Current Activities

I’d like to update you on some of my activities and those of the Traumatic Stress Institute.

This past week I was honored to attend two activities that emerged from the Newtown tragedy. My boss Dr. Steve Girelli was one of the local experts chosen to be part of a panel at an event focusing on Gun Violence. The event was held at the campus of WestConn University in Danbury and the keynote speaker was Vice President Joe Biden. Many local politicians also participated including Senator Richard Blumenthal, Senator Chris Murphy and Representative Elizabeth Esty. Attending with Vice President Biden was U.S. Secretary of Education Arne Duncan. Newtown First Selectman E. Patricia Llodra was also present. The first panel focused on gun control, and some of the participants were Hartford Mayor Pedro Segarra; Lynn and Chris McDonnell, parents of Newtown victim Grace McDonnell, a first-grader; and Dale Hourigan, a state police captain and Newtown first-responder, Capt. Dale Hourigan of the Connecticut State Police and Dom Basile, an advocate for gun owners and safe storage. The second panel focused on mental health and school safety. In addition to Dr. Girelli there was Kathryn Seifert an author and psychologist and University of Connecticut professor George Sugai. It was very interesting and moving.

The following day I attended a conference sponsored by Connecticut NASW and the CT Schools of Social Work entitled: Social Workers Respond to Newtown. This involved a panel of speakers including Kenneth J. Doka, PhD is a Professor at The College of New Rochelle and Senior Consultant at The Hospice Foundation of America.  He provided an overview of “Coping with Public Tragedy” including a discussion of grief, the tasks and styles of grief, and what happens after the tragedy. Kathi Legare, LCSW founder of the Family Affirmation Center for Treatment in Vernon spoke on “Tools and Interventions for Working with Traumatized Children”, Joshua Miller, PhD, LICSW a Professor and Associate Dean at Smith College School for Social Work speaking on “The Use of Groups to Foster Resiliency in the Wake of a Tragic Disaster” and my friend  S. Megan Berthold, PhD, LCSW an Assistant Professor at the University of Connecticut School of Social Work and has over 20 years of experience as a clinician with survivors of trauma, war, and torture in different parts of the world who discussed “Attending to Our Own Vicarious Trauma: How to take care of ourselves as we treat the trauma of those in the community”. I was delighted to hear Risking Connection acknowledged by several speakers.

While we are on the subject of NASW, this coming Friday I will be presenting a day-long training for the new Clinical Solutions series. My topic is “Using the New Brain Science to Create More Effective Treatment.” There may be space left, check it out at http://www.naswct.org/. And I will also be presenting at the 28th Annual NASW/CT Statewide Conference April 19, 2013
Coco Key, Waterbury, CT. "Weaving Threads of Resilience and Advocacy: The Power of Social Work" Gary Bailey, MSW, ACSW, from Simmons College is scheduled to be the Keynote Speaker. I’ll be speaking with a co-worker, Rebecca Desautels, LCSW,  on Sustaining Trauma Informed Care through Supervision. That’s always a great conference, and you get to see a lot of old friends.

My co-worker Steve Brown took off today for a trip to the Yukon Territory in Canada. We are doing an exciting research project there, and Steve is also meeting with the leaders of various Yukon departments as they would like to expand the use of Risking Connection there.

I am heading out early tomorrow to Los Angeles California to do a two-day Restorative Approach training at Maryvale in Rosemead, California. This is my first time doing a two day RA which is based on my book, and I am very excited about it.

On Thursday, April 11, 2013 both Steve and I will present at the MASOC conference in Worchester, which is a premiere conference about treating adolescents with problem sexual behaviors. I’m doing a pre-conference half-day on the Restorative Approach Thursday and Steve is presenting on VT during the conference. Why not come- find out about it at http://www.masoc.net/conference-information.html.

Then later in April I will be presenting at the Professional Day March 21- 23, 2013
of the True Colors’ 20th Anniversary Conference: Celebrating our Heroes of the Past, Present & Future. It is held at the University of Connecticut, Storrs. I’m very honored to be part of this event.

