Hidden victims: Domestic Violence and Children

 

She left home while he was at work.

Erasing her presence from the house, she left nothing behind, not even a note.  Over a stressful 3 hours, she escaped from the man she had been living with, the man she thought she loved -  and disappeared from his life.

It had been building up.

Little things like checking her phone when she was at work, then emails, then his increasing moodiness and an intimidating, simmering anger. Her life became subject to his moods, tiptoeing around his temper, trying to avoid the dreadful consequences of triggering him. She was scared and anxious most of the time. At times, she even blamed herself.

 He hadn't seemed like a violent man when they met.

Nor did he look like someone who wanted to control her every move, but as the months unfolded she understood how damaging the dynamic between them had become - especially for her young son. She couldn't relax at home, never knowing what mood her partner would be in when he came home from work.

She  had resigned from her stressful and frustrating job after becoming pregnant and was now financially dependant on her partner. Lately he had started getting drunk every night. And when he was drunk he became aggressive, verbally abusive and unpredictable.

In order to escape a dangerous and intolerable situation, this young woman was forced to uproot herself and her child, leaving the family vulnerable to poverty and homelessness. Luckily, she had a friend who helped her pack up her household and provided her and her son with somewhere to live.

This is just one of many true stories about women who are victims of domestic violence. Not all women are so lucky.


Sometimes violence can be overt, but at other times it can be insidious and entrenched, an unwelcome dynamic poisoning relationships and making home life unbearable.

Sociologists like Carolyn Whitzman (2008) argue that violence is preventable and that much of the violence that occurs globally is hidden or invisible, particularly that directed against women. Nearly half the world’s population is directly affected by violence in some way. All of us are indirectly involved and we are all affected by it.

Whitzman also argues that safety is both an objective state and a subjective feeling. Women's lives continue to be constrained by the possibility of being victims of male violence. Feminist theorists argue that violence against women continues to be marginalized as a personal issue and responses can take the form of “blaming the victim,” ignoring the wider cultural impact of patriarchal constructs on women’s (and men’s) lives. We need to remember that family violence takes place in the context of the disempowerment of women. “Feminists …believe that domestic violence is not a private problem but rather a societal problem with structural roots.” (Straka & Montminy, 2008, p. 259)  

There is, for example, an unspoken consensus amongst women not to walk in certain areas at night, to confine oneself to certain behaviours - in order to stay safe - it is hard to think of men needing to be careful in this way. The recent murder of young comedian Eurydice Dixon has highlighted the tendency of those in power to blame victims and to underline the responsibility for women to take steps to avoid violence against them, where men's behaviour remains unchanged.

The #metoo movement is part of a global push to raise awareness of sexually predatory behaviour including harrassment and violence against women. It is part of a cultural tide hoping to change the social equilibrium. But far from the bright lights and glamour of hollywood, many women are too scared to be in their own homes. And for those with children, the issue becomes even more urgent.

Violence in the home affects those who witness, as well as those who are directly involved.  Domestic violence is not just about physical aggression - it is about control and power and encompasses the emotional underpinnings of relational violence.  Implied violence, intimidation, financial control, verbal abuse, intrusive and controlling behaviour - these are all strategies used by partners to control those closest to them. A recent Conversation article has highlighted the use of new technologies to stalk, harass and intimidate women - "the borderless nature of the internet...allows abusers to traverse geographical barriers to reach their victims through the use of technology."

Children are exquisitely sensitive to the atmosphere at home and where there is bullying or controlling and dysfunctional relationships, they will absorb the fears and the pain, perhaps even understanding these as a blueprint for all relationships. They will also feel a level of discomfort and disquiet which bleeds into their experience of family and limits their ability to relax and be themselves. Over one million Australian children are affected by domestic violence, according to the Personal Safety Survey (ABS, 2006) In 2006, the Australian Institute of Criminology (AIC) found that for the years ‘2003–04, children were recorded as being present at 44 % of D/FV incidents.’ (Quoted in Bartels, 2010, p.7)

Unfortunately, abusive partners often target the mother-child relationship, a strategy which can be considered as an additional form of child emotional abuse. Buchanan (2008) describes a pattern of behaviour in abusers which she describes as “Maternal Alienation,” where partners “attack the mother-child relationship,” threatening to harm the children and deliberately undermining and alienating the children from their mothers. (Maternal alienation should not be confused with the more controversial concept of parental alienation where a child is purported to be deliberately alienated from a parent, usually during acrimonious divorce proceedings. For more on maternal alienation please follow this link.)

Israel and Stover (2009) cite a 2000 study which found that children were more fearful of stepfathers and that stepfathers were more emotionally abusive. Alcohol abuse by partners is cited as “one of the consistent and predictive risk factors for injury.” (Thompson et. al., 2001, 2003, cited in Humphreys et. al., 2005, p.1308)  When a mother feels unsafe or intimidated, her ability to parent will most definitely be affected and this, in turn will damage the child, threatening their sense of security and well-being. This can have lasting and significant effects.[1] (Carpenter & Stacks, 2009; Connolly and Cashmore, 2010; Vickerman and Margolin, 2007a).

Researchers such as Megan Sety (2010) argue that “Children experience serious emotional, psychological, social, behavioural and developmental consequences as a result of experiencing violence."

The younger the child, the more vulnerable they will be. An insidious climate of violence and insecurity will impact more severely on very young children, but of course all members of the family will be affected. We know that early experience, including attachment experiences, will impact on the developing child’s brain. A mother who is the victim of a partner’s violence is unlikely to be able to provide the kinds of secure experiences which are needed to create (and retain) a secure attachment.  “Experiences with caregivers and other aspects of the baby's environment, for example violence in the home, play an important role in social and emotional development...” (Carpenter and Stacks, 2009, p.830).

A child with a secure attachment history will carry certain protective factors (trust, the ability to self-regulate and self-soothe as well as prosocial abilities). “A secure attachment relationship …is associated with optimal infant development and prosocial outcomes, including higher levels of social competence, more advanced emotional understanding, higher cognitive and language skills, and less dependence on adults.” (Carpenter and Stacks, 2009, p. 832)

Risk factors for children coping with family violence include “socio-economic disadvantage, social isolation and dangerous neighbourhoods” whilst protective factors include personal characteristics of the child such as positive self-esteem, intelligence and independence, as well as friendships outside the home and good community resources, including schools. (Haskett et al., 2006, p.800). “Single parent families headed by women are among the most vulnerable in society and are at greatest risk of poverty.”  Mothers who are the victims of domestic violence may not have many alternatives. (Alston (2005))

Some theorists have argued that the use of the term “exposure” to describe children’s experience of domestic violence both downplays the negative impacts and implies that the mother can prevent the children from being affected by the violence.

The reality is that violence perpetrated by men against their partners is normally both pervasive and enmeshed in a relationship style which is unlikely to be segregated or siloed by any actions undertaken by the mother except by leaving the relationship. (See Sety, 2010, p. 2) Davies and Sturge-Apple (2007) outline that interparental violence is associated with “other forms of destructive interactions” meaning that children in violent homes are likely to be exposed to a range of behaviors which can have a more “insidious impact.” (p.169) “Children and young people …have a higher level of awareness of the violence than their mothers report. Children do not have to directly witness or be involved in violent episodes in order to be affected.” (Mulroney, 2003, p.7) Domestic violence is likely to create an atmosphere of threat, intimidation and insecurity. According to family systems theory, (Minuchin, 1974) one member’s distress will have an impact on all members.

Theorists such as Vickerman and Margolin (2007a) view exposure to family violence as a “complex trauma” which is defined as one which is chronic and unpredictable. They argue that the cumulative effects of being exposed to violence can trigger or precipitate PTSD (see also Carpenter and Stacks, 2009). Being exposed to interparental violence is a risk factor for other forms of abuse such as physical and sexual abuse, particularly where substance misuse is also present, as is the case with Luke. Buchanan (2008) argues that infants in violent homes are at risk of “symptoms typical of post traumatic stress disorder, including sleep disturbances, night terrors, separation anxiety, aggressiveness, hyperactivity, emotional detachment and constriction.” (p.3) 

Using theories of stress and coping, Rossman, Hughes and Rosenberg, (1999) outline the potential for helpful and unhelpful modes of coping in relation to children exposed to violence in the home. Children may respond to violence by internalizing cognitive schemas (for example “anger is uncontrollable,” “escape is the safest strategy” or “interpersonal interactions are dangerous”) which may be inappropriate when used in other contexts, such as at school. On the other hand there may be some coping strategies (e.g. hiding from attackers), which might be useful. Rossman et.al. (1999) also argue that the younger a child is, the greater the risk that development will occur in the context of violence. (p.66) Social learning theory tells us that being exposed to interparental violence is likely to teach older children dysfunctional approaches to the resolution of conflict. “witnessing violence in the family predicts the perpetration of aggression in intimate relationships in adolescence and adulthood.” (Bartels, 2009, p.8)

For many Australian children, home is not a haven, but a place where they are at risk. Cultural values of privacy and self-sufficiency can prevent family violence from becoming public. I believe that our cultural assumptions around family life can blind us to the domestic realities faced by many children (and adults). The emotional abuse of children has been a neglected area of research and response, yet it is clear that it can be both pervasive and have long-lasting effects. With the emphasis in the media and through Government interventions on the horrors of severe physical and sexual abuse, the more subtle and insidious forms of child abuse can remain hidden. Bodies of research and agency responses and services have largely been targeted at specific forms of family violence, but a holistic approach is needed if we are to address the “totality of violence” (Tomison) in families at risk. Flexible interventions and support for families need to be better resourced to respond to those in need prior to the legal mandates of Child Protection. It is a matter of providing resources which are appropriately accessible and de-stigmatised, including education and counselling. Unfortunately, the child protection system is crisis driven and designed around the need to intervene after abuse has occurred. Healthy relationships and healthy children require nurturing, education, and support – prevention rather than cure.

