ISSUE 112  JUNE 2008 /  CONTENTS /  BACK

PRACTICE

From self-destruction to self-awareness: A “Massaging Numb Values” LSCI

Trevor Thomas, Signe Whitson, and Frank Fecser

In this intervention, Anne, a 15-year-old girl in residential treatment, is helped to sort out her conflicted feelings of anger and attraction to a female staff member. Through the Massaging Numb Values Reclaiming Intervention, she is guided to find more productive ways of expressing her emotions and to begin to feel more personally competent in managing her interactions with the staff person.

Background information
Anne is an openly bisexual 15-year-old female referred to residential treatment with a history of aggression, impulsivity, and physical abuse. According to Anne, her parents have not accepted her lifestyle and often condemn her for what they call her “immoral” behavior. In the year since Anne first revealed her bisexual identity, she describes several experiences of rejection by family members, friends, and her peer group. As a result, Anne says she feels unworthy of affection from anyone. She calls herself “bad” and “dirty”.

During her six months in the residential treatment program, Anne has developed a crush on her individual counselor, Tina. Anne and Tina have discussed the parameters of their relationship. Together, they have spent time processing normative transference issues that can occur within the therapeutic relationship. Despite this, Anne’s impulsive behavior often increases when Tina is working. More and more often, Anne provokes her peers and becomes both verbally and physically aggressive toward staff members during Tina’s shifts.

The incident
The incident took place at Anne’s residential unit during the shift change that occurs amidst afternoon chore time. Anne began to verbally challenge Kim, one of her female peers. Anne told Kim, “You had better stop looking at me or else!” Kim returned Anne’s challenge, asking, “Or else
what?” Anne began shouting obscenities and making specific threats of violence against Kim. Her shouts were creating a major disturbance on the unit. When Tina intervened, Anne turned her anger toward the counselor, cursing and threatening to “hurt” her. Anne was taken to an administrative office, where she was able to regain some calm.

The drain off: Stage 1
When I met with Anne, she was crying and saying that she was a “stupid failure.” I acknowledged her pain, saying, “Are you upset about what happened upstairs?” Anne nodded in agreement and said, “The way I act, it’s no surprise that people hate me. Tina will probably never talk to me again.” I let Anne know that she was not a failure and that I and many others, including Tina, cared for her very much. I assured her that needing help was not a sign of failing and that it took courage to accept help from others. Anne said, “I am ready for my consequences. That’s what people like me deserve.” I repeated to Anne that what she deserved was to have someone listen to her, and that I would be willing to do so whenever she was ready. After allowing several moments of silence, Anne said, “I’m ready.”

Timeline: Stage 2
Interviewer
: Anne, I can see that you’re very upset, but you–ve done a nice job regaining your control. I appreciate your willingness to talk to me about your feelings. Can you help me understand what happened on the unit this afternoon?
Anne:
I yelled at staff and they brought me downstairs.
Interviewer: Tell me what led up to your yelling at staff and coming down here.
Anne: I said I was going to hurt Tina. (Pause) I didn’t mean to.
Interviewer: What made you make such a threat?
Anne: I don’t know. I just got so angry.
Interviewer: Tell me what was going on before you made a threat.
Anne: I was arguing with Kim.
Interviewer: What were you and Kim arguing about?
Anne: She was looking at me.
Interviewer: Does it upset you when people look at you?
Anne: Not usually, but today I was just angry.
Interviewer: I believe you when you say you were feeling angry, since usually you do not mind if people look at you. Was there something else bothering you to make you so angry?
Anne: I guess. I don’t know. I’m always doing stupid stuff.
Interviewer: Well, let’s look at the situation so far. You were upstairs on the unit, holding some anger inside. When Kim looked at you, your anger came out. You argued with her and then threatened Tina. Is that right so far?
Anne: That’s right.
Interviewer: I really appreciate your helping me out like this. Let’s go back even further to try to figure out what was causing you to feel angry. What were you doing before you noticed Kim looking at you?
Anne: I was cleaning my room. (Pause) I watched Tina walk in from the parking lot.
Interviewer: Let’s try to put this new piece together. You were focusing on your daily routine of cleaning your room when you saw Tina walk up the sidewalk. Pretty soon after that, you saw Kim looking at you from her room. You were feeling angry, so the two of you began to argue. When Tina tried to redirect you, you threatened her.
Anne: Yeah, that’s when I came downstairs. I’m such a screw up.
Interviewer: You are telling me you were not angry with Kim?
Anne: No, Kim and I are cool sometimes. But when I saw Tina, I just wanted to flip out. That’s why I’m here ““cause I can’t control myself!
Interviewer: So, seeing Tina is what made you mad?
Anne: Yeah.
Interviewer: That’s a wonderful piece of information, Anne. Being able to identify the source of
your feelings is important. Being able to understand what makes you angry is a way to control your actions. (Pause). I’ve noticed that you and Tina usually have a good relationship; what was it about seeing her today that made you feel angry?
Anne: I like Tina, but when we spend time together, I always get angry and in trouble. I like her too much.
Interviewer: Too much?
Anne: You know what I mean. I like her in “that way”.
Interviewer: It’s important to me that I make sure that I am understanding exactly what you are trying to tell me here. When you say that you like Tina in “that way,” do you mean that you are sexually attracted to her?
Anne: (Pause, then; without looking up,) Yeah.
Interviewer: Anne, thank you for your truthful openness. This is not easy to talk about and yet you are working through it. Now, I have to ask you another hard question. When you saw Tina from your window, what were you thinking?
Anne: I don’t want to talk about that.
Interviewer: And I don’t want to put words in your mouth, but were you thinking something like, I know Tina and I can never have an intimate relationship?
Anne: Yes.
Interviewer: And when that thought went through your mind, how did you feel?
Anne: It made me mad.

