Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / From Inside The Consulting Room. The Child In The Middle

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From Inside The Consulting Room. The Child In The Middle · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:02
  SPEAKER_00: Hello, this is Kim Lee, child and adolescent psychotherapist.
• 0:06
  SPEAKER_00: This next episode in the series, From Inside the Consulting Room, looks at part two of the situation that has to do with not just outcomes for the patients that I see, but facing the reality that sometimes therapy is just not enough.
• 0:30
  SPEAKER_00: And as I said in the previous podcast, these sorts of situations are so strongly influenced by what happens outside of the room.
• 0:41
  SPEAKER_00: Now this episode is entitled When Parents Can't Work Together and When the Child is then in the middle.
• 0:49
  SPEAKER_00: There are some children who aren't asked to choose, but live as if they must.
• 0:56
  SPEAKER_00: And when I say choose, it's between parents.
• 1:00
  SPEAKER_00: And there are some who are not only in the middle, but they're exposed to everything.
• 1:07
  SPEAKER_00: Everything that sits between the two parents.
• 1:12
  SPEAKER_00: In this episode, I want to continue to talk about the child who lives between parents.
• 1:18
  SPEAKER_00: And when I say that, I don't mean necessarily in a physical sense, but that too.
• 1:26
  SPEAKER_00: But we're also going to go further.
• 1:30
  SPEAKER_00: Because we're talking about not just parents who live in this way, but they can't work together.
• 1:36
  SPEAKER_00: And then we're going to look into what happens when conflict becomes something far more serious.
• 1:43
  SPEAKER_00: Because not all conflict is the same.
• 1:46
  SPEAKER_00: Okay, there's disagreement and then there is hostility, and then there are some environments that become frightening.
• 1:55
  SPEAKER_00: They become frightening not just for the children but for maybe the adults as well.
• 2:02
  SPEAKER_00: I worked with a 12-year-old girl over a period of several years, and she had a younger sibling, and both children had grown up within a family system marked by chronic alcohol misuse, drugs, repeated verbal conflict, and episodes of physical and verbal aggression between violence.
• 2:27
  SPEAKER_00: Police were frequently called to deal with what was happening between the parents, and it was an incredibly volatile and dangerous situation.
• 2:42
  SPEAKER_00: She described nights where shouting would escalate, objects were thrown, she would hear her mother screaming, the father shouting, abusive language, and where doors weren't just slammed, they were effectively knocked off their hinges.
• 3:04
  SPEAKER_00: The atmosphere there shifted very quickly from being tense to being intensely volatile.
• 3:10
  SPEAKER_00: Now, from a developmental perspective, this is not simply exposure to conflict, it's much, much more.
• 3:17
  SPEAKER_00: It is exposure to uncontained, incredibly frightening emotional states.
• 3:25
  SPEAKER_00: If the environment is no longer able to receive and process emotional experience, then the child is left to absorb it.
• 3:34
  SPEAKER_00: Over time, this creates hypervigilance, emotional instability and emotional dysregulation, heightened threat response, and difficulty distinguishing internal from external experience.
• 3:48
  SPEAKER_00: The neuropsychological effects upon children whose brains are growing at a rapid rate is very significant.
• 3:58
  SPEAKER_00: And once the neural pathways between the transmitters and receptors within the brain are formed, they become automatically triggered, often as a consequence of very minimal stimuli.
• 4:14
  SPEAKER_00: She'd been excluded from two private schools, subsequently a state school, not because of a lack of ability, but because of behavior that just couldn't be contained within the school environment.
• 4:26
  SPEAKER_00: And her behavior became increasingly more difficult.
• 4:31
  SPEAKER_00: She was stealing significant amounts of money, she became physically aggressive, she attacked her sibling and at times required physical restraint.
• 4:42
  SPEAKER_00: And on more than one occasion, she was found holding a knife within the family home and making very threatening gestures with it.
• 4:51
  SPEAKER_00: Now, these moments are difficult to picture, and and and they must be.
• 5:00
  SPEAKER_00: Because if we move too quickly to control the behavior, we lose sight of what is being expressed.
• 5:10
  SPEAKER_00: Yes, of course, we have to respond to the behavior in the moment.
• 5:14
  SPEAKER_00: However, a child in this kind of incredibly inflamed state needs something a lot more thoughtful.
• 5:25
  SPEAKER_00: From a Kleinian perspective, I'm talking about the Melanie Klein, Melanie Klein, the famous child psychoanalyst.
• 5:32
  SPEAKER_00: We can understand this in terms of overwhelming emotional, internal states that cannot be integrated.
