Listen to thisThis intervention targets distortions in thinking which contribute to conflict with students and staff.
Background
After numerous assault charges in her school, June was placed in
residential treatment. During her first sixty days, she experienced
several crisis situations which included assaults on staff and students,
physical restraints, and eventual separation from the group culture.
Prior to placement, she committed so many assaults in a short period of
time that her charges escalated from misdemeanors to felonies. At the
time of the incident, June was fifteen years old, had a below average
intellectual ability, and had been diagnosed with bi-polar disorder and
ADHD. She was on several medications to help stabilize her behaviors.
June struggled to form relationships with adults or students and had
been verbally disrespectful towards both during times of crisis.
School was an arena for conflict with June. She walked to school with the group and had made a commitment to her education, but by 10:00 each morning, her behaviors began to deteriorate. She appeared to fall asleep and only picked her head up from the desk to move from class to class or when she became interested in something going on in the classroom. June has also refused to answer questions of staff or teachers and, when moving from class to class, would just stop and lie down on the floor. When questioned by staff, she would become verbally assaultive. The team of staff working directly with June made a commitment to help June move past her difficulties with school.
A meeting was set up with June's teachers to establish an education plan. June had struggled to pass the safety test in vocational education. The teacher was stern with her about failing and, since that time, June had refused to take the test again. June signed a behavioral contract with the treatment team to stay awake in school, not to yell at adults or students, not to assault anyone, and to attend the group meeting each day. When June failed to comply with her behavioral contract, staff escorted her back to the residential setting for the remainder of her school day, where she worked on her schoolwork and made up all of her assignments prior to participating in recreational events with her group. She had been on the behavioral contract for two weeks at the time of the incident. Although she had been verbally defiant on occasion with this plan, she complied nonetheless.
Prior to placement in the program, June lived with her mother, her mother's boyfriend, her 17-year-old sister, and her 6-year-old brother. June also had an older sister in adult foster care. She had a history of failed residential and community program placements, and continued to assault teachers and students in the school setting. June's 17-year-old sister was placed in this same residential program for assaulting a peer who was teasing June in school and completed the program easily and successfully. June looked up to her sister.
The incident
June had been attending school sporadically throughout the past two
weeks. She was taken out of school whenever she appeared to fall asleep
or lay in the hallways or refused directions from teachers or staff and
was returned to the residential center, where she would complete her
schoolwork. On this particular day June had attended school all day. She
had been to all of her classes, but had words with a member of her group
mid-morning. She was able to focus on school the remainder of the day,
but was visibly upset and struggling to respect others. Once the group
returned to the residential center, June became even more defiant. She
refused to attend group meeting and was verbally disrespectful to those
staff who attempted to help her. She was yelling that she had been “raped" and that no one wanted to help her. The staff attempted to
de-escalate her, but their efforts did not work. Eventually, for her own
and staff's safety, several staff members surrounded June.
Drain-off stage
When members of the treatment team approached the situation, June
re-escalated and claimed she knew she was going to the administrative
segregation unit. However, no one reacted to her proclamation. Based on
other interactions the team had with June, they remained calm and
re-assuring, and June quickly de-escalated. When she asked to speak with
members of the treatment team privately, she was given this opportunity.
One staff person (Interviewer) took the lead in the intervention, while
others observed and supported June.
Timeline stage
The timeline was very lengthy and a bit disjointed. June did not easily
track the situation and was redirected several times. Based on the
comments June was making outside of the meeting, the Interviewer asked
her to tell them what she was feeling. She said she was upset and really
needed to talk to someone. She was supported for asking appropriately
for that opportunity, compared to the past few months when she became
assaultive or verbally aggressive to have her needs met. June then began
discussing her day and how things were going.
Interviewer: June, can you tell me what's been going on today?
June: I went to school all day you know. The staff wouldn't let me talk to Bonnie. I really wanted to talk to her, and they wouldn't let me. That was after I had a fight with Tammy. I know I was demanding it and I was really mad, but I don't know why people won't let me talk to her.
Interviewer: June, why do you think staff didn't let you talk to Bonnie right then?
