After obtaining my B.S. in psychology I started my career in the realm of support for people with intellectual and developmental disabilities as a paraprofessional in a special education school. I would come to find this school had earned a reputation for accepting students with especially volatile behavior. For just shy of two years I both taught and learned from my students. Of note, I worked with one young woman whose behavioral data exhibited a 100% correlation between physically aggressive behavior and an impending grand mal seizure. Collecting and reviewing those data was foundational to my understanding of what can drive truly dangerous behavior. I still have a small scar on my abdomen from when this young woman bit my stomach with enough force to cause a pressure wound in the center of the ring of her enfleshed dental records. Yet, when a seizure was incoming, we as staff had a variable timeframe in which we needed to shift from protecting ourselves and her classmates to protecting our attacker. That understanding did not preclude the risk to physical safety, but it needed to inform how I responded to those risks.
It was also at that school that I would go on to meet a member of a behavioral consulting organization that specialized in understanding and adaptively addressing behavior which put people at risk of significant harm. I had student loans to pay, and I saw an opportunity to make more than $10.50/hr. At the tail end of 2015, I began working for this organization that continued to build upon that foundation.
In my time there, I was quite fortunate to receive direct supervision and guidance from people I consider to be truly brilliant in their approach to understanding behavioral challenges. They helped guide me toward a more sophisticated understanding of human behavior and the resultant impacts of various neurological, psychiatric, and environmental conditions. However, I also began to note the discrepancy between my own standards and the standards accepted in general practice. Anchored in my mind now is an understanding that no matter how deeply I care for those for whom I am responsible, I cannot transfer that motivation to anyone else.
In one case, I worked with a young man whose brain conferred to him a delay in auditory processing. Within 10 minutes of meeting the young man I was confident that simply allowing him more time to process what was asked of him would be a step in the direction of peace. This young man’s parents disagreed. Instead, they insisted on repeating their demands of him more vociferously, to the point of triggering an aggressive response. No matter how much I modeled the efficacy of my suggested intervention, the parents remained unwilling or unable to allow 5 extra seconds for him to respond appropriately. Instead, they insisted that I train them in non-violent crisis intervention, i.e. restraints. I bristled at the thought. Yet, the lead behavior analyst on this particular case, to whom I was beholden, agreed to have me train them. There is no way I could in good conscience justify their certification and use of this program. Yet, according to the standards as set forth by the organization that developed the materials, they passed. On their third attempt with an open book, open note, ten question test, they passed. Who did I help?
On that same case, a few weeks later, my client’s mother informed us that they had purchased their dog, a Doberman, with the express intent of intimidating her son. She then recounted to us an instance in which, after her son had lashed out, she ordered her daughter to let the dog off the leash. Graciously the dog did nothing more than bark at the young man, but her words still echo in my mind:
“At that point, I didn’t care what happened to him.”
Once we returned to the office, I practically skipped to our conference room so that we could generate the report to Adult Protective Services. As a mandated reporter I didn’t have much choice in the matter, but my head swam with the possibility of getting this young man into a more supportive environment, and one in which we might have greater sway in determining his treatment.
A few days later, the mother called to cancel our scheduled session and discontinue our services. We spoke with a member from another involved agency who had reported the same. The mother had apparently cut contact with every outside agency set to support her son. My director and case supervisor told me there was nothing else I could have done, that I had done the right thing.
But who did I help?
I entered this field recognizing that I am walking a razor’s edge in terms of ethics and morality. While I have strived for therapeutic outcomes, I cannot call this kind of work therapy. My clients were not dictating their goals according to their values, nor can they fire me if they feel my work or understanding of them is inadequate. Only those who care for them, who relied on my and many others’ professional experience, can decide that. Yet I have found that those professionals are human too.
Another case of mine involved a young man who would attack and wrestle his father to the ground almost nightly. Over the course of ruling out potential medical or psychiatric causes, this young man’s parents grew desperate and sought psychiatric intervention. Thankfully, my client’s mother asked me to attend the first visit with them. Within the first 10 minutes of their 15 minute long telehealth session, this psychiatrist had prescribed Risperidone to my client. After the session I asked that my client’s mother not fill that prescription, as I did not feel it would have been an appropriate intervention for him. I have no doubt Risperidone would have impacted the data I used to justify closure, likely enough that I could have justified closing the case- but it wasn’t a solution any better than other forms of restraint. Thankfully this client’s mother listened to me, and I was able to close the case a few months later after successful implementation of my proposed intervention: asking him about his day around the family dinner table.
I know for a fact that my education in psychology did not adequately prepare me for those situations, and yet I was still the one expected to have answers when I was on a case alone. I have tried to give the best of myself and my knowledge in the interest of people living in societal darkness, but intent without understanding paves the road to hell, as it has with this population throughout history. I know I cannot accept patting myself on the back when my actions lead to further isolation for abuse to occur. Nor can I accept drugging a person inappropriately to justify closing a case. Yet I expect there would be no pushback whatsoever had I accepted them. If I were to act in true ignorance- not knowing what I don’t know- how could I possibly learn how to do better than what I’m trying to avoid when I can just continue doing what has always “worked”?