 

 

REFERENCES

Alston, Margaret (2005) “Working with Women” in Margaret Alston and Jennifer McKinnon (eds.) Social Work, Fields of Practice, South Melbourne, Oxford University Press

Australian Bureau of Statistics 2006, Personal Safety Survey, Australia, 2005, cat. no. 4906.0, reissue, ABS, Canberra Australian Institute of Health and Welfare 2011

Bartels, Dr. Lorana Research in Practice no. 10, Canberra: Australian Institute of Criminology, April 2010

Belsky, J. (1993) “Etiology of Child Maltreatment: A Developmental-Ecological Analysis,” Psychological Bulletin 1993, Vol. 114, No. 3,413-434

Buchanan, Fiona (2008) “Mother and Infant Attachment Theory and Domestic Violence: Crossing the Divide” Australian Domestic & Family Violence Clearinghouse, The University of New South Wales, Sydney

Connolly, M and Cashmore, J., (2010) Child Welfare Practice, in Marie Connolly and Louise Harms (eds) Social Work, Contexts and Practice, South Mebourne, Oxford University Press,

Carpenter, Georgia L. and Stacks, Ann M. (2009) “Developmental effects of Exposure to Intimate Partner Violence in early childhood: A review of the literature “ Children and Youth Services Review 31 (2009) 831–839

Davies, P., and Sturge-Apple, M., (2007) “The Impact of Domestic Violence on Children’s Development”, in John Hamel and Tonia Nicholls (eds) Family Interventions in Domestic Violence: A handbook of gender inclusive theory and treatment, New York, Springer

DeBoard-Lucas, Renee L. & Grych, John H. (2011) “Children’s Perceptions of Intimate Partner Violence: Causes, Consequences, and Coping,” Journal of Family Violence (2011) 26:343–354

Haskett, Mary E.; Nears, Kennard; Ward, Caryn, Sabourin; McPherson, Andrea V. (2006)“Diversity in adjustment of maltreated children: Factors associated with resilient functioning” Clinical Psychology Review 26 (2006) 796–812

Humphries, C., Regan, L., River, D., & Thiara, R. (2005) “Domestic Violence and Substance Abuse: Tackling complexity,” British Journal of Social Work, 35, 1303 -1320

Israel, Emily and Stover, Carla (2009)“Intimate Partner Violence : The Role of the Relationship Between Perpetrators and Children Who Witness Violence” Journal of Interpersonal Violence 2009

Margolin, Gayla; Vickerman, Katrina A.; Ramos, Michelle C.; Serrano Sarah Duman, Gordis, Elana B.; Iturralde, Esti; Oliver, Pamella H.; Spies, Lauren A. (2009) Youth Exposed to Violence: Stability, Co-occurrence, and Context, Clinical Child and Family Psychology Review 12:39–54

McPhail, Beverly A; Rice, Gail; Busch Noël Bridget, Kulkarni, Shanti (2007) “An Integrative Feminist Model: The Evolving Feminist Perspective on Intimate Partner Violence” Violence Against Women Volume 13 Number 8 August 2007 817-841

Minuchin, S. (1974) Families and Family Therapy, Harvard University Press; 3rd Printing, 1974 edition (1974)

Mulroney, Jane (2003) Australian Statistics on Domestic Violence, Australian Domestic and Family Violence Clearinghouse

Rossman, R. Hughes, H., Rosenberg, M., (2000) Children and Interparental Violence: The Impact of Exposure, US, Taylor and Francis

Sety, M. (2011), The impact of domestic violence on children: a literature review, Australian Domestic and Family Violence Clearinghouse and Benevolent Society, NSW, Sydney

Straka, Silvia M. Montminy, Lyse “Family Violence: Through the Lens of Power and Control”, Journal of Emotional Abuse, Vol. 8(3) 2008

Tomison, A., (2000) “Exploring family violence Links between child maltreatment and domestic violence”, Issues in Child Abuse Prevention, National Child Protection Clearing House Issues Paper, The Australian Institute of Family Studies, No.13, Winter, 2000

Vickerman, Katrina A. and Margolin, Gayla (2007a) “Posttraumatic stress in children and adolescents exposed to family violence: I Overview and Issues” Professional Psychology: Research and Practice, Vol 38(6), Dec 2007, 620-628

Whitzman, C., (2008) The Handbook of Community Safety, Gender and Violence Prevention: Practice planning tools, London, Earthscan

 

[1] DeBoard and Grych argue that the links between intimate partner violence and child maladjustment are well established. They cite “elevated rates of internalizing and externalizing symptoms, academic problems, and peer problems…witnessing violence in the family predicts the perpetration of aggression in intimate relationships in adolescence and adulthood.” DeBoard and Grych (2011), p. 343

 

The Journey of Eustace Scrubb

Its not my favourite Narnia book, but it has always held a special place in my heart.

The Voyage of the Dawn Treader can still make me cry.  

What is it about this old-fashioned and politically incorrect tale that affects me?

I am moved to tears by the harrowing journey of its unlovely and seemingly unloveable antihero (played with vehemence by Will Poulter in the film).

In Voyage, Eustace is a prig raised by vegetarians (but let's not hold that against him - or them) who seems to have been planted into the story to provide a foil for the friendly and morally upright Pevensies. (You know, the ones who found the secret land of Narnia in the back of a wardrobe filled with moth eaten furs). When their parents travel to America, Lucy and Edmund are forced to spend the holidays at the house of Eustace and his parents.

Filled with self-hatred and jealousy for his happier and more social cousins, Eustace spitefully determines to spoil their stay. He is, by turns, logical, vindictive, argumentative and most definitely a non-believer - he doesn't believe in magic, or in the magical land of Narnia and takes every opportunity to ridicule his cousin's beliefs. His solitary and perverse demeanour contrasts with that of the open and friendly Pevensies, whose ability to acclimatise to the privations of an unexpected sea voyage, marks them as thoughtful - and responsible. Without Eustace, Voyage would be a rather dull adventure story. Most of us, I suspect, secretly identify with him and I certainly identify with his journey of transformation and friendship through intense pain.

Halfway through the book, Eustace begins his own rather unexpected narrative arc.

On a shore trip to gather provisions, in a cowardly sulk and with the aim of avoiding the work of re-stocking and repairing the ship, Eustace deserts his shipmates and sets to exploring the island, spotting the treasure studded lair of a dragon.  Exploring the cave, he sets upon the gold glimmer of a beautiful bracelet, unwisely choosing to clip it onto his arm. His lack of belief in magic (and in particular, dragons) leaves him distinctly unprepared for the spectacular consequences of his greed.

The price for attempting to steal a dragon's treasure is to become one, and Eustace wakes to intense pain from the pinching bracelet, now far too small for his engorged and scaly arm, an intimation of the high price he is to pay for his transformation back into human child.

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The dragon Eustace flies over his colleagues and eventually makes it known that he is their shipmate transformed into the fire-breathing beast. Whilst they debate what to do about him, Eustace decides to make himself useful traversing the island to gather tree-trunks for a new mast. He also helps the becalmed ship make passage by blowing (air rather than fire) into its sails.

As a dragon, Eustace immeadiately demonstrates far more vulnerability than he does as a boy, and is able to connect with his shipmates and make friends despite his scaly exterior.  Reepicheep, the courageous talking mouse at the end of whose rapier Eustace is initially humiliated, now becomes his special friend, staying with him during the long difficult nights of his dragon-life and witnessing with compassion his scalding, hopeless tears.

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Of course, we know that things cannot remain as they are and that Eustace must either be left behind or must somehow transform back into a boy.

When he is discovered by Edmund wandering near the shore in the dead of night, Eustace recounts the tale of his transformation.

Late one night, he was awakened by the voice of Aslan who led him to a secret garden high up in the mountains of the island.

