Maintaining empathy for an aggressive, controlling child client.

Increasing control is a common and logical response to rising anxiety.  Yet sometimes reducing anxiety by increasing control can get out of hand, hurting relationships through pain and confusion.  At a meta-social level, author Alan Johnson points out that men in a patriarchy find the fastest path to control is violence.  (“Don’t make me hurt you…”  “She threatened to take the kids, and I lost it….”)

Children can also project commands, threats, and other attempts to find safety through control.  My first experience with such a child occurred early in my job at a Canadian mental health clinic.

A lovely but angry nine-year-old girl was brought in by her legal guardian.  As usual, I asked the safe adult attachment figure – in this case the guardian — to stay in the room with us.  [The four major benefits to this will be listed in a future essay.]  And as usual, I accepted the child’s symptoms as clues to what she had been through.  I knew from her history that she had grown up between divorced parents.  She visited one parent who would avoid her strong feelings as much as possible (resembling the “dismissive” adult attachment style).  And she lived with the other parent who treated her sometimes warmly and sometimes coldly, depending on her own mood (similar to a “preoccupied” adult attachment style.)

Consequently, the girl’s rude demands and commands in session were accepted as invaluable clues to her own attempts to make sense of her confusing history.  The challenge for me was to respond with Acceptance, Curiosity and Empathy — versus either opposition or cooperation.  (Note: it is best to avoid Playfulness with an upset child.  It can sound a lot like sarcasm.)

With children like this girl, who bullies, my initial hypothesis (to be tested) is usually that she is trying to put her anger and frustration into others, where she can observe it outside herself – giving her a rare moment’s relief from experiencing those feelings within, 24/7.  Peter Fonagy in the U.K. explains in a brilliant essay that the bullying person can experience brief relief from their own internalized shame and terror by forcing those feelings onto another person, whom they can then attack, drive away or even kill in an attempt to be rid of the feeling forever.  (Note the routine daily news of murdered women in patriarchal societies.)

I did not have long to wait.

“Robert!  Sit over in that chair!”

I let my jaw drop and outwardly reflected my experience of HER inner sadness and scaredness which she was trying to relieve by commanding ME.  Matching her ‘vitality affect’ (Daniel Stern’s fine term), I used her commanding voice, but my words.

“You want me to change chairs!  And if I do, you hope that you feel better!  And I so want you to feel better!”

At first she registered only my failure to obey.  “Go!!  Sit there!!”

I continued to keep my voice loud, like hers, but my words empathic, like mine.  “And if I don’t sit there, you’ll get more upset!!  Oh dear!!  I feel terrible!”  I appeared visibly and audibly distressed — loud and vulnerable and without mocking sarcasm.  I was reflecting from a stuck place, a spot she had experienced so many times in her short life.

“GO!!  SIT THERE!!”  The only response to non-compliance this girl had ever learned was her parent’s escalation.

Without mocking (practice this), I continued to mirror her affect (her outer expression of her inner feeling) and reflect on how it was affecting me as I cared about her.  This ability to reflect is something she should have learned early in life, instead of being made to feel ashamed of her own feelings.

Me:  “Now I am stuck!!  I want you to be happy, because I like you, but if I don’t do what you want, I’m scared that I’ll disappoint you and then you won’t like ME!!!”

Being one-third my size, she did not try to push me, but she did try the other parent’s response: abandonment.  Looking away she announced, “I’m ignoring you.”

I then shared my sadness at feeling ignored by her, whom I liked, and said in a hopeful, lonely voice that I hoped she would talk to me again soon!  (This modeled for her how to articulate a complex relationship with feeling.  I suspect she had never heard this before.)

She suddenly became vulnerable herself.  “You’re scaring me, Robert!…..You know how come I’m afraid of you?”

Me:  “How come you’re afraid of me?!”  (Repeating her phrase tells her both that I’m listening, and avoids distracting from the huge window she is about to open onto her own thoughts and feelings.)

“Because,” she nearly spit in self-protective anger, “I WAS TREATED LIKE A LITTLE STUPID IDIOT MY WHOLE ENTIRE LIFE!!!”

I quickly reflected my feelings, while matching her vitality affect.  “I AM SO SORRY TO HEAR THAT!!!”  And I continued to share my own affective response to the thought of a child being treated like a ‘little stupid idiot’ her whole entire life.  Almost wailing I said, “Oh!  I am sad to think of you being treated that way!!”

Then, I introduced my curiosity: “What did you do?!  How did you cope?”  (Note:  It sometimes requires a cool hand at the tiller to steer away from knee-jerk reassurances such as, “You’re NOT an idiot! How could anybody treat you like that!!?”  But reassurance shuts down feelings, while I wanted to articulate her need for a way out – What shall I do?  How shall I cope!?)

Now she deepened into her memory but still could not differentiate her inner life (remembering the past) from her outer life (being here now).  She could not yet reflect from the safe emotional present, as most adults do.  She was still emotionally in the past, stuck in the memories and trying to manage her old feelings by making others change (“instrumental” use of affect) instead of describing her feelings to deepen connection (“signal” use of affect).

Suddenly she glowered fiercely at me.  “If you ever hit anybody in my family – I’ll shove that notepad down your throat!!”

That was low-hanging emotional fruit, for which I was extremely grateful.  It is important to not waste it with the following abstractions:  (‘How do you think that makes ME feel!?’) would demand of her a complex ability to feel empathy for others.  (‘I can teach you to relax and let go of those old hurts.’) would go prematurely to cognitive solutions while she is stuck in a state of highly dysregulated emotion; I would be abandoning her in freefall with her scary feelings.  Such a response would be congruent with van der Kolk’s theme of The Body Keeps the Score, emphasizing meditation and other pulse-slowing approaches to stored childhood trauma.  Yet this path would be premature to where she was in this moment.  I still had to establish safety, and co-regulation of her affect.

Accepting the low-hanging emotional fruit (“…I’ll shove that notepad down your throat”) I match her harsh vitality affect again: “(gasp!)  Somebody shoved something down your throat!!”

Immediately she is able to reflect on the past, protected by the empathy I am giving her in the present.

“Instead of spanking me every time I was naughty I had to bite into the bar of soap and chew it and swallow it!  And I didn’t get any water!”

She is tearing up.  And as I imagine being her being made to eat soap, my own eyes fill, I bite my lip, and my mouth turns deeply down in empathy.

She looks at the ceiling.  “And if you cry, Robert, I’ll burst out into tears!!!”

For the rest of our session we had trust.  I had helped her feel understood beneath all her fierce threats, by responding only to the feelings under the behavior, and responding preverbally (voice, facial expression, mirroring affect) instead of with cognitive insight.

Co-regulated at last, this aggressive child was finally free to reflect on her life from a safe, outside perspective, something parents usually, unconsciously, provide to children from birth onward.