A Different Side of Difficult.

I have been seeing a married couple for approximately a year. Sara and Joseph are smart, self-reflective, artistic, honest and a healthy split of emotional and rational. They lean more towards the latter and I work to dig into the former. They are raising 3 teenage girls- one of their own and 2 neices that they took full custody of early in the girls' lives. They have both shown time and again what solid parenting they bring to the table.  I have heard when they work as a team and when they lean on each other to take the lead.  The complexities of raising these girls takes a toll on their relationship and is, in part, the reason they sought therapy. 

We've had a solid therapeutic relationship- everyone in the room works hard in each session. I feel I am able to understand and reflect each of their positions in a way that they (hopefully) hear each other with more clarity.  Obviously, part of the complication of seeing a couple is staying unbiased to either side.  With this couple,  I have had little trouble remaining in that position. In the past year, things have become increasingly more difficult with one of the girls (Phoebe).  She is angry about being abandoned by her parents, but as a 14yo is not in touch with that fact. That kind of sadness and anger shows up in outward defiance, belligerence and blatant disrespect to the very people that have offered her the privileged life she has today. 

Sara seems to have a better understanding of where Phoebe's anger comes from and how to manage her behavior.  Joseph takes it as a personal affront and lashes out at her, escalating the power struggle to an uncontrollable level.  I have only recently heard the shocking report that Joseph is guilty of hitting her. Twice.  I probably don't have to state how troubling this is to me.  I believe in these clients and they are the ones I am treating.  I hear Joseph's frustrations with Phoebe and his own history of abuse, which allows me to feel empathy for him and comprehend the reason for his actions.  But first and foremost, I am a social worker and a child advocate.  I have not heard remorse on his part and he has been unable to "promise" it wouldn't happen again.  I have been sitting with how to address his actions for the past few weeks.  There have been talks about seeking individual treatment, and threats from Sara about asking him to leave the home if it were to happen again. 

It came to a head in our last session. He addressed the fact that Sara's trust for him with Phoebe has diminished. He expressed hurt and anger over this.  Sara did not back down and maintained that "the family could not afford to have this happen again".  His defense slid into a justification of his actions and a request for her to acknowledge all the times he had not hit her.  My heart rate kicked up and I knew it was time.  The moment that I dread in this profession.  I had to risk a rupture in our relationship.  I had to speak up against my client in an attempt to educate him, but in a moment that he was already very hurt and angry and he would most likely not hear the message immediately.  I told Joseph that not being hit is a basic right for children and that there is no reward for not hitting.  I reminded him how traumatic it is to be hit as a child (as he directly knows) and that the dynamic between him and Phoebe is dangerous for both of them. 

Several minutes passed and he didn't say anything.
He appeared incredibly injured. 
I offered the opportunity to express any feelings he had towards what I had said.

He didn't do that.
With his toxic, seething anger still in full force - he turned on himself.
It killed me to see the shift into self-deprecation, but I was pretty sure what I had said made a direct hit.
Maybe not a move forward, but movement nonetheless. 

Now we let the session marinade.
And I need a drink.

sex.sex.sex.

"Y'no it's normal for kids my age to be doing it"

"I told him I was a virgin and he asked me if I at least go down low"

"well, obviously he would wear a condom..."

"Is anal sex worse than regular sex?"

"I'm going to an all girls school next year, maybe this is the last chance I'll get in middle school"

"We went to the movies and he asked me to jerk him. I was like NO WAY"

"No, it's different if you have sex with your boyfriend..."

"If I've had oral sex, I'm not a virgin?!"

"Yeah, she talked to me about sex. She told me 'don't do anything stupid'."

"He said he wanted to teach me- not just anyone. We been knowin each other mad long."

"You mean, like put the condom on the banana type thing? No, they don't do that in Catholic school."


Just a few snipets of various sessions today. 
Spring must be near...

Balancing the blessing

She listens. She laughs. She provides feedback and levity. She is not a client- she is my friend.  As a fellow social worker she understands my work in a way that others friends do not. As a similar sensitive soul, our work can be the very thing that creates static between us.
Caretaking.
It's what good friends do for each other. It's what I like to provide for others and have endless gratitude when my friends do so for me.  There comes a time when you put yourself first -your caretaking has to be about yourself. It's a lesson for everyone, but outwardly defined in the education of a social worker.  It's an important message that gets played repeatedly as we are trained to take care of others as our full time job: self-care.  So, what happens if two friends are in an emotional place where they have to put themselves first?
It gets sticky, and things fall apart.
What happens if these two have the emotional knowledge and stability to see what's bigger than the immediate situation that has becomes sticky?
Things get put back together.
My gratitude for this relationship runs deep- in times of conflict or the best of times.  It seems that it is the moments of imbalance that stand out and make me appreciate her all over again.

