Children, Young People and Families, Violence and trauma

Mud sticks

An exclusive chapter from 'Stop F*cking Nodding: and Other Things 16 Years Olds Say in Therapy', by Jeanine Connor, courtesy of PCCS Books.

16 May 2022

Kenzie has been accused of sexual assault. Again. His mum describes him as a little shit, and he seems to have been set up to repeat family history. Can therapy help him to contemplate a future that’s different to the past?

Kenzie’s mother, Maria, emailed me. She told me that she needed advice about ‘how to control’ her 16-year-old son, and that he needed professional help to ‘sort himself out’. This type of language isn’t unusual at the time of referral; parents and carers are often at their wits’ end by this point, although I admit that my hackles rose a bit and my heart sank slightly. It’s not in my remit to ‘sort someone out’ or advise how they can be controlled, and so I emailed back to Maria saying, ‘Thank you for contacting me. I’m sorry to hear that your son is struggling. I’d be grateful if you could complete the attached referral form so that I can learn some more about the current situation in the context of your family’s history, and then, if you would like, I can offer an initial consultation for the three of us to meet together and explore things some more.’

She replied, ‘I’d rather not fill in your form. Can’t we just meet? And as soon as possible? He’s out of control.’

I found Maria’s response a bit abrupt and wondered about her reluctance to complete the referral form. In it, I request basic demographic information, such as address, date of birth and school details, as well as an outline of the referrer’s concerns and significant experiences and interventions. I also ask about their hopes and expectations for therapy and how they will recognise if and when they have been achieved. The answers to these last two questions are particularly informative and are elaborated on through discussion at the initial consultation. My intention is to help the referrer to be realistic in their expectations of psychotherapy. I don’t have a magic wand and I can’t prescribe a magic pill. I’m asking the referrer, often a parent or carer, to think about why they are asking for therapy for the young person from me, right now; what they hope they will get out of it and what that will look like if it works. I was trying to ask Maria what ‘sort himself out’ actually meant for Kenzie.

If, after I’ve met with a family for the first time, we decide to work together, the information about hopes and expectations will form the basis of regular therapy reviews, giving us something tangible to refer back to. Something like, ‘I remember you said you wanted X to spend more time with the family and less time getting into trouble with his peers. I’m wondering how that’s been going since we last met?’ Or, ‘In the referral, you were hoping that Y wouldn’t be so emotionally up and down and that they would be sleeping better. Can you tell me if there have been any changes in their mood or sleep patterns over the last few weeks?’ These questions allow me to make qualitative assessments about whether therapy is working for the young person, or not. It’s important to note that sometimes a sign that therapy is working is that things look like they’re getting worse before they look like they’re getting better. This is because therapy can stir up thoughts, feelings and memories that a young person has been trying not to think, feel or remember, and these can manifest in their behaviour. It can also stir up thoughts, feelings and memories for the parent of a young person in therapy too.

Some therapists use quantitative assessments to measure progress and outcomes. They’ll ask their clients to complete, or complete with them, strengths and difficulties questionnaires (SDQs), and other such formal measures for anxiety (GAD-7) or depression (PHQ-9). These routine outcome measures (ROMs) can be useful, as they provide a numerical score at the point of referral – a starting point, if you like – and a comparison score at different points along the therapeutic timeline and at the end. Numbers are easy to compare; some people think that whether the number has gone up or down can tell us whether what’s happened in therapy has made things better or worse and by how much. Organisations such as school counselling and child and adolescent mental health services (CAMHS) tend to use ROMs, as do GPs and inpatient hospitals. They provide a quick and easy way of producing data about clinical need and therapeutic outcomes that can be used to plan treatment and commission services.

The problem with ROMs is that they don’t take into consideration the nuances of the individual’s needs and the nature of their lived experiences. They are also biased. Self-report questionnaires may be completed honestly, or they may be a complete fabrication. What if a young person who has been asked to fill in a strengths and difficulties questionnaire doesn’t want to engage with services? Easy – they just tick the boxes in a way that demonstrates they have no difficulties and don’t need any formal support. What if, on the other hand, a young person really wants one-to-one therapy but has been told they don’t need it or they don’t meet the criteria? Simple – they just up the ante on the depression questionnaire, to ‘prove’ that they do. I’ve seen this happen. I once gave an SDQ to a young man who had been sent a screening form for anxiety. He looked up the diagnostic criteria online and copied it onto the screening questionnaire, so that he effectively ticked every single box for an anxiety disorder. Another young person scrawled all over the questionnaire, ‘None of your fucking business’. I’ll let you work out for yourself what they thought about therapy.

