Engaging Boys in Treatment

Creative Approaches to the Therapy Process

Craig Haen, Craig Haen

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781135184049
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Traditional therapy can often be an off-putting experience for boys as it is in direct opposition to the ways they generally interact and connect with others. This book explores a variety of creative approaches that professionals can use to enhance the clinical experience and better reach their young male clients. Chapters discuss the theory behind and implementation of various creative approaches to therapy with boys, such as play therapy, including sports, movement, and gross-motor activity; animal-assisted therapy; the use of video games and computers; the use of superheroes in role play, metaphor, and play therapy; and art therapy. Attention is also given to methods for working with several subgroups of boys that require specialized treatment approaches, including gender variant and sexual minority boys and boys with ADHD. The first book of its kind, mental health professionals will find this a comprehensive and highly valuable text to help them understand, help, and support boys and their development.

SECTION
III

Special Populations

CHAPTER
9

Doing Anger Differently

Working Creatively With
Angry and Aggressive Boys

MICHAEL CURRIE

Alan, a 13-year-old boy, is teased by some classmates on the school playground regarding his sexual preferences. He reacts quickly and angrily, pulling a metal ruler from his bag and hacking into the necks of his classmates, wounding them. One of the boys Alan attacks requires admission to the hospital. After Alan has a tearful, remorse-filled encounter with the deputy principal, the school's head of student welfare asks me to talk with Alan about his anger. The principal, clearly the angry one now, says to me, “He's a nice boy but he just won't do what he says he will. This is his last chance. If you can't help him control his anger and this happens again, he is going to be expelled.”

My initial meeting with Alan was similarly filled with tears, remorse, and many promises to “not be bad again.” I had been told that his remorse was a familiar script to the school authorities. He appeared genuine but, according to the school, his remorse counted for little if he was provoked. Unlike the majority of his peers, even the threat of dire consequences from the principal appeared to have little effect in helping him abide by the school rules of reasonable conduct. There appeared to be a force operating within Alan that was stronger than any of these factors.

At a second meeting, Alan revealed that he could not stand that someone else thought he was “a faggot” and that the classmates who were teasing him seemed so smug and self-satisfied that he felt he had to strike at them. This seemed to be the first mismatch that was involved in Alan's angry outburst. His rules, necessary for maintaining his view of himself, asserted by his ruler, contravened the school's rules.

I AM NOT WRONG ABOUT MYSELF: MIRRORING AND THE FEAR OF DISINTEGRATION

Peers form an important function in late boyhood and early adolescence. For most older boys, peer groups are the primary means of social expression. It is within the peer group that an important “mirroring function” occurs, which assists a boy in maintaining a coherent self-image. In their social environment, boys encounter friends, classmates, and enemies who reflect back a more or less coherent view of themselves as a whole, integrated person. As the move from boyhood to adolescence progresses, the importance of these peers tends to increase, and the importance of the mirroring function of the family tends to decrease, although family, particularly parental figures, maintain an importance throughout life, as they are associated with the origins of the individual.

We all carry with us a more or less conscious idea of a unified image of ourselves, a sense of who we are as individuals. When this sense is attacked or threatened, by someone who seems to be more successful or beautiful than us, or by someone who directly challenges us regarding our competence, authority, and the like, it is likely to destabilize this coherent image of ourselves. This instability of self-image is particularly marked in boyhood and adolescence, where a sense of stable identity is still being formed and is subject to rapid change within the context of the peer group. Peers come to act as a sort of mirror. Boys tend to think negatively about those peers who reflect a negative image. In some cases, boys can think that their own self-image is threatened with disintegration: It seems one might “fall apart” in comparison to stronger or more competent others. Anger (and resulting aggression) can be seen as an assertion of a boy's own self-image over how he thinks someone else is devaluing him. In short, anger is a statement: “I am not wrong about myself.”

Alan's aggression can be seen as a protective act, attacking the unity or wholeness of those whose taunts threaten him with disintegration. Within angry individuals, the fundamental psychic tendencies can be very different from the face that is shown to the world. Rather than the aggressive, swaggering tough guy we might expect, we find a boy who is fragile and vulnerable and reliant on the constant affirmations of those around him. However, precisely because this is how things are organized, his fragility cannot be approached directly.

