Coming In June: Making It Real, a Unique Course

Making It Real is a unique course- there is nothing else like it. It is NOT a course in which individuals go through the course and get some new knowledge about trauma and how it affects the brain. Those courses are very valuable.

But that’s not what this is.

Making It Real is a course for a TEAM to IMPROVE THEIR TREATMENT. As a team, you work through it together. You learn from the videos. The Resources enlarge your options and possibilities.

And then you take action.

Every implementation plan starts with exploration and discussion for the team. Then, the team makes a plan, describes the action steps, decides who will take the lead, and sets a review date.

Then they take action!

The power is in the thinking and the discussion. And the super power is in the action. You actually change what you do. And your treatment becomes more effective, produces better results, and you have more satisfied and fulfilled employees.

That is a REAL change.

Crucial Questions in Changing Behavior Two- When Martin Threatened the Teacher

For the month of May we will examine the role of punishment in changing behavior, and we will explore what other, more powerful options we have,

Angry teen2In his fifteen years before his admission to residential, Martin has been repeatedly abused by multiple people, including horrifying sexual abuse. When first admitted he was primitive and reactive, unable to trust anyone, easily panicked and always alert for danger. Whenever he felt threatened he lashed out, often physically. Gradually however Martin began to feel safe and was able to form some relationships with staff. His outbursts became less frequent and less severe, and he was more often able to participate in fun activities. He demonstrated an ability to draw and created some amazing cartoons. Both he and the staff are beginning to feel some hope for his future. He and his therapist are talking about a possible move to a group home or a foster family.

It was very discouraging then when the report came from school that Martin was suspended for threatening his teacher. He became extremely agitated, would not go to his next class, threw some books, and told the teacher that he was going to kill her with a knife. He was so intense that the teacher was frightened, and a restraint resulted.

What happened here? How do we understand this behavior? What should our response be?

Martin will not have a life worth living if he often becomes so agitated that he threatens to kill people, destroys property and disrupts whatever is going on. There is no doubt that we need to help him change this behavior. What is our most powerful strategy to achieve that change?

Punishment is the first idea that occurs to everyone. Martin needs to learn that he cannot treat people this way. He should be suspended from school for three days, and not have any activities or fun events during that period. Then maybe next time he will think twice before threatening someone.

But will he? In fact, the problem is that Martin cannot think once when he is agitated, much less twice. The punishment will confirm Martin’s world view: that he is a horrible kid who continually does bad things, and that the world is a place where he has no role, where people do not like or accept him.

Because Martin has formed relationships with his treatment team he was able to tell them several days later what had happened in this incident from his point of view. First, Martin is feeling anxious because discharge is being discussed. He is facing leaving the first place he has experienced any success and formed connections. That day, Martin was scheduled to go to art class. He had been dreading art since the last class earlier in the week. Martin has decided that the art teacher, Mr. Howard, is a homosexual. Mr. Howard has been very nice to him and encouraged his drawing skills. Martin has started to like Mr. Howard. Last class, while helping him with a project, Mr. Howard put his hand on Martin’s shoulder. Martin knows this is the first step towards Mr. Howard molesting him. He is terrified. The only way he can protect himself is to avoid art. But Miss Lesley, his home room teacher, didn’t understand this (nor did he tell her). She kept insisting he had to go to art. Martin was terrified and flooded with feelings of being small, vulnerable and powerless to prevent abuse. So he tried to save his life by threatening people and getting them away from him. He did not have to go to art or see Mr. Howard.

It is quite likely that throughout his life Martin will encounter situations that evoke his previous abuse and make him feel desperately afraid for his life.

What do we hope that he will be able to do when this happens?

We hope that Martin will feel safe enough and trust someone enough to turn to them for help. We hope he will have one moment of realizing what is happening to him, one moment of considering that it may not be the truth that the art teacher is going to molest him, it may be related to his past. In that moment, he could say to someone: can I talk to you? I need help.