Central issue: Stage 3
Through the information gathered during the Drain off and Timeline stages, what had originally presented as a behavioral episode with no logical sequence began to take a more coherent shape in my mind. It became apparent that Anne was experiencing guilty feelings about her attraction to Tina. This inner conflict coupled with Anne’s negative comments about herself and her remorse for the original incident pointed to a Massaging Numb Values Interview.

Insight: Stage 4
I felt Anne was ready to further explore her feelings for Tina and understand the connection between these underlying feelings and her overt behaviors.

Interviewer: It’s understandable that you would have some strong feelings.
Anne: I feel lousy; it’s disrespectful to think like that about her.
Interviewer: You are someone who wants to treat others with respect. I’ve seen that quality in you.  (Anne looked up with a mixture of pride and confusion.)
Interviewer:
You have strong feelings toward Tina, and at the same time, you have maintained a respectful relationship with her. That shows you have some self-control and you are working at maintaining the personal boundaries that you–ve been learning about.
Anne: I feel dirty when I have thoughts about Tina. I wish I could stop, but I can’t.
Interviewer: You feel dirty when you have thoughts and feelings for Tina. You try to stop those thoughts, but it’s almost impossible to do.
Anne: Yeah. It’s impossible. But my mom says being gay is wrong. I don’t want my mom to hate me.
Interviewer: You care about your mom, and when you can’t make the thoughts stop, you start thinking about your mom’s anger.
Anne: Yeah. And I know I should be punished! That’s the only way to stop them.

Regardless of the message that Anne has received from her parents, I had to focus on Anne’s feelings and her right to have them. Her feelings were real and needed to be validated. Although her emotions were natural, she had control over whether or not to act on them. The behavioral choices she made were inappropriate and ultimately made her situation worse.

Interviewer: Let’s think about that for a minute. You have strong feelings for Tina that pull you in one direction, and also a very strong “and very natural “desire for your mother’s approval and love. There are times when these two sets of feelings seem to collide and those moments cause you pain. (Anne looks up into Interviewer’s eyes).
Interviewer:
Anne, I have to ask you another hard question. Is it possible that you act out your anger toward others so that you will be punished? Punished by restrictions, by rejection, or in some other way? Is it possible that you believe punishment is the only way to stop your bad feelings, so you behave in such a way that you–ll end up being punished?
Anne: Well, it seems like I do that all the time. That’s what happened today.
Interviewer: So, this happens often; when you feel bad, you make others feel bad; you’re then “punished.” Would you say it’s a pattern?
Anne: Well, I never thought about it as a pattern, but it always seems to work out that way. I’m such a jerk!
Interviewer: No, jerks don’t take the time to think through how their behavior affects other people. you’re doing that right now; you’re taking responsibility. Let me ask you another question. When you do that “when you act out your feelings by hurting someone else, does it help your pain to go away?
Anne: I don’t know. Maybe for a minute. But then things just get way worse!
Interviewer: What I hear you saying is that there are times that you really experience a lot of pain on the inside. When that pain becomes too much to take, you try to get it to the outside, usually by hurting someone else. The problem you are finding, though, is that the pain actually does not go away “at least not for long. In fact, it comes back worse a lot of the time.
Anne: Right. I just go wild sometimes “out of control “and I get myself in so much trouble that I just feel even worse than I did in the beginning.
Interviewer: Well, Anne, you are doing a brilliant job right now discovering a pattern that is not very helpful in your life. I think you might be on the road to creating some new patterns that are much more helpful. Do you mind if we look at some new ways to deal with the painful feelings you are having?
Anne: Go ahead.

Anne and I continued our conversation by taking a look at the Conflict Cycle. I illustrated for Anne the close connection between her thoughts, feelings, and behaviors. Beginning with her thoughts for Tina, Anne was able to see how these thoughts created feelings of guilt, due to Anne’s parents” lack of acceptance for her homosexual feelings. Anne was able to connect her guilt over her feelings with her desire to be punished. Next, Anne was able to connect her desire for punishment to negative and inappropriate behavior. In the end, Anne was able to state, “I started arguing with Kim and attacking staff because I knew I would get in trouble. I thought I deserved to be punished for the thoughts and feelings that began the minute I saw Tina walk up from the parking lot.”

