Jennifer Fieten, MA, CCLS
Chicago Children’s Advocacy Center, Chicago, IL
Concordia University, Ann Arbor, MI
Willow House, Chicago, IL

As child life professionals, we assist adolescents in processing their healthcare experiences, their current medical and physical state, processing their new “normal.” All of which we do using a trauma informed approach. As professionals engaging in a therapeutic relationship, we must also avoid judgement, meeting our patients where they are to best maintain that relationship. Yet, we are also in a position to be strong advocates, bringing our knowledge of adolescent development, the effects of trauma and maltreatment, and the influences of culture and environment on the overall development of the individual.   

There is a comprehensive body of research which has documented a significant relationship between family violence and adolescent violence (Li, Xiong, Lang, Zhang, 2021). “In their harmful relationships with caregivers, maltreated children may develop the belief that coercion and violence are fundamental to all relationships” (Calvete, 2007, p. 132). We know from recent research that “an aggressive individuals’ deviant processing is guided by underlying mental structures and that these structures take the form of normative beliefs about the social appropriateness of aggression (Calvete, 2007).”  So how do we as CCLs support these adolescents when there are complex systemic issues that are contributing to the violent behavior?

How can we then support? 
• We can provide a safe space that promotes healthy expressions of anger. 
• We can foster an environment that promotes talking about feelings. 
• We can encourage calm expression; asking the individual if they feel their response is safe or reasonable. 
• We can promote listening to others and encourage taking a different point of view. 
• Be a sounding board for negotiation; help the individual consider alternative solutions and compromises. 
• And lastly, we can encourage the individual to take a time out before responding to the situation or person that has triggered their anger.

(American Psychological Association, 2022).
 
What does this look like in practice? While working with a teen survivor of gun violence, he often vocalized difficulty in developing rapport with hospital staff; feeling that he was often misunderstood.  As his CCLS, it was important that I provide a space where he felt comfortable to share his feelings.  So, I scheduled daily individual sessions with him in the teen space. During these times, I would offer a check-in to assess his current emotional state and to promote expressions of feeling, especially anger.  Together, we identified reasonable coping strategies that he could use when he was feeling angry or frustrated.  We incorporated music into his sessions, so that he could use music as an outlet and as a method to de-escalate. We also discussed his views related to hospital staff; where I suggested alternate points of view, acknowledging his feelings while also emphasizing the care that staff felt toward him. We discussed alternate ways in which he could respond to staff that would yield a different result, a more favorable result to support his goals. Phrasing that he could use to better express his thoughts, feelings, and wishes. During these times, we also discussed the importance of taking a moment before responding, how responding emotionally may be counterproductive to achieving his goals. Lastly, these sessions provided an opportunity to model different coping strategies and non-aggressive interactions between individuals.

References:

American Psychological Association, (2022, February). https://www.apa.org/topics/physical-abuse-violence/youth-warning-signs

Calvete, E. (2007). Justification of violence beliefs and social problem solving as mediators between maltreatment and behavior problems in adolescents. The Spanish Journal of Psychology, 10(1), 131-140.

Li, S.D., Xiong, R., Liang, M., Zhang, X., & Tang, W. (2021). Pathways from family violence to adolescent violence: Examining the mediating mechanisms. Frontiers in Psychology, 12(611006). 
doi: 10.3389/fpsyg.2021.611006