Are Restorative Tasks Punishments in Disguise?

When programs first begin to use the Restorative Approach™, staff often think of restorative tasks as punishments by another name. This leads them to attempt to create tasks that take as long as their traditional punishments did. Staff are still thinking that the power of the tasks lies in their deterrent value; in other words, that the kid will stop doing the behavior because the tasks will be so hard and they will not want to have to do them. In other words, that the tasks are punishment. This leads to the piling up of tasks, and continuing hopelessness on the part of both the child and the staff.

Instead, let’s go back to our theory of what is wrong, and what do we actually think will promote change.

Why are the children hitting people and throwing chairs and running away and cutting themselves? Is it because they lack motivation to change- that the previous punishments they have received for doing so have been inadequate?

No, it is because they are doing the best they can to solve current intolerable problems.

They do not have safe, strong trustworthy attachments in which they can relax and learn new skills, and they never have. They do not know how to resolve problems that arise within relationships. Trauma has changed their biology, sensitized their nervous systems, and left them hyper-reactive. They have not been taught the basic human feelings skills: how to hold onto the belief that someone loves you; believing that you are worth the air you breathe; and what we do when we experience strong emotions.

Because of this, they over-react to current setbacks, do not believe that anyone can or will help them, and have no way to manage their emotions. So they act out.

Will punishment help all this? No. The children have already been punished. If that would solve these problems they would be over them by now.

The Restorative Approach™ is designed to provide what will help:
Attachment- safe, regulated relationships in which people speak from their heart and are honest about the relationship effects of behaviors, and are Respectful, Informative, Connected and Hopeful.
Containment of hyper-reactivity: an environment structured for success with available regulated adults helping children become regulated.
Teaching of feelings management skills: Opportunities to develop relationships. Active effort towards creating inner representations of those relationships. Many different methods to experience competence, help others, examine shame, surface what is shameful, and to see delight in another’s eyes when they look at you. And feelings management: active teaching of noticing, naming, soothing, distracting, and utilizing feelings.
Teaching of relationship repair skills: when something goes wrong between me and another, there is something I can do about it.

The power of change happens in these areas. The restorative tasks should be designed to take a small step in one of these tasks- it could be in any area. Often, the learning piece is in the area of feelings management: what was I feeling? What happened? Or, it could be feeling worthy of life: make a list of my skills and good points.
The amends piece works in the area of attachment, relationship skills, and also contributes to self worth.

So the idea is not to make up a task for every thing the child does wrong. The idea is to figure out what we think is going on in a given event, what skills is the child lacking, and assign a task that will help develop these skills. It does not have to be aversive. It has to be our best guess at something that will work- help the child learn a little something new, and be a little more connected with the people around him.

It is not fear of punishment that will change the child. It is developing the relationships and skills that will allow her to weather current set backs without having to resort to such desperate behavior.

Excuses

"I guess I can understand how his trauma history can be an excuse for his behavior yesterday" Sarah, a child care worker, said to me in training. "But today, he was feeling fine and I don’t see how his past is an excuse today."

The fact is that a child’s trauma history is never an excuse. It is always a reason. The child’s daily life, emotions, and thoughts are always affected by their past. The child’s biologically different, hyper-responsive nervous system does not change from day to day. His distrust of others is always present. His fear of being weak or vulnerable remains a part of his choices. His lack of emotion management skills, his sense that he is not worth while, that he is to blame for everything bad that happens, his inability to maintain a connection with others, stay present in every day life.

However, this does not mean that the child cannot change. He can begin to feel safe and to relax. He can slowly learn to trust a few people. Through experiences of success and approval from others, he can discover positive parts of himself. He can learn feeling management skills.

If a child had diabetes, we would not refer to his diabetes as an "excuse" for his reaction to sugary foods. We would not speak of his diabetes as an "excuse" to avoid eating certain foods. We would hope that the child would gradually increase in his competence in managing his diabetes, and would use the skills and technology available from others, and would lead a largely normal life. And, the diabetes would be always present as a reason for some actions and choices.

Even if a child had a broken leg, we would not call his broken leg an "excuse" to avoid a hike. If we were taking the child some where, we would make adaptations to promote the child’s success on the trip. We might bring a wheel chair for long distances. We would plan frequent stops to rest. We would teach him how to use crutches and bring them along with us. We would not be blaming the child for needing these adaptations.

At the same time, we would expect the child to get better. We might enroll him in physical therapy and encourage him to work hard at the exercises. We would gradually do less and less for him as he healed. His whole leg cast would be reduces to a smaller cast and then to a bandage. There would be a constant balance between understanding his pain and incapacity, and supporting his efforts to heal.

How we speak about kids can strongly influence how we feel about them and thus how we act towards them. When we speak of their trauma histories as an excuse, we imply that kids should have no responsibility and that what will help them is to simultaneously blame them for their incapacity and to have low expectations. This is, in fact, the opposite of what will help. If instead we understand the child’s trauma history as a reason, a fact, a condition they have been given, we will both not blame them, and we will have hope for their potential to heal and to achieve greatness.

Thinking Blogger Award

I was tagged for a Thinking Blogger Award!

Congratulations, you won a Thinking Blogger Award! The participation rules are simple:
If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
Link to this post so that people can easily find the exact origin of the meme,That was that! Please, remember to tag blogs with real merits, i.e. relative content, and above all - blogs that really get you thinking!

This all started at:
http://www.thethinkingblog.com/2007/02/thinking-blogger-awards_11.html

The blog that tagged me is:

http://theyreourchildren.blogspot.com/
And I was very interested to discover this blog and add it to my reading list.

This is the link to the entry in which I was tagged:
http://theyreourchildren.blogspot.com/2007/09/thinking-blogger-award.htm

I was also fascinated by another blog that was tagged, Sunshine Girl On A Rainy Day. She's a former foster child who now writes about foster care issues and how kids in foster care could be better served. Very interesting!

So now I have to tag 5 blogs that make me think. I have not been able to find many blogs in the therapy world, so if any one knows good ones please post in comments. I read a lot of blogs about promoting change, and non profit management.

One of them is: Change This
http://blog.changethis.com/changethis_newsletter/
"ChangeThis is creating a new kind of media. A form of media that uses existing tools (like PDFs, blogs and the web) to challenge the way ideas are created and spread. We're on a mission to spread important ideas and change minds." Since I am working on changing how treatment is provided to children, this blog often gives me good ideas.

World of Psychology
Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999.
http://www.psychcentral.com/blog/
This blog is part of Psych Central, "the Internet's largest and oldest mental health social network created and run by mental health professionals to guarantee reliable, trusted information and support communities to you, for over 12 years." It contains updates of the latest news and information in the mental health field, which can be very helpful.

The Trouble With Spikol
http://trouble.philadelphiaweekly.com/
is a blog by Liz Spikol, "managing editor of Philadelphia Weekly. She writes the award-winning column which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop. This blog is about mental illness- policy, news, personal journeys and more." I like the combination of personal experience and news updates.

Net Squared
http://www.netsquared.org/blog
New Squared is a central site for the non-profit community which introduces us to Web 2.0. They state that: "Our mission is to spur responsible adoption of social web tools by social benefit organizations. There's a whole new generation of online tools available - tools that make it easier than ever before to collaborate, share information and mobilize support. These tools include blogs, wikis, RSS feeds, podcasting, and more. Some people describe them as "Web 2.0"; we call them the social web, because their power comes from the relationships they enable." I have gained much useful information here.

Nonprofit Communications
http://www.writing911.com/blog/

Descibes its content as: "Tips and ideas on nonprofit communications, publications, marketing and PR. As a nonprofit consultant, I love helping organizations communicate more effectively with their members, donors, volunteers and other supporters, so they can make the world a better place." I like the fact that each entry is a "carnival"; a compilation of many articles on a certain subject. It is a wealth of information.

Then here is a bonus blog. I love Mind Mapping and use Mind Manager for all my planning, writing and thinking. Therefore I also love the official Mind Jet blog:
http://blog.mindjet.com/

"This is the blog of the Mindjet Corporation, the makers of MindManager® software. Mindjet Corporation is the leading provider of productivity software for visualizing and managing information, allowing individuals and teams to more effectively think, plan, and collaborate. The Mindjet® MindManager® enables users to visually connect and synthesize ideas and information to improve decision making, shorten business planning processes, and harness the intellectual capital in their organizations."
I get many ideas as to how people are using Mind Manager in new and creative ways.

I hope this post leads you to some interesting reading. Please add your own favorite blogs in our field in the comments. Thanks!

The Children are Running the Program

"Help us Pat!" the call comes in.
"We need you. Ever since we moved away from points and levels, the children don’t care what they do. They are getting worse and worse, rude, defiant, acting out. Since they don’t lose points they have no deterrents to bad behavior. A two-minute apology letter means nothing to them. We need to put back some more consequences."

What are the assumptions behind this plea for help? That the main reason that the kids ever acted politely was because they would lose points if they didn’t. And that the only response we have to address problem behavior is consequences.

Do we really believe this? I don’t.

What about the relationships?I think what happens is that when the behavior management system of a program is changed, if we are not careful a staff paralysis sets in. If I cannot take away points or drop levels, what can I do? So I do nothing, and sit by helplessly, another sort of neglect.

