In the shoes of a therapist for kids who have caused sexual harm

(For your information: the following stories contain potentially heavy or upsetting material. They are modifications and conglomerations of stories from nearly 200 kids and families throughout North Carolina. The identifying information and situations are fictional and could not be linked to our clients, past or present.)

Caleb, Stage II, Affect regulation and Attachment, Family

Caleb and his dad both report that they have never gotten along. Caleb’s older brother, Shawn, is currently incarcerated for selling drugs. Shawn coerced Caleb into watching pornography from the ages of 5 to 8 with him and would laugh when Caleb said he didn’t like the show or wanted to watch something else. Caleb was really close with his mother who died of cancer three years ago. A year after his mother’s death, he approached a classmate in the bathroom and touched him inappropriately. He has been in treatment for the last 5 months. Since Caleb’s offense, dad confided in you that he wants to be more involved in his son’s life. Caleb is currently living in foster care and he spends his time playing video games during home visits. Caleb’s dad does not want to stop Caleb from playing video games so there is little interaction during home visits. Family reunification is critical for treatment success and it is promising that Caleb’s dad is engaged in the treatment process.

Welcome to our bi-weekly TASK (Treatment Alternatives for Sexualized Kids) Program staff meeting where we discuss case files of our clients. TASK is a treatment model designed to meet the complex, heterogeneous needs of youth who have caused sexual harm. As the newest member of the team, you will be presenting background information for your 4 kids and current barriers you are experiencing in treatment. We will offer guiding questions to develop an action plan that could overcome the barrier. Your current clients are Matthew, Samantha,  Albert, and Rashawn. Go ahead and tell us about how treatment is going:

 

Matthew, Stage V, Risk mitigation, Affect regulation

Matthew, age 17, is in Stage V and has led conversation and offered honest responses to others during group therapy. His primary caregiver, grandma, is supportive and cooperative. She has mastered strategies on how to enforce boundaries for Matthew while still encouraging him. He wants to get a job but his grades are well below average and he is skipping class every few days, a violation of his safety plan. He told you a neighbor offered him a job mowing lawns. You would like him to be able to get a job but know that he has a pattern of starting projects and stopping halfway. You are excited about the overall progress throughout the past year of treatment and want to set him up for success as we approach his program graduation date.

Questions and action steps offered by the clinicians:

Review his safety plan and utilize motivational interviewing. Does he recognize any connection between skipping class and the rigor involved in maintaining a job? What are some of his big goals? What obstacles, like poor grades, might prevent him from reaching his goals?

Does grandma have influence in his life? Is she able to challenge him to attend school?

Has he established supportive friendships since starting treatment?

 

Samantha, Stage III, Conflict resolution and healthy sexuality, Family

Samantha is 13. She called last week during school and told you she felt like she was going to have a panic attack. You deescalated the situation by phone and she was able to function the rest of the day. During this week’s family meeting, you realize that adopted mom and dad are unaware that Samantha has struggled with anxiety. Instead, they are upset that she has not cleaned her room every day and washed the dishes like they had discussed.  They spend the first 20 minutes of the meeting describing everything Samantha has not done since your last meeting. Based on your conversations with adopted mom and dad from early on, they have tightened up their discipline and increased Samantha’s chores considerably. After 40 minutes have passed, mom announces that they caught Samantha with inappropriate pictures on her phone 2 weeks ago. Since then, they have checked Samantha’s phone every night before bed. Lastly, Samantha told them she might be interested in a boy in her class but mom and dad inform you that she is not allowed to talk to him anymore.

Questions to consider:

Have you had a conversation with mom and dad about their perspectives around healthy relationships and attitudes towards sex?

Can you provide mom and dad with specific suggestions about how to handle crises?

At the end of the meeting, inform mom, dad, and Samantha that you are going to work together to review Samantha’s safety plan in the next family meeting. Provide time for all 4 of you to contribute and ask questions. Ideally, a reviewed safety plan will address the insecurity and doubt felt by her adopted parents, provide age-appropriate autonomy to Samantha, and ensure she is progressing towards her stage goals without causing harm.

