The Process of Change

A cold and rainy weekend in March in New England provides us the opportunity to consider the process of change.
In nature, change never happens in a straight line. The seasons do not move from winter to spring through each day being one degree warmer than the day before. Instead, we have a warm day, and we notice buds on a tree. Then it snows. The crocuses come up, then the temperature drops and we wonder if they will survive. It’s very cold and raw, yet we see some skunk cabbage by the side of a river. We get discouraged, and say things to each other like "I am so done with winter. Is it ever going to warm up?"

Yet if we compare May to February, everything is different.

In February, if it is 45 degrees, we say: "A warm spell!!"

In May, if it is 45 degrees we say: "It is so cold!"

The parallels with our work are obvious. The children don’t get better each day in a clear progression. One day, Juan responds with kindness when another boy is upset. Staff make hopeful remarks to each other. The next day, Juan says something very mean to that same boy. Staff feel hopeless. Marcie has not had a restraint in months- maybe she is changing? Then she does and all feels lost.

Yet often when we compare this month to last year at this time, Marcie is substantially different. She is going to school and doing her work, and has not hit anyone in months.

We loose track of these changes. Now we complain with great intensity that Marcie is using a sarcastic tone when she speaks to us- forgetting that a year ago she would have hit us.

We have to learn to look for the snow drop in the snow, the red buds on the spring trees in the cold. Let’s rejoice in the warm day and point out the yellow willow to each other. When we see the small yet certain signs of change, we will have the strength to hang on through the raw days. Remembering to notice changes over time will help us celebrate the miraculous transformation we help our children achieve.

Emotional Intelligence and Trauma

I have just returned from the National Council annual conference. It was an excellent conference, very large. I enjoyed the keynote speakers especially: Howard Dean, Malcolm Gladwell, Geoffrey Canada, Lee Cokerell from Disney and others.

I attended a workshop given by Dr. Hendrie Weisinger about emotional intelligence at work. He quoted research that shows that emotional intelligence correlates much more highly with having a good life than any other measure, including IQ. He described the problems that bring people to therapy as failures in emotional intelligence. Therefore, we should be more deliberate in teaching EI skills to our clients. So, I wondered how the ideas of emotional intelligence interacted with our ideas about trauma.

Dr. Weisinger listed five key skills in emotional intelligence. They are:
1. Self awareness- processing information about yourself
2. Mood management- how quickly can you change your moods?
3. Self motivation- how can you get yourself to do things you don’t want to do
4. Interpersonal expertise-Build consensus, handle conflict, accept feed back, etc. Effectiveness in interpersonal emotional situations
5. Emotional mentoring

Self awareness is the key skill that is the foundation for all others- how can you be emotionally aware of others unless you are aware of yourself? This of course correlates with the skills of feelings management. I remember at the Bessel van der Kolk conference seeing evidence that the part of the brain that provides self awareness and self reflection is under developed in survivors of trauma.

In Risking Connection® training we read a letter written by a woman who grew up in the child welfare system. She describes eloquently how her repeated moves and continual re-defining by various families resulted in her not developing a sense of who she was and what her characteristics were. In short, she had no continuous self narrative.

So if self awareness is a key skill of a happy life and our clients are impaired in this area, what should we do? We should be consciously creating a narrative with the client. We should teach them self observation, including how to notice emotions in their bodies, patterns about themselves, awareness of their own strengths and weakness, a sense of their own skills and interests.

Mood management is also a key area of difficulty for our clients. Too much of their behavior is mood dependent- the child wants to be a lawyer, but because she discovered a stain on her shirt she is dropping out of school. At first we may have to support, cajole and help the kids in learning how to change their moods and to get through them without derailing. Hopefully they will improve in doing this on their own once they experience that it is possible.

Self motivation is another hard one. How do you get yourself to do things you don’t like to do? I usually promise myself a reward when it’s finished. Also, I picture other people who will be pleased. So I guess inner connection comes in here- being able to hold the awareness of someone who cares what you do, even when they are not physically present to help you complete the task. If we say to a child, let me know how that turns out, I will be waiting to hear from you, we are developing this skill.

Interpersonal expertise- how to defuse situations, handle conflict, work through differences, build consensus, accept feed back- of course this is a focus of much of our efforts. The Dialectical Behavioral Therapy skills manual by Marcia Linehan offers one excellent curriculum for teaching these skills.

Emotional mentoring means teaching others- and actually, we do see these among our clients when one gives another good advice. We can encourage this.

