Individual Therapy with Aggressive Children

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Dr. David Crenshaw is one of the leading experts on psychotherapy with children and we are grateful to him for writing this for our blog:

Aggressive Children have too many Tears Buried Inside

David Crenshaw, Ph.D., ABPP

The profound losses of those born and raised in extreme poverty; urban youth who grow up in dangerous and crime-filled neighborhoods where exposure to violence can be a daily reality, often cause wounds, both visible and invisible, that in many cases result in traumatic losses, often never grieved. The child or family may be unable to attend to their grief because it would make them too vulnerable and threaten their orientation to survival.

What happens to this buried, unexpressed grief? In many cases it turns to anger, and ultimately to rage. Some of the angriest kids that are encountered in clinical practice are children whose grief was buried long ago in the inner recesses of their psyche. When the losses are compounded and buried so deep that the child can no longer acknowledge the sorrow, the result can be dehumanization of the losses. At this point the child can evolve into what is considered the ultimate menace or threat to society because the child not only loses his or her capacity to feel anything for his or her own losses, but can no longer feel for the pain of others. The child then becomes capable of committing a violent assault or even a homicide without any feeling of remorse whatsoever.

Children, who never develop the capacity for empathy or those children who lose the capacity to feel empathy for the losses of self and others due to repeated, unresolved traumatic losses suffer deep lacerations to the soul. They have lost their sense of humanity as well as their soul.

Dignity and self-respect becomes an extraordinarily vital issue if that is all that children can claim as their own. Many youth who suffer repeated losses experience devastating assaults on their dignity and self-worth as a result of being born into extreme poverty associated with limited educational and vocational opportunities. Some face threats from violent homes, neighborhoods, and schools.

If your very existence is at stake everyday, survival becomes your total preoccupation. It is hard to contemplate a future, one does not dare to entertain a vision, and hope may be dangerous because emotional survival may be contingent on keeping expectations low. How does a child who along with the rest of the family dives to the floor in his or her bedroom to dodge stray bullets from a gun battle in the violent streets outside the home, learn to trust, believe in self or others, embrace hope for a better future? Just staying alive is the challenge of each new day. Many families in our land where great wealth is enjoyed by a privileged few don’t know where there next meal will come from. The pantries in these families are not well stocked. Food for the day is purchased as money allows or not.

Climbing out of the deep hole, the slippery slope of abject poverty is a treacherous undertaking. Just when the family believes they are making some headway, often a child becomes ill, a parent loses his or her job, the car that was barely running is now completely dead, and they find themselves once again sliding to the bottom of that deep pit. If a child grows up in a society that devalues the poor, women, people of color, he or she finds out at an early age that class matters and it powerfully determines what doors will be open or closed to him or her. The devaluing messages will come in many forms but no child can escape the inevitable insult to one’s dignity and humanity. To be judged harshly and narrowly because of gender, race, class, ethnic, regional or national group membership is a dehumanizing experience. It is like an arrow that pierces the soul, a searing pain to the very core of self.

Moreover, an immeasurable number of children are forced to endure aggression as helpless bystanders, watching members of their families and communities fall prey to gang warfare and other acts of violence, all the while living in constant fear for their own safety and well-being. Sexual victimization is another form of violence experienced by children living in chaotic and hostile environments.

What can heal the lacerations to the soul of a child?

Violence can’t be condoned in any way as a solution to our social ills. In fact, violence is ugly, deplorable, and can only lead to further suffering. But, far too long only balm has been applied to the deep wounds that need healing. We need more comprehensive solutions that address the social toxins described so eloquently by James Garbarino in his book The Lost Boys. Until we as a society more adequately address the devastating impact that abject poverty, frequent exposure to violence, the ravaging effects of drugs, the despair that emanates from limited educational and employment opportunities, we will only be applying balm to the wounds.

Due to the shattering of the sense of trust in children exposed to violent crimes and abuse, I have long advocated for intensive individual treatment since the dyadic collaborative therapeutic relationship provides an opportunity for the child to learn to trust again at a pace that is safe and largely determined by the child. For children who have had so little control in their life the ability to determine the pace is crucial. This is not always possible in group and family therapy although those modalities offer some distinct advantages of their own and may be helpful at a later point in the child’s healing. To heal the wounds of an individual child, we must go beyond anger management and social skills training, although these interventions can make a contribution, they do not substitute for addressing in-depth the emotional wounds, unacknowledged and unsupported losses that these children repeatedly suffer. To accompany them through the emotionally focused work of addressing these lacerations to their core self, requires that the therapist be able to deal with profound sorrow and rage.

It is through the experience of empathic acceptance by the therapist that the child can begin to experience empathy for self and others. Children will not tell their stories of pain and trauma unless an empathic healer is present to hear them. The kids can always tell and are never fooled. All too often they have encountered adults who did not truly want to hear their pain and they will only reveal their lacerations to the soul when they are convinced they are in a safe place with an empathic adult they have gradually, after persistent and relentless testing, learned to trust. It is by telling their story and learning it can be heard in a non-judgmental way, and that the pain of it can be borne and tolerated by the trusted other, that they learn their own pain is survivable. They gradually internalize the empathic acceptance of the healer so they begin to empathically accept themselves.

I never cease to be amazed at the hope, courage, and resilient spirit of these children. At the same time we should never assume that no matter how poisonous or toxic the social and economic circumstances of their lives are that these children will somehow manage to rise above it, to be resilient. I have been inspired by a number of courageous and remarkable children, but for every child who incredibly overcome the steep odds there will be many children who will not be able to make the steep climb out of the deep crevice that their lives’ harsh beginnings represent. It is not easy to crush the spirit or lacerate the soul of a child, but it can and does happen, sadly all too frequently.

David A. Crenshaw, Ph.D., ABPP, Founder and Director of Rhinebeck Child and Family Center, LLC ( Co-author with John B. Mordock of A Handbook of Play Therapy with Aggressive Children and Understanding and Treating the Aggression of Children: Fawns in Gorilla Suits. Author of Evocative Strategies in Child and Adolescent Psychotherapy; Therapeutic Engagement of Children and Adolescents: Play, Symbol, Drawing, and Storytelling Strategies; and an edited book: Child and Adolescent Psychotherapy: Wounded Spirits and Healing Paths. All of the above books published by Jason Aronson/an imprint of Rowman & Littlefield ( )

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