In fact, points, levels and consequences are a small part of our arsenal of tools to impact the kids’ behaviors.

Here are some other tools:
· Talk about it. Say you don’t like it. Describe how the behavior affects you and the other community members. Express hopes that change will happen.
· Work hard and constantly to form caring relationships with the kids so they care what you think.
· Validate the feelings behind the behavior.
· Express an understanding that this is the best the kid knows at the time- and the hope and confidence they will learn better.
· Develop in the child the basic feelings management skills of maintaining an inner connection to others, feeling worthy of life, and feelings management.
· Teach specific feelings management skills to do things differently.
· Use feelings management skills your self and label out loud that you are doing so.
· Have group meetings about what kind of place we want here.
· Have group meetings about bad things that happened and how everyone felt and how we can support each other to do better.
· As a team, discuss how we understand this behavior. What is our formulation about what is going on here? What problem is this behavior solving for this child? How can we teach her to solve that problem a better way?
· With the kid, develop a treatment theme- what is the basic thing this kid is working on? Examples would be: feeling emotion without acting to make the situation worse. Learning to trust. Growing up. Then relate all behavior to that theme.
· As a team support each other in the long, difficult process of doing this work.
· Work on developing self worth.
· Address shame.
· Use (possibly as restorative tasks) exercises that help the child understand and manage his behavior, such as mood charts, emotion thermometers, collages of how they are feeling and/or things they can do differently, interviewing others about how they handle emotions, etc.
· In treatment team develop restorative ideas for each child that are significant, require thought, and are related to their treatment.
· Don’t take the kid on trips when they have just hurt you- and explain why you don’t want to.
· Make sure you have enough fun and interesting things going on so that kids who can’t participate because they are working or restorative tasks will be missing something they want to do.
· Make sure your structure and planning supports success.
· And- TALK ABOUT IT. Address every problem. Take the kids on. Tell them what kind of behavior you expect. Tell them how different actions make you feel.
· And tell them, and show them, over and over again, all the good things you see in them and how delighted you are by everything positive (and even neutral) that happens.

Points and levels are so insignificant when compared with these (and other) more powerful tools. Changing to a trauma focused approach does NOT mean paralysis in the face of destructive behavior. It means active, complete and relationship based engagement. And then both the staff and the kids will be co-running a programs that supports growth and change in all.

Attention

Many times when we start discussing what is going on with a particular child I hear staff say: "she is just doing it for attention". We say this dismissively, as this invalidates the behavior and means we don’t have to take it seriously.
If you go to a play ground where children are playing and adults are near by, what do you hear constantly from the children: "Look, Mommy!" "Daddy, watch this!" "See how high I can go!" The children are clamoring for attention.
In fact, as adults we also demand attention. When you receive a compliment or an honor, do you call someone to tell them about it? Do you get upset if you try to tell your partner something and they are not paying attention?Attention is the food of the soul, the building material of the brain. It is necessary for growth and change. It is through the attuned attention of another that our brain develops and we form a sense of who we are, what the world is like, and what we can expect.
Attention is one crucial part of what was missing in the development of traumatized children. They were not central. Their needs were not put first. Often there was no one to listen to their stories and to take their disappointments seriously. Their needs were problems to be dismissed, not legitimate. Their cries were not answered. They have an attention deficit- not just that they cannot concentrate, but that they have empty spaces that have not been filled through the loving attention of another. No one was watching.
And now they are in treatment programs in groups of 12, 14, 17. Adult attention is in short supply, and is often monopolized by extreme behaviors. It some times seems the only way of being heard is to scream.
Paying attention is the greatest gift you can give another person. So next time you hear the words "he was just doing it for attention" stop. Pay attention. Listen. Express delight. Remember. Comment. Watch. Look, and describe what you see.
Attention is the nourishment you can give that will enable others to grow.

Change Your Conversations, Change Your World

You can further your change towards a trauma informed treatment program by changing the conversations you have as a staff.

Lisa is a sixteen year old girl who has been at this therapeutic group home for almost a year. During that time she has been known to sneak off and be where she is not supposed to be, and to lie to staff. However, recently she has been doing really well and everyone is quite proud of her. Lisa is scheduled to be transferred to a lower level of care shortly- a graduation which makes her staff very proud.

The other night Lisa sat with her favorite staff and said she had some thing to tell her. She then proceeded to confess a series of occasions when she had lied that no one knew about- such as saying she was at her job when she was really with her boyfriend, and sneaking out of the house at night. These things happened weeks and months ago.

What is the FIRST thing that you talk about at a staff meeting?

Is it what is the correct consequence- should she be grounded even though these things happened a while ago? Do staff take sides on yes, ground her, she needs to learn; no don’t ground her after all she told us voluntarily?

If this is your conversation, the fact that you decide not to ground her does NOT prove that you are using a Risking Connection® / Restorative Approach™ approach.

Instead, your first conversation, and ultimately the only interesting one is: what is going on here? Why is Lisa telling us these things? What was happening with her when she was doing them and what is happening now? Of course, her telling this is probably related to her impending discharge. She is probably saying: Look you guys I’m not so sure I am ready for less help. I know you are proud of me and all but I am scared to death. Plus I don’t want to leave you just as I am finally getting used to you. Look what I am capable of- I should stay right here.
And that conversation leads us to lots of possibilities. Is there more we can do to help her get to know the people at her new place? What conversations can we have with Lisa about her fears of going, the difficulties of saying good bye, and what she needs? We do not need to lecture her on the dangers of running away, or how she will never keep a job if she is not reliable. Instead we can talk about what it all feels like to her, the job, the boyfriend, this group home, the place she is going.

And with these interesting conversations going on we never even need to get back to boring subjects like whether or not she should be grounded.

If you want to change your program, after every event ask: what is going on here? What does this behavior mean? How is this action an adaptation for the kid, what problem is it solving for her? How can we help her to meet her needs another way?

These thoughtful conversations among staff and with the kids will strengthen relationships, teach feelings management skills, help the child (and staff) feel sane and worthwhile, and offer the greatest possible power for healing.

Cereal on the Counter

Scenario number one:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. "Dahlia!" Mary, a staff member says. "Clean up this mess you made! Put away the milk!"
"No" replies Dahlia. "You do it".
"Dahlia, I have given you a directive. Please get over here and put away this milk and clean up this mess!" Mary insists.
"F you" replies Dahlia.
Eventually Dahlia leaves for school, counter unclean, milk untouched. Mary cleans it up.
Mary is fuming. "These girls" she says to a co worker. "They are so lazy and they have no respect for me or for this house. They are hopeless. How will they ever be able to live on their own?"


Scenario number two:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. Mary looks at the counter and says: "Hey, Dahlia, what a mess. How about I’ll put away the milk- will you get the counter after you are done eating?"
"Okay I guess" says Dahlia.
After she is done with her cereal Dahlia cleans off the counter in a half-hearted way, leaving some cereal. Then she goes off to school.
Mary finishes up the cleaning.
"Ahhh, teen agers" she thinks to herself as she goes on with her tasks.

Which was your morning like?

We have all had both types.

Notice the power of how a request is made: a "staff directive" or a request and a mutual effort.

But even more important notice the power of how an event is defined. Is this an obstinate child defying a Staff Directive, a sign of disrespect and a hopeless future? Is it clear evidence that the child has no caring for Mary or for the house? Does it demonstrate beyond doubt that Dahlia will never manage her own life well?

Or is it a teen ager in the morning?

The Real World

I have not written anything in this blog for a while because I have been working on a SAMHSA grant application that has demanded every bit of free time and writing energy I could dredge up.

However, in a Risking Connection® training we were doing recently, a participant made the familiar objection: "we are not preparing these kids for the Real World". I’ve heard this a lot. The idea is that if we do not punish the kids for their behaviors they will never learn that these behaviors are not tolerated in the Real World- we are coddling them, spoiling them, and giving them an unrealistic view of life.

Consider the following analogy:
My 8 year old friend Ryan is in Instructional Little League this year. In this league the kids get five strikes, some times more if the coaches decide that the ball throwing machine isn’t working right. Everyone always says encouraging things to them: "good swing Cameron" (Ryan's team has three kids named Cameron, two girls and a boy) for a strike; "nice try" for a throw to a completely unpredicted part of the field. And the coaches constantly teach the kids skills: move your foot up a little. Keep your eye on the ball. Move your body to catch the ball, don’t just stretch. Every thing the kids do that is even remotely in the direction of what they are supposed to do is highly praised. They can only run two bases (otherwise everyone would get a home run every time, as no one ever catches the ball) and the innings are over when a team gets 5 runs. Obviously, the idea here is to begin teaching the kids the skills, and to limit the humiliation/ disappointment/ frustration they feel so they will want to play again. The game is set up to encourage success and limit damage.

And no one ever says: "we aren’t preparing these kids for the Real World if we give them special treatment like this".

Maybe we can consider our treatment centers to be instructional real life.

In the actual Real World ideas of Restorative Justice are gaining ground, and many more court systems are using them.

I would also hope, however, that the Real World that our kids live in will contain (as mine does) people willing to negotiate, and flexibility, and understanding. I hope that they will not in fact be punished for everything they do wrong (luckily, I am not). When they hurt someone, I hope they will have a chance to make up for it and heal the relationship. I hope that their Real Worlds will not be characterized by unremitting harshness.

