Conversations with young people in rural and remote places: transforming the emerging self (ANZAP 16th Annual Conference "Trauma and the transformational conversation").

Bannerman, Anne Morris

Working with young people can be like working with an echo--an echo of our own youth and sometimes the stereo echo of the youth of our own children if we have been parents of adolescents. These echoes can inform us, mislead us, motivate us, and tempt us to become parents to our clients rather than therapists. This paper describes the laying of a foundation for transformation of the inner world of a young person through the use of the Conversational Model. I describe some of the background of the young people I am working with and the gradual transformation of the emerging self of one young client through the use of the Conversational Model with its relational qualities of recognition (Jessica Benjamin, "Bonds of Love") mirroring, and reflection, and gradually the amplification of aliveness.

For the last 18 months I have been working with young people in a rural and remote part of Australia. There is both beauty and alienation in these areas--for some a relief from too much connectedness and intimacy of the metropolitan environment, but for others, alienation from "self' and isolation from "other."

An alternate title for this paper is, "Is there anybody out there? The words of Pink Floyd (2) "Is there anybody out there: AND Will you hear me?" This title describes more accurately my experience of the inner world and disfigured selves of young people in remote communities--an inner world of isolation and abandonment amplified by an outer world of remoteness and distance.

I am working with young people whose selves have been shaped by extreme violence, neglect, chronic criticism, and abandonment--abandomnent physically from fathers and alternative father figures--and abandonment emotionally from mothers. The emerging self-identities of these young people have also been shaped by extreme financial deprivation, inhibition of choice of alternate models of family, models of community and relationships, suppression of ideas, and prejudice and polarization of social and political views. For these young people, kindness, caring and respect are rare, knife-edge experiences--not to be trusted and to be rejected.

I believe the remoteness of some demographic locations exaggerates the experience of rejection through limitations of the availability of resources, cultures, opportunities, and options. In the book Communication and Culture in Rural Areas, (3) edited by Perry Share, the researchers found that certain social problems were unaddressed and that individuals or families in socially exploitative, abusive, and prejudiced circumstances had far less generous response to their situations than did people dealing with material loss or natural disasters. The study showed that people, including young people, in the rural community with problems of abuse and violence were not only unlikely to receive sympathy from the community, but were likely to be the subject of intense gossip, scandal, and innuendo.

The layers of survival strategies cover thinly like rice paper, the physical and psychological distortions which are visible to me as a therapist. The young men present as brazen, tough, and confrontational or hidden, faceless, and formless. The young women, faces lined with experiences beyond their years, looking blank, emotionless, and ambivalent.

Their histories include:

* Never known or little-known fathers

* Multiple stepfathers

* Male violence toward mothers, grandmothers, and children

* Frequent loss of male figures through violent deaths, accidents, and abandonment

* Violent mothers

* Exposure to sexual abuse and pornography

* Rape from outside or inside the family

* Siblings from multiple fathers

* Poverty, pensions, and government dependence

* Alcohol and drugs available from early childhood and consumed in large quantities by surrounding adults

* Criminal elements in the family

* Spirituality including fundamentalism, satanic worship, superstition, and magic practices

The hopeful signs are that the young adolescents are seeking an education to qualify for the government pension, and maybe there will be a job along the way. The young people who come to see me have had many experiences with counsellors and social workers in schools, government departments, and the health system. They have stories of being let down by authorities who have ignored their reports of violence, sexual abuse, and neglect. As children, they were not protected, their abusive situations disregarded. They had to look after themselves, and sometimes their parents. They don't really trust the therapist in front of them--what can they do to help change their lives? So much damage done.

With such a client background there is a strong counter-transferential temptation to parent the young parentless who longs to be parented properly. However, they have had enough of parents and authority--so it is therapy that they seek. Damaged young people, experienced in the world of counselling and therapy, enter the room with the new therapist with an air of familiarity about the system and psycholanguage. They tend to either take over the session--reversal--or sink into cynical disconnection. Yet they come. In the film "Good Will Hunting," the character Will, played by Matt Daemon, is used to handling therapists. The system failed him as a young child. He sees through the narcissistic needs of the therapists, their own personal flaws and their need for comfortable therapeutic outcomes. He experiences the containing strength of a therapist Shawn (Robin Williams) who listens to him, matches him, and recognizes his inner alienation. Will's true self emerges.

Let me tell you of the beginnings of the transformation of "self" of a young client with whom I have been working for almost a year--the transforming of self as observed through affect and affect regulation, including language, and represented by an emerging creativity, developing language, and improvement in relational skills.

