Boy drawingMarcus came into the psychiatric hospital after having been ejected from a previous residential program. He is adopted, and his current adoption is actually his second; he was removed from his first home because he was abused there. He is small for his age and a bit strange looking. In the month he has been at this center he has not made any friends; in fact the other kids seem to pick on him. Several times he has said inappropriate sexual things to female clients and to female staff, which does not increase his popularity. Generally he is the kid who is always doing what staff just told him not to do, then accusing staff of talking to him only when he does something wrong. Staff are finding it hard to engage with Marcus.

However, recently a more upsetting issue has emerged. Tony and Jarell, two of the other boys, and Amber, one of the girls, separately came to staff to complain that Marcus has been showing them some very disturbing pictures that he drew. A search of his room in fact produced many of these pictures, which are very graphic (and skillfully drawn) renditions of men torturing naked women, complete with blood and gore. Amber said to her staff member that she thinks Marcus is going to grow up to be a murderer; the staff who have seen the pictures tend to be worried about the same thing.

At first when this stash of drawings was discovered, staff gave Marcus a sketch book and said he could draw the pictures in there, but not show them to anyone. However yesterday his roommate Tim told staff that Marcus had been showing him his latest creation, one of the bloodiest yet. Lisa, Marcus’s therapist, finds that the pictures make her very uneasy, and she does not know what to do to help Marcus. In fact lately she has been avoiding meeting with him. In the staff meeting the most popular suggestion is that Marcus be forbidden any access to paper and writing or drawing materials in an attempt to prevent him from making these drawings.

Is this the best approach?

How do staff understand Marcus’ behavior? In what way are these pictures adaptive for him? What positive results is he getting from drawing and sharing them?

What does Marcus need? What approach should his team take?

What should be done to support Lisa and the staff in helping Marcus to heal?

If staff keep in the front of their minds the idea that symptoms are adaptations, they must consider what doing the drawings and sharing them with his peers is accomplishing for Marcus. They suggest several possible theories, such as giving him power, expressing his pain, giving him one area in which he is in control and can have an effect on others.

The drawings express a part of Marcus, however disturbing they are. If staff just try to ban them, they are giving Marcus a message that they are turning away from his pain, and that they do not want to see, share or accept all of who he is and what he has experienced.

Taking drawing supplies away from Marcus will not help at all. For one thing, staff won’t win on this one. There are many more pencils and pieces of paper in the world than they can ever confiscate. But more importantly, that response tries to eliminate his behavior and not to understand it.

Treaters need to take seriously the effect the drawings have on the other kids, the staff, and especially the therapist. This reaction is something they have to discuss as a team and make deliberate plans to give themselves the stamina to take this on. For example, the therapist may wish to include a male staff member at first when she talks with Marcus about the drawings.

Then the therapist can explore the pictures with Marcus, and not in a judgmental way. What is happening? What are the characters thinking and feeling? What is likely to happen next? The therapist can express her thoughts: “Really? I think the woman might be scared and angry.” But all discussion comes from a centered, calm place: “Tell me more. Explain how it feels. What does it remind you of?”

These discussions are entirely exploratory; they include no mention of a need to change.

Meanwhile, staff can talk with the other kids about how sometimes when people have had painful lives they draw painful drawings. Encourage the kids not to react, but just to bring staff into the conversation if Marcus shows them a picture. Of course, Marcus’ showing them around would decrease if he got less reaction. Then staff would handle it more matter-of-factly: “You know, Marcus, better to save these for therapy. I’ll give this one to your therapist and you can talk it over with her.”

Another area of treatment could be to offer Marcus other opportunities to have power and control, using his drawing. Could he draw some posters for an upcoming agency event (subject to review, of course). Can he draw a picture for the unit illustrating some positive message, and can staff get it framed and hang it up?

Marcus has been hurt repeatedly over his lifetime. He has found a way to both express his pain and get strong reactions from others. His behavior will not change quickly. Staff must understand that the way that they feel in looking at these pictures is the way that he often feels in his life. And staff must support each other in doing the long hard work it will take for Marcus to develop a new, kinder view of life’s possibilities.

Constant vigilance is needed to maintain a perspective that symptoms are adaptive, as the behaviors themselves are so persistent, annoying, and often scary.

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