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

The Manipulation Trail

As part of a Risking Connection® training I have been teaching a new way of looking at behaviors we consider “manipulative” (see previous post 7/3/06). I urge all of us to see any use of the word manipulative as a flashing light, telling us that we need to explore further what is going on between us and a child. Here are some questions to ask yourself and your team any time we say that word:

Follow the “Manipulative” trail…..

A child is being “manipulative”…

1. Describe the behavior. What makes it “manipulative”?
2. What problem is the child trying to solve? What is s/he trying to accomplish? (such as: get more attention, return to previous placement, get more phone minutes, get her way)
3. What is the need beneath that need? (such as: feeling alone, wanting to reunite with previous connections, needing to touch base with family or friends, needing control) Is the child trying to avoid any intolerable emotion? (such as rejection, loneliness, hopelessness)
4. What does this show about what self capacities s/he may be lacking? (i.e. ability to manage feelings, ability to maintain an inner connection to others)
5. How can we help the child meet “the need beneath the need” right now, in a more direct way? (i.e. pay attention, help them connect with others, give them some choices)
6. How can we help the child develop their self capacities further? (i.e. practice grounding and calming techniques, review their good-bye book from the previous placement)
7. How can we speak with the child in a respectful, informative, connected and hopeful way about the effects of direct and indirect communication on our relationship?

When we call a child manipulative we distance ourselves from him. Asking and answering these questions can lead instead to growth for the child, and a deepening of our relationship.

Attention

Traumatized development changes a person’s ability to focus and changes the way they pay attention. The children we work with are often hyper alert, and tune into to many nuances of their environment with great clarity. These are the children who know every staff’s schedules, and what car they drive. They know more than we realize because they have listened to phone calls and conversations that we thought were private. They over-react to change: in routine, in tone of voice, in the environment. They have little ability to screen out events. When another child is having a problem, they are having a problem. It is as if they have no skin, no filter. This is a painful way to live.

It is also important to realize that this attention is primarily a screening for danger. When an organism senses danger, the first step is to scan the environment for the source of that danger, to evaluate the direction and the severity of the threat. During that scan, one cannot take in other aspects of the environment- whether it is beautiful, what new activities are going on, etc. The only information absorbed is that relevant to danger. Our children always sense danger.

In order to understand the quality of this experience, picture yourself walking down a street in New York City with some friends at 2:00 on a sunny afternoon. You are looking around, appreciating the architecture, enjoying the people on the street, noticing a new restaurant, looking in store windows, enjoying talking with your friends, relaxed and open. Then picture yourself walking down that same street at 2:00 A.M. by yourself. Now you are tense and scanning for danger. You notice movement and how close/far people are to you. You do not appreciate their unique style, you evaluate them for threat. You completely miss the architecture and you don’t see the stores, but you are exceptionally aware of lighted areas, dark areas, open doors, potential sources of harm and help.

If some one asked you questions about the street after each experience, what you could remember and report would be very different.

Our children’s experience is always the 2:00 a.m. scared experience. So we have to realize they may not be taking in a lot of what is around them, especially sources of pleasure, opportunities for growth, and things to learn. Our best help to them is to provide safety and to soothe, to help calm the activated nervous system. Only then will it be useful to point out positive and joyful aspects of life, and draw them slowly into an experience that includes more than survival.

Manipulation

We often refer to the clients we serve as “manipulative”. We say: “she’s just being manipulative” in response to a superficial cutting episode. We speak of “splitting staff” as a type of manipulation when a client asks a second staff when he doesn’t like the answer the first staff gave him. We describe a client as a “manipulative” person when we feel that she often tries to get her needs met in indirect ways. This term is judgmental and pejorative, dismisses the client and distances us from them.

Risking Connection ® (www.riskingconnection.org ) states that: “Manipulative” is a word we use to describe behaviors whose intent is to persuade or compel other people to act using indirect or devious means. It is a learned skill.

