Activists' Community

I was wondering...
How is it to combine: beeing a psychologist, doing therapy with our youngster... and at the same time showing resistance by doing announcements and sit ins

In our setting, I find it not to be such an easy match. During a sit in the youngsters sometimes express that they don't know any solution, that they don't know how to manage their agressivity for example
Our therapist is trained to answer that question, to look together with the youngster for a way to deal with this... But as part of the resistance she must keep her mouth shut... While playing a totaly other part next week in her individual session with this kid.
On the other hand it's much more easy for us, educators/opvoeders to show resistance: we have much more time to make a connection with these kids, to do 'verzoeningsgebaren'... For a therapist, who has only her sessions, it's much more difficult to make a positive connection and much more dangerous to disturb this connection by doing a sit in for example, because there is not that much time to reïnforce it.


What our the experiences here?

Thanks again!
Ulla

I think you raise an interesting issue and i'm curious to hear what others think about it too. On the one hand the therapist in the theraputic context does not have a disciplinarian role and offers the youth a safe place, one without judgement or an educational agenda. She/He is not there to correct or demand but rather to reflect and accept. But the therpaist also may repesent boundaries (such as setting) or may insist on such things as saftey and obviously would not accept violence, etc..
In my mind it may be too problematic to have the therapist involved in acts such as a sit-in, espcially if the child has regular sessions with the therpaist. I fear it might "pollute" the theraputic context to have therapist involved in direct NVR actions, but again I'm curious to hear what others have to say.

I am working as a psychotherapists and I choose not to participate to the announcement and the sit in or w-sms.
I already wrote a support letter and I feel that this is an appropriate action. I also noticed that because of the NVR training, the way I wrote it, is more of NVR compared to how I wrote letters before. I put more attention to the fact that I work in a team and that I support my team members and that I cannot accept violence, but then I also offer my help and support to find a way out.
I already did phone calls to the network as well and this also feels right towards my therapeutic role. I expressed my worries and my good intentions towards the youngster.
An I-SMS is also possible within my role where you use the silence and at the same time you show your presence and support.
This is my experience, and as Michal wrote, I am also interested in more idea’s of other colleagues!
Annelies

Dear Ulla,

A first question to my point of view is: "Are you the therapist of the child or one of the educators from whom we expect to enter an educational relationship with the child?" If you are the individual child-therapist, I would do everything to keep your position clear, which doesn't mean that you cannot be supportive. Talk with the child about the bizarre things the educators, parents started doing, ...
I agree with Michal and Annelies and I would carefully consider the desirability of the presence of the individual child-therapist during the sit-in/the announcement. Not only would he/she put at risk his individual therapeutic relationship, he/she would also risk that everybody will be looking at the therapist during the sit-in/announcement with lots of expectations, maybe without anything happening. Not being present and discussing the sit-in / announcement afterwards during the individual therapy with the child could be much more helpfull in my point of view.
Concerning the 'pressure' on the child during the sit-in: Uri Weinblatt did an interesting workshop during the NVR-conference in London (april 2011) and presented some variations on the sit-in for children with specific problems (e.g. internalising problem behavior,...). I have some notes in Dutch ... just let me know if you are interzested...
Frank

Hello Frank!

Welcome at this forum. As you can see I try to work on my presence here, so I'm glad to see some others present : ) The more presence, the more we can learn.
I'm an educator who felt the tension created by the fact that the therapist all of the sudden had to choose a different role. I discussed it during the teammeating, and we decided to experiment doing it without her.
Another thing we felt was indeed the pressure on this kid. One specific sit-in he entered the room, together with us, willing to coöperate, willing to accept our authority, and came out of the room angry, with distance... because of this tension built up by the use of silence. The first suggestion he made was 'I can stay up in my room all evening, so I don't get mad (so I don't use violence)'. We asked if he sees that as a realistic option, he said maybe not. But than he didn't know, and the fact that we kept quit made him angry. While we felt like he really wanted to look for solutions. We did our 15 minutes and stopped. But afterwards we had mixed feelings: is this the goal? What if we feel that the kid really wants to look together with us, that he needs our help?
I would be very interested in some more information about that tension, if you want to share this...

