Wednesday, August 31, 2011


Last weekend, we had two back-to-back visits with T at the treatment house; a six-hour outing on Saturday, and our usual Sunday night family-dinner-plus-family-therapy.

He said something to me in the course of our time together that sticks with me. He mentioned that he was having some conflict with one of the other kids in the program and had gotten into some trouble for it. I started to ask for details and suggest corrections (read: nag). He stopped me and said,

"Listen, these things are about my behavior. I know I need to work on my anger. But it's going to take awhile. I can't do it all at once. But I've made a big change inside, you know? I feel different now that I'm not using drugs anymore. The rest will come."

I know what he meant. I said, "You seem happy," and he said, "I am."

Sunday, August 21, 2011

Teenagers are Children Too

Last week, during our family visit at the treatment house, I was being a nag. T lost his patience, stormed away from the table where we were having dinner and refused to come back for group family therapy (which we do every Sunday). We shrugged our shoulders and, after he made it clear he would not return, left.

During the course of the week, we got a reasonable apology letter explaining that "I get a lot of feedback here every day and sometimes I just don't want to hear anymore. I'm working on myself, and I'm making change, but more pressure from you doesn't help." He added "What I did was wrong," and also "You are the best parents I could have!" He excels at stream-of-consciousness.

We returned to family group this week, and T made me an origami paper heart while we were talking. He also made a lengthy speech for all present about how he is there voluntarily, and about how he came there because he wanted to stop hurting us. He went on to explain that he used to think that it was his choice if he wanted to do things that caused him harm, but eventually saw that hurting himself was hurting us, and realized he didn't want to cause pain to those who love him.

He also went on to share an epiphany that I found most striking. It went something like this:

I like to help other people, but I could never help myself. I wanted to focus on others, because to focus on helping myself would mean thinking about my history. I didn't want to look at my history. I've been through pretty much everything you can go through. I am starting to realize that I can help myself by looking at what I've been through, and that helps me listen better to other people too.

I am often astonished when the kids join us for the join parent/teen session at how much they illuminate the room with their insight and tenderness. Most are on parole, and all are "at risk", or however you want to put it. Many are not there voluntarily. And yet they are all working so hard to communicate with their moms and dads, and they are full of self-reflection and uncertainty and perception. It makes me think that perhaps teen addiction and teen treatment is quite unique; their motivation to repair a rift with a parent, and their awareness about needing parenting in the first place is surprising and moving. Their flexibility is also striking - they try out new ideas, and absorb optimism when it is offered to them. They are all still children, in many ways, some perhaps all the more because they have missed out on certain healthy experiences of adolescent independence by falling into substance abuse and dependency.

Tonight, we mixed it up and parents spent some time talking with a kid other than their own. The boy I was paired with told me how much he wants his dad to take him to the movies. He said that his dad works so hard that he only has time to talk to him when he does something wrong. He wasn't accusatory - he offered this in a shy, gentle way. What struck me was how earnestly he longed for his dad to just ask him to the movies.

I think sometimes as parents of a teenager, it's easy to assume that they'd rather die than spend time with you in public. But that's not true, according to these kids. They seem to just want a break from official parenting, long enough to see that you really really like them. As one of them said tonight, "When we were using, we stayed out all night and all we thought about was what we wanted. Now we're all in here, all we want to do is get that next visit with our parents. All week, I just think about when I'm going to see my mom."

Wednesday, August 10, 2011

My Kid is not a Hot Potato

I'm bugged. Tonight we went for "family therapy" at the treatment house, only to be diverted into a group meeting with his treatment team, and faced with the possibility that he'll be expelled from the program.

It felt like an ambush,because this is a treatment house for drug addicted teenagers with "dual diagnosis"--in other words, co-occurring mental health issues. And yet, the subject of the meeting was T's behavior--he got into several "verbal altercations" and "punched a wall." We reminded them that he has a history of severe trauma, and a PTSD diagnosis, and that it wasn't too surprising that getting sober is producing some misbehavior. Forgive me for siding with my kid, but he's 60 days sober after several years of alleviating his traumatic memories with drugs, so if he loses his cool and punches a wall and calls someone a name, that is not a five alarm fire in my book.

