We just had an interesting, positive moment. Some of you know that Nat — still living at home since July — has been exploding into rages almost daily when things go a little wrong/not his way. It passes, but it’s horrible: screaming, slapping his head hard, pleading loudly and sadly for what he wants. But he can’t always have what he wants — no one can. Things break. Too much chocolate makes you sick. Plans change.
Ned and I have been working together on this problem for weeks. We’ve been focusing on getting his meds right. But I realized yesterday that all of my strategizing and analysis has been obscured by my fear, my despair. Old feelings roll me back, pin me down in the past.
Yesterday I needed to talk about this dynamic and Ned was not able to. So I called my Dad and Mom. Dad listened, and eventually was able to organize the pieces of the problem, separating them out to medical and doctor issues; technique of response to the outburst; and putting aside my feelings of failure to help him. “Look, you worry about him, you are deeply, personally involved with him,” Dad said, “and that’s right, because you’re his mother. But you also need to be objective.” He might not have said precisely that, but that’s what I remember. “You need to have a plan,” he said, echoing his own father’s words. (Grandpa Irving Senator was well organized, fastidious, and always had a plan.) “You have to keep in mind,” he went on, “that this behavior is going to happen. It is a patch he’s going through, that he’s gone through before, and it means that he will explode from time to time. But you also need to remember that for most of the time, he’s a great guy. Sunny, sweet. So you have to go into it knowing that this will happen and you need to be ready with a plan.”
Together we thought back to the last time when Nat was like this. It was ten years ago, just before he moved into his school residence. At that time, the school implemented a time-out technique. They would have him go into a small room within the classroom and set the timer for one minute. If he could be calm for one minute, he could come out. If not, he went back in and the timer was reset.
I’m well aware that this may not be a legal technique anymore, and some judge it as inhumane. I disagree. When done with concern and care, the way Nat’s teachers did it, there is a space created for the person to decompress. In that space he can once again think and hear and communicate eventually. And so, Nat learned how to collect himself and then to articulate what he needed and to stay calm even when thwarted. All without harmful restraints. The time-out room eventually faded out and then the staff could direct Nat to sit at a table off to the side to collect himself, still using the timer.
We then had about ten years of Nat thriving in school, work, and with friends. He soared in his development and became the successful man he is today.
The behavior is back. Although we cannot know the larger underlying reasons — PTSD? Wanting not to live with parents? Something else altogether? — we do know the overall catalyst: loss of control. So our task, then, is to help him feel in control even if he cannot fix what goes wrong, or change things to go his way. Visuals! you may say. But Nat is more aural, and wants to hear and be heard. He’s not one to work with velcro boards or Meyer-Johnson stick figures, charts, or the other Behaviorist’s tools — at least not for this kind of problem. He loves calendars and schedules but the problem here is when Life goes counter to the calendar or schedule.
What else does Nat love? Repetition. I reasoned that if I repeat exactly what he is saying to me, he will feel validated. Then I can add in, slowly, my agenda. Maybe.
So today we were ready for the eruption. As soon as we saw it coming on, we put our plan into play. First, I pointed out that he was getting upset. Second, I reminded him that I was listening to him, and that his talking was helping. “Nat, let’s keep talking about it. I’m listening. You said, ‘short walk to JP Licks.’ But Dad wants a long walk.”
“No long walk! Walk to JP Licks up Harvard Street!”
So Ned said, “How about walk to JP Licks up Harvard Street and then take a long walk back home?”
Nat: “Walk to JP Licks up Harvard Street and then walk home down Harvard Street.” Ned and I almost smiled at this point because Nat was making it very clear what (short) route he wanted to take. But then Nat started tapping his head, beginning to get worked up.
“Nat,” I said, “let’s talk about it. I see that you want to walk up Harvard Street to JP Licks and then walk back down Harvard St.”
Ned said, “Okay, Nat how about we walk up Harvard Street to JP Licks and then walk back down Harvard St. and then walk some more.” (This way Ned was echoing Nat and then altering the plan a little bit to get a longer walk without sparking Nat’s panic by using the trigger words “long walk.”)
“Okay,” said Nat.
“Okay,” we said. Ned repeated the plan again. “Okay,” said Nat.
“Okay, great!” said Ned. “Nat, you see what happened? We kept talking, you kept telling us calmly what you wanted and we were able to understand!”
“Yay Nat,” I said, and Ned and I applauded him. Instantly Nat was grinning and laughing.
Off they went. Perhaps it is true that one long journey begins with — a walk up Harvard Street to JP Licks and then a walk down Harvard Street…