In the mean time, maybe we can continue with the Instructional level and teach them skills, encourage them, and limit the damage so they will want to continue to play.

Just Ask What’s the Matter

I want to remind you that there is a major way you can implement trauma informed care without needing any committees, any program change, and without eliminating your points and levels system.

When a kid is upset, ask them what is the matter.

Don’t talk about consequences. Don’t talk about better ways they could be handling it. Don’t try to get them to take responsibility for their actions.

When you ask, be prepared that their response will be about something that someone has done wrong at your "stupid place" (that’s if they are putting it mildly). Don’t argue. Don’t tell them why the person was right to do what they did- even though you know they were.

Paraphrase what the kid said: so you are very angry about being sent up from school? It doesn’t seem fair to you? You can add an element of the possibility of change by introducing such phrases as: "Right now" as in: "right now you don’t like any thing about this place?" or "at the moment it seems impossible that you will ever have any friends?"

Emphasize any feelings they impart, especially any besides anger: you are discouraged, you are sad, you are frustrated, you were hurt.

Ask what else is upsetting them?

Stay for as long as you possibly can at the exploring and paraphrasing stage. No suggestions of how they could have handled it better, no mention of consequences that will happen, no taking responsibility for their action, just explore what are they upset about.

During all this keep your breathing slow, your voice calm, yourself regulated.

And this takes patience. You may have to keep doing this for a long time.

And then when (and only when) you notice some de-escalation on their part, some slowing of breath, and reduction of yelling, willingness to talk, then start considering: so where can we go from here? The kid is upset and wants this, the adults think this is necessary, how can we go forward? Where ever you can compromise, be creative, use unique solutions, do so.

At this point also slip in some discussion of other, non-problem related things: how the room floor is hard, how its cold in here, how you remember they had their basketball game yesterday, how did it go- chit chat. If the child is really much calmer, some humor can often help.

Once the child has regained some sort of regulation, you will often be surprised how easily the next steps can be figured out.

Try this today.

Recent Conference Presentations

I have just returned from presenting at the Black Administrators in Child Welfare Conference in Baltimore and at the Child Welfare League of America Conference in Washington, DC.

At BACW I was struck by the power of inspirational stories and of invoking past heroes and heroines to create courage for the current struggle. Presenters repeatedly told their own and others’ stories of triumph after trauma, prejudice and adversity. Heroes such as Rose Parks, Sojourner Truth, and Martin Luther King were called forth to bring energy to current problems. How can we use these methods more in our own agencies, and in our own change efforts? All of us in this field know inspirational stories of kids and families who have changed, programs that have been transformed, and treatment that has been effective. Many agencies have their own founding heroes and heroines. While we do turn to these rich legacies for help, I felt after attending this conference that we could do so more and with greater emphasis. Also, in this conference I experienced more acknowledgment of the struggle of this work, and the need to comfort and care for each other.

In my presentation I referred to the kids we treat as "damaged". Joanne V. Rhone, Ph.D., Professor at Clark Atlanta University suggested I would be better served by referring to them as "wounded" because as we know, wounds can heal. Damage, she stated, sounds more permanent and unchangeable. I thought this was an excellent point and will adapt my language in the future.

I attended a workshop on "Working Between Circles & Lines: Using the Restorative Circles Process to Create Effective Collaborative-An African Centered Construct for Organizational Prosperity". This workshop includes an introduction to Restorative Justice as a best practice in Child Welfare and how to use it to create paradigm shifts in organizational culture and practice. Restorative Justice is a set of values that guide decisions on policy, programs and practice. The Circles process restores the collaborative effort of agencies working together for the greater good. It was led by Saleem Hylton, CEO, President; K. Ivy Hylton, MSW, LICSW, Youth & Families in Crisis, LLC, Washington, DC They described and demonstrated the power of a Circle to bring people together and hold meaningful discussion. They gave examples of the use of this circle in creating agency collaborations, as well as in offender/victim encounters. I hope to utilize this technique further.

I also purchased two useful small books: The Little Book of Restorative Justice (Little Books of Justice & Peacebuilding Series) by Howard Zehr and The Little Book of Restorative Discipline for Schools: Teaching Responsibility; Creating Caring Climates (Little Books of Justice and Peacebuilding) by Lorraine Stutzman Amstutz and Judy H. Mullet. Both have clear explanations and many practical implementation ideas.

At my presentation at CWLA I had participants from all over the country, and it was very interesting to experience this national change in treatment approach. Many agencies are starting to implement trauma informed treatment and to move away from point and level systems. One agency expressed concern about whether such a change led to longer lengths of stay. Others talked about child care workers indoctrinating each other to "be tough" and not show feelings. It was clearly helpful to connect with others doing this work, and reinforced my hope to start more email net works and communication mechanisms.

Altogether it was a very interesting and inspiring trip.

Upcoming Conference Presentations

Is any one attending either the Black Administrators in Child Welfare (in Baltimore) or the Child Welfare of America (in Washington D.C.) conferences next week? I am presenting at both and would love to see you there. If you read this blog, please introduce yourself to me at the conferences.

My workshops are:

BACW
Friday afternoon
C-4 Creating a Culture of Connection in Residential Treatment

This workshop explores the transformation of a Residential Treatment Center into a trauma-informed, relationship-based treatment program. It explains the Restorative
Approach theory of change, new language used, specific treatment techniques and response to acting-out behaviors. The Risking Connection Curriculum-trauma framework, therapeutic relationships, counter-transference and vicarious
traumatization-will be introduced.
Moderator: Dr. Sharlyn Bobo, Washington, DC
Presenters: Patricia D. Wilcox, Vice President of Strategic Development; T’Kai Howard, Coordinator, Nia Sage House, Klingberg Family Centers, New Britain, CT


CWLA
Tuesday morning
C11 Creating a Culture of Connection in Residential Treatment
This presentation explores the transformation of a residential treatment center into a trauma-informed, relationship-based treatment program. It explains the restorative approach theory of change, the new language used, specific treatment techniques, and the response to acting-out behaviors and it introduces the Risking Connection Curriculum. Presenter: Patricia Wilcox, Vice President of Strategic Development, Klingberg Family Centers, New Britain, CT

Hope to meet you there!

A Wonderful Example of a RICH Interaction

I am in the midst of a Risking Connection training with two co-trainers, Michele May LCSW and Richard Nicastro, Ph.D. Michele is the Clinical Director of Natchaug Hospital’s Journey House Program. Richard is a therapist specializing in trauma with offices in Glastonbury, CT. He is also a life coach, and his blog can be found at http://www.relationshiptuneup.typepad.com/

Richard gave a wonderful example of how even a brief interaction can be RICH.

A few years ago Richard was running an anger management group for boys at a local community center. He noticed that one boy was standing near by imitating his movements and mocking him. After the group, Richard went up to the boy and say: "You know, I am looking for some new members for this group, so if you or any one you know would like to join I’d welcome new people. But you know what, I am looking for someone who is a real wise-ass, because we need some humor in this group. Even though we deal with some serious topics we need some comic relief and I’d like someone like that in the group. So, if you know any one..."

The boy did not join the group, and in fact Richard didn’t see him again for over a year. He learned from others that the boy had been in a lot of trouble and a lot of programs, and that since he was young he had been living with his father’s serious illness and constant near death.

Much later someone called Richard with a referral of an adolescent boy whose father had just died. Richard accepted the referral and was astonished to find the same boy in his waiting room. It seems that when the boy needed to go to therapy he remembered Richard’s name and asked if he could see him.

Think how completely Richard displayed a RICH relationship in those few minutes. He demonstrated Respect for the boy in his approach, and in his assumption that a sense of humor could be an asset. He gave Information: the group is available, you could join, and you could help others. He established Connection (more than he realized) by appreciating the boy and his skills. And he conveyed to the boy the Hope that there is some one out there who wouldn’t judge or dismiss him, who might see the good in him and who maybe could really help.

And look at the power that one moment of RICH interaction can have in someone’s life.

Many thanks to Richard for this excellent example.

Asking Directly for What We Want

Asking directly for what we want is very difficult.

First of all you have to know what you want. That is not always easy. It involves noticing your own distress or need, and correctly diagnosing a possible solution. Many times we feel vaguely unhappy or sad and have no idea what would help.

Then, you have to have in your heart the concept of needs being met, the possibility of improvement. You have to have some experience of feeling bad, then feeling better. When you need help, some times people help you.

And which people would that be? You have to have people you can trust around to receive your requests. You have to experience them being willing, pleasant, and regularly saying yes to you. Your experience must also be that they are gracious and generous about helping you, and do not extract a high price.

Also, to ask for help you have to feel enough okay about your self that you can handle not being perfect. I need help, I cannot manage everything myself, but I am a good enough person over all. I actually deserve help. I help others.

That deserving is a big thing. You have to think there is some reason that some one would actually be willing to do something for you.

Asking for help directly makes you vulnerable. The other person could say no. They could make fun of you. By telling them what you need you are showing how they could hurt you.

