Hope

I thought since I was last talking about hope, I would share some quotes about it. These came from the NASW National Conference, the theme of which was Restoring Hope. It would be interesting to print these out and discuss them in a staff meeting, always wondering- how do we promote hope in our clients and in ourselves?

“At bottom, everything depends on the presence or absence of one single element in the soul- hope.” Henri Frederic Amiel

“There is no such thing as false hope”  Elizabeth J. Clark

“Hope and hopelessness are both choices. Why not choose hope?” Greg Anderson

“Hope is the dream of waking man.” Aristotle

“Where there’s hope, there’slife. It fills us with fresh courage and makes us strong again.” Anne Frank

“Courage is like love. It must have hope for nourishment.”  Napoleon Bonaparte

“We should not let our fears hold us back from pursuing our hopes.” John F. Kennedy

“We must accept finite disappointment, but we must never lose infinite hope”. Martin Luther King, Jr.

“There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow”. Orison Swett Marden

“Were it not for hope the heart would break.” Thomas Fuller

“Is there a social worker who, though he is weary, tense and with a soul worn threadbare, is not ready to start work all over again in this cause?” Nora Deardorff

It Ain't Easy Being RICH- Hope

Anyone who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This fourth week I will focus on Hope.

Hope is the foundation on which all the other qualities rest. In the dictionary hope is defined as: “to cherish a desire with anticipation;” “to desire with expectation of obtainment;” and “the feeling that what is wanted can be had or that events will turn out for the best.”

I previously posted on Hope on 4/15/12. The focus of that post was the ways that a RICH relationship in itself creates hope, independently of the external reality.

Not surprisingly, the Risking Connection curriculum (Saakvitne, K., Pearlman, L., Gamble, S., & Lev, B. (2000). Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran) has quite a bit to say on hope. The authors maintain that holding hope is a key responsibility of the therapist. Our clients come to us hopeless, and they often experience setbacks that discourage them further. Meanwhile, we are doing this difficult work in the middle of an ineffective and inadequate child welfare system. So, it is possible for both the treater and the client to become hopeless. It is the treater’s responsibility to take care of him/herself and do whatever is needed to fight vicarious trauma in order to maintain hope. The treater’s job is to “Hold onto vision of the survivor’s potential future self,” and to “serve as trustees for the survivor’s future possibilities.” (RC pp.15-16) The treater is at her best when she can see clearly the client healed, living a productive life. The treater must maintain the tension between seeing that version of the client’s potential and also seeing the current reality of the client. The authors ask us to direct our attention to evidence of hope and resiliency in our client’s stories. When presenting or discussing a case, talk about strengths in a real rather than pro forma way. They also point out that hope is fueled by compassion for our clients. If we understand the adaptive nature of their symptoms, we feel less exasperated and less personally attacked. In other words, having a theory, a road map, that helps you understand the behavior and plan your next treatment intervention creates hope that counteracts the bewilderment and discouragement we usually feel in the face of extreme behaviors.

What is the meaning we ascribe to our client’s behaviors? When Aisha ran away and became involved in dangerous situations, Louis reacted: “How can she be so stupid! We have explained a thousand times that she is putting herself at risk. In fact, I just had a great talk with her last night about this! I told her how worried I was about her when she put herself in such danger. She told me she understood and would not run away again, and she thanked me for spending time with her. I guess she was just manipulating me to be able to stay up longer. She doesn’t care about me or anyone else. She doesn’t even want to get better. She’ll probably end up being kicked out of here just like our last two clients. Sometimes I wonder why we even bother.”

Mario was also affected by Aisha’s running away. He said: “I am so scared for Aisha. She still doesn’t value herself enough to keep herself safe. And we haven’t yet been able to teach her an alternative to running, or to make her safe enough to try it. I wonder if we set up a place on grounds where she could run and stay until she calmed down enough to come back if that would help her. And when I think of it, I realize that Aisha has been forming some close connections with both me and Louis. I wonder if that is scary to her, especially since we are guys? I’m going to talk to Tracy, her therapist, about that, and bring it to team. I don’t  know what we should do differently but maybe there is something. Aisha is so bright and has so much spunk. I know she has a great future if we can just find a way to get her there.”

The enemy of hope is vicarious traumatization (VT). Since it is the treater’s responsibility to maintain hope, it is essential that we combat this aspect of VT specifically. Some strategies, largely taken from the Ricking Connection curriculum, include:

·         Challenging negative thoughts and looking for evidence of resiliency

·         Celebrating all kinds of successes

·         Collaboration with others, within our agency, outside, and even outside our treatment community. For example, when a local business joins us and gives backpacks to all the students returning to school, it helps to know that there are others outside our world who care.

·         Noticing the advances in understanding trauma and in treatment that are being discovered through science and new technology.

·         Appreciating the gifts of the consumer movement.

