trpsyche

Drug use wasn’t the most feared behavior or phenomenon at Thunder Road. Acts of sex and aggression were. Officially, acts of violence were supposed to be met with expulsion from the program, with little or no process, privately or publicly. To be violent or sexual was to violate two of the weightily-named Cardinal rules (they included drug use, they, and running away, also). This seemed politic, if nothing else. If, for example, parents of non-legally mandated kids were to be convinced of the safety of the program, management had to at least pay lip service to a strict policy. In reality, I think that hundreds of couplings and beatings, some minor, some severe, have occurred over the years of operation, with varying degrees of punishment being meted out. But the truth is that not every kid that got serviced, or bled another’s nose or bruised another’s rib with so-called “body shots” got kicked out, not by a—excuse me—long shot.

            Emotionally-driven confrontations groups were one thing; the more common and mundane confrontations of negative behaviors were another. The kids with significant ego deficits reacted badly, of course, to the day-to-day imposition of “consequences”, whether they were assignments to write one-page essays, three-day bans from the rooms containing the video games, or else, more spontaneously, the directive to take a seat upon one of the Therapeutic Community’s iconic wooden benches. Alas, the bench. Along with a set of mirrors lining the hallways, the bench was one of two devices commonly used for on-the-spot containment of clients that were acting out. The bench was a half time-out device, half a place for quiet rumination, at least in theory.

While a previous generation might have associations with the “go stand in the corner” clichés of severe classrooms, I think that latter day kids will have thought of the bench as a kind of penalty box—sometimes welcome, usually not. It was the kids’ school requirement that triggered the most number of benchings. Hitherto, at nine o’clock in the morning of an average day, most Thunder Road clients will have been practicing truancy with evolving sophistication. As many of their schools had been saddled with overstuffed classrooms and overworked teachers, the typical Thunder Road kid had experienced numerous suspensions, and a fair share of expulsions, with truancy being cited as the least of their offences. Walking out of a classroom, either out of boredom, disgust, or else at the insistence of an angry teacher, had been a common enough experience for many. However, being told to leave the room and then sit quietly on a wooden bench for twenty minutes will have been unheard of.

The intent was for the bench to serve as a place to reflect; that is, for youth to consider the inappropriateness of their behavior; to reflect upon the distress brought to a teacher, the disruption brought to a classroom (or a group, if that was the case). The benches lined the hallways of the milieu, sometimes situated opposite one another, otherwise at intermittent intervals. Staff were meant to monitor a client’s “bench time”: to maintain the correct standards, which included silence, proper posture (hands on knees, back straight), and appropriate signals for attention (that versatile thumbs-up gesture). Bench time was meant to last in 20 minute increments, but could conceivably last for hours during marathon group sessions, with stretch breaks woven into these 20 minute segments. Over the years, the bench has been the source of many debates—some private, in management circles—some open to an all-staff contribution. Controversial yet oddly beloved, the bench was a device—a therapeutic tool—deemed cruel and unusual by some, an inspired proto-meditation device by others. The accurate view is somewhere in between, I think. At least when utilized properly, the bench was a tool that saved many kids from themselves. It enabled, gave an opportunity, an excuse—whatever—to suspend action long enough for an impulse to abate, even if fixed beliefs, levels of frustrations and internal strife did not. A wooden bench of about six feet in length and about a foot deep was therefore situated outside just about every room used for a therapeutic or educational purpose, save for the assessment rooms used for intake interviews. The bench was an instant reminder of impending consequence; a gloomy symbol of infantilization, of the shame of expulsion, and an artifact of a system’s need for control.

The bench wasn’t the only tool of consequence at staff’s disposal, just the most commonly and most spontaneously used. Otherwise, the behavior modification system, as it was called, consisted of an array of jobs assigned to clients, formed in a hierarchical order, and a process whereby clients (and staff) would pass out what were called “bookings” for negative behavior. These bookings, paper slips with infractions curtly scribbled upon them, were passed out like parking tickets by kids assigned the role of “team captain”. The team captain would book a peer for breaking a rule such as “respecting staff and peers”, write something like, “disrespecting staff” across the slip, and then approach the offending client for a signature upon the slip, signifying acknowledgement. At this stage, contrition wasn’t required—only compliance was. Then, at a later date, bookings for the week would be gathered by staff from a box wherein team captains had been directed to deposit their quotas. Staff would then review the bookings and from that point onwards give assignments based upon the patterns indicated.