We have quite a few more agency trainings set up. For our Associate Trainers we have a wonderful series of in person consult groups and webinars this year. The first one is on March 5^th on the subject of Brené Brown on Vulnerability and Shame: What Are Millions of Viewers So Excited About? I think this will lead to an important discussion.

In addition to all this, I am teaching a course at the UConn School of Social Work- a regular credit course. I really love doing it.

We are also continuing with our project of training people to train foster parents in Risking Connection. We held a training for our Associate Trainers who wanted to learn the new Foster Parent Curriculum. That was very successful, and there was a lot of enthusiasm about the material. Out next step will be to hold a training for people who are not yet RC trainers, but who would like to be specifically trained to teach foster parents. It will be required that participants have attended a Risking Connection basic training. This will be in New Britain probably in late May. Let us know if you are interested by emailing Marci at marcim@klingberg.org.

This seems like a lot, doesn’t it? And that’s not everything. But it is fun! Please attend one of these events, and come up and introduce yourself to me. I’d love to meet you!

Brain Based Social Work

Those who know me or who have been following this blog know that I am interested in the works of Bruce Perry and the neurosequential development of the brain. I believe that if we take his work seriously it could lead to a reveoution in the helping programs. To over-simplify, I believe that our most important task is to teach the child through experience that people cen be associated with pleasure. Then we also have to support brain development, offering that youth as many experiences as possible to promote his brain catching up to where it should be. This has all sort of ramifications.

So what do we actually do? I am giving a seminar for CT NASW: Using the New Brain Science to Create More Effective Treatment
Friday, March 1, 2013 - 9:00AM to 4:30 PM
(http://www.naswct.org/ to register, hope to see you there), and in my preparation I decided to make a list of brain based interventions. This list is not complete by any means but it might be enough to start you thinking,

 

Brain Based Social Work

1.      With children and Youth

a.      Evaluation of brain capabilities

b.      Evaluation of verbal abilities

c.       Individualize approach to treatment

d.      Concentrate on positive interactions

e.      Use rhythm

                                                              i.      Walking

                                                            ii.      Rocking

                                                          iii.      Hand games

                                                           iv.      Throwing ball back and forth

                                                             v.      Use OT materials like large ball, mats  

f.        Emphasize narrative

                                                              i.      Journals back and forth

g.      Art

h.      Rythmic non verbal interaction when beginning to escalate

i.        Music and dance

j.        Sensory interventions

k.       Cooperative games

l.        Specifically inquire about safety

m.    Create opportunities for effective action

2.      With Families

a.      Playing together in session

b.      Project Joy

c.       Psycho-education

d.      Teach narrative, reading, etc.

e.      Sharing of skills

f.        Own trauma historie

3.      With adult clients

a.      Opportunities for motion

                                                              i.      Rocking chair

                                                            ii.      walks

b.      Sensory interventions

c.       Activity groups

d.      Cooking

e.      Parenting

4.  Specifically inquire about safety

g.      Create opportunities for effective action

h.      Create own narrative

i.        Not just trauma

j.        Teaching skill

k.       Effect of trauma on parenting

4.      As a supervisor

1.      Prioritize supervision

2.      Teach awareness and use of own feelings

3.      Celebrate success

4.      Hiring and promotions

5.      Awareness of VT

6.      Self and other care

7.      Notice and reward uses of brain-based thinking

8.      Acknowledge and troubleshoot obstacles

9.      Specific action on resistance

10.  Cultivate mindfulness

5.      As an administrator

1.      Enthusiastically support trauma informed care

2.      Clear vision of whyyou are making this change

3.      Measure results and share

4.      Resist  off over-using people

5.      Provide time to talk and think

6.      Promote inclusion of families

7.      Emphasize supervision and provide time for it

8.      Celebrate success

9.      Pay attention

10.  Acknowledge VT

 

So, what do you think? Do you have more examples? Click on#comment# and share them.

 

 

 

 

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Evolution in Thinking

Long post- please read and comment.

