Help

Well, it’s been quite a week.

As T unravels these past few months, we’ve experienced dramatic truancy, daily marijuana use (before and after school most days), and stealing, culminating with an arrest, for petty theft, on his birthday no less.

This week, we hit the wall. He was accused for the second time of stealing (from a teacher!), disrupting the classroom, and expelled from school. At home he was vengeful and full of rage, or withdrawn and disconnected. It’s hard to encapsulate in words, but the most alarming thing is that T is not a kid who is routinely delinquent – his nature is to be sensitive and soulful. His misbehavior has an aspect that hits you right in the gut – it feels wrong on an instinctive, animal level. Something is wrong! it screams. I suppose that’s a distinguishing quality of crisis.

Yesterday, in a tizzy, and with the help of a friend who happens to be an LCSW, I wrote a letter and emailed it to his past and present therapists and social workers. “I need help getting an elevated level of care for T” I said. It ended “We are committed to T but we urgently need help meeting his needs.”

By evening, we had an emergency psychiatric team on our doorstep. (Thanks, by the way, to his FORMER social worker, who was the only one who responded in a helpful way—we have yet to even hear back from his primary caseworker.)

I thought the problem was addiction and substance abuse. But last night I learned that I might be wrong.

They spent four hours here, talking to T, talking to us, searching his room, and formulating an opinion. Then they called us all together. It wasn’t what I expected. They said they considered hospitalizing him, because it’s clear he’s in crisis, but decided it wouldn’t help. He has PTSD and a hospital environment is likely to be overwhelming and frightening for him. They said that we are dealing with serious confusion stemming from sexual abuse, combined with puberty, and that kids like T often have their first major mental health crisis right about now. They said that his emerging sexuality combined with his abuse history lead T to fear he may hurt people and become a bad person. And so he is acting like a monster to try to save people from the harm he imagines he might do—and to try to get us to pay attention to what he can’t put in words.

I did not see that coming, though of course, as soon as they said it, it made perfect sense. They walked in and put their finger right on the raw nerve that is causing daily convulsions right now. Their skill and clarity were truly awe-inspiring. He has never discussed sexual abuse with a therapist before, and I'm the first adult he confided in about it. And yet it took these two doctors less than half an hour to identify the problem and open it up.

They had spare, direct advice for us. First, they said he feels safe with us and our home is the right place for him. He feels loved and secure here, they said, and that is part of why he is confronting his demons now. Second, they told me to adjust my expectations. “But he’s facing criminal charges!” I protested. They said yes, and there’s very little you can do about that. This is who he is and where you are right now. Deal with it.

They told us to let go of our desire to have him graduate from mainstream school. They said not to worry about the fact that his friends are dropouts and delinquents. “Those are the people he feels safe with, because he feels like he can’t hurt them or freak them out,” they said. They told us to let go of our attempts to treat the substance abuse, because it’s a symptom, not a cause. They told us to learn with him about the aftermath of sexual abuse and let him show his ugly bits. They said we must find ways to talk about what happened, and about sexuality, and help him do the same. They told us that “the human condition is to have both good and ugly feelings and thoughts” and to teach T that we are all complex in that way.

I learned so much last night. I learned that he wants help and he will comply. I learned that he trusts us. I learned that my expectations and sense of “normal” are getting in the way of recognizing his needs. We talked this morning, and he was calm, receptive and even grateful—I explained that the doctor talked to us about PTSD, that abused kids and soldiers who’ve been in wars often have PTSD, and that for now we need to make sure we reduce stress and avoid situations that are chaotic and noisy. He felt understood. He said he felt it might be best for him to be in a different school.

(As a side note, I have also learned this week that there is a HUGE difference in Los Angeles between Department of Mental Health programs and DCFS. That sounds like a bureaucratic distinction, but when you need somebody to help your troubled kid on a very bad day when the shit is raining down on your head, it’s a visceral thing. By using the right language, thanks to my friend, we got tapped into DMH, and to these two superhero ninja therapists in the middle of the night, after months of struggling with inadequate therapy and inattentive social workers.)