As I work in private practice, I can hone my referral form and regularly review it, so that it is, and remains, a useful, valuable, workable tool. It’s not fail-safe, which is why I meet with the young person and their parent or carer for an initial consultation, to discuss the form and elaborate on the content, but it’s a good starting point.

I wondered why Maria was unwilling and/or unable to share any information with me before meeting and what that might mean for ongoing psychotherapy if I were to work with her son. I considered some possibilities: did she have difficulty filling in forms, perhaps practically or psychologically? Was she worried about confidentiality? Or was she intentionally withholding information from me? As is quite common in therapy, I was left in a position of not knowing, holding these unanswered questions until we could meet.

Withholding

After considerable to-ing and fro-ing – it seemed that Maria and I had different understandings of ‘as soon as possible’ as she rejected several appointments offered and didn’t respond to others until the dates had passed – we set up an initial consultation. In my mind, this appointment was, as I’d suggested, ‘for the three of us to meet and explore things some more’. Maria’s idea of the appointment was different. At the designated time on the designated day, I opened the door to find a slightly built, middle-aged, white woman standing alone on the threshold.

‘Maria?’ ‘Yes. Are you Jeanine?’ ‘Yes, please come in.’

Once we were inside and seated, I stated the obvious: ‘No Kenzie.’

Maria stated the obvious too: ‘No, I didn’t bring him. I thought it was best to come on my own so I can speak honestly about him.’

Up went my hackles and down went my heart again. Maria thought it best not to bring her son to his own initial therapy consultation – what was that about? First, she had withheld information and now she was literally withholding her son!

‘That’s interesting,’ I said, ‘I’m wondering how Kenzie feels about you coming here without him…’

‘He doesn’t know I’m here. I didn’t tell him.’ ‘You didn’t tell him about this appointment?’ ‘No.’

‘What about that you’d contacted me, does he know that?’

‘He knows I’ve been trying to find someone to sort him out, but I didn’t tell him I’d found you. I wanted to meet you first to see what you were like.’

She was right to want to suss me out; the match between therapist and client is a significant factor in the success of therapy. But so is honesty. Still, I decided it wasn’t the time to fight that particular battle. The truth was, I didn’t want to get into any kind of battle with Maria, and so I tried to get on with the task at hand.

‘Can you tell me why you decided to contact me about Kenzie?’ ‘He’s been accused of rape. Well, sexual assault. He’s a little shit, don’t get me wrong, but he wouldn’t do that.’

‘He’s been accused of sexual assault. That sounds awful.’

‘Yeah. And it’s not the first time, either. I’ve told him, mud sticks, and he’s gonna end up locked up at this rate.’

Although I was both alarmed and intrigued, it’s not my job to investigate or pass judgement. I was concerned for Kenzie (as well as for his alleged accusers, of course), but if I was going to offer him therapeutic support, I needed to establish first and foremost that it would be ethically and legally appropriate to do so. Concern has been expressed that therapy, and interpretative psychotherapy in particular, can present evidential problems in ongoing crime investigations. The worry is that the outcome of a criminal trial could be tainted if witnesses, and in particular child witnesses, have explored the details of an alleged crime in therapy (Crown Prosecution Service, 2020). Occasionally, I find out about an ongoing investigation during the course of long-term psychotherapy, which poses an ethical dilemma about whether or not to continue. There is less of a dilemma if I’m told about an investigation before commencing therapy, as was the case in this instance. I asked Maria if the police were still involved.

‘No. There was no evidence to prosecute him. Same as last time. But he’s got himself excluded from school again and referred tosocial services. He’ll soon have been to every school this side of the Watford Gap. And they won’t be any help.’

‘Social services?’ ‘Yeah.’

‘It sounds like Kenzie’s had a difficult time. I just need to confirm that the investigation is finished, though, because if not, we would need to put therapy on hold.’

‘It’s finished, yeah.’

‘Okay, good, that’s one less thing for us to worry about.’

