Every Child Can “Attach”

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“Attachment is our limitation, not the limitation of the child.”

I heard Dr. Yvon Gauthier say this at a Child and Adolescent Psychiatric Conference and it struck me as if with physical force. What an encouraging thought!

In the teen treatment industry we often hear of the “untreatable” child. I think this is totally false. The untreatable child is just the child we haven’t figured out yet! But heaven knows I’ve run into a few in my lifetime. :)

I was on a conference call yesterday and one of the participants said that her mantra is “behavior problems are indicative of unmet needs”.

When my wife and I adopted our son, Michael, who is turning 7 next month, I was nervous about whether he’d be able to attach or not. He did just fine and over time I relaxed. The truth was, I had figured out how to connect with him.  Now that he’s almost seven, I still take the “temperature” of our relationship every night when I tuck him in bed, just to see if we’re still connected.  Last night he wanted to cuddle three times before he’d go to sleep. I think he’s connected!

One of my former New Haven students had a child she thought was Autistic. She wasn’t connecting well with her at all, and then she was diagnosed with Autism. I suspected the diagnosis was misguided. Over time, as my young friend worked to engage her daughter in the way her daughter wanted to be engaged, this perceptive mother discovered that the child’s speech and physical abilities improved. The misdiagnosis fell by the wayside.

Contrast the relatively easy time my alumna friend had with the experience of one of my former co-workers, whose first sonmost definitely has Aspergers. After years of behavioral work, she is finally getting him to eat on his own, hug her occasionally, and so on.  He’s thriving.

I realize now that attachment is not about the child’s capability. It’s about ours.  The only children who can’t attach are the children whose caregivers give up trying.

This may sound like I’m blaming parents or professionals.  Not so.  What I’m trying to illustrate is the immense hope I feel. Think about it:  we’re not dealing with a deficiency in the child, rather we’re dealing with our own lack of knowledge or skill. And we know where to get knowledge and skill: our own experience and the shared experiences of others.  That’s incredibly empowering.

What challenges have you any of you had in connecting with your own children or the children you serve? What knowledge or skills have you developed that you could share here?

Popularity: 61% [?]

The Leprosy of the West

Mother Teresa said, “In the West there is loneliness, which I call the leprosy of the West.  In many ways it is worse than our poor in Calcutta.”

In my experience, loneliness is best predictor of relapse.  If a young woman finishes treatment successfully but returns home to no friends, even if her parents are “there” for her consistently, she will relapse within a very short amount of time.  Teens need a support system outside of their immediate families.

Think about it:  if someone loves you and wants to be around you, and they are not required or expected to do so, doesn’t that make you feel good?  Parents and siblings are supposed to love us.  But friends are not.  Once we experience love and validation from others outside of our immediate families, something within us changes. We begin to believe that we DO have value and that the nice things our parents have been telling us about ourselves could possibly be true.

Mother Teresa went on to say, “There is a terrible hunger for love. We all experience this in our lives – the pain, the loneliness. We must have the courage to recognize it.  The poor you may have right in your own family.”

Residential treatment centers have fallen short. We have not incorporated teens’ friends into treatment and transition as well as we should.  Well before they transition – even from as early on as admission – we need to provide teens with ways of connecting with good friends.  We can provide them with easy ways of keeping in touch with the friends they make in treatment through creative use of social media, such as Facebook and Ning, cell phones and instant messaging.  We can help them determine more effectively – on their own – which friends at home are supportive and helpful.  And then we should get them to connect with those friends in creative, non-electronic ways.

One young woman went home during treatment and invited her friends to a “non-alcoholic party”.  She was nervous that they would think it was dumb.  She was even more nervous that no one would show up, because she planned it for a Friday night – a night when “everybody goes out to party”.  Well, she had a great turnout and she led them in a game of “supermarket relay”. She formed teams of two, each team filled a cart in the supermarket with goods, they all switched carts, and the first team to put the goods back on the shelves in the correct places won.  Her friends had a blast and many commented that they didn’t know they “could have fun without getting drunk”.

Many teens think that being “clean” means being lonely.  This young woman returned to finish treatment with a new confidence that she could be successful without having to be lonely.

Popularity: 68% [?]