We all use manipulation. A staff member wants a second cookie, and waits until the food service director is out of the room to ask the soft-hearted server who always says yes: that is being manipulative. If an employee considers how to describe an issue to her boss to present it in the best possible light, that is manipulative. Being manipulative is described as having good social skills when you do it well. Doing it well seems to involve some sense of knowing when it is okay and when it becomes too much, knowing when to stop, knowing the limits, understanding and caring about your effect on the other person, and combining a small amount of manipulative communication with a large amount of direct communication.

Yet, something is going wrong between the “manipulative” kids and the adults who are reacting to them. What is it, and what do we need to teach them?

Why would a traumatized child find it difficult to ask for what he needs directly? Asking for what you need is risky. You feel vulnerable. It has rarely worked before. You may have been hit, ridiculed, or ignored when you tried to get your needs met. You may also have lived in congregate care settings where life is regulated and very few individual needs are met, where the answer is usually “no”. You may have learned indirect methods of getting people to do things as a life survival skill- literally, something you needed to know in order to stay alive.

So one step towards helping a child do less indirect, dishonest communication is to say yes. If the child lives in a place in which individual needs and wants and preferences are legitimate, are taken seriously, and are met whenever possible, she will gradually trust enough to ask directly for what she wants.

In order to create such an environment we must start with the assumption that whatever the child wants is legitimate and important to them. If they are trying to get extra minutes on the phone- why? Maybe because having been cut off from everyone they know and love, their friends have become the only family they have. If they are trying to get attention, why? Because we all need attention to survive, and in times of distress or danger (which are these children’s whole lives) we need more attention.

Another step is to share with the child from our hearts (in a regulated way) how we feel when we are tricked, how it affects our relationship and our trust, and how it affects our interest in giving them what they want.

And then we have to teach the actual skills of asking for what one needs in a direct, clear way. The child has not seen this modeled. DBT (www.behavioraltech.com ) offers some great skills training in this area in the module “Interpersonal Effectiveness”. Another way to teach this is to model it ourselves- not say to the children: “you need to quiet down” but instead to say “Could you please quiet down because I cannot think while you are yelling.”

A child will be able to become more direct in their communication when they feel safe, feel that their needs and wishes are respected, when they learn the skills, and when the experience the adults they care about communicating directly. We can use our feelings of anger at being tricked as a sign that we have more work to do in these areas.

A Week of Miracles

This was the week that school ended, and because there were many awards and celebrations, it became the week of miracles.

A nine year old boy who has such terrible aggressive outbursts in the morning got an award for most improved reading as he has actually learned to read this year.

A shy and social uneasy girl got a drama award for her small part in the Wizard of Oz which represented such courage on her part.

Tabitha is thirteen year old girl with no active family connections. When she came to us she was entrenched in a pattern of running away to the most self destructive and dangerous situations she could find. She had already endangered her health and her life. She hasn’t run for several months now, and is even beginning to express doubts as to whether the 30-year-old man she met up with “really loves her”. She has a new relationship with a boy her own age. She received three school awards, including most improved in her class.

Then there is Mark. His background included some of the most horrific abuse I have ever heard. He came to us at fourteen so primitive, eating with his hands, unable to handle bathroom and self care, socially inept, demanding and aggressive. Yesterday he received the Principal‘s Award! He is helping younger kids, working in the vocational program, and learning computer skills.

Of our four high school graduates, two were kids we didn't even think we could keep at various points. I have written about Sandra and Rob previously in this blog. Another child has lived three quarters of his life in residential, and had no sense of autonomy and no ability to make choices. Now he is an assistant to the PE teacher and may have found a vocational direction. Bob has a history of problem sexual behavior, and has grown partially through participating in the Poetry Club.

These children changed and grew because they were able to relax. They grew through developing trusting relationships, through being noticed and validated. They changed because the gradually shared their hearts, their fears, their dreams, and they were met with encouragement and understanding. The structure and safety around them were essential. People- staff, therapist, teacher- engaging them around their behaviors and emotions was an expression of caring that drew them out of their isolation. In some cases the family work played a huge part in the child’s recovery.

We all had tears in our eyes and new sense of hope and commitment in our hearts

Of course, some other younger kids, dysregulated by the end of school with its losses and changes in the routines, had a big crisis in the afternoon, lest we think we could spend our whole day resting on our laurels. But some of them had received awards as well, and although they had a bad afternoon, the healing has begun.

