Incident #3. Verbally and physically out of control, extremely distraught, uttering profanities and claiming "life's a total mess - I'm going to kill myself." In this case, not willing to follow simple directives was enough to send Martin over the brink and out of control. For a considerable part of the evening Martin was instigating confrontation with other residents. Finally, staff told Martin that he would not be staying up ant later and could make his way upstairs to go to bed. Once upstairs, Martin then bolted towards the lower floor screaming obscenities in the process. As staff approached he picked up the phone and became increasingly angrier. He then kicked the table and had to be held to regain control. He continued yelling profanities at staff for almost an hour. During this time he said he was going to kill himself and that his life was a total mess.
Incident #4. Attempting to jump out of a second story window, very depressed. At the onset of this incident Martin appeared very angry and depressed. He was unable to finish his supper without snapping at peers and staff. He arose angrily from the table and wentoutside with his plate. After being allowed some space he was told that supper was at the table and not on the porch. He stormed upstairs. Staff attempted to give him more space, but Martin began yelling and satff went simply to check that he was OK. Martin was extremely angry and tried to run from the group home. He was told that he could not go outside the building in his present state and to cool off. He then said that he would kill himself instead and was blocked from exiting onto the fire escape from his third floor window.
DISCUSSION:
Incidents 1-4 are "problems of confict with others" where Martin becomes overwhelmed by his anger and allows it to get out of control to the point where he becomes destructive. Martin then does things that hurt people, enjoys putting people down, acts selfishly, and doesn't care about the needs or feelings of others. Being so easily frustrated due to a low tolerance level, Martin seeks revenge. Martin aggravates others and treats people in negative hostile ways, challenges, provokes, intimidates, bullies, and tries to goad others to fight. In sum, Martin displays poor impulse control, poor reality testing and low self image or, as Albert Ellis (1983) says, he suffers from self-downing depression. Incident 3 and 4 demonstrate that when Martin is restarined from acting out his negative emotions he then interjects his anger and becomes self destructive and has suicide intentions.
In other words, as Martin's primary worker, I knew that it was imperative to create a climate of change for Martin, which would support his positive potential yet include confronting his escalating negative behaviors. As Pazaratz (1993) has stated, the communicative pattern in milieu therapy encourages interaction and feedback, allows warmth, empathy (security) as a springboard to autonomy and independence. In my intervention, I wanted to teach and clarify for Martin, different emotional states, because I felt he had difficulty understanding his and other peoples emotions. The next step was to teach him specific techniques for dealing with several interpersonal problems, and then to show him how to replace his negative and destructive behaviors (Stark, 1990) with positive choices. The real value of treatment within a therapeutic milieu is that the nature of the relationships (worker-youth) encourages the youth to reveal him/herself. However, the task for the youth worker is to translate the theory into milieu practice. Thus, my efforts were directed at drawing Martin out.