·         Cultivating our spirituality, whatever that may be

·         Look for meaning and inspiration in everyday events and in natural beauty

·         Seeking and embracing the personal transformation that comes with this work. How has this job, and being involved with these clients, changed you for the better? What have you learned from them? In what ways have you grown?

There are also many ways the agency can help workers fight VT and remain hopeful- another time, another post.

Hope is an essential element of every moment of our work. In fact, our work defines hope- we embody a conviction that people can heal and change. We have seen it happen many times.  As we are presented with each new scared, snarly, obnoxious, difficult client it is our job to shine with the hope of all that they can become.

 

 

It Ain't Easy Being RICH- Part Three: Connection

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This third week I will focus on Connection

Connection is the central concept in a trauma-informed approach. People heal within relationships. Our programs should offer our clients RICH relationships and train staff how to utilize these relationships for the most powerful healing.

Some of the complexities of this approach become clear when we talk about the fact that relationships have two sides- the clients and ours. These relationships affect us too, and all of who we are shapes the relationship.

On April 9, 2009 I wrote about the Restorative Approach and Boundaries. In this post I discussed some of the common complexities that arise from our caring for the children and wanting to help them. People sometimes assume that because the Restorative Approach emphasizes relationships and speaking from the heart, we are throwing out the idea of boundaries. Quite the opposite is true! For relationships to be safe and healing, the boundaries must be clear, reliable and trustworthy.

Because abuse is in its essence a violation of boundaries, it is especially important that we pay attention to boundaries when working with abused clients. Our children have experienced major boundary violations, such as sexual abuse. They have also experienced many other chronic, less obvious boundary problems. Many of our children have had to handle responsibilities far beyond was is reasonable for their age, such as an eight year old being responsible for her two year old sister. They have been way too involved in adult issues, such as being worried about the rent or finding food. They have been exposed to adult sexuality and to relationship worries. They have had to parent their parents- care for a sick mother, listen to parental problems, help ease a parent’s depression.

So many tem[potations can arise for staff. We may want to give the kids gifts; take them to lunch; give things or money to the family; etc. The family may give the therapist a gift. We consider sharing personal information, either because we feel close to the client or we think it would help them. The client may tell us a secret, on the condition that we don’t tell the rest of the team. When the child is leaving, we may consider giving her our email address. We wonder if we should give this boy a hug.

In our training, we emphasize that as a staff you should TALK ABOUT every decision that is outside your job description before saying anything to the child or family. Talk with your supervisor or your team. It may be just the thing to do; it may be dangerous to the child or the group. But it is much easier to make the right choice when you step back, take time to think, and talk with someone else.

That we even have these dilemmas illustrates how much the kids and family matter to each of us. And so, with each of these real connections comes our exposure to the pain the child is feeling.  When a sad thing happens to the child, we feel it too. It is often hard to stay with that pain- we often just wish to fix it. Part of that impulse is to sheil ourselves from really experiencing the painful worlld of the child.

And we experience losses. We don’t talk much about what it is like to take these children into our hearts, and then have to discharge them- often to a less-than-optimal situations. One person in my agency used to say (when we had residential) “You know they are ready when you don’t want them to leave.” But they do leave, and staff are expected to be ready to open their hearts to the newest snarling child. It’s a hard thing to do, and one aspect of Vicarious Traumatization. It’s good to talk about this in our teams, especially every time there is a significant positive or negative discharge.

One more thing about connection and our part of the relationship. We cannot open our hearts to these clients if we are feeling lousy. If we feel hopeless and incompetent; if we feel mistreated by our boss or the agency; if recent encounters with clients have been scary or hurtful. We will not be available for new relationships. A new admission will be greeted with cynicism or distant formal interactions. This is why a trauma-informed relationship based approach cannot work unless we take care of our staff. How do we do that? Imbed discussion of VT. Schedule time to think, reflect and get support. Provide regular supervision for everyone. Utilize a clinical road map to make sense of the behavior. Have retreats, Have many systems for staff recognition. Do fun things together like potluck lunches and sports.  Time spent in these activities will be completely repaid in more effective treatment, less physical interventions, and less turnover.

Connection. It’s been a scary thing in the children’s lives. It has its complications in our own lives. Yet it is what makes us human and what builds our brains. Let’s look at our settings and consider how we are supporting connections in the way we do things.

I’d love to hear your ideas about ties. Just click on “comment.”

 

It Ain't Easy Being RICH 2: Information

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This second week I will focus on Information.

This might seem like the easiest one- just give our clients information. Tell them things. But I would like to explore four areas of complexity: collaborative treatment including the use of medications; sharing information with the team; psycho-education about trauma; and information and heartbreak.

Collaborative Teatment Including the Use of Medications: When working with trauma survivors it is essential to be collaborative. They have had so much experience of things being done to them, and of having no control, and they are exquisitely sensitive to such treatment. Also, trauma survivors have not had a chance to develop a voice, learn to speak up for themselves and advocate effectively. In treatment settings, especially with children, we tend to repeat the same dynamic. We make the decisions and when a child tries to object we call that “resistance” and respond with a punishment or at the least disapproval.