I would like to write about the way my thinking has changed over time about what we like to call “behavior management”, I am referring to treatment programs in which, in addition to providing treatment, staff have to respond to behavior that hurts others. The idea hopefully is that we respond in a way that helps the youth decrease such behaviors. This applies to any group care program, such as a hospital, a residential, a day program, a special ed school, an after school program…in short, many programs.

First of all, I wonder if we could invent another term. What could we call our attempt to change behavior in the day-to-day setting: behavior support? Learning to be kinder? Any thoughts?

Anyway, once upon a time I worked in a traditional points and levels residential treatment program. In fact, when I first got there it had points, level, phases, and many punishments. The most severe was called “Sub” level because it was below all the other levels. As I recall it involved spending days in a small room without stimulation. The kids were supposed to be thinking about what they did wrong and how they could do better. They weren’t.

I began to have thoughts about this being a bad plan. One of many issues was that when one kid hurt another kid, the victim looked to staff to punish the hurter. No learning what so ever about how to work things out with each other. And we were punishing the kids by ordering them to do things they couldn’t do, like stay in their room quietly for hours. When they popped out trying to re-engage staff, we would order them back in and restart their time. It was the whack-a-mole method of discipline.

We were telling the kids what not to do, but we were not teaching them what to do instead. We struggled to consider things like the function of behavior.

Even in those dark ages, we had wonderful staff who cared about the kids and who formed strong relationships with them. But this was harder when you had to rate their points every half an hour, which took quite a bit of time. And like every place else, we had our own elaborate jargon, which the kids picked up quickly. The behavior management system became the way we talked. Instead of asking “how was your day?” we asked “How many points did you earn today?” When a child became agitated, staff would often react by telling them the consequences that would occur if they kept that up or got worse. They would not ask what was going on. We were embarrassed when we told an outside consultant that our kids earned up to 180 points in school, and he said “You do know that Marcus can only count to 8?” Consistency was highly praised, although rarely achieved. There was no room for individualization.

My colleague Leeora Netter and I, as well as some other Klingberg staff, began to learn about attachment and trauma. We discovered and learned from Daniel Hughes. We knew that what we were doing was not sufficiently healing. And yet everyone was doing some version of the same thing. We had no idea what to do instead.

A neighboring treatment center, Wellspring in Bethlehem CT gave us our first glimpses of alternatives. They gave us ideas as to how to include making amends and learning skills into our responses. They served a different population, so we had to modify their methods, but they were invaluable in getting us started.

So, we began to invent a system that responded to behavior that hurt others in a new way. We wanted to incorporate the concept of making amends from the Restorative Justice movement. We wanted to include skill building, and incorporate an understanding that the kids were doing these things for a reason. In the lives of the clients there had been trauma, attachment disruptions, and neglect and we wanted to understand how that history influenced current actions. We felt our responses had to be individualized. We tried to get away from time-based restrictions and move towards restrictions that ended when a child had made amends and was cooperating with the program. We called our new system the Restorative Approach©.

This was a hard sell. Staff were sure that chaos would break out as soon as we lifted long punishments.

I made a huge book of worksheets and tasks, organized by type and origin of problems. We needed concrete tasks to replace our punishments. This led to kids basically being sent to their rooms to do worksheets. They were allowed to “work off” their earned punishment time by doing tasks. But the tasks had to take as long as the punishment would have. I began to see that the tasks were being used as punishments in disguise. Staff without realizing it believed that the tasks would work by being aversive, the way punishments do. That was not how it is supposed to be.

We were lucky enough to encounter the Risking Connectionâ foundational trauma training. This gave us the language and theory that we needed behind the Restorative Approach. I now believe that it is very hard if not impossible to implement a new way of acting in the day-to-day program without extensive teaching of theory. It is hard enough to make this change. Without changing how you understand the behavior, it is impossible.

Later we became a training center for Risking Connection. Gradually this way of thinking made more and more inroads into our daily life. There were so many ups and downs- but that is another story. But mostly when I heard a kid yelling in the front hall I would NOT hear someone say “you are earning out of bounds time and won’t be able to…” Instead I would hear them say:”What’s wrong?”

