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eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) – ISSN 1605-7406

ISSUE 123 MAY 2009 •  CONTENTS •  HOME PAGE

PRACTICE

Further considerations relating to Michael White’s ‘Ritual of Inclusion’

David Epston and Annette Henwood

Following a workshop on the “ritual of inclusion” sponsored by the New South Wales Family Therapy Association in Sydney, a small interest group formed. With the consent of Alistair, aged 10, his mother who had “belonged” him, and her mother who had acted as support person, the video they had made of their “ritual of inclusion” was made available to this study group. I quote from their letter, written by Amanda Kamsler, on behalf of the group:

After viewing the tape, we had an energetic discussion which raised a lot of questions for us (and the group even started to come up with some creative ideas about possible rituals!). Here is a summary of the questions, which we’d like to have your thoughts on:

  1. How do you decide whether or not a ritual of inclusion might be appropriate for a family?

  2. What are the kinds of cues you would pick up on that a child has not been “belonged” by a family?

  3. How do you prepare yourself and the family for the ritual?

  4. How much do you go through the possible consequences of the ritual beforehand?

  5. How do you know a family is ready for a ritual?

  6. When there is a couple raising the child, how do you decide who should do the holding? How do you deal with the other person during the ritual? What are the instructions about who talks to whom? Do you decide this and discuss it with the family beforehand? Have you ever had complications in relation to changes in the couple’s relationship after the ritual? How have you dealt with this? Have you ever had a couple holding the child and each other during the ritual? Would you consider this?

  7. When would you decide not to try the ritual?

  8. Has the ritual ever not worked? Under what circumstances?

  9. Do parents have to feel they are “belonged” by someone before they can cope with the ritual?

  10. Have you ever done the ritual with a family where the parents were very angry and have not been belonged themselves?

First of all, I have no “rules” about determining the appropriateness of the ritual. Secondly, I propose the idea of “belonging” /ritual of inclusion far more often than I apply it. What probably is more important is the context of ideas surrounding “belonging.” (See, for example, Epston and White, 1992.) Now there are some very obvious clues, especially in relation to those young people, who have had multiple foster placements, unsuccessful adoptions, etc. No one would have any difficulty identifying such young people. They have often been abused, malnourished, and neglected. Michael utilized the ritual for young people with uncontrollable behaviour but when we discussed it together, he recalled that many of these young people had what I have called “unbelonging” histories. Searching the child psychiatric/psychological literatures, I’m confident you would come up with any number of analogous descriptions that aren’t as interactional as I would prefer: rejecting, rejected, unbonded, etc. I prefer to steer clear of these conventional terms as they can be taken by any of the parties to the labelling as personal attributes. Many of these terms have as strong a standing in “folk” psychology as they do in the “disciplining” psychologies. Still they may help identify these young people.

Many of the young people I have seen feel their lives to be out of their control, paralleling Michael’s experience; however, some seem to respond to that very differently from the “uncontrollable” behaviour he reported. They are withdrawn, worn-out looking, hapless, and miserable. They feel “hollow” when you talk to them and seem estranged from themselves.

The stories parents tell will often give things away. Let me provide you with a few vignettes: Rogier, now aged 9, was born prematurely in Europe. His parents were not permitted to touch him until he was four months of age. With the birth of their second child two years later, they realized that their connection with their child was, in their words, “not normal.” This conclusion is often reached through an invidious comparison with a subsequent child. I first met Rogier when he was placed at a therapeutic residential community in Auckland. His mother was only able to approach him up to a two-foot distance separating them, at which point her toothgrinding became audible. She found herself unable to close this gap. Rogier was very promiscuous in his affection towards others, slobbering kisses over relative strangers like myself. He was unable to sustain any friendships despite his effusive social displays. He “drives people mad,” according to his parents. He regularly stole and hoarded the proceeds of his thefts. He has a seemingly insatiable appetite, regularly stealing his class-mates’ school lunches and eating out of rubbish bins.

