This is the text of a presentation made to the goodenoughcaring conference Love Is Enough : sincerity and professionalism in the care and education of children and young people which was held in London on October 4th, 2008 at the Maria Assumpta Centre.
Harry Enfield's character Kevin always brings a smile to my face as I conjure up my experiences with young people age 13 and over. I can laugh at the unreasonable demands and equally inappropriate responses from Kevin's parents. I can joke about the stereotypical teenager who cannot string a proper sentence together and blame their volatile temperament on their hormones.
That is possibly my fantasy about a warm fluffy relationship with young people that eventually they will grow out of to become a mature functioning adult like myself!
Why is it then that the reality of working with troubled young people is not like that for me and many of my colleagues? Try as I might the young people I have worked with have been anything but warm and fluffy. At best they have been obnoxious, angry, abusive and generally not very lovable; so how does one go about making a relationship with a troubled young person and really loving them?
Messer and Warren (1995) describe adolescents as
especially difficult to engage” They are often counter dependant and oppositional, struggling to develop autonomy and independence. They may be anxious about losing control, being controlled or experiencing shame or inadequacy. The idea of revealing one’s concerns to an adult is filled with the unconscious dread of infantile regression and loss of a newly found and tenuously held sense of self.
Let me start with a case study.
Kim was a 16 years old female who was referred to the project I managed. She had been in and out of foster care and children's homes from about the age of 9. Her mother was a long term drug user with mental health problems. From her infancy Kim had gone out to shoplift with her mother to fund her habit. Kim had one older sister who lived independently in South London.
Kim was hostile towards the staff and the notion of not being independent from the offset. She was often rude and abusive refusing to engage with the staff team and absconding to South London for periods of time. Kim refused to disclose where or who she had been with, making it difficult for the staff team to sustain a relationship with her.
Kim began inviting her peer group to her flat and there were regular incidences of her using alcohol and drugs in the flat and she appeared to enjoy the excitement of sneaking her boyfriend in at night.
The staff team were left feeling hopeless and frightened of what they may encounter at Kim’s flat, although her friends were always polite and left when asked. It seemed to me that we were being rejected by a young woman with such rigid defences and in exasperation I contacted her social worker to discuss Kim’s placement and her lack of engagement.
At the meeting Kim was able to articulate her feelings of isolation and loneliness as her sister and peers were in South London whilst we had given her placement in North West London. She explained her wish to be nearer to her sister as they had shared similar experiences whilst growing up. Kim resented the fact they had been separated for so long and wanted to focus on her relationship with the only stable family member she had.
Kim talked about her plans to go to college; she had identified a place in South London and wanted help to set up the interview. She acknowledged her anger at the “system” explaining that she was unhappy that no one had listened to her point of view; she felt that things were done to her rather being discussed with her.
After some discussion it was agreed by all of us that an alternative placement would be found closer to her sister and peers. Kim was happy to accept the staff’s offer of help to set up her interview at college as well as our offer of practising some interview skills.
I went to visit Kim once she had moved. She was enrolled in college and talked animatedly about her course. She appeared happier telling me about her sister, the things they had done and the plans they had together. Finally she thanked me for listening!
I have often thought about Kim and wondered whether I made the right decision in encouraging a placement elsewhere. Did I not feel we were the placement most able to meet her needs? Did I unconsciously reject and abandon her because I could not bear her pain? Or was it that I heard Kim? Did I think about what would meet her needs in the here and now, confident that she would be okay in the future.
I do not have the answer but I was reminded of Kim when I read a paper written by a George Mark Pearce, psychotherapist for The Brandon Centre on engaging young people in six sessions(Pearce,2001). A little controversial I thought for psychodynamic practice and I like to pride myself on being in for the long haul. No sticking plasters here!
However as I reflected on the paper it seemed to make sense in terms of engaging and showing young people they are cared about.
The paper asks the reader to think about attachment and rank. Nearly all the young people I work with have not experienced a secure attachment to a parenting figure and their experience of being parented is not usually “good enough”. With this in mind it is easy to see how the attachment difficulties will be played out within the transference with other caring adults often making any relationship hard to maintain.
Add then the issue of rank; rank is especially
important to a young person as it indicates their social standing, self
esteem and status. In reality the “professionals” involved in a young
person's care have higher rank. Depending on the young person's
background those “caring adults” can be experienced as persecutory and
threatening; in Kim’s case leading to her acting out behaviour.
Very simply the argument for the time limited intervention is to focus on the future. By focusing on the future fantasy “in Kim’s case her plans with her sister and college “the hope is that the worker can engage the young person. The future can permit a freedom to discuss painful events without the humiliation of the past (you will remember Kim talked about her feelings of loneliness and isolation probably akin to her feelings about her mother).
Perhaps by focusing on Kim’s fantasy of the future she was able to think about her need to form a secure attachment to her sister and at that point in her life she needed to be closer geographically as well as emotionally. Perhaps by enabling Kim to talk about the future she was able to feel held and loved by the “caring adults” and no longer had the need to act out her distress.
This model used by The Brandon Centre considers that troubled young people come with a dysfunctional paradigm “a cluster of theories conscious and unconscious about their potential for status and rank. By repeating past experiences the paradigm is verified. Of course the young person attempts to get this verification within the therapeutic relationship and it is important that the worker is able to think about and draw upon the real relationship highlighting the discrepancies between the paradigm and the reality of how they perceive the young person.
Let me illustrate my thinking with another case study.
Callum is an 11 years old boy at a mainstream primary school. He lives with his mother and younger sister; they have recently moved from a refuge into a permanent family home. Callum has talked about his father; he feels humiliated and embarrassed by his father’s violence towards his mother. Callum is confused by his desire to continue to have a relationship with his father and is struggling to hold the “bad parts and good parts” of his father together in his mind to represent a whole person.
Callum has had difficulty managing his temper; there have been numerous incidents of Callum hitting out at other pupils, usually girls within the classroom.
I have only met with Callum for two sessions; Callum has wanted to address his violent outbursts comparing them to how his father has behaved towards his mother. He has expressed guilt and fear that he is becoming his father. Callum has been surprised when I have reflected back that although his violence needs to be addressed it needs to be understood. By accepting this part of him in conjunction with his other parts such as his sense of humour and tenderness towards other pupils; Callum has been able to think about himself as a whole person rather than splitting off those “bad” parts of himself. The level of violence has decreased in recent weeks. Perhaps Callum has tested his paradigm within the relationship with me and is beginning to recreate a different one.
I am not suggesting that this particular model for working with young people does not come without problems. Some young people will be stuck in a cycle of repetition and re-enactment of their experiences which are difficult to break. I am not suggesting that short term intervention works for all young people and I would certainly agree that problems for troubled adolescents do not get better later in life without some therapeutic intervention.
What I am asking you to think about is how we can
love young people in our engagement and that this engagement does not
always need to be a long term piece of work. Perhaps by sowing the seeds
of the possibility of “good enough” parenting troubled young people will
feel heard and loved; not necessarily ready to address and resolve their
difficulties as soon as we the adults might like but nonetheless with an
experience they are able to think about and revisit when the time is
right for them.
Messer, S. and Warren, C. (1995) Models of Brief Psychodynamic Therapy: A Comparative Approach. New York. Guilford Press.
Pearce, G. (2001) 'Engaging troubled adolescents in six-session psychodynamic therapy' in Baruch G.(ed). Community-Based Psychotherapy with Young People Evidence and Innovation in Practice. London. Routledge.