Sometimes the assignments were tongue-in-cheek and intended as fun, sort of. I remember a veteran staff member named Bobby, a fixture in the milieu during the nineties, who was known for his gruff approach and somewhat un-PC assignments. Standing beside a six-foot wide mirror, he’d preside over a girl staring into the glass and repeating the affirming line, “naughty girls don’t cuss” as her post-booking assignment. Otherwise, he’d assign what were called image-breakers to especially tough-minded boys: a clothing change involving pens in pockets, a bow tie, and most importantly, a pair of bright red suspenders. This was nerd insertion; emasculation, driven with gentle humor, and for the most part it was received that way. The sexism of these chores was coyly indulged. So called “mirror time” and image breakers were standard repertoire, though any given assignment might reflect the idiosyncrasies of the overseeing staff. The idea of any assignment, whether it was verbal, written, or even performance-related, was for day to day and moment to moment infractions to be identified, and then be subject to a learning experience. It was an opportunity for clients and staff to practice this oft-promoted idea of community: of negotiating conflict, the demonstration of leadership and cooperation.

Of course, there were all different kinds of responses to the bookings dispensed, and the assignments later given. Often kids would create a scene over the initial booking, and compel staff intervention because of a seeming escalation of tempers. This typically happened when clients received bookings from other clients, as most were unaccustomed to being subject to a peer’s authority, especially those kids who came from families with multiple siblings. Many kids displayed their avoidance patterns, especially if booked by adults. These were the kids that walked off back to their rooms, and shouted insults from beneath their pillows. The will to aggression, towards revenge, competed with self-loathing, the desire to hide and be left alone.  These kids perceived confrontation, explicit or implied, as a kind of assault—threats tantamount to abuse, abandonment, or simple disregard, because those were the associations that were downloaded at an earlier stage of development. Those parental limits that had been set—those ancient “don’t do that”, or “what are you thinking” remarks, and punishments meted out—limits we might ordinarily associate with parenting, had accompanied a range of preoccupied states and sometimes disorganized states. Some parents had been abusive. Some were merely distracted. Some had simply not been around.

Being there. For many, this was and is good enough. Being present, consistently, is as good a characterization of caring as any other. Scott Peck wrote of love in The Road Less Traveled, the philosophical gem adopted by the 12-step community after its publication in the late seventies, and commented that love entailed above all else the giving of one’s time and attention to another. Implicit at Thunder Road was the understanding that being consistently present in every sense of the word was the most important quality of any staff or peer within the community. As one oft-rejected yet resilient parent once put it to me, “it’s all about showing up.” Predictability, over time, was soothing for many; it provided safety, and in some cases, was sufficient in and of itself for the containment of negative behaviors. This is why consistency of rules, and of structure, seemed so important: the predictability of the treatment experience came to represent an antidote to otherwise unpredictable lives. It’s just unfortunate that while rules and structure may have been consistent for clients over the years, the same could not be said for staff composition. Unlike me and a handful of others, most clinical staff members outside of management came and went within a year, let alone several.

            These clients soothingly focused on the external, upon what they observed, and much less upon what was explained to them. What they observed was filtered through past experience, through the bond with the person engaging with them at any given time. Fonagy (2006) argues that insecurely attached children come to experience their own arousal as a danger sign for abandonment, which triggers a crudely teleological, non-mentalizing function; one that makes quick judgments as to others’ intentions. The securely attached individual may feel safe in making attributions of mental states, thoughts and feelings that are not immediately apparent, to account for others’ behavior. The avoidant person shuns the mental state of the other to a significant degree, instead condensing it into a simplified package. The resistant or ambivalently attached focuses on the state of distress, to the exclusion of others’ thoughts and feelings. The disorganized, meanwhile, represent a special category: hypervigilant of caregivers’ behavior, they use all cues available for prediction and may be acutely sensitized to intentional states, and thus prepared to construct a view of others’ feeling states, but uncomprehending of their own feeling states.

