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From inside the consulting room.The Angry Child · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:02
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:06
  SPEAKER_00: In this series, I'm talking about what happens inside the consulting room, how it initially presents inside the room, and how I guess what I do is to try and understand it at a much deeper level.
• 0:24
  SPEAKER_00: So this episode is about the angry child and what their rage is protecting.
• 0:35
  SPEAKER_00: Anger is an emotion that people sometimes describe as negative, but there is no such thing as a negative emotion.
• 0:49
  SPEAKER_00: Good mental health requires us to be able to understand, experience, and tolerate whatever that emotion might be so that it doesn't find expression in behavior.
• 1:03
  SPEAKER_00: And when it does, then people might become concerned.
• 1:09
  SPEAKER_00: They might talk about the need for anger management.
• 1:15
  SPEAKER_00: Well, yes, I understand that, but management on its own is not enough.
• 1:23
  SPEAKER_00: We have to understand what the expression of anger is trying to tell us.
• 1:32
  SPEAKER_00: And there are some children who are simply known for one thing, their anger.
• 1:39
  SPEAKER_00: They shout, they refuse, they break things, they push back, they erupt, and very quickly they become understood as the problem.
• 1:52
  SPEAKER_00: But what if the anger is not the real problem?
• 1:59
  SPEAKER_00: In this episode, we are thinking about the angry child and more importantly, what the anger might be presenting, and indeed protecting.
• 2:12
  SPEAKER_00: Many years ago I worked with a very well-known child psychiatrist, a man called Vladimir Gahan, who was involved in the production of a book on violence, and within it were a number of very high-profile people in my work who were looking at this forensically, and the single most unifying theme in that book was fear.
• 2:48
  SPEAKER_00: That in some way the violence was understood as a what's called a maladaptive conversion of fear.
• 3:01
  SPEAKER_00: So if we look beneath the surface, people who behave angrily and sometimes violently were experiencing something in which their internal fear, which had been triggered, was translated or transformed in a nanosecond into angry, aggressive, or violent behavior.
• 3:25
  SPEAKER_00: And so when we think about that in relation to children, what we're really seeing is children who react very quickly.
• 3:36
  SPEAKER_00: Small things become big.
• 3:38
  SPEAKER_00: Could be a change in plan or a request or a moment of frustration, and suddenly everything escalates.
• 3:46
  SPEAKER_00: At home, well, this is exhausting.
• 3:52
  SPEAKER_00: And at school it's often labelled as disruptive, oppositional, difficult, and over time a different kind of narrative begins to settle and become normal.
• 4:05
  SPEAKER_00: This is just who they are.
• 4:07
  SPEAKER_00: This is just how they are.
• 4:10
  SPEAKER_00: In my mind, that's lazy thinking.
• 4:13
  SPEAKER_00: Because psychologically, anger is really the primary expression.
• 4:20
  SPEAKER_00: It's almost secondary, almost always it's secondary, which means it comes after something else.
• 4:29
  SPEAKER_00: Underneath anger, there is often hurt, fear, shame, or a sense of being overwhelmed.
• 4:37
  SPEAKER_00: And these feelings are harder to tolerate.
• 4:40
  SPEAKER_00: So the mind does something quite remarkably, which has to do with transformation.
• 4:47
  SPEAKER_00: These things are transformed into expressions of anger.
• 4:53
  SPEAKER_00: A boy I worked with who had been described as constantly angry, came into the room, sat down heavily, looked around, and everything about him said this boy's on the edge, so be a little careful.
• 5:12
  SPEAKER_00: And if something hadn't gone his way, he reacted immediately, sharp, fast, intense, and at first glance it looked like defiance.
• 5:24
  SPEAKER_00: But if I stayed with him and began to notice something else.
• 5:29
  SPEAKER_00: He watched very carefully every moment, every shift in tone, as if he was asking, Am I a safe person or not?
• 5:41
  SPEAKER_00: Was I going to react to him?
• 5:45
  SPEAKER_00: Was I going to protect him, correct him?
• 5:53
  SPEAKER_00: In attachment theory, we understand that a child who's experienced inconsistency and unpredictability or emotional uncertainty may develop an internal world of the world as unreliable, unpredictable, unsafe.
• 6:10
  SPEAKER_00: And when that's the case, the system stays alert.
• 6:15
  SPEAKER_00: It's almost as if the arousal in the neurological system is set to look out.
