Sarah Rigney is an independently licensed clinical social worker. Alice Barber is a licensed mental health counselor. Both women work at Behavioral Health Network's Child Guidance Clinic at 110 Maple St.
SPRINGFIELD - Early intervention can make a life-time of difference for children with behavioral health issues, something area therapists stressed when asked about their work with the young and their families.
Sarah Rigney is an independently licensed clinical social worker. Alice Barber is a licensed mental health counselor, as well as a registered art therapist. Both women work at Behavioral Health Network's Child Guidance Clinic at 110 Maple St., and hold master's degrees in their field.
Rigney is a graduate of the Smith College School of Social Work in Northampton, and Barber, author of "Blue Butterfly Open: Moments from a Child's Psychotherapy Practice," Springfield College.
Rigney works with adolescents.
Barber's focus is mostly young children.
"I tend to work with kids from 2 to 6 or 7, primarily, though I do see some adults, and what that looks like is that a parent would bring their child in to see me and what I want them to know immediately is that the parent and I are forming a team. We are forming a partnership in order to help this child," said Barber when asked what she would like to convey about her work.
"Many parents feel like if I have a three-year-old who needs therapy, there is something wrong with my child or me as the parent. That is absolutely not the case."
She adds, "Part of the therapy is helping the parent understand what their child might be experiencing in the environment. If your child does this, it may mean this."
For the young child, she said, therapy should be a place where what they are experiencing can be recognized and addressed.
"Young children are a very marginalized group. People who are not listened to a lot of the time. We tell them what to do when we take them here and there, but lot of the therapy looks like I am 'just playing' with the child,'" Barber said.
"Typically, children should like coming to therapy. It should be relatively fun for them. It should not feel like a punishment or chore for them. This is a place where they are able to express what they are feeling and be met with validation and positive regard. There is a person there with them who will play and understand what they are playing about and be able to help them make sense of their world."
She adds, "When kids are stressed, the primary goal is to make sense of their world."
"It is really hard when you are four to make sense of a chaotic world, or make sense of stress. When we sit with them and play, or do art or talk, we are helping them make sense of things. When you are feeling like this, this is what you can do. And then we help translate how they are doing back to their parents," Barber said.
"A child therapist enters into this system of parent, guardian and child and acts like an advocate, translator. They play, they do art. We really try to strengthen any system that is around this child."
She adds that mental health intervention in early childhood can really make a difference as it is "one of the periods of greatest brain growth in a child's life."
"What is exciting about early childhood work is that it absolutely works. You can see the impact of making some very subtle changes because the child's brain is very malleable at this time. It goes to the changes like it wants to feel stable, healthy. It behooves us to start treating as early as possible when there has been stress," Barber said.
In her work with teens and young adults, Rigney adds, "Adolescence is the other period outside of early childhood when a person's brain is really growing at an exponential rate."
"The challenge with adolescents is that they start to look like adults," she said.
"Their bodies have gone through puberty. They are looking more fully formed, and they are taking on the trappings of being an adult. They are looking around and seeing all this stuff is being model for me and I am going to act like I see how people are acting. Yet, inside they are still children in a lot of ways. Their rate of growth is happening so quickly, but it can't quite integrate all the pieces simultaneously."
In working with an adolescent, Rigney said she doesn't "set expectations or go in with an agenda."
" I think a lot of times when teenagers are coming to me, part of what they are coming in with is how much people have put on them in terms of agendas and expectations. Especially around being adults before they are ready to be adults," she said.
"My favorite illustration of that is when I was a teacher at an alternative boarding school and I was a dorm parent. These same kids, whom I would see over the course of a day in an English classroom and who had makeup and grown-up clothes, were the same kids who were showing up at my dorm at 10 at night wearing pink fuzzy slippers and feeling kind of sad, or missing home or being in this vulnerable more child-like space. This is an illustration of how all that is packed into one person and is reminder of how complicated this stage of development is."
The following are some other excerpts from an extended interview in which the two women talked about what they do as therapists and how the process is designed to help those with behavioral health issues.
