Friday, June 13, 2008

Feeling Sorry For Her

A central assumption of our approach is that symptoms are adaptations- these kids are doing these crazy things for a reason. The problem behavior is a solution for the child. It is accomplishing something, getting the child’s needs met, in the short term, even though there are longer term negative consequences.

In order to practice this thinking, we give training participants a scenario:

Alexandra is a 14-year-old-girl who has a history of trauma and multiple separations from her mother. She has a history of self-injury and suicidality. She has been placed in this home for six months, and her foster mother has noticed that in the last month she’s been opening up to them in a new way that she has not before. Last week, it was announced that one of the other kids in the home was going to be leaving to go to a group home. This morning her mother observed that she was wearing long sleeves even though it was 90 degrees out. When her mother asked why, she told her to "f__off." She eventually revealed that she had been scratching herself with a paperclip.

We ask people to consider:
What are 2 or 3 hypotheses about how Alexandra’s self injury might be adaptive for Alexandra? What problem (s) might it solve, how might it help in the moment, even though it leads to negative consequences in the longer term?

And then to:
Choose one hypothesis. If this hypothesis was true, what are possible ways the foster mother might help Alexandra to solve that same problem with fewer negative consequences?

In a recent training that I did, people responded (as they often do) "she is doing it for attention". So why does Alexandra need attention? (She may be scared of opening up to the foster mom and then possibly losing her as the other child is going to.) Why doesn’t she ask directly for what she needs, or express her fear directly? (She doesn’t know how, she can’t be that vulnerable especially now when the relationship feels tenuous.)

One participant added: "she just wants the foster mother to feel sorry for her."

Do you agree that the phrase "feel sorry for her" connotes an illegitimate need, something that she shouldn’t want or need? Doesn’t it imply that she is trying to get some kind of unwarranted or excessive response?

Also, this phrase implies that we should resist feeling sorry for her- and by extension resist coddling her, fussing over her, or being sympathetic. Yet some cuddling and caring may be just what Alexandra needs.

Of course, there is every reason to feel sorry for Alexandra, or to feel sorry about what has happened to her. She has had a very difficult life, and terrible things have occurred that were not her fault. Her basic needs have not been met. She has not been safe. These experiences have changed the basic biology of her brain. Her life has not included much relaxation and fun. She has not been taught that she is worthwhile, special, and that people love her. She has not been shown the feelings management skills she needs for life.

Yet when we say "she wants us to feel sorry for her" we are forgetting that Alexandra is doing the best she can, that her fears and needs are legitimate to her, and that she is using the only means she has to meet them. She will only be able to change when she feels safety within a committed relationship, and when she gradually learns new skills.

Although using the phrase "feeling sorry for her" seems like a small thing, it is important to stop and challenge ourselves. This phrase can lead to an entire attitude that will infect our response to the child and interfere with her healing.

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