Sunday, November 30, 2008

Does Our Discipline Threaten Our Relationships?

In a recent training we were talking about relationships, as we often do. A therapist asked the following question:

"I am often called onto the floor to intervene with a kid who is acting up. I take on the role of the child care workers. I end up giving him consequences. When that happens how can I preserve my relationship with him, and not seem to him like just one more person trying to manage his behavior?"

 I was struck by what I see as dangerous assumptions beneath that question, which I will exaggerate for purposes of discussion. I think in fact these assumptions often do underlie our thinking and actions in treatment programs.

This question assumes that the therapist has a special healing relationship with the child, which would be threatened by the therapist addressing the boy’s behavior in the normal way of the program. The child care workers, on the other hand, are expected to address behavior routinely and so whatever relationship they have with the child is expendable. They are those people who are just trying to manage behavior.

I would propose that there should be no people in a treatment program "just trying to manage behavior". The first priority of every person who interacts with the child should be to form, maintain and strengthen their relationship with the child. Every relationship can be healing. Every relationship is important.

I would also suggest that none of us, whatever our role, should ever be just managing behavior. Of course, in a crisis one has to direct traffic to restore safety. But with regard to any individual child, our constant focus should be to understand the meaning and adaptive function of every symptom, and teach the child more positive ways to meet those same needs. Our programs, and all our staff, should in every way promote a sense of safety and caring. We do not ignore behavior or remain paralyzed as the child becomes increasingly upset and out of control. We intervene actively and constantly from our base of relationship to help the child calm down, and, when he is calm, to figure out how to get what he needs. Our goal is not to control his behavior. It is to help him to feel calm and safe enough to try new ways of meeting his needs.

I seriously believe that everyone in the program should be thinking this way- every child care worker, every therapist, and every teacher. Everyone should be engaged with the child from a carefully formed relationship. Naturally, the child may be angry, unappreciative, nasty, upset and uncooperative with any one of the many people on his team. Any one should then acknowledge and validate his feelings, and (when he is calm enough to hear) share their experience of whatever happened from their heart.

When we acknowledge the central importance of all the relationships between the child and the team members; when we truly believe that the child is doing the best he can; when we see symptoms as adaptive; when we react by helping the child to learn better ways to meet his needs: then we can all do all parts of the job of treating and raising these children, and we can all enrich our relationships as we do them.

Sunday, November 23, 2008

Meeting Their Needs

In Risking Connection® training we focus a great deal on counter-transference, the helpers’ feelings while doing the work. Our basic point is that any feeling is okay, it is what you do with it that matters. In order to illustrate this, we use scenarios. In each scenario, the questions are: what is the staff member feeling? How could they use their feelings to enhance the treatment? How could their feelings get in the way of the treatment?

Here is one of the scenarios:

"Lucinda, a fourteen-year-old resident, told you that her aunt had called her and told her that her mother was very sick. She seemed quite distraught. You arranged with other staff for her to have an extra long phone call outside of phone time. Later you learn that she actually used that opportunity to call her boyfriend and her mother was never sick."

The usual response is that the staff member is feeling angry, betrayed, used, foolish, and ashamed. And maybe we had better think again about allowing Lucinda this relationship with her boyfriend, since it apparently gets in the way of her treatment. Our reaction is to toughen up, make sure we never believe this child again, that no child can ever trick us again. She has betrayed our trust and we will not trust her again for a long time.

We talk about noticing that this is how the kids we work with always feel. That moment when the staff member, feeling humiliated, decides never to open her heart and let any child trick him again is the place where our kids live.

In a recent training, however, a miraculous thing happened. One staff member said: what if we realized that Lucinda doing this was a sign that she was not able to trust us to meet her needs? What if we assumed that her wish to talk to her boyfriend was legitimate? It is developmentally appropriate, and also part of her understandable need to have connections, someone who cares about her, attachments.

What if we worked hard to assure Lucinda that we would like to meet her needs, and we would like to discuss how we can make sure she has regular access to her boyfriend without the necessity for lying to anyone?

