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Consequences can broadly be described as what happens after an action, whether or not that action was pro-social or healthy.  I say that to clarify that although the word “consequence” is often thought of in negative terms, we work to teach that all actions have a reaction or consequence, and that the initiator of the action is the one who will be reaping the greatest effects of their action.  Cause and effect is one of the most basic skills my coworkers and I hope to teach clients who come to treatment.

The way we teach that sort of cause and effect is through natural and logical consequences.  Logical consequences are the consequences that occur external and planfully.  For example, getting a ticket for speeding or earning a paycheck for working are both logical consequences.  Natural consequences are the consequences that will occur regardless of any logical consequences.  In the same examples, feeling guilty or being late because you got pulled over are natural consequences.  Earning trust with your supervisor would be a natural consequence for working consistently.  Identifying the natural and logical consequences for actions assists clients in being able to eventually anticipate them, and modify their behaviors accordingly.

When a child or adolescent client comes to residential treatment, they typically go through four different phases. The first phase is the “Honeymoon” or Assessment phase. During this time, the client is discovering whether or not their new setting is safe, getting to know others and learning and testing the rules. A client may stay in this phase for any period of time, typically anywhere from an hour to a few months. Anecdotally, I have noticed that children with a more significant history of trauma typically honeymoon for a longer period of time. When you consider that clients are discovering whether or not the placement is safe, it makes sense that children or teens with serious histories of trauma would honeymoon longer. This phase is important because the client needs to know that there are safe and this is time that they do it. Additionally, this phase helps with the later phases because while the child is “on their best behavior” they have the opportunity to earn relational “points” with their staff and peers. Later, when they feel safe enough to act out, staff can call upon positive memories with the client to recall that the client has positive parts, in spite of the fact that they are using non-adaptive parts at the time.*

After the child learns that they are safe, they transition into the Resistive phase of treatment. This is the phase where as a counselor, I have most of my more absurd behavioral stories from. (I remember one night coming home and tweeting: “I got whipped in the face with a belt – otherwise, it was a good night.”) During this time, the child is showing the behaviors that got them into residential treatment. They are acting out and testing limits to a greater extreme. It is important to note here that not all children act out in a physically aggressive way; some kids act out by attempting to control or manipulate relationships through triangulation, slander, or gossip. Additionally, some kids act out internally, cutting and purging being some of the more common ones I have seen. It is at this phase that the child begins to recognize their own behaviors that brought them to treatment.

Following the Resistive phase of treatment, comes the Explorative phase of treatment. During this phase, children begin to be willing or able to ask for help understanding why they act out the way that they do. They begin to understand the reasons for their acting out.  It is important to note that all non-adaptive coping techniques were adaptive at some point.  There are obvious examples, like the child that screams or tantrums to get what they want.  Examples that have interested me more over the past year and a half of working in residential treatment are the unexpected ones, like an adolescent who would squawk like a bird during times of stress.  Their interest in non-utilitarian relationships also increases exponentially during this time. This is where the “beef” of residential treatment occurs – it is where we as treatment counselors, cease to be compared to babysitters or correctional officers and become counselors. It is here that we use our specifically “counselor” part.

Finally, the last phase is Integrative.  During this time, children are learning to integrate the skills and coping techniques that they have learned in treatment to their home environments.  They are learning to integrate their past behaviors, past coping techniques, new skills, new relationships into one whole and integrated person albiet and appropriately made up of a variety of different parts.  It is at this point that discharge plans are made, and the child prepares to leave treatment.  There may be some backsliding at this point, but that is fairly normal with the stress of impending discharge.

*One of the most effective interventions that I have learned is using “Parts language.”  By identifying the child’s various parts obviously (“angry part,” “crying part,” “curious part”) or more descriptively (“gangster part,” “entertainer part,” “puppy part”), counselors model integration of the whole person.  It is reasonable to expect to see an entire post devoted to Parts language someday.

“This life, therefore, is not righteousness, but growth in righteousness…”

I am white, young, married, middle class.  I live in a one bedroom apartment in a affluent area of St Paul, MN the more homogeneous half of the Twin Cities.  When I wake up in the morning, I go to the Y to work out.  While I run, I read Self Magazine, celebrity gossip, or every now and then the New Yorker.  I come home, I check my email, my Facebook.  I do laundry most mornings, and then I shower.  I straighten my hair and then I go to work.

They are sometimes biracial, sometimes products of single parenthood or grand-parenting, and all socio-economic classes.  They live at Holcomb because it is unsafe at home, either because of their actions or the actions of their caregivers.  (Often those actions are in tandem.)  When they wake up, they take turns in a bathroom with 4-6 other residents of the same gender.  They brush their teeth, they apply sheen spray or gel, they straighten their hair.

“…not health, but healing…”

We meet in the afternoon.  My coworkers and I introduce the day, run through the daily shift plan.  It is the same as every other Monday, Tuesday, Wednesday, but we review it.  They have not been able to trust adults before; the adults in their life have sometimes reneged on their responsibilities, sometimes been unable to live up to them.  Because they cannot trust adults, they need to trust the schedule.

Together we snack on beef sticks or cereal and go to different rec activities, different therapy groups, and a different dinner every night.  They flood their food in ranch dressing.  The evening commences with trips to the pool and a rec center and on Wednesday nights, the mall.  We play with teenagers who were unable to play as children.

“…not being, but becoming…”

We teach empathy to teenagers who never had empathy modeled.  We teach the actions of forgiveness with the hope that the feelings follow.  We teach accountability with the hope that the forethought eventually follows.

We laugh both with and at them and expect them to do the same.  (We walk the earth, not eggshells.)

Sometimes the nights are tough.  At the end of those nights there is extra paperwork, sometimes extra laundry.  I have been called names that are physiologically impossible and filed charges for assault.  By the same token, I have received hugs from kids who used to flinch at physical touch.

“…not rest, but exercise…”

At the end of the shift, my coworkers and I fill out logs and count their successes.  The teenagers sleep, and we slide our peacoats and parkas back on to slip into the Minnesota night.  Our cars scraped and brushed we go home.

I open my door quietly, my husband long asleep.  I check my email, brush my teeth and crawl into bed.

They are changing old habits, learning the safety of routine, that adults can care for them, and that they really are capable.  We are learning to let go of ourselves, let our affect fade, care for kids who are unlovable, that diagnoses can hardly be described in textbooks.

“…We are not what we shall be, but are growing toward it…”

As a counselor, I am unfinished.  I am in the process of pursuing a graduate education and licensure.  I still find myself locked into power struggles I am unsure how I started, I still notice my affect showing, and I am learning more and more about the craft of counseling.  When I started at Holcomb, I thought that a year later, I would be done with my practical education, ready to move on to other things having have mastered the craft.  Yet, I continue to find that each teen brings new challenges to me, new opportunities to learn and refine.  When I think of Martin Luther’s quote, woven throughout this post, I think first of the teens I work with.  They certainly are not what they shall be.  They are growing, physically, socially, emotionally.  However, I find that the growth is not only theirs.  It is also my own.

I am learning more and more that I will never finish my education as a counselor and helper.  When I have my doctorate, post-doc, supervision hours, license, the process will have only begun.

“…the process is not yet finished, but it is going on…”

March 2017
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