One area in which this happens is in the use of medications. We all (I hope) do discuss with a client why we are suggesting a certain med, what the benefits could be, and what the side effects are. We often give them and their families an information sheet. Yet do we truly respect any hesitation or objection the client has to the medication?

Did you know that even accounting for race, social situation, and other variables foster children receive 2-3 times as many medications as other children? I understand it this way: children handle stress and achieve emotional regulation through strong relationships. Connection is the antidote to stress. If a child does not have the strong connections to help her regulate, medication is used instead.

Back to information. It is important to REALLY be collaborative about medication with the child If the child refuses to take her medications she should NEVER be punished (or consequenced) for this choice. It may be an appropriate decision not to take her on a long trip if staff is concerned about her safety and the safety of those around her. But if a child does not want to take her medication, the therapist will be talking with her trying to understand her reality and what the meds mean to her. Why does she not want to take the red pill when she will take the others? Because it has a bitter taste, because her friend told her it was poison, because ever since that one started she can’t sleep. The therapist will get important information and in working with the psychiatrist perhaps something better can be found. And in collaborating with the child the therapist will be developing self awareness as they together monitor how she feels and acts. So, information about medications is not just giving the client a fact sheet. It is a truly collaborative exploration of the suggested meds and the client’s valid needs and wants.

Sharing Information with the Team: I believe that in a residential treatment center or hospital or any congregate care setting, the line of confidentiality should be around the Team, not just around the individual therapist. Some therapists have difficulty with this belief. In our theory, everyone who interacts with the child and family is a treater and contributes to healing. Therefore, they all have to know what is going on. They need to know the child’s discharge plan and destination and what their goals are. They also need to know what is currently happening in the child’s life. In my consulting I have encountered situations in which the full time child care workers have no idea about either the child’s history or their discharge plan. In some situations, such as when the child is disclosing sexual abuse, she may not want everyone on the team to know about it. Her therapist will create with her a phrase that the therapist can tell the team, such as “Nina is talking about some difficult things from her past right now, so she needs some extra support.” The therapist will help Nina to expand the circle when/if she feels ready. But in general, the team is all there to treat the child, and all need to know what is happening. This policy should be clearly explained to the child and family (and documented) when they are admitted. In order to gather this information and discuss its significance, the child care worker must be able to spend time in Treatment Team to learn about the client and understand their reactions.

Psycho-education about Trauma: How many of you in your programs are teaching the biology and psychology of trauma to the children and their families? Even younger children can learn something about their brain and body and why they act the way they do. This knowledge can be extremely important to our children. It helps them feel less crazy. When they learn that the body reacts a certain way to stress, and the same thing happens to soldiers, and policemen, and the workers in the program, it combats that conviction that their crazy behavior is their own fault. I will never forget Colleen, who when reading The Courage to Heal (Bass and Davis, Morrow, 2008) said: “This is me! In a book!”  For her it was so normalizing to know that others understood her.

Of course, there is my Blub book on “A Kid’s View of Trauma”. This book uses the Risking Connectionâ concepts to explain trauma to kids, including how they can heal. It can be found at www.blurb.com.  Some trauma-specific treatments, like TARGET, also explain the biology of trauma.

Another part of this is the parents. As we know most of them are also trauma survivors, and many have never worked on their issues. When we do psycho-education with them to help them understand their child, many parents immediately relate this information to themselves. Like Mrs. Jennings they say: “I wish I had had this information years ago!”

Information and Heartbreak: When we form caring relationships with children in the child welfare system, we are constantly dealing with heartbreak- the child’s, and hence our own. We often struggle with when to tell the child disturbing information. At what point do we tell Marvin that the foster family he is visiting is beginning to have doubts that they can take him? When does the DCF worker tell Melissa that her mother has dropped out of the drug treatment program? Or does she tell her at all?

I have seen people, especially state social workers, be so reluctant to tell a child bad news (you are not going home) that she hedges and leaves the child with an unwarranted sense of hope. This prevents the child from being able to explore new alternatives.

One are in which we struggle with imparting information is when a beloved staff is leaving. How long in advance should we tell the children? Some feel we should wait until the last minute to tell the kids, as otherwise they will get upset and have melt downs. Yet, if we do not give them time to process this departure, we will be repeating their past trauma in which people came and went without explanation.

In all these situations we have to tell the child in a straight way what is happening, and be prepared for some appropriate emotions of despair and hopelessness. If we can stay with the child through their reactions, and witness and empathize with the painful situation they are in, they will eventually, if reluctantly, be able to move on to the next plan. Their reactions are not inconveniences for us. They are the child’s legitimate protest against an unfair world.

What other dilemmas around Information can you thinkof? I didn’t even get to sharing personal information. Click on “comment” and share your information dilemmas.