I know a lot of very competent people (especially women) who cannot ask for help. I know many professionals that have trouble delegating and work from an "I-can-do-everything-myself" stance. I know women who take on every responsibility in their family, and men who can’t share worries about work. I know a man who overwhelms his friends by doing things for them until they become annoyed, because he can’t imagine they would like him unless he "bought" their friendship. I myself often have difficulty asking for and accepting help.

When we work with treatment systems we try to teach staff willingness to step back from an interaction with a kid and accept help from a peer when you are stuck. People say that this is hard. Harder still is identifying the kid you are struggling with and asking the team members to help you figure out what is going on for you and thus do better treatment with that kid.

So...

When we focus with our kids on "asking appropriately" we are demanding a very high level of functioning, maybe more than we ourselves can do. How many times have I heard a staff saying "you didn’t ask appropriately" or "she is only doing that for attention". Manipulation, as we have seen, is the essence of asking indirectly and dishonestly for what one needs.

If we believe that symptoms are adaptations and solve a problem, we cannot wait until our kids can "ask appropriately" to meet their needs. None of the above conditions have been true in their lives. Instead, we have to guess and use observation and trial and error to figure out what their needs are. Then we have to meet them. We have to volunteer help, give graciously and generously to them as best we can. Then, maybe, after much time, they can relax, trust, and feel safe enough to ask for what they need.

Maybe even appropriately.

And maybe if we also create environments in which we can relax, trust and feel safe, we can also learn to ask for and accept help from each other.

Non Profit Blog Exchange

I am writing as part of the Non-Profit Blog Exchange, a method of connecting the non-profit blogging world and further spreading our work. The blog I am reviewing is Marion Conways’ Consultant to Non Profits Blog, at http://marionconwaynonprofitconsultant.blogspot.com/. This blog covers many aspects of non-profit leadership, including fundraising, finding volunteers, on line donations, promoting your web site, and Board responsibilities. I recommend it because it contains information that is helpful across many types of non-profits. It is very interesting to learn skills from say, museums, and apply them to behavioral health. It helps us identify the commonalities in our struggles. Marion offers very useful help for non-profits of all kinds.

Who Are These Kids?

If I walked up to the first child care worker I saw at your place and asked, "Who are the kids who come here? What are they like?" what response do you think I would receive? Would the person say: "They are kids who have experienced severe difficulties in their lives, who are hurt, who haven’t developed the skills they need to have lives worth living. But they are really great kids"? Or would the response be more like: "they are very difficult, aggressive kids. They have committed crimes or done other bad things. They are wild and out of control. They can’t be trusted, they will hurt you, you need to watch them, you can’t let them get away with a thing"?

Of course the response would vary with the day, with the minute. It might be different from program to program. And most likely the response would contain parts from both responses above.

But who we think the kids really are determines what we think they need. In the first scenario (again, keeping in mind that these are extremes on a continuum) those kids need to heal, to learn to manage their pain and emotions, and they need skills. In the second scenario, those kids need control, punishment, vigilance, to be watched, a tough staff who holds them accountable and doesn’t let them get away with a thing.

And that leads us to who we have to be. Who we think the kids are leads us to our ideal for child care staff. What is the actual ideal that is operating in your culture? Are new child care staff socialized by experienced workers that they should be kind, calm, soothing, and should gently teach the kids new skills? Are they taught and shown that liking, enjoying and appreciating the kids is essential to what we do here? Or are they scared by violent war stories, shamed for being innocent and trusting, or weak, and taught you have to be tough and firm and not let the kids get away with anything? Do staff brag about their moments of connection? Or are they proud of the battles they have endured, the injuries they have received without flinching or showing any response? Is the staff ideal closer to a person or to a rock?

Again, the reality is undoubtedly somewhere in the middle. But let’s have these discussions out loud. Ask staff what they learned from experienced staff when they first came to work here. Talk about what we want the ideal to be and how we can put that into practice. Remember, how we see the kids is undoubtedly how they will act.

Manipulation Part Three- Us

I may seem to be obsessed with the concept of manipulation, as this is my third blog post about it. This concept, for me, represents how hard it is to create an entire world-view change in the treaters who work with our damaged kids. So often we teach the section in Risking Connection on manipulation, only to hear as I did the very next day a child care worked in the training say with indignation something like: "and I couldn’t believe that child was trying to manipulate me to get what he wanted, what did he think I was, an idiot? And by going to that other staff he did get exactly what he wanted!"

First of all, it actually isn’t a crime for a child to get what he wants. And if we would like to encourage direct communication of needs, we have to be prepared to say yes when ever possible.

Secondly, the question of what may have prevented this boy from asking directly for what he wanted was missing. And more and more I become aware that our systems prevent a child from asking directly- for more phone time, for an extra snack, for a later bed- because we are so wedded to our structure that we automatically say no. "He knows the rules. Who does he think he is?"

Yet we ourselves often ask for and get extra, against the rules- an extra cookie from the cafeteria staff, the ability to leave early just because we are tired from our supervisor, some extra telephone time (when we are being paid to be working) because our child is sick.

I have begun wondering why we get so angry about this. We feel angrier than we do for more severe behaviors, such as aggression, at times. One aspect, I think, is that manipulative behavior appears deliberate and calculating, within the child’s control, as opposed to an angry out burst which is clearly emotionally based. We lose sight of the factors beneath the child’s inability to meet his or her needs directly.

What do we feel when we have been tricked or manipulated? When we are vigilant to spot and stop all manipulation what are we guarding so heavily against?Staff comments give us clues: Does he think I am stupid? I felt like a fool. The rest of the staff will not respect me. He thinks he can get over on me. I looked bad in front of every one. I felt like an idiot because I believed him.

So, being tricked makes us feel foolish and stupid. It taps into our fears that we may be incompetent. We feel unsafe, exposed, laughed at. We imagine we look bad in the eyes of our peers and they are judging us as naïve, gullible. In short, we feel a type of shame. We strengthen our resolve never to feel this way again, and become more guarded and distrustful with the kids. We determine to be trickier than they are.

Can we use this experience to develop a new depth of empathy for our kids? After all, they feel this way most of the time. They have been tricked, used, and made to feel foolish. They have trusted and then discovered lies. They have been counting on someone and been left. They, too, have felt unsafe, exposed, judged, laughed at. And just as we do, they develop the protection of being hardened, guarded and distrustful- and indirect.

Humans, adults and kids, are vulnerable. We don’t like to be exposed. We don’t like to be rejected. We don’t like to be taken advantage of, tricked or lied to. If this happens a lot, we close down, form a protective barrier, hide our true hearts, and interact defensively. We try to get what we can through indirect, covert ways. When we feel safe and trusting, we are most likely to ask directly for what we need and want.

When we hear ourselves use the word manipulation, and we feel that familiar indignation, let’s look deeper into our selves. Let’s use what we feel to help us understand in a new way what our kids feel. Let’s use this understanding as a platform to create meaningful, caring discussion about the possibility and benefits of honesty between people.

Dr. Ross Greene

I did attend a training by Ross Greene (http://www.ccps.info/) at the Brattleboro Retreat (http://www.retreathealthcare.org/) Ross Greene does not speak much about trauma. However his approach that children do well if they can, and that defiance and other problems are caused by learning disabilities, are very compatible with our work. He states that rewards and punishments teach that external bad effects rapidly follow bad behavior, when you are caught. This is not always true in the world, and leads mainly to an emphasis on not being caught- a radar detector approach to speeding. Learning how your behavior affects others is a much more powerful force for change.

As I have often stated, it all goes back to your formulation of what you think is going on when that kid is acting up. Why do you think he is not doing well? If you believe it is because he doesn’t want to, then an approach of increasing motivation (rewards and punishments) is appropriate. But if you believe he doesn’t know how, then a skill teaching method is called for.

Ross Greene had some thoughts to add to our investigation of manipulation. He stated as others have that our kids are bad manipulators- their manipulation is too obvious and makes other people feel bad. Good manipulation is more subtle, makes the other person feel they are doing just what they want to do. It involves planning and organization and the other person does not know they are being manipulated, or does not resent it. So- can we start working "being a good manipulator" into our skills classes?

I liked the phrase Dr. Greene used: "decisive not punitive". When we first teach staff about the Restorative Approach some feel that it means that they should ignore kid’ harmful behaviors, not step up to what they are doing that is hurting others. The best Restorative Work requires very active involvement with the kid and lots of feed back on how what they are doing affects others. Decisive but not punitive!

Dr. Greene describes our role as being a "surrogate frontal lobe" for the kids while helping them grow one of their own.

Dr. Greene’s method of collaborative problem solving is certainly an excellent idea. One thing I like was the suggestion to teach kids a few key phrases they can use when they are starting to feel upset. As we know, our kids don’t know what to do when they become over whelmed, don’t know how to ask for help, and resort to old solutions such as throwing chairs. Learning some phrases like: "Gimme a minute"; "I need a break"; "Something is the matter"; "I can’t talk about that now"; and "I don’t know what to do" could be a great help.

Dr. Greene suggested there are really only three basic ways to solve a problem between two people: ask for help, give a little, or do it a different way.

I enjoy the convergence of these various methodologies.

