If you regularly attend psychotherapy conferences, you can easily get the idea that doing therapy must demand a high level of sophisticated know-how—perhaps a firm grasp of the role of attachment theory in clinical work, or how to integrate mindfulness training into daily sessions, or which of the latest high-tech interventions best matches with a client’s specific presenting complaint. Though all these skills can undoubtedly help us become more creative and knowledgeable practitioners, I sometimes think we’re in danger of forgetting that some of the most important work we do isn’t based on any complicated methodology, but relies on the homelier values of compassion, patience, and common sense. The cornerstone of what we do is the ability to be present for people, making them feel seen, heard, and supported, whatever comes up.
In no area of therapy is this truer than school counseling, a field whose practitioners could be considered the equivalent to emergency first responders working on the front lines of a battlefield, dealing with sudden crises in the lives of little soldiers. As a school social worker in a South Bronx elementary school, the kids I see have a vast range of personal, social, economic, and medical issues, which can have disastrous consequences for their chances for success and well-being, even before they arrive at adolescence. Issues that come up routinely often include academic difficulties, PTSD, family violence, cognitive problems, an incarcerated dad, neglectful or abusive parents, social isolation, poverty, and the absence of community resources. Add homelessness, overcrowded housing, parental substance abuse, and violence in the neighborhood, and it’s no wonder that many families simply don’t have the emotional, much less the economic, wherewithal to nourish a child.
With so much stacked against these children, what can a school counselor do? How can we make a difference with children whose life circumstances seem so dismal? A few stunning miracle cures may be floating around out there, but the rewards of time, dogged persistence, and ordinary kindness in a supportive school environment can work their own kind of wonders. With these children, counselors shouldn’t expect to see changes in one or two sessions: this work can take years. It requires looking for small triumphs—little victories, which, in addition to improvement in school academically and socially, can include smiles where there were none, more resonance and volume in a voice that only spoke in whispers, a child looking forward to seeing the counselor and asking for specific activities, sharing small and large confidences, and making more eye contact. Working early enough with these children can help counteract an incapacitating present and provide vital coping skills for the future.
Getting Alex through the Door
I met Alex four years ago, when he was in first grade—a plump, Latino boy with large brown eyes and curly dark hair shaved on the sides. One morning during the first week of school, the assistant principal asked me to talk to Alex outside the school building because he flat-out refused to come inside. He was standing by the entrance with his arms crossed. His stone-cold face said, “I’m not going in there with you,” and for a long time, he didn’t. Students walked by in bunches, the latecomers straggled in, and then a tiny trickle, child by child, as Alex stood his ground. My attempts to break the ice by asking him about things he liked—TV shows, video games—were met with silence. Finally, I said, “Well, I’ll bet something happened that upset you this morning. Do you want to talk about it?” His eyes welled up and he began to cry. This is usually a prelude in young kids to opening up and talking, but not with Alex.
Usually an older sibling will have insight into family problems and can talk for the younger one. So I was glad that when I asked if he had an older brother or sister in school, he nodded and softly told me that his sister, Ali, was in the fourth grade. Soon Ali came downstairs and the three of us walked up to my office, where she explained that their mother had yelled at him that morning for taking too long to get ready for school. We then drew pictures of the family. Ali drew mom, Alex, and herself, while Alex drew himself, mom, Ali, and his dad. Family drawings are a great way to get kids to talk about who is and isn’t in their family. Whom they include or leave out is significant. After a while in my office, Alex told me that his mom and dad had just divorced and how sad that was making him. He missed his dad and described crying in bed nightly before falling asleep.
As the school year continued, Alex’s grief radiated into his school life. He became indifferent to social connection with classmates and unmotivated to work or even walk into class. In fact, during that first year, I got daily calls from his teachers to come up to his class, where I’d usually find him lying on the floor outside the room, refusing to go inside or even speak. Sometimes I could convince him to get up to a sitting position—but supine or sitting, he could stay outside the classroom like that for hours, despite my invitation to come to my office and talk. I’d stay with him as long as I could until my next appointment, or until his mother could come and pick him up to go home. Either way, he got no classwork done.
Early on, Alex’s mom explained her frustration with Alex’s delaying in the morning and his general sadness. She was initially empathic toward his missing his father, but soon became impatient and didn’t hide her feelings. One time, Alex sat brokenhearted, tears dropping to the floor in my office, as she described how she’d lose her job if she continued to come in for him. I tried having both parents come in together, but the rancor between them was palpable, and we accomplished little. His mom felt that his dad had no place to ask her to be more patient with Alex since he wasn’t around, and he directly blamed her for Alex’s sadness.