Thank you,
Ulla

Dear Ulla,

Maybe I didn't get the whole picture but I was wondering: why would you choose for a unilateral action like the sit-in if you an open constructive conversation without escalation and with positive outcome is possible ?

I added some notes from the workshop by Uri Weinblatt I attended at the London-conference. It are personal notes.They are incomplete but, in my point of view, the essential ideas are displayed.

Yours,
Frank

thanks for sharing this Frank
i was at the workshop but didn't get as thorough notes as you
Alex

Hi everybody,

Today an announcement was made for a young man of 17 years old.
He threatened a social worker verbally ("I will destroy you"), he twisted her arm and poured pepper on her hair, he took her by the arms and threw his soft drink over her and often he pretends to throw his hot thee over her and then he sees that she gets afraid...

Now half of the announcement was read to him and he reacted with violence towards himself and made threats: "I will kill myself, it was a joke, she was laughing with it, I will jump out of this window, I will destroy the face of the social worker, you'll see, I want to die," At the same time he was hitting his hand against the window and wall.

The coordinator decided not to leave him with the letter because he thought it could lead to more escalation.
He told the young man that he would come back to read the second part.

The announcements lead to escalation, as we were told during the training. But at this time we are more afraid then before the announcement, towards the safety of our staff... So we'll have to prepare ourselves and increase the safety measurements.

Maybe reactions of this forum could strengthen and encourage the team, because automatically people wonder if we did not provoke him by making the announcement and choosing for NVR...

Greetings,

Annelies

Hello again Annelies,

Sounds like NVR is the only option you have at the moment, no?
What network is there? How do the groupmembers think about it? Wich position does he have? It sounds like he has a lot of power at the moment... Is there anyway you could reïnforce your autority as a team, as an institution? Friends he has, kids of school, family...

In our facility I feel as if it's kind of easy to do the part of announcement, sit-ins etc... but to have the network meeting etc... always provokes a little resistance (weerstand)... We are so used doing it by ourself... Needs an attitude change I think...

Bye!
Ulla

Hi Annelies,
it does get scary when kids react with extremes to anything that we do and i think its a natural instict to start wondering if we were maybe to severe but i think that it exactly that kind of "paralysis" that is even more damaging to kids. If you think about it, how "severe" is the announcment, saying that you will resist his violent behavior? I truly believe that it cannot possibly be in the child best interest to have adults "walk on egg shells" because they are afraid that he might hurt himself or turn into a monster. It is however, in his best interest to be told that the adults are not giving up on him and will DO ANYTHING to help him but they cannot accept his violent behavior. I think you are right that if his reaction is so extreme than you have no option but to increase safety measures for the staff and for his own protection. ANd I also agree with Ulla that you can think how you can reinforce the message. You can also think how to incorporate "softer" measures, i.e. making sure he has someone to talk to, reinforcing positive behavior etc.. But in my mind, it is more damaging for a child to walk around with such destructive power than being confronted with the calm and determined resistance of adults.
best of luck
michal

Hi everybody,
I got a question on how LSCI (Life Space Crisis intervention) and NVR are situated to one another.
Since I don't know that much about LSCI, I post this message on this forum and am already very curious to get some responses!
thx in advance and lots of greetings,
Annelies

Hello Annelies,

Since in ter Wende we followed a few days of LSCI training some years ago, the question that you're posing was on my mind too. I don't know the correct answer and I don't know how my collegues of TW feel about it, bit this is my intuïtive respons.
LSCI is a part of vigilant care. I think situated on the second level, or on the third. I think it is the stap before NVR, before the one sided steps. It is the part where you are still trying to understand the behaviour, trying to see the pattern, trying to help the kid see it too. If it helps: fine. If it doesn't help: time for NVR : ) Or it can be used together with NVR: we don't do a sit in to have a long talk, but maybe sometimes, we get there some way or another. One intervention of LSCI is for kids with no feeling of guilt, they think there right doing what there doing (steeling, beating someone up, yelling...) I think LSCI is not enough for those tipe of situations: this is were NVR comes in very handy! To resist, and to keep resisting, instead of keep talking (LSCI style)
For me the LSCI feeling is softer, more about helping the kid, beeing next to him, trying to give him insights to change his behaviour etc... He's accepting your authority and help. But when he's not accepting: there's NVR. NVR is more about resisting behaviour, it gives me a stricter feel, opposed to him instead of next.
LSCI is giving the kids new tools to deal with a situation, to very rigorously analyze a situations and see what we can do better next time. Sometimes a kid just needs to know that slapping a back to say hello is not really nice, so this is maybe why another kid doesn't like him. So he has to learn to wave goodbay or shake hands. (Sorry for the simple example). Just resisting the beaviour would be... Hard? Because we don't give an alternative. We don't need to resist if the kid is willing to take our advice.

