We really wish that we could begin this presentation by saying that this is how you work with so-called disturbed children; that we could say "Here are the books to read". Alas, we cannot. All we can hope for is to share our understanding and for you to share your understanding, and for both of us to go away knowing just a tiny bit more about how the child understands and experiences his world.
Let us begin by asking what we mean when we talk about “the disturbed child”. Stop for the next 30 seconds, be silent and try to get in touch with what this means to us. How do so-called disturbed children compare with so-called normal children, and what they do that we or others consider to be disturbing? It is our belief that the only way to define a disturbed child is to say that the disturbed child cannot be defined. This is similar to what Professor Mike Baizerman had to say on his work with adolescent prostitutes: "They are children who have sex for money, we work with the child". In the same way, disturbed children are children who live in a world that they find disturbing, and who act in ways that are considered disturbing. We try to build a relationship with the child, and we would go as far as to say that the disturbance often tells us more about the society they live in than about the child.
The first, most important and perhaps only, message in work with the disturbed child is that he needs a consistent, trusting and caring relationship. Part of building this relationship is learning to understanding his world. Let us try to understand that world.
Placement away from home is a bewildering experience for a child, but soon, after what is called the honeymoon phase, the most pressing question for the child becomes "Why am I here?"
It is not an intellectual question, nor will any answer satisfy the question. It is a painful riddle, for if the child were not in a residential home, or had come to accept it, he would not feel the desire to solve it. In psychoanalytic terms it is "an act of homage to the missed reality – the reality that can no longer produce itself except by repeating itself endlessly in some never attained awakening". Furthermore, to accept being in such a place means learning to accept and live with a lot of pain and injustice, and one wonders to what degree this pain and injustice should be accepted.
Let us look at differences between a normal adolescent and a disturbed adolescent. In adolescence there are rapid mood swings, from one emotion to the other, often in an unpredictable and contradictory fashion. Peter Harper argues that one of the major tasks of adolescence is to achieve emotional maturity, and "... to acquire such a maturity involves a monumental change of attitude and a profound internal rearrangement of emotions. It is small wonder that we encounter mood swings and erratic behaviour".
Where the one child differs from the other, is that the one is at certain times unable to contain his emotion, or manage what is going on around him. He is like a bucket with no bottom! What do I as the care worker see? More often than not, a cold, hard exterior: "I can get by, I don’t need ..." However, what we believe the child is experiencing is overwhelming feelings – feelings for which he has no name. He is choked with feelings. This child is moved from one situation to another, his emotions run wild, and worse still, the child comes to see himself as a helpless victim. To use an analogy, the child is like a knight in a battle, only his shield is made of sponge, each event penetrates to the core, to the heart. Tommy bleeds the first time he has to walk into the dining room. Sue bleeds when, after endless efforts, she fails her geography, and Penny bleeds when her dad promised to visit and she sits by the window only to realise that the sound of her father’s car is one she will not hear. What is dangerous is when this cold, hard exterior becomes a cold, hard interior. It is what people like to label "splitting" or "borderline disorders."
We need to realise that the child is in extreme pain. When in this situation, the child will latch onto anything if there is the hope that the discomfort will disappear, even if it means moving into a fantasy world or adopting some other strange behaviour. This behaviour may seem anti-social to us, but in it the child finds meaning, he is not alienated.
The other thing that we notice is that the child takes everything personally, that he acts and reacts to everything; that the child cannot be (stand still) but jumps from one thing to another. Ironically, this is somewhat akin to Marx’s analysis of "thinghood", a process without a subject.
In personal terms, it is the child's incomplete history – the old story of too much, too soon, too early, in which the child has to grow up too quickly with a lot of living getting left behind.
And so it is that the child care worker encounters this inappropriate behaviour. The child will, particularly in the early stages of a relationship, attempt to develop inappropriate relationships. The child cannot see different stages, or the difference between feeling something and acting out the feeling – the child just acts, what we call acting out.