I don’t regret one moment I’ve spent with T. This week was horrible. I don’t know how we’ll find him a new school and a new therapist next week. I’m not sure I can stomach the external consequences that are being levied on him by people who know nothing of his story. But I understand that this is where we are, and I know that our job is to be his family. We are honest and we stand by each other in ways that I didn’t know were possible before. I am much stronger than I thought, and he is much more vulnerable than he realized. This kind of extreme parenting is exhausting, but I also find it to be soul-satisfying in its honesty, unpredictability and brutal acknowledgement of humanity in all its frailty and resilience. I find that happiness, for us, is not the avoidance of pain, but the acknowledgement of truth.

I love you I do this I'm sorry

I returned this week to Parenting the Hurt Child, an incredibly insightful book by Gregory Keck that I think every person should read regardless of who or whether they're parenting. His honesty and tolerance for complexity relax me.

Lately, it is more or less impossible to get T to go to all his classes, or to go to all of them without first stopping off to smoke marijuana. We do substance abuse counseling. We've tried escorting him to school. We talk to the administrators. We restrict privileges. We offer incentives. Nothing works.

Last night, we decided to take a night off. We made dinner, left it on the table (he was awol at dinnertime) with a note explaining our whereabouts, and went out. When we came home, he was asleep on the sofa in front of the front door. I tucked him in with our own quilt and went to bed.

This morning I heard footsteps. I opened my eyes and it was T. "Shhhh!" he said sternly. He bent over and kissed me on the forehead, patted the top of my head, and tiptoed out.

Sometimes his adorable gestures mean "Aren't I charming? Give me what I want!" (money, a ride, some slack). But in my half-awake state, it came to me immediately that this particular kiss on the forehead meant "I love you. I do this. I'm sorry."

That could be a tragic apology from a certain point of view, meaning something like: "I have a compulsive drug habit and no impulse control and I feel badly about it." Certainly we're up against one of those moments when you're just not sure the child is yet capable of changing old habits and destructive modes of thought. But from another point of view, he has made progress.

His responses to caring adults used to tend more toward silent statements like "I don't know you, who cares what you think?" From that point of view, "I love you, I do this, I'm sorry" is profound. In fact, it occurred to me that in this recent period of escalated misbehavior and delinquency, I've now received three gentle kisses--the first he's ever delivered.

He used to try occasionally to kiss me on the cheek - not at my request, but of his own volition (he arrived extremely physically reserved and we have always let him determine whether and how we share physical contact). When he began trying to show affection, he'd get close to my face and then he'd purse his lips and squint his eyes and say "Ew! Can't do it!" (I did find this totally hilarious.) But two weeks ago, I got a sudden peck on the cheek one day, out of the blue. About a week later, on a day when we were relaxed and had spent some time together, I got a tiny kiss on the tip of my nose. And this morning, a farewell peck on the cheek.

This is in marked and dramatic contrast to some of the other "feedback" we get from him, just in case it sounds like it's all sweetness and light at our house. Indeed, two nights ago, I asked him to work with me on his homework to get caught up in a class he's been cutting. He flatly refused to even try. I said, "what are you doing instead?" and he said, "I'm doing me. What the fuck does that have to do with you?" Obscene, yes.

I said as calmly as I could, "Wow I'm very sorry to hear that you feel that way," took his iPod, and closed the door. The next day I left a simple note on his door. It said, "The legal consequences for truancy are..(x,y,z). After 3 unexcused absences the court may place you on juvenile probation. You have more than 20 unexcused absences. This is your problem and you'll have to deal with it. We will withhold all privileges until you do. Love, Your Parents."