But why should a family environment of maltreatment or simple unresponsiveness undermine reflective function? Fonagy goes on to argue that while the faculty may be underdeveloped in some due to lack of repetitive neuronal activity paired with it, it may be further arrested in neglected or abused children because for them recognition of the mental state of oneself or the other can be dangerous to the self. For example, the child who recognizes the hatred or murderousness implied by the parent’s act of abuse is forced to see him or herself as worthless or unlovable. Put another way, the child is rendered unsafe by an acknowledgement of reality, and reassurance of safety in defiance of historical experience seems false, which further undermines the capacity to trust inner reality[1]. Abuse forces—that is, trains—the individual to attend primarily to the physical world, to be hypervigilant of external cues, but distrustful of playfulness, disregarding of internal worlds, feelings that may disorient, shame, or persecute. This person is arrested at a point wherein all that matters is sensation, and appearance. I’ve heard clients allude to this strategy when questioned about family history: “I thought if I did what was right, that would keep him from being mad,” reported one teen, explaining a history of seeming compliance with a violent father. Did? Behavior: not thoughts, and certainly not feelings—what he did. As for those clients who insist that therapists, program directors, and judges do not like them, they are convinced of such realities because the external cues tell them such things are true, and ironically, because they feel it. As to the true significance of their own feelings—of their history, for example, or layered meanings—they are not only uncomprehending, they are dismissive. These things simply do not matter. Perception in the here and now was what mattered at the Thunder Road, and the denied meanings were terrifying.

But what strikes me most about the compromised reality testing and reflective functioning of Thunder Road clients was not so much the pervasive distortions, but the strange way in which surrounding adults—parents, collateral professionals, even staff—at times colluded with these patterns, either because they had developed that way themselves, or because they had surrendered to the chronic nature of the problem, likely for unexplored personal reasons. Countertransference: there was never enough time, it seemed, to give it the attention it was due; never enough time for a parallel reflective function across all the divisions of staff, or the divisions beyond, even. To be frank, most staff members, by my observations, had not done sufficient work on themselves. Therefore, it was easy to act on automatic pilot: to focus upon clients’ behavior, the broad and troublesome question of “how to keep kids off drugs” in strictly pragmatic terms. It seemed expedient to focus on behavior, or thinking instead of underlying affects; to reassure escalating teens that treatment was safe when it clearly wasn’t, and in the process disregard the subjective experience; to assuage rather than truly address anxiety; to avoid conflict. It seemed a paradoxical submission, this periodic and later habitual pattern: at times an appropriate adherence to reality, it betrayed a dispiriting lack of attention throughout the system.

Step back even and consider the ubiquity of teleological process in industry, and within society as a whole, and within ourselves. A client of mine in my current private practice—a sales representative—will report to me each session about his numbers. The numbers are what his livelihood depends upon, and his mood, whether upbeat or anxious, vacillates alongside this tangible ebb and flow. On the weekends I like to watch sports. The success or failure of my teams, and thereafter (to some degree) the volatility of my own mental state, hinges upon a simple question with a black and white answer: did they win? At Thunder Road, there are fifty beds to be filled within the hospital unit. Now, rarely has all fifty beds been filled at any given time. In fact, over the last decade, the hospital has rarely filled over forty of those beds for a meaningfully sustained period. However, a certain minimum census had to be maintained. The success and/or failure of the program similarly rested upon this idea of numbers. From 2001 to 2004, when my role was that of a coordinator of Thunder Road’s modestly-sized outpatient program, I was charged with the task of maintaining a minimum caseload over a period of months, lest funding be thereafter cut as a result of failing to meet a numerical threshold.

            I could cite the examples ad nauseum, which may seem unnecessary given a seeming obviousness to this argument. The prosaic economic realities that govern our lives needn’t be bludgeoned into our minds. Or, perhaps they do: those are the ingredients of another kind of reality testing after all. But on this question of reality, I’m not only referring to money, but rather to a more fundamentally economical, and physical way of perceiving reality. Those who study outcomes in treatment programs, psychotherapeutic practices: what are they really looking at? In science, this process of assessment might be referred to as empiricism, versus the more philosophical construct of teleology. What is the baseline barometer at which we are left staring come the end of the working day? Fancifully, I might argue that our community, especially our politics, seems rife with crude, teleological observations, blunted reflective function, lack of empathy, and a resultant failure to bond.

