Fiori d'Acciaio

NEW FORMS OF SUFFERING, NEW FORMS OF

INTERVENTION: THE COMPAGNO ADULTO MODEL

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The following reports are made by two Compagno Adulto operators about their work with adolescents.​

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M, the boy hidden in his hood​

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First of all a few words on the parents:

Parents came from humble and large families from the south. Both with many brothers and sisters, with a complex history: the mother has unborn sisters, others who have died very young, and pregnancy issues. The father has four dead brothers, some of which have no known grave. The mother was a head nurse in a hospital and she worked with disabled and psychiatric patients. She had three children. M often asked his mother: “why was I born?” and his mother used to say:  "because I was sad so a little angel saw me and said ‘I'll come and keep you company”. M often asked her: “did I hurt you?”. M. fantasies about his birth are very violent. Two years before M was born, his mother wanted to adopt a newborn abandoned in the hospital, even if the husband was contrary. At the hospital they said he wouldn't make it through the night but instead he survived. Anyway they wouldn't let her take him because of bureaucracy issues.

There were many complexities in the process of working with M parents: first of all they used to think that M was the only problematic child they had, leaving him the role of bearing the family system symptom. Secondly, the father's fatigued to accept his son's homosexuality, even to this days.

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When I first met M he was with his parents in the psychiatrist's office: he was very thin and tall, with short platinum blond hair, piercings on his lip and eyebrow, the hood of his sweatshirt pulled up.

M parents came to me, sent by the psychiatrist in charge of their son, to include him in our project. M was 19 years old at the time of my first meeting with his parents. He left high school at 17 and he has been homebound ever since. He has had four hospitalizations, including one in a therapeutic community (from which he was removed after 48 hours), and an attempt to live alone in a flat rented by his parents in which he stayed for a couple of weeks. After one of his hospitalizations he attempted suicide, his father found him in the bathroom with a belt tied around his neck. His parents explained that they also tend to stay confined in their room: M, who had his own room next to their parents' room, could not stand the noise produced by them in the course of their daily livelihood, and has asked to live in what used to be the living room. The parents are only allowed in and out of the house if authorized by M, who locks himself in his room/living room to avoid meeting them. When M encounters them or spends time with them, he has to do some cleansing rituals with boiling hot showers that can last an hour or more, often accompanied by 'noisy' attempts to produce vomit that he then leaves in the sink and his mother has to clean it up for him.

The home setting initially frees the children from getting in contact with their need for the other, or rather makes it tolerable. There is no need for them or their parents to keep in mind the day and time of the session or to move from home. In this context the operator comes home, gives rhythm and new meaning to the days all similar to each other. She must be delicate and secure in her movements, in order to restore meaning to closeness, to closed doors and to the hours spent getting ready to walk around the building. The process will be long and difficult, but we have the possibility of creating a therapeutic pathway that the adolescent in withdrawal will be able to "use" to acquire those first relational rudiments such as identifications and mirroring.

M spends many hours at the computer playing games and talking to people on the other side of the world; he often disrupts his schedule by sleeping during the day and playing at night; he communicates with his parents via mobile phone and wakes his mother up at all hours of the night, often more than once, to ask her to prepare food (pasta, sandwiches, milk, etc.). M's room was actually the living room of the house. A large room separated from the corridor by a glass door. Once inside, the part immediately visible of the living room housed a table and chairs, next to the wall there was a piece of furniture on which his mother placed the tray with lunches and dinners, receiving empty plates in return. In the middle of the room a large cupboard divided the more intimate part where M actually lived. Between this cupboard and the wall, a blue curtain had been erected to emphasize the clear definition of this space. Beyond the curtain there was a smaller space housing a desk with TV and PC, a bed and a bedside table. The level of emotional and physical closeness that M felt he could sustain in the different moments of our journey together corresponded to the part of the room where he could welcome me and be with me. At times of total closure with the world I had no access to the flat at all. When he experienced a relational difficulty with me, I could get to the threshold of the glass door. In the good times if we were alone in the house, we would come to the kitchen to prepare snacks or we would even go to the park to do yoga in front of the pond while he genuinely questioned the distance between his perception of his body and what he saw from the outside. When he was very depressed about the break-up with his boyfriend and our relationship became much firmer, he would welcome me to his bedside completely hidden by the duvet.

For the withdrawn youngsters, the room becomes the actualization of psychic boundaries. At certain moments it can be a tool for controlling the distance from the others in the relationship, a protection from their gaze. Everything is done to avoid being constantly in contact with shame and the sense of inadequacy resulting from feeling that they do not live up to their ideal.

