This is an e-mail from a client’s mother. The client is a 10-year old boy who was diagnosed (by others) variously as ADHD or Asperger’s Disorder or Bipolar. I can understand these diagnoses, and I frequently run into these type of previous diagnoses for the type of issues displayed by my client.
However, my diagnostic interpretation of the symptom pattern places it more in the DSM-IV category of an anxiety related disorder secondary to disruptions in his capacity to metabolize emotions through the communication-relationship systems.
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Hi Dr. Childress,
I'm in the throws of one of William’s meltdowns and could use your advice on how to respond and discipline right now.
Background: I had asked William not to take his glass of ice water into the living room for fear it would get knocked over and broken. As he crossed the threshold from the kitchen into the living room, not minding me, he tripped and the glass flew out of his hand, shattering in pieces on the floor.
My response: in my admittedly not happy voice and in my punishing, yelling and reprimanding voice I said, "Damn it William, this is exactly what I was warning against and exactly why I said not to take your glass into the living room. You chose to disobey me and in doing so dropped the glass on the floor, causing it to shatter. Please go sit on the sofa while I clean the broken glass up."
He screamed back at me, "No, I don't have to. Glass doesn't fly this far. I don't have to listen to you." So this back and forth tit-for-tat tirade ensued (again, I'm not proud of it, but it was the impulsive response from both of us).
I said, "William, I need you to listen and follow the rules. If you choose not to listen you will lose a privilege." He started yelling and saying that my rules were stupid and that he hated me and that I was the worst mother ever and then he got up off the sofa and started walking, barefoot, on the floor where the broken glass was, knowing doing so would make me upset.
I responded by telling him his friend Joseph could not come over and play because of his tantrum, so he replied with, "Yes he can. I'm not listening to you," and he stormed outside to play (I knew Joseph was not home from school yet, so going outside was not an opportunity for him to disobey and go find Joseph). He came back in and said, "Please mom, please let Joseph come play." And I said, "No, I'm sorry. You were rude and disrespectful and you are not going to have playtime with your friends when you show this behavior."
He replied back that I was horrible and mean and that I didn't know how to raise children and that he hated me and would never speak to me again. He started to go outside and I told him he was not allowed, now, to go outside because his disrespect was continuing and he was being defiant. I asked him to go upstairs and he screamed, "No. I don't have to!" and kicked a wooden basket across the living room and then threw an umbrella across the living room.
I don't know how to implement your suggested technique here... I don't know how to be a disciplinarian in this situation, and be admittedly angry, and at the same time show love and concern for his frustrations.
Can you provide any guidelines?
Cynthia
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According to his mother, these type of interactions happen on a daily basis, often multiple times during a day.
This is my response:
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Cynthia,
This is a very difficult situation, particularly in shifting from one response approach to a new response approach.
First, it is okay that you are angry with him for the broken glass. He disobeyed your wishes and bad things happened. You now need to clean up a mess and someone could get hurt with the broken glass. You are not happy that he did not listen to you're wishes regarding the glass, because there are reasons you said not to take the glass into the living room. So this will be the core of the message that will be conveyed... but it may take 30 minutes, 2 hours, or a day and a half to finally get to this message.
The first issue is to express your frustration with his disobedience, then when he further "dysregulates" into excessively angry defiance, the immediate task-at-hand becomes to help him restore some degree of interpersonal and emotional regulation so that he is capable of incorporating your anger (rejection), frustration, and disappointment without it becoming overwhelming for him.
His expressions of "I hate you, you're the worst mother" are actually "I adore you and it is far too painful for me to have you be angry (rejecting) toward me. I'm overwhelmed by my emotional pain and I don't know how to repair our relationship. You're a wonderful mother, and so your anger means that I'm a horrible person. You're rejecting me because I'm a horrible person. I'll never be able to be good enough to get your love, and that's too painful for me (that "I'm a horrible person and I'm in soooo much pain” is why he started to walk on the glass; self-punishment for being horrible and an outward expression of his inner pain). I'm in so much emotional-psychological pain and I don't know how to make it stop, I don't know how to find your love again when this happens. AHHHHHHHHH!!!! Help me!"