• 5:39
  SPEAKER_00: And aggression in this context is not simply directed outward because it reflects an internal world that feels dangerous.
• 5:49
  SPEAKER_00: Now, when I worked with this girl, one of the things that was most noticeable was that she would arrive for her sessions almost always in a volatile state.
• 6:03
  SPEAKER_00: Certainly, this was the case for the first 18 months or so.
• 6:08
  SPEAKER_00: By volatile, she she was she was loud, her presence was clearly felt.
• 6:13
  SPEAKER_00: From the moment she stepped through the doorway, she looked as if she was offended, angry, defensive, she was defiant, oppositional, but not with me.
• 6:28
  SPEAKER_00: She would describe all of the things that had happened, which unsavory person, I'm choosing my language carefully, had offended her, what they had done, why it was the case that she had then what done what she had done, and nobody understood.
• 6:44
  SPEAKER_00: And actually that was true.
• 6:45
  SPEAKER_00: Of course she didn't either.
• 6:47
  SPEAKER_00: And I used to sit and listen and just ask her to tell me about it.
• 6:53
  SPEAKER_00: Tell me what had happened.
• 6:55
  SPEAKER_00: And she would be loud and aggressive, and I would just listen and occasionally say something, acknowledging what she was telling me.
• 7:08
  SPEAKER_00: And the reason for doing that was because I wanted her to I wanted her to have a sense of being with someone who was saying, I understand, not I know how you feel, or and how did you feel about that, because young people tend not to like that very much, and it's not the way I work anyway.
• 7:26
  SPEAKER_00: But it was a real sense of it's all right, you can tell me.
• 7:29
  SPEAKER_00: Nothing bad is gonna happen.
• 7:32
  SPEAKER_00: And she told me some pretty horrific things, and but nonetheless, it didn't matter how how uh dramatic these things were, they just got listened to, and that was fine.
• 7:48
  SPEAKER_00: And then what would happen is she would she would just come down bit by bit she would come down, and I said to her one day, I said, I'm gonna call you my helicopter girl, because when you arrive, you're on the ceiling, you're quite noisy, but after a little while you land.
• 8:11
  SPEAKER_00: And she laughed, and because she could see that what I was describing was something I could see, it wasn't criticism, it was just okay, that's how you need to be.
• 8:20
  SPEAKER_00: And bit by bit she started to land sooner.
• 8:25
  SPEAKER_00: Sometimes I would say when she started to quiet and something like, You okay now?
• 8:30
  SPEAKER_00: All right, and to smile, and then we could talk, and it was really good because what I would see was this far less defended person who was able to talk about what was really going on underneath and what it really felt like.
• 8:51
  SPEAKER_00: It was interesting because her relationship with her her younger sister was somewhat inevitably affected, and at times she would move toward her with intensity that felt disproportionate.
• 9:08
  SPEAKER_00: But when we looked at that, something else emerged, and she said she gets to be the normal one.
• 9:18
  SPEAKER_00: Now, here we were facing envy, loss, and the unbearable awareness of unmanageable difference.
• 9:29
  SPEAKER_00: And from an attachment perspective, there was no secure base, no consistent place from which she could internally organize herself.
• 9:38
  SPEAKER_00: Instead, she lived within unpredictability, emotional fragmentation, and relational instability.
• 9:47
  SPEAKER_00: Unsurprisingly, she came to the attention of multiple services, police, safeguarding, mental health services, and everybody was concerned, and everybody tried to intervene.
• 10:02
  SPEAKER_00: But there was a central problem.
• 10:06
  SPEAKER_00: Over the three years of work, it wasn't possible to establish a consistent collaborative relationship with parents.
• 10:16
  SPEAKER_00: They remained hostile, divided, and completely unable to work together.
• 10:22
  SPEAKER_00: I remember trying to see them together on a couple of occasions, and it was chaos.
• 10:30
  SPEAKER_00: And I remember in one session actually intervening and saying, enough, we're not doing that here.
• 10:37
  SPEAKER_00: The aggression, hostility, accusation was phenomenal.
• 10:44
  SPEAKER_00: And of course, what it did was to show me what was going on, and I pointed out to them that regardless of their differences, we had to focus on their daughter and indeed her their other daughter, because that was why we were here, not for anything else, and that I wasn't prepared to enter into anything else.
• 11:09
  SPEAKER_00: And that was a line that I held, although it was tested quite heavily.
• 11:15
  SPEAKER_00: And I remember in another session saying to them, okay, I'm going to talk to you about trajectories.
