Billy was up on the roof of his school, threatening to jump. Police and firemen arrived, ladders were raised and a net was put in place. Kids in the street were laughing, taunting him, encouraging him, admiring him. They wanted to see him jump. Some were scared, some teary, some possibly envious. This wasn’t a normal school day.
After the incident, his school referred him to a therapist at a local hospital for individual therapy. The therapist didn’t know much about Billy when they started. Billy was African-American, 13 years old, not particularly good at school, and, like most of his friends, kind of a goof-off. He liked to wear baggy pants and long, coloured shirts and cut his hair short in the popular flat-top style.
He could be boisterous, but recently he’d become glum and distracted, sitting at his desk and staring into space. He’d also been experiencing fits of anger, picking fights and swearing at friends, even at teachers. The therapist diagnosed him as suffering from bipolar disorder.
Billy resisted going to his therapy sessions, and when he did go, he didn’t seem to be benefiting from them. His therapist said he wasn’t forthcoming or willing to talk about his family or how he was feeling. The therapy appeared to be going nowhere.
It just so happened that at the time, Billy’s 10-year-old sister Isa was in one of our girls’ therapy groups at The Family Center. Their mother, Vicky, suggested that maybe Billy could see a therapist with us. Isa told him it was a nice place. The therapist at the hospital agreed to give it a try.
A meeting was arranged for Billy with Crystal, a Family Center therapist, who asked that the whole family come for an initial session before anything else was done. Since Isa was already in one of our groups, and Vicky was peripherally involved in her daughter’s group, seeing the entire family first made sense to everyone.
So, Vicky brought her four children—Billy, Isa, 8-year-old Latasha and baby Tonya—to The Family Center to meet with Crystal and the leader of Isa’s girls’ group, Daphne.
Becoming sculptors
Crystal began the session by asking everyone in the family to take turns making a picture of how they saw their family. She explained that instead of using paper and pencils, everyone would agree to be a piece of clay that could be molded by a “sculptor.” Each family member would take a turn at being the sculptor who would use the other family members as the raw materials to create the picture.
Crystal explained that there were three rules to making this sculpture: vertical distance—who was higher than whom—would show power; horizontal distance—who was closest to whom—would show emotional closeness; and facial expressions and gestures with arms and legs and the whole body would express the type of emotion felt.
The “sculptor” could arrange the other members of the family any way he or she wanted. In this way, they could all see how each of them viewed the family from the perspectives of who was the most and least powerful, who was close to whom and who more distant, and what the emotional quality of each relationship was.
The family was intrigued by this novel game and was willing to participate. Billy agreed to go first.
Crystal asked Billy to place his family members in relation to each other according to these rules in a way that best expressed how he understood and saw his family, and lastly, to place himself in the picture as well. She also gave him a life-sized doll that he could use to represent anyone outside the family whom he thought might be important to the picture.
Billy started with his mother, deciding to build the sculpture around her. He had her sit on a chair. He placed baby Tonya next to her on her right side. He asked his mother to smile as a gesture of love toward the baby. He placed Latasha at some distance behind his mother and to her left. Asked what her expression or gesture was, he said she was looking away from the family. He also placed Isa on the left, but close to Vicky, with only a little space between them. Her expression was sadness, with her head bowed.
Crystal asked Billy if they all held the same amount of power in the family since they were all positioned at about the same height. Billy thought carefully, and had his mother stand. Then he changed his mind and had her sit down again. He put Latasha on her knees on the floor, lower than Vicky. He also had Isa sit on the floor, still with a sad, resigned expression. He had her cross her arms in front of her.
When Crystal asked him to place himself in the picture, Billy put himself closest to his sisters, but a long distance away and standing. His expression was angry.
Another “person” appears
When Crystal encouraged him to show more of that anger, Billy put up his fists in a kind of helpless gesture. Then Crystal asked him if anyone was missing. He got up, dragged a chair over to his mother, and then grabbed the life-sized doll and stuffed it on the chair between his mother and Isa, so that the doll was hovering above the two of them. He said this was his mother’s boyfriend.