Taking Responsibility Part Two

In treatment programs we talk a lot about kids taking responsibility for their behavior. It seems to be very important to us that the kids acknowledge when they have done something wrong. It is, of course, important to identify when one has done something wrong- how can you fix it if you don’t acknowledge that it ever happened? I have previously written (June 15, 2006) about how shame paralyzes our kids in this area: doing something wrong to them feels like all is lost, all my worst fears about myself are confirmed, no one loves me, everything that has happened is my fault. If admitting you have done something wrong plunges you into total hopelessness, and you have no feelings managements skills, and you have no skills for repairing relationships, your only defense is a complete refusal to own the behavior.

Recently I have been thinking that our indignation that kids "won’t even take responsibility for their own behavior!" might be tempered if we look at ways we find it difficult to take responsibility for our own behavior.

I attend Weight Watchers and that is a wonderful place to learn about adults (including myself) who are trying to make difficult changes- like our kids are. These adults (including myself) by in large have many more assets than our kids do- supporting networks, developed feelings management skills, intellectual abilities. Yet what do we see? People having difficulty taking responsibility for their behavior.

If a person has not been following the eating plan their first impulse is to skip the meeting all together, and to think of a good reason they cannot attend. If they go to the meeting they may want to skip the weigh-in. If they have gained they have many reasons and many extenuating circumstances (in the kids we would call this making excuses, although just as with the kids many of these reasons are completely legitimate). If any one has a bad day of over eating, we often feel that all is lost, that we will never lose weight, and then we keep on over eating more and more. Much in the same way the kids are plunged into hopelessness and despair, these high functioning adults are similarly affected.

We can think of other situations in which we hide our failings, conceal our mistakes, find reasons to excuse our less desirable actions.

I guess it just isn’t that easy for the human being to take responsibility for his or her behavior.

When Programs Have Problems…

Recently we noticed that one of our units, the Acute Unit, was experiencing an increase in the number of restraints and seclusions. This unit provides excellent treatment for extremely damaged children ages five through twelve. The unit has fourteen kids at a time and is co-ed. This was our first unit to transition to the Restorative Approach. The program has a high reputation for attachment focused treatment.

The first step in responding to a problem is to notice it and pay attention. It took us longer than it should have to take the increase in restraints seriously, analyze the data and begin discussions with the staff and with the kids about what was going on. When a program is in crisis mode people’s time is eaten up responding to the demands of the moment. This stepping back and thinking is especially hard. But it is also especially necessary. The staff of the unit described a feeling of relief when the restraint numbers were reported to them- so that is why I am feeling so tired and drained! Finally someone is paying attention!

We analyzed the reports as to time of day, staff involved, reason restraints started, which kids were involved, etc. and then scheduled a meeting with the entire team and administration to discuss the problem. The meeting tone was not "what’s going wrong down here?" but instead "what help do you need?" However, by the time we had the meeting the team had already reduced the restraints and seclusions and changed the unit situation. So, instead we discussed how they did it. These discussions are as important as problem solving. They serve to underline and re-enforce the changes made, give employees recognition, and further unite the team.

So how did they change the unit atmosphere and reduce restraints and seclusions?A therapist from the team led training on "The Attitude" from Daniel Hughes (playful, accepting, curious and empathetic) and everyone committed to using this through out the day.

The difficulties had partly been caused by staff turnover- several people had left at once and the unit had been operating with open positions. So now that the positions were full, they had activities to create the new team, get to know each other, and discover each other’s strengths and interests. That way each staff could lead from their strengths. An example given was staff starting activity groups based on what they liked to do. As one child care worker said: "don’t have the crafty people leading the sports". The retreats and trainings focused on self awareness, understanding one’s emotional responses to the kids, and asking for and receiving help. They spoke proudly of their ability to be honest with each other and share their feelings, let each other know when they are burnt out or depleted.

Analysis of the data revealed some times when restraints were highest, notably after dinner. So the team changed the structure of that time period. They divided the kids into two groups for dinner (instead of all eating together), eliminated "siesta time" when they were supposed to be in their rooms but didn’t want to be, instituted calming and relaxation groups, and decided their would be no gym or active games after 7:00. They also added more structure and planned activities on the weekends, deciding in advance how to split the kids up to break up difficult combinations.

A large turnover in kids had also contributed to the restraints and seclusions. The data showed that only 4 of the 14 kids contributed most of the incidents, and that both the frequency and duration of restraints decreased over time for each of them. So the unit decided to adapt ways of getting to know new kids sooner and better, such as by assigning individual staff to spend time alone with each child. They reported that when they concentrated on this they more quickly learned how to help the child avoid escalation. One example was a kid who could accept a tight hug and avert a restraint.

We also discussed: what are other indicators of how unit life is going, in addition to restraints and seclusions? People identified- there is more laughter. We see the positives in the kids and in each other more clearly. We say more complimentary things to each other. We feel closer to each other. We have more fun with the kids.

The unit management now plans to watch all these indicators, including restraint and seclusion numbers, more closely and report them in staff meetings weekly. There is a tendency that when things get better we drop the practices that made them better, such as carefully planning the activities of each shift. The weekly discussion will guard against this. Also, key times such as a grouping of discharges and new admissions, or several very young kids coming at once, have been identified. When such a time approaches, staff will implement special active plans.

It was so moving to see a team of people realize a problem, take it on, and change it, through using the fundamental building blocks of this approach: relationships, the Attitude, planning, and thoughtful understanding of our traumatized kids.

I Don’t Do Vulnerable

More and more I see a lot of our kids’ behaviors as desperate attempts to avoid being vulnerable.

Priscilla tells me she does not care about her foster parents. Why do I keep asking how she feels about their divorce? Nothing that happens with them affects her, why would I imagine it would? They are just people she happens to live with.

Joey, a boy who is small for his age, enters the unit insulting everyone, making death threats, talking about his gang affiliations and the weapons he claims to have hidden in his room.

Aaron is scheduled for discharge. He becomes aggressive and angrily attacks his favorite child care staff.

Katie is desperately hurting herself, refusing all offers of help, screaming that she needs to go to the hospital shortly after moving to a new group home. She finally says how unsafe she feels the place to be, the locks do not seem secure, it is in the middle of no where, who knows what the neighbors are like, and she’s not all that sure about the staff.

I think we can go far by looking at every episode of aggression we see and think: fear. When we observe unexplained anger, look for anxiety.

The video "Multiple Transitions: A Young Child's Point of View on Foster Care and Adoption" available from The Infant-Parent Institute is a profound and moving story of the child welfare system from the child’s point of view. One part that has always stayed with me is:
"Did I mention how much I am growing to hate smallness, and weakness and defenselessness? It's getting so the only thing I know how to do is to just be as tough as I can, and to try to rub out smallness and weakness wherever I see them:
In the kittens that get hung by the clothesline in the backyard and squished with a tennis racquet.In the babies in my recent foster homes who turned up scratched. In my own Self, which I attack, particularly when I am feeling small or scared, and I need to beat myself into more toughness."

Our kids have seen weakness and where it leads. They have been vulnerable. They have seen their mothers beaten and bleeding. They have been too small to stop the hitting. They have been molested and been unable to protest. They have had it with being too small, too weak, too powerless, too vulnerable. Now they are going for power and protection, whatever the cost.

So what does this mean for us? Try to keep the vision of the hurt little child in your mind’s eye when you relate to the raging teen-ager. Validate the anger and (when you can) identify the fear underneath, and validate that. Understand that the child has real and necessary reasons to hate the softer feelings. Mostly create a caring and respectful environment in which the child can relax and feel safe enough to dare to share how scared she is.

And this will be the priceless gift that you can give these kids.

One of Those Scary Nights

I was expecting eighteen people from the Department of Children and Families Juvenile Justice Division for a presentation on the Restorative ApproachSM. As I was arranging the room, checking on the food and preparing the brochures I began learning about the previous nights’ problems.

It all started with boyfriend issues, and then rapidly escalated from there. One girl pulled the fire alarm, one ended up in the emergency room. The Program Director had to come in to help the girls calm down.

I started to wonder- am I a fraud here? I am teaching all these people about this new approach, and yet we experience a night like this. We have just been enjoying a period of relative peace and calm with the girls- why did this happen? When I do training I teach that staff should not judge their work by whether the kids act up. Judge the night instead by how they, the staff, act, and whether they use the Attitude (courtesy of Daniel Hughes)- playful, accepting, curious and empathetic. Do I actually believe this?

As often happens, I learned from our child care staff. During the presentation the Girls’ Unit Supervisor Karen Pac began to talk about the differences she experiences during a crisis since we began the Restorative Approach. Staff are warmer and more compassionate with the girls. The emphasis is not on the rules, but on helping the girls calm down. If Katie wants to take a shower, although it is not 'shower time'- let her, that is an excellent de-escalation technique. The team of therapists and staff works closely and calmly together. The team concentrates on reaching out to the girls- what is the matter? That approach allows Robin to switch away from anger at her boyfriend and Nicole who has talked to him and the staff that won’t let her beat both of them up. She begins talking about her father, who said he was going to become re-involved in her life and has disappeared. Now she is crying instead of yelling and threatening. Staff are next to her sharing and validating her sadness. The next morning, the conversation centers on what is happening in the girls lives and better ways to help them. Education staff comes to the unit to meet with the girls and gauge their mood, to make plans with them for entering school (where of course the boys are) and becoming students. The girls are calm and able to attend school. Life goes on.

