Liz

Henry W. Maier

Situation

Elizabeth (Liz, to her friends) is fourteen years old. She has been living in our group home for four months now. We know that she has lived in numerous placements since her parents abandoned her at the age of six. At that time, they both disappeared and have never been found or heard from since. The file material says that her previous foster home placements broke down because of her inability to accept limits and her excessive demands to be the centre of everyone’s attention. She was, it seems, just too much for anyone to handle. This is her eighth placement since living with her parents.

She’s not what one would call a pretty girl. She’s twenty pounds overweight, is plagued by adolescent acne and some of the boys call her “horseface” when they are angry with her. That’s usually because she’s trying to participate when the others don’t want her to. It seems she’ll do almost anything to be accepted and when they call her “horseface” she makes neighing sounds that cause them all to laugh at her.

At the staff meeting last week team members shared their frustration with how demanding and needy she is. We agreed to try and meet that need rather than try to extinguish it. Unfortunately, we never got around to detailing how we might do that on a day-to-day basis.

When I came on shift tonight Liz was acting like she was especially needy. From the moment I walked through the door, she has been clinging to me, throwing herself on my lap when I am sitting down and following me everywhere I go. I feel my own frustration creeping up but I don’t want her to feel that I am rejecting her. I need to meet this need, not punish her for having it. At this moment I have a particular problem.

I need to intervene in an argument that is going on between two of the other kids and Liz won’t let go of my arm. She wants me to stay and talk with her, but I need to attend to them. I don’t want to do that with her dangling like an unimportant appendage. Yet I can’t focus on them without getting her off of me. I’ve told her that she needs to let go so I can deal with the others but that has just caused her to hang on tighter. I don’t know how to handle this moment.

Situation response

This is an important inquiry that you raise. You present so clearly a frequent youth care dilemma: that care workers are asked, even challenged, to meet the insatiable demands of some youngsters. The workers, however, are often not receiving the necessary guidance as to how to proceed. I shall try to fill in by suggesting a few (in your words), “day-to-day” care work interactions that might be helpful.

First, I want to convey my pleasure for your own as well as your coworkers' help to Liz as a person by attempting not to “extinguish” her behaviour in order to obtain a smoother life within your group. Your brief summary highlights her unsatisfactory life of eight moves within eight years; a life of rootlessness and an apparent void of experiencing a semblance of being actually wanted. Yet, she exhibits enough strength to reach for growth-furthering human contacts. Let’s nourish that! And now, what can actually be done?

If at all possible, you must take the initiative. You need to seek her out and you must take the reins when she “lassoes” you, by creating some mutually satisfying moments in being together like sitting or walking arm-in-arm, or listening together to a tape. You could also promote an activity to be done together, hopefully playful: such as finger-play (e.g., cats-cradle), a brief game of cards, table tennis, hang-man, or other alternatives that the other youngsters in the group tend to play with each other. In taking the initiative by seeking her out or in readily accepting her overtures, you and your co-workers will convey to her that you welcome contact and the opportunity to play and do activities with her! Refrain from phrases like: “How well she is doing–; instead accentuate your experience in being with her. Liz has to become aware of the other person's outreach (want) for her rather than a conditional acceptability. When group members rival for your attention, or make disparaging remarks, underscore your presence with Liz: “Yes, I am with Liz!” It conveys a mighty message that she is another valuable kid. The latter should be offered in place of censoring her peers for picking on her.

Clarify the above strategy further in your daily action plan. First, if appropriate, you need to seek her out. Try to create positive brief joint activities with instances where you will have (within the span of your own personal tolerance) mutually satisfying engagements. When she “captures” you before you have had the chance to take the initiative, and provided you have the time and disposition; it is then up to you to reconstruct the occasion. You can elaborate that you had hoped to do something with her, following with suggesting a spontaneous joint activity – fixing a snack, for instance, or whatever fits. It is important to note here that we tend to feel more reassured of another person's closeness when we experience the other person's active outreach beyond our own efforts to connect. This occurs, for instance, when one experiences an invitation to join.

Before continuing with other suggestions, let me highlight a point I mentioned earlier. I said that care workers might introduce and favour activities which Liz’s group mates typically play. This may further Liz’s skills in peer activities and will also provide occasional opportunities to invite other peers to join you and Liz.