So at this point I was advocating that when a youth did something that hurt others, we assign them a restorative task. I suggested that the task contain two elements. One was the learning element. This was supposed to help them explore anything about the behavior, with the idea of helping them learn not to do it again. I had a lot of ideas for this, from research, to role plays, to interviewing others how they handle similar dilemmas, etc. The second part was the making amends part. That involved figuring out whose life they had made more difficult and do something to make their life easier. Here, too, we had a list of suggestions. The underlying idea of making amends was to teach the youth that if they hurt a relationship, it could be mended. They did not have to give up.

It is important that the response should arise from the case formulation. What had happened to this child? How did we understand his current behavior? What did we think was needed in order for him to change? And furthermore, that the response had to be individualized, based on each child’s needs and abilities.

As I trained treatment centers and people began to implement the Restorative Approach, some problems began to emerge. Most people saw the tasks as punishments in disguise. The kids would get task after task, and end up feeling as hopeless as they did with previous punishing systems. People often assigned tasks in a perfunctory way, using standard worksheets that had no relation to the child or her actions, or having everyone make a card for the person they hurt and apologize. The idea of the tasks having meaning was being lost.

Then, in a conference, I experienced an a-ha moment. After I presented on the Restorative Approach, a woman asked for my help. She said: “We have a girl in our program, Andrea, who is incredibly mean to others. She always says just the perfect thing to really hurt someone’s feelings. We don’t know what kind of Restorative Tasks to give her. We assigned her to research Martin Luther King Jr. and do an essay about him, because we thought he would be a good model for her. She did a very nice job on the essay. But she is just as mean as ever.”

That made me stop and think. We have to go back to our theory of behavior and our theory of change. Why do we think that Andrea is being mean to others? I don’t know her, but I will guess that it is because she feels horrible about herself, and wants to share that with others; and that people have always hurt her, she has not had any good friends, and so she has developed a self-protective strategy to strike first.

So what does this essay about Martin Luther King Jr. do for Andrea? This is exactly the sort of intervention I had been recommending, but I now feel that it misses the point. The essay teaches her that there are people who are good to others, and they can have a profound influence. But if Andrea takes this in at all, I doubt that she relates it to herself. If anything, it would probably be: “I wish I were a good person like Martin Luther King, but instead I am a rotten nasty person.”

Now I feel that our intervention has to be more complicated. If we have a theory that Andrea is being mean to others because people have been mean to her; is hurting others because she has been repeatedly hurt; is protecting herself from further pain, and is sure she cannot ever have real friends, what would the antidote be? It would be to be good to Andrea, to help her discover her own worth, to support her in positive friendships, and to give her experiences that show her (with repetition over time) that people can be kind.

What! My audience would say. Respond to her meanness with kindness? How is she ever going to know that you can’t just do this in the real world? She will get beaten up if she continues to act like this. When will she being to take responsibility for her behaviors?

Not only is this new thinking counter-intuitive, it is harder. Andrea would have to learn skills, and we would have to teach them to her. How do you make a friend? What can you say to people that isn’t mean? What is she good at, in which she can lead or teach others?

So am I saying that we ignore her meanness? Sometimes that might be a good idea. But when possible people can also speak from their hearts and say “that hurt my feelings, Andrea. I am much happier when we are having fun together so do you want to go for a walk?” Andrea’s mean comments are a sign that she is dysregulated, that she is scared. If adults can move closer to her at these times, be more affectionate, they will help her learn to regulate her emotions and not spiral far into her fear.

Another evolution in my thinking is coming to see fear everywhere. When our kids attack, insult, damage property, run away, they are afraid. They are confused and overwhelmed. They have no feelings management skills or trusted relationships to help manage their feelings. So they fall into deep pits of hopelessness. These symptoms are their way to climb out.

Another a-ha moment came when I was training at an agency, and during a kids pickup basketball game one boy was taunting another. The victim hit the taunter. (I wrote about this incident on 7/2/11.) The men in my training came up with ways they would handle this without hitting, and all agreed that in order to do so, one would have to have confidence. You would have to be sure that these insults were not necessarily true and didn’t represent the views of the entire world. How do we give our boys (and girls) the confidence these men have? Not by confining them to their rooms, and not, unfortunately, by having them write essays.