True Words from a Parent

I subscribe to a list serve for parents of attachment challenged children (http://groups.yahoo.com/group/DailyParentingReflections/) who are trying to implement Bryan Post’s method of parenting (http://www.beyondconsequences.com/)

A mother named Mia had these important words to help us understand the experiences of these children:
“I used to try and figure out what my daughter was afraid of but I have come to realize that the real problem lies in the way her brain learned to react to stress a long time ago. Because her stress level was severe at a very young age she learned things like: people cause pain, people that come in and out of a room cause pain, noise in the room means more pain, an open door means more pain, raised voices means pain, women mean pain and aren't safe, the world isn't safe, I'm not safe anywhere... etc.

So I have learned that even when I can't always figure out what is stressing her, she is reacting to something I don't recognize as stressful and she reacts in a different way than I do. She is on high alert and is in a fight for her life. Little things (to me) put her in survival mode. She can't help it. The connections in her brain were formed before she was able to make a safe and secure bond with a parent. The challenge is to heal her brain and make new connections. That is a very big challenge and something that isn't coming easily. To change pathways in the brain, is it even possible? I certainly hope so. We need knowledge and strength for such a challenge.”

I hope we can keep this description in mind as we open our hearts to the children we treat.

Earning Everything

Another phrase that is common in our work is that the kids should “earn privileges”. Many activities, events, later bed times, TV time, use of games, and special treats are earned. This is another part of our thinking that has to change.

Like many aspects of our current system this started as a good idea. The plan was to motivate the children to behave better by showing them that positive behavior led to better things in life than negative behavior. Of course, they probably already knew that, and if they could have changed their behavior they would have.

We don’t have to earn all our positive experiences, thank heavens. We can watch TV whether or not we have been “good” that day. We can stay up as late as we want, or go on a trip. Of course it could be said that we do earn these things by being productive citizens and by making money, but we are not evaluated minute-by-minute as to whether we have earned the right to have fun.

Children should get many things just because they are alive and they are people. These should include many types of fun, treats, extras, and playful times.

We would be better served to look at our children’s problems through the analogy of a physical ailment. Suppose a child named Bob was in a car accident (not his fault- he was in the back seat, just along for the ride). Both his legs were multiply broken. Now he is in a rehab facility and is learning to walk again. Bob is receiving physical therapy, medications, a doctor’s care, and the help of a social worker for the emotional effects of the accident.

The treatment team knows that Bob’s recovery will be slow, involve many ups and downs, and will require effort and patience on their parts and on Bob’s. They do not assume that Bob could just walk better if he wanted to. They do not intervene primarily by setting up rewards for walking long distances and punishments for falling down.

They structure Bob’s day carefully. They encourage him to walk short distances at first, between bars, and then always with someone with him to catch him if he falls. They break the activity of walking down into many little steps and teach them to him one by one. They praise effort, not results. They only expect him to do what they know he can currently do. The physical therapist does not tell Bob that because he falls when he tries to walk a long ways he is not allowed to go on a trip. If Bob needs to go somewhere that is further than he can currently walk, they get him a wheel chair. A trip might be just what he needs to have some fun and get some more hope and energy for his recovery.

They do offer much encouragement, and remind him what is at stake, and try to show him what will be possible as he learns more walking. But they do not make current enjoyment contingent on his daily progress, because they know his progress is affected by many things and is only partially within his control. They know that enjoyment, people who love him and encourage him, and a sense of the possibility of change will get him through the hard, discouraging effort of regaining what should be rightfully his.

Our children are as damaged by trauma as Bob was by his car accident. Their recovery is as slow and difficult and takes as much energy and patience. We should not make them earn activities and privileges. Instead we should provide whatever supports are possible to help them experience the delights of life. We should evaluate their current skills and invite them to do just a tiny bit more than they can currently do easily, with us there to catch them when they fall. With a combination of joy, relationships, and fun our children will have the hope and energy to continue their hard work of growing and changing.

