Monday, August 27, 2012

It Aint't East Being RICH

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For the next four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

The first week I will start with Respect.
The dictionary defines respect as: esteem for or a sense of the worth or excellence of a person, a personal quality or ability and as: deference to a right, privilege, privileged position, or someone or something considered to have certain rights or privileges; proper acceptance or courtesy; acknowledgment. The RC manual states that it is demonstrated through forms of address, respect for confidentiality, punctuality, language used, assuming the client has a valid point of view, and validation of the client’s experience. The therapist believes and believes in the client.

These definitions do not really capture the essence of respect for me. To me it almost carries some aspect of admire. So, if we truly respect our clients we actually, deeply honor the way that they have survived all the pain life has handed them. We look up to them, are in awe of them, for having come through alive and kicking. We actually let ourselves feel how profound the pain was, how deep the losses, how scary the world. And we respect what these kids had to do to survive.
Of course anyone who is caring for someone with problem behaviors (be it one of our kids or your aging mother) knows that it is easier to maintain these lofty attitudes when you are away from the person and their demands. When some kid is yelling at you, or trying to hit you, or refusing to comply with the simplest request, it is hard to see their behavior as an admirable attempt to survive. That is why we all need down time, a time to step back and think about the work, often with the help of a supervisor. We can then let ourselves remember the painful truths of our clients’ histories and respect the creativity of their adaptive behaviors.

Here’s another aspect of the word Respect. Martha, a therapist in our special ed school, tells me that when she asked Tyquan what led up to his throwing several chairs and then leaving the classroom, Tyquan told her that his teacher, Miss Mitchell, was disrespecting him. Miss Mitchell reports that she just asked Tyquan to end his conversation with his friend Marvin and take out his math book. And she probably did so pleasantly. Martha tells me that feeling disrespected is a common complaint of the youth. Now of course our staff may at times speak in a sarcastic or belittling way to the kids. But let’s assume this time Miss Mitchell spoke conversationally. What went wrong here?
Maybe Marvin is the best friend Tyquan has had in years, and having a friend is finally making him feel a little safer. Maybe he is just tired of adults telling him what to do and putting their needs before his. What do you think?

School work is often associated with humiliation for our kids. Tyquan can’t do math. It makes no sense to him. Maybe the fact that when most kids were learning math he was trying to protect his mom, his sister and himself from his step father’s angry rages has something to do with it. It could be that his brain hasn’t developed the ability to think sequentially or use logical problem solving, because no one has ever modeled such a process for him. But anyway, he knows he is in for another period of feeling stupid and hopeless, and that maybe the other kids will see how dumb he is. Marvin’s pretty smart in math- he will probably give up on Tyquan as a friend when he sees how lame Tyquan is.
So, when Miss Mitchell says in her happy voice: “Tyquan, time to end your conversation with Marvin and take out your math book.” Maybe Tyquan hears: “Tyquan, time to stop doing something pleasant that you enjoy and to do something you can’t do, although everyone else can, and to show the world how stupid you are.” This feels deliberate to Tyquan. She is trying to humiliate him. So naturally he feels disrespected.

Does that make sense to you? If anything like that is going on, what does Tyquan need? How can he feel respected in this situation? (I have some ideas, but what are yours?)
One thing we do know is that the more fragile a person’s sense of self is, the more frantically they protect their image from external threat. If you feel fine and happy about yourself, and someone teases you, it’s relatively easy to let it go. If you are already feeling pretty lousy and fairly sure you are doing everything wrong, the teasing arouses such panicky feelings in you that you attack with all the ammunition you can find. And others say you are “over-reacting”.

Which brings me to the final concept of Respect that I would like to explore- and that is its use by staff. Teacher Mr. Hoover says: “I told Luis to stop talking and he went right on talking. He does not respect me!” Crisis worker says: “If I am not very strict with the kids they will lose all respect for me.” Therapist Ron says: “I just will not tolerate the kids swearing at me. It is a sign of disrespect.” Merva, a foster mother, tells her case worker: “We told Natalie to go to bed and she keeps coming out of her room. We can’t read her stories or any of that nonsense. That’s just catering to her. She just has to respect us and do what we say.” Laura, a Child Care Worker says, “I told him he had to go through the front door. He insisted he had to go through the back door. I know it’s trivial, but I will not back down. They need to respect what I tell them to do.”
The first thing that comes across in all this is that the staff seems to feel it is all about them. They want the kind of respect that is evidenced by obediance. Often times a person's position will get them this kind of respect (such as in the military or many offices). But that creates no lasting change. As soon as that person isn't looking, the subordinate does whatever they want, Much more important is to have influence; to be respected for person characteristics and for how you have treated the other.

What the kids are doing is not primarily about the staff. Of course, how a given kid feels about a certain staff does affect their actions. Nothing like relationships to influence behavior. But a lot of times other factors intervene.

Like the youth is dysregulated and no longer even sees the staff for who he is. Or he is caught up in old feelings of mistrust. Or she is testing the staff- will you stay with me even when I show you how bad I am? Or he is desperate for some control in an entirely out-of-control life.

