Saturday, May 22, 2010
Kids Gone Mad
I had a conversation with a colleague of mine this week, a psychiatrist who has been providing treatment to children for at least 35+ years. I was telling him about the difference of opinion I was having with some of my staff, regarding children who "act disrespectful" in sessions. I tend to believe that children should be able to come into therapy and feel free to say or do whatever they please during their 50-minute session. I have co-workers who do not allow tantrums or sass and are appalled that I allow that. It gets very frustrating sometimes. This doctor laughed at me and said, "We were debating that 30 years ago!"
So apparently this has been a source of conflict among psychotherapists for some time now. I don't think I can argue the other side with real conviction, but from what I understand, these therapists feel you are reinforcing negative behavior by allowing tantrums in session. For example, a child comes into therapy and begins to yell and curse about her Mom making her share a room with her little sister. There are some therapists who would say, "I know you're mad about this, but I don't allow that kind of language in here. It's not appropriate for a 12 year-old to curse like that. If you want to stay here, you need to calm down and stop yelling, so we can talk about this." One of my co-workers has explained to me that she is establishing "good boundaries" with this client and "I don't allow people to yell and curse like that at me, and this child is no different than anyone else." I can actually see the logic in this argument. It is perhaps teaching the child to get control of herself and emphasizing the importance of showing respect with adults. In this scenario, I would also say the therapist was calmly setting parameters for the therapy sessions.
Faced with a similar scenario, I tend to encourage the child's expression of this anger and may even repeat her words to show that I do not judge her anger. For example, after the child has made some loud "inappropriate" comments about Mom, I repeat it back to her with similar conviction, "You think that bitch is just favoring your brother again and you are very mad about it!" Often this diffuses children right away, because they're shocked to hear their therapist cursing. After several instances of this, however, the child becomes settled in knowing that their anger and tirades are not going to be shut down or judged, and they will express themselves freely. After several sessions of this, I've seen children gain a comfort in knowing that their anger is heard and respected in this room by this therapist, and the need to yell and curse about things tends to diminish. I think it's important to note that there has to be some realistic limits to what a child can do in treatment. These limitations should not feel restrictive and are there to keep the child safe and to protect property from being damaged.
I take this stance because I want children to bring all their ugly stuff into therapy. I want them to say the vile things for which other therapists might reprimand them. It's my opinion that giving a child this kind of freedom, allows them the space to bring everything that is inside to the outside. There we can look at it all without judgment, and children tend to sort it out for themselves. The fear of many therapists is that aggressive behavior acted out in therapy may transfer to the home or school environment. I will say that I have not had this happen. It seems that working freely through the anger in sessions actually decreases the need and desire to do it elsewhere. Often when children have been allowed to cut up drawing pictures of siblings or beat up dolls of Daddy, they have come back to me later and reported improved relationships with these people. Anyway, that's the debate!
I feel really passionate about allowing this sort of freedom of expression, because I see it work so well. I work with a 9 year-old girl who shares deeply painful memories of bullying and abandonment by Mom only after her puppet doll "beats me up" for about the first 10 minutes of therapy. I've seen another 10 year-old boy gain insight on his own about jealousy toward his sister, only after I allowed him to dump an entire bin of toys on my floor, toss them around for 40 minutes saying, "THIS is my anger!" With this child, all I had to do was stand by to ensure safety and validate as much as I could, "this is your anger! It's a lot! It's big and very messy!"
I have to say that, as a therapist, you must be really comfortable with your own anger to allow such expressions from other people. I've clipped some shrubs to pieces "working out my mads" and scrubbed some tubs to a sparkling shine while crying it out. I have to believe this has allowed me firsthand experience of physically kneading through emotions, letting them run through my body and my words until they are spent. Perhaps if a kind therapist had allowed and encouraged this from me years ago, I wouldn't have struggled with it as an adult. Nonetheless, my landscaping looks great these days! So, the debate "rages" on, so to speak, and I will continue to encourage my little people clients to come on in and let it on out.
Photo above found at: