“How Should I Handle this Paradox?”

Question from a colleague in upstate New York —

 

I encountered an odd dilemma.  I have a private practice in New York, and it is close enough that sometimes, not always, I bike to the office, instead of drive.
Last week I had a light morning schedule, just one family at 0930. It is a family with a history of shame and blame, based in their intergenerational transmission of many struggles and disappointments.  Now the father brings his young adult son, and things are going well.  They are on their way to new-found resolution and stability.

 

On that particular morning I arrived at 0900 (checked the time) and parked my bicycle in back of the office building.  The waiting room was already open for other offices, so I opened my office, turned on the lights, read my mail, penned some thoughts for today’s session and waited.

 

Unlike some, this family usually arrives a few minutes early, so at 0925 I stepped into the waiting room to greet them when they arrived. But for whatever reason, they no-showed, and at 0945 I closed up my office and headed off on the next part of my morning.  (When clients no-show, I usually wait a few hours to contact them without the pressure of immediacy.)

 

A half hour later I received an email from the father asking me to call the son about today. He wrote that they had arrived on time at 0930, and the son had gone in and reported back that the office was locked and dark.  If an email can have a tone of voice, this one would have been accusatory.

 

I called the son and he said that they had not seen my car so they assumed I had not arrived.  He added that his father had looked in and reported that the office was locked and dark.  (In the interests of time, I did not point out the discrepancy in their stories.)  I apologized for any confusion and rebooked for next time.

 

When do you recommend I confront these folks about their discrepant stories?  When should I try to get to the bottom of the truth?

 

Thoughts from Vermont —

 

Thanks for a good question – New Yorkers have a knack for them!

 

You could certainly take the inquisitive or direct confrontational route – many therapists would.  My suspicion is that focusing on their obvious discrepancy is premature. Here’s are a few possible reasons….
(Assuming that there were no simple explanations such as daylight saving time, or broken digital clocks.)

 

1
You report that “they are on their way to new-found resolution and stability.”  With many families with long traditions of conflict, starting to change things for the better will trigger unconscious pushback – the system is trying to maintain equilibrium, as they say.  Trying to make that the next focus of therapy may be premature to repairing the relationships and co-regulating whatever affect comes up about their memories.  THEN you might be in a position to discuss actual events without defenses, if it still seems relevant. Relationship connection first.

 

2
In families such as you describe – steeped in blame and shame — any crisis will require finger-pointing and assigning some failure and/or negative motives to others, if only to avoid being on the hot seat oneself. The goal of each member becomes, ‘it wasn’t MY fault’.  Suggesting that you are the one who must be lying or mistaken helps expose the family’s dilemma like an x-ray.  No need to waste this vulnerable moment trying to rush everyone into cognitive realities.  They are ripe for empathy for their fears of vulnerability to each other.  Spend your opportunity wisely.

 

3
Having made what sounds like lovely progress on the surface, you may be being tested before being allowed in to a deeper level of worries and fears of this family.  To pass this test, you must show them a different way to handle the shame/blame cycle – and you have to do it under the spotlight of a crisis.  ‘How can you maintain you were there when we say you weren’t?’  Can we get you to argue with us about our clumsy different stories? (As we do all the time…) 
Or will you continue to deliver empathy for our accusatory defenses, continue to value our stuckness as an honor to work with, and avoid our surface invitation to divert your care for us into a search for ‘the facts’?

 

My guess is that ‘the facts’ – or anything else — can be discussed after re-affirming your deep empathy for this family and their need for safety and co-regulation of their big feelings.
Here are the priorities in order: 1) a sense of safety for the family,  2) help regulating their traditional big feelings,  3) then, lastly, if you get there, reflecting with empathy on the cognitive meanings of this situation, after no one is any longer fearful (as you are not) of being in the crosshairs of family blame.  After all, sometimes all things are true at once.

 

All the best from Vermont —

“May I Get a Copy of the Refrigerator List?”

This request arrives by email after every presentation when I run out of handouts.  The most desired handout is the Refrigerator List.

It is called the Refrigerator List ever since some of the first foster parents to receive a copy — while attending my talk in Indiana — told me later they stuck it up on their frig for quick reference.  It helped them in the heat of the moment when they struggled to maintain understanding and empathy for newly arrived foster children.

The Refrigerator List suggests that acting out behaviors are a coded language — the best the child can do to communicate given the insecurity of their inner thoughts and feelings.  Sometimes the child is simply testing the waters — as children need to do to find out for themselves where the rule are.  But an emotionally struggling child is often saying as best they can, “This is what I was given, and this is the safest way I learned to ask for help — to just dump it on you and hope you can figure me out…..please?  PLEASE?!  Nobody has gotten it yet, and I’m going crazy trying to regulate my awful thoughts and feelings.  Here, have some….show me how to manage them!”

And next thing you know you are feeling frustrated, resentful, even furious and despairing.  But it didn’t come from you.  You weren’t feeling those feelings before.  They came from the child as a desperate gift to you, in hopes of getting help they have been asking for since their development was left behind.

And the catch is — their horrible paradox — they have to reject, refuse and hide from whatever direct help you offer, until you have been tested to the bone for about three months longer than you can possibly stand it.  Hang on to your sense of humor, your supports, and your capacity to consult for outside help!!

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The Refrigerator List

Suggestions for decoding behaviors — possible explanations

by Robert Spottswood, M.A., LCMHC      Norwich, Vermont

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Violence, picking fights
— (Chronic fear of being deserted.  Feeling abandoned usually triggers rage in humans and primates.)  The surest way to prevent desertion is to keep you mad and angry at me for fighting.
— Please stop me!  I’m begging to feel contained and safe!
— I need closeness but I do not deserve it; hitting is the safest way to be close, while disguising both my need and shame.
— My endless fear, sadness and loneliness only gets a moment of relief when I put it into other people and then laugh at them for feeling it for me.  That temporarily numbs my own anguish — when I can laugh at seeing others feel my pain for me, outside of me.

 

Bizarre goofiness, endless pestering, whining
— I have to be in your thoughts all the time or I’m afraid I’ll disappear!  (I feel empty inside; don’t yet know who I am.)  Are you thinking of me now?  How about now?  Now?  Still?  What about now?….
— I didn’t have much for role models, so I provoke other people to react so I can observe them and try to learn.
— I’m so under-socialized, this is the best I can do. I’m so used to being called ‘weird’ it feels normal.
— Closeness, intimacy — terrifies me.  This behavior keeps people annoyed and at a safe distance.  Not hard at all.

 

Hiding’ behaviors
(sneaking, tricking, lying, stealing, hoarding, cheating, shoplifting,……….all very annoying!)
— I know I’ll be kicked out of this home, so I have to practice hiding and sneaking for when I must survive on my own.
— I don’t deserve to have my needs met.  You don’t realize that yet, but I realize it.  Nobody will give me anything I need after they realize how bad I am.  Sneaking will be my only way to survive.
— Depending on adults is like volunteering for a concentration camp; not possible, not on radar, can’t happen ever again!
— Since I am a shameful being, but you think I’m good, I’ll try to preserve our doomed relationship as long as possible.  I will sneak around and lie to protect you from the horrible reality of who I am; because you are so nice.
— Lying is my way of trying to tell you about my past; it’s what I had to learn in order to get along in my old life.  Can you talk to me about that, or are you just too freaked out by lying to help me integrate my past nightmare life?

 

Oppositional defiance
— I need to feel safe by maintaining control.  So whenever you suggest something, I immediately say NO, to create some safe space to think it over.  Then maybe I can say Yes.  This is me coping.  And it starts over every time.  Sorry.  Help!
— Saying ‘I’m not coming!’ and then screaming ‘Don’t leave me!!’ recreates an early conflict drama, over and over.  I’m trying to work it out, and need help, but can’t accept help.  (If that doesn’t make sense, welcome to my world.)  All my shame about this I must project onto you: you’re wrong, you’re mean, you’re stupid; I have to make my failure be about you.  (It hurts too much that it’s really about me.)

 

Letting adults down, disappointing them
— Positive adults make no sense to me.  All I can do is humor them until I run away or fight again, and watch their fragile dreams for me crumble over and over.  Are they stupid?
— The horrors I lived through (including neglect) are not even in the middle class vocabulary of conceivable experiences, so what do I do with these nice people?  Let them think their big thoughts and make their big plans for me, until I have to act out my real shame, letting them down over and over.  Sorry, nice people.
— Get over your disappointment and stop caring about me.  I did.

 

Avoiding
— You’re moving too fast.  First I need emotional safety. Second I need you to co-regulate my huge emotions.  Lastly I might talk about all your great ideas….. But make me feel safe first.
— Getting involved with closeness or even with conversation means getting vulnerable.  Can’t happen ever again, thanks to my past.
— I never learned normal conversation, so I feel stupid when you talk to me.  Just leave me alone so I don’t feel stupid.

 

Blowing up when told No; zero frustration tolerance; big rages when limits are set
— I’m stuck back in the Toddler’s Dilemma, back when kids normally come to accept that grown-ups who love us can also say No, and may set limits.  I never was helped to resolve that back then, and I’m still trying to intimidate and terrify people into always saying Yes.  I need help learning this lesson late, sorry.  Please help.  (But remember that I have to reject your help.  Good luck, and don’t give up!)
— Too much choice, freedom, and independence!  And too soon!  I can’t handle it, but I can’t refuse it either – just like if you let me drive the car.  I’m stuck!  Please step up to the plate, take charge, and don’t let me intimidate you out of it, because I’m really stuck.  Did I mention that I’m stuck?  Need more Momma!  Need more Papa!
— Though I can’t ask for help, I need help – it is scary to be aging with only infant skills to handle frustration.  So please be confident, be in charge, figure me out, and set loving yet firm limits I can struggle against without being shamed; early and often until I am done with that struggle and can move on. I don’t need screen time, electronics, or stuff.  I need parents and I need them to be in charge.  I’m just a kid trying to figure out complicated stuff.  (This is so frustrating….)

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The Attachment System — thoughts over coffee

John Bowlby, “the father of attachment theory,” was a British psychiatrist and psychoanalyst who studied many British orphans after WWII.  He lost a great deal of face in his professional circles when he observed — counter to popular assumption — that “attachment” is not primarily about love.  He had to conclude that attachment was an infant survival mechanism.  The field has gradually come around to see what he meant.

Bowlby observed that most infants are born with an inherent set of skills — crying, waving, cooing, smiling, etc. — which are designed to attract and hold the attention of a caring adult.  The adult will hopefully organize both of them to provide the infant with nurture — the baby’s only hope of survival.

More recently Dan Hughes and Jon Baylin proposed that the infant’s attachment system actually triggers a complementary “caretaking system” in adults.  That is, when an infant cries, waves, coos and smiles, we adults are hardwired to respond — perhaps waving back while saying, “Hey cute baby!  Are you talking to ME?”  In this and many other ways a feedback loop is established which keeps infant and adult connected at an emotional level, long before babies understand language.

That caretaking system supports most adults to be ‘good enough’ parents to most children without having to think it through logically.  The hope for every child is that they experience enough safety and enough help with their overwhelming feelings that they gain trust and confidence in their adult caretaker — their ‘attachment figure’.  With such a “secure attachment” the child’s anxiety about survival is low.  They will rarely fear catastrophic abandonment, even in stressful situations.

When kids have a secure attachment, the cognitive-behavioral approaches to behavior and therapy tend to work more easily.  Phelan’s 1-2-3 Magic, for instance, can engage a child at the level of cognitive intellect, because that child is NOT distracted by and preoccupied with deep, unresolved anxiety about some unmet early need for connection to a safe caretaker.  Less secure children may try to force relationship reassurance first.  This is probably why the question of whether or not ‘the teacher likes me’ is a major variable in elementary school performance.

Seven illustrations at the following site attempt to show how early parenting can convey a sense of security and safety to an infant, using preverbal cues such as closeness, responsive facial and voice expressions, a kind and soothing tone, and eye contact.  I hope they are helpful.  (And I do intend to learn to ‘insert links’ before another decade passes.)

http://ddpnetwork.org/blog/parent-child-relationships/intersubjectivity-without-words-robert-spottswood/#jp-carousel-2484