How can we help our staff feel calm and good about themselves so that they do not need the kids to act a certain way in order that they may feel respected?
Wow, a lot for one word- Respect. And we have three more to go. PLEASE share your ideas by clicking “comment.”




Saturday, August 18, 2012


Sonia and Ralph were talking on their break.

“These kids.” Sonya says. “They are just not grateful. Here we have done all these extra things for them this summer. And they do not seem to appreciate it at all!”
“I know,” replies Ralph. “Very few of them even say thank you. We have taken them to the beach, to Six Flags, to go-carts and mini-golf. And they are just as obnoxious as ever when we get back!”
“Just yesterday” Sonia chimes in, “I took the girls out for ice cream. I didn’t have to do that. We stayed for quite a while- it was so hot out. And then when we got back, I asked them to go to their rooms and chill out for a while. Several girls had the nerve to talk back to me, and Lisa and Tanika started to get into a fight with each other!”
“You’d think after all we do for them they could at least respond to a simple request. It makes me not want to do any extra activities at all.”
“Yeah. Maybe if they see what it is like to stay on campus all the time they will be a little more grateful for what they do get.”
Ahh yes. Grateful.
How our assumptions do leak through in the most casual of conversations.
What does grateful actually mean? Dictionaries define it as: Warmly or deeply appreciative of kindness or benefits received; thankful. Gratitude is a positive emotional reaction in response to the receipt of a gift or benefit from someone.
Gratitude, thankfulness, gratefulness, and appreciation are feelings, emotions or attitudes in acknowledgment of a benefit that one has received.
And how is one to know whether the other person is experiencing these emotions? Of course one indicator is what the person says. Do they say thank you, do they express how wonderful the experience was, acknowledge the effort of the other person, describe how good it felt to them, etc. And it would be reasonable to expect that the person who was feeling especially grateful or thankful would treat the giver well, want to reciprocate in kindness, and would demonstrate a pleasant attitude. And maybe we could expect…well, hope…that the person would stop some of their most obnoxious behaviors after they have had this fun experience.
Where has this process gone wrong between these staff and these clients?
There are many possibilities. We start with some basic understandings:
Our children’s experiences with relationships have left them with a deep ambivalence about getting close to someone. If a staff member is taking me on a trip, will she meet my needs, stop for a bathroom break, keep me from getting lost? What can I expect at this place where I have never been in the care of these people I don’t really know? A wonderful time together can be scary- can I really trust this person? If I open up to her, will she hurt me?
The brains and biology of our children have been altered by early abuse, neglect and attachment disruption. Sensory data may be difficult to integrate. What seems fun to others may seem overwhelming, confusing and scary. Who knows who could be at this place? Needing to constantly scan for danger can be exhausting.

When the staff take the children on enjoyable activities, they are literally rebuilding their brains. The children have deep seated expectations that interactions with other people will hurt; this is being changed when they experience pleasure associated with other people. New connections are being built between parts of their brains when they successfully master an amusement ride or survive a go cart. Yet, the changes do not happen fast. One pleasant afternoon does not create a pleasant child. Or even ten pleasant afternoons. Many, many repetitions are needed to build a new brain.

Our youth do not know how to modulate and manage their feelings. If they start to feel lost, confused or overwhelmed- or even hot and cranky- they can rapidly spiral into a sensation of complete hopelessness.
When a person does not feel worthy of life, feels like a bad person, she may not feel she deserves pleasurable activities. She may need to sabotage good feelings. She may need to push away any one she has had fun with.
If someone has not developed an inner connection to others, any separation can seem like forever. We just had all this fun together and now you are leaving?!? Who knows if I will ever see you again? I knew I should never have relaxed and enjoyed myself (back to the beginning).
And then there is another, more worrisome over tone in this expectation of gratitude. I will illustrate with an example:
Kayla was 8. She was absolutely adorable with big blue eyes. After early abuse and neglect, she had been recently taken in by Mr. and Mrs. Whitmore. About five months after she was placed, the couple went on a cruise to Alaska, asking DCF to find two weeks respite for Kayla. She stayed with a nice family she had never met before. The parents returned and brought her back a stuffed seal, which she promptly threw away. Mrs. Whitmore complained to her social worker that Kayla did not seem grateful that they had brought her this nice present; in fact she did not seem grateful that they had taken her in. She didn’t seem to understand what a terrible life she would be having if they had not done so!
This is expecting children to be grateful that they are now getting some small part of what they should have had all along; what every child deserves; love and safety. This is seeing the children as less than, as poor unfortunates who should be glad for any scrap. How about the idea that they should be angry about the unfairness of their lives, and protest loudly that they have been wounded through no fault of their own?
Some of this tone can sneak into all our thinking on the hottest days.
As Sonya and Ralph read the above, I can hear them saying: “Oh for heaven’s sake. We know all that. But can’t the kids just say thank you? Can’t they just express some appreciation of the effort we have made, or some happiness in the experiences we have shared?”
Yes. And they will. They will share this with you with they come back and visit in three years, or ten years, or bring their daughter to “see the place that Mommy became a person.” At that time you will be amazed how they remember every detail and say things like: “it was the first time any one celebrated my birthday” or “I was so scared on that roller coaster and I remember that you held my hand.”
And that will give you the stamina to take this present surly group out for one more ice cream cone.