• 11:21
  SPEAKER_00: And I said, Your daughter is on a pathway that involves alcohol, drugs, self-harm, possible promiscuity, criminality, and failing mental health.
• 11:39
  SPEAKER_00: And they looked at me as if to say, Why are you dramatizing this?
• 11:45
  SPEAKER_00: And I said, But it doesn't have to be that way.
• 11:49
  SPEAKER_00: In the father, there was a bit more receptiveness, a bit more understanding, and he was starting to pay attention to his relationship with alcohol, and I think the fog started to lift.
• 12:07
  SPEAKER_00: However, the acrimony between the parents remained.
• 12:12
  SPEAKER_00: Now, without a coherent parental system, the child has nowhere stable to place their experience.
• 12:22
  SPEAKER_00: One evening there was a knock on my door, and it was the girl.
• 12:29
  SPEAKER_00: By the time she was about fifteen, and her arms were bleeding, and she was crying.
• 12:37
  SPEAKER_00: And I immediately took her straight in, and she had cut her arms by punching through some glass panels in the doorway of her mother's home.
• 12:52
  SPEAKER_00: And this was this this was quite shocking.
• 12:57
  SPEAKER_00: And so, you know, I dressed the wounds, called the mother, called the father, and of course called the police because here was further evidence of a young person at risk.
• 13:11
  SPEAKER_00: Fortunately, she had sufficient trust to come to me.
• 13:16
  SPEAKER_00: But she had walked some distance to do that.
• 13:22
  SPEAKER_00: Now, I think about connection, and this was a moment when there was a real sense of connection, but translating that into something else required the familial environment and a relationship between the parents to radically shift.
• 13:45
  SPEAKER_00: But she came every week.
• 13:47
  SPEAKER_00: Sometimes she would come more than once a week, which was actually strongly indicated.
• 13:52
  SPEAKER_00: There are times when patients just cannot manage a whole week between one 50-minute appointment and the next.
• 14:01
  SPEAKER_00: Sometimes therapy has to provide more than that initially until we see stabilization.
• 14:08
  SPEAKER_00: But also it's because there are times when we have to monitor risk, and waiting a week is a long time.
• 14:16
  SPEAKER_00: Where this girl was concerned, there was limited or no capacity for mentalization in the parents.
• 14:27
  SPEAKER_00: And when I say that, what I mean is that they were so locked in their into their own mental health states and their own preoccupation, particularly with blaming the other, that the great chasm that was created is something this girl fell down.
• 14:48
  SPEAKER_00: Sadly, over time, the risk increased.
• 14:52
  SPEAKER_00: She was frequently arrested, behavior became more and more unpredictable, and the internal pressure continued to build.
• 15:03
  SPEAKER_00: There were two serious suicide attempts, and they weren't gestures, but they were moments where the internal experience was so painful and unbearable, she just wanted for the pain to stop.
• 15:21
  SPEAKER_00: At this point, we must be very clear.
• 15:25
  SPEAKER_00: When a child is repeatedly exposed to uncontained emotional environments and has no stable relational base, then risk really escalates.
• 15:38
  SPEAKER_00: The statistics bear that out.
• 15:41
  SPEAKER_00: The ending of therapy was abrupt because her father removed her from the country in an attempt to create a different start.
• 15:50
  SPEAKER_00: It was very hopeful, but too late.
• 15:57
  SPEAKER_00: I remember him saying, I keep thinking she'll turn a corner.
• 16:04
  SPEAKER_00: And I said, for that to happen, we have to get her off the roundabout.
• 16:10
  SPEAKER_00: Sometime later I became aware that she had been admitted to psychiatric hospital under the Mental Health Act following a series of incidents.
• 16:25
  SPEAKER_00: Now this isn't a failure of therapy.
• 16:28
  SPEAKER_00: It's a reflection of what therapy alone cannot hold.
• 16:34
  SPEAKER_00: The same father contacted me a couple of years back and said, I wish we'd listened.
• 16:43
  SPEAKER_00: Everything you said has come true.
• 16:46
  SPEAKER_00: And I remember feeling an overwhelming sense of sadness and futility.
• 16:56
  SPEAKER_00: Therapy doesn't replace the environment.
• 16:59
  SPEAKER_00: It can only work within the limits of what surrounds the child.
• 17:04
  SPEAKER_00: The child in the middle is not simply caught between parents.
• 17:10
  SPEAKER_00: They're living inside what they can't resolve.
• 17:15
  SPEAKER_00: And what remains unheld doesn't stay between them.
• 17:20
  SPEAKER_00: It becomes the child.
• 17:23
  SPEAKER_00: Thank you for listening.