Taking Responsibility

One phrase that is commonly heard in children’s treatment programs is: the children have to learn to take responsibility for their actions. This inevitably means, of course, taking responsibility for their mistakes and negative behaviors- although actually our kids don’t take much responsibility for the positive things they do either.

I’m in favor of taking responsibility for ones’ actions. It is part of working through mistakes that one makes. For example, recently when I forgot about a meeting and thus caused others to scramble around to get the work done, I felt it was important to admit I had messed up and apologize personally to the people I inconvenienced.

Yet when I hear this phrase I cringe because it usually seems to be associated with a punitive response in which we tell the children what they did wrong and they admit it.

Why do we imagine that kids deny what they did, blame others, claim extenuating circumstances? Is it actually because they do not know what they have done? Or is it because they are so ashamed, and feel so hopeless about their behavior that they can not bear to face it? Maybe denial is the only mechanism they know. Certainly they have not learned that one can make a mistake and then work it out- which is a very important skill in life. In the past mistakes may have led to abuse. In fact, in many cases physical abuse came randomly and it was in fact difficult to figure out which mistake had caused it- but the child is sure that they must have done something wrong.

When we punish children by isolation and restriction, does this increase the likelihood that they will take responsibility for their actions in the future? The idea of such systems is that as the child experiences consistently that punishments are associated with certain behaviors and rewards with others, they will make the link and learn to admit and understand their mistakes. Yet this ignores the role of shame. When a child is banished she feels hopeless and lost, and cannot bear to sit and think about what happened. So she may become even more entrenched in blaming others to lessen the pain.

In a Restorative Approach the child does some task in which he makes amends to the person or people his behavior impacted. During this task the child will get an emotional sense of how his behavior did affect the other, developing a deeper internal sense of responsibility. The teenage boy who was threatening to blow up the school has to go to the elementary classrooms and apologize and tell them he will not blow up the school. In doing so he can see that these little kids were actually scared by what he was doing- that his behavior mattered to them. And equally importantly, he learns that when he has messed up there is something he can do about it. He can reassure them. He can work it through. So, instead of feeling worse, more ashamed, and thus insisting more vehemently that it wasn’t his fault, he feels better, knowing that it was his fault, and that he has done something to fix it.

We can help our children learn that what they do does impact others, both positively and negatively. Through creating strong relationships we can help them learn to care whether they affect others. And we can teach them what we all practice every day- that you can make a mistake, the world doesn’t end, your relationships don’t end, and you can do something to make it better.

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

Socks and the Restorative Approach

I observed an interaction today that captured the Restorative Approach.

In the Main Hall outside my office door Cassidy, age 12, was yelling and swearing. She had burst out of the dining room and was agitated and upset.

A staff approached her and said: “what’s wrong?”

Cassidy yelled that she had not worn socks to school today, and now a boy was saying that she had stinky feet and that she smelled. Now no one was going to want to sit next to her and she would not have any friends ever again.

There were many educational and responsible things the staff could have said. She could have said “that’s why you have to wear socks” or “you have to stop swearing or get a fine” or “you are out of bounds now” or “you can’t let that boy upset you and you have to go back to the dining room” or “I’m sure it’s not that bad and you will still have friends”.

Instead, she said: “I can see how you would feel that way”.

Stop.

No: but you have to… you must… you will get….

Cassidy’s voice went down two decibels immediately. The next thing I heard the staff say was “I don’t think not wearing socks is really such a big deal. Look, I’m not wearing socks right now.”

After that I couldn’t hear them because they were talking in normal conversational tones. I think they were discussing how to get back to dinner and what to do about the rude boy. When I left to go home they were both eating.

I left with a feeling of pride from having seen the Restorative Approach in action.

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

What a Restorative Approach is NOT

I have the opportunity through Risking Connection training to meet many people in different agencies who are starting the switch to a trauma-informed treatment approach. At the beginning staff have many mistaken assumptions about what a relational model would mean. It is important that we address these directly.