Meanwhile, these intake assessments, typically produced by more than one person, thereby forming a series of impressions, would also seek to assess other factors:  client motivation, the stability (or not) of their former living environment, the potential for a meaningful inclusion of the extant family system; the influence of a development history, often accrued in a piecemeal fashion, through (again) checkered recollections. Factors such as ego boundaries—the patterns of self and other perceptions—were harder to determine at the level of intake assessment, but levels of mentalization or mindset were observable. Kids could be asked, for example, how their behaviors—the ones admitted to—had affected others. Assessment could determine to some extent what capacity a client had for contemplating another’s experience, and whether they could reflect upon their own.
       Unofficially, I’d try to observe a client in the milieu in the days following an assessment, in order to see if I might notice something not evident in an interview. I remember a boy named Eddie who, when talking privately to me, asserted with righteous conviction that he never started fights, because he was a respectful person who merely expected a reciprocal treatment from others. The next day, I saw him poised to enter a room when situated in one of a pair of line-ups heading through a narrow doorway. The exercise resembled cars merging into a single lane of traffic. When the moment arrived for Eddie to enter the room, he and another boy moved simultaneously into the open space. Appearing to anticipate a collision, Eddie preemptively flailed his left arm, striking the other boy from his path and causing him to hit up against a wall and bruise his shoulder. “Why are you trying to invade my space?” Eddie spat viciously as the other boy recoiled. When later chastised over the incident, Eddie proclaimed his innocence, insisting that he’d been victimized by an interloping peer, and later by an unjust staff authority.
        Regardless of whether assessments or prior placement reports anticipated such incidents, those patterns of not only impulsive violent behavior, but also poor ego boundaries and arrested reflective function, were often left to chance, meaning that staff would work with deficits in these areas as best they could, whenever the disruptive episodes occurred. I found that there was information in those interviews that was subtle, yet significant, or else patterns that might be inferred from impressions forwarded from previous placements, such as the oblique comments of a former counselor that had concluded a discharge summary. Sometimes, there were clues in another professional’s semi-congealed yet intriguing suppositions. While supposedly admitted for treatment of a drug problem, many kids’ precipitating events hadn’t involved drugs necessarily, according to some placement reports. Instead, the criterion factors may have been assaults, thefts, binges of sex (as well as drugs); lurid stories with sometimes inchoate elements, behaviors that kids might recount but not explain. What the admitting adolescent thought of these events, felt about these events, and the major players involved, was crucial, in so far as these impressions might clue staff as to later obstacles in treatment. Whether or not clients could even speak of these matters, the intakes and later assessments were previews of all that would follow.
       Diagnosis of depression was often inferred from a description of behaviors or feelings, none of which needed to entail the characterization of depression necessarily from the kids themselves. Depression was often evident via a client’s affect, though a depressive presentation may have been denied. One opinion is that individuals who don’t reflect upon their depression simply discharge it through their behaviors. In the histories, sleep problems, appetite problems (leading to weight loss) might be attributed to drug use (particularly use of stimulants), but might also be a presumptive indicator of depression. So, too, would suicidal ideation, of course, or a history of suicide attempts. Irritability would also be an indicator or depression, or a pervasive experience of boredom. Because Thunder Road is a licensed health facility, psychiatric observation was available, and as a result, many of the kids were placed on a variety of psychotropic medications: abilify, wellbutrin, paxil, lexapro, haldol, concerta, to mention just a few; all for a variety of presenting problems, depression, anxiety, impulsivity; distraction. These medications were largely reserved for lower functioning clients, who were assessed in terms of symptoms that placed them at imminent risk. Other clients, deemed more stable in outward appearance, were commonly thought of as neurotics, kids whose defenses may prove rigid over the course of treatment, but nonetheless—not medically acute. In fact, many who were diagnosed as being depressed or anxious simply did not perceive themselves this way. 