• 6:24
  SPEAKER_00: Something bad might happen.
• 6:26
  SPEAKER_00: Be prepared.
• 6:28
  SPEAKER_00: So the nervous system in these children is often operating close to what we call a threat response, not because danger is present, but because it's been anticipated.
• 6:40
  SPEAKER_00: And when the system detects threat, it moves quickly into not reflection but into action.
• 6:48
  SPEAKER_00: And this is really important because this isn't a decision.
• 6:52
  SPEAKER_00: This is a neurobiological consequence of repeated exposure to those situations which cause children to react to perceived threat even when it's not there.
• 7:07
  SPEAKER_00: But on this one occasion, the same boy became he he became absolutely furious during the game because the rules changed slightly, or at least that was his perception.
• 7:19
  SPEAKER_00: Nothing seemingly significant, but for him it was everything.
• 7:24
  SPEAKER_00: He shouted and he swept the pieces of the game away.
• 7:28
  SPEAKER_00: And he said, You always do this.
• 7:31
  SPEAKER_00: And it would have been easy to respond to this behavior, to correct it, to contain it, but instead I said it it feels like something just changed, and I I I it didn't feel okay.
• 7:46
  SPEAKER_00: What what was it?
• 7:49
  SPEAKER_00: And there was a long pause, and he just said, I thought you were going to stop.
• 7:56
  SPEAKER_00: Now I didn't understand what it was he was trying to tell me in his the best way he could, but I heard I thought you were going to stop.
• 8:12
  SPEAKER_00: So on reflection, I thought, well, the anger wasn't about the game, it was about something else.
• 8:20
  SPEAKER_00: It was about an expectation and the fear of something being withdrawn.
• 8:27
  SPEAKER_00: Now, I couldn't put this together coherently at the time, but one thing that really occurred to me was the importance of my response, and that had to do with containment.
• 8:42
  SPEAKER_00: The fact that I was able to experience and tolerate that which had just happened was really important.
• 8:52
  SPEAKER_00: I didn't correct, I didn't intervene, I didn't reframe, I just stayed with the fact that he had had that experience, which was something he couldn't make sense of, and to be honest, neither could I in that moment.
• 9:06
  SPEAKER_00: But from the perspective of Donald Winnicott, who talks about the holding environment, in a sense, what had happened was that he felt safe enough and held enough and understood enough to just be himself.
• 9:25
  SPEAKER_00: And nothing bad happened.
• 9:28
  SPEAKER_00: Now, I think this is so incredibly important that when a child can have a moment or a series of moments inside the consulting room which feel unpredictable, inexplicable, that something about that experience signals to them nothing bad has happened is really important.
• 9:57
  SPEAKER_00: So, but we also have to understand what else this says, because being angry can be a way of creating self-protective distance, a way of experiencing some degree of control, and a way of not feeling something that's more vulnerable.
• 10:19
  SPEAKER_00: It's not random, it serves a purpose.
• 10:22
  SPEAKER_00: Another child who would become angry whenever she made what she perceived as a mistake, whether it was an error in drawing or a game she couldn't win, her reaction was immediate.
• 10:36
  SPEAKER_00: I hate this to the swear word there.
• 10:40
  SPEAKER_00: I'm not doing it.
• 10:41
  SPEAKER_00: But then when we slowed it down, something else emerged, and it was I don't like getting things wrong.
• 10:49
  SPEAKER_00: And underneath that was it feels bad, and underneath that was I feel bad.
• 10:58
  SPEAKER_00: Peter Fonegie, who is something of one of the most powerful people in the field of mentalization, helps us to understand that a child needs support to recognize and name internal states, because without that, the feelings are experienced as overwhelming sensations, not thoughts, not meanings, just states that the child has to try and escape.
• 11:33
  SPEAKER_00: Over time, anger begins to organize the child's relationships.
• 11:40
  SPEAKER_00: Other people respond to this anger because they withdraw, they react, they judge, they discipline, and the child's experience becomes I'm the problem, which reinforces the internal system that produced the anger in the first place.
• 12:01
  SPEAKER_00: You know, I come back to this notion that telling a child or telling anybody that anger is a negative emotion is absolutely meaningless.
• 12:11
  SPEAKER_00: There are no such things as negative emotions.
• 12:16
  SPEAKER_00: All emotions are relevant because they come from the subjective internal experience.
