Sunday, March 02, 2014

Decreasing Scary Behaviors

Scary days at the Group Home
It is a difficult time in the group home. Sally, a new admission, has been terrorizing the place. She very skillfully causes commotion with all the other girls, making them mad at each other and at her. When they become angry, Sally is astonished and begins to escalate. In her agitation she has left the house in her nightgown and stood in the middle of a busy road, has punched a hole in the wall, hit her favorite staff Tina, cut herself and threatened suicide. The police have already been called three times and she has had one visit to the ER and she has been at the group home less than a month! The other girls are starting to deteriorate, and two of them ran away for a few hours the other night. The staff are very upset. They have begun complaining to each other that the therapist Melissa doesn't seem to know how to handle Sally. Some staff feel the director is being too indulgent with Sally. They say we should impose stricter rules and have stronger consequences for what she does. There is discussion that this is not the right level of care for Sally and the group home should return her to the hospital that she came from.

Sound familiar? What would you and your team do?

Why is Sally acting like this?
Is it because she is unclear about the Group Home expectations? Because she does not know that these kind of behaviors will get her in trouble? Because she does not care about other people? Because she is borderline, manipulative, or bipolar? Because she wants attention?

Sally is acting this way because she is terrified.

She has just moved into this home from a hospital. In many ways she feels more vulnerable. She is right in the town, no campus, no security guards, no gates. She had little control of which group home she moved to, or when, and feels that others are making all the decisions for her. In the past, when adults have made decisions it has not turned out well.

The home reminds her of other homes she has known- both in good and bad ways. She feels much more exposed. She doesn't know these people. She is expected to be more intimate with them than she ever was at the hospital. There is no place to hide. She assumes the girls will hate her and the staff will abuse her and leave her.

When Sally becomes scared, she becomes terrified. She has no one she trusts, so she cannot share her fears with any one. Her already agitated body becomes extremely tense and reactive. She cannot call on any memories of good experiences with relationships to smooth herself. Sally is so sure that she is a horrible person that she knows these new people will not like her and will hurt her. The best defense is a good offense. And Sally does not even recognize what she is feeling, she has no name for it. She does not realize that it is normal to be scared when you move into a new place. She has no ability to calm herself down or use strategies to get through this hard beginning part.

Sally has few skills. She does not know how to make friends. She does not know what to do when her body becomes agitated. She cannot catch herself when she first becomes upset, and she winds up tighter and tighter until she explodes.

When Sally feels hopeless, terrified and overwhelmed she does the best she can to escape these feelings. All the behaviors she displays immediately bring in extra resources and make the situation better. Sally has no idea of any other way to accomplish any relief.

Will consequences and rewards help Sally?
Punishments and rewards effect motivation. Sally wants to to do better. She wants to succeed here and get her own apartment, graduate from college and become a nurse. She just does not know how.

When Sally is emotionally dysregulated, the strength of punishments or rewards is minuscule compared with the mounting pressure of despair and hopelessness. They have no power to influence her behavior.

Punishments and rewards can actually make things worse, by increasing Sally's already strong sense of shame and unworthiness.

If we truly believe that Sally is doing the best she can, why would we punish her?

What will help Sally?
Sally will act better when she feels safer, more noticed and loved, more in control, and when she learns some skills. She will act better when she is happier.

So we can:
Normalize how hard it is to move to a new place
Help her test the safety and security of the Group Home, put her in charge of the locks.
Get to know her.
Do fun things together.
Help her gain control of anything in her life that she can.
Teach her feelings management skills and social skills.
Facilitate relationships with the other girls.

But you say, those are the kind of things we always do. They aren't working fast enough.

These interventions are the fastest and most effective ones there are. Sally won't change quickly. There are no shortcuts.

What can we as a team do to be able to offer the most healing treatment?
Talk to each other. Acknowledge how hard this is. Recognize small progress and special efforts. Plan fun activities together. Talk about vicarious traumatization. Make jokes. Remember other kids who came in snarling and got better. Pay attention when someone gets hurt or has a rough night. Be good to each other. Talk openly about rifts and disagreements that develop. Remind ourselves of Sally's history, and of how hard it has been when we ourselves have tried to change. Have a retreat. Don't work too many hours. Have regular supervision. Take a vacation. Dance together. Have fun with the kids.

There is no magic answer- but there is the possibility of healing
We do not have a system which will immediately result in Sally giving up the strategies that have allowed her to survive her difficult life. However, we have the immense power of love. And again and again we are privileged to create miracles of healing with the young people we serve.

1 comment:

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