Our Boys Unit presented a skit for our visitors in which they act out 'before' and 'after' we switched to the Restorative Approach. The situation they chose this time was Steve who had not done his homework and was supposed to be in his room completing it. Instead he was sitting in the lounge refusing to move. In the 'before' scenario, staff concentrated on the fact that there was a rule and Steve was not following it. We must be consistent. We must focus on compliance. The therapist stood near by, but she was not relevant when the goal was to get Steve to do as he had been told. This situation rapidly escalated into a restraint. In the 'after' scenario staff asked Steve what was wrong. They noticed that he had been acting differently all afternoon, had been withdrawn and sad. They called in his therapist. They ignored the fact that he was still in the lounge. Soon Steve began talking about what was troubling him, went for a walk with his therapist, and then easily finished his homework.

These kids come to us severely damaged. They have no ability to manage emotions, and every small setback escalates into despair and panic. A problem with a boyfriend evokes all of their many devastating losses. We cannot expect that we will have no crisis’s, no emotionally over-wrought nights. Instead, we can change how we act in those times. We can stay emotionally regulated ourselves so the children have a chance of regaining emotional regulation. We do this by having a plan and through strong teams. We can shift our focus from rules to compassion. We can concentrate on helping kids calm down. And then we will experience crisis that are shorter, less destructive, less frequent, and that provide opportunities for growth for our children.

Yesterday Yet Not Today

One comment we often hear is "She was able to handle this yesterday without acting out so I know she can do it. So why is she so upset today? She must be doing it for attention." The implication behind such comments is that if a child can function without her symptoms on one day, she should be able to do so on all days. Therefore, her symptom today must be somehow contrived, phony or unnecessary. We can become very exasperated with kids who are acting out when we have seen them do much better at other times.

What is going on when a child’s functioning is uneven? When one day the tiniest little setback seems to completely destroy him, yet on another day he can get bad news from his family and react calmly and with understanding? As we consider what may be happening, let’s look at ourselves first.

When I am dieting, some days it seems so easy and so obvious- just make good choices. Why would any one ever do anything else? On other days, however, every minute and every food decision seems like agony. The bread and butter are essential to my survival. I can’t even remember why I ever thought of dieting. Some times I have some ideas why one day is harder- I am tired, or I am in a situation with a lot of food. But sometimes it is inexplicable. I just wake up in an easier place, or a place of struggle. People tell me it is always this way with change, and with improvements we try to make- quitting smoking, doing exercise, changing a behavior towards a person, learning a new athletic skill.

So for the kids, some days are just harder than others.

We can and should learn with them what may contribute to days of greater strength and resiliency. This can include good self care skills, such as getting enough sleep, eating right, and getting exercise. It can include changing the environment- spending time with positive people, finding interesting things to do, being in a safe and nurturing space. It can include setting up supports, be they friends, letters, pictures, sensory distractions, music, art. It can also include predicting times of potential stress (such as phone calls from family) and planning to have support and safe options available if distress occurs.

In the same way, I would do well to employ good self care, not have the most tempting foods in my kitchen, seek out, interesting activities to distract me from food, cultivate supports such as other dieters, and plan for what I’m going to do to manage eating events.

And, we have to understand that for our selves and for our kids, some times all this just doesn’t work and we have inexplicable bad days. And we have to do what we can to limit the damage, and get back on track as soon as possible. And these bad days don’t negate any progress we have made (although it feels like they do). The bad days are real, the difficulty is not "for attention". Change is not linear. We all need relationships, compassion, understanding and connection to just keep going.

Alliance Conference

I have just returned from presenting at the national conference of the Alliance for Children and Families (http://www.alliance1.org/) in St. Louis, Missouri. Many agencies represented there are some where along the path of incorporating trauma understanding into their residential or group care. Many are just at the beginning, and are struggling with similar questions. People are concerned about lack of staff skills, boundaries, time, resistance, and fears that chaos will break out. Several people made the point that in some ways the trauma-informed approach is a return to our roots. Many agencies started as orphanages, and in the early days love was considered the main tool. There were strict rules, but also an emphasis on caring and flexibility. At my agency, people who grew up there in the orphanage years (now in their 80s) come back to visit- and they remember "Miss Mable" who "thought I was special". The relationship is the power!

Mark D. Freado, Director of Re-education and Consultation, and Lisa A.
Shepard, Senior Director of Clinical Services, Pressley Ridge. Presented on "Creating a Trauma Sensitive Culture through Competency Training". They described how Pressley Ridge (http://www.pressleyridge.org/) is using staff training, competency development and evaluation to change the treatment culture.

In addition to implementing trauma informed care, agencies are focusing on more effective, careful management, branding, outcomes, fund development, and Board development. In a keynote presentation Stephen B. Heintz spoke of the power non-profits and their staff have to influence public policy in his address: "Power to the People: The Critical Role of Civic Engagement". Thomas J. Tierney highlighted "The Leadership Deficit" in the non-profit sector, and emphasized the importance of active succession planning at all levels of all our agencies.

It was heartening to see so many agencies beginning to add a trauma framework to their approach. Let’s all work together to figure out how to do this! Please add your experiences through the comments option in this blog- just click on the word "comment".

Siege Mentality

We know that trauma and the resulting fear changes our thinking. Remember that severe trauma produces a constant re-experiencing of the trauma, in the forms of flashbacks. So the trauma survivor is in effect constantly being re-traumatized. He lives in a state of fear.

When a person is living in a state of fear she develops trauma-based thinking. Trauma-based thinking is characterized by a tough, battle mentality. It is a "batten down the hatches, we are in for a storm" way of operating. The person is ready for the worst. She is constantly scanning the environment for sources of threat, and is not noticing much else. She is unable to notice her own inner feelings, and especially must put aside any feelings of vulnerability, weakness, softness of sadness. She develops an "us-vs.-them" mentality. Everything is black or white- war allows no subtlety. You can’t tolerate nuance or ambiguity when your life is on the line. People are either your friends (few) or your enemies (many). Bad things will happen soon, you will soon be attacked- so better to take the offensive now.

If we stop and imagine a situation of real danger, whether it be the proverbial lion attack, a war, or being mugged, we can see how such a method of thought is helpful and in fact necessary.

It is very important that we realize that this is how our kids are thinking, and that only by helping them feel safer and in less danger will they be able to move to any other kind of thought.

In addition, in a parallel process, this can also be how we are thinking.

When programs have become out of control, when there have been numerous staff injuries, when the staffing seems inadequate and the kids unmanageable, when the staff do not feel cherished by the administration and feel blamed by the larger system, we too fall into trauma-based thinking.

We batten down the hatches, and prepare for each day’s storm. We expect the worst from the kids and families. We look at the unit for sources of threat and don’t notice positive events. We turn away from our own feelings of being scared, sad and inadequate. We develop “us-vs.-them” thinking: staff vs. kids; child care workers vs. therapists; line staff vs. administration. Everything becomes black and white for us. The kid in front of us will probably hurt us soon so let’s restrain them now and get it over with.

What is the antidote for trauma based thinking? It is the same for the kids and for us: safety and connection.

Developing connections with each other can start with just talking about what is happening, our feelings, our vicarious traumatization, our exhaustion. Connections and safety can be knit throughout the organization, from the administration to every worker to the kids. Mechanisms can be created for fun, play and relaxation. Patterns and policies can be revised to increase safety and allow for the possibility of heart-to-heart relationships.

If we focus on creating an atmosphere of safety and connection, over time we can all relax. And when we are using less trauma-based thinking, and are more flexible, vulnerable and positive, the kids will be better able to thrive and grow.

Alliance for Children and Families

I am presenting at a national conference this coming Friday- the Alliance for Children and Families. (http://www.alliance1.org/conferences/national2006/) If you are there, please come by and say hello!

Alliance for Children and Families 2006 Annual Conference
Building Community Voices: Creating a Healthy Society and Strong
Communities for All Children and Families
St. Louis, Missouri, October 18 – 20, 2006

Session E
Friday, October 20
8:30 – 10 a.m.
Creating A Culture of Connection: The Transformation of a Therapeutic Program
This presentation will describe the process of changing a residential treatment program from a traditional approach to a trauma-informed relationship model. The presenters will cover the challenges and issues that motivated the change, the theoretical underpinnings of the model and how it operates, the change process, outcomes, next steps, and lessons learned. Participants will
learn about the human trauma-informed relationship approach and how it works, and also about managing a major change in system.
Presenter: Patricia D. Wilcox, LCSW Vice President Strategic Development, Klingberg Family Centers

The Restorative Approach and the Collaborative Problem Solving Model

I have been reading Ross Greene’s new book: Treating Explosive Kids: The Collaborative Problem-Solving Approach (Ross W. Greene and J. Stuart Ablon; the Guilford Press, 2006). I am struck by how much overlap there is between his methods and the Restorative Approach.

Ross Greene reminds us of the important truth: children do well if they can. He emphasizes the connection between one’s understanding of the causes of children’s explosive behavior and ones’ intervention. If you see the cause as inept parenting and lack of motivation by the child, strict consistent parenting responses and systems to increase motivation might be helpful. However, if you see the cause as more related to cognitive inadequacy (as he describes) and/or biological changes and skills deficits created by trauma (as we emphasize) then your response would center on opportunities to learn new skills and improve cognitive and emotional functioning.