• 12:24
  SPEAKER_00: By enabling the child or young person to tolerate those emotional states and begin to put them into words, mean that they are less likely to find expression through behavior.
• 12:39
  SPEAKER_00: Now, for parents, this is incredibly difficult because anger invites or evokes reaction, it pulls you into control, escalation, confrontation.
• 12:52
  SPEAKER_00: And it's very interesting because when you think about it, if you meet anger with those things, it will escalate.
• 12:59
  SPEAKER_00: If you meet anger with quietness, it will dissipate.
• 13:03
  SPEAKER_00: And I know that's hard.
• 13:05
  SPEAKER_00: I do have, as I constantly say, the luxury of the consulting room in which the time is completely devoted to the child.
• 13:16
  SPEAKER_00: And the fact that I can tolerate whatever their emotional state might be without correction or judgment is the thing which begins to change what's happening underneath because they experience something else.
• 13:32
  SPEAKER_00: Hence my work as a relational psychotherapist.
• 13:36
  SPEAKER_00: And underneath the behavior, there's a child who just doesn't know how to feel safe.
• 13:46
  SPEAKER_00: So what helps a lot is not reducing the anger, but understanding it and responding to what lies beneath, even if you can't see what that might be.
• 14:01
  SPEAKER_00: And this involves, as a parent, staying regulated and calm yourself, naming the feelings that you imagine or can see the child experiencing gently, holding boundaries without escalating.
• 14:20
  SPEAKER_00: Don't try and fix it, don't criticize it, because I promise you it won't work.
• 14:25
  SPEAKER_00: And remaining emotionally available.
• 14:28
  SPEAKER_00: Now, I'm saying something that I do all day, every day.
• 14:34
  SPEAKER_00: And for parents, they have a lot more to do than I do.
• 14:38
  SPEAKER_00: Nonetheless, every parent who I have worked with in this way notices a dramatic change in the child's acting out behavior when they stop, take a breath, and wait and listen.
• 14:56
  SPEAKER_00: The child is going to experience this not just because of what you do or don't say, but because they experience how you are when they are at their most difficult.
• 15:18
  SPEAKER_00: They are a child with a set of needs that have a solution, and solutions that work well enough to endeavor to help them to hold whatever it is that is painful.
• 15:36
  SPEAKER_00: It it's a bit like I remember a story some years ago, and it was about Buddhist practice.
• 15:43
  SPEAKER_00: This is off script, so I'm adliving.
• 15:46
  SPEAKER_00: And it was a it was a story of um a Buddhist monk who was on a train with a man who was drunk, and the man who was drunk was being threatening and aggressive.
• 16:01
  SPEAKER_00: And the monk invited him to just come and sit next to him, and the man was being belligerent and difficult and all kinds of other things.
• 16:11
  SPEAKER_00: And the monk said to him, What is what what what what's happened to you?
• 16:19
  SPEAKER_00: And bit by bit the man who was being angry and aggressive and threatening began to talk about his wife who had died, how he had lost everything he'd worked for, how he didn't care anymore.
• 16:39
  SPEAKER_00: And what was really touching about this story was that it kind of concludes with this large, aggressive, angry man crying with his head in the lap of the monk who just accepted him who is as he was.
• 16:58
  SPEAKER_00: Now, whether or not this is a true story isn't the point.
• 17:30
  SPEAKER_00: Sometimes that sort of gentle soothing, it's okay, I understand.
• 17:35
  SPEAKER_00: I mean you don't when I say you understand, I don't mean you can make cognitive sense.
• 17:40
  SPEAKER_00: What you're understanding is here is somebody who's in pain, and the pain is finding expression in this way, and we're not going to ask why, we're just going to acknowledge the fact that here is someone in pain, and what we do is a real act of simple human kindness, and that is felt.
• 18:02
  SPEAKER_00: I've worked with so many young people who have behaved incredibly angry and who melt when you're kind to them, when you just say, it's okay, it's alright, it'll be okay.
• 18:20
  SPEAKER_00: Simple, but not easy, particularly if you're a parent who's trying to manage everything.
• 18:27
  SPEAKER_00: And I really do understand that.
• 18:30
  SPEAKER_00: Nonetheless, we still have to do it because if we only focus on stopping the anger, we risk taking away the very thing that's been holding the person together.
• 18:50
  SPEAKER_00: Because behind the angry child, there is almost always a child who once felt very alone.
• 18:57
  SPEAKER_00: This is such an incredibly powerful and important thing.