In the midst of the garden is a deep pool where he is invited to bathe. But first he must "undress" and remove his scaly skin. Losing his dragon skin proves both much more painful and more difficult than he could have imagined and Eustace must seek Aslan's help to shed his skin  and reveal the more loveable human underneath. He initially pulls his own skin off, but  this is not enough and Aslan intervenes, ripping the scales with his frightening claws. 

It is not too long a leap to see these scales as the defences he has unwittingly developed in response to a childhood filled with inflexible rules and logic rather than magic. As we learn in The Silver Chair, Eustace has also been mercilessly bullied at the ominously named "Experiment House" (Lewis seems to have had an aversion to alternative lifestyles and schooling).

Obviously C.S.Lewis was writing from a Christian perspective and Eustace's immersive cleansing in the magical pool is meant to signify a kind of baptism. But I think that Lewis was also (and certainly not in a mutually exclusive way) interested in the psychological journeys of his characters, their pain and joy and more importantly, their growth. I feel that these two ways of reading his works overlap and also resonate with one another, providing greater depth and meaning to these now classic children's tales. One doesn't need to have Christian beliefs to gain meaning and joy from his work. 

Returning to the Dawn Treader with Edmund, Eustace must deal with the fallout from his nastiness (most of which we might sum up as a defence against underlying vulnerability) and the hurt he has caused to others in his pre-dragon persona. As he becomes more fully himself and opens to the people around him, his friendship with Reepicheep deepens.

But by the end of the novel, Reepicheep's own journey takes him away from his new friend and the mouse starts his final voyage in a tiny boat, heading into the sweet water waves of the end of the world.  

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Eustace's grief at the loss of his first friend hurts deeply. He has come so far, and as part of his transformation has taken the risk of caring for someone, but now must let them go - a moment that is dense with sorrow -  and meaning.

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Eustace's redemption reminds us of our own journey to connect and how we must all, in the end, learn to let go.

Sometimes the worst characters are the ones who can tell us the most.

 

 

 

 

 

 

 

 

 

 

 

 

Medication Isnt the Answer

 

Sabrina di Lembo was just 19.

A high achiever who was 'sailing through" her law degree at Charles Darwin University, she had a bright future.

“My daughter had everything. She had looks, she had everything,” Sabrina's father told journalists. She also had friends and family who loved her dearly.

Yet on August 17th last year, Sabrina took her own life.

Her parents are angry. 

They believe that the Mental Health system let them down.

Their daughter was suffering from severe anxiety leading up to her exams. “She wasn’t sleeping for two or three nights. I knew this was something we couldn’t deal with alone,” Mrs Di Lembo said.

They took Sabrina to a GP who recommended she see a psychologist.

However, even with ongoing therapy, she didn't seem to be getting better and they sought help from another GP who prescribed her the antidepressant Effexor as well as Valium to help her sleep, but soon after she started to have suicidal thoughts.

Desperate to do something to help their distressed daughter, they sought help from Northern Territory Mental Health Services .

"Ms Di Lembo phoned the Northern Territory Mental Health Line for advice and asked for her daughter to be seen by a psychiatrist, but it wasn't possible.

Sabrina's dose of medication was instead tripled over the phone and the family was told to go back to the GP to get the new script.

When the family took Sabrina back to the GP, they said the local doctor didn't agree, prescribing her with a double, rather than a triple dosage.

Ms Di Lembo said her daughter became "catatonic" on the higher dosage and wasn't able to effectively engage in therapy."

From the ABC Online article by Eleni Roussos

After all the funds injected into youth mental health.

All the awareness campaigns.

The suicide prevention programs.

What are we doing wrong?

There are many issues to consider in this tragic story. 

For a start, our current mental health system is inflexible and under-resourced. It is unable to respond to individual crises or to adequately support ongoing mental health issues in young people. The threshold for support is too high and waiting lists frustratingly long. There aren't enough places to get direct support.

Although the policy of deinstitutionalisation has been in place in Australia since the 70s, there has not been an adequate and appropriate injection of funds into community based mental health services to replace the now defunct large institutions and asylums. With the advent of the NDIS, community mental health is reeling from more changes as well as the removal of government support for mental health programs.

I also think that as a society, we are too dependant on medications and medical models of illness and recovery that negate the importance of social and structural contexts. The more we believe that medications will provide a solution, the more many of us will be tempted to take a pathway that may give us temporary relief, but that can create its own problems.

Primary care providers are under increasing pressure to give answers where there are none - at least in the short term. As parents we can be co-opted into our children's panic, thinking that they must be helped to get better now.

Some meds can help to temporarily support and calm us enough to get some much needed sleep and to undertake the work of psychotherapy. Some more structured modalities like CBT and mindfulness can give us strategies to help get us over a bad patch when we are particularly challenged by life's demands. BUT these things aren't the answer in the long term, at least not on their own.

It can take many weeks for even the most skilled therapist to develop enough of a rapport with their client for a young person to trust them with their vulnerabilities. Most young people are very reluctant to share their scariest thoughts with anyone - that includes their therapist and those closest to them. They may not even want to admit to themselves that they have these feelings. They often will not tell us when they are feeling bad, panicky or suicidal and can take steps to rid themselves of the pain they are going through, but that also take them beyond our help. 

For some young people, appearing weak or needing help can feel shameful. They don't know how people will respond,and in some cases they don't even have the words to describe the often overwhelming feelings that accompany panic and depression.

Suicide is a final and irreversible step that can feel like the only way out, especially without the life experience to understand that panic and fear can be survived and that life can get better.  The terrible but transient feelings that can interfere with study and cripple performance are only a small part of life, but can subsume a young person's ability to see the larger picture. For adolescents whose brain development hasn't finished, these issues are particularly important. 

Sabrina di Lembo took her own life after struggling to deal with the pressures of preparing for her final exams. Exam time can cause anxiety and panic for even the most well-balanced young person. If we don't have the skills and self-soothing to calm down and help ourselves, anxiety can escalate into panic.

Just missing a night's sleep can make us feel terrible, especially when we need to perform the next day. The stress and anxiety can then snowball into an insomnia that destroys our physical and mental well-being and bring us to a place where we can't think straight. We can no longer make good decisions or look after ourselves. We can end up finding ourselves in a black hole into which we fall without any notion of how to save ourselves.

For parents, the best thing to do is to make sure your child is receiving the right sort of help. If they are seeing a therapist, then make sure you support them to continue therapy, preferably weekly or twice a week.

You will not help them by shopping around for the "perfect" therapist or by choosing someone who gives you the answers you want to hear.

You can help them by looking out for signs that things are not right.

SIGNS TO LOOK OUT FOR:

"Predicting suicide is difficult. Changes in behaviour outside the person's normal range of behaviour (and which do not make sense to those close to them) may be a warning sign.

Other warning signs may include:

  • Loss of interest in previously pleasurable activities
  • Giving away prized possessions
  • Problem behaviour and substance misuse
  • Lack of care (apathy) about dress and appearance, or a sudden change in weight
  • Sudden and striking personality changes
  • Withdrawal from friends and social activities
  • Increased ‘accident prone’ incidents and self-harming behaviours.

From Better Health.

If you feel that something isn't right, then you will need to approach your young person and open up the space for them to talk about how they are feeling - without judgement, and without bringing your own fears and emotions into the conversation. The more calm and matter of fact you can be, the better.

There might not be time to allow them to come to you, although in less urgent circumstances this can work better.

Much will depend on your relationship with them. 

 If they feel that they can talk to you without your judgement or anger and most importantly, without your becoming overwhelmed, then they will feel more able to bring these most troubling thoughts to you. Many depressed and suicidal people believe that they are a burden, so will react strongly to your upset. You will obviously have emotions around this (I am not telling you to become a robot!) but you will need to put aside your own needs and fears temporarily in order to reassure and connect with them and how they are feeling. It can be a scary place for both of you, but in order to help them, you will need to be able to sit with these strong feelings - yours and theirs.

If you need support, are worried about a young person, or if you are a young person who is feeling unsafe, please get in touch.

Below are some support services that are free. Many of them are open after hours for phone calls.

For my earlier article on youth suicide, please click here.

 

 

 Sabrina di Lembo was just 19 when she took her own life after battling with anxiety and depression.

Sabrina di Lembo was just 19 when she took her own life after battling with anxiety and depression.

Why Psychotherapy?

Its a big commitment.

Money, time and emotional work.

Why do the hard yards if you are not going to get anything out of it?

With the right therapist you can feel safe to bring out your most vulnerable parts, to explore those parts of yourself that might be hidden or repressed. With integration as the aim, psychotherapy allows us to discover and re-integrate those lost parts and to become more fully ourselves.

To commit to the process of psychotherapy can be financially and emotionally challenging but without a full commitment, you can never do the hard work of changing your own life.

Having been through the process myself I can say that it was - and has been, life-changing.

It's been a journey that's sometimes been challenging, often irritating, at times frightening, often enlightening, always engaging, and, at times surprising - and most importantly for me - deeply creative.

It has been the only space in which I could explore my inner worlds fully - and safely. 