June: Probably because of my attitude. But they still should have let me. I was upset about that movie, too. All that drinking and using upset me. You know I really have had problems with that in my life, too.
Interviewer: So you saw a movie in health class on using chemicals?
June: Yeah. (Crying) It was about using drugs, and it brought up all my stuff from before. That's what I was trying to tell staff, but they weren't listening.
Interviewer: June, I know you were upset about some things this afternoon, but let's back things up a little. Tell me what happened this morning.
June: When this morning?
Interviewer: Well, you had some struggles throughout your day, and you obviously were upset about the movie and not being able to talk to Bonnie, right?
June: Right.
Interviewer: So, I'm just curious if you can tell me what happened earlier in the day.
June: I got in a fight with Tammy. She said some really bad things to me, too. I was mad to begin with, and she just kept going at me.
Interviewer: Okay, June, can you tell me about the incident with Tammy?
June: Nothing really happened, I just wanted to get out of the room and she stood in my way. I said a bad word to her, and she said something mean to me. That was it. And then I had to watch a movie, and it brought up all my stuff. I really have to talk about this. I did some things I feel really bad about before.
Interviewer: So you are saying that the movie reminded you of some things from your past. Can you tell me about that?
June then proceeded to tell staff about using chemicals with older males in her community. She discussed an incident where her mother's boyfriend's 10-year-old daughter was with her one night. She reported allowing the girl to become intoxicated, and some men took advantage of her. She then said that she was also assaulted in the past. June was visibly upset and wanted resolution to this issue immediately. Staff re-assured her that they would definitely report the incidents to the authorities, but it would help if she could focus on herself right now. Staff were concerned that she had not looked at the entire day and her reactions to others. They attempted to continue on with the timeline.
Interviewer: June, I am very glad you are able to discuss these serious issues with us. However, I'm wondering if we can back up a little bit and discuss the rest of today. Now, you said you had difficulty with Tammy mid-morning. What happened before that?
June: I guess everything was fine. I got up and went to school. You know, I made it through school all day today?
Interviewer: I know you did and that's very good progress. I am concerned about what happened leading up to your incident with Tammy. You say that all was fine and you made it to school, but it doesn't make sense that you would have a difficult time with Tammy during vocational education.
June: Well, there was one thing.
Interviewer: What was that?
June: On the way to school, I saw Mr. Johnson really yelling at one of the students. He was really mad at him. I didn't like that, and it upset me. I called Mr. Johnson a mean name later, too. I did say I was sorry though. I really like Mr. Johnson.
Interviewer: I appreciate that you spent time with Mr. Johnson after calling him a name. Did you tell him what you were upset about?
June: No. Why doesn't the staff let me talk to Bonnie? I really like her, and she is my best friend. I have been waiting for a friend ever since I got here. I really want her to stay my friend. And you know, last night Jackie said I couldn't have her in my circle. I really want her in my circle. I can ask anyone I want, right?
Interviewer: Tell me about last night, June. Were you upset by what Jackie said?
June: Yes. It bothered me all night.
Interviewer: Did Jackie know you were upset?
June: I don't know. I'm sure she could tell.
The Interviewer then proceeded to process with June about her perceptions of both staff behaviors and student's comments. They attempted to guide June toward understanding how her perceptions of what was going on between staff and students in other groups may not have been what she thought. She did not know what Mr. Johnson's intent was with the student he was addressing. She only identified with how it looked and made her feel. When encouraged to communicate that to the staff, she seemed uncomfortable and unwilling. Also, she was not willing to look at the fact that Jackie may have been concerned about her negative conversations with Bonnie and did not see her as an appropriate person to attend her circle. June was merely working out of what she felt reality was.
Interviewer: June, do you see how you continued to have a crisis throughout your day based on things you heard last night as well as today?
June: Yeah, I guess. I just have all this stuff on my mind. It upsets me and I don't know what to do.
Interviewer: Okay, I will give you that. You don't know what to do. That's why we're talking about this. I don't want you to have to continue going through crisis situations based on things you hear or see. You have had enough of those crisis situations, don't you think?
June: Yeah. Do you all have to report to the police what happened to my little sister?
Interviewer: Yes, as a mandatory reporter, we will report what you told us. Does that make you nervous?
