Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / Trauma, Sexualisation, and Adolescent Risk-When Closeness Feels Dangerous

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Trauma, Sexualisation, and Adolescent Risk-When Closeness Feels Dangerous · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist from the Children's Consultancy.
• 0:06
  SPEAKER_00: Now, I said that I do a three-part series, almost like a kind of mini-series, which has to do with sexualization and trauma and the ways in which these things find expression in not just in relationship but also in terms of the child or young person's behaviour.
• 0:30
  SPEAKER_00: Now I've I want to try and focus on what happens in what we call an interpersonal sense with such children and young people and the sort of cycles of self-sabotage that tend to happen.
• 0:49
  SPEAKER_00: And this doesn't happen just in childhood.
• 0:52
  SPEAKER_00: I'm sure listeners will have come into contact with people who repeat patterns of behavior that they don't understand, but which always have the same outcome.
• 1:03
  SPEAKER_00: And of course, these things are always underpinned by what we call internal beliefs.
• 1:09
  SPEAKER_00: And I've done some some podcasts on that if you care to scroll down the extensive list, which you can find at thechildren's consultancy.com.
• 1:20
  SPEAKER_00: So this is about what I would call holding what was never held.
• 1:25
  SPEAKER_00: And that has to do with relationships, rupture, and self-sabotage.
• 1:31
  SPEAKER_00: Now there are some young people who do not struggle so much to make connections, they just struggle to keep them.
• 1:40
  SPEAKER_00: In this episode, we're thinking about something that sits at the very center of many high-risk presentations, not just the behavior, but relationship and what happens when a young person can't sustain one.
• 1:56
  SPEAKER_00: Now, one of the most striking features in some adolescents is not simply what they do, it's what something happens when something begins to go well.
• 2:09
  SPEAKER_00: Because it's often that that's the point when things begin to fall apart.
• 2:16
  SPEAKER_00: And I think people understandably feel confused by this.
• 2:21
  SPEAKER_00: I remember uh working with a young girl who initially engaged very well.
• 2:28
  SPEAKER_00: She would come in, sit down, she would talk, and there would be moments of what felt like a real sense of connection that moments where something real seemed to be be emerged, moments where real things would begin to happen, and then without without warning, something would shift.
• 2:50
  SPEAKER_00: She'd become dismissive or withdrawn or suddenly provocative.
• 2:56
  SPEAKER_00: And at times she wouldn't attend at all.
• 2:59
  SPEAKER_00: Now, my initial view of this was that this was a sort of unconscious testing of my capacity to tolerate how she was.
• 3:10
  SPEAKER_00: And I say unconscious because I don't think patients necessarily decide to test for therapists.
• 3:16
  SPEAKER_00: What they're doing is demonstrating and reproducing the behavior that they bring with them and finds expression in other circumstances.
• 3:28
  SPEAKER_00: So at first glance, that something like this can feel and look confusing and even frustrating.
• 3:35
  SPEAKER_00: But over time a pattern becomes clear.
• 3:38
  SPEAKER_00: It's not so much the absence of connection that's difficult, it's the presence of it.
• 3:44
  SPEAKER_00: So actually it's the coming into contact with connection actually arouses the desire to withdraw or the need to withdraw.
• 3:57
  SPEAKER_00: Now from an attachment perspective, and I refer back to the work of John Bowlby, this begins to make sense because if early relationships have been inconsistent, unsafe, intrusive, compromising or abandoning, then closeness itself becomes associated with risk.
• 4:19
  SPEAKER_00: And so the core belief that develops out of this and which becomes organized or the internal world becomes organized around is something like nothing good will last.
• 4:33
  SPEAKER_00: Therefore, the person will withdraw.
• 4:37
  SPEAKER_00: And when I say that nothing good will last, sometimes that is spoken.
• 4:42
  SPEAKER_00: Sometimes children and young people will say that.
• 4:46
  SPEAKER_00: I mean, I've heard adults say it as well.
• 4:51
  SPEAKER_00: There was a moment in the work with her when this became particularly clear because she'd begun to seemingly trust the experience, but not fully, but enough.
• 5:03
  SPEAKER_00: And then in one session she said, This is gonna stop anyway.
• 5:09
  SPEAKER_00: You know, you won't see me forever.
• 5:11
  SPEAKER_00: And I asked if she could tell me what what she meant.
• 5:14
  SPEAKER_00: I mean, she said, Well, the relationships always do.