I had come back to Melbourne with my tail between my legs after a fulfilling and well-paid role in SA finished. Luckily I had savings behind me. For a while I stayed on the treadmill of applying for roles, being flown around Australia for interviews, only to find the position allocated to someone less qualified/more aligned/more successful in pulling in research funding or who had managed to hang around long-enough to convince the hierarchy that they should be rewarded with an ongoing appointment. It was humiliating and exhausting. Every position I applied for had at least 80- 100 applicants. I was tired and fed up. Enough was enough.

I had always had an interest in helping young people. I had enjoyed mentoring honours students as part of my role at UNISA and was slowly fanning the flames of an interest in therapy and counselling.

I started having counselling myself and although my counsellor was great, we weren't getting anywhere. He agreed that it was time to move on and recommended that I see a therapist he had met during his ACT training . Sally (as we shall call her) had just completed her registration and psychiatry training, was working psychodynamically (my preference) and had a practice nearby. 

I had a picture in my head of the perfect therapist for me - someone warm and fuzzy like Judd Hirsch in Ordinary People or perhaps a wise and witty German like the diminutive septuagenerian Dr Fried in I Never Promised You a Rose Garden. I imagined someone seasoned, perhaps slightly overweight  with thick eyebrows and grey hair, dispensing life advice and witticisms from a swivelling office chair.  Definitely not a tall young blonde with an incisive gaze and cool blue eyes.

I was probably taken aback by her attractiveness, but I stayed and told my story while she listened carefully, keeping her assessments to herself.

 

And so my journey in psychotherapy began.

 

Those first few sessions were hard.

I wasn't having therapy, but I was describing my pain and in many of those early moments, reliving it.

After this initial period of assessment, she indicated that there was something to work on (I always wondered if this carefully worded phrase was part of her commitment to understatement - a quality which I learnt to value rather than dismiss) and that she and I could work on it together.

Initially I was raw from the events of the recent past, but it wasn't long before we got to one of the many paths that lead backwards, into my childhood.

Psychotherapy has been a mainstay of my emotional life. Somewhere where I have felt safe and nurtured. A place to explore and find myself. A place where all the parts of me were welcome and greeted warmly, but where I was also challenged and confronted.  A relationship where I was listened to and thoughtfully considered. 

Sally has been there in my life for the last 10 years. Every Friday, and for a period, on Wednesday as well, I would come to her rooms, tap in the code and wait impatiently on the undersized chairs of the hallway waiting room, feeling as if my life was hanging out for everyone to see, trying to avoid the eyes of any other clients.

I will miss her rickety hatstand (a public liability suit waiting to happen), the comfy chair I would inhabit for 50 minutes (and sometimes, rarely, a smidgeon more) and the psychiatry texts lining her bookshelves. Amongst those weighty tomes my eyes were always  drawn to a battered copy of Marie Cardinal's incendiary and poetic memoir The Words to Say It, carving its own special niche above the fireplace.

I will miss the smell and feel of the room, the lamps and paintings, the gauzy texture of the curtains keeping my vulnerabilities and my tears out of the public eye. I notice that I don't say I will miss her - perhaps because it feels too sad. Although we go into psychotherapy to find ourselves, we do so through a relationship, and our therapist becomes special to us, reparenting and honouring our most vulnerable and fragile parts through the perilous journey of self-discovery. 

It is hard to leave. 

Sally knows art is important to me. Without her I don't think I could have got back to it. And of course, now I am here trying my wings as a therapist myself. 

When I started therapy I was all over the place. Now I feel stable and centred - able to find meaning and to give back.

So what has she done for me?

Its not something for the metrics of randomised controlled trials. Nor a glib and packaged testimonial.

Its something for dreams perhaps or poetry, something to contemplate on those days when I am grateful to be alive.


kari-shea-109894-unsplash.jpg

The First Mirror

 

"In individual emotional development the precursor of the mirror is the mother’s face."  D. W. Winnicott Mirror-role of Mother and Family in Child Development

 

When we look into someone's eyes, we can feel loved, or hated, dismissed or understood.

Even as an adult its often a powerful experience and brings us into contact with the lingering resonance and echo of infancy and with that a sense of our struggle to be recognised by our first mirror - our mother.

We all have buried inside us a felt memory of the experience of being mirrored in our mother's eyes.

For first-time mothers, breastfeeding and interacting with their infant can bring back that sense of continuity, symbiosis and connection - in a good way.

But it can also bring feelings that are frightening and incoherent, like falling into an alternate existence - or into nothing at all.

In his article inspired by Lacan's essay on The Mirror Stage, psychoanalyst D.W.Winnicott examines our early experiences of being mirrored.

"What does the baby see when he or she looks at the mother’s face? I am suggesting that, ordinarily, what the baby sees is himself or herself, In other words the mother is looking at the baby and what she looks like is related to what she sees there. All this is too easily taken for granted. I am asking that this which is naturally done well by mothers who are caring for their babies shall not be taken for granted. I can make my point by going straight over to the case of the baby whose mother reflects her own mood or, worse still, the rigidity of her own defences. In such a case what does the baby see? 

Of course nothing can be said about the single occasions on which a mother could not respond. Many babies, however, do have to have a long experience of not getting back what they are giving. They look and they do not see themselves. There are consequences. [... ]the baby gets settled in to the idea that when he or she looks, what is seen is the mother’s face. The mother’s face is not then a mirror.  So perception takes the place of apperception, perception takes the place of that which might have been the beginning of a significant exchange with the world, a two-way process in which self-enrichment alternates with the discovery of meaning in the world of seen things." [My emphases]

Although, of course this is quite dense, what I think Winnicott means is that mothers who are distracted by their own thoughts or are emotionally unavailable (through stress, anxiety, fear, or unresolved trauma) will not respond to the baby in a way that is useful for the infant's developing sense of self. This lack of response takes away the opportunity for the baby to see his or herself reflected and responded to in the mother's face. They also lose the opportunity for exchange and to understand the social environment as a place of exchange where their developing self is part of a potential for relationship.

This early mirroring is also theorised by self-psychologist Heinz Kohut in his psychoanalytic theories. For Kohut, the major task of the therapist is to provide the mirroring that was absent in infancy and he sees the therapist's role as that of "self-object", providing empathetic acknowledgement for the often neglected or repressed "true" self and allowing that often fragile self to emerge.

Both writers underline the  power of these experiences - the experience of being mirrored.  They also emphasise that our first social experiences can impact our felt sense of being attached, being loveable and underneath those,  being there at all.

It seems like a huge and weighty impact for something that most of us don't remember.

Contemporary researchers have found evidence to support Winnicott's theories. For example, we know from the work of Alan Schore that facial expressions and visual cues are vitally important for early development and the attachment relationship.  Schore has theorised that our right brain dominates brain growth in infancy and he has helped us understand where some of the unverbalised feelings teased out through the work of therapy come from and why they provide a powerful undercurrent for our social relationships - and our sense of self.

In her book on attachment and mother's eyes, psychoanalyst Mary Ayres argues that the consequence for those who miss out on being mirrored adequately is a primary sense of shame. This sense of shame becomes conflated and incorporated into the developing sense of self and provides an unrecognised core around which the personality is formed. It is not normally available to conscious thought, but remains as a felt sense of being unloveable or somehow defective.

As adults in therapy we seek help for issues that unfold as a result of underlying feelings of unloveability. The right therapist will provide us with mirroring, and allow us to feel understood and empathised with.

As a therapist, I am well aware that words often fail - they fail me and they fail my clients. But understanding, empathy,and yes, love can bridge the gaps that language just falls into.

For Kohut and other theorists, empathy is the primary healing force in therapy, and without it we merely provide intellectual argument - words and ideas that glance off the deeper wounds of early trauma.

 

 

Between self-esteem and self-concept

A world of difference.

Researchers at a Canadian University have found that an adolescent's self-concept influences whether they will be need an inpatient stay or be able to be treated in an outpatient clinic. In other words, how serious their illness might be.

Its not rocket science - or is it?

It sometimes seems like language is obfuscating our view of what is really going on in mental illness and in our minds.  Language isn't always the best tool - or the right one, to convey our experiences of consciousness.

Drilling down and separating out concepts, especially something as apparently ineffable as identity, can seem banal and at times counter-productive - perhaps like pulling apart a daisy in order to study it more closely.

But how else can we conduct research that stands up to the rigours of evidence?

Just as in other disciplines it can be hard to reconcile academic debates with everyday clinical practice.

Of course, there are always those gifted researchers who can conduct research and have a real impact in their clinical work as well as being armed with the skills to popularise their research.

Working in a busy inpatient unit has taught me that people with serious mental illness are at heart, struggling with self - self-definition, self-worth, self-knowledge, self-esteem - the boundaries between self and others. Some of them are struggling with the idea of existence itself.

But are these just words, or do they actually have traction in a person's presentation - do they have meaning for how people are in the world and how we experience them, and more importantly, how they experience themselves?