The time spent outside the room by the operator becomes a time of deep listening. This is the time the adolescent makes sure that he has not destroyed the object with his aggression. Once both have survived, it is possible to make sense together, little by little. This is needed to build and maintain a therapeutic alliance. It is not at all easy to wait in front of a closed door. The countertransference experienced by the operator consists often in feelings of helplessness, a sense of uselessness, doubts about one's professional abilities, efforts that seem to have been lost at that moment. It is only in the equipe dimension and in supervision that these experiences can be re-read. 

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E, the girl who punches the tiles

 

E, 13 years old, is the second of three children: the first is 17 years old and the youngest is 11.

At the time of our first meeting, the girl had already been diagnosed with an attention disorder, which caused many difficulties during primary school.

She had no failing grades, but her behavior and conduct worried her parents significantly: she still does not respect authority and cannot tolerate the frustration of hearing "no", reacting with complaints and, often, self directed violence. Frequently, in these cases, she locks herself in the bathroom and punches the tiles until she inflicts deep and bloody wounds on her knuckles. She then photographs them and shows them off.

The mother recounts that even as a young child, E often expressed anger and discontent by banging her head against the wall. Believing that the child just wanted to draw attention to herself, during these episodes the mother used to leave her alone in the room in order to let her calm down on her own.

The parents seem to have different narratives about their daughter, as much as different approaches with her. However they both agree that she exposes the whole family system into a regime of terror. The mother’s approach seems to be anxious, controlling, symbiotic, intrusive and judgmental, while simultaneously downplaying the girl's reactions. 

The father claims to have never actually seen her punching the tiles; on the other hand he seems to have a firmer and more welcoming approach towards his daughter: he supports the need for a common educational goal and a unified way to manage provocations, oppositional behaviors, and consequences.

 

Despite the girl’s declarations - “I don't want to talk to the psychologist!" -, she has always attended the meetings without any opposition.

 

During the first meetings with the psychologist, E immediately appears capable of forming a relationship. Since the beginning she does not seem opposed to the idea of being in a Compagno Adulto project. E recognizes and talks about the peaks of anger she experiences and she acknowledges her difficulties in managing them. The girl admits to having an oppositional and derogatory attitude towards school and teachers. She explains her way of managing anger, proudly showing photographs of the bathroom tiles completely covered in blood stains. She speaks candidly about when she started hitting the tiles, admitting she cannot stop at just one punch, feeling the need to continue until she feels calm. 

These outbursts of anger occur when she’s frustrated: deprived of her cell phone, prevented from doing something, or during an argument with someone.

The girl proudly says she always arrives late to school; she maintains a role within her peer group as a bully and a tough girl who answers back to teachers and talks during lessons, disregarding the rules. She often argues with teachers and then hides in the bathroom, where she spends much of her time.

 

The established treatment presumes a multifocal intervention including: the girl, the family and the school.

In order to be effective, it is necessary to establish a strong alliance among the clinician, the school institution and the family system. If the school and teachers do not agree to collaborate or if the parents are not cooperative, downplaying the problem, the intervention could, and probably will, fail. The girl herself has a specific role in ensuring the success of the therapeutic activities, making it essential that she’d be involved and committed to the therapeutic alliance.

 

Our broad intervention approach was built on a multimodal model involving the following areas:

 

- Compagno Adulto Intervention: As a personalized and individual psychological therapy (two-hour meeting per week). The girl's strong oppositional behavior required intensive work on building the relationship, trust and alliance. 

The Compagno Adulto Intervention focused on the following areas:

  → Emotional Awareness: E shows significant difficulties in recognizing, expressing, and verbalizing her emotions, avoiding confrontation with unpleasant ones, particularly regarding relationships with adults, rules, and limits.

  → Impulse Control: E has pervasive difficulty in recognizing and managing impulses and frustrations, which are transformed into violent acts, both self-directed and outward, marked by high levels of emotional and behavioral dysregulation.

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- Expressive Workshop: Integrating E into a peer group to work on social relationships proved to be an effective strategy. Through participation in a bi-weekly workshop group, she was able to confront and identify with other aspects of herself, particularly working on frustration derived from peer and group interactions.

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- Parental Support: It has been essential to start a parental support program to help the parents manage daily difficulties in their relationship with E. The goal was to help them create a supportive environment that enhances self-regulation and reflection, providing space and time for the girl to think about what she is doing.

 

- Teacher Support: The school environment is where the girl’s difficulties manifest most clearly and frequently. Therefore, it was useful to provide guidance to help teachers recognize and understand her specific characteristics.

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The work with E was built on a proposal for a choral and multimodal intervention.

The fundamental point of this proposal for care, whose primary objective was the girl's well-being, involved the activation of different intervention methods on various fronts. This has been possible through the creation and maintenance of a network of operators coordinated by the clinician. Frequent contact and moments of comparison allowed to maintain the therapeutic alliance of a cohesive network, a key factor for achieving the objectives of the intervention. The results can only be reached based on the level of involvement, effort, and flexibility of the entire network.

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