A Restorative Approach does not mean no limits or rules. The adults are responsible to create a safe, orderly setting that maximizes the safety and success of the children. This means clear expectations, organized schedules, plenty to do, and immediate intervention when things start to go wrong. Unsafe behavior should be stopped. Restraints will some times be necessary (although less often). Children will need to be separated from each other or from the group at times.

A Restorative Approach does not mean that staff does not have or use authority. It means we use our authority honestly, directly, and with respect. We use our teams to make sure of our direction. We are in charge of the children, and responsible for their well being. We become the kind of authority that we appreciate in those that have authority over us. For example, we have supervisors who have the authority to correct our behavior at work. Yet it would be easy to describe both respectful and disrespectful ways they could exercise that authority. The same applies to our work with the children.

A Restorative Approach does not mean that staff ignore maladaptive behavior. It is one more form of neglect of these kids if we just ignore their behaviors because it is easier for us, or because we don’t know how to intervene. We must have the strength to be direct with them about what they are doing and how it is affecting us, others, the community. We do so in a context of our own self-awareness and emotional regulation. We engage with the kids in a respectful, collaborative manner that is based in our complete conviction that behaviors are adaptations and have been learned for self protection. And we know that the child needs to learn new, more effective behaviors.

A Restorative Approach does not mean that our prime intervention is constantly asking the child how they are feeling. It is rarely helpful to ask the kids how they are feeling. They usually don’t know unless it is obvious to us all (i.e. furious), and they react to the “therapy sounding” question. Instead we use the art of engagement, exploration, humor, distraction, looking for patterns, listening, repeating, until we and they discover what is going on.

A Restorative Approach is not something that can only be employed when everything is calm and we have plenty of time. If that were the case, it wouldn’t be much use in residential treatment. Whether we are intervening in a crisis, whether we have to fill out a form for external requirements, whether we are in a hurry and only have ten minutes, we can still be respectful and collaborative with the children. We can be honest and share directly what our constraints are. We can speak from our hearts. We can convey our certainty that the child is doing the best she can, and that together we can learn ways to do better.

As we explore the misconceptions about the Restorative Approach and learn what it is not we will have a better ability to discover and practice what it actually is.

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

Further Thoughts on Shame

Shame is a central concept in understanding the traumatized children with whom we work. Our work becomes more sensitive and thoughtful when we remain aware of the profound shame operating in our children, and remember how it affects everything they do.

When I was training with Laurie Pearlman, Ph.D. (Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors; written with Karen W. Saakvitne, Ph.D.; and http://www.heal-reconcile-rwanda.org/) last week, she added some further thoughts on shame.

The first concept is that the opposite of shame is contempt. Or, to put this another way, contempt is the escape from shame. When a person feels unbearable shame, he lessens the anguish by moving into contempt: I feel less horrible in comparison to you if I can act as though you are worthless, beneath my notice, not worth caring about. If you can be made contemptible, I will feel relatively all right. Therefore, if we do not address the shame, the children may treat us with contempt.

Laurie also quoted Donald Beere (http://home.insightbb.com/~donaldbeere-phd/index.htm) as describing shame as composed of two parts: being disconnected and being less than. A person feeling shame feels separate from the human race. I am other, I am uniquely bad and unlovable. And the person feels not only separate, but less, worthless, lower.

It follows from this that shame can be healed in two ways (preferably both). The first is to establish the connection- you are like us, you are part of us, we care about you, keep our caring in your heart even when we are not physically with you. All the methods we know to form, honor, intensify and internalize relationships address this part of shame- the disconnected part.

The “less than” part can be healed through any development of competence and self worth, and also by information. We give information about trauma and its effects, for example. Your symptoms are not signs that you are crazy, they are the expected human reaction to trauma.

Isolation, restrictions, and banishment would seem almost designed to reinforce both aspects of shame- separate the child from connection, and re-affirm for him through punishment that he is definitely less than others.

If shame is not healed, the person continues to act to prove how awful they are, and continues to reject caring and closeness as impossible to achieve.

Both parts of shame are healed through authentic relationships.