Jimmy, aged 13, was the physical size of an eight-year-old. He was being investigated by the Growth Clinic due to his growth retardation. In fact, his parents were considering “buying” a shotgun growth hormone treatment in another country, as their medical advisors here could not discern any medical grounds for such an invasive procedure. He, too, was excessively talkative, promiscuous with his affection, but friendless. He was so anxious to please that he usually ended up tripping over himself in his efforts to do so. He lied continually (saying what he thought other people wanted to hear). He had been expelled from every school placement from pre-school to the present. He hoarded his thefts, which in and of themselves made little apparent sense, e.g., collections of pencils, pens, erasers, and left socks. His mother, first in private, told me that when she gave birth, she was immediately informed she had borne twins. She recalls through a drug-induced stupor that then both twins were removed from her. She was then informed that one had perished. She was to learn covertly that the cause of death was likely medical misadventure and that the doctor concerned was, according to her informant, consequently forbidden to have further hospital privileges. Her surviving child was kept from her and when she complained, she was told: “You’re a nurse. You should be happy you have one alive.” When she insisted on having the survivor with her, she was offered someone else’s child to suckle. The next day, her father arrived at her bedside from their remote farm to seek her assistance as he had raped the young woman who was to “look after things” in his wife’s absence so she could be present at her daughter’s birth. The next day, her husband “cracked up” and was hospitalized. She recalls thinking to herself: “I’ve just got to do it” and forced herself to go through with the day-to-day routines. She too realized with the birth of her second son that her relationship with her first “wasn’t normal.” She was unable to touch, kiss, or hug him.

Now these above-mentioned instances are fairly obvious. I have also included as “unbelonged” those children who, for whatever circumstances, e.g., chronic illness, frequent hospitalization and obligatory seclusion, pain and suffering, and “hyperactivity,” have been somewhat excluded from connecting up to others. Now you can go to the other side of the “belonging” relationship: a candidate for “belonging” and candidate(s) for “belonging” — the unbelonged newborn, adoptee, etc. Such circumstances such as partum depression (I prefer the description of “dismay”), unwanted pregnancies, pregnancy resulting from rape and violation, or the relationship breaking up around the time of the pregnancy and/or birth, etc., any of which could have pre-occupied the “belonger.”

Questions that assist me and others to both describe the experience of “being belonged /belonging another” and remove it from the taken-for-granted revolve around “belonging” and other associated metaphors:

You can then explore the following:

Quite often, parents, particularly mothers, weep with relief at this point, now being able to appreciate and make sense of their own experience. This is often something they have not dared to discuss with others and if they have, they have been dismissed, reassured that it (the “belonging”) will come in time, or that this is how everyone feels. I think it is very unhelpful to “normalize” matters as the persons themselves are only too keenly aware that this is not normal. If they feel free to speak about it, they will usually use descriptions such as “hatred” or that the child is “evil.”

You can ask similar questions to the young persons, of course taking account of the age and capacity and fitting the questions to those considerations:

By externalizing the problem (“unbelonged - unbelonging”/“un or disconnected/short-circuiting in touch/out of touch”), a reasonable account of the evolution of the relationship in a very unsatisfactory direction can be easily constructed. This account usually provides a great deal of relief for all parties as it explains, both dramatically and forcefully, so many incidents and unfortunate episodes, histories, and feelings, etc. that hitherto have remained outside any form of understanding, save the characterological (e.g., she has bad blood) or implications of malevolent intent (e.g., he is trying to kill us). It also, and this is extremely important, allows the therapist to have compassion and sympathy for parents who seem so “rejecting,” “intolerant,” and ungenerous, especially when the young person is one of those who is superficially sociable (even if there isn’t much substance to it). I think too that this is a great relief to a young person who perhaps for the first time can comprehend their experience by way of a new frame of intelligibility: “belonging/unbelonging.” This can overturn and substitute for previous explanations such as “my badness/stupidity” or the badness/stupidity of their potential “belongers.”