I came up with some questions to ask after an incident:

1.       What led up to the incident?

2.       What do we imagine the child was feeling?

3.       What do we want the child to do when he or she is feeling this way?

4.       What skills, knowledge, attitudes, beliefs…would the child have to have to act that way?

5.       How can we assist the child to take one small step towards acquiring what he or she needs?

So I was already getting too radical as I began to see punishment as largely irrelevant. Then I became involved in studying Bruce Perry’s new work on the developmental evolution of the brain. The most important part for me was the idea that for kids with early preverbal trauma, words didn’t reach the problems. Now I was starting to doubt the efficacy of verbal therapy, at least for some of our most damaged kids. Instead, I began advocating positive rhythmic play with an engaged happy adult. The template of relationships is also stored pre-verbally. So, if we engage in rewarding, repetitive play with our kids, we can reach both the reorganization of the body and the reprogramming of the relationship template.

What? These kids are so wild and crazy, so aggressive and destructive, and you want us to have fun with them?

I began to think that the most important job we have is to reprogram the relationship template. I draw on the words of my friend Martha Holden- the child care worker’s most important job is to make sure than child has a wonderful day. If what is practiced grows, should we help our kids to practice being happy? What if we believe that everyone, all of us, act better when we feel better- safer, more connected, more effective? Many agree with that statement but we do not act that way in our programs.

So now I am balancing at the extreme ends of these two continuums:

Do you think that most misbehavior is related to disrespect, disobedience, manipulation, selfishness….. or that it is related to fear, hopelessness, overwhelm and despair?

What do you think will be most likely to reduce hurtful behavior: is it rules, punishments, rewards, lectures…. Or is it love, fun, safety, and belonging?

You might think these answers are obvious, but our day-to-day actions show otherwise. And as my thinking evolves I am worried that people might think I am a bit nuts. Oh well there is no going back now.  I would love to know your thoughts on this journey and where you are. Just click “comments”……. Thank you.

Our Goals In Training Foster Parents

On February 5^th from 9-2:30 we are offering a training for our licensed Risking Connection Associate Trainers who want to train foster parents. At this training the trainers will receive the new materials in a beautiful new Trainer’s Guide, and will be introduced to that changes in the new version. The full brochure and registration form can be found at: http://traumaticstressinstitute.org/wp-content/uploads/2012/12/Foster-Parent-Training-Brochure.pdf.

As I approach this training I am thinking about our goals in training foster parents. It is a different situation than training staff. These parents are interacting with these children in their homes. Many of them have successfully raised their own children. They have friends and family around them who are free with advice on how to parent (“Why are you letting her get away with that behavior?!?!”). There are limits to how much the parent may be willing to change.

I have come to believe that our fundamental goal is to help the parent keep the child. There are many styles of parenting that are comp[lately fine. I do not really care if the parent grounds the child when he acts up or if she doesn't  If the parent sees the good in the child, cares about him or her, enjoys being with him or her- how can we help that parent not give up? What our children need most of all is to stay somewhere. It can be an imperfect somewhere- as long as it is not abusive, safe, and caring- how can we support the parent in perseverance?  What role does training play in this?

I would suggest that we have two fundamental goals in training. One is to redefine the parent’s understanding of why the child acts the way he does. We would like to use trauma theory to help the parent to use trauma theory to understand the adaptive nature of the child’s actions. Three important concept in achieving this are: biological changes from trauma, lack of learned skills, and using behaviors to help you feel better in the moment (since we all do this). In other words, move away from words like “disobedient” and “disrespectful” and towards words like “frightened” or “confused”.  We hope that the foster parent can see behaviors as less about them.