God bless Keck and others like him. Before bed, I re-read the sub-chapter "Children for Whom Nothing Works." I expected to see a description of our situation. T has none of the behaviors on that list, which begins with "injuring, mutating or killing animals on multiple occasions" (page 156, for anyone eager to check it themselves!). I rejoiced. We're not even there. T rocks our pet kitten in his arms and sings lullabies to her. Phew. His range of available behaviors is extremely broad, extending from frank delinquency to tender loving compassion for all the world's small creatures. That's the wonder and the challenge of him, the risk and the opportunity as he moves toward adulthood.

Apart

I do a lot of reading on parenting kids with Oppositional Defiant Disorder and ADHD. Over his many years in foster care, T has received several different diagnoses, all of which basically come down to the same profile of a kid who is severely stressed and unable to calm himself. I am not sure I really place value on diagnoses; something about the medicalization and medication of traumatized kids makes me very uncomfortable. However, the writing on parenting kids with profiles like ODD is often very thoughtful and helps me devise new strategies.

Today I read a nugget of wisdom I've been searching for all along:

"In some teenagers, ODD may represent a remnant of separation anxiety disorder, in which oppositional defiance reflects a reaction to feelings of ambivalence and anxiety that arise from the developmental move toward inde­pendence."

It was like an equation suddenly adding up; that is exactly what my gut tells me is going on with T much of the time. Many things make sense from that point of view: his anxiety and frequent refusal to attend school, his difficulty falling asleep by himself, his inability to regulate his feelings when he is outside of our presence, his annoying, anxious behavior toward his friends, his tendency to sabotage opportunities that would take him away from home.

In some ways, I think settling into a permanent home at the ripe old age of fifteen has actually exacerbated his separation anxiety and thus his misbehavior at school. I wouldn't be surprised at all if, unconsciously, he is kind of bummed about impending adulthood and would prefer to hit the pause button so he can fulfill some unmet needs first.

Separation anxiety can't even begin to account for an early childhood like his, with social workers coming in the middle of the night to remove you from your family suddenly and without warning, separating you from your siblings, and moving you from caregiver to caregiver (16 homes in 15 years). If separation anxiety includes worrying about losing someone/something/someplace to which you are attached, he is worrying over that every day, all the time. I suspect that when he leaves home for school each day, some deep instinctive part of him does not trust that home will still be there when he returns. He is defiant at school because he is extremely agitated.

Kids like T receive so many messages of failure. He is disruptive and challenging in the classroom, forgetful and unfocused on academics. From the F on an assignment he neglected to complete to "cleanup in lieu of suspension" for repeatedly getting up out of his seat during history class, his typical school week is full of negative feedback. That feedback feeds into an already negative self-perception that comes from being severely abused as a young child. And so the cycle continues, and on top of his agitation at being away from home, he experiences anxiety about his ability to control his own impulses and the impending shame and guilt that follow on misbehavior--all of which only serves to produce more misbehavior.

To counterbalance those messages of failure, at home it works well to offer him choices and suggestions for resolving conflicts and then reward him when he tries out a new strategy even if it's an awkward attempt. By trial and error, we've identified a few other techniques that seem to help:

- Asking for eye contact, as in "show me some eyeballs please." Even a split second's glance seems to interrupt the circuits in his head, especially if we can meet him with a gentle face.

- Staying physically close to him. When he is in a tantrum, the thing that guarantees that he'll completely come unglued is me walking away from him.

- Having talks in our bed. When he had his wisdom teeth out, we let him recuperate in "the big bed" during the day. It was eye opening. If we need to really hash something out, we all lounge around on our bed while we talk. Particularly if the message is difficult (the consequences of cutting class, for example), the physical proximity is soothing and he listens better.

- Shutting off television and video games an hour before bed. Invariably he spends this hour hanging over us and chatting about his day and tickling us and pulling our hair and making plans and generally reconnecting before sleep.

- Text messaging when we're apart. One of our basic house rules is "keep in touch" and he excels at this one, sending texts like little sonar messages to make sure we're still out there paying attention.

- Talking about the future. He love stories about what we'll do when we're old, or how we'll visit him when he lives on his own.