Strategies that Dr. Weisinger gave included:

1. Learn to listen to how you talk to yourself. Five minutes 3X/day listen to what you are saying to yourself- change your self talk
2. Write down three statements on a card that put you in a good mood, keep it handy
3. Use emotional self instruction. Create a learning aid. What would you want “Little You” to be whispering in your ear to help you manage the situation. Remind yourself that you have options.
4. Praise- write down behaviors you want more of in others, then praise when you see them (Imagine if we taught kids to do this with staff?)
5. Physical arousal- learn how to physically relax. Learn to notice when you are tense. Tension and relaxation exercise. Four components of relaxation exercise: Quiet environment; physically comfortable position; key image or phrase; passive attitude. (the quiet environment is hard to come by in some of our programs.)
6. Humor 10-14 good laughs a day- Get staff and kids together and have joke sessions
7. Can change our responses to difficult situations- the real problem is my own response. Then you can do something about it

It would be interesting to incorporate some of these strategies into our work.

Gloves and Lying

An example from a recent Risking Connections® training demonstrates simple, free interventions we can use to implement trauma informed care- and also demonstrates exactly how hard they are to do.
Juan constantly lies, according to the staff of his group home. He lies to avoid consequences or to avoid admitting he has done something wrong. He also tells lies about things that are happening in his life- such as that he has a girl friend in school. He doesn’t have a girlfriend! He makes up whole stories that simply are not true. For example, staff gave him some new gloves the other night to replace the pair he lost. Now tonight he is saying that he doesn’t have any gloves, that no one will ever give him any, and that none of the staff care if his hands are freezing off.

It is such a normal human response to argue with the truth of these assertions. You KNOW you gave him gloves Tuesday night. He has probably just lost them again or left them in school. Juan really has to learn to be more responsible! We don’t have enough money around here for an endless supply of gloves. And what is this story about a girl friend! You know from talking with his teacher that mostly Juan is a loner in school and has few friends. How is he going to manage life if he keeps lying? So it seems important to tell him that you know this is not the truth and how can you trust him if he keeps lying.

What is happening with Juan during these events?

His hands are cold and he cannot believe he cannot find his gloves again. He feels like such an idiot and a loser. No one likes him, no one cares about him, and no one should- who would want to be around such a jerk? He feels stupid and unloved, and plus his hands hurt. Saying no one has taken care of him enough to give him gloves expresses his emotional truth. Certainly he cannot admit to having lost the gloves again, then everyone will be mad at him, as usual.

What if staff IGNORED the truth/falsehood dimension of the situation and just reacted to the emotional and physical reality? What if Mark, Juan’s favorite staff, said- "Hey Juan I see you have no gloves, let’s find some you can wear." And when Juan said "No one ever gives me gloves" Mark could say "You’re feeling right now that no one cares enough about you to help you- so let me see what I can do to help you right this minute."

How hard would that be? Mark might feel that if he doesn’t confront the lie Juan will have put one over on him, or will never learn that it is not okay to lie, or will start telling more lies to get what he wants. He might feel that he needed to defend staff against Juan's charge of neglect, point out that staff have been responsive and would never let Juan go without gloves. But I would suggest that Juan will need to lie less when he develops a new view of the universe- that this world is a place where people will help you, where people care what you are feeling, where they do not shame and blame you. Only then would Juan be able to admit that he left his gloves at school.

And what about the girlfriend? Juan is desperately lonely at school and is sure he will never fit in there. He thinks none of the kids like him or ever could. Especially not the girls. So when he comes home he creates a new reality, life as he wishes it could be.

What if Mark were to reply: "wow it would sure be nice to have a girlfriend at school. What do you like in a girl, any way? What kind of girl would be the perfect girl friend for you?" and start a discussion of girlfriends in general. At some point Mark could ask, "If you wanted to make friends with a girl, what would be the first thing to do?" and start teaching social skills.

Note that Mark just side steps the true/not true question and again, reaches for the emotional reality. He doesn’t believe or challenge Juan’s story. He just turns it into a discussion of an important subject to Juan- girls. He avoids shaming Juan further (“Juan, I talked to your teacher an in fact you do not have a girlfriend”) which would just lead to Juan’s needing to lie even more.

What would it take for us to respond like this much of the time? When we are away from the situation in a training it all sounds like a good idea, yet in the pressure of real life we find ourselves reverting back to arguing about the lie. Time to think and plan, time to consider what needs the child is meeting, and to choose a more thoughtful and healing response are essential.