What is inside and what is outside the child appear the same. Little events, big events, trauma, all become one and the same thing when pressures overwhelm him. The child is hungry inside, and has a hungry look which increases in intensity when pressure builds up. This hungry look frightens others away. What society does, causing his inability to function in society in a way that makes him feel acceptable, is to hold a mirror to his eyes. What the child sees in the mirror is the buried, broken, lost, fragmented parts of the past – the broken, lost, little empty girl or boy.
The child, seeing this broken child inside him, feels that society is saying "I’m no good, I’m a bad person" and in this alienated state he begins to believe this.
The child experiences himself as incomplete (a lack, a gap, a hole, a split, a dysfunction). Life has failed him. The extent of this feeling of incompleteness is the extent to which he is dependent upon another and aligns himself to another – something other than himself, an imaginary image of wholeness. We represent the non-realised experience and through this we encounter the confused message, the confused feelings. It looks like "I want, I don’t want, stay away, don’t go away". The care worker can feel "I don’t understand, yesterday we got on so well. Today he is ignoring me".
The child has had to live for so long without what he needs, that this unmet desire is all he gets to know: a loveless world that does not give him what he desires most.
What the child desires most is that which is most difficult to show and accept. I want to be noticed, I want to be special, I want to be helped, but don’t know how to show you this. All the child is capable of doing, without being aware of it, is to make us feel the way he does, to treat us in the same way life treats him.
To make sense of, and more importantly, to be able to act upon what the child is saying, we need to build a caring, trusting and consistent relationship. Without this we can be very destructive. I enter John's room wanting to be helpful, so I say, "I know how you feel." No! I have no idea how he feels unless I have a relationship with him. It is like reading his private diary without his permission.
Everybody has his own style in developing a relationship, but the following should be kept in mind:
Do not rush into a relationship.
An initial period of thorough observation is needed. As much as you need to see what the child is about, the child needs to see what you are about.
It is in the small details and events that relationships are built, for example, closing his curtains before he goes to bed at night; offering face cream for his pimples.
Allow the child to set the tempo.
Beware of inappropriate relating.
Avoid over-verbalisation in the initial period. Instead allow for non-verbal cues to act as indicators: eye contact, facial gestures – no physical contact until he is ready, especially with a sexually abused child.
Respect for the child's privacy – knock before entering his room.
Respect the child's vulnerability, particularly once he has opened himself up.
Three ways of saying the same thing:
The child makes lots of noise, e.g. Bob, aged 16, who comes home and screams at the domestic worker because his clothes are not washed.
The compliant child, e.g. the child whom everybody likes but who shocks us when he is caught stealing or abusing the younger kids. Or, Sue who was to have gone on camp with me, and when I let her down, she just shrugs he shoulders.
The withdrawn child. The child who sits in the green chair all day, or, Jack who climbs into bed each day after lunch, reads and sleeps.
What the silent child is saying as loudly as the other children, is that this is the only way I can cope. The person lives in a silent world, his conversation with life has left him silent; life gave a reply which he can only cope with in silence. Each child mentioned above is screaming out inside. The bucket is empty.
Now comes the tricky part. Sure I care, but it is not the same way as a mother cares. An honest reply could be "I can’t care the way you wish I did, but I do care". I am not getting into the destructive game of playing perfect. Two people are trying to meet by removing their masks, and when this meeting takes place, the relationship is under way. Now the child stops trying to manipulate me as much, but the testing will never stop. What does happen is that he puts his trust in my hands, his life in my hands.
This is a difficult time, for now I have to teach the child. That is, I have to teach the child all those things which he was not taught. He has to re-learn the past, how to hold a knife and fork, how to read, physical hygiene, and other basic life skills.
Because there is a relationship, there is somebody, the child is prepared to take this second chance in life. However, there remains much rage at not having been given these skills in the first place. One part of the child is prepared to try; the other feels that “life owes him”. What is of vital importance is not to see the one part as good, the other as bad. What is good or positive is that the child is prepared to live with the tension which these two opposites evoke in him.
To confront this tension and endure it, the child needs the relationship and for me to stand my ground, not to be blown over by his rage and frustration at having to re-learn. He needs me to confront him, to lend him my resilience to see things through.
