We’ve all heard the age old proverb “it takes a village to raise a child”. With mental health care taking a sharp, yet important, turn towards exploring the effects of trauma and adverse childhood experiences, the saying may be more important than ever.
Last week I met with the teachers from a private school in Adelaide to brainstorm new solutions for a 16-year-old who, although thriving academically, had ruptured relationships with a few of his teachers. These teachers were fed up and tired. I acknowledged that when I first met this boy, I found our initial sessions challenging, but addressed the warning signs showing that maybe our work wasn’t as effective as it should be. Things changed and his family reported significant improvements at home.
But school remained an area of concern and the teachers organised a meeting. The morning of the meeting, I read a wonderful Maggie Dent article reminding me of the importance of engagement and where the responsibility really lies.
While even an average therapist is likely to help the majority of his or her clients, there is one looming problem, not spoken of publicly, that plagues the field of mental health: dropouts. As Maggie pointed out in her article, we can’t teach the student if they don’t show up. For mental health professionals, we may say that person is not ready, doesn’t think he or she has a problem, is in denial, resistant, lying, precontemplative, or any other term placing blame on the client for not engaging in the service we’re providing. Although these terms have been used for decades, they haven’t prevented dropouts or predicted what person is likely to benefit from our services.
When I started working with this boy I took the risk of dropout seriously. I knew that if my service did not benefit him or the family early on, they were more likely not to come back. Also, issues in our relationship can forecast future dropouts. Favouring these two key areas, I found where I could change my approach and address issues in our relationship to improve his engagement in the therapy process.
As a survivor of severe, early life trauma, this boy has struggled to keep positive relationships with authority figures around him. While some teachers work seamlessly with him, others find themselves in a constant power struggle, arguing over minute details that interfere with the experience of other students and escalating to the point of warnings, detentions, and risk of suspension. While these processes may work for other students, this particular adolescent tends to internalise what has happened, becoming more withdrawn and disengaged in the classroom. This approach wasn’t working.
I give this school immense credit. Inviting in an outsider and hearing a different point of view does not happen all the time. And in truth, sometimes these consultations are uncomfortable and challenging. After all, we were all trained differently and come from different fields. What was said in the meeting was, however, positive, focused on outcomes, and collaborative. I started with the idea that, together, we had the opportunity to do some profound work for this boy, a survivor of unimaginable early life experiences. While he had that “tough guy exterior”, he was cut deep and knows where his struggle hid.
I brought up the importance of engagement and relationship. As a therapist, I can take the usual route of calling my client resistant or in denial, but this will not improve the chances of me helping him. As a teacher, we could say he is the delinquent child that takes up the majority of my time in the classroom and disrupts the other students. This approach is also unlikely to solve the problem. As parents, we can say to ourselves, “he just doesn’t get it” or "he needs to pull his head in". Again, these approaches are more likely to distance ourselves from the boy, breaching collaboration and potentially rupturing future attempts to help.
We came up with a new plan that shifted responsibility to this boy’s “village”…the adults. We brainstormed ideas for engaging the boy using the all his key strengths. Caring about social justice, athletics, playing with younger children, and working one on one with the educational specialist of the school were all identified.
One teacher courageously acknowledged that teaching the 90% of students that respond to her is easy. Addressing the 10% that tend to disrupt her classroom is very challenging. She is absolutely right. If therapists don’t address their rates of dropouts, things are likely stay the same. It is not the child’s responsibility to engage with us, it is ours. From the first day in the bush or our initial session in our office, engagement is the responsibility of the professional. Using our relationship to earn this engagement, we can make sure that the young people who need our services the most, those most vulnerable, will stick around, giving us the opportunity to be the best “village” we can be.
Will Dobud MSW