June: Kind of. I don't want to have to tell my dad. I know he's not my dad, but I've just always called him that. My mom won't even care, because Sandy isn't her kid. When will all of this happen?
Interviewer: I will report what was reported to me within 24 hours. We then have to wait for the court to decide what they will do. But, right now, can you focus on yourself and how to get things back on track?
June: Okay.
The central issue
stage
June was very disjointed throughout the timeline stage. Obviously she
was dealing with a lot of stressful situations which she was importing
into school. However, her muddled thinking made it clear that the
intervention needed was a Reality Rub. June struggled to establish a
timeline, was distorted in her recollections, and moved from topic to
topic, focusing the intervention in different directions. She also was
very focused on her friendship with Bonnie and did not appear to see how
her behaviors affected Tammy or Bonnie.
The reality rub needed to focus on June's reaction to others and how she misinterprets their intent or behaviors and then becomes defiant herself. She was not necessarily concerned with the fact that Bonnie may be hesitant to befriend someone in the group who had been in crisis for two months. The remainder of the intervention focused on her relationship building skills.
The insight stage
Interviewer: June, you appear concerned about your friendship with
Bonnie.
June: Yeah.
Interviewer: Do you think that your behaviors today or in the past month or so have affected her wanting to be around you?
June: What do you mean?
Interviewer: Well, when another student reacts negatively to comments from students or things they see staff doing, their peers don't seem too excited to get close to them. What if they get hurt?
June: She's my best friend and I love her.
Interviewer: How long have you known Bonnie?
June: Since she got here, two weeks ago.
Interviewer: Okay. Does Bonnie feel the same way?
June: I thought so. We always talk about this place and how we hate being here and how it's so dumb. I know this isn't what we're supposed to talk about, but that's what friends do.
Interviewer: Well, you know June, good friends actually help each other rather than hurt each other. Maybe if you two would talk about positive things, like helping each other succeed, Bonnie would be more interested in your friendship.
June: Maybe. But I really don't want her to be afraid of me. I really want us to be okay.
Interviewer: Well, maybe you could to talk to her about how you feel. She probably would like to hear that you are okay and are not going to hurt her. Also, that you've been learning some things about yourself in the past few weeks. You and I have talked about how you don't want to continue to have problems in school, right?
June: Yeah.
Interviewer: So, maybe you could tell her about how you are planning to get better and set goals like we talked about. That might make her feel better.
June: Can you be here when I talk to her?
Interviewer: Do you want me to be?
June: Yes, I am very nervous.
New skills stage
The interviewer was aware that, based on her misperceptions of reality,
June would need support and practice with peer interactions. Her
behaviors had really alienated her from the group and most peers were
avoiding her at this point. The staff then decided that it would be good
to role-play with her in the future when she was having difficulties
with making friends. They agreed to support her when she spoke with
Bonnie and help guide her toward appropriate communication. As June was
very nervous, the staff suggested just a brief check in with Bonnie to
begin the process.
The transfer of
learning stage
Once a plan was devised for June to speak with Bonnie, the treatment
team met with on-duty staff to let them know about the intervention that
had taken place. Many staff were just as concerned and frustrated with
June's behaviors, and the processing was extremely crucial for her
successful return to the group.
The treatment team also spoke with specific group members who were understanding and empathetic to June's situation to make her reintegration easier. The group made a commitment to help June, and Bonnie agreed to speak with June. Following the intervention, June and Bonnie spoke directly with the treatment staff who were present for support.
Summary
This LSCI was a bit confusing at first as was June's thinking. This
required spending a substantial amount of time on the timeline of
problem events. June was very forthcoming about her feelings, but her
jumping around made it difficult to ascertain the appropriate
intervention. This proves the value of constructing a careful timeline.
It would have been very easy to merely seize on some problem of the
moment without spotting the underlying thought distortion. In addition
to clarifying her thinking, June needs considerable ongoing support in
developing her social skills and relationship-building capabilities.
This feature: Laursen, E.K. and Peterson, D. (2005). Chaotic thinking, challenging behavior: A reality rub. Reclaiming Children and Youth, 13, 4. pp.236-240.