Barber: We recognize here that children can experience stress from the moment they are born onward, and because they can experience this stress, they can also experience some sort of help from that period onward.
A parent may not really know what to do if a child is stressed, anxious about something or dealing with a change, trauma. Parenting is hard enough when those things aren't there.
I learn as much from the parent as the parent learns from me. Most of the time more, actually, because the parent - mom, dad, guardian, foster parent, whoever it is - they are with this child, they know the patterns of how this child behaves, what this child likes, doesn't like, they are the ones with the information and I am like a partner or guide or consultant to them in helping their child feel better in the world.
A lot of the work is helping parents feel better as parents and trusting their instincts to be able to help this child. It is not something that is taught to people in school - how to be a parent. It is not something like you have a child and there is a book that can teach you what to do.
Many, probably the majority of the kids I see, are diagnosed with an anxiety disorder. This means their nervous system has gotten so activated, so fired up because there has been stuff going on in their life that is hard. They don't know what to do with themselves.
Little children, when they are feeling they don't know what to do with themselves, may do things like hit, yell, kick, scream, push, not be compliant if asked to go do something. Some of these are really normal behaviors in a certain amount. If they spill over what the normal amount is, that is when it becomes much harder for parents to know what to do.
This is where the parent partnership comes in. We try to figure out what the function of the behavior is. We know there is anxiety. What are they trying to manage by kicking? What are they trying to get from the environment by hitting? This is where we listen to what the child is saying because the child saying is with their words and with their behavior. Do they want attention from us, do they want something from us, do they want to avoid something? What do they want from us? We try to give it to them in a way that is healthier and not so destructive to the child.
For some kids, it might be that the child may be doing something because they need a certain level of attention from the parent. If a parent is in a stressful situation, it is harder for them to give that. So, I may say, three times a week this week, I want you to play for 20 minutes with your child. Put your phone down. This sounds very basic but in a context of a family that is in stress, it is not. It can be very challenging and just being a busy parent, this could be a challenging thing to implement.
I may say I want you to play for 20 minutes - and you can set a timer - doing whatever your child wants to give him or her that attention, so they don't have to ask for it in other ways.
Every child is so different. I may choose interventions with the parent from the same family of interventions but they are always different, depending on what this child likes, what is being communicated by the behaviors, but it is always in conversation with parents.
Rigney: In my first session with an adolescent, I ask a handful of questions and one of them is like, Have you ever done this before? Do you even know what this is? What do you think it is?
I get a variety of responses. If it is someone without an experience, or has had a really negative therapy experience, part of what I say is that my job is just to kind of hear what is happening for you. Hear the story of what you are experiencing right now. And see if there is any way for me to support you through this period. I am not here to tell you what to do. I am not here to be another adult in your life saying you are doing this wrong. You need to do it better, or whatever. I am really here to just walk with you through this process.
That is often how I frame it with them. I am also clear that I am going to be really honest with you, and direct. I am also going to hold everything that you have to tell me, with the exception of the bounds of confidentiality. Everything you say in here, stays in here. It is not going anywhere else.
Most of the people I have met with relate positively to that being said because a lot of teens come in with a level of distrust around adults. What their parents are going to find out or what is going to be told to their parents. They think, if I say what I am really thinking or feeling, you are going to tell them. It is really important for them to understand that that is not going to happen with the exceptions of what I am mandated to report which is that they are going to hurt themselves, by that I mean kill themselves, or seriously injure another person or if someone is hurting them.
My goal is to really hear the story that they are experiencing, the story of their life and sometimes work within that. Sometimes pull up the strength and sometimes to really challenge that story if part of what they are presenting, part of what I am observing, shows me that there are strengths that they have not yet realized and to reflect that back to them. This is so that they become empowered and they begin to learn the language of negotiating the world and feeling successful at negotiating it because the next step is adulthood and that is both the parental expectation, whether it is spoken or not, and it is the world's expectation.