I think LSCI is everything we try before we say: time for NVR! Or we're doing it at the same time: f.e. helping a kid deal with aggression and at the same time resisting. But splitting it up seems unnatural sometimes: it is like having a conversation about what to do when you're feeling angry and the next time entering a room and keeping quit. Wy the sudden change? Is it a problem then to 'NVR' new kids in our facility? Because we first want to talk to them, give them tools, do everything what we're used to do before writing the announcement and doing sit ins? I think somehow we can bring it together but don't know how yet... Maybe experimenting more with NVR will solve this problem...

Is this a little bit clear? Or does this raise some other questions?

Bye bye,
Ulla

Two weeks ago we wrote an announcement to D, to say that we were going to resist his agressive behaviour towards the children in our setting and to objects (beating), the threaths he expressed (I will beat you, I will bring a knife), respecting bounderary's of other children (when D asks a cooky and they say no, D should stop asking the question) an smoking in places he can't smoke (for example his room; the danger te whole place would catch fire!). As said in my previous message: these 'problems' were expressed by the group, during the groupmeeting, so our authority came from there.
A week later we planned to do an sms, but the people who were supposed to dot it, changed their mind because they had the feeling that an SMS would increase the agressivity at that moment, so they did an 'aandachtsgroepje' (group of attention) instead. The focus here is more on giving attention, looking for a solution together, giving care, showing concern etc, not so much on showing resistance. First I felt a little disseapointed because I was really curious about what the SMS would be like, but than I thought that since he is not staying in our setting for such a long time, there hasn't been so much real 'talks' with this youngster. I was sure that his behaviour was not going to stop, so was ensured that we would have enough chances to do an SMS in the nearby future. The week later we had our teammeeting, the youngster was at that time in our center because he is expelled from school, so we decided to do an 'sms' at our teammeeting. It was a little bit an impulsive decision. We saw it also as an excercise for us in silence. We were there with five staffmembers of our group, and our psychologist/teamcoördinator. Actually it was not a real sms but maybe even more an exercise for us: our goal was to keep quit for 5 minutes. (Every start is difficult).
During the last two weeks we collected data: we made a list of all behaviours that concerned the announcement. For example: When D goes to sleep, we ask for his mobile phone. The rule in our group is you can't keep it at night under the age of 15. When we ask it, he gets very angry, saying 'my stuff, my rules' and slaps with his door so hard that his door is a little bit broken. So, since this is 'damaging property', this is part of the sms. Last time I askes his mobile phone, I did it very gentle just saying 'Dieter I am here to collect your mobile phone', instead of giving it to me he throws it away so it is broken. Damaging (his own) property again. The list contained 5 'cases' where he crossed the line that was drawn by the announcement.
So at the SMS we said that he has problems giving his mobile phone so he throws it (damaging property), and he is busy finding out if it's really broken so he is in his bed 30' later than he should be. Since 'not giving his mobile phone' nor 'respecting the timetable' is in his announcement, I was worried that the message we gave was maybe a litlle bit to complex? Because we find it difficult that everytime we ask for his phone or playstation portable or whatever, this turns into a dramatic reaction from his side, as a result he is in his bed 30' later or starts his study 30' later... But it's not a part of the announcement, and we can't make it part of the announcement because than we have to much things to resist to. (It's now allready too much I guess?) Sometimes we have the tendency to say 'hey, this we can resist to because it's also sort of respecting boundary's', but I find this difficult because than it is not concrete enough, and we are actually resisting everything.
I was wondering what the rest feels about this. How can we than 'make' our message?
I also realise now that we didn't even asked the group to collect data with us: when Dieter crosses the boundary or does anything else expressed in the announcent, they should come and report this, because we need it for the sms. We did say they have to tell us when we don't see it, but were not transparant enough to say it really specific.
Also I have the feeling it is such a stronger message when we do it togheter with the parents, I was even wondering if we could do it together with some youngsters, because the group is resisting, or do we bring them than to much on the level of the adults, when it's actually our responsability and not theirs?
I'm sorry about the very long and complex message: it was more a thinking process while writing. The last thing I think about just now is that for this youngster we should make a good boy book, he really wants to do it right but he is not so strong and very impulsive...

