No. 1912

Saving Hello

Often when I am asked to describe Child and Youth Care I say it involves the use of daily life events for therapeutic purposes. I then go on to talk about how the simplest of daily events has the potential to be a pivotal point of change for a young person. How we wake children up in the morning or help them retire to sleep at the end of a difficult day; how we assist them in learning to prepare a meal or clean a room; how we explore with them new ways to solve social problems or succeed in little ways where they have failed in the past. All of these seemingly simple moments can be the unexpected foundation on which the child's new experience of self is built. Saying hello to a troubled child for the first time is one such moment. It is a moment which can be the foundation of a therapeutic relationship and the beginning of a new sense of self for that child.

Let us imagine for a minute the arrival of Maria, on her first day at the group home. There she stands with her Social Worker, Mrs. Smith, in the entrance to the house. She is one step behind, her head held defiantly high, a black garbage bag containing her clothes and important possessions dangling heavily from her left hand. We walk down the corridor to greet her and immediately we are faced with an important decision. Do we start with:

"Hello, Mrs. Smith, nice to see you. This must be Maria." "Hello, Maria. Hello, Mrs. Smith. We've been waiting for you. Hang your coat on the hook there and let's go to the kitchen for tea."

Or, "Hello Mrs. Smith. Maria. Bring your things into the office.  We have a lot to do so let's get started."

Or we may start with anyone of a hundred other options.

Whichever opening we choose we send a message to Maria beyond that conveyed by our spoken words. And her brain, vigilant and alert in this new experience, will read more than just our words. Is our message that she is an appendage to her social worker (option I)? Is our message that she is welcome here and will be treated with respect (option 2)? Is our message that she is another task to be managed in an already too busy schedule (option 3)?

As soon as we have made the first move in opening up this new relationship with Maria we are faced with another decision. For no matter how we open, Maria will respond.

Let's imagine that we have invited her and her social worker to the kitchen for tea and she responds by pulling her coat a little tighter around her, grasping her garbage bag more firmly and moving back just an inch or two. She stares you straight in the eye, the scowl lines deepened on her forehead and she blurts out "I don't want no tea."

What are the thoughts that run through your mind as she does this? Defiant? Scared? Angry? Nervous? Threatened? Testing you? Not wanting to appear friendly in front of her Social Worker? Doesn't like tea and doesn't have the skills to say so differently? Abused in the kitchen by a friendly relative? Defining herself and her interpersonal territory? Doesn't know if it is okay to be friendly with staff here and so not willing to take that risk until she sees how other residents behave? Afraid of losing her possessions? Tired? Wary? Needy? Controlling? Certainly, the thoughts that run through your head will depend on your perception of troubled children, your experience, your treatment philosophy, your sensitivity and the message you wish to convey to her. We remember, always, that just as we are interpreting her behaviour, so is she interpreting ours.

Do you respond with "Very well, then, let's go into the office and check your things," possibly inviting a power struggle over her possessions and perhaps confirming for her that this place is not about friendliness and your opening move was only a manip­ulative social ritual.

Do you respond with "Well, if you don't like tea, we have coffee, soft drinks and juices. Why don't you just bring your things along and I'm sure we'll find something. I think it's a much nicer way to get acquainted than sitting in the office. Or perhaps you'd like a tour of the house first?" This lets her know that you heard both the verbal and the non-verbal message and giving her a way to recover in case she feels like she backed herself into a corner.

Either response (and there are a hundred others) gives Maria a message about you, herself and your possible relationship. It is never easy to know how to begin with a youngster new to your program and yet the beginning is so important. There are a million mistakes we can make and an equal number of opportunities of which we can take advantage. Some of it is good planning, some of it is good training, some of it is natural ability and some of it, quite frankly, is good luck.

When I was a student of psychotherapy, our instructors spent numerous hours helping each of us to develop ritualized openings with clients that were designed to stimulate the maximum amount of comfort and trust and the minimum amount of anxiety and defensiveness. What I learned was that ritualized openings create the maximum amount of security for the therapist and contribute unintentionally to the therapeutic dance. They do little to personalize the opening of a relationship with a stranger who is balancing precariously on a fragile self.

There is no "right way" to open up a relationship with a troubled child new to you and your program. There is only the "individual way" — the way based on your sensitivity to the young person and your desire to encounter her in a way that invites her to venture into a relationship with you. If we want to develop a therapeutic relationship, we begin with a focus on the relational, on making this relationship a place of safety.

There is an old English saying that each new voyage begins with a single step. The voyage of the therapeutic relationship begins with that first step of "saying hello". How you take that step may well determine how the journey goes.

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Updated from the original article which was published in the Journal of Child and Youth Care, 1989, Vol. 4(2), pp. v-viii.