What do you think about the likelihood of this sort of response in your setting? Click on comment and let me know.

Connection in California

I received the following email on Friday afternoon. What a wonderful way to end a long and successful week!
Pat,

I wrote to you in May of 2009 and shared that I am a therapist in a Level 12 co-ed group home in San Luis Obispo California. We had recently changed our residential treatment program from a CBT based program to a Relationship Based model and we were having some growing pains. Since then we have made some tremendous growth, yet there are just a few things that keep us coming back to the table. Each time it does my thought is "what would Pat do," and more often than not due to the AMAZING blog you share we are able to work through the issue. ...

I have to say that is was an article that you wrote that finally helped change our program. For years I worked as line staff and was pleading to make some changes and then I found Pat and your blog. Thank you doesn't even express how much I appreciate, respect and admire you..you have started a movement toward healing these children. "Change your thoughts, you change your world." ...

And I want to leave you with this quick story...we have a young man who has been in our program almost two years. When he would get upset at times his coping skill would often be breaking the T.V. or other items the other kids enjoyed using. His response when given feedback by the kids or staff was to defend himself and say "I don't care." Within 3 months of us changing our program he sat in a group meeting with the other kids and said, "I know I broke the T.V. and I am working to fix it," he also had the other kids jump in to help him in that process. It was AMAZING!!!

Anna K. Yeackle, LMFT
Program Therapist
Transitions Mental Health Association
The Youth Treatment Program

Thank you Anna... people like you are the reason we continue our efforts to change the world.

Dr. Robert Davis to present on Benefits and Implementation of Trauma Informed Care

Risking Connection® faculty trainer Dr. Robert Davis to present on Benefits and Implementation of Trauma Informed Care at the Doctor Franklin Perkins School in Lancaster, Massachusetts.

This workshop will describe efforts to implement a trauma-informed approach to residential treatment and an on-campus school environment. Over a five-year period, this multifaceted initiative resulted in substantial reductions in both physical management episodes and staff injuries. Research in the area of trauma-informed practices within residential schools is still in its infancy.

Objectives:

1. Participants will learn about the national movement toward use of trauma-informed strategies.

2. Participants will learn about the benefits of training interdisciplinary staff in Risking

Connection®, an established curriculum for working with traumatized youth.

3. Participants will learn about numerous trauma-informed milieu and/or classroom approaches which can be integrated into existing evidence-based models of treatment.

4. Participants will learn about future directions in trauma treatment for youth, including

several body-based interventions.

5. Participants will learn ways to anticipate and overcome many of the institutional challenges of implementing trauma-informed treatment.

Presenter:

Robert Davis, Psy.D. Director of Clinical Services, Devereux Rutland, MA

Dr. Robert Davis has served as the Director of Clinical Services at Devereux as well as the Chief Psychologist of Devereux’s APPIC-approved Predoctoral Clinical Training Program. He also is a Faculty Trainer for the Risking Connection® Training Program for which he has trained multidisciplinary staff from congregate care settings throughout the country.

The workshop will be from 9:00 a.m. to 2:00 p.m. The cost is $45 for Members and $65 for Non-members. (Lunch is Included in registration fee).

To Register: copy this link into your web browser:

http://maaps.org/cde.cfm?event=300568

Deep Listening

One of the more difficult concepts which we teach is the power of listening. Such an old idea, so commonly taught, so rarely applied. In our training we have a section in which participants role play handling a crisis using a trauma informed approach. The most common problem is that people jump too quickly to offer solutions. They do not spend time to explore what the child is experiencing. In practice in our agency I hear the same thing. It is so tempting to offer advice, and so difficult to just stay with and share the other person’s pain.
We do this in spite of the fact that we ourselves do not like it when someone does this to us. What if I were to tell you that I was at my elderly father’s house last night, and I felt so tense about his deteriorating condition and what I should do that I ate two boxes of cookies? How would I feel if you responded: "Pat, there are better coping skills you can use. Next time you go there, bring some carrots." I actually might slap you. I would not even appreciate it if you told me about Visiting Nurse agencies in the area. Instead, what do I need? Some one to just say: "That sounds difficult. That must be very stressful for you."

Since I struggle to teach this is a way that people will remember it, I was struck when I recently read an interview of Thich Nhat Hanh by Oprah featured in O, The Oprah Magazine February 16, 2010. Thich Nhat Hanh has been a Buddhist monk for more than 60 years, as well as a teacher, writer, and vocal opponent of war—a stance that left him exiled from his native Vietnam for four decades. He speaks here of the incredible power of listening and not correcting:

"Oprah: The case is the same for deep listening, which I've heard you refer to.

