When we get a referral, it (usually) specifies why the family is being referred. Sometimes it focuses on the parent. “The mother is hitting the children with a belt.” Sometimes it’s more about the child. “The teenager is staying out all night and the parents suspect she’s using drugs.” Often it’s a combination of both. “The teenager is staying out all night, and the mother is responding by hitting her with a belt.”
When they focus on the kids, it’s usually that they’re “acting out.” Something is dysfunctional. They’re doing something they shouldn’t be doing.
Sometimes, it’s OK. Doing things you aren’t supposed to is a developmental phase. It lasts from age two until death, but is usually a bigger problem at around fifteen. There are ways that kids test boundaries, and while it’s annoying, it’s appropriate.
At other times, kids are really acting out. They’re setting fires, they’re staying out for days at a time, they’re hurting themselves, hurting someone else, getting so stoned every day that they can’t function…there are many, many options.
When it’s standard acting out, “catching an attitude” and wanting independence, a lot of the work is on getting the parent to understand that this is what they signed on for when they brought that cute little baby into the world. They need to work with it, and their kid is far from the worst.
When it’s the more intense stuff, there’s a reason. Routinely, we know what it is.
“The teenage daughter was raped by her mother’s boyfriend. The mother did not believe her. The case did not become known to us until the child told a teacher who called the case in. The child has been extremely angry and leaves the home without permission. She refuses to speak to her mother.”
She does? That’s so weird. Why wouldn’t she want to talk to her? Clearly this kid has problems.
Or is she doing exactly what she’s supposed to do in that situation? Who would handle it better? And how?
“Family was referred by the child’s school. She is easily distracted and fights frequently. It is believed she suffers from ADHD and needs a mental health evaluation. Child witnessed her mother’s death in another country eighteen months ago and moved to the Bronx to live with her father.”
Definitely medicate her. There’s no other explanation.
Mental health counselor: “This boy refuses to even admit that he was sexually abused.”
SJ: “He never admitted it?”
MHC: “No, he told when it was happening, and he testified in court. But now he refuses to talk about it.”
And the problem is…? Wouldn’t we be more concerned if a kid nonchalantly told everyone he met about being orally raped by a family member?
“The children have been truant for the past two months.”
Sounds like straightforward bad behavior until you find out that their secondary caregiver was dying in the home during that time.
We label and pathologize behaviors that are so understandable. Grief? Fuck grief, get it together! (Or so says my obscenity ladened parody version of DSM-V. Look for it in bookstores this fall!) It’s not to say that not going to school, or running away, or fighting, are ok and we should let it go on. They’re not, and we shouldn’t. People need to be getting help and working through these things.
But they need to be getting the right kind of help. Working with someone who thinks your behavior makes sense, and that you don’t just need to knock it off or take the right pills (I’m not against medication, I swear, except when I am) can make all the difference. Especially when that person is willing to advocate on your behalf to the powers that be–someone else saying that you’re not crazy, you’re not bad, you’re just traumatized can be a pretty powerful way to develop the therapeutic relationship.
We’re rarely the only service providers involved in our families’ lives. There are mental health professionals, school staff, child protection specialists, and more. There’s often a lot of talk about taking a no-nonsense approach, and not letting a child “make excuses” for their behavior. That’s fine if we’re talking about a spoiled kid whose led a charmed life and has decided she doesn’t want to go to school.
Am I the only one who doesn’t work with many of those?
Understanding trauma, how it changes the brain and affects behavior, and how long it can take someone to feel safe again is something that everyone in this field (caseworkers, social workers, supervisors, receptionists) need to take upon ourselves. Otherwise we’re just spinning our wheels.