Outcome: Stage 5
Interviewer:
I have another question for you, Anne. How angry at Tina were you on a scale of 1 -10?
Anne: Nine.
Interviewer: So, you were about as mad as you can get; “out of control” as you said earlier?
Anne: Yeah, I just lost it, you know?
Interviewer: I’m confused. If you were a nine, if you were out of control, if you lost it, how come you didn’t hit her?
Anne: That would be wrong.
Interviewer: So, what you are telling me is that even though you were so angry, you recognized that hitting Tina was wrong and you stopped yourself?
Anne: Yeah.
Interviewer: Would an out-of-control person make that decision?
Anne: Probably not.
Interviewer: So you do have control over your actions?
Anne: I guess so.
Interviewer: Sounds to me like there’s no guessing needed here. By not hitting Kim, you showed control “even when you were at a “nine” in the anger department! You already possess control over your actions. What we have to do is work on strengthening the control you already have and helping you to take actions that allow you to deal with your pain “rather than making it worse.

I emphasized to Anne that having a greater understanding of her own behavior was a major accomplishment. Although her fantasies for a relationship with Tina could never be realized, Anne was able to acknowledge that simply having thoughts and feelings did not make her “dirty” or a bad person. Anne could realize that the actions associated with her thoughts and feelings were in her control. Anne was able to realize that the pattern of allowing feelings of guilt to fuel aggressive impulses was causing her ongoing difficulty in her past and present relationships, but that this pattern, too, was something over which she could exercise control.

Return to the milieu: Stage 6
Interviewer:
Now that you know the connection between your feelings for Tina and the behavioral choices you made, what are some steps you can take to stop the cycle?
Anne: Instead of standing around thinking about Tina, I could talk to another staff or listen to music.
Interviewer: (Nodding) That’s great.
Anne: When the feelings start, I need to control them before I get in trouble.
Interviewer: Exactly.
Anne: I think I can do this.

Anne stated that having specific steps to rely upon gave her confidence to go back to her unit and face her peers and staff.

Comments by Frank A. Fecser
Anne’s story illustrates so well the depth of conflict and confusion that many of our youth confront on a daily basis. Anne is struggling with her feelings of sexuality, her identity, peer connections, and relationships with adults. She carries with her the concepts of “right” and “wrong” that she learned as a child and finds that her thoughts and feelings are conflicted. This torrent of cognitions and emotions bubbles up from within and emerges as hostile, illogical, and troubling behavior. In her effort to purge herself of these painful feelings, she impulsively lashes out against others. When they respond with anger and rejection and other kinds of punishment, Anne is remorseful, guilty, and demeaned. The ironic twist in this scenario choreographed by Anne is that in the aftermath of the fray, as she is feeling the brunt of the other’s rejection, Anne is quietly comforted. What she is feeling parallels her beliefs about herself. When one believes oneself to be “dirt,” there is harmony in feeling like dirt is supposed to feel. And, by the way, there is no more tangled knot of conflicted thoughts and feelings. All is as it should be.

The adult who guided Anne through a Massaging Numb Values Reclaiming Intervention helped her take a strong step toward recognizing, understanding, and changing her self-defeating pattern of behavior. With support, Anne can begin to connect her impulsive behavior to her feelings. She can learn to decode her own behavior and find more productive ways of relieving her stress. As Anne gains the ability to manage the expression of her feelings, she also gains a new level of competence, which leads to increased self-respect and self-reliance.

The adults who will be supporting Anne as she works at building new skills will need to keep a sharp eye for opportunities to engage Anne in a review of her efforts to change her behavior. On those occasions when she is troubled and chooses to talk with staff, Anne will need plenty of affirmation. She could also benefit from some questioning about the cognitive process which led to a good choice: What did she do today to make it possible for her to come to staff instead of acting out? What did she say to herself? How does she feel about the way her choice worked out? We ask her “how she did it” in order to anchor attribution. We have to make sure Anne understands that it was she who changed her behavior through a cognitive process; we don’t want to risk her thinking that it was her lucky sweater that saved the day. Likewise, when she fails, we explore what went wrong and make plans to change it. This way, Anne will learn how to cope and plan and try again. The more times she tries, the greater the chances of eventual success.

The Massaging Numb Values Reclaiming Intervention is one of the most challenging for staff. Not only is identifying the central issue dependent upon the staff’s ability to correctly decode behavior, but issues which drive the behavior are often complex ones with substantial history behind them. Yet, helping a student gain confidence, self-respect, and competence is the goal we strive for as helping adults, and this intervention is a powerful tool in helping us attain our goal for the Annes of the world.

This feature: Thomas, T.; Whitson, S. and Fecser, F. (2001). From self-destruction to self-awareness: A Massaging Numb Values LSCI. Reclaiming Child and Youth, 10, 3. pp. 164-168.

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