Exhaling (NOT inhaling)

There is an amazing 13yo girl that I have been seeing and has been bringing joy to my life since I met her in October of  '08.  Smart, funny, animated, emotional, sensitive, tough, sassy and a sense of herself that is so solid, it defies logic.  Our bond was instantaneous- (possibly from another life?) and her session can sometimes feel like "the girls" hanging out.  I have to catch myself from slipping from therapist to friend...it's that natural.  You should know some things about Nikki (we'll call her)- she watched her mother die from alcohol related illness at age 9 and was left in her father's custody.  About 3 years later, her father had a psychotic break and one night lost his sense of boundaries, becoming physically inappropriate with her. The morning following this incident, Nikki told her camp director, authorities were notified and she was removed from the home.  Just like that.

She has landed in the full time care of her 30-something, recovering addict, completely narcissistic half brother.  Ill-equipped to parent a teen, especially a teen with this much trauma in her past- their relationship is volatile, to say the least.  Nikki vents her frustrations about her living situation on a regular basis. She looks for a way out, she brainstorms solutions, she has even considered foster care for herself. She is starting to accept that this is how her life will be until it isn't anymore. 

Nikki is socially pretty savvy.  Her social status is very important, and if it means faking her friendship with the untrustworthy popular girl, she'll do it.  The difference with Nikki and your typical 13 yo, is that she is aware of such choices.  She discusses her social life in great detail on a regular basis.  I have been comforted by her appropriate (or what I would deem appropriate) interests as a girl in middle school. She loves fashion and hair and music and dancing....the biggest snag Nikki has shown in her behavior is fighting.  As I understand it, as a Latina, this is par for the course. In our last session: (dum-da-dum-dum)...smoking.
No, not cigarettes.
Weed.
She has several friends that do it and she verbalized her interest. Shit.Shit.Shit. 
I explored what piqued her interest, who has it, what level of interest we were talking about. We discussed safety and effects and side effects. I steered so clear of that judgmental voice in order to keep this important opening we have between us- I started to panic at the end of the session. ("wait, did i forget to mention the part about this really isn't a good idea? did i become so permissive that i have encouraged this behavior?") I threw in a really clumsy reminder about my not supporting this choice and wanting to supply info to her. "Yeah, yeah...I know", I get in return. 

This session has been taking up a lot of space in my brain and my heart.  As a girl with addiction in her family, did I present as too lax? Did I supply the right info? Should I have provided a heavier hand to divert this behavior? My true aim was to continue to provide that nonjudgmental, empathic place where our relationship has been firmly grounded. That way, if she chooses to engage...we can continue dialoguing about it. Man, I hope that's what I did....

K. That's it for now.

Freedom

A 25 year old client I see on Saturdays is dealing with a number of issues- today it was about her kids.  On the one hand they are the most important humans on earth, on the other- they are the bain of her existence. They are the symbol of her entrapment in this life.  She told me she is a "doer" and she needs to be spontaneous and adventursome and her young children hold her back from this.  She didn't wait, like the rest of her friends. She started her family early and there is no changing that now. There is only making the best of her not-so-planned-life, which gives her the feeling of being in shackles.  Because of her genuine love for her kids, this sort of honesty does not come easy for her.  Today she was flowing with resentment, confusion and sadness. 
I looked into her tearful eyes as she spoke about the "order" in which things have happened for her and the irony was almost too much to bear.  I sat there, as a 36 yo woman who has lived a free life- let the wind determine my direction for years and now feeling trapped by those decisions. Same issue, opposite direction. I have traveled the world, got an education, moved across the country and tried out several careers. I didn't take the time to settle down and start a family, like the rest of my friends. My imprisonment is the one associated with biology and while my client has to wait 14 years (as she has calculated) before she is "free", I wonder if my window of opportunity will be closed by the time I get there.  

I think that's it. For now.

Occupational hazard

She is 4. She has a brand new baby brother. He was named after his father, and the man who sexually abused her. She has been questioned by more officials in her 4 years on this earth than most of us will our entire life. Oh, and she lives in a shelter. Guess what? She's pissed.

Lucy (we'll call her) is still new to treatment.  Her mother has trouble getting her to the agency on time and today was the first I've seen her in about a month.  Lucy is pretty much out of control. She curses wildly ("fuck that shit"), is hypersexual ("let me see if that doll has a penis"), and incredibly defiant ("I'm not cleanin that up!"). She is no easy task.  Although she's angry and verbally aggressive, I've always taken solace in the fact that she doesn't show any physical aggression towards me. So much for that.

Today Lucy had so much aggression, she lost the little bit of impulse control she normally shows around me.  In a session, I am typically on the floor with them or in someway physically on their level.  She looked me in the eye and pulled down hard on the bangs hanging in my face. I became firm with her about touching.  She moved on. When it was time to clean up, Lucy couldn't handle what must have felt like rejection and knocked me on the forehead with a spoon. Strike two.  Leaving the office, I attempted to prevent her from using the water cooler (as this usually means an immediate dumping of water on the floor).  Remaining in a standing position, as I learned that she was going for the face today, I got a two handed slug in the stomach.  Amazing, the strength on an angry little girl.