• 5:18
  SPEAKER_00: And the following week she didn't attend.
• 5:22
  SPEAKER_00: And I it's a very difficult position to be in because there's a sort of real honest desire to help a person in my in my work, help a person learn that it doesn't have to be that way, and that what is happening inside you is a replay of what's happened before, and that's understandable, but that was then, and this is now.
• 5:51
  SPEAKER_00: It's not always possible to do that.
• 5:54
  SPEAKER_00: Her not attending wasn't about resistance in the usual sense, it was about protection.
• 6:03
  SPEAKER_00: And so, from a psychodynamic perspective, we're into the territory of what are called internal object relations.
• 6:14
  SPEAKER_00: So if an early relationship or if early relationships have been experienced as unreliable or painful, inconsistent, etc., then those experiences are internalized.
• 6:28
  SPEAKER_00: And the child doesn't simply remember them, they live within them.
• 6:33
  SPEAKER_00: So when something good begins to happen, it doesn't feel safe.
• 6:36
  SPEAKER_00: It feels temporary, fragile, and at risk of collapse.
• 6:43
  SPEAKER_00: I recall another young person who entered into friendships really quickly, intensely intensely, almost urgently, but just as quickly those relationships would break down.
• 6:55
  SPEAKER_00: There would be arguments, withdrawal, accusation, misunderstanding.
• 7:01
  SPEAKER_00: And we thought about this together, her and I, and we we we tried to identify, or I tried to help her identify that when these happen when these things happened, they weren't single moments, they weren't single event.
• 7:22
  SPEAKER_00: Because when we looked at them together, what they demonstrated was a kind of pattern.
• 7:27
  SPEAKER_00: And I remember saying to her, it's very hard when you have essentially a single event to remember the other times this has happened.
• 7:37
  SPEAKER_00: But if we stand back, we can see this happens a lot.
• 7:42
  SPEAKER_00: Now we could you you you might see this as a a failing, but I think it's telling us something.
• 7:49
  SPEAKER_00: I think it's telling us how hard it is for you to trust that when something goes wrong, it can be put right.
• 7:58
  SPEAKER_00: And I'm not surprised because everything you've told me shows that you've never really had that, have you?
• 8:06
  SPEAKER_00: And what was interesting was that she she was able to see something in that, but it took a lot more than that to actually work through to a point where she was prepared to try and be different in those situations where her desire for withdrawal had been aroused.
• 8:31
  SPEAKER_00: Donald Willycock, who I speak about quite a lot, emphasized the importance of a reliable holding environment, not perfect but consistent enough for the child to develop trust in continuity.
• 8:47
  SPEAKER_00: Where this is absent, the child can't rely on the relationship, so they rely on themselves and accordingly, you know, may very well vote with their feet.
• 8:58
  SPEAKER_00: Now, when emotional experiences are not contained, it becomes difficult to hold on to anything that feels good because good feeling becomes associated with loss.
• 9:13
  SPEAKER_00: So the sequence becomes something like connection begins, hope emerges, and then anxiety rises with the expectation of loss.
• 9:24
  SPEAKER_00: Then we see self-sabotage, then we see collapse.
• 9:29
  SPEAKER_00: In the consulting room, this can be felt very clearly.
• 9:34
  SPEAKER_00: Moments of closeness are often followed by withdrawal, testing, rupture.
• 9:39
  SPEAKER_00: Not because the relationship is failing, but because it's becoming real.
• 9:44
  SPEAKER_00: Peter Fonegie, the leading light on the topic of mentalization, uh really explains this rather well.
• 9:54
  SPEAKER_00: Now, mentalization helps us think about this because if a young person cannot be held in mind, then their own feelings, the mind of the other, and the continuity of relationship, then connection can't be sustained and it becomes unstable.
• 10:11
  SPEAKER_00: Now, this notion of holding in mind is having a sense of the other within us and us in the other, that we exist even when or we exist in the minds of others even when we're not there, and they exist in our minds when they're not there.
• 10:32
  SPEAKER_00: So what we're talking about is there's also known as mind-mindedness.
• 10:36
  SPEAKER_00: If those if if those functions, so to speak, are unreliable because early experiences haven't demonstrated that you're somebody who can be held in mind, thought about when you're not there, then connection just can't be sustained.
• 10:57
  SPEAKER_00: And because it becomes unstable.
