How Can Your Client Not Get “Attached”?

I’m 28-years old and single, but when I’m at work, I often feel like a mother of a 4th grader. My client Tanya is a ward of the state but she lives with her mom and grandmother. Her father is absent and mom spends time in and out of prison. From the stories Tanya tells me, it doesn’t sound like responsible adults are consistently around. With as many times as Tanya has threatened to run away from school, she never has. She doesn’t have anywhere she wants to run to.

I spend approximately 6 hours a day in school with Tanya. We work primarily in a one-to-on ratio. I’m trained to maintain a professional, therapeutic relationship with Tanya. I’m not supposed to let her get attached to me; she needs to learn to generalize her communication and social skills to other people. However, Tanya doesn’t appear to trust anyone. She even accuses my iPhone timer of cheating the clock. But Tanya has to learn to trust teachers, administrators and the educational system before she can acclimate to a mainstream classroom.

My job is to teach Tanya how to follow the expectations in a traditional classroom. In order to even attempt that, I have to demonstrate to Tanya that it’s worth it to try. She has been so traumatized that her default response to everyone and everything is variations of aggressive defiance. I needed to build a relationship before I could tackle any academic tasks. After 3 months of working with Tanya, she will barely tolerate a 1-minute conversation, and that’s an improvement.

While my clinician, my supervisors and my training continue to preach the adage “don’t let clients get too attached,” I ask, with what does it even mean to get attached? Do we really want to teach kids that they should feel a personal connection to their professional but not too much because they are just going to leave you? Important, influential and memorable people come in and out of everyone’s lives. It’s natural and normal. Why not teach that life lesson instead of ignoring the inevitable?

For a kid that feels abandoned, its crucial to teach them about these transitions as no professional will be in their life forever. Teaching Tanya how to transition between different types of relationships is in her best interest. No matter what happens, eventually she and I will part ways. When that happens, I want Tanya to understand that while it was my job to support her academically, I care about her as a human being who was a part of my life. I want her to know it’s not bad a thing we won’t be working together anymore. I am not leaving because of a bad reason.

Clients like Tanya need these experiences framed as a normal part of life rather than another act of betrayal they can add to the memory bank. As professionals, we do our clients and ourselves a disservice when we ignore the likely outcome of children forming strong personal attachments beyond the therapeutic relationship.   We are missing a teachable moment.

 

 

Got Hugs?

Section 28 clients have developmental delays and Section 65 clients have a behavioral diagnosis. But professionals working in Section 28 can hug their clients. I can’t because I work in Section 65.  When my 9-year-old client gives me a hug goodbye at the end of the day, I have to teach Charlotte to give me a fist bump, high five, or side hug instead. When she asks why she can’t hug me, I struggle to answer.  I follow company policy, but I don’t understand or agree with it.  It’s uncomfortable to withhold appropriate affection towards a child.

“But behavior kids are dangerous!”   If you, or someone you know works with children with developmental delays, you might be chuckling. Kids with developmental delays can be just as unsafe and unpredictable as kids with behavioral concerns! The actual risk depends on the individual, not whether they are in Section 28 or 65. The perceived risk of working with behavioral challenges is deceptive.

Working in Section 28, there was a decent chance my client Michael, who was nonverbal and did not use sign language, would try to bite me on a daily basis. I am trained to avoid physical harm, but Michael’s aggression was often quicker than my training. His wants and needs were extremely difficult to understand. Charlotte is my current client in Section 65. She is physically aggressive, but her aggression is more manageable. If Charlotte threatens to stab me with a fork, I remove my body from harm’s way and call for backup. Charlotte never exhibits dangerous behavior without a physical or verbal warning. If you give her space, she leaves you alone.

Charlotte has never made a true attempt to follow through on her threats. Michael, however, sank his teeth into me on more than one occasion. The actual risk of injury is significantly less working with Charlotte than Michael because her physical aggression is predictable and avoidable.  Now, consider the risk management involved from a client’s perspective.

Michael can’t tell someone to stop touching him if it makes him uncomfortable. But healthcare professionals may hug him without specific guidelines. Conversely, Charlotte is fully capable of telling people to leave her alone. Yet Charlotte is the client I have specific directions regarding physical contact. It makes no sense that the client who cannot speak for himself can have his personal space violated more easily.

But hugging isn’t the focal point. The question is, what kind of physical contact is most beneficial to the client? Physical interventions should not blanketed statements applied to each department.  Instead, we should look at the role of physical contact in the client’s life.  We should assess what kind of boundaries would best support the child, and then decide what kind of physical contact is appropriate.

