7-22-12 One More Try

People have been coming to this site and I feel apologetic about not having anything written, nothing to offer that might be salient or helpful. I guess you could say that I've been stumbling and drooling
for the past five years. It's not true, but feels like it when I survey where I am in my social work right now. I am in the habit of saying "I don't know" and, in honesty, there is a lot I do not know to the extent that I feel like I'm stumbling. The reality is, like most of us, I am learning a lot I just don't have a lot of time to organize what I'm learning. There is not enough cross fertilization occurring between my colleagues and I. Not even my supervisor who I love dearly. There is just not enough time.

Let me explain as briefly as I can what I have been doing in the past 5 years. I began working in Springfield, MA, 5 years ago in a local "mom and pop" agency that tentatively called itself "community based". I grew restless there because it was not community based enough, or purposefully enough. I grew anxious and depressed myself (like my clients) which was not a bad thing. I was working primarily with youths who had been referred by DCF or another agency, or a school, or a parent, on the grounds of their behavior.

The learning curve with this population is steep and long. Most agencies, teacher, school administrators, parents, the courts, the police, probation, and clinics have no energy or time for this population. They want them on meds ASAP. A school adjustment counselor called to me down the hall of the elementary school where I was seeing a client. "What are you going to do with so and so," she asked? Before I could even think of an appropriate response she added with a snap of her fingers, "because we need a quick fix here." She was a bit of an extreme it turns out, but she echoed a wish on the parts of teachers, administrators, and the courts. The Quick Fix folks.

Too bad there isn't one, I thought. I kept thinking about this idea of a quick fix. If I was working for up to 2 years, or more, with one of these clients how could I learn enough, fast enough, good enough and train myself in the vicissitudes of a different approach to these kids. How could I be the quick fix and be able to build my capacity to get these kids back on track in a year or less? What would that take?  Burn-out was one thing to expect, but is there a way and where do yous start.

Here are some issues I felt needed to be reviewed. These came about as a constant internal inquiry. What were the issues the kids were having based on? How could I generalize these? One was the issue of parents/family/home/finances/security. This was an ecological question. How did these all
contribute, in a reciprocal, interactive way, to the dilemma the kids were facing everyday. That WAS the reality. If I was having a hard time figuring things out they were having a much harder time trying to figure things out.

The kids I asked, as I was slowly but inexorably (because they wanted to get better!) able to develop incredible, honest, open, brilliant relationships with them, what they felt the source, the exact origin, of their anxiety was in their bodies and minds defined it classically and in a way that could be applied to the idea of "ambivalence". I began to work steadily on the ambivalence using a lot of ego supportive inteventions, a lot of venting and reframing, and in participatory treatment like role plays for decreasing explosive anger, off-the charts anxiety, the residue from childhood (often vicarious) PTSD.

The kids gave me ideas to work with. One was to consolidate a team around each child. What would that look like? In my first two years I contacted all the colleges in the Valley and asked if I could get mentors, tutors, and teachers' aides from the undergraduate and graduate students who would use a term in Springfield as an internship pro-bono. The few interns that volunteered were wonderful and full of energy and ideas but, predictably, struggled with schedules and consistency. Transportation was a huge problem for them. Public didn't work for them. I pulled back to the city itself and had luck getting one or two Springfield College MSW students, but they seemed to fade away as the year and progressed and their schedules go tighter. So it was a great idea but I did not have the time or energy to supervise these students and, in the meantime, the kids were being treated to another dose of unpredictability, inconsistency, broken promises. At one point, and I am serious, I talked to my supervisor and other clinicians at my agency about letting my older clients help with the younger client. Although confidentiality

I went to schools, churches, and community centers; bricks and mortar places, that I could think that might be willing to open community outreach programs and activities including weekly groups for parents, particularly single mothers, and kids and other groups, what I call Fish Bowls, for parents and kids to talk simultaneously (but facilitated) about issues in the homes and neighborhoods. I had a few responses but that was when everyone was starting to run out of money.

I continued trying to push this forward at two community centers and an elementary school in Springfield. The contact with these community entities started to have other results which was those agencies got to know me and a first-hand relationship developed. Often, when a client was acting out, they would call me to help and if I was close I would drive there and take part in a team intervention. My authority was respected. I was a huge help, but more importantly the kids, themselves, began to reciprocate.

If Oliver was triggered by the taunts of his nemesis at the next table and the client threw something at, or towards him, the client was given a "time-out". I quietly legislated against time-outs, or any kind of seclusion. I developed quick de-escalation methods and worked with the clients to be more forth-coming in defining needs in simple terms that teachers could respond to. This was Cognitive Behavior Therapy but I included some DBT as in meditation-like exercises in the classroom. The idea was to get the client out of the regression as quickly as possible. Sometimes all this meant was giving the client a task to do.

Stepping back to the in-school "justice" issues as in Oliver throwing a marker at his nemesis they can quickly run everyone into the ground. You have to start from the here and now. I tell the clients that when they're feeling pleasure in suddenly turning to a discussion about justice issues stuff and get them to capitulate and to stay in the here and now they have a hard time transitioning but they will do it if you help them with a transitional space. I like the space offered by role plays even if they're brief and to the point like re-enacting a fight or an argument using student "actors" but not the student