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Hidden Harm. The Child Who Never Complains · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:01
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:05
  SPEAKER_00: In the last episode that was concerned with a series on safeguarding, I indicated that I wanted to do a companion series, which I think has more to do with understanding risk and the hidden harm that children may be experiencing and what adults may very well miss.
• 0:36
  SPEAKER_00: So in this first episode, I want to talk about the child who doesn't complain.
• 0:41
  SPEAKER_00: There are some children who don't cry out, they don't make a fuss, they don't demand, they don't protest, and they don't really cause disruption.
• 0:50
  SPEAKER_00: They're often described as easy or mature or no trouble at all.
• 0:56
  SPEAKER_00: And because of this, they're often missed.
• 0:59
  SPEAKER_00: They slip under the radar.
• 1:03
  SPEAKER_00: There's something quite compelling as adults about the child who appears to need very little, you know, in busy homes, pressured school environments, in families under strain, a child who adapts, who complies, and who doesn't add to the emotional load can be quietly experienced as something of a relief.
• 1:27
  SPEAKER_00: But psychologically, we really need to be asking a different kind of question about this.
• 1:33
  SPEAKER_00: And the question is, what has this child learned about their own needs that they no longer express them?
• 1:42
  SPEAKER_00: Because children aren't born without needs.
• 1:44
  SPEAKER_00: They're born in a way which is obviously not self-sufficient, and then they're certainly not born easy.
• 1:50
  SPEAKER_00: They become this way in response to something.
• 1:54
  SPEAKER_00: Now, developmentally, this kind of adaptation emerges in environments where emotional space is limited, maybe because it's being taken up by other family members, adults are overwhelmed, unavailable, or preoccupied, or where expressing need has at some point led to discomfort in themselves or in others.
• 2:19
  SPEAKER_00: And the child begins to register something subtle but powerful.
• 2:23
  SPEAKER_00: And that is, my needs don't fit here.
• 2:26
  SPEAKER_00: And so rather than risk rejection, frustration, disconnection, or aggravating what already might be happening, they begin to withdraw the expression of those needs altogether.
• 2:40
  SPEAKER_00: Now, what this looks like externally is a child who never asks for help, a child who accepts disappointment without protest, the child who gets on with it, the child who comforts others rather than seeking comfort.
• 2:57
  SPEAKER_00: And importantly, these children are often praised.
• 3:02
  SPEAKER_00: But internally, something very significant is happening.
• 3:05
  SPEAKER_00: The child is learning to inhibit emotional expression, prioritize others over themselves, and disconnect from internal states.
• 3:15
  SPEAKER_00: And over time, this can lead to emotional flattening, difficulties recognizing their own needs, and vulnerability to relationships where they may be and may remain unseen.
• 3:30
  SPEAKER_00: Now, this isn't about blame.
• 3:32
  SPEAKER_00: Many parents listening will recognize this and feel concerned, perhaps even guilt, but this isn't about failure, it's about awareness.
• 3:42
  SPEAKER_00: Because what's required isn't perfection but recognition.
• 3:48
  SPEAKER_00: What helps?
• 3:49
  SPEAKER_00: Well, not dramatic change, not interrogation, but small consistent invitations, like, how did you feel about that?
• 4:00
  SPEAKER_00: What was that like?
• 4:03
  SPEAKER_00: Or saying, you know, you don't have to be okay all the time.
• 4:08
  SPEAKER_00: And things like sometimes it's like you behave as if you and what you want isn't there.
• 4:18
  SPEAKER_00: And essentially what you're saying to the child is I am the caretaker.
• 4:24
  SPEAKER_00: I am the I am the person who takes care of you and your needs, thus validating that needs are okay.
• 4:35
  SPEAKER_00: Because the task isn't about fixing the child, it's to help them rediscover that what they're experiencing matters.
• 4:46
  SPEAKER_00: The quiet child is not always the subtle child.
• 4:50
  SPEAKER_00: Sometimes they are simply the child who has learned not to be heard.
• 4:56
  SPEAKER_00: I see children who have this kind of adaptive quality.
• 5:02
  SPEAKER_00: Sometimes in the consulting room, what I what I see is children who behave towards me as if they have a sense of how I want them to be, which is really not the case at all, but that's what they bring.
• 5:23
  SPEAKER_00: They bring this template of adaptation, and very often such children will rationalize their needs, they will say, I'm okay, or no, I don't, I no, that didn't make me angry, I understand.
• 5:42
  SPEAKER_00: And this kind of suppression of internal emotional states and it and their denial really is concerning because those feelings may very well be there, but they've been so suppressed that they will inevitably find expression in some way or other.
• 6:06
  SPEAKER_00: When I see patients who have self-harming behaviors, eating disorders, almost always what I see is that there has been a history of the suppression of needs.
• 6:22
  SPEAKER_00: And I think what happens is this causes the most powerful internal conflict in the child because their only way of gaining relief from this conflict and the sense of powerless, powerlessness, uh is something which will find expression through symptomatic behaviors.
• 6:45
  SPEAKER_00: Many years ago I was doing a placement at the Maudsley Hospital where I was involved in the eating disorder unit, and I remember the lead clinician talking about and reminding us that eating disorders were family disorders, and that eating disorders do not develop in isolation, they develop as a consequence of a complex family system.
• 7:17
  SPEAKER_00: And this has informed my thinking and a great deal, and almost always what I see with patients who have eating disorders is that there is a notable denial of the self, a notable denial of the their own emotional states and the reality of those.
• 7:43
  SPEAKER_00: They become suppressed, and as a way of controlling the conflict that that causes, restrictive eating self-follow-on.
• 7:53
  SPEAKER_00: It's probably where self-harm is concerned, it isn't always the case that this is something which is only connected to the suppression of needs.
• 8:07
  SPEAKER_00: There might very well be other factors involved, and sometimes we see a cluster of symptoms which is fairly typical.
• 8:16
  SPEAKER_00: So I suppose, in a sense, what I'm what I'm trying to convey is that those are some of the ways in which expression of this adaptive behavior may occur.
• 8:28
  SPEAKER_00: And these are things that tend to develop over time.
• 8:34
  SPEAKER_00: They're not dramatic, but they develop over time.
• 8:39
  SPEAKER_00: Therefore, we have to then think if such children are compliant, if or more specific compliant, but also easy and quiet, what don't we know?
• 8:53
  SPEAKER_00: What don't we know about what that child is experiencing?
• 8:57
  SPEAKER_00: Does this adaptive behaviour mean that they are more likely to be vulnerable to risk of some kind?
• 9:10
  SPEAKER_00: In the next episode, I want to look more into this subject.
• 9:17
  SPEAKER_00: I want to look more into how compliance, the overcompliance, is another feature that is actually signaling something else.
• 9:29
  SPEAKER_00: Thank you for listening.