They Are Us

Last week I was honored to do a Risking Connection (RC) training with one of the original authors of the curriculum, Laurie Ann Pearlman, Ph.D. Laurie is an internationally known expert in trauma and vicarious traumatization, and her book: Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy With Incest Survivors written with Karen W. Saakvitne, Ph.D. (another Risking Connection author) contains the theory behind the RC curriculum and elaborates the content. (http://www.amazon.com/gp/product/0393701832/qid=1148758585/sr=1-2/ref=sr_1_2/102-3747173-8619359?s=books&v=glance&n=283155)
Laurie also works in Rwanda helping to heal the trauma caused by genocide in that country, and details of her work there can be found at: http://www.heal-reconcile-rwanda.org/

Laurie speaks eloquently on the subject of vicarious traumatization, an inevitable result of doing treatment with trauma survivors with an open heart. VT is defined as the negative changes in us that occur over time as a result of doing this work. RC emphasizes awareness of VT, and that the practitioner has an ethical imperative to monitor and address VT symptoms in his/herself in order to maintain hope and connection for the clients.

As Laurie spoke of what we can do to minimize and heal VT in ourselves I was struck in a new way that what we need is exactly what we are saying our clients need. Treaters need respect- the audience responded so powerfully to the acknowledgement of the effect the work has on them. We need information- that VT is inevitable, it is normal, it is not our fault or the fault of the client, that it can be minimized, addressed and transformed. Information is also important because when we have a theoretical treatment approach, a map, a strategy, we do not feel as lost and overwhelmed. We need connection- to have a community at work and at home that we can talk to, with whom we can share the pain and the triumphs, and who will not judge us. And we need hope- to know that abuse survivors do heal, and treaters do endure and in fact grow and thrive in the profession.

Suppose I suggested that as agency staff we would benefit from a reward system that gave us extra privileges (later bedtimes, more status) whenever we addressed our VT pain. The system would also punish us by banishment and restriction when the pain over came us and we did a VT behavior such as over-eating, or zoning out in front of the TV, or being less than responsive to a client. Maybe there would be some short-term gain in such a system. But do any of us feel that would be the most powerful way to help us overcome our vicarious traumatization?

We know so deeply what we need, and what we respond to. Why is it so hard to imagine that our clients need exactly these same things?

I Statements

Recently someone asked me whether it was really a good idea to encourage staff to speak about their own emotions when talking with the kids. We encourage staff to speak from the heart, and to use I statements. Examples would be: “when you ran away, I was so worried about you. I couldn’t sleep because I worried that something bad would happen to you.” Or, “You just hit me. I am not ready to give you a hug. I feel hurt and upset right now. I’m sure we can work this through later but right now I need some time to calm down before I can reconnect with you.”

What are the objections to this approach? People worry that staff will be emotionally out of control, and will be too intense/vehement/dysregulated in their response to the kids. Will the staff be using the kids to meet their own emotional needs? Will the staff emotion be overwhelming to the kids? Will the staff forget that they are the professionals and being paid for the work?

And there is also some concern that staff expressing distress, hurt, worry or other personal reactions will interfere with giving the kids unconditional positive regard.

In my experience, staff members’ emotional reaction to being hit, kicked, bitten, to the kids being mean to them, to the kids running away, is always a part of what is happening in the treatment. If staff has no direct way to express those emotions they will act them out, through excessive harshness, through distance, through over-involvement. And no one ever feels unconditionally positive about anyone, and it is dishonest to act as though a staff feels completely positive about a child who has just physically hurt them. Better to have the real feelings in the open in a controlled way, to be worked through and transformed.

But even more importantly, children learn emotional regulation through relationships with emotionally regulated adults. How better can a child learn what to do when something goes wrong, than through a close connection with a staff member who is deeply affected by an event, but then mends the relationship? Authentic relationships are the source of healing. How can a relationship be authentic if one person is not allowed to make I statements?

There is always the possibility that there will be emotionally dysregulated staff, staff with poor boundaries, staff with over-intense reactions either positive or negative. That is true no matter what system you use, no matter what instructions you give them. This becomes first of all a team issue, because a well functioning team will allow staff to confront each other directly on such matters. It also becomes a supervision issue to be handled directly and vigorously by the unit manager.

