In working with children with
developmental disabilities, my job is to treat the child's challenging
behaviors, including aggression, tantrums, non-compliance, self-injury, and
property destruction. My treatment
typically consists of first conducting a functional assessment, which is an
assessment method through which I observe the child's behavior in a number of
manipulated situations to determine why he engages in the challenging behavior
(i.e. to determine what function his behavior serves). During the functional analysis, I observe the
child for a 10-minute period, typically with a caregiver, and I count the
frequency of the challenging behaviors. Treatment,
then, stems from this: once I have determined the "reason" a behavior
is occurring, then I am able to develop a treatment plan that creates a
functional way for the child to get that need or desire met.
Like any good research, I also
have a control condition to make sure there isn't something else going on that
might cause the child to be engaging in challenging behaviors. In this condition, the child has access to
attention, to preferred items, and demands are not placed. Basically, the parent just sits and plays
with the child for 10 minutes.
Typically, there are no challenging behaviors during this condition: the
child chills out and enjoys watching "Bubble Guppies" or "Blue's
Clues" or playing with beads or puzzles or their Nintendo DSi.
A few years ago, I worked with a
young man with a significant developmental disability who had very significant
challenging behaviors. As with most of
my patients, I began with a functional analysis, and we started with the
control condition -- the condition in which parent and child sit and play
together. For this particular child,
though, the control condition was a mess.
I sent mom into the session room with the directions to "just sit
and play as you normally do. Do not
place demands, just sit and talk to him and watch Bubble Guppies
together."
He engaged in challenging
behaviors throughout the session...but the issue was clear. In the 10- minute "play" session,
his mother placed 60 demands. That's 6
demands a minute, every minute, and kid was having none of it. He tantrumed, he was aggressive, and he was
noncompliant with just about every demand that was placed. After conducting multiple observations in
session and at the family's home, it became clear that this was their normal:
mom just placed constant demands all day, every day. Even though it led to aggression. Even though it increased his tantrum behavior
exponentially. Even though the
functional analysis was incredibly clear that he only engaged in tantrum
behavior when demands were placed...she continued placing demands.
For months, we talked about why
he was being aggressive. I showed her
all of my graphs of data supporting this hypothesis. We talked about how we had to back off on the
demands and then slowly increase his tolerance to them. We talked about how the number of demands she
was placing was unrealistic for ANYONE to follow. We laughed about how even I would probably
throw myself on the floor if someone asked me to do something 6 times a
minute. I used analogies about how even
simple demands such as "what color is this?" and "where is your
nose" are "work" for him, and that he was working 24/7 without much
pay...so of course he was bitter and resentful.
Mom got it, and she was able to explain back to me why she had to back
off, and she understood that it wasn't forever...that we had to just back off
to gain some compliance and to decrease the rate of problem behavior. She understood that even though she was
placing 6 demands a minute, he wasn't complying, and that it would be better to
have one successful demand and no aggression than to have 6 unsuccessful
demands and bite marks. She saw that he
complied with me when I placed demands at low-rates. And she continued to place all of the same
demands.
After months of this work with no
change, I knew there was something I was missing. There was a piece of the puzzle I wasn't
seeing, no matter how many ways I tried to explain it. I thought I was asking the right questions:
"what is hard about decreasing the number of demands?" "What makes it difficult to cut back on
the number of tasks you ask your son to do?" "What is most challenging piece of
following through with these recommendations?"
Her answers were always the same:
"It's not hard. It's not
challenging. I'm trying to do it, I see
that it works. I just can't."
Finally, I called her in for a
session by herself for us to really hash things out. After talking for a good 30 minutes and
getting the same answers, I finally changed my question.
"What would it mean for you
to not place as many demands on your son?" I asked. Here, mom's eyes filled with tears.
"It would mean I'm not doing
everything I can," she said.
"It would mean I don't care about him. It would mean I'm not setting him up for
success."
We talked about this for a long
time, until she said, "I know that what you are telling me is right. I know it is more important to go slowly now
so he will listen more in the future.
But I need him to be successful.
I need to teach him everything now."
"Tell me what success would
mean for your son," I said.
"When you picture his future, what does success look like?"
"He will have his own
business," she said. "He has
to have his own business." I
reflected internally on her non-verbal 13-year-old son, and considered the
feasibility of this plan.
Very gently, I asked, "What
would it mean for you if this is not something that happens for him? What would it mean if he does not have his
own business?"
Here, she began crying. "If he is not a successful
businessman," she said, "my parents will disown me. Having an adult son who cannot have a job
will bring such shame on the family, he and I will be disowned."
And in that instant, everything
changed.
Naming the fear for me, naming it
for herself, discussing it thoroughly...it enabled her to change her
behavior. After another few months, we
were able to end treatment as he was engaging in no challenging behaviors at
home or at school. Mom was able to place
a reasonable number of demands at home, and he was able to comply. Thanks to the simple shift of one question,
everything changed.
*****
This question is now one that I
use frequently in therapy, and I am rarely disappointed. It takes us out of the realm of what is
happening or not happening, and into the realm of meaning and possibility.
To the young man who is cutting:
"What would it mean for you to find another way of expressing your anger
and hurt?"
To the parent who yells that
their child does not have autism: "What would it mean for you if autism is
an accurate diagnosis? What would it
mean to your child? What would it mean
for your future together?"
To the dad who refuses to stop spanking
his 3 year old: "What would it mean to find other methods of discipline? What would it mean to find other ways of
getting your little guy to respect your authority?"
These questions take us so much
further. They often evoke tears, and
they take us straight to the heart of the issue.
*****
I'm so far past exhausted, I
can't even see where I passed her. I'm pretty
sure I ran over her somewhere on the highway around Wednesday or so, and I've
been running on fumes ever since. Due to
several client cancellations, I was able to come home from work early today and
tried to take a nap, but my mind is busy and refuses to shut off -- ever. I decided to read, and was preoccupied by all
of my thoughts about what I should be doing instead: grading papers, writing
notes, responding to emails, washing dishes, reading the chapters I'll be
teaching in my class this week, ending rape culture and racial inequalities...the list is endless.
Instead, I laid on the couch with
the dog for a bit and made myself focus on being and breathing.
What
would it mean,
I asked myself, to just let myself have
this time?
I let myself follow this thought
further and further down the rabbit hole until I landed on the final question...the
one that is hiding behind the walls and resistance:
What
would it mean to allow myself to believe that I am worthy of time, and love,
and self-care?
Pffffft,
I
thought, I already believe that. Come on now...
But do I really?
What
would it mean...what would it REALLY mean to believe this...to embody it?
What would it mean for us -- any
of us -- to give our souls the time and love they are looking for? What would it mean for us to admit that we
need time to cry, and fall apart, and put ourselves together again? What would it mean to believe that we don't
have to earn this time? That we have
already arrived, are already worthy, are already enough?
What would it mean to accept the
fact that our energy is finite, that our body is a resource that can feel
depleted, that we need time and care and love in order to survive? What would it mean to remember, and
re-remember, and re-remember that survival is not always something we need to
do alone?
What would it mean to remember
that it's okay that this is hard? That
all we ever do in this life is practice, and practice, and practice, and
hopefully learn to give and receive love?
What would it mean to let
ourselves do just that -- to practice, and to give and receive love?
Are you ready? Can we practice, and give love -- and receive
it -- as already-worthy human beings together?
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