Slowly Alex warmed up to me, and his morning behavior began to reverse. He started standing outside the door instead of lying down, and he’d come with me regularly to my office. He wasn’t talkative, but we moved toward doing as the basis of our work, rather than speaking. We both seemed to evolve in each other’s presence, me making efforts to bring in creative interventions like art and story-making, and him making efforts to speak. In fact, making things allowed him to be less conscious of the focus on him, easing the path to verbal communication and, as an added benefit, raising his self-esteem.
Alex’s dad continued to come in so we could discuss Alex, their weekends together, and the things he admired about his son. It was a nice way for him and Alex to have some time together. In his dad’s presence, Alex’s entire demeanor would change dramatically. He sat straighter and smiled, and his eyes brightened as he paid close attention to what his dad said. Unfortunately, despite my doing anger coaching with his mother, she continued to yell at Alex for his sadness. Alex often commented that he wanted to live with his father, but he worked such late hours in the catering business that such an arrangement wasn’t feasible. As it was, Alex’s paternal grandmother had to watch him and his sister on weekends.
Because Alex was doing so poorly in first grade, he was placed in a special education classroom for second grade. He was referred for an evaluation and diagnosed by the school-based support team as having a learning disability caused by his lack of ability and motivation to work, a result of his depression. I began seeing him twice a week—once individually and once in a group session. In group, he was hard to engage and uninterested in making interpersonal connections. Usually, he’d sit back with his eyes half-closed and sink into sadness. But sometimes he was outright hostile toward group members. They’d challenge him in the beginning, pushing back with their own hostility, but soon learned to just look at him when he lashed out, understanding that he was acting out of his own sadness. While he remained depressed in his second year, he became more verbal in the individual sessions and gradually made a few friends. He began to be more accepting of his home life and showed so much academic improvement toward the end of the year that his teacher suggested he be mainstreamed into regular math and reading classes.
Alex was initially afraid of the mainstreaming and walking into a class full of new faces. For the first two weeks, he stood outside the classroom door in misery, refusing to go in. Every day I stood with him, encouraging him to try and reminding him that he could go back to his regular class afterward. Finally, we had success: he entered the classroom, caught on to the material quickly, and even began making new friends. A sign of his progress was revealed in a craft project he made: a scroll book, or roll of paper attached to chopsticks at either end. On the scroll, Alex wrote a story about a leopard who had no friends because everybody was scared of him. As he turned one of the sticks, unrolling his scroll, the story revealed that the leopard met a lion who also had no friends. It ended with the two deciding to play together.
Seven months into second grade, with success in the mainstreamed classes, his teacher wanted to place him full-time into a new class, comprising regular-education children and special-education children in equal numbers, with two teachers. Once again, Alex resisted the new move, but this time he went along anyway; there was no collapsing in a heap outside the door. To everyone’s great joy, he flourished there.
Shaping Their Own Worlds
Part of the work with children like Alex is giving them undivided attention, conveying the unequivocal message “I care about you,” which counts for a lot with a child who gets little loving attention at home and must vie for it from a teacher with 29 other students. But just as important is how that attention is structured. Using therapeutic tools like pencils, rulers, hammers, soldering irons, and glue-guns to engage them in making things like homemade models, cardboard sculptures, and vehicles temporarily frees them from a crippling focus on themselves and their own depression or anxiety.
Crafting things with their hands not only makes talking easier for kids, but gives them a can-do attitude, boosts their self-esteem, and increases their feeling of personal agency. Often they begin developing the sense that they can shape their own worlds. A finished project to take home can be a beautiful thing to a child. This work, by and large, doesn’t provide major or permanent fixes to the unfixable circumstances of their lives, but it does help them find ways to transcend their sadness and build up stores of inner resilience.
Children like Alex have had little choice in what happens to them, so when I work with them, I want them to feel, as much as possible, that they are making the choices. I allowed Alex to choose the supplies we used, the colors, and the kinds of projects we did together, be they making cars, rockets, or homemade board games. During these sessions, his voice rang with excitement and purpose, and he took obvious pride and pleasure in the objects he made.
Today, in our fourth year together, Alex still admits to feeling sad about seeing his father only on random weekends, but he smiles often and laughs. Even though I wasn’t successful in helping Alex get what he really wanted—more contact with his father—and could only facilitate a partially improved relationship with his mother, simply showing Alex that he has someone walking alongside him has made a big difference in his life.
Helping children who live in what many consider near-hopeless conditions of homelessness, neglect, chaotic households, and little intellectual or emotional stimulation can be quite a challenge. Yet the techniques I use—comforting them, encouraging them, letting them know I deeply care, giving them my undivided attention, teaching them a few simple craft projects, making jokes with them, focusing on small victories—can make the difference between hope and despair. My interventions may not seem complicated, but they help children replace feelings of worthlessness with a sense of their own possibilities.
