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Learning a new language with brandt steele
Child Abuse & Neglecr, Vol. 11, pp. 309-3 11, 1987 Printed in the U.S.A. All rights reserved.
LEARNING
Copyright
A NEW LANGUAGE
ELIZABETH
DAVOREN,
0145.2134/87 $3.00 + .OO 0 1987 Pergamon Journals Ltd.
WITH BRANDT STEELE
A.M., L.C.S.W.,
A.C.S.W.
Tiburon, CA
STARTING A NEW FIELD, as we did with child abuse, can be so exciting that inherent problems do not seem important or particularly bothersome. On the other hand, problems can submerge a new project before it gets started. Whether the difficulties of a developing field are ignored, placed in perspective, or take over in such a way that they prevent progress, depends on who is in charge. The child abuse field was blessed. Brandt Steele brought such remarkable qualities to the direction and development of child abuse treatment that the excitement and the challenge of the work could and did overcome the potentially overwhelming problems. The most immediate problem stemmed from the predicament the child abuse field was created to address, namely, the severe injuries parents had inflicted on their small children. The extent of the injuries and the inappropriateness of parental discipline was distressing to everyone except the parents, who believed their behavior was justified. Since abusive parents were not distressed about their behavior, we had difliculty making appointments with them, let alone treating them. When Brandt Steele asked me to visit and evaluate two mothers whose babies had long bone fractures and subdural hematomas, I had retired from the social work field to have children. My first son was 6 weeks old and I was very pleased to be offered a research assignment that would not require much time or emotional involvement. I thought we were talking about a few hours of observation. Our experience with child abuse families that followed this initial misperception was to become intense and absorbing. The abusive parents referred to Dr. Steele, and to me too, as we subsequently became a team, were at high risk of reinjuring their children. Reporting laws that would make the court process commonplace and encourage judges to be better informed would not be a reality for some time to come. The general bias, and the bias of judges too, was that poverty and mistreatment of children went hand in hand. Seeking protection of the court from parents of middle and upper class children was difficult at best. The parents did not agree that their children needed protection, nor did they agree that they needed help in protecting their children. The motivation for contact with them was all ours. Our offers of help carried no threats, but from the parents’ point of view, our offers were thinly disguised attacks. Confronted with extensive distrust that made even the simplest contact with many of these high-risk parents next to impossible, we tried to make their seeing us easy and appealing. Appointments were offered any time of day or night, at any place of their choice. When rebuffed, we did not give up easily. We pursued, although uncomfortable about doing so. We were used to patients who were eager to be seen, not patients who had to be tracked down. Our pursuit of patients seemed more distasteful than ambulance chasing by attorneys.
Reprint requests to Elizabeth Davoren, ACSW, 5080 Paradise Drive, Tiburon, CA 94920 309
310
Elizabeth Davoren
The self-determination of patients has been a condition of treatment for all therapeutic disciplines. Self-determination has been overlooked only when there is absolutely no other choice. Such was the case in the serious child abuse situations we faced. Self-determination was a goal, not a condition of treatment. Pursuing patients was further complicated by the fact that in a way we were almost as anxious to avoid them as they were to avoid us. In addition to everything else, they were not easy to like. We were most put off by their cruelty to their children, but it was the risk to their children that kept us unhesitatingly involved. A mother said she was always home and vowed she would be there at a time she selected. When I arrived she was nowhere to be found in the house, on the farm, or in the neighborhood. On returning from one 140-mile trip, I needed the person who could understand not only the minor issue of the frustration I felt about a wasted, time-consuming trip, but the sense of failure I felt because a parent was unreachable and a child was at risk. Brandt was there. In addition to being one of the most understanding human beings on the face of the earth, he knew the feeling because he himself was right there on the front line. Despite losses, we began to build a caseload of patients to whom we were always available. Our knowledge of our patients was enriched by that availability and the way we worked together. As a team, we each worked closely with all of our families. Brandt saw the patients first, and if they strongly distrusted women, he would help pave the way for me. If home visits were our best means of reaching a family, I saw them, although Brandt and I visited homes together from time to time. We held joint office interviews as well. When psychiatrist Carl Pollock joined us, the three of us continued to function as a team. We were each knowledgeable about and available to all of our families. In this way we were sure our patients would have adequate attention if any one of us was not on hand. Furthermore, when working with high-risk families, none of us felt isolated. When I describe the comfort we felt in our working relationships under Brandt’s leadership, I believe I speak for Carl, too. Carl’s untimely death a number of years ago prevents his speaking for himself. Brandt’s knack for keeping