Byebye NA-network : )
thanks in advance for the response

Hello Ulla,

great to hear how your team keeps on experimenting. It's always interesting to see what the reactions are. The description of this boy makes me wonder if your team is supported by anyone in it's authority. So, your suggestion to recrute the parents is very important, I think. And also, school! He was expelled from school... Does he have any contact anymore with youngsters from school, but more important teachers.Is he expelled to never return? I think it's crucial he gets the message that behaviour in school was unacceptable, and hence getting expelled, BUT he must get some messages of support from the school (if not teachers, maybe someone from "CLB", sorry don't know the English word). Maybe your team can repeat what behaviour (if it's not clear, this will have to lead to contacting the school to be able to describe the concrete behaviour) couldn't be accepted in school, that your sorry it happened and that your now here for him to think together.You could then tell him how you think about him (the positive things you said). Maybe your team can invite him to do a reparation act towards the school (even he is never to return there). And if it's possible in any way, motivate the parents to do this request together with your team. They could then think about what they could do as a reparation act, in case D. doesn't want to. This is what I think I would suggest in my team if a boy was acting like this.
I hope this can help a little.

Doing this makes you realize how we're all just one little part of the net. A ward can't solely replace the network that really matters to children, don't you think?

And now I'm off to my next supporters meeting (the one Ishay helped me with). I'm curious how it will go. The father was amazingly confident when we prepared yesterday and at ease (not expecting anything, only for me to talk about new authority). he's almost more relaxed then me :-)

Ulla, lots of success with this boy. I hope you can get your message strengthened.

Kind regards,
Elfi

Hello Elfi
Thanks for your remarks. He's expelled to never go there again, and will go to a special school (buso) next week. Think the reparation act was just a sorry, and the parents were not involved in that. It's a good idea to think about, I will bring your FB back to my team.
you're very supportive on this forum! : )
I think it's great that you're doing supporters meetings. This is a challenge that lies there for us also, I think. Hope this can be part of our 'parentgroup' were building. Next session wil handle about escalation, with roleplay, so I'm very curious about that also... But the parents without a network... No go! Third session is about Network, so very curious! Let us know how it went! Good luck!
Ulla

Hi Ulla,
You raise some important and complex questions and i doubt i'll get to them all (my own kids have drained me today :-) )but what stands out is the question of what do we do with those kids who have negative behavior all the time? Or what if we have violent behavior behavior as part of the announcement but on top of that the child all of the sudden doesn't want to take a shower, and so forth. I think your concerns are valid and that you can look at it two ways, the first one is if we take your phone example than instead of concentrating on the 30 min delay in schedule you can just stick to the "red" behavior and react to his aggressive (and throwing objects is aggressive behavior), and not even mention the fact that it means he goes to sleep late. That way you keep the message simple, the act concrete and stick to teh announement target. Another way is to consider dividing the behavior into the different baskets and to make sure that what is not in the red gets different reactions or you mightalso decide to ignore some of the problematic behavior for the time being until the bigger stuff gets settled. The two problems with having too many target behavior is 1) the staff feels overwhelmed with having to react to so many different behavior 2)the child feels that he is constantly being reprimanded .
and lastly before i go to sleep, using the good boy book or any other form of saying to the child "we see you and REMEMBER when you are nice/good" is excellent for these kind of kids that keep getting into trouble because of their impulsivity.
best of luck
michal

Thanks a lot for your answer
it is allways very helpfull and strengthening to get an answer of 'the professionals' : )
Ulla

Hello everybody,

the team in our ward is getting more and more in NVRmode. This also leads to more parents being counseled in writing announcements.
Doing this, we have a few specific questions:
1. Are there specific differences in the announcement when a child has autism (do you make it more concrete or use other communication means) or don't you make it any different, since it is mostly meant for the parents? Does this diagnosis have any repercussions on the other aspects of NVR (eg use of sit-in)?
2. What if a parent has an illness which invalidates him/her in being present (cancer/multiple sclerosis) and with a negative prognosis? Does anyone have any ideas about writing the announcement in this situation. Do you elaborate more on installing a broader support network?

