Saturday, October 24, 2009

Marcus and the Scary Pictures-What Would Your Team Do?

Marcus came into residential after having been ejected from a previous residential. He is adopted, and his current adoption is actually his second as he was removed from his first home because of abuse. He is small for his age and a bit strange looking. In the month he has been here he has not made any friends, in fact the other kids seem to pick on him. Several times he has said inappropriate sexual things to female clients and to female staff, which does not increase his popularity. Generally he is the kid who is always doing what you just told him not to do, then accusing you of only talking to him when he does something wrong. Staff is finding it hard to engage with Marcus.

However recently a more upsetting issue has emerged. Tony and Jarell, two of the other boys, and Amber, one of the girls, separately came to staff to complain that Marcus has been showing them some very disturbing pictures that he drew. A search of his room in fact produced many of these pictures, which are very graphic (and skillfully drawn) renditions of men torturing naked women, complete with blood and gore. Amber said to her staff that she thinks Marcus is going to grow up to be a murderer and the staff who have seen the pictures tend to be worried about the same thing.

At first when this was discovered, staff gave Marcus a sketch book and said he could draw the pictures in there, but not show them to anyone. However yesterday his roommate Tim told staff that Marcus had been showing him his latest creation. It is one of the bloodiest yet. Lisa, Marcus’s therapist, finds that the pictures make her very uneasy and she does not know what to do to help Marcus. In fact lately she has been avoiding meeting with him. In the staff meeting the most popular suggestion is that Marcus be forbidden any access to paper and writing or drawing materials in an attempt to prevent him from making these drawings.

Do you think this is the best approach? Why or why not?

How do you understand Marcus’ behavior? In what way are these pictures adaptive for him- what positive results is he getting from drawing and sharing them?

What does Marcus need? What approach would you recommend?

What should be done to support Lisa and the staff in helping Marcus to heal?

Share your answers by clicking on "post a comment" below. I strongly encourage you to participate in this discussion. Let’s generate a robust list of possible answers. I will write more about this in my next post.

7 comments:

Darryl said...

Taking the pictures, his drawing utensils, and giving him some punishment in his room would be the suggestion. Thinking about it Marcus is expressing his emotional experiences through drawing and it can be hard for others to get past the content of the drawing without looking at the meaning of the behavior. It might start by praising his ability to draw well, then try and discuss the significance of his drawing ability. Our treatment team might shift to have the female staff ask to use his skills to make drawings that they might feel good about in his cottage and other peers might enjoy.

Laurel Downey said...

Ok, here's my take on this boy.
It wasn't stated how old Marcus is, but I am assuming pre-adolescent? 11 or 12? If he is older, the issues and strategies are not that much different, but the internal difficulties may be more entrenched and harder to shift.
First, discount organic and genetic conditions - it is said that he is small and strange looking, so good to rule this out.
Second, make sense of this behaviour. He is testing you! He is sending you a message with these drawings, and the fact that he is showing them to others for a reaction indicates that he is asking for help.
If we use an integrated trauma/attachment approach we can see that his internal working model is in a very negative state. His drawings probably express "this is how horrible I am", rather than "this is how horrible I feel", which is where we might be tempted to go. IWM tells us the child's view of self, and of the safety they feel in adult relationships. With this boy, I would suggest that he feels very bad about himself and has very little trust that adults can help him feel safe. In terms of trauma, I would suggest that the abuse he has suffered is probably worse than you know, if the drawings are a reflection of his experience.
Why is he drawing? It is much better that he is drawing his fantasies than acting them out, there is no mention of him actually hurting others, so the drawing is acting as a release valve. The danger in punishing him for this is that the issue will go underground and emerge in some other form - the next form may well be much worse than drawings.
Also, if we think about Anglin's idea of 'pain based behaviour', this behaviour is an expression of the pain he is in, and the best strategy for pain is empathy, which brings us to strategies.
My suggestion would be to increase contact rather than withdraw. His IWM will expect you to withdraw, as he is showing you how horrible he actually is and expecting that your response will be one of shock, horror and disgust. In withdrawing you risk showing him he is right, and he is horrible and disgusting. Try to find ways to connect with him, use empathy to give him the message that you feel very sad and upset that he feels this way, saying things like "wow, you must be feeling very sad and miserable to want to draw things like this", without expecting that he will respond of course!
Sounds like the therapist needs some help to address her own fear and disgust with this boy, perhaps she can be helped in supervision to think about how our theories explain this behaviour, and what her role might be in counteracting his negative IWM, as well as her own reactions and where they come from. It will be difficult to get to the trauma story until safety is established in his relationships with the therapist and with the care workers. He is testing you all to see if you can withstand his disgust with himself, and help him to feel safe.
The team of course needs support and debriefing, and to be helped to see this behaviour as having meaning. Encouraging them to manage their disgust and horror and treat his behaviour as just 'behaviour', while avoiding moralising about it, will help. Punishing him and taking his drawing things will probably not be effective in the longer term.
all the best with your work
Laurel

Anonymous said...

Has anyone asked this boy to tell them about his pictures? There could be several reasons he is showing these pictures to his peers....asking him to share/explain his pictures may give some insight into this. Is he testing, does he get aroused/excited by his peers reaction, does he get a sense of power....until there is a good understanding of his motives it does not make a lot of sense to focus on how to treat...

Anonymous said...

Has anyone asked this boy to tell them about his pictures? There could be several reasons he is showing these pictures to his peers....asking him to share/explain his pictures may give some insight into this. Is he testing, does he get aroused/excited by his peers reaction, does he get a sense of power....until there is a good understanding of his motives it does not make a lot of sense to focus on how to treat...

Landon said...

Use curiosity vs. interpreting without judgment or value
Explore how he feels before, during and after the drawings
What value, if any, does Marcus put on the drawings?
Who does he show the drawings to and what is their reaction?
How does Marcus feel about the reaction he receives?

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