Sunday, November 29, 2009

How to Help Malina

I was doing a recent training when Martha, a therapist asked me: "Pat, I know you say not to blame the kids for their behaviors. However I am a firm believer in the kids needing to take responsibility for what they do. So what do you do when a kid just will not take responsibility for what she did and keeps blaming others?"

When I asked her for further clarification, the situation got worse, in my mind. Martha told me that a fifteen year old girl named Malina was on a plan that she had to earn her weekend pass with her mother by maintaining good behavior in school. Last week, Malina had a major outburst in school, tipping over tables and completely disrupting the classroom. So, she lost her pass. When Martha attempted to talk with her about this incident, Malina would not admit that it was her own behavior that caused the pass to be withdrawn. She blamed her therapist, her teachers, everyone else.

What’s wrong with this (very common) picture?

1. I don’t think I said that "we should not blame the kids for their behaviors." I actually do not think that blame is a useful concept here. I think we should help the kids understand their behaviors, and teach them the skills they need to act in new, more helpful ways.

2. I do not believe that children should have to earn their home passes. If the home situation and the child are safe, they should go. The ties between the child and her family are essential for both recovery and the child’s future. We should do everything possible to enhance them, and nothing to interfere. If the child is actually unsafe (such as suicidal) the family should be welcome at the agency and, when possible, transportation provided for them. Home passes should not be part of a reward system.

3. Okay, so Malina was on this plan, and she blew it. What are we asking of her when we ask her to "take responsibility for her behavior"? We are asking her to admit that she did the one thing she did not want to do, and in the process disappointed herself and her family once again. We are in her mind asking her to admit she is a no good, worthless person who will never change. How can she possibly be able to do this?

4. Why do we even think that "taking responsibility" is such a good idea? I guess it is because we feel a person needs to admit something before they can change it and as long as they are blaming others they will not try to change themselves. There is of course some truth to this. Yet, there are many gentle, face saving ways to discuss an incident and the factors that contributed to it.
Most importantly- what will help Malina to stop turning tables over when she gets upset? Not mere increases in motivation. The "earn your home pass" plan is designed to make Malina want to behave better. And I’m sure it did, I’m sure she wanted to earn the pass. But the problem is, she does not know how. She is not able to be different yet.

5. So what can we do? We can look carefully at the incident in school, with Malina in any way she can participate. Not in a blaming way- let’s discuss this and get you to admit you were wrong. Instead, to understand what happened. What upset Malina? Where did the incident start? What did she first feel? What were the warning signs that she was getting upset? What alternatives did she have then? What help could we have given her at that point? This discussion is a search for better understanding, looking for patterns. It is a path to interventions both we and Malina can do to avert a meltdown next time. Was Malina frustrated by work she didn’t understand? Did another girl make fun of her? Was she agitated because she hadn’t heard from her mother in several days? No- these are not excuses for her behavior. They help us understand the skills she needs to handle such events in the future without making things worse. What can we do to make it easier for Malina to ask the teacher when she needs help? What skills and sense of self worth does Malina need to withstand peer teasing, and how can we help her build them? How can we teach Malina techniques (such as the ones we know and use daily) to get through anxious situations? These are things she has never learned in her disrupted upbringing, and we are here to teach them to her.

This thinking will actually bring us forward in our treatment. Making her earn her home pass undermines the only fragile support she has and increases her anxiety. Forcing Malina to admit that what she did was wrong will leave her feeling more shamed, more stupid, and in fact more likely to do the same thing again. Working with her to determine why she acted this way, and to teach her other alternatives, will (after many repetitions) create real and lasting change.

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