Another advantage of the “belonging” description of events and its associated metaphors is that they are uncontaminated by the pathologizing discourses of psychology, child development, and psychiatry. This can prevent what Lukacs refers to as “phantom objectivity”:

a relation between people takes on the character of a thing and thus acquires a “phantom objectivity,” an autonomy that seems so strictly rational and all-embracing as to conceal every trace of its fundamental nature: the relation between people. (1971, p. 125)

The “bonding” discourse has been reified and as Taussig comments,

through a series of exceedingly complex operations, reification serves to adhere guilt to disease. The real task of therapy calls for an archaeology of the implicit in such a way that the processes by which social relations are mapped into diseases are brought to light, dereified, and in doing so liberate the potential for dealing with antagonistic contradictions and breaking the chains of oppression. (1992, p. 93)

By proposing accounts that implicate injuries, unjust circumstances, unforeseen events as disrupting “belonging,” built/blame can easily be bypassed. The relief provided can, at times, be profound. For example, one mother’s two-year-long headache disappeared the night of the “belonging” discussion.

The next stage is the presentation that there is a way to “belong” people and that it is unlikely that they would have heard about it as it has only recently been invented and tried out. “However, there is no point in going into detail about it now as it is too involved. If you were merely to accept that ‘belonging’ Johnny was now a real possibility, would you go away for as long as you wish? Would you consider whether things have gone too far for you to do it? Have hatred, disappointment, frustration, etc. taken too great a toll? Johnny, if you were merely to accept that you could still be ‘belonged’ by your mother and your father, do you think your unbelonged life is too far down the road to turn back and unite with the family that bore you? Have you had too many growlings and hidings and hurts that the possible would seem impossible to you?” I generally leave plenty of time for thinking about this, “as this could be the biggest decision in your son’s/ your life since your physical birth/ since giving birth to him.” Often months elapse.

The following is a letter to Jimmy, aged 10, his mother, Sue, and his stepfather, John. They had approached the Child and Young Person’s Service to take Jimmy into care as “we don’t want him around the place anymore.”

Dear Sue, John, and Jimmy:
I request you consider the questions that follow. I believe them to be the most important and far-reaching questions you will ever have to ask yourselves. The answers to these questions could very well have more bearing on Jimmy’s future than anything else in his life so far, save his birth.

Sue, you made it crystal clear to me that you have “lost touch” with Jimmy and understandably find it hard to get close to him. Not surprisingly, this separation did not occur overnight. As you put it, “It’s been building up ... it’s been at crisis point for the last year and desperation for the last six months.” You had to admit that “a number of times, I would have liked to have dumped him.” Jimmy, too, is fully aware of this in his own 10-year-old way. He described his son-mother relationship as “utterly war ... just a big battle.” So, to some extent, he experiences the person who is usually most loved as more like an enemy and let’s face it, it’s hard to get close, get comfort from, confide in, or care about your enemy. Enemies are typically hated rather than loved. However, lately, Jimmy had to revise this by saying that he thought you both were now creating a “more average relationship.” In fact, he thought “Mum likes me a bit more” and he was of the opinion that he could tell this “by the way she is quite proud of me.” When I asked him what he saw on your face in the war days, he thought it was “a hateful look.” It seems that by taking some guidance from his recently deceased Nana, he now can feel her presence in his everyday life, and that has assisted him to “improve my homework ... stop getting into fights.”

Still, Sue, none of the above denies the feelings you have been feeling for some time now, and now when you try to repair the relationship by doing something especially nice or giving, everything sooner or later blows up in your face. It’s almost as if the mother-and-son wiring short circuits, every time you try to make a connection.