If we don’t trust the staff to have real, straightforward relationships with the kids, how can we leave the kids in their care? We have to teach people how to speak from their hearts, while maintaining good boundaries and emotional regulation. If we do not do this, we lose the most powerful tool we have: ourselves. We rob the kids of the reparative experience of good, flexible, calm relationships.

Rob and Jonathan

When Rob came to us, he was extremely aggressive. He assaulted staff, got arrested, broke things, and repeatedly lost control. We were not at all sure we could continue to treat him. Rob’s mother had placed him at Klingberg and said she did not want to see him again. His dad was initially involved, but then got caught up in his own life difficulties and became less available to Rob. His mother, however, gradually started limited visiting and contact, and then began participating in therapy.

After much time, Rob told his therapist that he had always felt he wanted to be a girl. He stated that he prefers women’s clothes and that he wanted to get an operation to become female.

Rob entered a period of experimenting with women’s dress, a little at a time. He would try something such as a female blouse, and then stay with male clothes for a while. He spoke in group and in family therapy of these feelings. At times he felt great urgency and demanded to have an operation that afternoon. At other times, he was not so sure.

As Rob became more blatant in his female dressing, and started wearing a female wig at times, many staff reacted. Some felt we should forbid this, that it was wrong. Others felt compassion for the struggle this young person was experiencing.

The kids by in large were supportive to him. He had shared his feelings with them, and he is well liked. The kids can be amazingly kind and tolerant to each other when it comes to important issues.

Jonathan, however, was back from the hospital. Jonathan has always been mean to others, especially anyone he sees as vulnerable or anyone who makes him uneasy about himself. He does not know another way. So he started saying nasty things to Rob, and tried to rile the other kids up against him. They weren’t buying it. So Jon went over and pulled Rob’s wig off. Rob hit him.

In the old days, punishment would set in. Rob would receive restrictions for assault, Jon for instigating. Both would be in their rooms for long periods of time. The restrictions would eventually be over, and both would emerge angrier than ever and more sure than ever that the other was alien, and evil.

Yet what a learning opportunity for both boys! Jon has to develop ways to handle people who make him uneasy without such meanness. Rob may face hazing and even people touching him throughout his days if he continues in this path.

So, Jon sat down with his therapist and wrote up a list of questions to help him understand Rob better. They included: why do you want to dress like a girl, have you always felt this way, why did you react as you did, etc. Rob answered the questions very seriously in writing. At the end of his answers Rob wrote: “Please feel free to ask me anything else you want to know about this. I will answer any questions if you ask them respectfully.”

Jon is still uneasy about Rob dressing as a girl, and thinks he is weird. But he can see Rob as a person with a struggle. Rob doesn’t exactly like Jon, and he also knows that many people will react to the choices he is making. And he can understand their confusion.

Both boys have emerged from this event wiser, and with just a little more skill in handling the many difficulties life will give them.

Self Capacities

Risking Connection (www.riskingconnection.com ). is a foundational trauma theory course. The basic premises are that symptoms are adaptive, and that they are best healed within a RICH relationship (one containing Respect, Information, Connection and Hope). The underlying trauma framework is that:
Childhood traumatic experience(s) lead to traumatized development, which includes disrupted attachments, a sensitized nervous system, and impaired self-capacities. These self capacities are: inner connection, self worth, and feelings management. When the youth encounters a current stress, he or she experiences an intolerable emotional state. He only knows negative/extreme coping strategies. We call these coping strategies symptoms. They include: retreat, self-destruction and other-destruction.

The only path to decreasing these symptoms, preventing crisis, and helping the youth to have a life worth living is to increase the self capacities. The youth must learn how to keep a sense of a loving connection to others even when the other is not physically present. She must develop a sense that she is worthwhile and deserves to be alive. And she must learn feelings management skills.

So when a child has had a behavioral problem, how can our response help him develop these capacities? Our first step would be (in advance of a crisis) to assess which of the skills he particularly lacks (many of our clients do not have any of them), and which skill deficits tend to lead to the most problematic behavior.

Then our Restoration for the behavioral issue can focus on activities that develop these skills.