To me, self-esteem is a popularised concept that doesn't really equate to the deep-seated existential issues faced by young people (and all of us) in creating, managing and sustaining our identity. Giving a child a prize for coming 7th isn't going to make a lasting difference in how they feel about themselves. As well-meaning as the self-esteem movement was or has been, it is still a problematic distraction from the reality of the emotional problems faced by teachers and students in classrooms. Pretending that the world can reward those who don't perform is unrealistic, but we should still help our children to understand that failure is a not necessarily a bad thing - and support them to keep trying.

Measuring someone's sense of self by finding out how highly they rank or esteem themselves doesn't really tell us a lot about the intricacy of our relationship to ourselves.

Our sense of self is a whole lot more complex than that - and perhaps - in the end ineffable.

 

"Self-esteem key to treating mental health"

February 20, 2018, University of Waterloo

Improving how mental health patients perceive themselves could be critical in treating them, according to a study from the University of Waterloo.

The study found that youth with psychiatric disorders currently receiving inpatient services reported lower self-concept, particularly global self-worth, compared to those receiving outpatient services.

"This was the first study that examined youth with psychiatric disorder by comparing what type of service they were receiving and whether that was associated with self-concept," said Mark Ferro, the Canada Research Chair in Youth Mental Health and an assistant professor in the Faculty of Applied Health Sciences at Waterloo. "We know that global self-worth is lower in the inpatient group and we know from other research that lower self-concept is a precursor to other more serious mental health problems."

The study examined 47 youth aged 8-17 years who were receiving inpatient and outpatient psychiatric services at McMaster's Children Hospital in Hamilton. The participants' self-concept was measured using the Self-Perception Profile for Children and Adolescents.

Self-concept might be an important aspect to consider when implementing treatment programs to improve the mental health of youth who are hospitalized.

"Because youths who are in the inpatient service have a lower self-concept, therapies within their overall treatment program aiming to improve self-worth might be worthwhile," Ferro said. "Interventions to improve an individual's self-concept or self-perception would be complementary to some of the more pressing needs within child and youth inpatient psychiatric services."

The study, which was undertaken by Ferro and Hamilton Health Sciences bursary student Chris Choi, was recently published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry.

 

 

Why Anger Management might be bad for all of us

“One obstacle to innovation...is branding of psychological interventions...branding prevents dissemination and implementation of psychological therapies, and stifles innovation by implying ownership.”

Anger management, ACT, Solution-focused therapy, DBT, CAT.

Powerful brand names in the therapeutic marketplace.

A recent article in The Lancet has suggested that the branding of psychological treatments might be preventing knowledge from being shared and helpers from developing new skills for helping.

Branding is about one thing - money. It raises brand awareness for therapists and It controls who can use their treatment - only those trained by them or trainers trained by them. It allows governments and service providers to feel safe about using discreet treatments that have an endpoint and that lend themselves to being tested through randomised controlled trials.

Heaven help those therapists who haven't attended the latest PD, or spent hundreds on training packages that are marketed as "the answer" to drinking, domestic violence, anxiety or depression. We all know that these and the many other mental health problems that plague us and our clients are multi-faceted and have multifactorial causes including structural ones. These are not things that can be cured by a one-size-fits-all approach or a package of limited sessions.

Insights to be found in all modalities, but in the large grey area that is human emotion and personal growth, none of us has all the answers. 

Just being able to sit with someone who is in pain without trying to find a solution  -  without attempting to distract, or dazzle them with a clever interpretation, can be the greatest challenge of all.

Especially when we (and our clients, funding bodies, organisations and governments) desperately want (and need) to believe in a quick fix. 

Psychotherapy is not designed to be an easy or fast solution and that can be a barrier to some of those who need it most. It can be expensive, challenging, at times disappointing, exhausting and frustrating, yet it can also provide us with some of the greatest moments of connection and help us find meaning - and deeper healing.

 

For The Lancet article click here.

 

The long white corridor

 

"A picture tells a thousand words"

Sometimes cliches can be unnervingly accurate. 

Photographer Laura Hospes' disarming and brutally honest self-portraits tell us things about mental illness that can never be captured through words.

These beautiful and haunting images also tell us something about the strange and secluded world of the psychiatric inpatient unit - where people's emotional wounds appear distressingly overt. These are places where screaming, crying and emotional collapse happen as if on cue, and conversations are peppered with acronyms like ABI, BPD, CAT, ECU, MSE and DSM. Nowadays treatment in facilities like these (especially in public mental health here in Australia) consists largely of management and containment, keeping people safe with drugs or restraints. For some, perhaps, it might serve as a retreat -  a place to stay when the world becomes overwhelming, but for many an inpatient stay can exacerbate the wounds they brought with them. Other people's pain can trigger our own.

Whilst still a student, Laura Hospes documented her stay in a psychiatric hospital where she was admitted following a suicide attempt. To survive and make sense of what was happening, she took photos. She found a way of reckoning with herself and her emotions through the lens of her camera.

Working in an inpatient unit has taught me that the people who come in often don't have a voice. They are either not listened to, ignored, dismissed, or lack the courage or the means to talk about how they feel.

That is why pictures are so important.

 

From Laura Hospes' website:

"About Laura.

Laura Hospes (1994) has been capturing her own self with the camera since the tender age of 16, out of a need to connect with people. This need has not waned over the years; it has only become more necessary. Hospes' self portraits are her way of making clear what is inside of her. Her camera consoles and understands her better than anyone else. Photography is her medium to accept and process the many struggles in her life. The resulting images are intense and arresting, as well as being a captivating glimpse inside the world of a young woman dealing with depression and anxiety. 

Hospes was named one of the 50 best emerging photographers of 2015 by the international jury for the Lensculture Emerging Talent Awards. Her work has been frequently featured both home and abroad."

 You can now find Laura Hospes’ work in a book entitled “UCP.” 

It can be hard for people who don't live with mental illness to understand the terrifying nuances that come with the disorders. That's exactly why 21-year-old Dutch photographer Laura Hospes published a series of stunning self-portraits that expose what mental illness can really be like.

The project, named "UCP-UMCG" after the psychiatric hospital where the photos are set, shows Hospes as she receives treatment for anxiety, depression and disordered eating. The images beautifully expose her daily life in the hospital -- and the strength it took to seek treatment.

"Having a mental illness is the hardest thing I experienced in my life," Hospes told The Huffington Post.

"People can't see that you’re ill, they just see a normal person that can still laugh sometimes and having a nice evening. What they don't see is the miserable hours after any social event and the breakdown I had every morning when I had to leave my bed. ... And that's just a small part of all the difficulties."

Hospes began taking the photos her first day in the hospital, adjusting her methods of photography based on what the center would allow. Her goal for the project -- in addition to documenting her own journey -- is to prove to others that you can be the textbook definition of "normal" and still need to overcome difficulties.

People can't see that you’re ill, they just see a normal person that can still laugh sometimes and having a nice evening.

 From Huffpost:

"I hope people are aware of the fact that people who are in a psychiatric hospital are not crazy. They have a very difficult period in their life and need time to recover so they can be themselves again," she said.

The photos were a cathartic way for Hospes to be in-touch with her feelings as she moved forward in the treatment process. She wants the images to serve as a powerful reminder for others whose loved ones suffer from similar mental health conditions.

"Stay with them in your mind and let them know you are thinking about them," she explained. "That is the most thankful thing for a person who feels to be slowly 'going crazy' and having no control of it."

When Dutch photographer and student Laura Hospes was hospitalized in a psychiatric hospital, she processed the experience one of the only ways she knew how — through her lens.

Now her photo series, “UCP-UMCG,” named after the psychiatric hospital in the Netherlands where she stayed, documents the 21-year-old’s journey to recovery through a series of self-portraits. After a suicide attempt, she began treatment for depression and an eating disorder, according to the Daily Mail.

During her stay, Hospes told The Mighty in an email, she was allowed to have one item in her room.

“I had no difficulties having my camera with me, only when I had to stay in an isolation room I couldn’t photograph anymore. But after a couple of days the rules were less strictly and I was able to have one item in my room. I changed from camera to laptop to phone etc.” she told The Mighty.

Feeling overwhelmed and confused when she first entered the hospital, Hospes used photography as a way to rediscover herself.

“I couldn’t make contact with my own emotions and I felt like I was floating somewhere in the air with heavy stones tied on my whole body,” she told The Mighty. “After a month I slowly found myself back and the emotions screamed in my head. I was extremely sad or extremely angry. I felt so desolated in hospital, even if there were friend or family around me.”

The photo series won the photographer a spot on LensCulture’s list of 50 best emerging photographers for 2015 in the LensCulture Emerging Talent Awards.

“At first, I made this complete series for myself, to deal with the difficulties and express my feelings,” Hospes told The Mighty. “After that, I want to inspire people who are or have been in a psychiatric hospital. I want them to see my pictures and recognize themselves in it. I hope they feel taken seriously, less crazy and less alone.”

