CLIENTS' USE OF SYMBOLISM

The use of symbolism in communication about complex situations and tangles of emotion is perhaps best explained through some of the moving images children and young people have used during CRRES therapeutic assessment sessions.  Here I set out some examples, with elements changed so as to preserve anonymity.

Samantha

Background

Samantha was 14 years old.  She had been excluded from school, and was in her 2nd children’s home, after disclosing abuse towards a younger sibling 2 years earlier.  She behaved in a loud, brash, shouting, bouncing, over energetic manner, answering back to adults who gave her instructions and being highly disruptive both in school and in her residence.  She was intensely fidgety and seemed hyperalert all the time, and did not sleep well.  Her keyworker asked for a therapeutic assessment, wishing for some guidance as to what might be most concerning her and affecting her day to day behaviour.

 

The session

When we met, after explaining about what the session was for and that I would be liaising with her key worker after the session, I offered Samantha the full set of craft materials and miniatures, wondering if we might make something that showed how she was feeling in her life.  I chose an unstructured and non-directive task, given her current difficulty with taking instructions from adults, and included the subtle invitation that we could do it as a shared activity.  Her energy changed from bouncing effervescence (which felt almost too big to be confined in our small room) to still focus.  After scanning the materials, it was as if she had something waiting to be made.  She started immediately.  For the first half of the session she constructed a carefully crafted kitchen and dining room scene, with figures who may have been her family – she did not say.  The mother figure set the miniature table with cutlery, plates and cups.  The children figures were sat to watch the tiny TV. 

She placed the father at the table.  All was quiet.  She moved the mother to place a cooking pot on the table – at which point Samantha took up the father figure and started shouting a lengthy tirade of threats and abuse, to which she stood the mother back to the edge of the room.  Moments later she lunged the father figure forwards and  swept everything off the carefully laid table top, upturning chairs, tables and sending lamps and miniature TV flying from their place.  She hid the children figures in the corner.  She imitated the mother sobbing and apologising.

Without leaving space for me to comment (- it seemed enough for me simply to be there, with her, witnessing, observing and accepting) she packed the scene away.  I took an obvious deep breath and exhaled slowly, showing the contrast of calm in our room that day, stating “things must have been very hard for that family…”  and, after a pause, “I wonder what it was like to be there when that sort of angry explosion happened”. 

Samantha ignored me completely and turned to the stack of large coloured paper.  She carefully extracted a brown sheet, chose some chalk pastels and began to draw – with great focus and concentration.  She drew a large tree, with considerable care, under which she shaded in a grey ancient looking tombstone.  On it she inscribed the letters R – I – S , before proceeding to add detail to leaves.  I waited and watched until she sat back, satisfied that it was finished. I asked her to tell me about what she had made.  She announced matter-of-factly “Rest – In – Shit”, as she pointed to the tombstone.  She then went on to say that she messed the bed most nights.  She didn’t do it on purpose.  She didn’t know why it happened.  The care staff were annoyed about it, and after checking her bed in the morning, called loudly down the stairs to her in front of the other residents to come and sort her filthy bed.  I commented on that sounding like a difficult situation to deal with, at which point Samantha looked at the clock and said that her key worker would be waiting, signalling her wish to finish the session.  It was 5 minutes to the end of the time we had allotted, so I started to offer a summary, aiming to round off the session comfortably.  Samantha interrupted with a question about whether she could come again.  I said if she would like to then I would ask about whether that could be arranged, at which point she jumped up, said "bye" and marched energetically out of the room.

Follow-up

When I was able to speak with her keyworker, 2 days later, he had been surprised that she had sustained working in the session for almost the full hour.  It became clear that the domestic violence scene she enacted in the miniatures was in line with his understanding of the sort of scenes that used to occur in her family home, along with more violent acts.  We both took from the session that those experiences were still very much at the forefront of her thinking, and that would perhaps explain her over-activity, constant need for noise and distraction, heightened vigilance and night-time wetting and soiling.  She was likely to be living each day in a state of high arousal and profound stress.  She needed help to find a calmer state, and that could be a useful focus for staff to consider.  We talked about what some options might be. 

We considered how this single meeting may have offered her a chance to check out how I would respond to some small indication of what she had been through, and that there was likely to be much more that regular creative activity, therapeutic play or non-directive play therapy could assist her in working through.  She had to date refused to attend regular sessions with mental health services, and had joined the session today on condition that it was a one off assessment.  Hence her keyworker agreed to discuss the option of further sessions with her planning team.

I then shared information about the RIS tombstone, and queried about the social humiliation associated with the way some staff may be dealing with the soiled sheets.  Her keyworker was concerned about the approach Samantha had described, and agreed to consider with house staff a clear agreed means of addressing the problem, whilst also helping them understand that the behaviour was coming from a place of intense anxiety and traumatic stress, and hence not something she could be seen as responsible for and treated punitively for.

On review a month later, Samantha's keyworker reported on a marked shift in the approach the care staff were taking, putting into action a more nurturing approach.  Her bedroom had been improved to help it feel cosy, with her own choice of soft furnishings and bed linen (which was changed when needed subtly), plus she had new toiletries and nightwear.  A second member of staff was asked to take a keyworker roll with Samantha, making sure that there was someone on shift more of the time who took particular care to get to know her, to connect, whilst doing creative activities, and lead her in finding her calm state. 

 

Reflection

The role of my assessment here was to enable Samantha's support system to base their approach on an improved understanding of Samantha's experience, emotional state and perspective, none of which she had been able to communicate with them about directly in words.  That understanding helped staff see the vulnerable stressed child beneath all the noise and powerful energy, promoting a more empathic, compassionate approach and enabling their emotional availability for connection.  