To develop a sense of a loving connection, the child could: write a list of people who love her, collect affirmations from people and put in a box to read in times of difficulty, make a poster of pictures of people or magazine pictures that remind them of positive people in their life, or chose a staff member she likes and interview him or her and write a magazine article about them.

To increase their sense of being worth while, a child could make something or cook something. He could make a list of his skills and his accomplishments with staff. He could do something for others- read to the younger children, collect food for a food pantry.

To learn feelings management skills a child can utilize a feelings chart or thermometer. She could make posters to explore her feelings. She could do a chain analysis. She could practice relaxation techniques, make a list of distraction activities, or create a crisis kit.

Children will change and grow when they master the skills they missed during their development, and thus become able to survive life stress and to make, keep and remember loving relationships.

Books and Resources

I have been reading the book Creating the Capacity for Attachment by Arthur Becker-Weidman, Ph.D. and Deborah Shell, MA. This book further advances the theories we are working from, building on and expanding the ideas of Daniel Hughes, Ph.D. (Building the Bonds of Attachment). The book also gives two examples of using these theories in residential treatment centers: Villa Santa Maria in Santa Fe, New Mexico and Chaddock in Quincy, Illinois. The book is most helpful because it includes many specific examples, tips, techniques and practical suggestions. The author’s web site can be found at: http://www.center4familydevelop.com/.

I came to these authors through seeing Bryan Post at a workshop and being impressed by his teaching. B. Bryan Post, PhD, LCSW is the co-founder of the Beyond Consequences Institute, LLC. Dr. Post is the author of "For All Things A Season", "Dr. Post's New Family Revolution System", and co-author of "The Forever Child" series. He is an internationally recognized specialist in the treatment of emotional and behavioral disturbance in children and families. Dr. Post specializes in a holistic family-based treatment approach that addresses the underlying interactive dynamics of the entire family, a neurophysiologic process he refers to as, "The secret life of the family." As an adopted, and well-known disruptive child himself ("I've set fires, killed animals, and stolen compulsively."), Dr. Post has made it his primary work to speak to parents and professionals from a perspective of true-life experience and in the 'trenches' therapeutic work. More information can be found on Dr. Post and the Post Institute at: http://www.postinstitute.com/

I have also recently read Bryan Posts’ latest book: Beyond Consequences, Logic, and Control: A Love-Based Approach to Helping Attachment-Challenged Children With Severe Behaviors Heather Forbes, LCSW and B. Bryan Post, Ph.D., LCSW
http://www.beyondconsequences.com/. The main tenant of this book is that fear lies below all the acting out, difficult behavior of the children we treat. Therefore, the most effective interventions are those that identify and sooth the fear. This book also has many examples and specific techniques to address specific problems children may demonstrate.

Heather Forbes hosts an email listserve on which parents post for support and advice. It can be found at: http://groups.yahoo.com/group/DailyParentingReflections/

Conference Presentations and Training

We have been accepted to present our new methods in a workshop entitled: Creating a Culture of Connection: Transforming Residential Treatment for Severely Traumatized Children at the 11th International Conference on Violence, Abuse, and Trauma, scheduled for September 14-19, 2006 at the Town and Country Resort & Convention Center in San Diego, California. http://www.ivatcenters.org/. We have also been accepted to present at the Alliance for Children and Families 2006 National Conference. The 2006 National Conference will be held October 18-20 in St. Louis, Missouri at the Hyatt Regency, St. Louis at Union Station www.stlouis.hyatt.com. Contact Hillary Hanson with any questions. We appreciate these great honors and are looking forward to these events. We continue to get requests for training and consultation. At this time we have scheduled many Risking Connection trainings (www.riskingconnection.com) throughout the months of May and June.

We will be holding a 3-Day Basic Risking Connection Training July 12, 13 and 14, 2006 at Klingberg Family Centers in New Britain, CT. (www.klingberg.org) This training is open to any professionals who work with traumatized young people.

It is interesting and exciting to be participating in these trainings. Each time we meet new groups, talk over these approaches and connect with their concerns and fears it helps refine the theories and the practice.