Do It For Someone Else

A few houses ago, my next-door neighbor was a heroin addict. It was a frequent experience for me to come home from work and see a police car and an ambulance in front of his house, his children sitting on the front steps crying. I’d peek in the open front door and see paramedics working on his limp, clammy body, trying to revive him from yet another drug overdose.

One day I caught him sitting on his front porch, smoking a Marlboro and nursing a broken foot. I stopped to chat, and he told me he’d been welding a steel riser on the third floor of a new building and had fallen down the elevator shaft, landing on his leg, which shattered his foot. I asked if he’d been high. He said no. Of course, he was lying. I asked him if he were still attending his Narcotics Anonymous Meetings. He said yes. Again, lying. I asked him when he was going to stop using. What he said struck me: “Well, you know. My wife wants me to do it and my kids want me to and I just feel bad about it. But, as a therapist, you must know that people only change for themselves. Nothins gonna work until I do it for myself, right?” It was at once an admission that he would not stop using, and a challenge – no one in his life had arisen who was more important to him than the heroin.

David Kelley, famous designer and founder of IDEO (arguably the world’s most innovative design-thought company), recently gave an interview in Fast Company magazine. He talked of his devastating fight against stage four cancer. After nine months of chemo, surgery, radiation, and losing 40 pounds, he finally beat it. What motivated him to keep going? “At first, you think, ‘I don’t want to miss her growing up.’ [referring to his daughter] That’s motivating, but not that motivating,” he says. “It’s when you manage to get out of yourself and start thinking of her that you get the resolve to continue. When you think, I don’t want her not to have a father — then you want to stay alive.”

David’s point is important, and not just semantics. The most difficult task I face in my line of work is motivating young women to want what is best for them, even when it hurts terribly or scares them to death. I’ve found that appealing to their sense of self rarely works. They hardly ever “do it for themselves”, at least at first. We know from research about change that people – teenagers included – are more likely “do it for someone else” first.

This presents a fantastic opportunity for us to build relationships with suffering young women, and then use the resulting trust and love to help motivate them toward healing.

One young woman shut herself in her room this week. She wanted to give up. She was disappointed and disgusted with herself. In that state of mind, there is no way she was going to keep working on her issues “for herself”. Thankfully, I have a relationship with her, built over the last few weeks. A brief visit and short conversation with her brought her spirits up, and helped her return to participation in the House. Why? Because she didn’t want to disappoint me, and she could cling to my confidence in her, even when hers was low.

So, all of this begs the question: How can we use our relationships with those we love to encourage, motivate, and support them in their struggles to change for the better?

Perhaps even more important is this question: What are we avoiding changing within ourselves, and for whom will we do it?

Popularity: 62% [?]

When Teens Pull Away, Stand Still!

I flew kites with my two young sons. Michael was doing fairly well with his kite, but Cam, my five-year-old, struggled with his.

“Higher, Daddy!” Cam said. He could feel the kite straining against his little hands, and thought the best way to help the kite move higher was to walk toward his kite. The line would slacken, and the colored fabric kite would dip toward the ground.

It reminded me of when my nine-year-old, Hadley, was Cam’s age and informed me that her kite was like a helium balloon. “I’m going to let it float up to the sky!” she’d said. Before I could stop her, she’d let go of the string. It immediately lost altitude, but sailed an impressive distance, over the park, over three rows of houses, then crashed in a driveway, narrowly missing a small yapping dog! She’d been surprised that letting go of the string didn’t help the kite rise higher.

“Stand still!” I called to Cam. But he moved forward. Predictably, his kite soon crashed into the turf.

Michael was laughing. At first I thought he was laughing at Cam, but he wasn’t. He was excited because he’d found that if he pulled gently on his string, the kite would respond and dance on the wind. Unfortunately, he began yanking too hard, which caused the kite to dive and spin out of control. Soon, Michael’s kite had impaled the sod, a few feet away.

Kite flying is a fitting analogy for parenting, isn’t it?

The thing that seems to restrict and bind the kite is the very thing that enables the colored fabric to dart high among the clouds. Some teens have difficulty balancing their emerging independence with their dependence upon their parents. These teens want more freedom. They want adventure on their own. Like kites, they strain against the line their parents hold, pulling toward the clouds.