• 19:03
  SPEAKER_00: Many years ago, when I worked in residential care, I remember a boy who was in his in it.
• 19:14
  SPEAKER_00: We were having a Christmas party, but this boy was having a party of his own.
• 19:19
  SPEAKER_00: It wasn't a particularly pleasant one because he'd managed to throw or push a wardrobe through his bedroom window, and it landed rather ungraciously on the on the ground floor.
• 19:33
  SPEAKER_00: And one of the members of staff on duty with me was outraged, and we went up to this boy's room, and I fortunately I was in front, and the member of staff behind me was very angry and wanted to be very punitive.
• 19:57
  SPEAKER_00: I'm choosing my words carefully.
• 20:01
  SPEAKER_00: When we entered the room, this boy was white-faced holding a metal rod and was threatening me with it.
• 20:16
  SPEAKER_00: And the member of staff behind me was making the wrong kind of noises, and I said to this boy, it's okay, I know.
• 20:28
  SPEAKER_00: And he was really very, very fragile, very volatile situation, and I said, Come on, it's okay.
• 20:39
  SPEAKER_00: And I said, Let me let me have that, and it'll be okay.
• 20:44
  SPEAKER_00: And he he he put his arm out towards me as if to give me this metal rod, and unfortunately, the member of staff behind me didn't read the signs and lurched forwards.
• 20:59
  SPEAKER_00: And anyway, it was possible to prevent the situation from getting any worse, and I ended up looking after this boy, boy, 15, 16, who was sobbing on his bed, and he was in a state of complete turmoil because on the one hand I don't know what had caused it, but he had reverted to the frightened, angry, violent behavior that he'd grown up with.
• 21:40
  SPEAKER_00: And here was a man who was staying with him, who wasn't criticizing him, who wasn't trying to punish him, who was just saying, I understand, it's okay, it's all right.
• 21:52
  SPEAKER_00: And he was he bit by bit, over the next hour or so, he began to settle.
• 22:00
  SPEAKER_00: And you know, he was a real example of three different things.
• 22:04
  SPEAKER_00: We had this boy who was frightened, really frightened, and violent in the expression.
• 22:13
  SPEAKER_00: The member of staff who completely misread the situation and who overreacted.
• 22:20
  SPEAKER_00: And then another man who was saying, it's okay, you know, we can deal with this.
• 22:26
  SPEAKER_00: It's okay, it's gonna be fine, it's all right, it's okay.
• 22:30
  SPEAKER_00: And that's so incredibly powerful to have someone who can say this is tolerable.
• 22:39
  SPEAKER_00: We you know, we we can bring this down together, not as a technique, but as a real felt sense of helping a desperately troubled person just come down.
• 22:55
  SPEAKER_00: It's so powerful, it's a wonderful position to be in if you can do it.
• 23:00
  SPEAKER_00: But I suppose out of all of this comes a number of principles.
• 23:07
  SPEAKER_00: We see anger in whatever form it takes as an expression of something.
• 23:12
  SPEAKER_00: But rather than just seeing it as anger that we have to deal with, it is something which signals something else.
• 23:20
  SPEAKER_00: If we can get beneath the anger, and if we can actually talk to the part that's frightened or dysregulated, not to fix it, not to ask questions, not to say stop it, because that tends not to work, or why, and that definitely won't work.
• 23:41
  SPEAKER_00: But if we're soothing something that's inflamed.
• 23:44
  SPEAKER_00: Beneath the anger is something that's very, very inflamed, and our task is to soothe it.
• 23:50
  SPEAKER_00: As parents, we do this with toddlers.
• 23:55
  SPEAKER_00: We say it's okay, all right, we understand, it's all right, it'll be better soon, rather than to escalate it with criticism.
• 24:06
  SPEAKER_00: So I suppose where I conclude with this episode is that there is something inside of us which we need to listen to.
• 24:17
  SPEAKER_00: It could be our own fear, our own anger, our anxiety at not being able to control what's happening, or the part of us that says, what if this develops?
• 24:33
  SPEAKER_00: It's a lot to learn when you think about it because as I said in uh another podcast, they don't come with a manual, do they?
• 24:42
  SPEAKER_00: However, there are some things we can do that make an incredible difference.
• 24:49
  SPEAKER_00: I hope that this episode has been helpful, and I'll be back soon.
• 24:55
  SPEAKER_00: Thank you for listening.