As a young social worker, I used to feel frustrated and impatient with the slow pace of behavioral and emotional change in children like Alex. I thought I’d be the superhero of their lives and in a few months they’d blossom magically into problem-free, capable young people. Now I know better. However long it takes, however painstaking, this work is well worth the effort and the wait. Patience, compassion, and being there can help our youngest clients draw vitality out of living, and even the unhappiest can begin to believe that their lives are worth living after all.
Alex is doing far better academically, socially, and behaviorally than we might have expected of a boy who wouldn’t even get up off the floor to go into a classroom a few years ago. Recently, we built a castle out of cardboard and hot glue. As we played with medieval soldiers in and around the battlements, I commended his valiant effort to get through the day without having a meltdown. In fact, during our next session, I plan to have him knighted and the castle named after him in honor of his courage and his refusal to give up.
By Janet Sasson Edgette
Honigsfeld’s case study is a good example of why, in our fascination with flashy interventions, we shouldn’t play down what he calls the homelier therapeutic values of compassion, patience, and common sense. Anyone who’s worked with children or teenagers can probably relate to Honigsfeld’s early account of trying to break the ice with Alex by asking him about TV shows and video games—things he figured his young client liked. But it was only when Honigsfeld abandoned that tack and spoke in a way that reflected more directly what he himself was feeling and thinking—that something must have happened at home that morning—that Alex responded. Clinicians may see small talk as a way of easing into a conversation, but what kids see is a therapist who’s tentative and afraid to say the wrong thing. We don’t need the warm-up as much as we think we do, and kids are actually relieved when we come out and, with discretion and sensitivity, ask what they know we want to ask.
In reading through this case study, I did question Honigsfeld’s decision to stay with Alex for long periods of time outside his classroom. While this may have been a comforting and novel experience for Alex—an adult who adapts to him?! and who doesn’t get mad while doing it?!—with a passive, withdrawn child like Alex, I’d be careful not to reward his more regressive behaviors. Doing so can easily result in working harder at the client’s therapy than the client. So with Alex, I might’ve squatted down next to him in the hallway outside his classroom and said, “Hey, I heard you were having a hard time getting to class today so I thought I’d come visit for a few minutes. I hope you’re able to make it in there today. I’ve got to go, but why don’t you stop by my office during your lunch period and tell me how you made out? I’d really like that.” This would invite him to interact with me in a more active and intentional way.
Therapists naturally want to make their clients feel better, but many won’t mention to a client certain meaningful behaviors they observe in session because they’re worried the client will become upset or defensive. In my opinion, this omission causes a loss of faith in us, and limits our therapeutic impact. For this reason, I’d have seen Alex’s indifferent, hostile behavior in group, which seemed more expressive of contempt to me than grief, as a window of opportunity. By ignoring it, I’d risk communicating to Alex either that his provocations were acceptable, or that they weren’t acceptable but he’d be getting a bye because of all he’d been through—neither of which is a constructive message. Therefore, maybe after a soft, easy exchange in one of his individual sessions, I’d say something like, “Hey, what’s up with you and your groupmates? It seems as though you don’t want to have anything to do with them.” I wouldn’t necessarily expect Alex to answer, but it would get me an opportunity to communicate to him indirectly, I see you in this situation and recognize your discomfort. I don’t know what it’s about, but I’d like to. Maybe sometime we can talk about it.
I always look for opportunities to help my young clients realize that talking about their own behavior or reactions to things doesn’t have to make them feel defensive or embarrassed, the way it often does when their parents bring it up. A big part of that comes from normalizing human defenses by talking about how everyone develops certain habits to protect their feelings. To a child or teen who battles to be right all the time, for instance, I’d say, “Yeah, I get it. I mean, really, who doesn’t want to be right all the time?” but then I’d follow it up with an example of where I’ve seen his need to be right come back to bite him. An important part of the discussion, however, centers on the fact that I’m not telling that kid to stop battling to be right—he has plenty of people already doing that—and as a result, we can talk about this part of his personality, which allows him to reflect on whether it’s working for him as well as he thinks it is.
I don’t wish any of these comments to take away from Honigsfeld’s work with Alex. His contribution to Alex’s psychological health and well-being was huge, and he made an impact by doing something no one else was doing for this boy: giving him the feeling that he mattered. For a kid coming from a community and household in which attention, unconditional regard, comfort, and gentle humor were in short supply, what Honigsfeld had to offer was a spot-on match.
Illustration © Sally Wern Comport
CategoriesIn the Therapy Room Clinical Practice & Guidance Anxiety & Depression Clinical Skills & Experience Families Kids & Teens
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