It is really making sure that they have the internal tools to know themselves, understand themselves, believe in themselves, and the more concrete tools like, go out into the world and be successful.
There is nothing off limits in terms of what people come in with. You see everything from your really typical adjustment issues that teens go through, problems with friends, different schools, grades slipping, parents bringing the kids in because the kid is suddenly isolating themself in their room a lot more, and the parent saying, I used to be able to talk to my kid a lot more and then they went to high school and I don't know what happened. They are not talking to me anymore and that makes me really nervous and worried.
So some of it is anxiety being generated by the parent, and some of it is that the kid is legitimately struggling and having mood swings and feeling anxious about stuff, like dealing with environmental issues, bullying at school, divorce or separation of the parents, losses, to really traumatic events, like sexual assault, physical abuse.
I tend to work with a pretty eclectic tool box in terms of interventions that I use. I tailor them to what works for the person that I am seeing. So, the first few sessions are about, let's get to know each other. Let me hear how you work, let me understand some things. And then in the process of doing that I may try some specific interventions. Just to see how they respond to them.
Something that consistently works with kids in the cognitive behavior therapy model is the idea of helping young adults and teens understand the relationship between what they are thinking, what they are feeling and where that is coming through in their body, and how they are acting on that.
And the role of choice and decision making, especially between this is how I am feeling in my body, it is really intense and overwhelming, and this is how I react to it. These are then the implications of my actions.
Another psycho-ed piece that I do with both adolescents and their parents is this idea of let's talk about where your brain development is and understand the relationship between that and your growth. We are talking in the moment, your pre-frontal cortex where all your executive decisions-making happens, that is, forward thinking, planning, the ability to discern if I do X what is going to happen. It is in the process of developing.
So, let's understand your brain is not quite there yet which is why you sometimes think first and act later. Let's try and slow that process down and build those executive functioning skills so you can make a decision that feels better to you, feels better to your parents and helps you perform better and builds your self esteem.
This therapy is appropriate for the developmental stage because you are talking about kids beginning to move out of this really connected place with their parents and family and that more nuclear system to one that is much more social. It is all about separation and individuation. I am separating from my family, my parents, the things I typically know because I want to hang out with my friends, I want to experiment, I want to figure things out for myself. The process of doing that often looks like pushing boundaries, breaking rules and testing parents' limits.
So, for kids to understand some of what they are doing and the implications of that fits nicely with a cognitive behavior therapy and identity formation framework.
Communication is a huge issue not only with teens but with every single person I have ever worked with. Communication skills ends up being something that we do because encountering conflict in our interpersonal relationships, particularly in those that are the most meaningful to us, is very stressful.
We as a culture, as a society, really underestimate the importance of being able to communicate clearly and to communicate in a really thoughtful way where you are not only aware of what is happening for you, but when you are trying to communicate, you are using certain skills or techniques to both express yourself in a way that is appropriate and thoughtful and clear and direct, while also not being reactive and attacking, being defensive which are all of the things that further the conflict. They exacerbate it.
I have these conversations every day of the week with teens. How do you think you could say that to your parents? What would that look like? How do you think they would respond if you said it like this? It is a lot of modeling at that level. It is a processing. What is the difference between saying this way versus this way? What do you hear? What do you notice? Why do you think that would be better?
So, I am trying to build in that executive functioning. It is not just parrot what I say. Let us understand not only what I am saying but why I am saying it. This is so that they can really encode that in their brain so that in further conversation with their parent they are now thinking about, if I say it this way, then I think I will have a better chance of getting what I need or want from my parent and that is what executive functioning is about.
Do kids get better? Absolutely. Teenagers are maybe not quite as malleable as a 3 year old but they are incredibly resilient and adaptive. I think they get a little bit of a bad wrap as being difficult to work with because in my experience they see and understand way more than we give them credit for.
Even after 15 years of working with this population, I still love it because I love the kid who comes in and I am like, "Wow, you really have a pretty good bead on the situation here." I just like helping and supporting them to the next stage that they are trying to get to.