Sue and John, Jimmy is becoming a lost person, and people his age cannot find themselves by themselves. From what you say, Sue, in the overwhelming love and dotage of your mother whom he lived with from his birth to age 7, Jimmy got the idea, according to you, that he “is larger than life.” So was it any wonder, when you think about it, that when he joined your family, now with two younger sisters, that he was “too big,” in a manner of speaking, to fit in? And now everything he does to “fit in” threatens his place in your family and his future as a person. From what you tell me, Jimmy is becoming a lost person, a person lost to himself, and I have a professional responsibility to inform you that that predicts a most unfortunate future. To my way of thinking, it is impossible to come home to yourself without a home in which to do that. And home is where the heart is. Sue, you described a “brick wall” having developed between you, and how his mischief lays down course after course, until now you can’t see, feel, or touch each other. So, Sue, each of you is entering the worst kind of suffering I know of — an unbelonged child going wild and a mother whose love is turning into hatred. I fully appreciate and understand your talk about amputating Jimmy from your life, but I must forewarn you of the unendurable “phantom limb” pain that goes with it and never, never goes away.

Sue, have there been too many disappointments, hurts, etc. that your love for Jimmy has died? Have there been too many experiences of “war” so that a mother’s love has turned to hatred, that your unbelonged son has become your hated enemy? Has the “wall” been constructed so well that it cannot be broken down? Did you believe that the Berlin Wall would ever come down? Do you know that it stood for 17 years but was destroyed by the will of the people for freedom and a reunited country in one night?

Sue, do you feel so “unbelonged” to Jimmy that you no longer have the will or desire to seek a reunion, a mother-son reunion, to “belong” him again and make him your very own this time?
Sue, how will you face your mother, in this life or the other life, if you abandon Jimmy to his fate? How will you ever face yourself?

Sue, I know these are tough questions, but you led me to believe in no uncertain terms that the crisis has now become desperation. I ask you these questions with the best intentions and with concern for both the presents and futures of you, Jimmy, John, your relationship with Jimmy, and your relationship with your mother. I dare to ask these questions out of my respect, concern and compassion for each and every one of you. And I wouldn’t have dared to do so if I didn’t know, only too full well, that there is a way to reunite you, son to mother and mother to son, a way for you to “belong” Jimmy once and for all and for him to be “belonged” by your mother’s love.

We will meet on September 12th to review this. However, Nana could very well be making an appearance in Jimmy’s life and provide him with guidance. So please keep an eye out for this. In many ways, by doing so, you too will be keeping her alive in your everyday life, not just Jimmy. Perhaps she will find her own ways from her grave. Or, at least, encourage you with hope and desire. I don’t know; who am I to say? I have only “met” Nana through your loving accounts of her and Jimmy’s deeply felt grief. You might acknowledge her by paying heed to any influence she seems to be having over Jimmy’s actions. John, can I ask one thing of you? If, between now and then, Jimmy seems to get “lost” again, say this to him: “Jimmy, you need to feel your Nana’s presence more and take guidance from her. I am taking you when I am feeling in the right mood to her graveside so you can talk with her.”

Sue, I, in no way, intend a criticism of anyone. I am driven by compassion and my desire to avoid a grave tragedy.

Yours sincerely,
David Epston

In the matter of Jimmy, Sue, and John, the work never proceeded any further towards the actual ritual of inclusion. It is my practice at sessions to review their thinking. I am looking for “unique outcomes” on the one hand and reinterpreting further incidents to the “disconnected/making connections/short-circuiting” metaphor: stealing as a wrongheaded attempt to fill his emptiness up, lying as a concerned effort to please others by saying what he thinks they think he should say or do.