This is a major problem in speaking with such boys about their difficulties with anger. How can problems about their behavior be discussed without triggering the defensive reaction “I am not wrong about myself”? These difficulties are compounded when it appears to the boy that the aggressive act, such as screaming at his parents, solves the problem and is thus the best way to respond. However, the repetition of aggressive acts results in marginalization, then suspension, and finally expulsion from school or ongoing punishments and a negative atmosphere within the family. An “excluded” status is often perceived by an aggressive boy as victimization, and he considers himself a rightful avenger of what has been done to him. He may avenge himself until he has reached the margins of his family or social group, classmates, and school. Violent, vengeful acts are ultimately self-destructive. The consequences of these acts tend to have a negative effect on the boy's life opportunities. Boyhood and early adolescence is a time when intervention can occur before these opportunities disappear. The ideas I outline in this chapter—the use of percussion, the group work setting, and a model of intervention called the cycle of identity—are effective ways I have found to intervene in the face of “I'm not wrong about myself.”

Anger and Sadness

The fear of disintegration, discussed above, can also appear to be directed somewhat arbitrarily outward as anger, or inward as sadness or another attack on the self. The assertion of anger—“I am not wrong about myself”—and the resulting attack on those perceived as the source of the accusation are not far from the statement “I am wrong about myself” leading to an attack on the self. Anger refutes the reflected image, whereas an acceptance of the image gives rise to sadness, depression, and attacks on the self. This is why boys who are aggressive may show a worrying degree of somewhat arbitrary self-destructiveness and recklessness. Anger may have an important protective function against sadness and depression. Merely making it a boy's task to reduce or manage the expression of anger may bring about increases in other negative emotions.

What Do I Want?

For Alan, his problem seemed to be that the teasing from classmates in the school yard easily smashed his ideas about himself. In addition, his view of himself was influenced by the wrath of his school's deputy principal. His permeability to others’ views of him pushes Alan back and forth between anger and remorse with little prospect of being able to determine what he wants for himself. Questions such as “Who am I?” and “What do I want?” are central but difficult questions for boys. They are central questions because they provide a future for a boy to hang onto over and against acting destructively and impulsively.

In Alan's case, he has difficulty making progress on these questions because his permeability to others means that he is always looking to what others want of him rather than asking himself what he wants. Central to his treatment was the discussion of these questions. Such a discussion cannot occur in the shadow of Alan's (or any boy's) guilt and remorse, tempting though it may be. The guilt and remorse of an angry boy tends to reassure us that he has had the correct moral response to a crisis situation, but Alan's remorse was a response to what the school authorities had expressed to him in clear terms and was Alan's way of accommodating what the school wanted of him. However, the source of Alan's anger is more worthy of investigation than condemnation. His anger brings us closer to his self-perception and its disturbance by the accusation in the school yard. Although focused on the problem caused by the other, the cry of “that's not what I want” inherent in the angry act may be at least a start on the road of helping a boy answer the question of what he wants.

To reiterate, this question is important, because otherwise a boy has no reason for placing a limit on his lashing out. If a boy has nothing to preserve, cannot imagine some sort of future for himself that he could work toward, then he may as well savor the momentary enjoyment of being a victor in an aggressive exchange, of clearly showing his opponent who is boss. If an aggressive stance is all a boy has, it is unlikely that working toward being “pro-social” will meet with success, as he will then be left with nothing.

Aggression as an Existential Act

The case of Alan (discussed above) clarifies that anger is often an emotion that emerges when the stability of one's self-image is threatened from without. Aggression, the act of physically damaging or destroying something or someone in the world, emerges when this threat becomes unbearable. The angered individual can no longer stand the tension created by the threat to his status and strikes as a way to maintain his self-image. In this way aggression can be seen as an existential act that aims at “psychical homeostasis.”

Aggression is an externalization in action of the physical arousal inside the aggressor's body. What eludes the aggressor is speech. In bypassing speech, the aggressive act bypasses the codes—reasoning, doubt, ability to wonder—that are contained in the act of speaking. Alan's aggression was a response that guaranteed instant results, stopping the provocation and (presumably) relieving his bodily tension. Retorting with insults, going to the deputy principal to complain, or organizing a program of subtle retribution by exclusion among his friends are all less predictable responses, subject to greater doubt and less complete than the response of physical aggression.

At a fundamental level, the task with aggressive boys is to assist them to use words rather than fists. It requires a degree of containment (speaking takes time and the results are often not immediately apparent or able to be perceived by the aggressor) and the ability to withstand frustration (the results of speech are less precise, more imperfect than aggression). I move now to discussing three aspects that I have used to assist with this endeavor: the use of percussion, the use of the group, and the use of a framework for analyzing the relationship between a boy's speech and action. I will add that I have found the approach outlined below to be useful in treating boys with both reactive (or impulsive) aggression—aggression fueled by an overwhelming anger in the moment, as was Alan's aggression—and instrumental (or proactive) aggression, which is more planned and covert, as was John's aggression, discussed later in the chapter. See Connor (2002) for a discussion of these categories of aggression.