              Of course, many didn’t perceive themselves as having a problem with drugs either. They tended to normalize their drug-using lifestyle, especially their use of marijuana, as well as promiscuous sexual behaviors. Suicidal impulses might be dismissed as being aberrant and violent behaviors, or criminal associations, which brought with them legal consequences, were either blamed on others or somehow justified as being part of an established and accepted self-identity. Drug use was and is fun or relaxing, and with respect to certain drugs at least, ought to be legalized; sex is obviously a normal and healthy part of the human experience, and violence is a necessary response to a hostile living environment for which individuals do not bear responsibility. Many of the kids had experience living on the streets. They spoke of street values, street rules, with an air of virtue. Much of what attended the progressive use of drugs was essentially ego-syntonic; that is, congruent with an established value system, or self image. Those that didn’t make virtues out of self-reliance did so of neediness, or a version of neediness: the demand that others’ meet their needs, or that drugs serve that purpose. Still others made implicit demands for admiration, and dressed this need with euphemisms, the demand for respect.
       Staff commonly observed that kids in the program hadn’t suffered enough at the hands of a drug-using lifestyle; at least, not enough to motivate real change. Unlike adult Therapeutic Communities, wherein desperate addicts make, and persistently make, impassioned appeals for treatment in attempts to save their own lives, the adolescent milieu of Thunder Road lacked a dominant core of youths who’d experienced the depths of despair related to substance use. Of course, few die of lung cancer or liver disease at the age of sixteen. Few teens would compare their lists of rap-sheets and broken relationships with those of their elders and say they’d wrought as much if not more damage. The chorus of warning said, look where you’re heading, but the rub was and is that the addicted exalt the present, deny the past, and anticipate a future of immediate gratification. These kids’ bodies were stronger than they would ever be again, observed those warning as to the problem. Staff members, the 12-step veterans, ardently told their stories. They offered the paternalistic perspective of “I wish I’d gotten this at your age” with melancholy grace. Most drew attention to physical deterioration as a principal consequence of unabated substance use; others may have cited constant legal difficulties, a series of relationships destroyed by bad decisions, or the tragedy of estrangement from their own kids. Many clients had experienced these events from the other side, as witnesses: they had parents with disease; parents that were separated or divorced. Some knew what it was like to be removed from a home by an officious social worker. So the platitudinous cautionary tales of staff resonated with some kids, but often missed the mark with others, sometimes because the kids were not ready to cope with such painful histories, but also because the staff caveats aimed too narrowly at the projected results of an unresolved problem rather than the intrinsic problem of a disturbed inner self. “I’ve got problems because I’m messed up,” said the recovering addicts, reflecting on past damage but a chronic condition. “I wanna learn so I can avoid this stuff in the future,” the most motivated kids would answer, missing an important point. The slogan One Day At A Time seemed designed for them, for their myopic ambitions and short attention spans.
       Motivation for treatment was a precious resource, something that was scrutinized, asserted, speculated upon, and sometimes discovered. Flight into health, a term used by relapse prevention specialists, was often used to describe those who are not so much resistant to treatment, or even normalizing of their drug use, but instead proclaim themselves clean, sober, and cured, and therefore do not require any further assistance. They elicit skepticism, basically: inward smirks from staff (and senior clients) that saw through their gamey intentions—these were campaigns for early discharge, it was presumed. These clients behaved well, confronted their peers, said all the things that staff members appeared to want to hear, and diligently read their recovery literature. When sharing in groups, they spoke of the “new” me versus the “old me”, even when reflecting upon behaviors that may have been days old. They seemed oblivious to their own absurdity. They lacked reality testing skills, of course. In another sense, they were testing the reality of treatment: gauging the gullibility of treatment teams, angling for an advantage. Mandated into treatment as a pleasant alternative to incarceration, they sought to just get through the program.
               For some that have observed Therapeutic Communities, such as Shavelson (2000), this dynamic between provider and patient is a contamination of treatment goals, undermining the integrity of programs and leading to the impression that drug rehabilitation (perhaps narrowly defined) simply does not work for those coerced into change. Indeed, motivation did seem like a commodity to many clients at Thunder Road, as well as a residential program wherein I worked in Southern California. It was something to be proclaimed in all the right places, at the right times, and to the right people—and in this sense it was something to be played with, used and sold, for as long as treatment would last. The consumers of this sale were the clients as well as the concerned onlookers: the Thunder Road staff, the extended staff of probation officers and court officials; the suffering family members. The true motivation of clients was always difficult to assess, but it was likely the most important factor in a successful treatment outcome—more important than psychological mindedness; more important than reflective function; even more important than impulse control or reality testing.