Treatment

Russell Meares wrote of chronicles and scripts in conversation: "Successful therapy involves their transformation into a more spontaneous and complex narrative form." (4) The Conversational Model emphasizes close observation of the micro processes of language. The self of the young person who has experienced abuse in the form of violence, sexual intrusion, neglect, chronic criticism, and parentification is submerged in terror, distrust, and ambivalence. The therapeutic environment requires safety and trust in physical location constancy of session structure, and in the relationship with the therapist. Sessions with young people using the Conversational Model can be promoted by the addition of more activity in the session, including cognitive strategies to support their fragility and to elicit observational information for the therapist. The Conversational Model provides a relevant basis for correcting the lack of early mother-infant relationship. The mirroring and reflection, together with empathic attunement stimulate the foundation of recognition (Jessica Benjamin), the missing ingredient for self development which enables connections to others and separateness. Jessica Benjamin wrote:.... "the issue is not only how we separate from oneness, but also how we connect to and recognize others".... (5) Young people with a background of chronic traumatic intrusion have had little or no recognition to enable healthy separateness, and they have had little or no safe relating with others to enable healthy connectedness. The case I draw on, involves an 18-year-old named Peter. My clinical experience is that the trauma system of abused young people like Peter is so active that conversation is characterized by either very limited words or by rapid chronicling.

Peter initially said very little, so mirroring and reflection was challenging. It was difficult to distinguish silences from lack of conversation skills, from pauses, dissociation, or from disjunctions. I paid close attention to the words that he said, carefully drawing out a conversation in the spaces between pauses. A typical beginning session has been like this:

Anne: "Hello Peter. Come on in. [pause] How are things? [pause]

Peter: [pause, head down, eyes averted] "Oh, the same" [muffled]

This tells us something of a lack of language and relational skills--and a lack of experience of self-recognition.

Peter grew up in a highly violent and critical household. His father was violent toward his mother who would retaliate verbally and physically toward the father and Peter. It was a strongly fundamentalist Christian household, where there was poverty, rigidity, deprivation, neglect, and severe punishment. His inner world contains critical, abusive, and dangerous self-objects. His inner world is one of isolation, lack of connection to self and others, and punishing and critical messages. This is all mirrored by an external environment which also amplifies his isolation. A phrase which is deeply entrenched in his life is: "I am a waste of space."

My clinical experience with young people like Peter is that they are dealing with something more sinister than abandonment. With Peter, it is as if he was not actually ever claimed by a care giver--never owned--therefore not self-owning. Neglected to an extreme, he is in an emotional state of perpetual and chronic traumatic stress--a state of alienation and self-annihilation.

One meeting place of our conversations has been in his story writing and his cartoons. It amazes me that a human being in such a place of self poverty, has inner riches of creativity, however distorted those images, which indicate the supreme evolutionary human drive to be alive. The images in Peter's imaginary story world are of heroes and demons, usually a young man hero, an ineffective mother, and a destructive father. There are aliens, corruption, contamination, viruses, and secret agents. Our conversations have been full of metaphors--a sign of life. His cartoons are filled with images watching the characters of the stories.

Empathic attunement with nonresponsive clients is difficult. Peter is a nonresponsive client. It is hard not to retreat into a litany of questions just to make contact--to fill the space. My countertransference provides information about feelings not expressed, feelings not verbalized and probably not known or understood by Peter. It is as if his language and conversation have never before been acknowledged. I have had countertransferences of helplessness, a sense of failure, desperateness, lostness, and disconnection which tell me of his feeling state. Peter expresses himself physically by playing nervously with his fingers, hands covering his face, and talking quietly through closed teeth.

Van der Kolk writes of "speechless terror" which interferes with the ability to put feelings into words, leaving emotions to be mutely expressed by dysfunction of the body." (Van der Kolk, Traumatic Stress, p. 193). This state has a neurophysiological explanation. (6)

I have used a number of active strategies along with the Conversational Model in connecting with Peter. One strategy has been using cognitive observations around his eating and sleeping habits and his feelings and mood states. For example, I asked him to develop a list from 1 to 5 of feelings he experiences ranging from feeling down, unhappy, through feeling ok up to happy and high. Peter developed a list ranging from 1, very depressed; 2, fairly depressed; 3, okish; 4, stressed; and 5, very stressed. There was no happiness or sadness--only stress, tensions, and depression.

Another strategy has been to read his own stories with him. This leads to conversations around ideas and beliefs. I have also read some Dr. Seuss stories to him--Horton the Elephant and What Color is this feeling? Peter says his main feelings are of stress, tension, and worry about others. He pretends to others he is ok, because "it's easier for them."