Here’s an example. Marci is a wonderful foster parent in many ways. Yet she is really annoyed by her foster son Rob’s constant negativity. When Marci tells Rob that there is spaghetti for dinner, something she has made because she  knows he loves it, she responds by saying “oh no I hate spaghetti!” Marci answers him by saying it is very good spaghetti and she is a good cook. In telling this story, she indignantly reports that he has  eaten her spaghetti before, that others seem to like it, that she follows a good recipe, etc. She is defensive and has taken Rob’s comments personally. When asked if Rob would have responded the same way if she had announced chicken or steak, she said “of course. He is always that way.” So it’s not about the spaghetti. It’s about Rob protecting himself against the disappointment that has been such a feature of his life. When she is out of the situation, Marci understands this. And yet, shortly afterwards she tells Rob that the are going to the park tomorrow. He says that he has always hated that park and doesn't want to go there. Immediately Marci begin defend herself and her choice of park. We suggested that we were going to write on her hand in indelible ink: IT’S NOT ABOUT YOU!!!!!

The foster parent doesn't have to completely buy this. But any progress they can make along this continuum will be powerful in preserving the placement.

 

The other crucial continuum concerns what it will take for the youth to heal. Through trauma theory, we hope to lead the foster parent to understand that children act better when they feel better. When their child feels safe, connected, noticed and cared about she will be able to relax and have more fun. When through every day acts of caring the child begins to consider a new view of other people, the child will begin to trust, to come to the parent with their worries and concerns, and to ask for help.

Again, we can’t expect the parent to re-learn everything society has taught him about the value of punishment. But if through training wecan accomplish any movement on this continuum, we help preserve the placement:

So, can we do this? Is our training effective in preserving placements? If you are an RC Associate Trainer, come to my training on Feb. 2 and find out!

New Card about my Book

Here is a card I just made and ordered to hand out to people who are interested in my book:

Front:

 

 

Back:

What do you think of it?

 

 

 

Love Wins

Remembering Ana Grace Màrquez Greene

I am sure that all of you know about the horrible killings in Newtown CT. A 20 year old gunman shot 20 first graders and six adults in the Sandy Hook Elementary school. Prior to going there he shot his mother. Finally, he shot himself.

One of the children killed was the daughter of a Klingberg employee, Ana Grace Màrquez Greene. Her mother, Nelba Màrquez Greene, is the Director of our Family Therapy Institute. Her father, Jimmy Greene, is a jazz musician.

I spent much of the week helping our Klingberg community absorb this tragedy.

Staff and clients were deeply impacted by these deaths, Ana’s and the other 26. As an administration, we wanted to provide space for staff to discuss the events and to explore their feelings and reactions.

We transformed our former reception area into a Room of Reflection. We added soft lighting from lamps, plants, pictures and stuffed animals. We had a bulletin board. I originally thought that would be for staff messages, but instead people posted articles, poems, pictures, etc. AND copies of staff emails they felt were moving. We had a book to sign in and write a message, and a basket for cards. The newspaper article with the pictures of all 20 children was posted. All in all, it was a place where people could sit and reflect or talk with others.

We noticed that the room of reflection had a purpose far beyond its actual use. Often people looked in and said “I’m so glad you are doing this.” Whether or not they chose to hang out there, the room was a statement that we knew our staff were having deep feelings about this event, and that thinking and sharing were important and worthwhile activities.

Similarly, the discussion groups we organized had unanticipated results. We set up several times to accommodate the complex schedules of an agency like ours. During those times staff were encouraged to come to the Room of Reflection and discuss the way the killings in Newtown and our co-worker’s terrible loss were affecting them. My colleague Steve Brown joined me in facilitating the groups, and we had some ideas to get the discussions started. Not many people came, but those that did spoke thoughtfully and compassionately. They were impacted on many levels. The clients were having various reactions, and staff were creating space for them to explore their feelings. Some outpatient families had lost a child themselves, and were re-experiencing their own losses. In fact, everyone was experiencing their own losses, recent or distant. Many spoke of hugging their own children more. One father reported his child saying “Dad, will you stop hugging me!?” Concerns of personal safety were on everyone’s mind- what is our safety at Klingberg? We constantly deal with emotionally dysregulated people, are we doing enough to increase safety? People worried about the safety of their children and reported on how their children’s schools were responding. My colleague David Lawrence Hawley made the excellent point that “we are no less safe than we were last week, we are just feeling differently about it.” Our wall of denial has been pierced.

