Dear friends and colleagues to the NVR&NA spirit
When Iris and I planed the training schedule we were not able to spare some time for one of the most important things - case studies from the participants… It is important because those cases are the exact bridge that should be between theory and practice. One of our tasks and intentions in creating this forum was to use it as a kind of a reparation act for that. After that said, I would like to use Evelines' third question (see 4 conversations below) as an example for a new authority treatment plan.
The question concerned a governmental decision that - "every child has the right on an allowance (5 euro every week) and they can do with this money what they want. You can't use it to punish and you can't withhold it". And this is where the problems come in: an obese child has to follow a diet but we can't prevent him from buying sweets with this.
First if we look at the problem from a perspective that this poor boy is also addicted to sweets a plan that will prevent him the money and by that remove the "buying sweets option" is a possible and reasonable treatment plan. But as mentioned, sometimes governmental rules concerning childrens' rights seems to prevent this option. We are less able to use reward-punish plans and sometimes some good CBT treatment plans are weakened by that…
A different treatment plan will look at the individual and try to strengthen his inner abilities or in other words bolster his self-image. Of course this is also a possibility but then again - after 3 month the government will probably demand to release him from the ward. To our frustration building self-esteem with therapeutic plans takes usually more time than any government is willing to spend on a child. In many cases also our ability to use good psychodynamic treatment plans is seriously limited by that…
Can the New Authority concept suggest a different road for treatment? I believe in that … Now, let us try to look at the problem from a New Authority perspective. If you recall our slogan – from individualism and loneliness towards community and support, we can take a different road to help in this problem. Is it possible that at the beginning of each week (usually there are morning group meetings with the kids) there will be a discussion with all the children on how they spent the 5 euro at the weekend? Here we start to think in terms of community and the children are part of the wards' community. As you will read later on we can even recruit them as supporters for a treatment plan. We believe that children always need an adult around but sometimes they can heal each other and can do a good job as the wards' professionals. In our culture it's of course unprofessional to think that non-professionals can do a good professional job. (Sorry for that, but well, by now you know me already, I can't control myself sometimes, self-control is not my best part when I start to talk or write… :-)
But back on track now – let's look at that boy not from an individual perspective (self-image…) but as part of a community. As a child who's secret and most intensive wish is to belong – to be part of a community. Now suppose the child will say in the group that he bought sweets with the money, how will others react?
Here comes the first risk in "going public" and recruiting supporters with the Childs' problem - If someone from the group laughs at him, can we initiate support for him? Well, I'm sure we can – this is our duty as (new) authority figures in a residential setting. Indeed group dynamics tent sometimes to escalate quickly but here our experience and profession as therapist is useful (Sometimes a professional intervention is certainly needed :-)
What if the child devaluate us? - says something like "they forbid me to buy sweets – I "won" they can't forbid me so I bought it". Here again in terms of a new authority figure the reaction is simple – "we forbid it because we care for you but we know we can't control you." I think that here you can see the concept of recruiting supporters at its best. The same statement could be said in four eyes between the therapist and the child but the children in the ward sitting there in the group are like an amplifier for that statement! I'm also sure that within the children group you will find those who will not only understand the message but will also be able to help in stopping the power struggle of control between the authority figures (us) and the child. More than that, I can assume that in some cases the child will use the power struggle of "forbidding-buying sweets" to continue his behavior. For example if we don't talk with the group and keep it only in the therapeutic sessions he can tell a friend secretly he bought candies but I'm sure he will pick the one who will back him up in the struggle to "freedom" (and of course more risk for him…). Going public and using the childrens' group as supporters can prevent that.
But here comes a different dilemma – what if the child will not tell he buys candies in the group? Can we here again think in NA terms? Can we as NA figures initiate resistance? I think it's a possibility. For example – first to talk in individual therapy with him why he lied and later checks if he is willing to tell it to others.
More than that – another possibility is to make an Announcement about that in the group and ask the group for support. This is exactly what we mean when we say that the NA figure should be able to initiate resistance & support. After an announcement is made there is also a possibility that other kids will support him by calling him in the weekend to ask what he bought. Is it a possibility? Aren't we breaking here some privacy rules? Those questions are as I was trying to explain part of our cultural problem. I'm sure that most of us can agree that sometimes even "crazy" children can help each other when they are out of the ward on weekends, by calling each other. As mentioned before this can create sometimes an escalating process but just like Haim said in his lecture – when you solve one problem sometimes you create another. I would add that my believe is that when you change your problems it's a good sign, when you face the same problem again and again, well you have a problem. Putting it in terms of one of the participants who preferred to write an email instead of using the forum – " It’s pleasant to feel a reassuring mix between idealism en realism: NA en NVR are attitudes and have techniques but they don’t pretend they can ‘solve’ all problems. It’s more a way of life to deal with problems than to solve problems". So, I truly hope that the NA treatment option I suggested here can be useful for you as an example. I feel also an urge to say that one of the difficulties in trying to act in new authority ways is our cultural inclination to think in terms of individualism and professionalism instead of believing more in the power of community to heal. OOOpppss here I start again, this is the right time to stop – I'm also practicing self control with this example :-)
Yours always,
Idan