I can sense and sympathize with your uneasy concerns that by always reaching out to Liz, you will become her prisoner even more. Such concerns might be correct. Yet, as a genuine care worker, you have to risk and prepare yourself for the concrete care task of learning effective separation skills. This means you have to acquire added capabilities in acting out “leave taking” to Liz in order to be able to provide her with a relatively new experience; and that is the element of continuity, of attachment even while you are gone, with the assurance of eventual return. In short, sound attachment experience is essential; but it becomes more relevant when it is punctured by separations. To put it another way, we are working toward allowing the individual to experience her or his attachment to the longed-for person even when absent.

Such separating attachment behaviours are typical of most of our farewell gestures where we tend to add an extra squeeze and a verbal reassurance that we will be back, as in “See you later!”, or similarly, giving the other a phone number or the information on how we can be reached. All these symbolize continued but invisible presence.

In your day-by-day contacts with Liz, the events of separating from her are essentially therapeutic care interactions. Consequently, while taking leave of Liz it is important that you restate your satisfaction in having had a chance to be with her and the fact that you will be back for her. A person as starved for personal contacts as Liz, can only feel her own hunger! Note, don’t tax Liz with the charge that you have already been with her, or that now you also have to lend your attention to the other group members. Basically, she has to experience your involvement and that’s what counts.

Thus, in your leave-taking, clearly, if at all possible in an assured way, give her one or two extra form squeezes or other fitting tum-off interactions; for example, “give-me-five,” or another look back with a wave or for an eye contact, or whatever comes spontaneously to you. These same forms of disengagement are also appropriate when she tries to capture your full attention and you cannot actually be with her.

Let me add that, within the context of such a basic orientation, it is also assumed that there are occasions when you either do not have the time or you are too exhausted to struggle with a situation as you described in your note. Then, it is very appropriate to convey quickly and clearly as a matter of fact “No, I cannot be with you just now.” By your staking out your boundaries, you also deal with her boundary formation process.

In situations which you so well describe in your letter, you may also consider techniques that we tend to employ most naturally with young children and infants in our daily lives. We share ourselves symbolically. We give them something to hold on to during our absence (a hanky, a cuddly object, a piece of candy, or whatever). I hope that you will have a few extra give-away items like an emblem pin, a ribbon, a little toy, or possibly for Liz an extra inexpensive bracelet or rubberband on your wrist, ready for such occasions. Such interactions can readily lead to a “transition object” experience (Maier, 1987, pp. 57-58). It is a popular fear that sustaining attachment leads to unwanted dependency. This is not so! Solid research as well as common experience have established that genuine attachment development frees (Maier,1987, pp. 121-128). Probably, you can find the same experience in the course of your own life. The more you can be assured of a friend's connectedness with you, the more confident you can feel and act apart from that person. I trust that Liz can eventually develop such a sense of self by experiencing, however brief, genuine moments of intimacy. Hopefully, these moments of togetherness may become satisfactory and enriching events for you.

Within all of these suggestions there is one overriding factor which you were so honest to imply: Liz is so hard to like and consequently a youngster so very difficult to deal with. You bring up one of the most vexing issues in our Child and Youth Care work! It might be reassuring for us to remember that there is no requirement in our work that we like all (or most) of the youngsters with whom we are working. Our challenge, however, is that we face what bothers us about them and then we accept the task of having to engage ourselves with them for their therapeutic gains. The task is yours; that you work effectively with them.

In your letter you also cited Liz’s difficulties amidst her peers, describing her ineffective handling of being called “horseface.” Here, I think Liz requires special help with her self-management in order that she can negate that name calling by responding neutrally and with an unconcerned posture, as if it doesn’t apply to her. This requires more than advice; probably it will be necessary to provide real behavioural rehearsal (by the use of role playing) in order that she can acquire more adequate interpersonal social skills. Liz, once she has gained some experience of attachment development, will look to the care worker who can then be supportive of her in such social skills practice. It is important to remain aware that all of these processes, both attachment development as well as added social behavioural learning, take time to emerge.

Parenthetically, the apparent practice of name-calling has to be taken up with the whole group, not just for Liz’s sake, but as a feature of peership and growing up.

All of these above issues are important. I think the initial step would be to work with her attachment development. There is no doubt that Liz and you, including your co-workers, have to climb many steps within such a genuine youth care situation.

I shall be most interested for my own learning to hear of your reactions to these suggestions and about your progress in your work with Liz. Your inquiry suggests to me that you are doing pioneering youth care work. More power to you!

Reference

Maier, H.W. (1987). Developmental group care of children and youth. Binghamton, NY: Haworth Press.

This feature: Maier, H.W. (1993). Situations in Child and Youth Care: Liz. Journal of Child and Youth Care, 2. pp. 129-132.