 

Albert, Stage II, Family, Affect Regulation

Albert lives with his aunt and uncle. He is in Stage II and this is your 3rd family meeting. From the beginning, aunt has requested he be moved to therapeutic foster care, unaware that some of Albert’s mood fluctuations are a result of the family system. Albert has been diagnosed with ADHD and has broken a few dishes and a chair since you started meeting with the family. The uncle drinks frequently and Albert’s outbursts coincide with alcohol related outbursts. Additionally, Albert has a history of abandonment and his parents are no longer involved in his life. During individual therapy, Albert admits he is often unable to control his anger and has had trouble sleeping recently. He has a few friends but no one he is close with. When you try to gauge whether the aunt and uncle have motivation to change, they impatiently bring up the idea of foster care.

Questions to consider:

Are there pro-social opportunities in which Alex can get involved? Would he consider joining a sports team or other intramural activity? How can he gain a sense of belonging outside of home?

Have you tried talking to the aunt and uncle about their lives apart from Alex? Showing interest in them could foster an engaged relationship that would allow them to feel more comfortable participating in the treatment process.

Could there another diagnosis besides ADHD? Could you screen for other signs of depression or bipolar?

 

Rashawn, Stage II, Crisis at school, Trauma

At school this week, Rashawn got angry during class and walked out. He was not cooperating with his teacher and the teacher grabbed him and tried to make him sit down. Rashawn responded by screaming and cursing and nearly punched the teacher. The school called you after Rashawn had calmed down a little bit and was sitting in the principal’s office. Rashawn was verbally and physically abused by an aunt from the age of 7 to 9. He has no other trauma history as far as you know.

Questions to consider:

Is the school and the teacher aware of Rashawn’s safety plan?

Have the teachers had trauma-informed training on how to handle crises?

Does Rashawn recognize when his emotions are escalating?

Does he feel comfortable or able to call you or another support person when his emotions start escalating?

 

After this meeting, you have time with Samantha and her family,  Matthew and his grandma, and with Rashawn, individually. Additionally, you have group tonight so after staffing, you get ready to hit the road to meet up with Samantha. You take a few minutes to make sure you and the other therapist are on the same page about the group agenda tonight. You are excited to hear updates from the kids. Looking forward to a full day!

Thank you for reading more about what the day to day is like for our TASK clinicians. The research projects are still underway. We are currently revising the project plan in order to incorporate more preliminary steps before a more rigorous investigation. The therapists, business team, data team, and countless others have become a cohesive, engaged working group as we bring together our questions, experiences, and expectations for this project!

Ecuador: Ama La Vida (Ecuador: Love Life)

At the beginning of August I moved to Quito, Ecuador to begin my fellowship with Timmy Global Health. Before I talk about my fellowship, here is some background information on the organization I am working with and how I became their fellow.

Ecuador: Ama La Vida (Ecuador: Love Life)

About the organization: Timmy Global Health is a non-profit organization that expands access to healthcare and empowers volunteers to confront today’s most pressing global health challenges. Medical service teams travel to support 7 project sites in 5 countries by providing financial, medical, and human resources to the communities within each site. If you would like to know more about the organization visit www.timmyglobalhealth.org

How I became involved: My first year at Davidson I joined the college’s chapter of Timmy Global Health and it quickly became an integral part of my collegiate experience. Throughout my four years at Davidson I became more involved and dedicated to the organization’s mission to expand access to healthcare, including being the Davidson chapter President my senior year. Over winter break my last year I traveled to Quito, Ecuador on our chapter’s annual medical brigade. During the trip I was able to learn about TimmyCare (an electronic medical record system created specifically for Timmy Global Health) through using it in clinics and talking to the director of TimmyCare, Muz Ahmed. I left Ecuador knowing I wanted to go back to help expand TimmyCare; I just did not know how it could happen.