Nhat Hanh: Deep listening is the kind of listening that can help relieve the suffering of another person. You can call it compassionate listening. You listen with only one purpose: to help him or her to empty his heart. Even if he says things that are full of wrong perceptions, full of bitterness, you are still capable of continuing to listen with compassion. Because you know that listening like that, you give that person a chance to suffer less. If you want to help him to correct his perception, you wait for another time. For now, you don't interrupt. You don't argue. If you do, he loses his chance. You just listen with compassion and help him to suffer less. One hour like that can bring transformation and healing.

Oprah: I love this idea of deep listening, because often when someone comes to you and wants to vent, it's so tempting to start giving advice. But if you allow the person just to let the feelings out, and then at another time come back with advice or comments, that person would experience a deeper healing. That's what you're saying.

Nhat Hanh: Yes. Deep listening helps us to recognize the existence of wrong perceptions in the other person and wrong perceptions in us. The other person has wrong perceptions about himself and about us. And we have wrong perceptions about ourselves and the other person. And that is the foundation for violence and conflict and war. The terrorists, they have the wrong perception. They believe that the other group is trying to destroy them as a religion, as a civilization. So they want to abolish us, to kill us before we can kill them. And the antiterrorist may think very much the same way—that these are terrorists and they are trying to eliminate us, so we have to eliminate them first. Both sides are motivated by fear, by anger, and by wrong perception. But wrong perceptions cannot be removed by guns and bombs. They should be removed by deep listening, compassionate listening, and loving space.

Oprah: The only way to end war is communication between people.

Nhat Hanh: Yes. We should be able to say this: "Dear friends, dear people, I know that you suffer. I have not understood enough of your difficulties and suffering. It's not our intention to make you suffer more. It is the opposite. We don't want you to suffer. But we don't know what to do and we might do the wrong thing if you don't help us to understand. So please tell us about your difficulties. I'm eager to learn, to understand." We have to have loving speech. And if we are honest, if we are true, they will open their hearts. Then we practice compassionate listening, and we can learn so much about our own perception and their perception. Only after that can we help remove wrong perception. That is the best way, the only way, to remove terrorism.

Oprah: But what you're saying also applies to difficulties between yourself and family members or friends. The principle is the same, no matter the conflict.

Nhat Hanh: Right. And peace negotiations should be conducted in that manner. When we come to the table, we shouldn't negotiate right away. We should spend time walking together, eating together, making acquaintance, telling each other about our own suffering, without blame or condemnation. It takes maybe one, two, three weeks to do that. And if communication and understanding are possible, negotiation will be easier. So if I am to organize a peace negotiation, I will organize it in that way.”
(Read the full interview at
http://www.oprah.com/spirit/Oprah-Talks-to-Thich-Nhat-Hanh)

So- Listening may be a path to world peace- and it is definitely the path through which we offer connection to our children and families. It can be painful, because it necessitates opening your heart to the sadness and suffering of the other person. But it is also healing, both to our clients and to our selves.

Transforming Resistance to Enthusiasm in MA

On April 6, 2010 (Tuesday) Steve Brown, PsyD. and Pat Wilcox, LCSW will be presenting at the Massachusetts Department of Mental Health Child & Adolescent Restraint/Seclusion Prevention Initiative Grand Rounds. Our topic will be: Transforming Resistance to Enthusiasm - Implementing Trauma-Informed Care. Trauma-informed care is an important element to the success of preventing restraint and seclusion use. This training will provide and understanding of how to implement trauma-informed care in child & adolescent settings. It will include an overview to the Risking Connections trauma training program, as well as the Restorative Approach which is a trauma- and relationship-based approach to treatment of children. The presentation will focus on the most effective transformation process for overcoming common staff concerns and changing resistance to enthusiasm.


The presentation will be held 9:00 AM – 12:00 PM, (Registration starting at 8:30AM) at the Lazare Auditorium of the UMass Medical School in Worcester, MA. The registration deadline is Monday, March 29th, 2010. To register please contact Annabelle Lim at Email: annabelle.lim@massmail.state.ma.us or Phone: 617.626.8087. An email confirmation with directions will be sent upon registration. CEU applications have been submitted for: Licensed Mental Health Counselors, Psychologists, Nurses, & Social Workers. Hope to see you there!