What if we thought that more important than the phone rules was a chance to teach a child that adults care and that you can turn to other people to help you get what you want?

I would love to live in a world in which this kind of thinking was even part of the conversation.

Monday, November 17, 2008


Let’s consider the topic of safety.

One of the most basic, immediate and continuous distinctions our brains are constantly making is: safe or not safe? Danger or no danger? This decision is made instantaneously in any new situation by the part of the brain known as the amygdala. Any change triggers a reevaluation. In a healthy brain, the amygdala’s instantaneous decision is combined with and moderated by information from other part of the brain, that add information regarding context, past experiences, reasoning, and observations from the sensory system.

If the brain concludes: Danger! Not safe! the body’s protective system is activated. Energy is directed to the parts of the body that will be needed for fight or flight. Non-essential systems, such as digestion and reasoning, are shut down. The activation chemicals in the body/brain are released, and the alertness system turned on. The person is alert, but focused only on signals of danger and safety. The heart is beating fast, the muscles are tense, ready for action.

Think of a time you can remember when you felt seriously unsafe. A near car accident? An encounter with a threatening person? A weather-related event? Even a common example like trying to drive home from work after an ice storm can be illustrative. In fact, an even more appropriate example would be being a passenger in a car when someone you didn’t know very well was driving through an ice storm.

What did you feel like? What did you do? What happened in your body?

If there was someone in the car with you, would you have been able to have a conversation about a movie you had seen, much less about something that was troubling you? If some one told you a joke, would you have laughed? Would you enjoy the songs on the radio? Could you take a nap?

To further elucidate the experience of danger, there is the experiment with the baby mice. (Panksepp, J. (1998) Affective Neuroscience: The Foundations of Human and Animal Emotions. New York, Oxford University Press) Some baby mice had been raised in cages. They had never seen or heard of a cat. Like all baby animals, they engaged in a lot of free play with each other. The experimenters put two cat hairs in the cage. Although the mice had no cat experience, the cat hairs were wired into their brains as signifying danger. Immediately, all free play stopped. And, also significant, when the cat hairs were removed after just a few days the mice play gradually returned, but it never returned to the level it had been before the cat hairs were introduced.

So what does all this have to do with our work? It is helpful to think of the children we work with as being stuck in the danger response. Because of early, overwhelming and unpredictable experiences of trauma, their brain chemistry was modified such that they can not come back to a relaxed state.

But the wonderful news of brain plasticity is that at any age, the brain can be rewired through attached relationships. In order to begin this process, and in fact in order to be available to attached relationships, the brain must sense "I am now safe". Since the brain patterns of danger are so deep, this will not happen quickly, but it can happen.

So it is important that we think closely and observe the ways in which our treatment environments are signaling safety to our clients, and the ways in which they signal danger. As part of this we must consider ways in which we as staff feel safe in our work places.

As you look around your environment, what safety and danger signals do you observe?

Danger signals could include sarcasm, not being allowed to speak ones’ side, restraints, loud noises, disorganization, emotionally dysregulated staff, belittling comments, physically ugly places, lots of damage and disrepair, creaky doors and funny noises at night, messages from other kids, boundary violations, bullying, messages from staff to other staff, blaming and scapegoating- the list could go on.

Safety signal could include warm tones of voice, respect, politeness, promises kept, organized environments, delight, fun, relaxed kids, caring messages when upset, physical protection such as locks, clear and observed boundaries, a sense that we are all in this together, team work, pleasant physical spaces, an appreciation of strengths and competences, a real voice in decision making.

It would be interesting to have a team discussion of this question. How safe does our environment feel to the kids- and to us? It would also be interesting to ask the kids to make lists of "things here that make us feel safe" and "things here that make us feel not safe".

And as we do this, it is important to remember that unless the body begins feeling safe, the person will not be able to begin the work of healing. It’s not that they will be resistant or unwilling- it’s that their brains will not be available for that work.

Thus it is very important that we pay more attention to this subject of safety.