For those who wish to take the matter further, there is more preparation. Families are invited to take away and consider transcripts of six-month follow-ups of other families. I will also go through the transcripts carefully with them. The transcripts are interviewer questions/ interviewee responses as to the precise detail of the experience of the “ritual of inclusion” and subsequent circumstances of everyone’s lives and relationships. If it is within their means, I provide them with Michael White’s “Ritual of Inclusion” paper to take home and read. Thanks to the magnanimity of the Henwood family (Annette and her son, Alistair, aged 11 at the time), I also provide them with a copy of the video-tape which they requested I make for them and an audio-tape of a six-month follow-up of me interviewing Alistair and Annette. This is much like a reminiscence guided by my questioning. Each stage in this process is, at minimum, a session.

However, I continue my search for “unique outcomes” and not surprisingly, this new context of ideas seems to be a breeding ground for them. When they happen, they would have been insignificant outside of this context of ideas of “belonging.”

Here are some examples: “When he went to his mother’s for the weekend, just before I put him on the bus, I put my hand on his shoulder and he didn’t shrug it off.” “When he saw me crying about my mother’s death, he came over and gave me some comfort.” Sometimes there are very overt gestures, for example, the giving of flowers, etc.

DE: Why did you give your step-mum those flowers?
B: I thought she might be nicer to me?
DE: Did it work?
B: Not really!
DE: What do you mean it didn’t work?
B: It didn’t last.
DE: How long did you think it would last?
B: A month or two.
DE: Gee, you might have been hoping for too much there! How long does a meal last?
B: Till breakfast the next day.
DE: Jan, how long did the flowers last for you?
J: Two days.
DE: That’s pretty good? If B’s father only showed you affection once every two months, what state would your marriage be in?
J: Not a very good one.
DE: B, you did a good job there with the flowers connecting up to your step-mum. But you might have had too high hopes. What do you think? ...

How do you know a family is ready?
Often, the need for a ritual as detailed by Michael White becomes unnecessary, and often some less demanding variant is arranged. I often allow the urgency of the situation to set the timing, but I wouldn’t undertake it if the parents weren’t desperate.

“This is the last-ditch stand. Is there anything else you can think of that you would like to try before you undertake it?”

So I would often encourage them to experiment with every other possible alternative before proceeding to the ritual of inclusion. However, if they said, “If things aren’t any better by tomorrow, he’s out,” then that is readiness enough to start discussions and the preparation stage. I would never proceed directly to the ritual.

When would you decide not to try the ritual?
Several family members have decided they couldn’t do it. The idea of viewing of such intensity terrified them. Usually the preparation stage and viewing the videos would sort these people out. From the outset, I make it clear that the ritual is extremely emotionally and physically demanding and that no one should embark upon it unless they can go through with it. If there is any risk of this, it would be better to forget about it and see if we could draft some other kind of relationship that doesn’t require so much “belonging” in it, e.g., roommates, boarder, etc. Also, if either parent is too angry, spiteful, vengeful, hurt, or embittered, I would refuse to go ahead. It is vital to have developed some compassion on the part of the parents for the young person and on the part of the young person for him/herself. So I am always very candid without wanting to be seen to be merely providing an apology for their children’s misbehaviour.

Has it not worked?
Some of my colleagues have told me that it hasn’t worked. Some retrospective speculation for the failures proposed inadequate preparation, were not in attendance at the first ritual, and weren’t in touch enough around subsequent rituals. As far as I know, there have always been improvements in relationships, although in every case they were so deteriorated that they could only get better. In earlier years, I didn’t follow up these families enough, and I think things could lapse over time. But now I caution people repeatedly that this just makes people feel “normal” rather than ensuring unrelenting good behaviour on the part of their children. In fact, I might add that the behaviour could be much the same, but they might feel differently about it and that it now can be discussed, and those discussions might be “felt” by the young person.

Do parents have to feel they are “belonged” by someone before they can cope with the ritual?
This is a very good question and something I wish I had asked a father who refused to consider the ritual. Matter of fact, when I told him about it, he started screaming with discomfort. I don’t know what I would do here, but I certainly would think about the idea of “self-adoption,” “self-belonging,” or parallel rituals of inclusion (“This ritual is about being belonged by your Dad, Billy; John, this ritual is about belonging Billy as his father and belonging yourself at the same time into the family you made rather than the family you came from but who weren’t there for you”).