        So what was it that kids were signing up for when they entered treatment? Assuming they’d understand all that was being asked of them—all that was possible—what would they be motivated to achieve? Firstly, did they agree with that program director, the woman who determinedly argued from personal experience that drugs, the “lifestyle”, promises much more than it can ever deliver? Before engaging the proposed solution, did they see the problem the same way? Some did. Perhaps many did; it was hard to tell given the play-acting that perpetually transpired. Some pretended; that is, they nodded reverently at staff pronouncements, while internally plotting their next using episode; their next run. Some understood the consequences of drug use: the legal, health-related, emotional and relational consequences; the guilt and shame. They actually feared those consequences, even if their caprices told them that getting high was worth the gamble that those things may or may not come to pass.
        Meanwhile, could they imagine a life without drugs, or violence or even sexual acting out. Would they understand the meaning of the stock treatment acronym HALT, which refers sequentially to hunger, anger, loneliness, and fatigue. Are kids mature enough to contemplate feelings such as existential emptiness? Did they fear the consequences of not acting out with drugs, violence, or sex? I wondered. Again, some did. Some thought of violence, for example, as a secondary disease, one that afflicted their communities, and therefore themselves. To not be violent was tantamount to capitulation, perhaps suicide. Ask an average Thunder Road client—not just Eddie—about their propensity for fighting, and they might reply with something like, “I don’t like to fight, but I’ll do it I have to.” Or, a counselor might hear something mournful like, “It’s how I was brought up,” in response to a query about why violence seemed necessary as a solution to problems. Problems were normalized, and futures were often characterized with flat hopelessness. Above all, choice was often presented as though it was illusory. 
            Could these kids consider consequences for drug use, physical and sexual violence, make decisions to pursue a different way, and possibly come to understand what treatment would be about; what something like psychotherapy might offer? In my opinion, hardly any of the kids, or their parents, truly knew what was in store for them should they last the distance of the program. Like desperate addicts who bang on the doors of treatment facilities, or shelters, in need of a bed and a second chance, some may have felt down for anything—at least when coming down of something and feeling their worst about themselves. Those who had taken their altered states to points of psychosis, or truly experienced crisis of another kind, the “bottom out” experiences that 12-step veterans speak of, may have felt prepared for interventions they would not understand. Even they couldn’t have known what it was like to live and work through the Therapeutic Community craziness. They can’t have known what it is work a recovery program, or to work through the pain that lay beneath their disordered pasts.              
        Reality testing was constantly put to test in the program. Along with limit-setting, it formed the core of the first stage of the residential program, lasting anywhere from three to six months typically. Assessed upon admit, reality testing was a likely area of deficit and was thereafter addressed repeatedly as a client’s program unfolded. The re-orientation to reality, as well as the questioning as to what was real, was exhaustive and ongoing. Prosaically, the re-establishment of structure, through a system of rules, and the attendant containment of affect states, was deemed the first major challenge in the restoration of reality. All kids play, and some adults remember what it was like to play, or still do play, sometimes recklessly. In play therapy, the therapist begins with a delineation of the limits, and then proceeds with the therapy, knowing that children, especially children with poor attachment histories, will test these limits—in many instances, test them unconsciously. All games have rules, we learn at some point. Games that don’t have rules, or don’t have consistent rules, are games that break the rules; they are games that have become unreal and become play gone wrong. For some staff members at Thunder Road, this was not only exhausting, this task of delineating treatment’s game, but also disillusioning. The most idealistic would sometimes heave a sigh upon delivering the background of a new client, knowing the steepness of the–excuse me—road ahead. Still, the job was to educate: to begin working with clients whom Prochaska, Norcross and Diclemente (1983, 1994) designated as “precontemplative” of change, and proceed to undo, as methodically as possible, all the obstacles—cognitive, emotional, systemic (as in familial)—that stood in the way of the client understanding the basic destructiveness of their previous and/or existing path.