Another area of concern was ourselves as mental health providers. Could we have helped this shooter if we had treated him earlier in life? Do we know what to do? Many are not sure. Assessments that we are currently making assumed a greater importance that was scary to some. And it feels like there are so many constraints and so little we can do. People spoke of youth they had known who seemed dangerous, and how little they could get the community to respond because the youth hadn’t done anything serious yet. One therapist describes one such youth who had gone on to kill his girlfriend. So, our confidence in our interventions was shaken, and at the same time we felt the importance of what we do.

One unanticipated results of the Discussion Groups was that serious, thoughtful discussions were starting everywhere, outside the discussion group times. This may have been inevitable, but I think it helped that the administration gave permission and acknowledged how important it was to set aside time to share our reactions. As the quote that we posted in our Room of Reflection says:

“Grief wounds more deeply in solitude; tears are less bitter when mingled with other tears. “

                                                                                                     Agememnon Seneca

Throughout this process we were encouraged by occasional reports of communication with our beloved staff member, Nelba. Her strength, honesty and grace in this terrible situation inspired us all. The family began to sign all communication with the phrase: “Love wins.” So we adapted that slogan. The town also said “We are from Newtown and we choose love.” Even while wrenched with this desperate sadness, the families were reaching for the meaning of their children’s lives, and trying to bring some good from the horror.

Then on Saturday I attended Ana’s funeral. This was the most incredible event I have ever been to. Ana’s father is a jazz musician named Jimmy Greene. He plays the sax. He is very connected to the jazz community. The held the ceremony in this huge cathedral church and there were literally over a thousand people there, all races, ages and types, most dressed in purple. Prior to the ceremony the family sent out an email inviting people to wear purple and sparkles because that is what Ana loved.

The ceremony, which they called "A Celebration of Ana's Homegoing", included lots of music, jazz, choir singing, a classical string quartet, etc. The message of the powerful speakers was all positive- acknowledging the sadness and pain, but emphasizing our learning from Ana's short life and becoming more loving.

On every email and communication they have sent out they have ended with "Love wins." I now have a purple bracelet (one of those plastic bands) that says "Ana Grace: Love wins". That was the message of the ceremony. It was so incredibly inspiring.

Now, how do we go forward as the media retreat and the attention moves elsewhere? How do we do the hard work of actually creating the change that children like Ana deserve? It is clear that we must work together, that we must be inspired to fight for what is right. And our efforts will matter because LOVE WINS.

Tragedy

The shootings in Newtown Connecticut are close to us geographically. And they have been brought even closer because one of the children shot was the daughter of one of our Klingberg employees. Nelba Marquez-Greene is the new Co-ordinator of our Family Therapy Institute, and a wonderful new addition to our staff. She and her husband, the jazz musician Jimmy Greene, lost their daughter Ana in the shooting.

I have been thinking about Newtown, Nelba and their family almost constantly, as I am sure many others have.

There have been many different clamors for many different solutions. More gun control! Easier access to mental health treatment! We wish so badly that there was a solution, something to do, a law to pass.

As a person who teaches others about treatment, I of course think of the shooter. Do we know what treatment would keep this from happening? I have read speculation that the shooter had Aspergers.  If he had received the most caring and skillful treatment possible, could we have presented this? We don’t know yet whether he ever had treatment. I do feel confident that any treatment that emphasized relationship, safety, caring and finding your voice would have had a better chance of reaching him than a  harsh, punitive approach would have.

But this is all speculation at this point. What is not speculation is the love and connection we are sending to Nelba and her family. We comfort each other by gathering and by sharing in an open hearted way. We can’t make sense of what has happened. But we can use our connection to each other to get through it and to strengthen our commitment to the work we do.

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Ruta Mazelis on the Experience of Self Inflicted Violence

This past week we held our annual Day of Learning and Sharing for Risking Connectionsâ trainers. My colleague Steve Brown gets credit for both the vision and the implementation of this event, which offers in-depth training on an important topic in trauma treatment. This is one of our most excellent achievements. The warmth in the room is obvious, as the community of trainers greet old friends and catch up on the latest events. This is a group of the clinical leaders in Connecticut, all of whom have attended Risking Connection training and an additional three days to become trainers. They have also attended Consult Groups and Recertifications to keep their knowledge current. They are seeped in a trauma-informed approach to their clients. They are our partners in changing the world.