Moreover, I get very tired of being preached at by "specialists" who don't take the time to learn his history, offer him some superficial palliative care, and then get angry with T when he doesn't change as fast as they'd like, and want me to side with them and tell him to get his act together. Their blame and anger were palpable. I spent the first fifteen minutes of the meeting counseling them and helping them calm down and recover their compassion for T. That annoys me. I understand exactly how challenging he can be. But if you think about his history, it is not that hard to stay objective and rational about why he is having difficulty, and get creative about treating him, without blame.

I am particularly un-cool with "specialists" who threaten him, by telling him that he'll be kicked out of their program, and may have to "go somewhere much worse." I probably don't have to tell the type of person inclined to read this blog why that is a bad idea for a kid with a long history of abandonment and multiple foster placements. Suffice it to say that ultimatums and threats generally don't work for anyone.

My kid is not a hot potato. He is not an interesting project to inform your graduate school paper until you begin to find his behavior challenging or unsettling and give him back to the system. He does not deserve to hear that the residential treatment program he chose for himself has now decided that he's too much to handle because he has trouble getting along with the other kids. We cannot continue to kick him on down the road and suggest that he find yet another program or specialist because his unique needs are just too much for his current provider.

If it were within T's capability to behave in a more civilized, conciliatory way right now, he absolutely would. Calling on one of my fave authors, Gregory Keck, I told them that I firmly believe that T is doing the very best that he can. At first they looked at me like I'm a fool. I repeated it. Then they looked at me like I am outrageous. They expected that we would be frightened and cowed by what they had to share, and they wanted to pass him back to us. We said no. We said, he's here voluntarily, to get help, and we want to work with you to get him that help. His behavior may not be good enough to meet your requirements, and in that case, let's make a transition plan to meet his needs. But let's not continue to talk at him and expect him to gain control of his behavior through mere pressure alone.

I also channeled one of my blogger pals, the Accidental Advocate, and, with her advice in mind, I proceeded to walk them through T's history and the THOUSAND AND ONE good reasons why a sober T might be facing some demons--and the thousand and one reasons why they are obligated to treat him. Thanks to T, I have finally grown into an adult who does not care if the other adults in the room think I'm a bitch--to assertive, too invested, too righteous. I am there to do a job, I am super-powered by love and attunement to his needs, and I will use every strategy I can think of to meet those needs.

By the time T came into the room, the lot of us were able to put on a united front. We let him know that he is frightening the other kids. We talked about the fact that it can be hard or impossible to gain control of your behavior if you are putting a lot of energy into avoiding difficult memories of your past. We told him that now is his chance to do the hard work to uncover some of the unconscious feelings that drive his behavior.

It pains me greatly to confront him in this way, particularly when I am surrounded and forced to ally myself with adults in whom I do not have complete confidence. Of course, he withdrew over the course of this conversation, and it went on much too long. The adults couldn't seem to stop talking at him. But he did listen and he agreed. He did not object to the suggestion that his current behavior is linked to a long-suppressed rage. His defiance melted away. He refused to speak to me afterwards, and asked to go to his room to be alone for awhile. Although it's painful to see him withdraw in this way, it also signals that we've hit upon the truth. I believe that it's appropriate that he should want to recover after such a conversation. Frankly, I think it's a little bit insane for a whole posse of adult specialists whom he has no reason to trust to think that a 17 year-old boy is going to hang out and talk about his feelings for hours on end.

Nevertheless, there are good people (one in particular) on his treatment team, and he has the possibility to get a kind of coaching there than we cannot provide at home. I told him I love him, I'm proud of him, I'll always be his parent. I hope by Saturday, he forgives me, because we have permission for his first outting, and I want to take him to the mall.