Anger is "you hurt me - so I hurt you"
The degree of his anger is the degree of his hurt. He's extremely angry and rejecting, so he feels extremely hurt and rejected. But he's communicating this in the second part of anger "... so I hurt you" rather than in the first part "you hurt me." When he broke the glass and you yelled at him, he should cry. Crying draws nurturance to heal the pain. Instead, he responds with anger and provokes greater anger (rejection) from you, and things spiral out of control. He doesn't know how to stop this process when it starts...
You're the adult, so it’s up to you to help him escape this downward spiral.
When he starts to dysregulate even more, saying crazy things like he hates you and you're the worst mother ever (whenever he says this type of crazy stuff you know he's gone off the deep end and he needs the loving mom to bring him back rather than the angry-disciplining-instructing mom --- we can get to that mom later, but not when he's in such excessive pain of "I hate you, you're the worst mom ever, I don't have to do what you say.” At that point he needs emotional rescuing).
So, once he goes off the deep end... take a few moments for yourself, maybe walk away, collect your thoughts and emotions, and realize that he is in horrible, horrible emotional pain because he feels you don't love him anymore. He's so God awful lonely and scared and wants his gentle nurturing mom to help him... but he doesn't know how to find her.
Collect yourself, and bring him the nurturing mom. Help him understand that his apparent anger is the second half of his experience (... so I hurt you) but that he also has the first half (you hurt me). Nurture him.
In a soft, compassionate tone of voice that understands his emotional pain, "Oh, sweetie, I think you're feeling sad and afraid, because you're saying awfully mean things. Did I do something that makes you sad or hurt?"
"Yeah, you’re mean."
"Was it because I got mad at you?"
"Yeah."
"So you don't like me to be mad at you, do you?"
"No"
<Very soft-nurturing tone> "Oh sweetie, I'm sorry. I love you so much. Come her and give me a big hug."
If a hug happens, then... in a calm and nurturing tone, explain how the broken glass is a mess, and that you asked him not to do that. Stay nurturing. If he tolerates this... then flash him a scowl, but then give another hug. At bedtime tonight, maybe revisit the issue of his disobedience and how you set limits to keep things safe. He needs to listen to you because you know what you’re talking about... then give another hug or a rub-pat-pat.
If he rejects the offer of a hug, consider disengaging for a few minutes, then go back and try to re-engage with love around giving and receiving a hug. The goal is to maintain relationship and build the strength of the relationship so that it can tolerate an ever-increasing intensity of your anger (rejection) without falling apart into crazy-angry emotional tirades.
Ultimately, over the course of 30 minutes, several hours, several days, communicate the message of --- he disobeyed your wishes and bad things happened. You needed to clean up a mess and someone could have gotten hurt with the broken glass. You are not happy that he did not listen to you're wishes regarding the glass, because there are reasons you said not to take the glass into the living room.
<with a mild but stern tone> "Don't do that again! <continuing a tone of authority without anger> When I say stop, you needs to stop. If you disagree you needs to talk it over with me, but you are not to simply disobey me... Okay, William?" <with a smile but also with a slightly stern tone of voice and/or an upraised eyebrow of disapproval, offering William a mixed complex communication of nurturance and authority>
Then give him a big hug and abundant affection.
We'll discuss this some more during our session. Give him some loving. He's more important than water on the floor...
Help him to find ways to find his loving mom when bad things happen. You can, and will, return to the angry (slightly) and disciplining mom later. There'll be time enough for that. But first respond to William's pain and psychological loneliness. Once the relationship is fixed and positive and strong and stable, then we can infuse some anger-rejection (in small tolerable doses - gradually increasing the doses as he is able to tolerate and integrate them into his nervous system).
Best of luck,
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857
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30 minutes later, this was the mother’s response:
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Goodness what fabulous advice.
I asked William to come see me. I gave him wide open arms and he came scurrying over and gave me a big giant hug. I said, "William, you know, I love you tons. You said some pretty mean and hurtful things." True to what you typed he said, "Yeah because I was angry." And I replied back by asking him if he felt that I didn't love him and if my anger made him feel rejected by me? He, with big huge eyes, said yes. He asked if he could call his friend Joseph and I said no, explaining that Joseph not coming to play was a consequence of his disobedience, but that (in the middle of big huge 2nd hug squeeze from him) I loved him so much, that I thought he was an amazing big brother and a wonderful baseball player and a great son. And that was that.
Great advice, thank you. I'll spend more time on this over the next few days, too.
Cynthia
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