our work arena trouble free contributed to our sense of well-being and kept our energies focused on our patients. The equality and acceptance characteristic of the way Brandt relates to people enhanced everyone’s sense of importance, including the abusive parents we worked with. As it turned out, these abused as well as abusive people had seldom, if ever, had the experience of being shown they mattered. Dr. Steele had come to child abuse with the well-honed skills of three professions. He was Chief of the Psychosomatic Liaison Division at the University of Colorado Medical School when he arranged to see an abusive mother at Henry Kempe’s request. An experienced internist, a “real doctor” our psychiatric residents called him when poking fun at their profession, Brandt was exceptionally sensitive to the somatic ramifications of patients’ emotional stress. He made sure they had good medical advice and attention. Brandt was also a psychiatrist and a professor of psychiatry. The skill of his diagnoses enabled us to avoid overestimating our patients’ ability to care for their children, while at the same time taking into account their strengths. As a psychiatrist, he was able to use his ability and reputation to counteract the tendency of a number of child and adult psychiatrists throughout the country to oversimplify and erroneously attribute child abuse to parents’ psychosis, or to a provocative child, or to poverty. As a psychoanalyst, his third profession, he was able to uncover the unconscious factors in our patients’ behavior and to describe how untreated child abuse is passed from generation to generation. Brandt’s fascination with history has been particularly useful to the child abuse field. He never lets us get lost in the present. He does not isolate today’s events as unique, but finds the continuity in human behavior that helps us explore the roots of behavior. He has
Early work with Brandt Steele
311
continued to make meaningful connections between ancient history and contemporary behaviors, so that the cultural persistence of the problem of child abuse is never overlooked or undervalued. In describing how we can interrupt the generationally handed down pattern of child abuse, Brandt has said that learning new patterns of child care is like learning a new language. It is difficult, but with a good teacher who can speak the language of empathic caring, human relationships, and good parenting, it can be done. And that is a perfect description of what we did. We learned to teach a new language. It was difficult, but we had a great teacher, Brandt Steele, the most empathic, caring human being I have ever known.
LEARNING
Copyright
A NEW LANGUAGE
ELIZABETH
DAVOREN,
0145.2134/87 $3.00 + .OO 0 1987 Pergamon Journals Ltd.
WITH BRANDT STEELE
A.M., L.C.S.W.,
A.C.S.W.
Tiburon, CA
STARTING A NEW FIELD, as we did with child abuse, can be so exciting that inherent problems do not seem important or particularly bothersome. On the other hand, problems can submerge a new project before it gets started. Whether the difficulties of a developing field are ignored, placed in perspective, or take over in such a way that they prevent progress, depends on who is in charge. The child abuse field was blessed. Brandt Steele brought such remarkable qualities to the direction and development of child abuse treatment that the excitement and the challenge of the work could and did overcome the potentially overwhelming problems. The most immediate problem stemmed from the predicament the child abuse field was created to address, namely, the severe injuries parents had inflicted on their small children. The extent of the injuries and the inappropriateness of parental discipline was distressing to everyone except the parents, who believed their behavior was justified. Since abusive parents were not distressed about their behavior, we had difliculty making appointments with them, let alone treating them. When Brandt Steele asked me to visit and evaluate two mothers whose babies had long bone fractures and subdural hematomas, I had retired from the social work field to have children. My first son was 6 weeks old and I was very pleased to be offered a research assignment that would not require much time or emotional involvement. I thought we were talking about a few hours of observation. Our experience with child abuse families that followed this initial misperception was to become intense and absorbing. The abusive parents referred to Dr. Steele, and to me too, as we subsequently became a team, were at high risk of reinjuring their children. Reporting laws that would make the court process commonplace and encourage judges to be better informed would not be a reality for some time to come. The general bias, and the bias of judges too, was that poverty and mistreatment of children went hand in hand. Seeking protection of the court from parents of middle and upper class children was difficult at best. The parents did not agree that their children needed protection, nor did they agree that they needed help in protecting their children. The motivation for contact with them was all ours. Our offers of help carried no threats, but from the parents’ point of view, our offers were thinly disguised attacks. Confronted with extensive distrust that made even the simplest contact with many of these high-risk parents next to impossible, we tried to make their seeing us easy and appealing. Appointments were offered any time of day or night, at any place of their choice. When rebuffed, we did not give up easily. We pursued, although uncomfortable about doing so. We were used to patients who were eager to be seen, not patients who had to be tracked down. Our pursuit of patients seemed more distasteful than ambulance chasing by attorneys.