 

Time Out?

We are all seduced by quick fixes.

For harassed and stressed parents, it can be tempting to believe that the answer to their child's behaviour is "out there" in publicised parenting tips or the latest fad doing the rounds of magazines and TV.

The reality is that parenting is a relationship and that your child's behaviour is influenced by your relationship with them, and by the home environment. 

Parenting strategies such as "time out" and controlled crying are a one-size-fits-all approach which deliver under the assumption that children need to adapt to parents in order to be effectively socialised.

The reality is that good-enough parenting involves keeping the child "in mind" and teaches children how to self-soothe and to relate well to themselves and to others.

Good-enough parenting looks to strengthen the relationship you have with your child and to help them understand their own emotions and behaviours.  Strategies like "time out" can ignore these important emotional learning opportunities.

Parents need to work to understand the emotions underlying their child's behaviour so that they can help meet the child's emotional needs rather than just focus on controlling difficult behaviours. This is what will work in the long-term.

 "Timeout" can end up teaching children that there is no help for them and no amelioration or soothing for the helpless and intensely aroused states that accompany tantrums.

 

Time Out

Australian Association for Infant Mental Health Position

(From the AAIMHI website)


The Australian Association for Infant Mental Health Inc. (AAIMHI) aims (in part) to:

  • improve professional and public recognition that infancy is a critical period in psycho-social development.
  • work for the improvement tof the mental health and development of all infants and families.

Time Out Defined

Time out involves time away from a rewarding or positive environment as a consequence of some form of misbehavior, usually for 1 – 5 minutes. The definition used by AAIMHI for this statement is where the child is also removed from the presence of and/or interaction with the parent or carer.


Background to AAIMHI’s Position

AAIMHI’s concern is that some parents and others caring for children in the community understand time out as exclusionary time out, that is, as separation from the parent or caregiver as well as from the activity in which the child had been involved. This statement refers in particular to the use of time out with children in the first three years. However, some of the issues raised will also be relevant to older children.

While there is research that supports using time out to control behaviour, especially for older children, this research does not address the emotional impact on the child. Developmentally, children less than three years cannot be expected to be able to self regulate emotionally. Therefore they still need the presence of a caregiver to assist them with this process, not separation from them. Separation may increase a child’s insecurity and distress.

Many older children have never had emotional regulation modelled to them by their caregivers in ways that enable them to learn self regulation. They therefore also need the presence of a caregiver to assist them with the management of their feelings.

Children under three years may not have the developmental capacity to keep in mind the connection between their behavior and the response of the caregiver, especially if there is any time delay.

Unregulated feelings are the cause of ‘out of control’ behaviour; responding to this behaviour needs to be about responding to the underlying emotional need of the child. The most effective, long-lasting way to respond to this behaviour is for caregivers to understand how the child is feeling and thinking. Then the parent or carer can anticipate when problems will arise and plan to prevent them.

When they do happen, the parent can show that strong feelings can be understood and managed. Sometimes therapy may be needed for persistent ‘out of control’ behavior.

Time out – AAIMHI’s Position

The AAIMHI position on responding to children’s behavior is informed by an attachment theory model of relationships which is now backed by a very significant body of research. The use of time out (where the child is removed from contact with the parent or caregiver) with children under three years is inappropriate. The use of time out with children over three years needs to be carefully considered in relation to the individual child’s experience and needs.

AAIMHI concerns in relation to use of exclusionary (where the child is separated from the parent or caregiver) time out for children less than three years are:
 

  • It does not teach constructive ways to deal with problems; instead it teaches separation as a way to deal with problems.
  • It does not take into consideration the developmental capacities of young children under three. From an attachment and development-based point of view, children this age are experimenting and do not yet have the necessary skills to control impulses and emotion, i.e. their behavior is not misbehavior.
  • It deliberately cuts off the child from the relationship with parent or carer so that the child feels powerless to connect with the adult; this cutting off from relationship is an intended consequence for the child’s behaviour and is seen by the child as a punishment.
  • It does not address the message (cause) behind the behavior.
  • It fails to recognise that young children do not learn self regulation of emotions by themselves; they need the support of a parent or carer.


Recommendations

Reinsberg (1999) lists five points to consider in responding to a child:

  • Is this a developmental stage?
  • Is this an individual or temperamental difference?
  • Is the environment causing the behaviour?
  • Does the child not know something but is ready to learn? 
  • Does the child have unmet emotional needs?


Some practical suggestions

1. Make sure the child’s environment provides for the basic needs of love, emotional and physical security, room to explore and encouragement. The emotional context should be with the parent and child in a partnership for growing and learning, not an oppositional one of controlling.

2. The parent needs to be the one in charge (in a guiding way), wiser than the young child. The child does better with a confident, kind caregiver.

3. Let young children be as much involved in helping with activities as is sensible. Show children how to do things that they can feel good about.

4. Monitor a young child’s activities and emotional state. Watch for early signs of distress or difficulty and act then (divert, attend to needs, give a hug, change the activity) rather than waiting for the emotional response to develop.

5. Respond to precipitating factors such as a child’s level of tiredness or excitement or family changes such as a new baby.

6. Calming routines before difficult situations are a good idea to get your child in a calm, well balanced state, e.g. a quiet game, a bath, a walk outside, a story.

7. Give young children choices where possible and within their capability.

8. Anticipate difficult situations. Think about when they happen and plan to avoid them if possible. For example, take with you some things to amuse a young child. Watching adults is very boring for them. If not, talk to the child about the situation ahead of time. Challenge the child with how you would like things to go: “I wonder if you would be able to (be clever, strong, etc.) and help me do this?” Have a plan in case things don’t go well.

9. Think about the event from the child’s perspective.

10. If you see an emotion rising in the child, note it and name it with them. For example:

“You are getting cross I know...”
“I understand you would like ... but we can’t because ...”

Give a short reason:

“We have to make sure you are (healthy, safe, kind to others, etc.).”
“I can help you (do something else).”

Or a challenge to the child of something acceptable to you:

“Maybe we could ... ”

11. If the above does not work, take the child away from the situation but keep the child with you (sometimes called ‘time in’). Remain as calm as you can and consistently restate your decision. Acknowledge the child’s feeling. Offer to connect with the child. “I know it is hard. Do you want a hug?”

12. Predict that this will be over soon. “I know we can calm you down. Very soon you will fine again.”

13. Importantly, parents who are very upset themselves need to take a break, as long as the child is safe. Helping parents to find support is important; there are always times in parenting when this is needed.


Specific resources for helping one and two year olds (and older) with behavior and feelings.


Time In

The Circle of Security model lists a step by step process called “Time In” during which the adult helps the child “organize their feelings.” In their approach, Time Out is for the parent to calm down (emotionally re-regulate) in order to be in a good state to respond to the child. See: www.circleofsecurity.com

Time-in Parenting

This book by Otto Weininger is highly recommended for helping children to learn strategies for self regulation. Weininger states,

When children are upset, out of control, rude or angry, what they need most is to be with a safe and accepting adult. They need to be with someone who is calm and non-punitive, and can recognize that anyone can get very upset at one time or other. They also need someone who can help them express these strong feelings appropriately.

The context of responding to young children’s behaviour is to use the parental relationship with the child to assist the child with emotional regulation, i.e. young children learn emotional regulation in the context of the relationship and with the support of the parent. It is not something they learn alone.

Weininger makes the following points about exclusionary time out:

[Time out] assumes that, at any age, we learn by ourselves and do not need others to help us. It assumes that we already somehow know the ‘right’ way to do things and can simply go to our room and ‘tune into’ the right way. Again, it appears to the child we do not need anyone to help us do this ... I do not believe that children of two, three, four, five or even six are able to perform such thinking tasks because they do not yet have the reflective skills to do so ... time out is a punishment that deprives a child of the very relationship that he needs at the time the punishment is given.

See: Weininger, Otto (2002). Time-in parenting: how to teach children emotional self-control, life skills, and problem solving by lending yourself and staying connected. Toronto: L. Rinascente Books. 

The Emotional Life of the ToddlerThis book by Alicia Lieberman also has very helpful information about toddlers and how the way we respond to them helps them with important learning and development. It gives parents and carers a real insight into the world of the toddler and what is behind their actions and feelings.
 

Related Reading:

 

Gentle Discipline Book Collection

Aware Parenting: Time Out

Circle of Security 

NAEYC Statement on Time Out (NaturalChild.org) 


References

Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT (Eds) (2005). Enhancing Early Attachments. Duke Series in Child Development and Public Policy. New York: The Guilford Press.

Betz C (1994). Beyond time-out: Tips from a teacher. Young Children 49:3, 10-14.

Cassidy J & Shaver PR (Eds) (2000) Handbook of Attachment. New York: The Guilford Press.

Elkind D (2001). Instructive discipline is built on under- standing: Choosing time-in. Child Care Information Exchange 141, 7-8.