Greene and Ablon describe four key cognitive skills that are often impaired in our children: language processing, emotion regulation, cognitive flexibility, and social skills. They advocate for the importance of careful observation and tracking to clarify which skills the child particularly lacks, and what triggers explosive episodes. They make an excellent point that a situation or condition does not have to always produce an outburst to be a trigger- it just has to increase the likelihood of one.

Greene and Ablon also emphasize the importance of the relationship, stating on page 91 that “The single greatest predictor of therapeutic change…is the degree to which a therapeutic alliance is formed between clinicians and patients.”

The collaborative Problem Solving Method involves working with the child to find a solution to the problem that satisfies the needs and desires of both parties. In the course of this process, skills of flexibility, emotion regulation, and social skills can be modeled and taught. This process overlaps with the Restorative Model response to serious behavioral issues, in which the child participates in figuring out a way to overcome the problems his behavior has caused.

Both models advocate for a treatment setting that relies on respectful treatment relationships, on listening to and learning from/about the child, and on skills teaching and practice.

Greene and Ablon even use the same example I always use in my training, about making basketball shots! (see page 217)

I will be attending a training with Ross Greene at the Brattleboro Retreat (http://www.retreathealthcare.com/) in December, and I look forward to learning more about his ideas.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

New Insights Continued

As I mentioned in my last post, I have just returned from the International Conference on Violence, Abuse and Trauma in San Diego, California. I presented the Restorative Approach at this conference as well as attending sessions. This post continues the subject of new insight on familiar concepts.

Dr. John Seasock from Renaissance Psychogical and Counseling Corporation in Kingston, PA spoke also about some of the risks of healing. He mentioned that some emotional difficulties such as ADHD may be in a sense protective against PTSD, because the capacity to think and ruminate is diminished. How can you feel bad about what happened to you if you can’t even concentrate on a thought? Therefore, when we medicate these disorders the child may actually feel much worse- her increased capability to think just makes it clearer to her how awful her life has been or often still is. We should pay attention to this possibility.

Dr. Seasock also cautioned that ritalin can increase biological hyper-vigilance and thus worsen PTSD symptoms. It can also worsen already disturbed sleep patterns, and lack of sleep can lead to other behavioral difficulties.

In Risking Connection we speak of symptoms as being ways to escape intolerable feelings. One further elaboration of this point is that if a person relies on dissociation to manage their distress, she may need anger, chaos and confusion to help produce that dissociation. This may be one part of the apparent “addiction to chaos and drama” we see in some clients.

Some of Dr. John Seasock descriptions of “trauma thinking” give further rationale for the Restorative Approach. He defines “trauma thinking” (he credits this term to Nancy Cole) as concrete, black and white, timeless and irreversible. Language is not effective when someone is in the grip of trauma thinking. It is almost a trance-like state, and logic and reality testing are suspended. Hence, logical statements from adults about the future, consequences, etc. have no meaning what so ever.

One of the main goals of therapy according to Dr. Seasock (crediting here Pat Ogden of Colorado; Trauma and the Body, WW Norton; 1 edition (Sep 19 2006) (http://www.amazon.ca/Trauma-Body-Pat-Ogden/dp/0393704 572) is to increase communication. Our children grow up in families that explicitly forbid communication with the outside world- don’t talk about this family’s business out side the family. The children learn to fear the response of outside helpers if they tell what is going on. But there are even more profound prohibitions on communication. There is no permission or practice in discussing even within the family what is going on. If the child tries to comment, her feelings are often denied and dismissed. In fact, the child does not even communicate with himself about what is happening. Dissociation provides away to even cut off your own knowing and believing. All of this may result in a condition called alexethymia, the condition of being without words- unable to describe your own experience. So any way we can teach and encourage communication is valuable to the child.

Many presenters, including some consumers, spoke about the effect of trauma on parenting. This is an area that needs more concentrated work and specific interventions.

I appreciate the opportunity to join others in thinking through the experiences of trauma and their lasting effects.

New Insight into Familiar Ideas

I have just returned from the International Conference on Violence, Abuse and Trauma in San Diego, California (http://www.ivatcenters.org/conference.htm). I presented the Restorative Approach at this conference as well as attending sessions. Several speakers I heard gave me a new way of thinking about some very familiar concepts.

Dr. Colin Ross is the author of The Trauma Model (Manitou Communications, Inc. 2000). (http://www.rossinst.com/) In his work he emphasizes two concepts, the attachment to the perpetrator and the shift in the locus of control. This may be obvious to everyone else, but his discussions of these two concepts made me understand what was happening with our kids in a more complete way. Dr. Ross states that attachment is a biological necessity for mammals. Mammals cannot survive to adulthood without attachment. So we are biologically program to form attachments with our care takers. At the same time, organisms are biologically wired to move away from pain. A child does not have to be taught that when his hand touches the hot stove he should move it quickly away. So children in an abusive family have this bind- the attachment that is biologically necessary is causing them pain. What can they do? He defines dissociation as a method of protecting the attachment. If the child does not experience what the adult is doing to them they are still able to maintain he attachment which they need.

Dr. Ross points out that we all face this dilemma to some extent, as no parent is perfect and we all need to attach to a perpetrator. But in situations of “good enough” parenting, the pain is not extreme, and so the child can form an attachment which includes some imperfection. However, the attach/move away dilemma remains unresolved in our abused children and is the essence of their relationship style. Since the extremes are so intense, they are unable to reconcile the attachment and the need to escape. They are forever caught in oscillation between them. Black-or-white thinking- their parents (and everyone else) are either all good or all bad- is the only option they can find.

Dr. Ross also clarifies the shift in the locus of control- the concept we have focused on as shame. We have discussed how children naturally think that the world revolves around them, and that they cause everything. In addition, however, an abused child is in a very scary unpredictable world. If the child can come to the conclusion that they are causing this abuse by being bad, they are giving themselves and illusion of control and mastery that is soothing and protective. In addition, concluding that they are causing the abuse also protects the possibility of attachment to the parent which is so necessary.

These concepts have implications for the process of healing. We often try to convince our children that no, in fact the abuse was not their fault. But have we considered what it means for them to give up this belief? If in fact they were and are innocent victims then there is so much to be angry about, grieve and mourn about their childhoods. There are all the awful things that happened, and all the good and normal things that did not. This grief is the overwhelming feeling that our children are avoiding at all costs. And if I am not worthless, bad and deserving of abuse I will have to change many things I do, and I do not know if I have the skills and strength to do so. Far easier to hold onto this protective feeling of badness, with the control and hope it gives me.

This is the first post on this conference, a second will follow. It is interesting to have the opportunity to re-think these familiar concepts.

Dilemmas of Love

Marisol is fifteen years old, and she has one connection outside of Klingberg- her mother. She hears from her mother occasionally, and there is great love between them. Some times her mother is so overwhelmed with her own health issues and survival needs that she is unavailable for Marisol. Marisol worries about her and reacts desperately to the ups and down of their relationship. Marisol has so little ability to manage her feelings, put them into words or ask for help. Things happen, she experiences strong intolerable feelings, and she acts out. However, lately she has shown some improvement and has generally been much safer.

Marisol formed a very close and intense relationship with an older girl on the unit, Jasmine. The girls became a couple and were “going out”. At times this caused difficulty, as Marisol reacted intensely whenever Jasmine was unresponsive or was having trouble herself. But generally Jasmine was kind, a positive leader, mother-like and caring towards Marisol. Jasmine helped her learn to stay relatively calm, and encouraged her to feel more hopeful.

Jasmine was discharged to a supported apartment program. This was hard for Marisol, but she used adult help to get through it. They stayed in close phone contact. The team had to put some limits on the timing and amount of phone calls just so that Marisol would participate in other activities.

Sadly Jasmine is not doing too well. She has been missing from her program, skipping school, and is said to be hanging out with an older man. There was a scare that she was pregnant- luckily this proved not to be true. Marisol calls her, and sometimes Jasmine calls, but not as much. Marisol is often upset by her calls with Jasmine, or by having to end them, and she is worried about her. This relationship is replicating her relationship with her mother. Recently, Marisol was hospitalized after a visit with Jasmine.

To many it seems obvious that we should end Marisol’s contact with Jasmine. When we suggested this, Marisol said please, no, she could not bear it. We have now talked about a period of stability followed by supervised calls. Can we use this situation to help Marisol learn how to survive relationship troubles? Can she possibly plan how to handle the distress she may feel after a call without doing anything unsafe, and can she use adult help to carry out these plans? We believe in the power of relationships-should we take away one of the two people this girl loves? Or are we doing her a disservice by allowing a destructive connection? What would you do?

Return to School

A mother in the email newsletter Daily Parenting Reflections (Dailyparentingreflections@yahoogroups.com) writes about speaking to her child’s new teacher about his needs. She has given me permission to reprint her post (with a little editing) here. I do so in the hope that we utilize these suggestions in our agency special education schools. Also, it makes me wonder how we could reach out more to teachers in the public education system and educate them about the special needs of children with trauma histories. I am glad that the blog example about attention was helpful to this mother.