Teens sometimes fail to realize that it’s their family ties that allow them to fly ever higher. After all, it’s counter-intuitive. Everywhere else in the world, if something is tied down, it’s more restricted – not more free.

And yet, the way parents hold the line with their kids is important. If we jerk too hard and too quickly, teens may react like Michael’s kite. If we move in too close like Cam did, we run the risk of over-protecting them. They won’t learn to navigate life’s currents on their own. If we let go of our teens altogether, like Hadley did, never guiding or directing, then our kids will never even have a chance.

Sometimes it’s appropriate and necessary to gently pull back. It’s our job to guide our kids from one shifting wind to the next. It’s important to keep our hands firmly on the line in case a huge gust of wind knocks our teens from their equilibrium. Frequently, however, the key to coaching teens is for parents to set clear family traditions, values, rules, and consequences and then stand still.

Here are some ways that parents can practice standing still:

1. Establish (and then follow through with) family traditions for holidays, birthdays, summer vacations, celebrations of success, etc.
2. Gather everyone together as a family at least once weekly to coordinate, plan, and review.
3. Have one-on-one time with your teen at least weekly. (Daddy-daughter dates and mother-daughter outings are great ways to stay connected.)
4. Hang a copy of your family values in a prominent place in your home.
5. Decide on a family symbol that represents what your family stands for. Obtain a trinket for each family member to carry with them. (One father bought pewter acorns and attached them to key rings for each family member – their family symbol was the Oak Tree.)
6. Create rational rules that support and teach your Family Values.
7. Decide on a few “zero tolerance” rules. (These usually involve issues of safety: no drugs; curfew set in stone; no boys in her bedroom; etc.)
8. Agree upon natural and logical consequences to reinforce your rules. (Wise parents include teens’ suggestions about appropriate consequences.)

I hope you’ll take a moment to post your thoughts about your successes and failures at standing still. It’s helpful for us all to hear what has worked/not worked for other families!

Popularity: 54% [?]

Do You Love Your Clients? Do You Tell Them?

I overheard someone telling one of our students that she loved her.  40 of us were packed into a room at a transition ceremony. We had formed a big circle, standing up, and the graduating student was going from person to person, hugging each one goodbye. As the student approached my right, she hugged my friend (staff) and my friend said, “I love you.”  The student, crying, said, “I love you too.”  Their hug lasted about 10 seconds.  Was this appropriate?  What would I say when it was my turn to say goodbye?  After all, I was a 30-plus-year-old man and she was a 16-year-old young woman.

Why does the word “love” carry such a taboo in treatment?  Do we really think that we can wall-off our hearts to those we serve? Do we really think that we can remain unaffected by their journeys, their stories?

As a relationship progresses, I believe it’s important to define what is happening.  It’s especially important because many young women in treatment have had inappropriate, unhealthy relationships and they become confused about what they are feeling. Particularly as a male therapist, I have to be constantly aware that the intensity of the emotions shared during healing process can be confusing to young women. So I am constantly defining what I mean and why I choose to use the words I do.

For example, if I tell a client, “I care about you very much,” I will immediately clarify that statement.  ”You realize that this is not a sexual kind of caring,” I’ll say.  ”The feelings I’m expressing are like those I might feel for my own daughter.”  Usually, the girl will become uncomfortable:  ”I know it’s not sexual!  Why do you even have to say that?!”

I’ll press forward.  ”You’ve certainly noticed where my eyes look.”  ”Yes,” she’ll usually say . “Your eyes never leave my face.”

“Why is that?” I’ll ask.  And we’ll talk about how my feelings toward her are fatherly, as if she were a daughter.  We’ll define the differences between platonic love and amorous love.  We’ll dissect the friendship that is developing.

I tell her that I am okay with the conversation being uncomfortable as long as we can take use that moment to be clear with each other about what kind of relationship is developing between us.  I submit that this is good therapy.

One student I worked with years ago had had a boyfriend ten years older than I.  It was difficult for her to reconcile her growing feelings of love for me with what she’d experienced with her perpetrator boyfriend.  As we grew closer, it was vital that I teach her the differences between what she’d felt for him and what she was beginning to feel towards me.