This year our guest speaker was Ruta Mazelis. Ruta is a popular speaker and trainer who presents nationally on behalf of Sidran on issues surrounding self-inflicted violence, trauma, and trauma informed care. She frequently consults to SAMHSA's Center for Mental Health Services on topics related to trauma, including trauma-informed care, co-occurring disorders, re-traumatization in systems of care, self-injury, and criminal-justice involved survivors. She provided extensive technical assistance to the SAMHSA Women, Co-occurring Disorders and Violence Study, served as a program manager for the National Center for Trauma Informed Care, and is currently on the board of the National Trauma Consortium. Ms. Mazelis, herself a trauma survivor, has worked as a substance abuse and mental health care provider in inpatient and outpatient settings. She is the editor of The Cutting Edge newsletter which she founded in 1990, and edits the web site, healingselfinjury.org, and she has published numerous books.

Ruta immediately sensed the skill and knowledge in the room, and realized that she did not have to teach this audience the basics about trauma. Instead, she used her personal experience to instruct us about the realities of being a trauma survivor who relies on self-inflicted violence to deal with unbearable pain.

I hope to write more about this training in a later blog. In this post I would like to convey some points that Ruta emphasized: The first is that self injury is not a distinct and uniquely horrible or dangerous symptom. It is just one more way people have found to deal with the unbearable pain that has been part of their lives. She emphasized that we all self harm, and that for all of us it is a method of coping with pain. It is adaptive, as are addiction, aggression, eating disorders, smoking, running away, sleeping all the time. It is actually not the most dangerous thing that many trauma survivors do. The long term harm to the body is considerably less than say alcoholism. Or smoking. It is not illegal, it can be kept hidden, and it does not hurt others. Ruta told us that she has learned from her newsletter that self-inflicted violence is part of the lives of people of all ages, sexes, socio-economic groups, professions, and statuses. She has known many treatment professionals who use this technique to manage their lives.

I was once again struck by the ways that the pressure to achieve change can so often interfere with change. Self harm is adaptive. The trauma survivor will stop doing it when they no longer need it. Therefore, if we immediately jump to methods to eliminate the self harm we are not respecting the survivor’s experience. If we start talking about replacement behaviors (writing on one’s self with red pen), it may seem naïve or insensitive to the client. If writing with red pen would accomplish what I need, I would have done that long ago. It may seem disrespectful: I am not interested in how you came to do this or what it means, I just want you to stop. Ruta said repeatedly that most trauma survivors stop self inflicted violence when they work on the trauma, are no longer in desperate pain, and do not need it any more.

This is such a hard stance to maintain with all the pressures surrounding us, both from our colleagues, from those outside our agencies who monitor our performance, sometimes from the client’s family, and certainly from inside ourselves. It is extraordinarily difficult to stay with such a painful symptom.

So all we have to do is work on the trauma. What exactly does that mean? And particularly what does it mean for those of our children (most) who are far from being ready to talk about the events in their lives? As Ruta presented it, it does not just mean teaching coping skills. It means interacting with the child at every possible moment from the understanding that their behavior comes from fear, shame and despair and is adaptive. If a treater expresses that conviction repeatedly the client may gradually question their own self blame. It means creating a safe enough space that the client can relax, play and sleep. It means engaging in rhythmic rewarding activities with engaged adults to begin rebuilding the brain and reshaping early templates of relationships. Most of all it means love and compassion, for the client, ourselves and each other.

So that’s all we have to do. And gradually the self inflicted violence will fade, along with the other extreme symptoms, as the client moves forward to a life worth living.

Ruta was intense, real, passionate, and at times uncomfortable. Just what we all need to counteract all the push towards shorter, more practical, symptom reduction quick fixes. Thank you Ruta for a reminder of the profound depth of the work we do.