Michael lives in a loving home; positive attention and human interaction are a common occurrence. Charlotte’s life is full of trauma. She needs healthy affection far more than Michael, but she is the client I have to push away or redirect to a side hug.   The bottom line: we should avoid a one-size-fits-all mentality and do our best to meet the individual needs of clients.

A High Five Amidst A Crisis

It’s 11:00 am. Tanya, my client, has alternated between running and hiding for over an hour. I’ve tried every strategy or behavior trick I can think of.  Surrounding teachers and students stare. I can’t tell if they think I’m a saint for my patience or a lunatic for not calling the principal. I wonder how much longer this behavior will last and what I can do to redirect Tanya from her compulsion to escape. I’m rounding the corner of the hallway to keep eyes on Tanya when I see my coworker, Danielle, head toward us.

Danielle used to work with Tanya but has since switched from behavioral challenges to developmental delays. She now works with Katie who is primarily nonverbal and has autism. Whenever I see them in the hallway, I always say hello. These exchanges help Katie practice appropriate social interactions. Every once in a while Katie will wave or whisper a barely audible “hi” but mostly she continues smiling silently as she glides down the halls.

As Katie and Danielle approach Tanya (who was marching 15ft. in front of me) I wonder if I can distract Tanya. Maybe engaging Tanya in conversation with Katie would give her chance to slow down and reset her thinking. I will try just about anything to keep Tanya from continuing to run around the school. I am slightly desperate. I prompt Tanya to say hello to Katie, even though I know Katie might not respond. I know Tanya understands I say hello to Katie to help her learn to speak. Tanya remains silent, but she does stop walking away.

When Katie crosses my path, Danielle prompts her to stop and say hello. I kneel down and go through my normal routine greeting. I see Tanya looking over. I casually tell her to come over and say hi. Tanya shuffles over, her eyes averted. She mutters “hi” while studying her shoes. Katie doesn’t respond. I tell Tanya that Katie probably didn’t hear her and she could try again.

Shockingly, Tanya pops her head up, smiles, looks into Katie’s eyes and cheerfully says “hello!” She also holds up her hand to offer Katie a high-five. Katie responds with a smile, a quiet hello, and soft clap of her hand to Tanya’s. I’m having trouble processing what I’m seeing. Tanya has not listened or followed any instruction I’ve given for the last hour yet here she is, nonchalantly exchanging pleasantries with a peer who most people never take the time to communicate with.

Tanya didn’t magically stop running away after seeing Katie. But I wish I knew exactly how Katie captivated Tanya’s attention long enough to stop running away for five minutes. I wish I knew how she inspires Tanya to pause and be kind to a fellow student. However, despite my lack of understanding, I continue searching for opportunities to facilitate these interactions.   It was a small moment in time, but it was magical to see Tanya, the queen of verbal insults and defiance, genuinely take interest in another human being. Especially since Katie does not meet Tanya’s usual standards for normal.

 

 

Redefining Ability

Going back to school means a bittersweet return to a land of structured learning.  Going back to school also means daily evaluations of individual abilities.  Grades and numeric scores are assigned to demonstrate students’ comprehension. Children are grouped in classes according intellectual abilities.  Physical abilities are evaluated in settings such as gym class or organized sports.  Overall, when children are participating in academic events, they are more often than not being evaluated on their individual abilities.

But what defines an individual ability?  Does a skill need to be measurable to be considered an individual ability?  What kinds of abilities do academics actually recognize?  The more I study educational pedagogy the more I find myself questioning traditional academic principles.  For instance I believe understanding simple math is as (if not slightly less) important as learning to resolve conflict with peers.  My view may be unpopular or controversial, but from my real world experience, my ability to work well with challenging colleagues or supervisors has been exponentially more beneficial and influential than my skills in mathematics.

The definition of ability becomes more complex when you look at children and adults with developmental disabilities.  My first reaction is to be politically correct and use the term differently abled, but honestly I don’t think it explains the situation fully.  Yes, people with developmental disabilities are capable humans with just as much to offer as the next person.  It’s also true that their physical, mental and emotional world is inherently more challenging.  I truly hope not offend anyone with my statements, but I think you need to understand my opinion to understand my story.  My goal is to generate thinking, not to persuade you to agree with me.

I broadened my perception and understanding of individual abilities when I started the school year working at a specialized school for children with social, emotional and behavioral challenges.  Some of the children experience developmental delays and others come from traumatic backgrounds.  My title is Behavioral Health Professional (BHP) and my job is to help students with traumatic backgrounds work towards goals on their treatment plans.

