Monday, May 30, 2011

VT, Culture and Complaining

I have just returned from completing a Risking Connection® Train-the-Trainer training in Hawaii. I taught some great people who are going to be very good trainers and leaders in their agency.

We were discussing imbedding discussions of VT within their agency. First we had a very interesting discussion of the role of culture in staff willingness and comfort with discussing VT. Cultural rules such as not sharing one’s feelings, trying not to stand out or be noticed at all, and never complaining are hard to overcome when trying to discuss the effects of the work on the person. As one person said: “Why should I squeak? I don’t see anyone else around here squeaking and they are all working as hard as I am. Better to just keep on going.” A therapist stated: “If the staff see the therapist being affected by the work, what are they going to do? As the therapist I am expected to be able to handle my emotions.” I believe that many of us have one form or another of these beliefs, and our agencies take advantage of this. We just keep doing wore and more, and not complaining, taking pride in how much we can do. When we urged the supervisors to model talking about their feelings, they were afraid this would be scary to their staff, who rely on their strength. How can we encourage sharing the way the work effects us without feeling we are showing weakness, scaring our staff and betraying our culture?

When I asked what the current practice was about sharing feelings about the work, these supervisors described that staff constantly talked about their feelings, both on the job and afterwards. And their feelings were anger at a certain kid, hopelessness about another, complaints about management, discouragement about the system, and general pessimism. So this provoked a lively discussion about what the difference is between sharing VT and what I will euphemistically call a complaint session. We have all had the experience of negative complaint session that spirals downward and leaves everyone feeling worse. What is the difference between that and a productive sharing of the effect of the work on us? We came up with the following ideas for what would make such a discussion healthy:

1. A willingness to look at ones’ self and the role of one’s own history in the emotions.

2. A spirit of compassion towards the clients and an understanding that their symptoms are adaptive, and that our feelings are not their fault.

3. An acknowledgement that VT is an inevitable part of our work, as we share the pain our clients’ experience

4. Looking towards positive action: how can we take better care of ourselves and each other? What can we do to make our workplace more sustaining?

5. Understand that the pain of our work is also the source of our growth and change as people

6. A consideration of possibilities for transforming the pain.

There are times when one just needs to complain. But the addition of these elements could help to turn the conversation into a healing experience.

Still, I think there may be more to this. Any ideas? Click “comment” and let me know.

Sunday, May 15, 2011

What We Say Matters

I was recently participating in a training at which we were discussing the function of cutting. One participant said:

“We had a girl named Megan who was cutting to be manipulative. She was doing it to get discharged and go to a place like detention where she wouldn’t have to work on her issues.”

What are the assumptions behind this statement? How does it differ from this statement?

“Megan has been working on some difficult issues recently. This has brought up some painful feelings and she has begun cutting for relief. Sometimes she doesn’t even want to work on her issues and wishes she were in a place like detention where she wouldn’t be in treatment.”

Same facts, different assumptions, leading us to different responses.

Another place I visited I noticed how often staff made statements about how bad the children were. Examples are:

“You’d better watch out putting that in your pocket. These kids will steal it from you in a minute.”

“These kids don’t care what we say as long as they get what they want.”

“You always have to watch your back around these kids.”

The staff tended to bond with each other around how awful the kids were.

Or, consider a staff member talking about a child who says mean things: "There is nothing you can do about Jesse. We have tried everything. Jesse just likes making other people feels bad. He admits it. It makes him happy to hurt others.”

Someone describing the cutting of a foster daughter: "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 she needs.

We make these casual comments constantly in our many discussions about the kids. Yet by each comment we are expressing a theory, an understanding of why they are doing these things. And at times it is a theory that blames the child and implicitly accuses him or her of doing the behavior deliberately to annoy us.

When we make these comments we forget that the child 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 committed relationships, and when she gradually learns new skills.

Try monitoring the conversation where you work, and see what assumptions are expressed in the casual comments about the children. Click on “comment” to let me know what you discover.

it is important to stop and challenge ourselves. One comment can lead to an entire attitude that will infect our response to the child and interfere with the child’s healing.

Sunday, May 08, 2011

Rethinking Restorative Tasks

At a recent presentation I did for the MAAPS conference, a question from a participant and a response from my friend Bob Davis crystallized some thoughts I have been exploring about learning restorative tasks. The participant asked: “We have a girl who is constantly saying mean things about others. As a restorative task we had her do research on peace movements and on Martin Luther King. She does this well- but it doesn’t affect the behavior. She keeps doing it.”

Let’s begin with the assumption that we are trying to create a response to a behavior that will decrease the likelihood of the behavior recurring. We must start by forming a theory about why the girl, let’s call her Kathleen, is saying mean things about others. What feelings is she having at those times? What need is she responding to? How is this behavior adaptive for her?

Most likely Kathleen is feeling small and vulnerable, lonely and unloved. She has no sense of inner connection to others. She does not have any friends, is sure none of the other kids like her and that she will never have any friends. At other times in Kathleen’s life when she has felt small and vulnerable, people have hurt her. Saying mean things and getting a reaction gives Kathleen a feeling of power, of strength and control. She does not know any other way to get that feeling.

Do we think that Kathleen is mean because she does not intellectually understand that meanness hurts other people? She has received a lot of meanness in her life, and knows exactly how it feels. Do we think she does not want friends and is just not motivated to be nice to others? We know how desperately she wants friends; it is not motivation that is the problem.