What would Martin need in order to do this? He would need to trust people. He would need to experience that the world has safety in it, that there are people who will not hurt you, that in fact people may care and want to help. And he would need to develop some self-awareness so that he can recognize when he is having feelings related to his past and be able to stop for a moment and consider whether in this case the present is different from the past. This is a very hard thing to do.

When Martin is in the grip of panic related to his past abuse, the thought that he will be grounded if he threatens this person is of no use at all. His cortex (analytical thinking) is not available to him. Even if he could remember that he will be grounded (and he can’t) being grounded would be infinitely preferable to being molested by the art teacher, an event he sees as a complete certainty if he does not get out of going to art.

So what can we do to help Martin?

When he is not upset, his therapist and others close to him can talk to him about these things, teach him about trauma, and help him understand the connection between past events and current behavior. Together with him, they can mourn and deplore the horrible things that happened to him. And they can begin to identify the situations that are most difficult and most likely to bring up feelings of the past. Martin can begin to observe what the first signs in his body are that he is becoming upset. Staff can also learn with him what are the early signs of anxiety, and can identify them to him.

In the crisis, it would be helpful if someone noticed when Martin was beginning to be agitated. There are many more options if we catch this event when it starts and before it has escalated into a full meltdown. In either case, it is helpful if staff approaches Martin asking what’s wrong, what’s bothering you, rather than by telling him what to do. Martin will not be able to tell anyone what is really bothering him when he is agitated. Their faces (even those he likes best) will be the faces of his past abusers. So staff should employ any calming techniques they know. Can Martin go for a walk? Can he draw? Can he play basketball? Does he need to be alone, be with someone? There should be no focus at all on making him do the next thing he is supposed to do. All the focus should be on helping him feel soothed, accepted, and calm.

What if this doesn’t work, and Martin threatens or hurts someone? What can we do afterwards? Remember that once Martin regains his sense of being in the present he feels very remorseful that he hurt someone. He also feels more shameful than ever. So what can he do to make amends to that person? He can talk with Miss Lesley. She can speak from her heart, in a modulated way, and tell him how scared she felt. She can relate that to how scared he must have felt as a little boy when people threatened and hurt him. Together they can plan some strategies for the next time Martin feels scared. Maybe Martin can also do something to make Miss Lesley’s life easier, like clean up the classroom or do some other chore for her. And what about learning? Could Martin draw a cartoon illustrating how the world looked to him right before this happened? Can he start a comic strip about a boy who is learning that the present is different from the past, and make different episodes as the boy learns new things?

The theme here is that Martin will not be less likely to threaten people if we make him feel worse. He already feels about as bad about himself and his life as a person can feel. He will be less likely to threaten people if we help him feel better. He will be less likely to threaten people when he trusts them, feels safe, and is relaxed.

There is a particular opportunity in this situation. If Martin feels up to it when he is calm, it would be great for him to meet with Mr. Howard in the presence of someone he trusts. He could plan this in advance. And of course Mr. Howard would have to be comfortable and at ease in this discussion. Mr. Howard could assure Martin that he will never in any way molest him. He could apologize for putting his hand on Martin’s shoulder, and say that he did not realize how scary that would be for Martin but he can completely understand how it would be given Martin’s experience. He could say that he hopes he and Martin can continue to work together as he sees that Martin has a lot of art talent. But he understands that might be scary for Martin, so could they set up any plan for when Martin gets nervous? Maybe he can leave the art room and go back to home room. Or is there anything else that could help that Martin can think of? This conversation and their subsequent work together can become an extremely important corrective experience for Martin. Maybe there are people in the world that are friendly and want to help you and will not hurt you. This is what we hope Martin can come to believe.

It’s not that we are letting Martin “get away with” threatening the teacher. Punishment is irrelevant here. What we are trying to do instead is to use our most powerful relationship tools to help Martin learn how to identify and cope with his understandable panic responses so he will not feel his life is in danger and thus will not need to threaten others in order to save his own life. It is a long process, requiring many repetitions. We have already seen progress in Martin and with this awareness we feel hope for his happiness.

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