At times the conversations were painfully direct.  ”I am not aroused by you,” I recall saying when she provocatively suggested that there might be more to her feelings than would be appropriate. Whenever I noticed confusion in her eyes during a group where a male staff member might have expressed compassion for her situation, we would take a moment to define what was going on for her and for him.

Years after treatment she came to an alumni reunion.  We had a few quiet moments to catch up on her life and she said, “You’re about the only man I trust.”  I was taken off-guard by that statement.  She explained that she’d caught her father looking at pornography, that she’d been “used” in every intimate relationship she’d had since treatment, and that she just couldn’t look at men without feeling sexually unsafe.  ”But not you,” she said.  I attribute that to the hours and hours we spent working at understanding the difference between appropriate and inappropriate love.

All of this and more flashed through my mind as I stood in that circle during that transition ceremony and anticipated how I would say goodbye to one of my favorite students.  It only took a few seconds for her to hug the person at my right and then be standing directly in front of me, but I relived every moment we’d shared during treatment.  I felt my heart swell in my chest.  I felt my eyes sting.  This was a student who would have been dead, had she not received care.  I thought back to the day she had arrived.  Images of her – angry, bitter, depressed – flashed in my mind:  her dark clothing, her darker countenance; her fear of connecting, her fear of others never wanting to connect to her.

I thought of the arguments we’d had, the times she’d screamed at me until she was hoarse.  I thought of the quiet moments when she’d trusted me enough to tell me something she’d never told anyone before.

The feelings within me burned stronger as I reminisced about the magical moment when something had seemed to “click” for her. I remembered her change of heart. I recalled the light that shone in her eyes that I hadn’t seen before, but which her mother said had been there up until only a few years ago.  Her face and demeanor had relaxed and she had become gentler with others – and with herself.

And so, as she stepped in front of me and reached up to hug my neck, without shame or pretense I wrapped my arms around her back and pulled her tight to my shoulder and said, “I love you.”  There was nothing sexual about me using that word, and she knew it.  ”I love you too,” she said.  There was no confusion in my mind about what she meant. For five seconds we enjoyed the connection of that hug.  We felt the bond of friendship forged in the heat generated by months and months of intensive psychological and emotional healing.

Then she pulled away and moved on to the person at my left.  I’m pretty sure I overheard them use the word “love” as well, but I can’t be sure.  I was distracted with trying not to cry.

Popularity: 17% [?]

Lapse versus Relapse

“I messed up,” the text message began, “and I just wanted you to know that I cut myself today.  But I’m back on track.”

Is this a relapse?  She’d been free from self-harm for over 13 months.  How would you have responded to her?

In my mind, there is a big difference between a momentary lapse and a full-blown relapse.  I had the following conversation with parents at a Family Weekend years ago, an event we hold for three intense days every other month of the year.  All of the parents in my group that weekend had girls who were coming home soon.

“I can’t wait for my daughter to come home,” one father said.  “New Haven has been wonderful!  All of her problems are fixed.”  I find that all too often parents expect their kids to be “fixed” when they return home.  Even after spending time at New Haven, arguably the most systems-focused residential treatment center in the country, they still believed that treatment is an event and when it’s over, they were done working.  “Oh, no,” I told him.  “Your journey has just begun!”

“What happens when your daughter returns home and you find her spending hours on the internet? What happens when she skips her curfew?  What happens when you find pot in her backpack?”  He began to sweat.  He stewed.  Finally, he couldn’t take it anymore.  He lunged across the room at me, red-faced and yelling.  “What is the point of this?  I came here to feel better about my daughter!”  He accused me of doing “poor therapy”, then sat down.

“I’m trying to prepare you for the inevitable,” I said.  And we had a robust discussion about how his daughter, in particular, was going to bring home a young man he didn’t like, was going to accelerate into sexual behavior faster than he would be comfortable, and they would have to deal with it.

“I’ll kick her out on the street!” he said.  “I won’t tolerate it.”

“But what if it’s not a relapse?  What if it’s a one-time screw up?  I doubt you’d kick her out if you knew it was an honest mistake.  She might ‘lapse’ but not ‘relapse’. So how will you define the difference between a ‘lapse’ and a ‘relapse’?” I asked.

In the end, the group decided together that a lapse is a one-time event which is reminiscent of past behavior.   A relapse, on the other hand, is a persistent pattern of the behavior we thought we left behind.