Reprint requests to Elizabeth Davoren, ACSW, 5080 Paradise Drive, Tiburon, CA 94920 309
310
Elizabeth Davoren
The self-determination of patients has been a condition of treatment for all therapeutic disciplines. Self-determination has been overlooked only when there is absolutely no other choice. Such was the case in the serious child abuse situations we faced. Self-determination was a goal, not a condition of treatment. Pursuing patients was further complicated by the fact that in a way we were almost as anxious to avoid them as they were to avoid us. In addition to everything else, they were not easy to like. We were most put off by their cruelty to their children, but it was the risk to their children that kept us unhesitatingly involved. A mother said she was always home and vowed she would be there at a time she selected. When I arrived she was nowhere to be found in the house, on the farm, or in the neighborhood. On returning from one 140-mile trip, I needed the person who could understand not only the minor issue of the frustration I felt about a wasted, time-consuming trip, but the sense of failure I felt because a parent was unreachable and a child was at risk. Brandt was there. In addition to being one of the most understanding human beings on the face of the earth, he knew the feeling because he himself was right there on the front line. Despite losses, we began to build a caseload of patients to whom we were always available. Our knowledge of our patients was enriched by that availability and the way we worked together. As a team, we each worked closely with all of our families. Brandt saw the patients first, and if they strongly distrusted women, he would help pave the way for me. If home visits were our best means of reaching a family, I saw them, although Brandt and I visited homes together from time to time. We held joint office interviews as well. When psychiatrist Carl Pollock joined us, the three of us continued to function as a team. We were each knowledgeable about and available to all of our families. In this way we were sure our patients would have adequate attention if any one of us was not on hand. Furthermore, when working with high-risk families, none of us felt isolated. When I describe the comfort we felt in our working relationships under Brandt’s leadership, I believe I speak for Carl, too. Carl’s untimely death a number of years ago prevents his speaking for himself. Brandt’s knack for keeping our work arena trouble free contributed to our sense of well-being and kept our energies focused on our patients. The equality and acceptance characteristic of the way Brandt relates to people enhanced everyone’s sense of importance, including the abusive parents we worked with. As it turned out, these abused as well as abusive people had seldom, if ever, had the experience of being shown they mattered. Dr. Steele had come to child abuse with the well-honed skills of three professions. He was Chief of the Psychosomatic Liaison Division at the University of Colorado Medical School when he arranged to see an abusive mother at Henry Kempe’s request. An experienced internist, a “real doctor” our psychiatric residents called him when poking fun at their profession, Brandt was exceptionally sensitive to the somatic ramifications of patients’ emotional stress. He made sure they had good medical advice and attention. Brandt was also a psychiatrist and a professor of psychiatry. The skill of his diagnoses enabled us to avoid overestimating our patients’ ability to care for their children, while at the same time taking into account their strengths. As a psychiatrist, he was able to use his ability and reputation to counteract the tendency of a number of child and adult psychiatrists throughout the country to oversimplify and erroneously attribute child abuse to parents’ psychosis, or to a provocative child, or to poverty. As a psychoanalyst, his third profession, he was able to uncover the unconscious factors in our patients’ behavior and to describe how untreated child abuse is passed from generation to generation. Brandt’s fascination with history has been particularly useful to the child abuse field. He never lets us get lost in the present. He does not isolate today’s events as unique, but finds the continuity in human behavior that helps us explore the roots of behavior. He has
Early work with Brandt Steele
311
continued to make meaningful connections between ancient history and contemporary behaviors, so that the cultural persistence of the problem of child abuse is never overlooked or undervalued. In describing how we can interrupt the generationally handed down pattern of child abuse, Brandt has said that learning new patterns of child care is like learning a new language. It is difficult, but with a good teacher who can speak the language of empathic caring, human relationships, and good parenting, it can be done. And that is a perfect description of what we did. We learned to teach a new language. It was difficult, but we had a great teacher, Brandt Steele, the most empathic, caring human being I have ever known.