After 9 months therapy, Peter told me a little of how he controls his thoughts, feelings, and stress levels. He has developed a system of affect regulation, or more accurately affect dysregulation, when there are any joyful or happy feelings. If he has a thought, which he calls a bad thought, his fear is that this might influence others, might lead him to say bad things and then do bad things which would hurt others. So to protect others, he punishes himself, the omnipotent self fearing the destruction of the other.

This process in which Peter engages is one of active and conscious affect dysregulation for an OK thought or feeling. Part of Peter's aim is to reduce the stress levels which are high at the point of the initial "bad thought." The self-imposed punishment, reduces that stress. This shows something of Peter's inner world: control with signs of obsessive behavior. Omnipotent thinking that his thoughts can hurt others, experiences of thought intrusions, and experiences that feelings of joy and happiness are unacceptable and need control through self-punishment. His application of punishment, in the form of self-mutilation is different from a release of numbing; it is an attempt to stop good feelings and to release the stress levels.

Van der Kolk (7) wrote: "The earlier the abuse [neglect] the more self-directed the aggression." He goes on to say: "Suicide attempts, self cutting, and other self-injurious behaviors may serve different functions in regulating affective states. There may be active attempts to kill, injure, or quiet [the] menacing hallucinations." I think this is what is happening for Peter. (8)

Peter first attempted suicide at the age of 10. I have discovered that this is a very common experience for the young people I am working with. One young woman, for example, attempted to hang herself at the age of 10 after a fight with her mother. Peter made several suicide attempts in his teens, but decided somewhere along the way not to kill himself physically but to put his "self' away and focus his life on trying to help others.

In the book Communication and Culture in Rural Areas, the authors point out that rural and remote communities suffer from a mixture of lack of health professionals in some places and lack of use of health professionals in other places. (9) My experience of Peter and many young clients is that they are very suspicious of authority, institutions, and professionals--including doctors. They have been severely betrayed by a community and a system that does not protect or respect children. There is strong resistance to taking prescription drugs. The young illicit drug takers will buy from dubious sources to regulate their pain, but resist taking antidepressants and the contraceptive pill. Therefore there are many very young drinkers and drug takers and many very young pregnancies. A 1990s rock group called "Morphine" released a song called "Cure from pain":

"Where is the ritual? Where is the taste? Where is the sacrifice? Where is the faith? Some day there'll be a cure from pain. And that's the day I throw my drugs away."

Peter does not use illicit drugs, rarely drinks alcohol, and refuses to take antidepressants. He does not want to lose control of his feelings. Although they are generally negative, they keep him alive and focused. I am very careful with amplification of feelings and responses. Young people like Peter don't trust and don't believe authentic compliments. Peter's response to a teacher's praise of his very interesting story was, "Now she'll expect more of me." It was like a loaded compliment that had an attached burden of expectation and pressure. One day he told me about something he had done and I immediately said "Oh, you'll be able to do X, Y & Z now." Then I saw his face--and said, "Oh my goodness, that's just what you fear isn't it--more pressure?" He grinned and together we suddenly had an understanding of what he was dealing with in his inner world.

I take care about amplification of bad feelings with clients like Peter. I mirror the feelings. With me he can now at least say each time "I'm feeling the same. I'm stressed and life is not good." He recently said he had felt a moment of happiness, but then explained how he controlled it. He went on to tell me for the first time how often and when this happens. So as time progresses, he uses more words.

A little on religion and spirituality with young people. I am particularly aware of this aspect of many of my young clients' lives and not sure whether it is a manifestation of a remote part of Australia or prevalent in Australia generally. In their bid to make sense of life, they reach out for meaning. This includes magical, pagan, or satanic spiritual explorations which match their world of violence and isolation. Or alternatively, they are in families of fundamentalism with rigid ideas, consumer deprivation, self-deprivation, and punishment. In the case of Peter, the extreme nature of the fundamentalism in which he has grown up is represented in his personality as an inflictor of self-punishment, an instiller of critical voices, and rigidity of discipline. Peter has been left with a disbelief in any God. His fear of, and hatred and betrayal by adults, has cured him of God. His experiences, however, have left him with a sympathetic and empathic understanding of the abuse experienced by other young people around him and a desire to listen to them, care for them, and protect them. He lives because of this; this has become his purpose for being alive and he has subjugated his "self' for this purpose. Paradoxically however, his level of traumatic stress makes this a process of traumatic repetition. His purpose for living is paradoxical and contradictory.

I have tried to glean from Peter's story the presence of a transitional object somewhere in his past. I have a bit of a thing about the transitional phenomenon. It seems, however, that the extreme religious orientation of his family together with his neglect indicates there may not have been any constant object of softness and connectedness. He does remember a favorite toy which was a Dinosaur.

