Sunday, April 18, 2010

Safety Empathy Action

I have been thinking that a shorthand guide for what we need to do for kids in treatment would be:
Establish safety
Teach emotional intelligence and empathy
Promote effective action

Now if only I could make it spell a word!

Safety- nothing good can happen when the child does not feel safe. If a person is in danger mode, he cannot learn. She cannot trust enough to form the relationships that will be the vehicles for healing. He cannot sleep- and so life feels so much more difficult. She has trouble relaxing and having fun. He misses much of what is going on because of the necessity to constantly scan for danger. Fear manifests in aggression, self harm, running away, and retreat. Fear without any one to turn to is completely overwhelming and is more powerful than both rationality and reward.

Of course, safety is not an all-or-nothing state. The sense of danger rises and falls. Yet we must pay close attention to the signals of danger and safety in our programs and in our relationships with the children (and families) we serve. If we actively strive to create safety in every aspect of our environments and relationships, we will help the children be more available sooner. And if we look for fear under many problem behaviors, we will discover more powerful intervention options.

Emotional Intelligence and Empathy: We could describe much of what we do in treatment under this category. I have just finished Dr. Bruce Perry’s new book, Born to Love (will review soon). His entire thesis is the necessity for empathy for societies to function at all. And as loyal blog readers will know, I heard a presentation on emotional intelligence at a recent conference. Dr. Hendrie Weisinger listed five key skills in emotional intelligence. They are:

1. Self awareness- processing information about yourself
2. Mood management- how quickly can you change your moods?
3. Self motivation- how can you get yourself to do things you don’t want to do
4. Interpersonal expertise-Build consensus, handle conflict, accept feed back, etc. Effectiveness in interpersonal emotional situations
5. Emotional mentoring

Self awareness is the key skill that is the foundation for all others- how can you be emotionally aware of others unless you are aware of yourself? This of course correlates with the skills of feelings management.

Empathy is a key part of interpersonal expertise. How can we build consensus, handle conflict or even form relationships if we have little ability to see things from another’s perspective?

Can we more deliberately build teaching empathy into our programs? When we use restorative tasks in response to a behavior that hurt others, we could include tasks that encourage the child to see another’s point of view. My friend and Risking Connection® faculty trainer Dr. Bob Davis shared some ideas from Devereaux. These included having the child write a story of the incident (or draw a picture) from the other person’s point of view, exploring what that person was feeling before, during and after the event. To create meaningful making amends tasks, the child should first think about who his behavior hurt and in what way. Then he should consider what could make that person feel better. That in itself is practicing empathy.

Of course the most powerful way we teach empathy is by showing it ourselves. We do this in our attempts to understand what the child was experiencing when she did something, and our working conviction that she was doing the best she could at the time. We model empathy is what we say about other staff, people in the news, people in movies or TV shows.

What else could we do to increase empathy?

Effective Action- Our children come to us believing that it is not possible to influence one’s own life. What happens, happens- and it is usually bad. There is nothing you can do about it- especially because you yourself are bad. We must teach, promote and make space for effective action. Particularly we must teach our children how to fix problems that happen within relationships. We grow as humans through relational attunement, rupture and repair. Our kids have had little of the attunement, a lot of the rupture and almost none of the repair. So again we must model- reach out to reconnect when we know we have missed the mark with a child. We can also demonstrate how we work out differences between ourselves as staff.

With restorative making amends tasks, we teach children what a person does when something goes wrong in a relationship, when you screw up. At first, we make the suggestions and offer the ideas. Later kids will think of ideas themselves. And when they see that genuine attempts to work through problems result in real reconnection, they will feel hope. They will begin to trust that maybe they can count on other people.

And then we have to offer opportunities for effective action in all other aspects of our programs. Examples include a student council, opportunities for volunteering and helping others, student input in activity planning, opportunities to develop special talents, and choice in everything from food to activities.

So- that’s all we have to do- create safety, teach emotional intelligence and empathy, and promote effective action. Not easy- not simple- but very powerful.

What do you think of this formulation?

Monday, April 12, 2010

Musing on a Busy Week

Last week I had a busy and exciting week.
On Tuesday Steve Brown and I presented at the Massachusetts Department of Mental Health Child & Adolescent Restraint/seclusion Prevention Initiative Grand Rounds. Our topic was: Transforming Resistance to Enthusiasm-Implementing Trauma Informed Care. Around 100 people attended, from hospital, residential and school settings. It was great to share ideas with others who are in various stages of implementing trauma informed care. As is often true, people seemed particularly concerned with how to overcome staff resistance to this change. We shared strategies such as: relating this theory to their own lives, celebrating every success, and having those who do it naturally teach others. We received many compliments of our presentation.

On Wednesday I attended a retreat of our Klingberg Therapeutic Foster Care Department. This staff is implementing trauma informed care for the entire department, including providing a six week training for the foster parents and more intensive training for the staff. Another component has been an increased focus of the experiences of the workers. This staff is on call for crisis 24 hours a day. They often have to experience the sadness and disappointments the adolescents endure. However, they also celebrate successes- six adoption this year! Their mission is to promote mutually claiming relationships and prevent disruptions. The trauma framework has helped make sense of some challenging behaviors, and enabled the parents to take them less personally and thus have more patience with the youth.

On Friday Steve Brown and I presented a workshop at the Massachusetts Adolescent Sex Offender Coalition Annual Conference. We spoke on a new topic: He Just Refuses to Take Responsibility!!! -- Implications of Trauma Theory on the Issue of Taking Responsibility. The phrase "taking responsibility" is used in all our programs, and I have written about it here before. However, it is central to sexual abuse treatment programs. We argued that it is helpful to see the word as response ability, and to realize that this is a skill not a characteristic. What can we do to build this capability in clients? This includes creating trustworthy attachments, teaching feelings skills, and most importantly reducing shame. The 70 or so workshop attendees participated in lively discussions of these concepts.

The conference itself was very interesting. The keynote speaker Cordelia Anderson was eloquent on the ways our culture sexualizes children and produces demand for child abuse, and she called us all to action in the prevention area. I attended a workshop by Phil Rich, PhD on ten things we think we know that we don’t, in which he pointed out how contradictory research can actually be on what really helps kids. Another workshop I attended led by Melissa Malter, MSW detailed a CBT approach to decrease shame.

All in all, a very worthwhile day. It was fun to have people coming up to me to say they saw us at the Grand Rounds or attended our conference in Worchester- our community is growing!

A very full week- and I must say I am glad to have less events scheduled this week!