       The ubiquity of poor reality testing was why the Kohutian technique of mirroring, so rigorously taught at my initial practicum placement, seemed an insufficient intervention for the kids in the program. The virtues of mirroring presume an orientation to reality on the part of the client; but to make affirming noises, or else paraphrase back (perhaps accurately) someone’s denial seems at times to do little more than reinforce that denial. Instead, the task with Thunder Road clients was to review the events leading to admission, and sort through what resulted from clients’ behavior; their “negative” choices. Motivation for treatment may have been genuinely present, but narrowly understood. Clients with closed minds or limited capacities became fixated upon callow understandings. For some, an entire year’s worth of treatment might attend to the issue of motivation, but still not even traverse the opening bullet points of a resistant argument. “My P.O. sent me here because the judge didn’t like me.” I once had a Thunder Road client named Aaron who believed this the first day I met him (day three, I think, of his program), and was still believing more or less the same thing eleven months later.
       Aaron did what he needed to do, and said what he needed to say, like many who are coerced into treatment. That is, he remained abstinent, as far as anyone could tell via observation and semi-regular urinalysis: compliance as defense. He agreed, in principle, to some roughly associated goals, and parroted back to staff the necessary rhetoric when interviewed at semi-regularly intervals. He agreed to go back to school upon discharge. He even agreed, sort of, to disavow allegiance to his chosen gang, a local strain of “northerners” as he put it, also known as Nortenos. Actually, the position he held was a commonly seized compromise, a contextually-based characterizing of his associations. To peers or a sufficiently entrusted adult, he “ran with northerners”. To authority or to the untutored in gang culture, he was blunt and dismissive: “I’m not a part of that no more.” He, like many others, before and since, agreed—even promised—to behave in the future, but never properly accepted that he had a problem in the first place. He played his game, and ours, as well as anyone. Of course, his mistake was thinking it was a game.
       This question of reality testing was, for the most part, not a question of psychosis. Though some may have fallen through the cracks over the years, the program screened out those with a psychotic level of reality testing. The poor reality testing to which I refer is therefore a more commonplace pattern of self-deceit, as well as a deep-rooted incomprehension of one’s self in relation to others: it is the poor assessment of the individual who does not perceive danger (to self or others) in a pattern of destructive behavior; it is the denial of someone who blames others for his or her problems, or who conversely takes on blame for a what is truly a systemic failing, often because of a false need to assert maturity. More fundamentally, it is the poor reality testing of someone who has adopted strategies for relating to others in the world, and those strategies are laden with distortions, as well as attempts to preserve homeostatic relationships, even those which are experienced as unhealthy. “Nah, this is on me,” complained the client anxious to protect the parent whose drinking staff threatens to confront.
       The former realities, the insecure attachment histories of these individuals trained quick assessments, accompanied by rigid beliefs. Impulses govern decisions, as well as flash-point associations. These are the people who, in the midst (or even the aftermath of a conflict) are convinced as to their own intentions and those of others. “I know for a fact that she hates me!” insisted another client with respect to that seemingly omniscient director, the one who fearlessly spelled out the past and present reality of everyone she came across. Reality, that client’s reality, and that of others like Aaron, was fundamentally distorted, but nonetheless presented with defiant certainty. The strongest of Thunder Road staff: those who had experienced pain in their lives yet worked on themselves so as to exude conviction, glared through the denial systems of the defiant. The most poised and gifted of caregivers didn’t need to put words to their stories. The way they carried themselves, maintained an unshaken pitch to their voices, at once saw through defenses and held the crumbling children behind the facades.
       Aaron was responding not so much to explicit verbal content, and much less to any behavior that could have been objectively observed. There was no “I hate you,” on which he could pin his assertions. Had the instructor of my one-time Rational Emotive Therapy course been present, he might have assigned an essay headlined with the question, “If there had been a camera on this scene, what would it see?” my client would have asserted his reality, speaking past my instructor’s teleological (inferring reality from what is observable) argument; utterly uninterested in its common sense philosophical center. His point of view, like that of many in the program, seemed impervious to either insight or cognitive reframe. I think this because I tried things like cognitive reframes with kids like Aaron, over and over again. All too often they failed to penetrate clients’ defenses.