THERAPY AND ANGRY BOYS: USING PERCUSSION

Angry and aggressive boys tend to avoid focusing on their inner experience: From a viewpoint that legitimizes coercion, there are seemingly few advantages in speaking about inner experience (Streeck-Fischer & van der Kolk, 2000; Wilson, 1999). However, this focus is exactly what is required in the therapeutic encounter. At the center of the Doing Anger Differently (DAD) program is a series of percussion exercises designed to overcome the myriad problems that prevent angry boys from participating in therapy. The program uses Latin and African percussion—congas, djembes and other hand drums, bass, snare and other stick drums, cowbells, whistles, and shakers—and allows each boy his own instrument with which to participate in the exercises (Currie, 2008a).

Percussion assists boys in symbolizing their inner experience, acting as a bridge between the physicality of the experience of anger and the ability to speak and think about this experience (Currie, 2008a). Many conduct disordered and angry boys experience difficulties in speaking about negative emotion (Fonagy, 2000). This symbolization acts as a metaphor for internal experience, assisting boys in understanding the difference between a situation and their internal response to it. The program addresses the characteristic habits of angry boys, which include blaming others for their feelings and actions, and confusing emotions and actions.

An exercise that illustrates these functions is the “mapping anger” game (see Currie, 2008a), in which boys create a simple map depicting the rise and fall of their anger and reactions following a provoking event. This map is then played on the drums, often with help from other boys in the group, giving musical form to components such as, for example, heart rate, buzzing in the head, thinking, or the urge to punch. Music is isomorphic with emotion: It rises and falls over time. This makes it a tool suitable for the symbolization of affect. Depiction of an episode of anger to the group in this manner can create a powerful moment for a boy in which he understands the anger to be his. Commonly, boys take an interest in the nature of their anger and its effects following this exercise.

Percussion also creates group cohesion, bypassing the negative and destructive language of aggressive boys. It offers an invitation to the possibility of play, creation, and enjoyment within a powerful lattice-work of in-group relationships. This enjoyment has led to boys returning to the group, despite commonly disliking school and having chronic conflict with their peers and family.

INTERVENING IN GROUPS

I have found group work with angry and aggressive boys to be a profoundly effective method of treatment, despite criticism of such an approach from several quarters (Ang & Hughes, 2002; Dishion, McCord, & Poulin, 1999). In my view, this is because those critical of group treatment view clinical group work as an economic asset rather than a clinical asset. To ignore group process is to abandon boys to the aggresso-genic meanings that inevitably form in the “storming” (Tuckman, 1965) stage of the group. These meanings must be approached, rather than ignored or “swept under the carpet.” Otherwise, group processes influence the group formation outside the formal group sessions in a manner that is as corrosive to individual will and identity as membership in a violent youth gang. Group approaches have been shown to be at least as effective as individual therapy with boys (Hoag & Burlingame, 1997; Kastner, 1998). One reason may be that the group forms a context within which young people can remake themselves, or produce an alternative identity. A second reason may be the interactive immediacy of group work that assists boys in understanding themselves through an initial emphasis on doing rather than t...

Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Contents
• Series Editor's Foreword
• List of Contributors
• Laying the Ground
• Boys and Therapy The Need for Creative Reformulation
• Honoring Masculine Strivings in Individual Psychotherapy With Boys
• Strengths-Based Group Work With Boys
• Creative Approaches
• Physical Play With Boys of All Ages
• Incorporating Animal-Assisted Interventions in Therapy With Boys at Risk
• From Virtual to Real Video Games in the Treatment of Boys
• The Therapeutic Use of Superheroes in the Treatment of Boys*
• Breaking Through With Art Art Therapy Approaches for Working With At-Risk Boys
• Special Populations
• Doing Anger Differently Working Creatively With Angry and Aggressive Boys
• Body-Based Treatment Approaches for Young Boys Diagnosed With ADHD
• Attachment Is a Verb Experiential Treatment for Addressing Self-Regulation and Relationship Issues in Boys With Sexual Behavior Difficulties
• Strengthening Bonds Between Nonresident African American Fathers and Sons as a Way to Reduce or Prevent Youth Risky Behaviors*, †
• Creative Approaches to Working With Gender Variant and Sexual Minority Boys
• Index