“Well, I followed up on the advice from Heather [Forbes] and Bryan [Post]’s teleseminar [www.bryanpost.com] and decided to be proactive this year and meet early with my son's teacher. He just started third grade. I felt a little silly about it and thought about canceling but decided to go ahead. It was Day 2 and the teacher and I agreed that it was the earliest parent-teacher conference either of us ever had.

All in all, I'm glad I did it. I worried that she might think I was making excuses upfront for my child's behavior, but I don't think it came across that way. She was very receptive to some of my suggestions (i.e. if he's doing something disruptive in class, rather than calling him on it publicly, simply go over and place a hand on his shoulder as a private kind of signal). I also asked her not to seat him near any child who gets in trouble a lot. I've found that if a lot of negative attention is focused even in the area in which my son is (even if not directed at him), that it's stressful for him. I also told her that if he was doing something wrong, time in would be better than time out and not correcting in the moment but rather later would be more effective at getting the message across. This teacher seems very calm and nurturing so I think the year will be a good one.

Pat, I used an example I got from your blog to illustrate how he can be hyper-alert and on the lookout for danger. It's the description of how you can walk down a street in New York City at 2:00 p.m. and what the experience is like (you're observant, enjoying it, etc.) and how different the experience is at 2:00 a.m. and that in my son’s world, it's often 2:00 a.m. in NYC. I thank you for that. She "got" it.”

Good luck to this mother and her son in the new year!

Boundaries

The girls on our adolescent Girls’ Unit are having trouble with boundaries. This means they are always hugging and lying all over each other, that they are creating elaborate relationship structures of family relationships that often lead to anguish and conflict, and that some are in love and/or going out, breaking up, and over involved in each other’s issues. It means the girls “interfere” when one is having a crisis, often triggering more crises. In general, it means lots of touching and lots of drama.

Before we start talking about “you are here for your own issues, pay attention to yourself” and before we start making more rules, let’s think about boundaries.

Some part of what we are considering here is really just about love. These teen-aged girls are alone in the world or have very tenuous connections to families. Most adults have disappointed them. They do not know where they are going next. And they are shame-based, unsure of whether they are worthy of life. They have a desperate need for love- as we all do. And here is where they can most easily find it, among the other girls with whom they live.

Of course, trauma histories affect boundaries. These girls’ whole lives have been boundary violations. They have experienced the more blatant violations such as sexual abuse, and the more subtle such as being parentified and sharing mothers’ struggles with her boyfriend. They have no idea what boundaries should be, how to set or keep them, why one would want to do so, what would be the advantages of doing so. They also do not know how to stand up for themselves, and are quite sure that if they were assertive no one would ever be their friend again.

Then let’s take a moment to realize how hard boundaries are for us. They must be, or why are we always having discussions among ourselves about boundary issues? In both our personal and our professional lives, limits on love and friendships are hard to establish and maintain.

So, where does that leave us in our leadership of our girls?

1. We can model loving boundaries with each other, trying to make sure our relationships are straightforward, honest, affectionate and respectful.

2. We can offer the girls many legitimate ways to connect and care for each other. We can find positive ways they can help each other when one is in distress.

3. We can talk openly about the difficulties of love and friendship and limits, without sharing intimate personal information.

4. We can teach the DBT (Dialectical Behavioral Therapy, http://www.behavioraltech,com/) interpersonal skills

5. We can use every method we have to increase the girls’ competence and sense of their own worth.

6. And we can advocate hard for anything that increases their connections outside of the setting- out reach to families, getting them mentors, enabling participation in community activities, etc.

Negotiating connections with others will be a key issue for our girls throughout their lives. It is for all of us, and their histories leave them especially vulnerable. We cannot focus on separating the girls, and asking them to turn away from their only sources of love. It is essential that we use this laboratory of intense relationships that residential treatment provides as an opportunity to help them grow towards better connection skills.

What if They Won’t Do the Restorative Tasks?

A question that always comes up at every Restorative Approach training is: “What if the child refuses to do the restorative task?” You cannot make a child do a poster, make cookies for someone, talk over a problem, do a peer’s chores. You have less control than in the past systems- you could make a child stay in a room, and many of the privileges we previously withheld were staff driven.

There are some structural supports that can be put in place to encourage the kids to do the tasks. Some programs institute Restorative Task time blocks, i.e. from 3-4. If you have an outstanding task, you are either doing it during this time, or staying inside not doing it. If you have no outstanding tasks, you are playing or doing something fun and extra. Also, if you have an outstanding task you may have to go to bed early to get more energy for the task. You cannot go on extra off-grounds trips because you are not re-connected with the community yet.

It is essential not to engage in power struggles around the tasks. The staff attitude should be: it’s fine if you are not ready. Some times it takes time to become ready to work through a problem. We have confidence that you will get there, and we will be here ready to work it through with you when you are. In the mean time, we need to keep a closer eye on you and keep you near us, because we have not rebuilt the trust between us.

And it is important to remember the reason for the task. The task is not punishment by another name. It is not designed to be difficult, to be a deterrent, to be arduous and unpleasant. The task is genuinely designed to be a vehicle of reconciliation and reconnection. People who have done something wrong or made a mistake want to put it right. We feel that way when we make a mistake. Sometimes, especially in children who have experienced repeated trauma and attachment disruption, this impulse is blocked by a feeling that it is impossible to fix mistakes, that I am so worthless, and now I have blown these relationships too. I just don’t care any more. Our job is to gently challenge that assumption, provide a step-by-step method for fixing mistakes, and to patiently and eagerly await the child’s readiness to engage in the process with us.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

New blog discovery

I just discovered that Marcia Brubeck, a therapist I have met in Hartford has a blog: http://marciabrubeck.typepad.com/. Her most recent post lists some light hearted ways to deal with problem behaviors. These strike me as very applicable to the Restorative Approach. They could be incorporated into treatment settings with some modifications. What are your reactions?

Beyond Consequences

This is an excerpt from a recent newsletter from the Beyond Consequences Institute. (http://www.beyondconsequences.com/)
Although Heather Forbes is responding to a parent, her words and methods of thought also apply directly to our work in treatment settings.

QUESTION: I understand that my adopted daughter has a trauma history, but if I'm not giving consequences, then doesn't my child think that her behavior is okay? I'm struggling because it isn't acceptable to be disrespectful to me. I have to say that her behavior is so appalling! I understand how reacting can be disempowering -- but what can I do that's empowering in that moment that sends the right message to her?

ANSWER: If we go back to the understanding that negative behavior comes from an unconscious place (see Chapter 1, Beyond Consequences, Logic, and Control), we can begin to see that the disrespect is about something much deeper. This level of disrespect began in early relationships where her own needs were never respected. She is simply acting out of the model that was imprinted within her system in years prior. As our book mentions, those are the patterns that bind us. If you work to change the behavior in the moment of her distress, you will find yourself becoming frustrated at the lack of change. This is because we cannot learn when we are stress out. Stress inhibits our cognitive thinking. So the life lesson of being respectful even when angry needs to come when she is calm and regulated. Work to calm her nervous system and calm her emotional state. Really listen to her. Many times children (and we as adults) become disrespectful, rude, and/or loud because we don't feel like we are being heard. Connect with the disrespect instead of trying to shut it down. When you truly listen to what is behind the disrespect, you will find the depth of pain and fear your daughter is experiencing. Saying something like, "Sweetheart, when you speak disrespectfully, that only tells me that you're hurting inside. It also tells me that someone must have really disrespected you. (feel that pain for her, apologize for how she was treated, join her instead of correcting her....etc.)" She needs you to help her to connect with her pain; it is too painful and too scary to connect with it on her own. She is reacting at you because feeling her level of pain is overwhelming to her entire system. Thus, the message you will be sending back to her at that very moment is one of respect, compassion, and love. You will be giving her the message that strengthening your relationship with her is your primary goal-that she is more important to you than anything else on this planet. Certainly the long-term goal is to teach our children to be respectful to their parents and that we should live a life of obedience. Yet when this lesson is given in the heat of the moment, defensive, disrespectful, and defiant feedback loops are created between parent and child (see Chapter 4, Beyond Consequences, Logic, and Control). And the most important point is:

The real consequence is that relationships become broken
and the relationship's focus becomes control and power.

So, an hour later, that evening, or sometime when you both are better connected, talk to her about the disrespect and discuss options and ways to handle it differently the next time. Express your reactions to her behavior and how it makes you feel. Perhaps relate a story of your own experience and from your past that would connect with her. All of this will begin to help her to learn how to connect with herself when she begins to get stressed out and dysregulated. This will empower her to come to you for help in a loving and respectful way and it will empower her to develop her own regulatory ability to handle stressful situations as an adult. Parenting out of this love-based approach is hard work. In most cases, it would be much easier to give out a consequence and be done with it. Yet, when we truly understand that behavior does not come from a cognitive, rational place, we realize that giving consequences is actually quite irrational and illogical. The Beyond Consequences Institute (BCI) was not established to help parents and professionals simply learn a new technique. Rather, BCI is about learning an entire new paradigm. It is a paradigm that you live out of and a paradigm in which your perspective of the world is forever changed-a perspective whose foundation is based in love and in the understanding that power does not come from control, but through loving influence.

Heather Forbes, LCSW
Beyond Consequences Institute, LLC
631 N. Hyer Avenue
Orlando, FL 32803
info@beyondconsequences.com