He leapt forward, grabbed the doll, and threw it on the floor and started pummeling it, screaming at it with almost animal sounds.
He was clearly agitated by this time, so Crystal deviated from her original plan and asked the question she’d been saving for after she had seen everyone’s picture. She waited for Billy to get into his position behind his sisters, and then she asked him, “Billy, can you now show us a picture of how you would like your family to be?”
He leapt forward, grabbed the doll, and threw it on the floor and started pummeling it, screaming at it with almost animal sounds.
After this, the other family members, who were clearly shaken by Billy’s performance, made rather innocuous, calcified family sculptures. There was very little distinction between their depictions of the existing family dynamic and what was desired. They were covering something up and fearful—frozen by Billy’s revelation of an unspoken family secret. Isa looked particularly scared and upset.
Seeing Isa’s response, Crystal told the family that she, Vicky, Isa and Daphne would meet the following day, and then the whole family would have a meeting in the afternoon afterward.
A dramatic revelation
The next day, Isa was afraid to talk, but Daphne and Crystal slowly helped her to tell her story. It came out that she was being sexually abused by Vicky’s boyfriend. Isa was terrified of the boyfriend, who had threatened to kill her if she told anyone, and she was scared that her mother might not believe her and might be angry at her for telling her story.
The two therapists promised to protect Isa from the boyfriend. They told her that they would report the incident to the Department of Social Services (DSS), which would probably have the man arrested. Then they helped her have a conversation with her mother.
Vicky was angry at Isa. She didn’t want to believe her, and told everyone in the room it wasn’t true. Isa’s knuckles were digging into a pillow on the couch. She looked away, tears dripping down her face.
Crystal said to Vicky, “Look at your daughter. Do you think she’s making this up?”
Vicky glanced at Isa and looked away again.
“No,” Crystal said, “LOOK at your daughter. What do you see? Do you see someone lying? Or do you see someone suffering and scared and not being cared for by her mother?”
“Well,” Vicky said meekly, “I didn’t know.”
Crystal went and sat next to Vicky as a comforting gesture, saying, “I’m at your side,” but she didn’t let her off the hook. She was challenging her from close up. Isa got off the couch and ran to Daphne, who hugged her and took her on her lap.
Legal obligations
As a family therapy clinic, we needed to take several actions immediately. First, we were obligated by law to report this incident to the DSS.
There were two ways this could be done. We could file the incident ourselves, which had to be done within 24 hours and had the greatest risk of the family being separated. Or, we could “partially” report the incident and ask for five additional days during which Vicky could file the incident herself and tell the entire story.
We strongly preferred doing it this way because it would avoid pitting us against her, while also encouraging her to be a strong, protective mother for her children.
A great fear for a lot of children like Billy and his siblings who live in the projects is that when something like this happens—a child being abused—the child will be removed from the family and taken into a foster home for safety. This is a dreaded possibility for many of these kids, even if they may be in rough straits at home.
Department of Social Services safety workers who remove a child from home to avoid a repeat assault often underestimate the emotional trauma caused by separating the child from his or her family. Separations of this sort add enormous additional loss and pain to the abuse the child is already suffering from.
We discussed this upfront with Vicky and said that we hoped that she’d call the DSS herself to report what had happened. If the call came from a concerned parent trying to protect her children, she was more likely to be allowed to keep all of her kids at home. After a day or so, she agreed to report the incident herself.
The second necessity following our meeting with Vicky and Isa was to get the boyfriend permanently out of the house and make sure he couldn’t decide to come back in the middle of the night. The police issued a restraining order and assured Vicky that they meant business.
Circling back to Billy’s emotional needs
After this, we returned to focusing on getting the whole family back together to address Billy’s feelings and behaviour, as well as reassuring the family that they would not be separated as a protective measure by the DSS. We were afraid Billy might not show up, but he did. He was silently treated as a sort of hero. He’d shown all of us, his family and the therapists, what was really going on in his family.
Crystal asked him if he thought that holding this information inside of himself had anything to do with what had happened in school. Billy nodded his head. How long had he known about what was going on between Isa and the boyfriend?