Signs of Transformation

A number of signs of transformation were found through conversation with Peter, which indicate an emerging self. Peter has a somewhat cynical sense of humor which pops up every now and again. When his mind is not frozen by trauma, it is fast and sharp. We have a laugh occasionally. For example, when I was reading Horton the Elephant by Dr. Seuss, I turned a page only to realize that one of my, now grown daughters, had as a child cut out a figure in the middle of the page. Peter laughed and laughed. There are signs of transformation in his affect--both physically and verbally.

In the early months, Peter's face was downcast; eyes averted, and chin down. When talking, which initially was rare, he spoke just a few soft words through his teeth, almost behind his teeth. He would cover his face with his long fingers when telling me something sensitive. He plays nervously with his fingers, twisting them around each other. However, I noticed some gradual changes. He now looks at me more often when we speak, smiling a little when he makes jokes. Recently he smiled--a full facial smile--teeth, gums, all visible--almost a shock for me the first time because I had never seen so much of him before. A face transformed.

Peter rarely spoke in the early months. It was as if he had no conversation in him, was not connected to our conversation, and could not respond. I knew he had a rich language base from some of his stories and that he wrote stories with content, conversation, description, and action--stories with rich vocabularies. Recently, after nearly 12 months of conversations together, Peter has started to talk--to begin the conversation. It is as if a light was turned on in the space between us--providing a glimpse of the stream of consciousness--as if the curtain had been taken down, the film of separation gone.

Russell Meares wrote of the stream of consciousness: "What is essential to this experience is a nonlinear "shape" resembling that of play." (10) This is what is starting to happen. A "preintimate relatedness." (11)

Socializing proves to be part of a cycle of contradiction for Peter. Having put his own self aside, he concentrates on others. However, the stories of other young people, their abuse and injury, act as an overwhelming stressor for him--unbearable--so when he gets overloaded, he cuts off from his friends. It is hard to have friends just as friends because he doesn't believe they are interested in him. He cannot tell them his story--that wouldn't be fair. There is one exception--a friend who takes him out for a meal occasionally.

For young people like Peter, the internet is a means of finding friendship. In this way, young people have friendships with others throughout the world--unfortunately a world of "virtual" connection which assists the socially active and I think further inhibits the socially inactive. But that's for another paper.

Finally, working with young people using the Conversational Model in an active way can enable the undeveloped, lost, or hidden self to emerge through recognition, reflection, and amplification of aliveness. With Peter, there has been as Heinz Kohut wrote in The Restoration of the Selfa "functional rehabilitation" of the enfeebled and fragmented nuclear self. There is a beginning of a self forming, based on connectedness to other with space for separateness.

Notes

(1) Anne Morris Bannerman is Counsellor to staff and students at the East Gippsland Institute of TAFE in Victoria and Academic Associate at Charles Sturt University, New South Wales. Anne has private practice as a psychotherapist in Canberra, ACT and Gippsland, Victoria. Anne is a graduate and full member of the Australian & New Zealand Association of Psychotherapy.

(2) "The clark side of the mood."

(3) Communication and culture in rural areas, edited by Perry Share. CSU, Center for rural social research, key papers, series 4, Wagga Wagga, 1995, p. 76.

(4) Meares, Russell. The self in conversation: On scripts, chronicles, and scripts. Reprinted from Psychoanalytic Dialogues, v 8, issue n 6, 1998, The Analytic Press, (p. 875).

(5) Jessica Benjamin (1988). The Bonds of Love: Psychoanalysis, feminism and the problem of domination (p. 18). NY: Pantheon Books.

(6) Van der Kolk (p. 193). His recent PET study showed that when people with PTSD are exposed to stimuli reminiscent of their trauma there is an increase in perfusion of the areas of the right hemisphere associated with emotional states and autonomic arousal and there is a simultaneous decrease in oxygen utilization in Broca's area--the region in the left inferior frontal cortex responsible for generating words to attach to internal experience.

(7) "Traumatic Stress: the effects of overwhelming experience on mind, body and society, edited by B. A. Van der Kolk, AC Mc Farlane & L. Weisaeth, NY: Guilford, 1996, p. 190.

(8) Ibid.

(9) Communication and Culture in Rural Areas, edited by Perry Share. CSU, Centre for rural social research, key papers, series 4, Wagga Wagga, 1995, p. 73.

(10) Meares, Russell. The Self in Conversation: On scripts, chronicles, and scripts, op cit, p. 876.

(11) Meares, Russell. The Self in Conversation: On scripts, chronicles, and scripts, op cit., p. 878.

Reprint requests to Anne Morris Bannerman, 7 Glover Street, Lyneham ACT 2602, Australia.