Kind regards,
Elfi

Hi Elfi,
I believe that one of the most important "by-products" of acting NVR is the enhancement of parent-team relationship in residential settings. The announcement serves also as a concrete tool for acting together. I'm delighted to know that you are using it more and more!

As to your questions: 1. I have no experience with autism but I think that the announcement should be very simple and concrete and the Sit-In a very short one. Also I hope that other professionals who used NVR in those cases may contribute their experience here. It may also be possible and to my opinion might be even better than a sit-in to consider a simple reparation acts done by an adult who invites the child to join him in that act.
2. As for parents with lethal illness we will strongly recommend that before making an announcement the parent should build a support network. The message that we will deliver to the parent is that the situation is such that it is neither possible nor wise to handle it alone. It will be very important, I would dare to say, almost critical, for the child to know, understand and feel that his parent is not the only one who cares for him! The child will know it when in the announcement the parent will mention the supporters, s/he will understand it when the supporters will act in ways that initiate not only resistance to destructive acts by the child, but also by supporters' acts that will initiate care for him (for example staying with him while the parent is in hospital). The child will feel that way if the supporters will be able to persist in their mission to help the family. This is an important message that should be announced to the supporters at the end of the supporters meeting by the therapist.
Hope that helps a little, we are in Passover vacation in Israel so sorry for the delayed respond
idan

Hi Elfi and Idan,

Elfi, I read your question on NVR and autism.

Like Idan, I also do not have experience in NVR with autistic children, but I did just finish a pilot project with Haim Omer, working with parents of high functioning autistic adults.

For that purpose we did some adjustments to the NVR methods which I thought might be relevant to your work as well.

- We didn’t do any drastic changes in the announcement. I do agree that the announcement should be concrete when dealing with autism. But we did find that a standard written announcement that lists the son's behaviors is concrete enough.
We did advise parents to add a sentence or two recognizing the son's diagnosed disorder, that they know he experiences difficulties. We found that some adults with autism (and their parents) feel that the son's diagnosis is a "free pass" to act in a harmful way. Such parental acknowledgement, in the son's diagnosis, makes it clear that the parents don’t overlook his condition, but still believe that their situation could be changed.

- I agree with Idan that the sit-in should be shorter, although I must say we didn't use it at all in our project (since the son was an adult, and not due to adjustments to autism cases).

- Referring to the son's difficulties in social communication and his concreteness, we added a tool to help parents communicate their message to him. We advise parents to deliver a unilateral message to the son, after he exhibited a behavior included in the announcement, or after he behaves in a positive manner.
Parents are advised to: (1) shortly describe the event. (2) describe how it made them feel. (3) how they believe the son might have felt. (4) how they intend to respond to such events.
For example, parents might say: yesterday you (hit your brother). We were (upset because we want to protect you and your siblings). We guess you were (mad because he didn't give you something you wanted). Yet, we will (not accept violence).
We advise parents to write down their message and hand it to the son, to make it more concrete.

I hope this was helpful,
Hila.

Hello Hila,

thank you very much for your response. Especially the concrete extra tool seems very usefull. In the case of the boy with autism however we notice that parents themselves are experiencing a lot of difficulty on staying focused on the announcement.So, I'm not sure if we will succeed in supporting them in doing it. I really hope it will!


Kind regards,
Elfi

Hello Idan,

thank you for the extensive response. As always you are a big support! In the case of a parent with a degenerative illness we notice even a changing proces in recruiting the father again as a parent in his daughter's life after already a long time. The parents are hurrying us now in going ahead! I would also like to mention that Haim's text of Enlisting fathers is also a big help for us in many cases. Fathers are significantly more present.
So, again thanks. I'll keep you updated.

greetings,
Elfi