How do you decide who should do the holding?
The question of who “holds” can be answered by who doesn’t feel “belonged” or “belonging.” When it involves both parents, we might all agree that they can take turns. How and when this happens could be left up to them. I have found the young people to be remarkably co-operative at changing the “belonging” person. Michael White details the requirements of the “holding” adult and the “supportive” adult. All the details are discussed at length beforehand. As little should be left to chance as possible , as no matter how much preparation everyone has had, I doubt if anyone could really be prepared for the experience of the ritual. It is beyond words. The idea of one adult “holding” another is a good one, and some couples certainly have arrived at variations on that. The other possibility is that both persons may be required to ensure the “hold.” Parents just naturally take turns, probably when distress or fatigue shows on their partner’s face.

Everyone in the family is involved in a discussion about how they might feel should, say, Johnny take up a place in the family. This is particularly important with “good” and “bad” siblings, and you can predict extreme reactions by the “belonged” sibling to the new “belonging” of their sibling. Couples should also be forewarned that this experience could have profound effects on their relationship. “Do you think your relationship with Jack/Jill could stand up to a fair increase in its belonging? Would either of you feel uncomfortable with a fair bit more intimacy between you? Going through this could very well get you two really in touch with each other on an emotional level. Could that be intolerable? Could you find out something you would rather not know in a way that could not be denied?” At least one couple separated almost immediately after the ritual. However, it was “just the final straw.” The husband was unable to “support” his partner nor “belong” his son.

The following are Annette Henwood’s replies to the same questions:

Here are my thoughts on the questions:

How do you pick up cues that the child has not been “belonged” by a family?

Alistair was always treated differently by his paternal grandparents who told me outright that we were stupid to have more than two children. There is an intense sibling rivalry between him and his older sister (+1) and jealousy over such things as playing with the baby next door. Alistair invariably feels excluded: either his sister has a girlfriend to play and doesn’t want him around or his older brother (+3) has mates to play with and doesn’t want a kid brother as a hanger-on. Alistair doesn’t really have any friends to either phone, visit, or invite to play. His father has never really had time for him and seems to spend quite a lot of time criticizing his bad behaviour instead of doing anything positive to help improve things.

Although you explained to me about the ritual, I really wasn’t emotionally prepared for the overwhelming feelings of love which came to the surface during the ritual. This I think can only be described by someone who has actually experienced these feelings.

I know you explained the possible consequences, but I don’t remember them.

When you first suggested the ritual, you remarked that I wasn’t ready because I was too emotionally bruised to cope adequately. I myself know when I felt strong enough to cope.

This possibility didn’t arise because I am a single parent and my mother was my support person. You explained everything very clearly beforehand, and apart from a quiet mouthing of reassurance from Mum, I don’t think there was any exchange of words at all. You were the one talking directly to Alistair. The closeness all three of us had afterwards was very special, as it really was a form of rebirthing. As Mum had been in Australia at the time when all the children were born, this was as close as she could get to that experience.

References

Epston, D. and White, M. (1992). A problem of belonging. In Experience, contradiction, narrative, and imagination (pp. 97-104). Adelaide, South Australia. Dulwich Centre Publications.

Lukacs, G. (1971). History and class consciousness. London. Merlin Press.

Taussig, M. (1992). The nervous system. New York. Routledge.

White, M. (1989). Ritual of inclusion: An approach to extreme uncontrolled behaviour in children and young adolescents. In Selected papers, pp. 7784. Adelaide, South Australia. Dulwich Centre Publications.

This feature:  Epston, D. and Henwood, A. (1994). Further considertaions relating to Michael White’s ‘Ritual of Inclusion’. Journal of Child and Youth Care, 9, 2. pp. 65-77.