It’s easy to recover from a lapse.  Yet it’s also easy to allow a lapse to become a relapse.

So, what stops a lapse from becoming a relapse?  They wanted to know!

Two things will keep a lapse from becoming a relapse:  #1) consistent, healthy relationships with parents and friends; #2) parents unified and consistent about implementing rules and structure in accordance with established family values.

We spent the balance of that Family Weekend session outlining ways  to keep their relationships with their daughters fresh and alive.  We outlined rational rules and boundaries which were neither too permissive nor too restrictive.

About ten months later at another Family Weekend, the angry father returned.  He sought me out during a parent group and apologized for his attitude.  “You were right,” he said .  Turning to the other parents in the room, he laid out his daughter’s lapses and how he’d helped her keep them from becoming relapses. He never “kicked her out on the street” and she was doing reasonably well.

He’d realized the truth:  our journey does not stop with the end of treatment.  We continue on, we fall down, we scrape our knees.  It’s how fast we get back up that matters.

So here’s how I responded to the text I mentioned at the beginning of this post:  “Thanks for staying connected.  As long as you are back on track, that’s what matters.  Call if you need to talk.”  After all, it was just a lapse.

Popularity: 26% [?]

Behavior Modification Needs to Die

What residential treatment needs is a clear vision.  The old ways of doing things are fading, but not fast enough.  I’m referring to the behavior modification programs of yesteryear.  Those well-intentioned but power-hungry programs and people who felt that they could impose their will on teens and call it “treatment”. There are still too many of them around

I’m calling for crystal-clear leadership!  We need therapists, nurses, teachers and all levels of staff to embrace the truth:  no one makes permanent positive change simply because we tell them to, incent them to do so, or punish them if they don’t.  People change for other people.

Read that last sentence again.

We need treatment that respects the suffering individual.  Who among us would berate or otherwise abuse, incent or punish a cancer patient?   Why then do we tolerate those treatment centers who believe that bars belong on bedroom windows and contact with one’s family is a “privilege”?

It is time to be done with our excuses.

Let’s have the courage to build relationships with those we serve.  Healthy, life-affirming relationships.

Today I spoke with a young woman who – not four months ago – harbored an extreme death wish.  She and I were outside on the swings, side-by-side, swinging and talking in the crisp fall weather.   We spoke for a long time about how far she’d come, about her new vigor for life and about her future plans.  I pointed to the relationship we’d developed.  A mutual friendship, full of life and joy and peace.  Nothing weird, nothing sexual.  Just the friendship of two people who have almost finished a difficult journey together.  The healing she’d experienced, I told her, was in the process of building that relationship.  “What is it about relationships,” I asked her, “that is so powerfully healing for you?”  She thought for a minute then said, “When someone wants to be near me and works to build a relationship with me, well, that feels pretty good.”

Let’s start being honest with ourselves.  Let’s simply answer this question:

How would I treat my own daughter/sister/friend?

After all, unless you’re a sadist, the answer to that question is sufficient to guide you toward more compassionate ways of dealing with those clients with whom we are privileged to work.

Popularity: 23% [?]

The Influence Girls Allow Men to Have – And Why

What influence do men hold over you, and why?

I ran a group therapy session yesterday.  One young woman began the conversation by speaking eloquently about her obsession with five college-age men who had sexually assaulted her.  ”Why can’t I let it go?” she asked.  ”What is it about me that clings to them, even when I know they are bad for me?”

Another girl chimed in:  ”I feel ashamed that I sexualize all males.  Even the staff here.  I objectify everyone, and I can’t stop.”

I had the girls and the staff (18 in all) place themselves in the room based upon how much influence they allow males to have over them.  We established a range; one wall and its couch became “100% influence” and the opposite wall was “0% influence”.  I was not surprised to see most people place themselves between 50% and 100%.  One girl said, “I’m sitting at 105%!”

We talked at length about the power that males have over us:  fathers, brothers, boyfriends, men we don’t even know.  The girls and adult staff identified their reasons for granting this kind of powerful influence to the men in their lives.  ”I like to feel protected,” one said.  ”I wanted to be accepted – that’s all I cared about,” another said.  ”Love is the bottom line for me,” one of our staff members added.