• 11:00
  SPEAKER_00: And inevitably what what you what you see is the person withdrawing and ultimately saying it's happened again.
• 11:09
  SPEAKER_00: And that's a pattern that gets repeated through adulthood.
• 11:14
  SPEAKER_00: So over time it leads to repeated relational breakdown, that which of course reinforces the belief nothing good lasts, increased isolation, and sometimes what we see is an escalation in behavior because the behavior then becomes the only reliable way of managing the internal experience, whatever that behavior might be.
• 11:38
  SPEAKER_00: Now, within the wider system, like the multi-agency context, sometimes this can be experienced as non-engagement, inconsistency, risk escalation, and across the services, match cams, police and education, and social care, this can lead to fragmentation if it's not understood.
• 11:58
  SPEAKER_00: Because the task is not to force engagement, it is to understand what makes engagement difficult.
• 12:05
  SPEAKER_00: Sometimes I've seen or taken referrals where CAMS, for example, will say, you know, something like fail to engage.
• 12:15
  SPEAKER_00: And I think, well, they failed to engage or you failed to engage them.
• 12:22
  SPEAKER_00: Because actually, what we have to do as therapists is engage our patients.
• 12:28
  SPEAKER_00: And in order to do that, we need to have an understanding about their capacity to engage and how fractured that might be.
• 12:38
  SPEAKER_00: So what helps is our consistency, predictability, tolerance of rupture, and the capacity to stay even when the young person pulls away, because over time the experience becomes different.
• 12:54
  SPEAKER_00: Years and years ago, I worked with a woman who is a consultant to the therapeutic community that I was a co-director of for adolescents, and she used to talk constantly about stickability, which is a very non-clinical sounding term, but I think it says everything you need to know.
• 13:16
  SPEAKER_00: That was our task to practice stickability.
• 13:20
  SPEAKER_00: Whatever happened, we would still stick with it.
• 13:24
  SPEAKER_00: And it didn't mean that then things were automatically okay.
• 13:29
  SPEAKER_00: What it meant was that our repeated demonstrated capacity to tolerate the child created a shift in them.
• 13:39
  SPEAKER_00: So, in a sense, we try and help the child move from not this is going to end, but this can be sustained.
• 13:49
  SPEAKER_00: And it's it's a very powerful thing to do.
• 13:53
  SPEAKER_00: I speak as someone who has had to learn that when things go wrong, exiting is not a solution.
• 14:04
  SPEAKER_00: And I learned this through my own analysis because my own experience of early attachments was very unreliable.
• 14:11
  SPEAKER_00: And so I developed this very effective way of managing through what we call compulsive self-reliance, which isn't a disorder, it's a it's a it's a way of being, essentially saying, nope, I can manage.
• 14:28
  SPEAKER_00: I I I I I basically learned I can do it myself.
• 14:33
  SPEAKER_00: Well through my training and through the analysis, the intensive analysis that goes with it, I learned that actually that wasn't very helpful, but also saw how that had come into being and then learned how, in spite of everything, it was possible for me to hold what I was experiencing and stay, it didn't always work.
• 15:02
  SPEAKER_00: Well, actually, I say it didn't work.
• 15:04
  SPEAKER_00: I think there were situations where it would have been smarter not to stay.
• 15:08
  SPEAKER_00: However, that's not to do with my work.
• 15:11
  SPEAKER_00: So I think if we can hold in mind the fact that some young people just cannot hold on to relationships.
• 15:22
  SPEAKER_00: If we can just hold in line, it's because often they have never experienced a relationship that could hold them.
• 15:30
  SPEAKER_00: That's how it works.
• 15:32
  SPEAKER_00: And so when something good no longer feels temporary, they no longer need to be the one who ends it first.
• 15:42
  SPEAKER_00: I do hope this is helpful because, in a way, it's a kind of metaphor for in parenting how the capacity to stay with is so very important.
• 15:59
  SPEAKER_00: There are times for all kinds of reasons we can't as parents.
• 16:07
  SPEAKER_00: And I think when that happens, it's very often something which is out of character or deviates from the usual way of being.
• 16:33
  SPEAKER_00: Or I don't know, or this was about how I was, not about you.
• 16:39
  SPEAKER_00: I think repair is vital, but it requires a preparedness to to enter into that.
• 16:47
  SPEAKER_00: Hope this has been helpful, and I'm gonna come back with another episode soon.
• 16:53
  SPEAKER_00: Thank you for listening.