Tanya is the most memorable student I’ve encountered.  She is easily the most defiant and angry child I’ve ever met.  However there continues to be one exception to Tanya’s unpredictable and aggressive mood swings.  Whenever she is in the presence of children with severe developmental delays, Tanya shows up as the best version of herself.  She speaks with confidence and respect.  Her body remains neutral and calm.  She shows genuine interest and concern for the condition of her fellow students.

I first recognized this phenomenon during one of Tanya’s frequent violent outbursts.   She and I were in a vacant room near the main office.  I was trying every technique I learned in training to help Tanya deescalate so we could return to her normal schedule.  However no matter what I tried, Tanya’s eyes glared at me from across the table where we sat.  Her fists clenched on the table, her feet shuffled restlessly and she occasionally muttered curses at me under her breath.  I prompted Tanya to use coping strategies to calm her mind and body. No response and no change in behavior. Eyes remained in slits, feet shuffled under her chair, fists remained clenched on the table, and she sporadically whispered curses or threats.

Unexpectedly another student named Gillian and her physical therapist Laurie walked into the room.  Gillian took cautious unsteady steps while Laurie held her upright.  She couldn’t walk without support. Gillian wore a bandage over her throat to cover a tube that enabled her to eat.  Gillian could not swallow food.  Gillian was nonverbal and Laurie helped her move her hands to communicate using sign language.  Gillian could not speak for herself. Gillian couldn’t do many daily tasks the average person takes for granted.   But Gillian could do something I have yet to see anyone come close to achieving.

As Tanya became aware of Gillian’s presence her mood began to shift. Tanya sat up straight; her hands relaxed and curse words were replaced with a slight smile. Curiosity and wonder appeared to replace fear and rage.

The social exchange itself was rather simple.  Laurie introduced us and showed Tanya how to sign “hello” to Gillian.  Laurie explained they were on a walk to visit people around the front office and I thanked them for stopping by to see us.  I prompted Tanya to say thank you.  She politely thanked them and wished them a good day.   After Gillian and Laurie left the room, Tanya remained in a relaxed state.  The anger that was palpable moments before somehow dissipated.  Tanya silently fidgeted in her chair for a moment and then asked me if we could go back to her assigned activity. We worked on a few coping strategies then safely met up her peers.

I continue to observe these exchanges between Tanya and children with visible developmental delays; no matter how severe or how different they appear.  Every time Tanya and I cross paths with these students, she is polite and moves to the side to let them pass rather than curse or intentionally bump them as she does with other students. What is happening between Tanya and the students with developmental delays? How can their mere presence evoke such drastic and consistently positive reactions from Tanya?

I don’t have an answer.  But I witness so many positive changes in Tanya’s behavior that I can’t help but conclude there is something yet to be discovered from these interactions.  Students like Gillian ease Tanya’s anxiety and fear, not forever but long enough to give her a chance to regroup and make a healthy choice for herself.  That in and of itself is such a gift and I daresay an ability.

However, Gillian didn’t get an A for her efforts.  And while some might argue she didn’t actually do anything, I counter with the fact that she woke up that morning and showed up.  With significant support, Gillian attends her individualized daily schedule like every other student.  She leads by example.  And perhaps that is the reason her presence can have such an impact.  Recognizing that another person who faces the same human daily needs and challenges, who is far less capable of managing them independently, but continues to put one foot in front of the other almost forces you to pause and reflect.

These moments invite you to step back.  Step back from your own perspective and become fully present to the truth of someone else’s reality. Appreciating someone else’s experience inherently helps you appreciate your own.  While I am still uncertain as to exactly what makes these moments and interactions so powerful, I’ve experienced their effect on countless occasions.

Just to clarify, Gillian didn’t magically cure Tanya of violent outburst and unsafe behavior.  I am not arguing that all interactions with people with developmental disabilities automatically result in significant social exchanges.  But I will say being in the presence of someone who is less able to meet his or her individual needs always provides you with an opportunity to pause, reflect and appreciate.  Once again, the ability to evoke personal reflection is something I call a gift.

It brings you back to reality when your mind is racing, puts your own challenges into perspective as well as enhance empathy and appreciation for yourself and others.   Personal changes won’t necessarily be immediate or last forever, but I hypothesize that over time, if you continue to embrace opportunities to pause and appreciate, your own challenges will be less potent and more manageable.  At least that’s my current prediction.  It’s also my hope that I have given you an opportunity to pause, reflect and appreciate your individual abilities.   I encourage you to use these gifts wherever you are, school, home and every space in between.