None of these desires/needs is bad in and of itself.  We discussed taking the shame out of wanting to be protected, accepted, or loved, and decided to more productively focus on what we do with the overpowering need for acceptance, protection, and love – especially from males.

The Lead Supervisor of our staff spoke up quietly and said that after she lost her sister in a car accident, her teenage brothers and her father all became very protective.  She described a healthy relationship with them as a leading influence for good in her life.  A young woman who just arrived at New Haven piped up and said that her father is someone she wants to please, and she knows he loves her very much.

We all decided that even though we are influenced to varying degrees by men, we should acknowledge how much we are influenced, discover what need it fills for us, and then seek a more healthy and productive way of obtaining that need.  Being influenced by males does not need to be a bad thing.  Shaming ourselves doesn’t work – we need to recognize that they underlying need for male connection or approval is not always bad.

By the end of the group, the young woman who said she “objectifies” the men in her life committed to practicing healthier relationships with the male staff we employ.  The one who started the conversation decided to end a flirtatious relationship she began on a recent trip home, since she was “using” the young man and not really interested in him.

I imagine we’ll continue this discussion in group next week.

Popularity: 11% [?]

Relationship-Based Treatment

Ropes Course

Aspiro – a wilderness adventure therapy program for boys and girls – came to visit last week. I was impressed and pleased with their approach to their students. They made this comment during their presentation: “Because we take our students into more ‘public’ ares such as Arches National Park, we have been accused of only being able to treat ‘softer’ kids – kids who won’t run away.”

I was struck with how similar our approaches are, and how similar the criticisms levied against us were during our first five years in business. New Haven has been around for 15 years this month. In our first five years, much like Aspiro, we were refining a more relationship-based model of residential treatment for girls. (We were tired of working in places that just applied a boot-camp or behavioral model to the treatment of teen girls.) We were questioned repeatedly about being able to treat “harder” girls – but what our critics really were wondering is if we would be able to “contain” girls who didn’t want to be in treatment.

How ironic that, 15 years later, our model is the most copied by new startups in the world of private teen treatment for girls! “Relationship-based”, “family therapy”, and “values” – all terms which were never spoken together in 1995 – are now tired old buzzwords in our industry. Even though it means competition for us, I’m glad. Girls deserve better treatment.

Why is Aspiro able to take its students into public places? Why is New Haven able to operate on 31 acres without magnetized steel doors? It’s because our students realize quickly that we love them and want the best for them. What’s more, we won’t constrain, abuse, or coerce them into doing what is best for them.

The beauty of a relationship-based model is that “tough” kids CAN be treated. No, Aspiro and New Haven don’t take highly violent kids. But we do take the very ill family systems, the kids who have internalized their problems to the point of suicidality, and the kids who have failed treatment time and again.

All good therapy begins and ends with a strong therapeutic relationship.

Popularity: 67% [?]

When is it Safe to Trust?

I get asked a lot how to know if you can trust someone, especially boys. Here’s a little formula I came up with a few years ago. Let me know your thoughts on it.

T = bottom line, you need TIME with a person before you can trust him. I’m fairly confident it takes longer than 3 months to know if you can really trust a guy with your deepest emotions and thoughts.

R = RESPECT is paramount. If he’s not respectful to you, to the waitress at your favorite restaurant, and to his mother, then you have a problem.

U = UNCONDITIONAL LOVE. He needs to accept you as you are. If he’s telling you to “lose some weight” or he makes you feel stupid, you are heading for a train wreck relationship.

S = you need to feel SAFETY with him, both emotional and physical. If he pushes your physical boundaries – in any way – get rid of him immediately. If he is overly sarcastic, rude, or argumentative with you, then he’s not emotionally safe, either, and doesn’t deserve your time and attention.

T = this one may be obvious, but you’d be surprised how many girls let it slide: TRUTH. He must be truthful at all times. If you catch him in a lie, no matter how small, he’s done! There is no excuse for lying to a friend.

So, bottom line, if you’ve spent time with him, he is respectful of you, he is unconditionally loving towards you, you feel safe with him, and he tells the truth, then your decision to risk trusting him is more likely to be a good decision.

Is this foolproof? No. But a majority of the time you will make a good decision.

Popularity: 6% [?]

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