Riding the elevator down with her was a chore and I couldn't have passed her off quicker to Mom.  I hadn't a clinical thought in my head. Just anger.  I guess that's what she needed. For someone to hold it for her as she overflowed.
Who signed me up for this again?

That's it for now.

A pat on the back.

I have been seeing a 4yo girl that I am incredibly attached to.  We'll call her Natalie.  Her mother's boyfriend (who she thought was her father) molested her.  There was DNA evidence. Now he's serving time and she is taking time to heal.  I have the pleasure of seeing this highly expressive, incredibly needy, terribly rebellious and ultimately adorable child 2x/week.  I look forward to these sessions almost like they are a playdate.  When her appointment is cancelled- I feel a loss. 

There have been quite a number of cancellations, which have mainly been due to family politics.  This client is part of a culture that prides itself on thier independence from the dominant culture, resisting assimilation, essentially - remaining off the grid.  The idea of bringing the youngest of the family to speak to an outsider about personal situations is abhorrent to them.  "They" consists of mother, grandmother and the big guy; grandfather.  Her uncle is currently the legal guardian and the one who is pushing for Natalie to remain in regular treatment, register her in school - in essence, taking the huge (unacceptable) leap into mainstream America.  They fight him every step of the way and the uncle keeps me regularly posted on his progress with them.  Some days he wins (she shows) and other days he is defeated (he cancels).  It can feel like we are TEAM NATALIE- working together for her safety, security and healing.  I should mention that I have met with each of these family members (aside from grandpa) who talk a good game about being on board, who have only Natalie's best interest at heart, and who ultimately become frightened of the unknown and work to pull her out.

Last week, the uncle was meeting with the Dept of Education to discuss her IEP (Individualized Education Plan).  This means that the DOE has evaluated for and acknowledged Natalie's special needs. I was notified about the meeting and arranged my schedule so that I could be present.  The uncle was pleased that I was attending and repeatedly expressed his gratitude (offering to bring coffee, breakfast, etc...).  The meeting started on time and was quick and to the point. I was happy to be there to show support. It wasn't until Natalie's next session that I understood the impact of this one small gesture.

The following day, as I opened the door to our waiting room, Natalie's grandparents were there with her.  They shook my hand, they gave me updates, they inquired about her treatment.  Natalie and I had our session and upon returning the uncle was there with the grandparents.  We all exchanged pleasantries once again, and this time the grandparents thanked me for my presence at the meeting.  Moments after returning to my office I received an email from the uncle. It had the tone of an excited little boy. He expressed the thrill of his father speaking with me, engaging, accepting.  He told me that my attendance at the school meeting so early in the morning and in the snow meant an awful lot to the family. 
I did it.
I earned their trust.
And apparently I did so by simply doing the part of my job I love, the genuine part. I'm not sure who was happier at that moment.
(big ole exhale)

That's it for now.

The Battle Within

I have a client that I have been seeing since I was an intern. He was 4 when I met him, and he is 7 now. Let's call him Nathan.  Nathan's father beat his mother to a pulp a few times. He was an infant caught in the middle of it and therefore ended up in my agency.  I learned quickly in this field that these issues don't happen in a vacuum. They are an outcome of  many other issues factoring into their environment landing them where they are when they arrive in my office.  In Nathan's case, there is not only a maniacal father- but a mother who is suffering from PTSD and the two are fighting for custody.  This has been going on longer in his life than it hasn't. 
I have seen Nathan grow and change in amazing ways.  When I met him, he wouldn't speak to me or even make eye contact with me. Now he races me to my office and takes the liberty of flipping the "In Session- Do Not Disturb" sign himself.  On his ever-changing trajectory, one thing never alters: army toys. Different battles, changing bad guys, varying weapons, adjusted storylines, but always, always within the same framework...little green and tan army men.  I have a confession: I hate playing with army toys.  Even more, I feel so confused and awkward with the rules and random words he uses I have begun dreading his session. 

"This guy goes here. No not there, that's water. Now shoot him. No, you're shooting the wrong direction. You missed him. Wait, I wasn't ready. You can't do that, he's made of electricity. Oh, your general just got killed- you didn't even protect him. You can have this ship. No, not that one. Just send him to medical and put him back in. Do you need reANDforcements? Are they in position? Keep shooting!!!"

Nathan is bright, talented, creative, funny and incredibly guarded.  He remains so cautious of letting anyone in emotionally he has to repeatedly play out his defenses with weekly battles that take over my office.  I just wish Nathan would directly share things with me. Isn't it time, yet? How can I get him to put down at least some of these weapons and allow me to see him? I get it-he is showing me a piece of his very confusing world where he is always trying to "figure out" what is next, who and how to please.  Things feel awkward and constantly stressful in his life and he needs to play that out. This is his one opportunity where he is never wrong and doesn't need to work to impress. I get it. It's hard- and I know a teeny piece of how hard by the agonizing 45 minutes I spend with him each week. 

That's it for now.