Therefore Kathleen will be most likely to decrease her mean behavior when she feels better. If she feels safe, loved, strong, connected, accepted, noticed, and appreciated she will have no reason to be mean. When she learns how to make and keep friends, is absorbed in her own interesting and successful activities, and trusts adults to care for her she will be more generous and kind. Our overall treatment plan and our response to each individual event should be planned to achieve these conditions.

Another way to look at this is to consider what happened right before Kathleen was mean. The most recent time was when two other clients were playing a game together and laughing. The time before that was when she was in math, could not solve a problem, and noticed that Maria was already done with the assignment. In both cases Kathleen felt inadequate and stupid, and spiraled quickly into despair and hopelessness.

What would we like Kathleen to do when she sees two girls playing and wishes she were part of it? What would we like her to do if she feels stupid because she cannot do her math? What would you do in either of these situations?

In the first case we would like her to approach the girls gently and ask if she could play too, or find another girl and engage her in some kind of activity. This is hard to do, requiring both social skills and courage. Another option would be to approach an adult and ask for help finding an activity. This requires trust in the adult. Or, she could absorb herself in a solitary pursuit like drawing, which requires that she has some solitary activities that she know she likes.

In math, we wish that Kathleen would ask her teacher or another student for help when she can’t do a problem. This requires having enough confidence to expose a weakness, and a trust that the other will not ridicule you and will pleasantly help.

This analysis leads us to a lot of ideas of areas in which we can help Kathleen grow. To recap, she needs:

• Social skills
• Courage.
• Trust in adults
• Discovering some solitary activities that she likes
• Confidence to expose a weakness
• Trust that the other will not ridicule her and will pleasantly help.

So what can we do?

• Use a curriculum like DBT to teach Kathleen the skill of joining in or proposing a play activity
• Be trustworthy our selves, do what we say we are going to do, and create opportunities to strengthen our relationship with Kathleen
• Teach Kathleen activities she can enjoy; build on any strengths and interests she has; celebrate her work
• Help Kathleen feel confidence in herself through activities in which she teaches others, leads groups, gives to social causes, and excels
• Treat Kathleen with gentleness and compassion. Make sure she experiences many instances of friendly, non-shaming help.

What if our response to Kathleen being mean to others was to build up her skills in one of these ways? We can look at the event that triggered her meanness and give her practice in another way of handling it; we can have her teach a game to some of the younger kids; we can have her work with a staff member to use her strength to make something for others; for example if she likes to cook she and a favorite staff could make a delicious dinner for the other kids.

Which brings me to my friends Bob’s comment that Kathleen could be an expert in the Civil Rights movement, and if she still felt small and scared inside, she still will need to make others feel bad.

I really, deeply, honestly feel that when kids feel better they will act better. Yet I wonder if we could actually act from that philosophy. It is so deeply engrained in us that the kids will change if we make them feel BAD after they do something that hurts others. If we acted from this belief we would have to see their harmful actions as an expression of how horrible they feel inside, and choose responses that make them happier. And I can just hear the responses now: you are going to reward her hitting me! How are they going to learn if they don’t pay? How will they take responsibility for their actions?

What do you think? Do you agree with my assumptions about the causes of Kathleen’s meanness? Could our programs move in this direction? How can we facilitate this transformation? Please click on comment and share your thoughts.

Wednesday, May 04, 2011

One Hundred Names for Love

I would like to call your attention to a book I am reading. It is One Hundred Names for Love: A Stroke, a Marriage, and the Language of Healing by Diane Ackerman, (W. W. Norton & Company 2011). The author Diane Ackerman and her husband Paul West are both authors, and their marriage included much loving word play and exploration of literary connections. Sadly, Paul West, a retired English professor and the author of 50-plus books, survivor of diabetes and a pacemaker, was struck by a massive stroke that left "a small wasteland" in his brain, especially in the key language areas. At first he could not talk at all. The book chronicles the story of his recovery through their love, creative and imaginative word play, and the help of others. Ms. Ackerman, who had already written books about the brain, researched his disease and tailored a program for him that utilized his unique strengths and interests. The book is very moving and demonstrates the power of love to heal. Ms. Ackerman also shares honestly the stresses of being a caretaker and trying to keep some hold on her own work and identity.

How is this book relevant to our work? It deeply increases the reader’s understanding of and faith in brain plasticity. It demonstrates without a doubt the way that when one part of a brain is damaged, the rest of the brain can develop alternative routes to achieve the same functions. Ms. Ackerman also teaches us many specifics about how the brain works, particularly in the area of language.

Furthermore, I think that what this couple learned about how to facilitate healing applies directly to our work. The first speech therapists that worked with Mr. West used straightforward exercises using child like words and simple sentences. The process felt demeaning to Mr. West and he was increasingly frustrated and depressed. His wife noticed that larger and more obscure words were in fact easier for him to recollect. She began to build on his strengths and interests to develop playful, silly games for him. She walked a fine balance between helping him and still letting him struggle on his own. She supported his growing independence and abilities even when it meant he was in situations which were not completely safe. She sometimes felt worn out and discouraged; she sometime felt exultant because of a small gain. I think our work also goes best when we are creative, playful and engaging our clients’ strengths.

This book is an interesting and absorbing read that both teaches and inspires. I recommend it.