’s underlying.  I’m sure you’ve known many adults whose cheerfulness and energy can instantly deflate into depression; or someone who “looks and acts good” but feels bad or empty.  These phenomena indicate years of layers of growth and evolution – of behavior – resting on the quicksand of an unhealed past.  This is as true of children as it is of adults.
*****
To help the kids, we must care for and encourage them, but we must not be blind to where their behaviors come from.  We must see the damaged roots, not only the broken branches.  Nor should we merely manicure the leaves and think we’ve carried the whole child.  We must help them find truer, more curative expressions of their hurt.  For example, saying their grievance rather than breaking something – while we are preventing their destructive behaviors.  The child must be truly listened to, without the adult inserting her own thoughts, feelings and expectations into his mental life.  To do that is to deny his pain an exit.  An example of this would be where the child says dejectedly, “I’m just a stupid screw-up.”  While your tendency would be to reply, “No you’re not – you’re a good kid,” this response tells him You are not listening to me.  You are not caring about how I feel.  Or, My feelings must be wrong, or unimportant.  Or, My sense of reality is flawed and I can’t trust it.  So, while you wouldn’t want to agree with his toxic self-assessment, you would be well served to show him that you actually hear him: “Bobby – you’re feeling really down on yourself.  Tell me more.”  This gives him the gift of feeling clearly heard – something everybody needs and too few of us ever get.  After­wards, you may give him the encouragement of your positive feeling about him.  Here’s another example (from Vereshack):  A little girl comes home from school.  “Mommy,” she cries, “the teacher was unfair to me today!”  Mother looks at her child and says, lovingly, “Honey, I’m sure the teacher was just doing his job.”  This could – admittedly at a subtle level – be considered mental abuse.  Now, despite mother’s kindly manner, the child sees that her feelings amount to nothing; she feels unheard; she may now feel the door is closed: she can’t go to her mother with her real feelings and thoughts.  Or alternately, she may accept mother’s view­point and start to distrust her own grasp of reality.  We need to listen and acknowledge the child’s emotional frame of reference; otherwise, he will continue to hide his pain, his truth, beneath apparent change and growth.
- - - - - - - - - - -
* I haven't changed, corrected or improved the original material.

No comments:

Post a Comment

Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.