Fonagy P (1996). Prevention, the Appropriate Target of Infant Psychotherapy. Plenary address at the sixth World Congress of the World Association for Infant Mental Health. Tampere, Finland. July.

Gartrell D (2001). Replacing time-out. Part one – Using guidance to build an encouraging classroom. Young Children 56:6, 8-16.

Gartrell, D (2002). Replacing time-out. Part two – Using guidance to maintain an encouraging classroom. Young Children 57:2, 36-43.

Haiman PE (1998). ‘Time out’ to correct misbehavior may aggravate it instead. Brown University Child & Adoles- cent Behavior Letter 14:10, 1-4.

Hannon J (2002). No time for time out. Kappa Delta Pi Record 38, 112-4.

Lang L (1997). Too much time out. Teacher Magazine 8, 6-7.

Lieberman A. (1993). The Emotional Life of the Toddler. USA: The Free Press.

Readdick CA. & Chapman PL (2001). Young children’s perceptions of time out. Journal of Research in Child- hood Education 15, 81-87.

Reinsberg J (1999). Understanding young children’s behavior. Young Children 54:4, 54-57.

Schore A (1994). Affect Regulation and the Origin of the Self: the Neurobiology of Emotional Development. Hillsdale NJ: Lawrence Erlbaum.

Schreiber ME (1999). Time-outs for toddlers: Is our goal punishment or education? Young Children 54:4, 22-25.

Weininger O (2002). Time-in parenting. Canada: Caversham Publishers.

Wolf T et al. (2006). Time-out interventions and strategies: A brief review and recommendations. International Journal of Special Education 21:3.

If you need help with your parenting or are feeling emotionally overwhelmed, please get in touch for a confidential discussion.

Amanda 0411749577
 

 

Ordinary People

"Uh... I don't know. It was like... falling into a hole. It keeps getting bigger and bigger and you can't escape. All of a sudden, it's inside... and you're the hole. You're trapped. And it's all over. Something like that. It's not really scary... except when you think back on it."
Con tries to explain his suicide attempt to Jeanine.
 

Ordinary People tells the story of a family at odds with itself after the death of the eldest son in a boating accident.

Their youngest son, Conrad, played by Timothy Hutton in the film, survives the boating accident which killed his brother and has left the family devastated.

Conrad is left with survivor's guilt, at least partially due to having clung to the boat during the unexpected storm and lived.

But there is much more to the story.

Unusually for a Hollywood picture, the "happy" ending brings us to a reckoning where the emotionally stranded Beth (played with intricate narcissism by Mary Tyler Moore) abandons her family in the wake of a realisation that things can't and won't be the same.

Threatened by the growing closeness of father and son, and the need to incorporate the emotional consequences of Bucky's death and Conrad's suicide attempt, Beth packs a suitcase and calls a taxi, leaving the family home in the middle of the night after a watershed conversation with her husband.

Beth's need for everything to be wrapped up nicely with the appearance of perfection becomes a more imminent threat to the emotional health of the family after Bucky's death and Conrad's illness.  She is a mother of shiny surfaces, perfect table settings and cocktail parties where family vulnerabilites, including Conrad's need to see a psychiatrist, are never aired in public.

Bucky's death provides the cataclysm that breaks the family's coping strategies apart.

Without that event, audiences speculate (with Cal) that perhaps they could have survived, with Conrad keeping his misgivings regarding Beth to himself, but I am not so sure.

Conrad's depression seems to be a mix of survivor guilt, anger at his mother, and a much deeper sadness. The feelings of worthlessness that contribute to his depression make him take out his anger on himself. His psychiatrist encourages him to sift through and express the feelings which he has been repressing and which seem to have swallowed him whole, absorbing his will to live.

In sifting through these issues, its important to look closely at Con's relationship with his mother and how this has affected his ability to cope with his brother's death - and his own survival.

Beth does not seem to be a good enough parent.

She views everything as a reflection on her and there is no room in her relationship with her surviving son for feelings which are messy, unmediated or don't coincide with her own thinking. She just can't seem to understand, acknowledge or accept that others may have a point of view which differs from hers.

Empathy definitely isn't her strong point.

At one stage in therapy, Conrad angrily accuses Beth of having been more concerned by the damage to her bathroom tiles than by her son's suicidality. Part of the problem and the reason for his depression is that he feels unable to express his anger and disappointment at his mother and his guilt over the boat accident. Although the film argues that a part of Beth died with Bucky, my sense is that she has been narcissistic for a long time, and that her ability to parent has been severely truncated by this primal soul wound.

In his "adaptive reparenting," of Conrad, Dr. Berger allows the young man to express his long-repressed wounded feelings: the anger, hurt and guilt, and eventually we reach the therapeutic catharsis of reliving the accident, where his seemingly stronger brother gets tired, slipping from safety into the water, while Conrad hangs on.

As part of his therapy Con is encouraged to forgive both himself and his mother, before he can move on.

Although I love Judd Hirsch in this wonderfully empathetic role, I feel that forgiveness is not necessarily a realistic goal for Conrad. Certainly he seems to end the film as a more mature and emotionally open person than his mother will ever be, but does he need to forgive her to reach this point? I would also argue that the idea that Beth "loves him as much as she is able" is also somewhat rose-coloured, letting her off the hook for the limitations that have traumatised all of them. My experience of severe narcissism tells me that love is not something of which sufferers are capable. Need, yes, admiration, perhaps, but not the kind of love that children need and not love as most of us would define it.

Forgiveness is not necessarily the ultimate goal in psychotherapy - self-knowledge yes, understanding the limitations of our parents and how they have affected us, certainly, but forgiveness?

It can take years to even begin to understand our own trauma and how we can and do live alongside it everyday. To reach the point of understanding and forgiving those who have wounded us - well perhaps that is a lifetime's work.

 


Still Talking After All these Years?

A recent article in the "Style" section of The New York Times celebrates the recent rise in the popularity of psychoanalysis.
But psychoanalysis has never gone out of "style" (especially in New York!) and most clinicians use psychoanalytic techniques and ideas in their practice - whatever works for the client and therapist and it's not that clear cut.

When I was studying social work, we were given a very small, rather dismissive introduction to psychoanalytic ideas as one of many theoretical streams upon which we could draw - even though the reality is that most current theories rely on psychoanalytic ideas for most of their assumptions.

I remember a colleague being shocked on starting a new job working with children and families, when she discovered that her supervisor had never heard of (influential child psychoanalyst) Melanie Klein!

There wasn't enough time or space in my social work training for an exploration of psychoanalysis, so I did my own reading and found that my placement supervisor was a wonderful mentor for using psychoanalysis and psychodynamic theory in family work.

The NYT article also discusses President Trump's mental health which I think is dangerous territory for any clinician. The student jumps in, but I note that the more experienced therapist declines the invitation to diagnose in absentia, especially not "on the record!"

 Yes, there are fashions in these things, but thoughtful practitioners find their own way through this and will use what seems relevant and helpful, even if it might be viewed as "old fashioned."

https://www.nytimes.com/2018/02/17/style/american-psychoanalytic-association-donald-trump.html

Identity

Searching for Self

“I used to spend hours when I was a kid just looking in the mirror, trying to figure out if I was handsome or not. It just depended on the day. If someone told me I was handsome, then I was handsome, and if someone told me I was ugly, then I believed that. I hardly ever look in the mirror anymore though, not if I can help it. It’s just too stressful.”

 

When Dane de Haan (as Jesse) appears for his last session in the HBO series "In Treatment", it’s a shock both for the audience and for his therapist. He arrives with Angelo, his adoptive father – a man with whom we feel he has little in common – at least from what we know of Jesse through his therapy. His therapist struggles to remain neutral in the face of this backflip – and Jesse’s choice to quit therapy. As viewers who have followed Jesse through his exploration of independence, we are also flummoxed - and disappointed, that this young man chooses to abandon therapy and what we might see as a search for his ‘true self.’

Part of his struggle is in trying to come to terms with his attachments, both biological and adoptive. Having “tested out” his biological parents by turning up at their home under the influence of drugs and asking them for money, he rejects them on the basis that they appear to have rejected him. Jesse’s step-father Angelo is waiting in the wings to provide reconciliation and the acceptance that the young man craves.  Jesse is seduced by this acceptance, even though we feel it comes at too high a price. His unstable sense of self is at risk, especially given Angelo’s scepticism about therapy and that he has disparaged his wife as part of his growing closeness with Jesse. These indicators provide evidence of an unhealthy tug-of-war for Jesse’s allegiance and affections that has little to do with allowing the real Jesse to emerge.

But just what is our true self?

The idea of identity is a fascinating one - who we are, what we believe in, what we value and how we manage our relationships in the context of holding onto a stable self-image. Identity is the way we picture ourselves and keep a sense of our needs, desires, ideas and thoughts consistent through time. It gives us a solid base from which to explore the world and relate to others. Without it we are at risk of being influenced too much by those around us, and by the external world.