Thank you, fellow trauma moms, for understanding. Sometimes you have to do what you have to do, and if that makes you a bitch, then you're a bitchin' advocate mom doing her imperfect best in an imperfect world.

Thursday, August 4, 2011

ADD and Attunement

After one of the readers of this blog recommended Gabor Mate’s In the Realm of Hungry Ghosts, which had a huge influence on me, I picked up his other book, Scattered. It describes the dynamics of early infant development and Attention Deficit Disorder. As I noted before, I resisted an ADD diagnosis for T for a long time, because it seemed to be the diagnosis du jour and I have a prejudice against medicating kids. While I still hold the belief that psychiatric medication should only be part of a treatment plan, I see now that I was wrong about ADD. Properly explained, it strikes me as a useful lens for helping kids like T and their adoptive parents get creative about addressing and sometimes repairing gaps in their emotional growth.

Besides the science, Mate is a lovely writer. I enjoy passages like this one, about early infancy:

Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and emotional self-regulation. It is a finely calibrated process requiring that the parent remain herself in a relatively nonstressed, non-anxious, nondepressed state of mind. Its clearest expression is the rapturous mutual gaze infant and mother direct at each other, locked in a private and special emotional realm, from which, at the moment, the rest of the world is as completely excluded as from the womb.

Mate draws a connection between the disruption of the mother/infant bond and Attention Deficit Disorder, which he says might just as well be called Attunement Deficit Disorder. In other words, if the dynamic of attunement goes awry, the prefrontal cortex may not develop normally, resulting in later problems with impulse control and emotional regulation.

When we were taking our foster/adoptive parent training courses, I remember that the teacher said that we must become “attachment experts.” She meant that we needed to find ways to help them create the tight bond with us that is at the root of the parent/child relationship. I hadn’t thought about attunement, and learned only by trial and error the practice of trying to remain calm and receptive in my mind so that T is able to sense that I am available to him. It also took me some time to learn that such bonding is mostly nonverbal, heavily dependent on eye contact and physical proximity. I watched Tim and T play checkers last weekend, and it was obvious that it had a more direct affect on T than any conversation could have.

Mate also writes about the fact that the dance of attunement and attachment is up to the infant, not the parent. The infant engages and, when he becomes overstimulated, withdraws. The parent is the one who needs to match the baby’s rhythm so that he learns that she is able to perceive and respond to his state of mind, and, thus, that he is understood. I found that useful, and true of T in my experience. In the beginning, we learned quickly that we needed to be available, but not assertive, and let him come to us and go away again according to his own needs and tolerance for intimacy.

It has proven to be absolutely true that it’s only when we are nonstressed, relaxed and open-minded that T is able to calm himself. In fact, living with a kid like him can be revelatory, because he senses any stress or unhappiness that we might be trying to bury sometimes before we are even aware of it. He is like the canary in the emotional coal mine. If he tells me I need to calm down, or that I’m getting angry, he’s always right, intuiting a change in my rhythm that I haven’t even noticed yet.

When one of us is displeased with his behavior and shows it, he often becomes very agitated. Last Sunday, during our family visit at the residential treatment house, he and I had a small disagreement and I made an expression of displeasure, which sent him into a tailspin and he spent the next half hour anxiously checking my face and trying to re-regulate. That kind of separation anxiety might seem tragic, but mostly it just strikes me as a sign of where he's at in his emotional development. His anxiety strikes me as a lasting indication of what he learned about life’s harsher realities, and a sign of the vitality of his surviving instinct to connect.

It’s tiring sometimes to interact with such intensity, in somewhat the same way that the constant needs of a young child can be exhausting. It can also lead to somewhat awkward situations in public; some people are taken aback by such a tall child interacting with his obviously non-biological mother with infant intensity. We don't really care though. We are busy bonding and filling that deficit of attunement.

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