He was quiet for a long time before he eventually spoke up. He said he’d found out just a short time ago, and by accident. He’d seen the boyfriend and Isa together. He didn’t want to talk about it and began pacing around the room. Did he feel relieved?
“Yes,” he said. Then “No,” he felt scared. Crystal explained to him everything that was going to happen next. The police would keep the boyfriend away, and Billy’s family was going to figure things out together.
With the crisis identified and the immediate needs dealt with, we were able to start meeting with the family to help them strengthen their family bonds and try to advance their well-being.
The children were very relieved. We weren’t immediately worried about Billy, though we still had plans to get back to him and why he’d been on the roof. That had been a pretty extreme way of making a statement or a cry for help. We thought there was probably more to it.
In the meetings that followed, Billy’s story emerged in a way it hadn’t with his first therapist. Billy was a vulnerable kid, wanting to find a safe place, with a family he could trust, which he wasn’t finding at home. As a result, he was ideal prey for the youth gangs who were prowling his neighbourhood.
He’d been approached by some slightly older boys who asked him to join them. They were well known in the neighbourhood as trouble. Billy wanted to belong to something, but he didn’t really want to join a gang. He just wanted a good friend whose family he might be able to go home to. But the older boys were persistent, and he felt trapped, caught between his family, where he couldn’t tell the truth and protect his sister, and the gang, which was both tempting and intimidating.
One day things finally came to a head. A boy from the gang told him that he was either with them or against them. He had to decide that day. Billy’s response was to go up on the roof and threaten to jump off.
Understanding “symptoms”
As we can see from this story, “symptoms” mean different things depending on where one focuses. Symptoms are signs of distress, and in this case, the startling, attention-getting symptom was Billy threatening to jump off the roof.
But what was it a symptom of? A bipolar disorder? A signal to the world that his family was in trouble and needed help? A cry for help in a community where he was trapped between two bad choices?
How we understand the meaning of the symptom will prescribe what line of intervention to take. And how we see the symptom will depend on where we choose to look. It is not necessarily an either/or situation, but if one approach is emphasized and another overlooked—which is often the case in the helping professions—we may hit a wall, or we may miss something terribly wrong that needs attention.
Billy was the “identified patient,” meaning that he was the one showing the symptoms, but not necessarily the one who needed the most help.
Billy and his family were among some of the early clients of The Family Center, coming to us around the time that we were starting to develop the first exploratory Parenting Journey group, which laid the bedrock for later Parenting Journey programs.
Going into the first family meeting with Billy and his family, no one thought that the real “patients,” to use a medical term, would be Isa and her mother. In this kind of situation, family therapists would say that Billy was the “identified patient,” meaning that he was the one showing the symptoms, but not necessarily the one who needed the most help. In fact, it’s often the strongest member of the family who raises the red flag.
In this case, once we’d met with the entire family, it became immediately obvious that it wasn’t Billy who needed individual attention as long as his family situation was addressed. We continued to work with the family through the resolution of the issues brought up in the illuminating session with Vicky and Isa, and, in part, because Vicky had decided to call the DSS herself to report the abuse of her daughter, the DSS did ultimately decide to keep the family together.
As the situation was addressed over time, Billy regained his earlier enthusiasm and goofiness, and Isa started on the long road to living as a survivor, now with the support and understanding of her family.
Vicky eventually became a member of our very first Parenting Journey group, where she could get the kinds of support she needed to accept and deal with the immense challenges she faced in her life, including both her own personal interests and those of her children.
Anne Peretz, MSW, LICSW, is a family therapist and co-founder of the Parenting Journey (formerly known as The Family Center). Her
new book Opening Up: The Parenting Journey is available now through Radius Book Group.
Excerpted from Opening Up: The Parenting Journey. Copyright ©2021 Anne Peretz. Published with permission from Radius Book Group — https://www.radiusbookgroup.com/
image 1: Pixabay; image 2: BSNBCS Students; image 3: Baltimore Heritage; image 4: Pixabay