Ecuador: Ama La Vida (Ecuador: Love Life)

How I became the TimmyCare Fellow: When I was looking for jobs senior year all I could think about doing was returning to Ecuador to work with Timmy Global Health to improve TimmyCare. However, I would have had to go as a volunteer and did not have the means to do so for a long period of time. The new “Build Your Own” fellowship through the Davidson Impact Fellows program provided me the perfect opportunity to pursue my dream job for the year after graduation. By receiving this fellowship through Davidson I was awarded the opportunity to give back to an organization that is important to me, to develop my skills as a computer programmer, to learn about another culture through living in Ecuador, and so much more.

What I do: As the TimmyCare Fellow I work with the director of TimmyCare, Muz Ahmed, to help update and improve the system based on its functionality during clinics and feedback from the clinic volunteers. Most days involve researching ways to improve the system as well as changing the code to update TimmyCare. My background in computer science is a basic foundation through two courses I took at Davidson. Thus, a majority of my time is learning how to make the changes in the system – either through research or with the guidance of Muz.

Ecuador: Ama La Vida (Ecuador: Love Life)

Although my fellowship focuses on my work with TimmyCare, it also entails getting to know a new environment. The move from a small town in North Carolina to a big city in Ecuador has been the hardest obstacle for me to overcome so far in the fellowship. For example, before I moved I had never taken any form of public transportation. Now I use the public buses, the trolley, or taxi services almost daily. I still get lost on occasion, but I have learned that being lost is not always a bad thing. The other day I got to explore a part of the city I would have never seen otherwise because I went the wrong way to a co-worker’s house. Another big adjustment is the language barrier. I am conversational in Spanish, but did not realize how nervous I get when I speak it until I arrived here and in most situations, speaking Spanish is my only option. I have become more comfortable in Spanish conversations and have improved since I have been here. I still have a lot to learn during my time here – both through my work with TimmyCare and culturally. I had a slow start adjusting to living in Quito, but as I get accustomed to living here I am looking forward to the rest of my time as the TimmyCare Fellow.

My Life is My Job… My Job is My Life?

We are constantly bombarded with:

Follow your dreams

My Life is My Job… My Job is My Life?

Birthday celebrations at the office

Do what makes you happy
Work life vs. home life
If you don’t like it, leave it

Obviously these carry undertones of privilege and access that not everyone has the fortune of taking advantage.

As the U.S. News reported more clearly in their article called “Why You Shouldn’t Follow Your Passion,”

“Do what you love” is privileged advice that ignores the fact that the majority of the world’s population works to get food and housing, not for emotional or spiritual fulfillment.

There have been many times that I have been madly in love and passionate about my work. Then there is the “ying to my yang,” those disappointing times that sometimes creep or jump at me from out of nowhere. After work, I Skype with my loved ones back home and I vent, I share.

My personal life and my work life coexist—they affect each other.

Talking about my day (which is predominately consumed by work) with my loved ones allows me the time to reflect with someone else about my joys and struggles. It allows me to attempt to understand the tangible things and actions that affect my mood, my personal well being, and my growth. I take that reflection and try to input it into my (work) day.

What I’m trying to say, is that it is OKAY to let the two influence each other (there are caveats to everything in life… so do with this as you will). I have benefited a lot in reflecting on my personal actions and using them towards my advantage in the work place. I have found what my passions are and pull on those little moments at the workplace when I can utilize my passions and skills to improve my work. When my work feels more passionate, I get better results. I put more energy into it. I can present it better. No, it most certainly not always easy to find those little things that brings you passion. But sometimes, I just have to look harder, maybe stretch the meaning of that passion more because I’m certainly not leaving this job opportunity any time soon (technically) and I want to enjoy the experience as much as I can. It’s a perspective thing, right? We hear that a lot, but do we put it into action?

I feel like this is an important time for me to understand what I love and what I hate, what inspires me, what makes me feel stifled and use that to find develop my productivity and efficiency in any job setting professionally and personally.

Having job security that also gives me emotional fulfillment might just be a matter of searching a little harder:

If I can’t do what I love,
Find what I love in what I do.

My Life is My Job… My Job is My Life?

Uayamón Hacienda, Field Work
Uayamón, Campeche

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