For adolescents and young people, identity is a common arena of struggle and achievement. It is something that can preoccupy young people to a greater or lesser degree, without necessarily being a sign of illness.

Dramatic turns such as Jesse’s are uncommon, but there are times when young people will try on different ways to be themselves, join different peer groups, adopt different personas, and explore different interests. For example, they may go from being a sporty early teen who enjoys the outdoors and an easy physicality, to a moody and sullen emo, wearing black and hiding in their bedroom. It can be a pretty confusing time for parents.

“Consolidation of identity is one of the most central tasks in normal adolescent development…Despite experimentations with different roles, the experience of the self remains consistent across situations and across time, forming an integrated identity that is both flexible and adaptable. It is this core sense of identity that permits the maturing adolescent or young adult to develop rewarding and satisfying friendships, form clear life goals, interact appropriately with parents and teachers, establish intimate relations, and maintain positive self-esteem.”

In exploring the idea of identity it can be useful to look at what happens when things go wrong. Personality disorders, particularly BPD and NPD can be seen as primary disorders of the self, where the formation of identity has somehow been derailed.

“Some adolescents struggle with this process [of identity formation] and have a loss of capacity for self-definition, experience a painful sense of incoherence and chronic emptiness, exhibit contradictory behaviours, have poor anxiety tolerance and impulse control, and lack commitment to values, goals, or relationships.”

(From Adolescent Identity Treatment: An Integrative Approach for Personality Pathology by Foelsch, P.A., Schlüter-Müller, S., Odom, A.E., Arena, H.T., Borzutzky H., A., Schmeck, K.)

But what does that look like in the real world?

Problems with identity can manifest in both subtle and more concrete ways. We might meet someone or have a friend who seems very different every time we see them - they might seem to hold one view of themselves at one time, but a contrasting one in a different context. If we disagree with them, they might feel rejected or negated, becoming hostile or adversarial in the face of a challenging difference. It can often be very hard to maintain a relationship with people who have an unstable sense of identity. They have difficulty with the “long view” of relationships and will react strongly to perceived slights or rejections. You are either “in” (the most wonderful friend in the world) or “out” (the worst of the worst). It doesn't take much to tip them over.

People with this problem often appear to be unpredictable, because they don't have that core of stability to guide them through the ups and downs of life and the social world. They can also be volatile, highly influenced by the external environment - if those around them don't reflect back what they want, expect or need, they may become angry, or demanding. And, depending on how important we are to them, they may lash out, take revenge, or dissolve in tears that can leave us feeling guilty, confused or frustrated, which may in turn, escalate their distress. This is why carers and people close to those with BPD often feel like they are treading on eggshells, fearful of triggering an outburst.

Looking at the theory behind personality disorders and identity formation can help us understand adolescence as the second major crisis of the self (the first being the age of “practicing” when an infant starts to crawl). From toddlerhood onwards, every "no" or temper tantrum, every slammed door or disobedient challenge to the authority of parents is really an attempt to assert the self and “individuate,” continuously testing out the possibility of self in the face of relationship - is it safe to be me and still be close to someone - will they still love the real me? Those are the questions to which we absorb the answers in our early childhood. That doesn't mean that we should indulge our child's every whim, which would be just as damaging as a constant and arbitrary rejection. It is more a question of remaining consistent and validating our children's emotional states even if we need to say "no" to them.

In his theory of psychosocial development, Erik Erikson describes eight stages which he sees as psychosocial conflicts. All individuals must resolve them successfully in order to adjust well to the environment and mature into well-balanced adults. The period of adolescence (13-21 years) is seen as a conflict between “Identity and Role Confusion” (or diffusion). Crisis at this stage may be brought about by expectations from young people themselves and from people around them (parents, peers, romantic partners or valued friends). It can also be the result of earlier failures in the developmental pathway. According to Erikson’s theory, not having navigated any period securely leaves us with unfinished tasks, and we bring these unfinished tasks forward into the succeeding stages as emotional "liabilities" or vulnerabilites that can get us into trouble, perhaps leading to more serious illness as we mature. 

An adolescent who is struggling with self will oscillate between attempts to please those around them, rebellion and rejection of previously held values and ideas, and adoption of identities or personas that appear contradictory, inconsistent – and fragile. Their relationships will often be fraught, and their moods unstable (beyond normal teenage moodiness).  They will often be highly anxious and their ability to withstand negative feedback or rejection is usually quite poor. They just don't have the core of self-esteem or self-worth to carry them through the upheavals of adolescent development. It can be a tough road for young people who find themselves without that core stability and it’s not an easy fix.

Catching it early is the best way to help, but it can take a lot of hard work in therapy to restructure the personality (if there is a disorder present) – and not something that everyone is up for. Of course, it’s not something that can be diagnosed very easily either – it’s a long term problem that needs to be assessed over time. No young person is likely to come to therapy saying that they want to work on with their identity!

But problems with identity may lie underneath many of the more serious behavioural issues that parents and young people struggle with, and treating the symptoms alone may not have a lasting impact. In the end, psychotherapy is never a quick fix and serious problems such as BPD and other personality disorders require long-term solutions.

 

For more information on what to look out for please follow this link:

http://www.asmfmh.org/resources/publications/normal-teenage-behaviour-vs-early-warning-signs-of-mental-illness/

 

 

 

 

 

 

 

5 Ways to Help Your Shy Child Thrive

Extroverts tend to absorb most of the good things that come from social success: they attract all the attention, the friendships, the approval and the popularity. But parents can learn to encourage a shy child or teen to spread his or her wings and make the social forays that will expand their world – incrementally.

Children and adolescents who are shy may have a shy or sensitive temperament, but they may also be anxious, and their anxiety will manifest more strongly in social situations where they are likely to feel self-conscious. They may feel that they need to perform, and be unnaturally gregarious; they may also feel that they will be judged - these feelings can cause anxiety.

Children will want to avoid these unpleasant feelings and will need a gentle push to take the risks involved in trying new things. You can help them by modeling healthy management of anxiety.

1. Encouragement: Be realistic. Baby steps are better than taking too much on at any one time. Small successes will result in positive reinforcement and good memories.

2. Listening: listen to their fears and their feelings about social engagement. It may be that there is something specific holding them back – and if there is, it's a good idea for you to know about it.

3. Validation: make sure they know that you understand what is going on for them and that you accept them as they are, BUT you want a bigger, more opportunity-filled world for them that includes more people and more experiences. That is why you are encouraging them to be more socially active.

4. Acceptance: sometimes that’s just the way they are: being highly sensitive or introverted doesn’t equate to being socially inadequate. You can accept them for who they are RIGHT NOW, but also gently encourage them to take advantage of social opportunities.

5. Spend time with them: getting to know your child is important, spending time with them and leaving emotional space for your interactions can make a huge difference. A shy, sensitive child will often take on your moods and will be affected by your emotions. Best to “clear the slate” and give them space to be themselves rather than bring too much baggage to your time with them.

 

 

Dating & Romance: how to handle rejection

Romance and flirting, liking someone and hoping that they like you, thinking about someone and wanting them to like you, talking with friends about them. Imagining what it might be like to be with someone. Trying to find out if they like you. Biting the bullet and asking someone out. Becoming involved and maybe getting a bit more serious. Dreaming, hoping and believing.

It can be like practicing and trying out what it might feel like. Its all a natural part of growing up and also part of taking the steps that will lead towards a first real relationship.

Reality can be a little different to the ideas we have in our heads.

 Its natural to have strong emotions when you like someone or start dating. You can get anxious, feel sad or excited, get hyped up or be miserable or angry when things don't work out. It can be a bit of a roller coaster and not so easy to keep your footing when you are in the midst of some pretty unsettling moods.

Being rejected, for example, can feel like the end of the world. 

From LOVE: the good, the bad and the ugly

How to handle rejection

Nearly everybody gets rejected at some point in their life, no matter how smart, gorgeous or popular they are.  Some rejection, like attraction, doesn’t really make sense – it’s not about how likeable we are or how attractive, funny or adorable.

What to do when you ask and they say no…

  • If they say no nicely, smile and move on.

  • If the other person says no in a rude or mean way, they’re just a first-class arse and it’s lucky you found out now.

  • Keep your dignity. Try not to make a scene, throw yourself on the ground, burst into tears, abuse them, sneer or say something rude. You can do all those things alone in your bedroom later.

How to handle rejection: later

  • Don’t try to figure out why – it’s not because you are fat, ugly or stupid – it’s just because the other person can’t feel any “chemistry” or they have their own quirky reason. It means it wouldn’t have worked out, so move on.

  • Don’t wallow in self-pity, and make sure you’re not obsessing about them just because you can’t have them.

  • Hold out for someone who’ll really like you.

  • Get on with something else to take your mind off it.

  • Give it time: after a while you’ll notice things that will make you glad you didn’t go out with that person.