- Using requests like "let's see if we can get back to working together" or "take a minute to think about what I've said and then let's come together with a compromise" that suggest neither "let's do this my way" or "I give up, you win".

- Vacations in small spaces where we all have to pile in together - a long car trip, camping in a tent, heaping together in a hotel room. The more cramped the quarters, the more relaxed is T!

In our parenting classes, they often said "Parent the need, not the behavior." Opposition and defiance seem to me to be mostly behaviors; it's somewhat counter-intuitive to think the driving need is connection and reassurance, but the more we stumble upon what works, the more obvious that link becomes.

T Two

Recently we have been working on a theory that there are two T's. The first we call "T Number One." He is generally balanced, perhaps a bit mischievous, mostly compliant, and approaches life with reasonable moderation. He accurately perceives the world, and has the capacity for judgment. He is generally optimistic, or at least practical.

The second, "T Number Two", is self-destructive, angry, defiant, and extreme. He damages friendships and other relationships, and makes dangerous decisions. He has distorted, negative perceptions of the world.

This week, unfortunately, we started strong with T Number One, and then by Wednesday, we were living with T Number Two. That pattern isn't unusual - his number one trigger is school, and he rarely holds it together for an entire school week. I think often of the wisdom of something Foster Cline says: assume that the child is doing the best he can. T tries hard every week. It is agony for him to be unable to modify his self-destructive behavior. And this is the best he can do right now. We try to stretch the capacity of T Number One to hold it together, and right now we can't get past Wednesdays. If we get to Thursdays or - one can only hope! - Fridays by the end of his junior year, it will be a monumental achievement.

I don't mean that T literally has a split personality. In the professional writing on such subjects, I guess you'd say that T number one is "regulated" and T Number Two is "dysregulated." His periods of dysregulation come on like bad weather - you can see them approach, they are intense and disruptive, and they pass.

I love him so much and feel so much wonder at the progress he's made and the meaning he's brought to my life that I probably do not always state clearly how difficult it is to be his parent. I'd hate for any parent of a traumatized kid out there to feel like I'm having an easy time of it while they struggle. I am as vulnerable as anyone else and I feel beat up and victimized by his behavior sometimes. He is intensely angry for many very sound reasons, and that anger has festered in him for many years until he doesn't even know it's name and when it takes hold of him, he is formidably difficult and frankly abusive. I am a strong personality myself, an "alpha" as I have said before. And yet when he takes revenge because we've withheld his allowance because he's using it to buy drugs, or when he rages at me that he is going to tell the social worker on me because I have restricted his privileges after he was picked up by a truancy officer, I feel despondent and exhausted.

At those times, I do sometimes withdraw from him. I cannot always maintain the authoritative parental stance of being strong, wise and compassionate. I get rigid and angry. I want him to just go to school, to hold it together just for five days on end without getting high, cutting class, interrupting my workday with calls from the dean's office. I lose my ability to communicate compassionately.

When that happens, I wait. T Number Two is not reachable, but he also doesn't stick around for long. He is a construct, a puffed up angry false self, perhaps produced by extreme duress to protect a tender T Number One when he was younger and constantly under siege. Indeed, when the storm moves on, T is often unusually tender and communicative afterward. He is apologetic, but he's also very receptive. He reaches out with many little tendrils of attachment to make sure you are still there, and upon finding that you are, grows very soft.

I worry over how little time we have to try to help him learn to regulate his feelings and modify his behavior so that he can hold it together in the grown up world. He is okay when he is with us - weekends and holidays are invariably peaceful. But a child who cannot make it more than three days at school without a meltdown is likely to have similar difficulty holding a job, or getting through college. Someday soon, he will be out of high school, out of the foster care system, and (eventually) out of our home. He will have to make his way in a world that takes him at face value, doesn't know or much care about his history, and delivers harsh and sometimes long-lasting consequences. Preparing him for that world is a daunting challenge.