Sunday, August 12, 2012

Reactions to My Book

Please pardon the shameless self promotion, but I would love for people to read my new book Trauma Informed Care: The Restorative Approach ( and let me know your thoughts.So to inspire you to do so I am sharing some reactions from people I admires and respect:

From Laurie Anne Pearlman, Ph.D. Co-author, Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse:

“Trauma-Informed Care: The Restorative Approach is a solid contribution to clinical work with children and youth in congregate care and their families. Patricia Wilcox offers a smart relational approach grounded in trauma theory and brain-behavior research. She presents the theoretical basis for the restorative approach, describes the approach clearly and succinctly, and illustrates its application lavishly with clinical examples. Her style is conversational and collaborative. Wilcox’s vast experience with this population shines through in both the examples and the comfortable way she raises and addresses potential objections to using the restorative approach. It is a must-read for trainees and workers new to this field and a wonderful resource for administrators, families, policy makers, and staff at all levels of experience. Anyone who works with this population or who is treating or raising kids can benefit from reading this fine volume.”
From Karen W. Saakvitne, PhD
Author Trauma and the Therapist, Transforming the Pain, and Risking Connection
President, TREATI 

“Pat Wilcox conveys the accumulated wisdom of her years working with children too often overlooked by others in this remarkable and inspiring book. The Restorative Approach has the potential to radically change child mental health treatment (and parenting) for children with challenging behaviors and histories of trauma. Integrating current research on trauma and treatment with practicality, compassion, and ethics, Wilcox presents a compelling case for the Restorative Approach as a best practice in trauma-informed child treatment. The book is exceptional in its many detailed clinical examples of effective interventions making it immediately accessible and useful to all staff. Wilcox’s full exploration of all objections to the Restorative Approach convinces the reader of her complete understanding of the real conditions under which most child mental health settings function. Ultimately this book is inspirational; it offers hope for children, their families, and mental health professionals working with them. It should be required reading for all staff working with children in mental health systems.”
And from: Roger D. Fallot, Ph.D.
Director of Research and Evaluation
Community Connections

“Pat Wilcox has written a book full of compassion and common sense.  She integrates the restorative approach with a trauma-informed one, enriching both in the process.  Her vast experience with children, youth, and their families is fully apparent here, as is her creative way of thinking about and working with them.  Pat tells important stories about young people and their traumas, about their responses to being traumatized, and about how a particular kind of setting with a particular set of staff behaviors might be most helpful.  Her bulleted lists of ideas are priceless and the volume’s valuable appendices are an additional highlight.  Pat’s deep caring for children and youth, their families, and the staff who serve them is evident throughout this important, new work.”

With testimonials like that, how can you resist it?

Sunday, August 05, 2012

Training for Therapists

 I am thinking of developing a training series for therapists who are working in trauma-informed congregate care programs. This would not be a training to learn about trauma, how it affects people and how they can heal. Risking Connectionâ and other curriculum do that. This is to teach therapists to be the most effective treaters and leaders within a team program that believes that every staff member is actively involved in the treatment process. How can the therapist be the best leader, and be the flag bearer for clinical thinking? Often such programs hire therapists right out of graduate school or with limited experience. And if the therapist has worked mainly in outpatient settings he or she will discover that the congregate care setting is quite a different role. There are many tensions, traps and dilemmas. What do you think a good therapist in congregate care needs to know? What have you wished that people hired into your program had been taught? Click on “comment” and tell me your ideas.

Here are my ideas so far. I envision this to be a four to six week program, 2 hours or so a week.

An Awesome Therapist in a Trauma-Informed Congregate Care Setting

The Role of the Therapist
Take away a screaming child and bring her back calm
Integration- Does not mean running to every restraint or crisis
Characteristics of a good therapist
Role with Family
Role with team
Where is the line of confidentiality?
Interactions with outside system
Need for support and use of supervision

Formulation, Treatment Planning and Treatment Themes
Skill of Formulation
Formulation guides treatment planning
Formulation- current case or examples

Using the Trauma Framework and Brain Science to Know What to Do
Using brain science to decide what stage child is in and vary interventions
Evaluate self capacities
Skill development
Use crisis prevention plans
Constantly re-evaluate

Doing Therapy- Ignoring the Push to Change
How trying to change the client prevents change
Do not talk to child about how his life would be better if he stopped doing these bad things
Explore, explore, explore
Using creativity
Walk, move
Involving team members

When Things Go Wrong
Behavior Problems
Lack of progress
Team De-moralized
Cultivating Stamina

Strengthening inner connection
Boundary questions

Vicarious Trauma
Staying alive and hopeful in the work
Understanding and recognition
Individual protection
Agency protection
Vicarious transformation

I also hope that such a course for the therapists in an agency would strengthen bonds between them and increase their ability to support each other.

So, what do you think? Would this be helpful in your agency? Anything else you think I should add? I would certainly appreciate your ideas, just click “comment” below.