Colin’s story -  Escaping the spider’s web 

             

Colin was 8 years old and of huge concern to his teacher and highly inclusive headmaster.  Colin was socially withdrawn, seemed unemotional for much of the time, with no signs of enthusiasm, no smiles, little eye contact, and no conversation, other than single word answers.  His teacher thought he was unhappy and worried, possibly, but felt like she couldn’t get near him, had no connection, and was at a loss as to how to build relationship with him.  He had occasional volatile reactions at varying times and settings, such that it seemed like staff never knew when he might erupt.  They had an excellent behaviour management policy in place in the school, and handled conflicts and outbursts well when they happened.  They did however feel they were “on eggshells” with him and wanted an EP assessment to help them devise a clear way forward that might improve things.

When we met, he was quiet, still and wary.  After my usual introduction about who I am, what our session was about and some general rapport building questions, which drew little response, I offered him teddy bear emotions cards to pick feelings that showed how he felt sometimes.  He looked at them blankly, kept his hands firmly by his side and gave me the rather clear message that such an activity wasn’t for him.  I posed that we might do a graph instead about how he felt in school or at home, which was received by the same nil response.  “I think maybe we could look in here…” was my next offering, as I opened my craft and miniatures cases.  “Let’s make something about what life is like and how it feels at the moment”.  This was the freedom and safety of symbolism he needed. 

 

Colin started rummaging around amongst assorted plastic animals and insects and chose a particularly large spider.  He then chose some pipe cleaners and string and set about making a large spider’s web, about a metre in diameter, attaching the ends to chair legs and my case and bag handles to keep the string taut.  I commented on what I saw him making as he went along and watched intently. 

Next Colin picked out a small boy figure and made him walk nearby… the spider started to chase him, and eventually caught him and wrapped him up in the web.  I wondered out loud what it must be like for the boy, and whether anyone was going to come and help him get out, at which point Colin stated firmly that no one was coming to help.  I wondered what it would be like if someone could come and help… to which Colin replied that they wouldn’t come.  After a short while Colin made the little boy figure break free whilst the spider wasn’t looking, only to be caught again several times over.  I asked what would help the boy, to which Colin didn’t reply.  I wondered what might be like this in his life.  He remained silent.  I said that I knew that there were people in school (naming his teacher and the headmaster), and his mum, who would all like to help a boy like the one in the web.  Would it be good for the boy to have help?  He nodded.  Our time was almost up, so I queried how he wanted to leave the session.  He wanted the boy to be back in the miniatures case, and the spider to stay in its web.  We placed things accordingly and I walked with him back to class, where he offered a fleeting smile back to his teacher as she greeted him.

During our meeting after the session, Colin’s mother looked at the web gravely and listened to the scene enacted in the session.  She then explained in faltering phrases that his father, who had left the family 2 years ago to live abroad, had found it impossible to be a good father.  On several occasions, she discovered that he had tied Colin to a dining chair and left him locked in the room, when he had not been able to cope with his behaviour.  She did not wish to talk further about those times, other than wondering if the spider and the little boy were Colin and his father.  We agreed that was possible.  I explained how Colin seemed to think that no one could come to help the little boy, but that he would like help.  His mother said that she had never talked about anything to do with what happened with his dad.  In fact she didn’t mention dad at all.  She just hoped he would stay away for ever and they could all forget about him.  She had hoped Colin had forgotten about him.  We discussed whether it might help Colin to have the opportunity to hear about dad, who he was, what he was like, why he left, where he went and whether he was likely to return.  We offered her one of the Mary Heegaard drawing books about when parents separate, in case it might help them draw and write about things instead of talking, given that both of them found talking quite uncomfortable.  We wondered if she could give the message to Colin that he could ask her questions about his dad.  She thought that would be a good thing to do.

School agreed to continue with their existing good practice, and the behaviour support team made a series of therapeutic play sessions available once a week in school, in case that might help him explore his thoughts, memories and concerns further.  On review a month later, mum had talked things through with him, and had been surprised to find that Colin had been fearful about whether his father might return home at some point.  He had imagined his dad as a frightening character, and mum was able to explain that he was not frightening or aggressive, but that he didn’t know how to spend time with small children, and he got it wrong when Colin was little, and couldn’t stay.  She had been able to assure him that she could make sure he was safe.  In school therapeutic play sessions, he had done several more scenes involving the spider and the boy, then had not wanted to leave class.  The class teacher reported a lessening of tension around him, and that she felt the emotional walls were coming down, and she was starting to build a relationship.  The school were satisfied that there had been a significant shift in his state, and that they could continue along this positive trajectory.

 

Reflection

Neuroscientists such as Bruce Perry have discovered the impact of trauma, how memories of the distressing event are stored differently, and how children continue to exist in a stressed, alert state, leashed to yet fearful of revisiting the traumatic events.  It seems that the therapeutic assessment sampling process enabled Colin to find the mode of expression that felt safe for him to communicate about his inner experience.  Having set it out for me, I could help him think about it in new ways, and then help his support network to understand what was worrying him, such that they could provide the types of reassurance he needed, and help him gradually unleash himself from the anxious stressed mind state he had been stuck in.

Once support networks like Colin’s understand, they can move mountains to help the child feel safe, to relax and be fully present again – ecosystemic therapy at its most powerful.

 

 

©2019 CRRES model of therapeutic assessment Hilary Hickmore