Feeling Sorry For Her

A central assumption of our approach is that symptoms are adaptations- these kids are doing these crazy things for a reason. The problem behavior is a solution for the child. It is accomplishing something, getting the child’s needs met, in the short term, even though there are longer term negative consequences.

In order to practice this thinking, we give training participants a scenario:

Alexandra is a 14-year-old-girl who has a history of trauma and multiple separations from her mother. She has a history of self-injury and suicidality. She has been placed in this home for six months, and her foster mother has noticed that in the last month she’s been opening up to them in a new way that she has not before. Last week, it was announced that one of the other kids in the home was going to be leaving to go to a group home. This morning her mother observed that she was wearing long sleeves even though it was 90 degrees out. When her mother asked why, she told her to "f__off." She eventually revealed that she had been scratching herself with a paperclip.

We ask people to consider:
What are 2 or 3 hypotheses about how Alexandra’s self injury might be adaptive for Alexandra? What problem (s) might it solve, how might it help in the moment, even though it leads to negative consequences in the longer term?

And then to:
Choose one hypothesis. If this hypothesis was true, what are possible ways the foster mother might help Alexandra to solve that same problem with fewer negative consequences?

In a recent training that I did, people responded (as they often do) "she is doing it for attention". So why does Alexandra need attention? (She may be scared of opening up to the foster mom and then possibly losing her as the other child is going to.) Why doesn’t she ask directly for what she needs, or express her fear directly? (She doesn’t know how, she can’t be that vulnerable especially now when the relationship feels tenuous.)

One participant added: "she just wants the foster mother to feel sorry for her."

Do you agree that the phrase "feel sorry for her" connotes an illegitimate need, something that she shouldn’t want or need? Doesn’t it imply that she is trying to get some kind of unwarranted or excessive response?

Also, this phrase implies that we should resist feeling sorry for her- and by extension resist coddling her, fussing over her, or being sympathetic. Yet some cuddling and caring may be just what Alexandra needs.

Of course, there is every reason to feel sorry for Alexandra, or to feel sorry about what has happened to her. She has had a very difficult life, and terrible things have occurred that were not her fault. Her basic needs have not been met. She has not been safe. These experiences have changed the basic biology of her brain. Her life has not included much relaxation and fun. She has not been taught that she is worthwhile, special, and that people love her. She has not been shown the feelings management skills she needs for life.

Yet when we say "she wants us to feel sorry for her" we are forgetting that Alexandra is doing the best she can, that her fears and needs are legitimate to her, and that she is using the only means she has to meet them. She will only be able to change when she feels safety within a committed relationship, and when she gradually learns new skills.

Although using the phrase "feeling sorry for her" seems like a small thing, it is important to stop and challenge ourselves. This phrase can lead to an entire attitude that will infect our response to the child and interfere with her healing.

Was He In Control?

Luke and Jason ran away last night. But they didn’t go far- they broke into the school and destroyed the kitchen. They broke several appliances, wrote mean things on the walls, and dirtied the place.

As staff discussed this incident one question that came up was: were the boys in control of their actions?

This often seems to be a key question for staff. It has many ramifications as to how they feel the incident should be handled. Although people do not articulate their assumptions, I think that they are:

The more we decide that a kid is "in control" the more we feel we should respond with punishment.

The more we think the kid is not in control, the more we can be understanding and respond in a more "helping" or "treatment" way.

Our sense of how "in control" they are is based on factors like whether they generally are psychotic, whether they appear emotionally dysregulated, whether the act is an impulse or planned, etc.

I think this is a false dichotomy.

First of all, I think we can all identify acts which require planning, but in which the person is not in control- compulsive sexual or other addictive behavior for example.

There is also a moral component here. The "in control" side includes elements of being deliberate, doing this on purpose to hurt others, and slides rapidly into labeling the boy a bad kid.

But most importantly- I don’t think that saying a child is "in control" answers any questions or even changes the questions.

Let’s postulate that those two boys had total control of their actions, planned this event for weeks (although in fact they didn’t), and were not apparently dysregulated at any time.

The question still remains: why?

With all that control, why did they choose this particular action? How was it adaptive to them? What needs was it meeting? What message was it expressing? What kept them from meeting those needs or expressing that message in a more positive way?
I would still assume that their attachment disruptions, lack of consistent positive parenting and early trauma is relevant to the needs they are meeting and to their inability to meet those needs in other ways.

And, I would assert that the response does not change. What would make a child be less likely to consider trashing a kitchen? After all, most kids don’t. Why not?

I think that this behavior would be less likely if the child:

Felt loved
Cared about some people and did not want to disappoint them
Knew that others expected the best from him
Expected that adults would most often meet his needs
Felt hopeful
Cared about the people who would suffer from his actions
Even knew that people would suffer
Had a sense of a future, of goals and a trajectory towards them that seemed possible
Had some skills to manage sad, disappointed, scared and hopeless feelings
Felt that he was a good person who doesn’t do things like this
Had a sense of belonging to a community and being responsible to that community

How can we increase these things? Mostly in day-to-day life, before and after the behavior, through all our treatment strategies which honor and build relationships, help children internalize relationships, increase self worth, and create feelings management skills.

But in response to the behavior? Will punishment increase or decrease these feelings and life assumptions?

Restorative tasks, making amends, working with people to fix the damage, and looking at what was going on will increase the above protective attitudes.

And the question of whether or not the boys were in control will fade into insignificance.