The other dynamic involved at this stage of the relationship is regression. The child has for so long refused to stand still, jumped from one emotion to the next. The child has tried to become like those heroes he has stuck up on his wall. Now he is prepared to admit what he is feeling as opposed to that which he wishes he is feeling.
To do this involves courage on his part and this is only achieved with the support of the relationship. Ideally, at this stage, the child should be in therapy, and child care workers are not psychotherapists. Our role is to "hold" the child, and to support the child. For those of us involved in third world conditions, often we are not given the luxury of such a choice; we are compelled to fulfil a number of roles. Perhaps the only advice that can be given, is to be cautious, and most of all, to be committed.
The question which now arises is whether or not to explore these issues. The choice is not mine, but the child's. What I need to know are my limitations. However, there is the danger of denying the child's pain in saying: "This is not for me; let’s rather talk about the good things." To do this is to be brutal to the child. Furthermore, pain unexplored becomes the ghost of the past which continues to haunt the child. The child needs me to open myself to his pain, to acknowledge his discomfort, to go through it with him.
This is of course not an easy task, and one which needs support, as well as continual self-reflection. It can be scary as well as painful for the care worker in that he/she undertakes that journey as well as one of his/her own.
Peter Harper warned us against the denial of trying to make everything in our program look “normal”, of playing “happy families”, instead of addressing the fundamental problems in the child's life: "The therapeutic milieu is a powerful teaching tool which can help the child identify his problems and achieve healthier solutions, because it is able to provide a series of alternative responses with which the child can, in safety, experiment ... The institution is there for the child and not the other way around ... The goal of treatment is change or growth of the individual, rather than cure."
Vivien Lewis says that to force the appearance of normality at a children's home is to be cruel to the kids. "... first they were seen as “poor kids”, then they were “bad kids” and we had to get past this to the actual work we are doing ... We moved youngsters from seeing staff as staff, to seeing staff as people, and then to seeing staff as friends. So they were taught to relate to adults, and what better skill to take away with them? If we had continued to act only as staff, by continuing with our external control, by not allowing them to show us where they were, by insisting on lady-like external behaviour, I’m sure they would not have become the kind of adults they are. They would have continued to see others as people to manipulate."
NOTE: At this conference presentation, participants added the following points during the discussion period:
The need of all child care workers, social workers, managers, psychologists, etc. to be able to share their fears and difficulties without feeling judged or inadequate. There is pressure for us to give the appearance of "I’ve got everything under control", and so the fear of making mistakes and the difficulty of being seen as somebody who has all the answers. Care workers need to have their vulnerability acknowledged, and to be allowed to say, "I don’t know what to do “help!"
The need for a support structure for those in direct practice with troubled youngsters, the acknowledgement that care workers also need “care”.
The need to be honest with ourselves, acknowledging our limitations.
That work at this level is both disturbing and abusive: the child abuses the care worker; staff abuse other staff due to work pressures; and working conditions (hours, pay and staff-child ratios) are forbidding and discouraging. It is often felt by those in the front line that these serious social and personal problems are passed down the authority ladder like a hot potato until they land in the hands of the child care worker, who then more than ever needs to be recognised and supported in the work being done, often with considerable risk and courage, for disturbed children.
Barends, A. and Harper, E. (1989). Play and
Relationships. The Child Care Worker, Vol.7 No.1
Benvenuto, B. and Kennedy (1988). The Works of J. Lachan. London: Free Association Books, 57
Harper, P. (1985). Treatment Planning In Residential Child Care. The Child Care Worker, Vol.3 No.4
Harper, P. (1985). The Psychological Tasks of Adolescence. The Child Care Worker, Vol.3 No.11.
Harper, P. (1986). The Family Model of Care: Obsolete? The Child Care Worker, Vol.4 No.9,.
Lachan, J. (1979). The Four Fundamental Concepts of Psycho-analysis. Harmondsworth: Penguin Books, 58.
Lewis, V. (1989). Interview in The Child Care Worker, Vol.7 No.4.
This paper was presented at the 1989 Biennial Conference of the National Association of Child Carte Workers, South Africa. Published in Gannon, B. (ed.) (1990) Competent Care Competent Kids. Cape Town: NACCW