Maria raised her eyebrows as if to say, ‘Is that it? Is that all you’ve got to offer me?’, but I noticed that her shoulders relaxed a bit too, and she sat back from her perch on the edge of the chair, as if shifting from high alert to an ever-so slightly lesser state of alert. I hoped she was realising that I had Kenzie’s interests in mind and that she could trust me to do my best for him.

Maria told me that Kenzie had first been accused of sexual assault when he was 13, but that it wasn’t reported to the police because the girl retracted the allegation. She said, ‘It’s what these girls do these days; they want a bit of attention and so they cry rape.’

I didn’t react. Instead, I wondered aloud how Kenzie had responded to the accusation.

‘He didn’t do it.’

‘But how did he respond?’ ‘He said he didn’t do it.’ ‘Was he upset?’

‘I suppose so. A bit.’

‘And you say there was another allegation, more recently?’ ‘Yeah, but there was another one last year as well.’

‘So, there have been three allegations of sexual assault against Kenzie?’

‘I know what you’re thinking.’ ‘Do you…?’

‘Same as everyone else – no smoke without fire.’

‘I’m not thinking that, Maria. But I am wondering why Kenzie has found himself in a similar situation three times in three years and I’m wondering what I might be able to do to help him, and you, to make sense of that.’

‘What can you do? There’s never been any evidence. We get over it. We move on.’

‘But it’s not okay.’ ‘No.’

‘Is this why you got in touch with me? Because of the allegations?’ ‘Partly that. But like I said, he’s a little shit.’

I noticed her smiling and took it as a cue to lighten the mood and get alongside Maria. ‘But he’s your little shit and you’re worried about him.’

‘I am, yeah.’

She eased up a little and the conversation began to flow more freely. Maria told me that Kenzie had ‘gone off the rails’ and she doubted he would gain any qualifications. It was the autumn term of Year 11 when we first met; mock exams were looming, GCSEs were within touching distance and Kenzie didn’t currently have a school place. Maria felt that he had given up on education. It sounded to me like numerous education providers might have given up on him. I wondered what he did instead, while he wasn’t inschool, and whether he was keeping up with his learning at home.

‘You’re joking.’ ‘I’m not.’

‘I can’t get him to do anything. He’s in bed most of the day and out most of the night.’

‘This might sound like a silly question, but I’m wondering what you’d like to be different. If I had a magic wand, which I’m afraid I don’t, by the way, can you say what would change, how things would be different?’ I often ask the ‘magic wand’ question in a first meeting.

Maria said, ‘Well, he’d be in school, for a start. He’d get a couple of GCSEs, enough to go to college. He could pass them if he tried, he’s not stupid.’

‘Does Kenzie want to go to college?’

‘He does, yeah, he wants to do animation. I think he’s quite good.’ ‘So, he’d get a place in a school, pass his GCSEs and go to college.

What else?’ 

‘He’d get his lazy arse out of bed and help out a bit more. He does nothing.’

‘What would you like him to do?’

‘General stuff, you know – tidy his room, maybe push the hoover round a bit, help me with the kids.’

‘The kids?’

‘Yeah, I’ve got three younger ones, as well as Kenzie. They’re 11, 9 and 3.’

‘You’ve got your hands full.’ ‘I have, yeah.’

Maria told me that her middle two boys shared the same father, who she described as her best mate, while Kenzie and her youngest son each had different fathers, who had no contact with the family. She didn’t seem to want to talk about them. For now, Ifelt I had enough of a sense of why Maria had contacted me about Kenzie without needing to delve any deeper, and Maria had relaxed enough to open up a bit, which I didn’t want to jeopardise by asking more. If I was to build a relationship with Kenzie, I’d be able to build on this initial contact with Maria over time as well. I wondered what she thought about me meeting Kenzie and she said, with a smile, ‘Yeah, I think you should,’ which is what we arranged to happen next.

Seeing and (not) being seen

Kenzie decided he wanted to meet me online, rather than in person, which was okay by me. It’s not what I prefer, but I’m happy to accept the young person’s choice and explore the reasons for their preference. I logged on to the platform at the agreed time, a week or so after I’d met Kenzie’s mum, and straight away there was a notification to tell me that Kenzie was waiting to join the meeting. I let him in and said hello.

‘Yo.’

‘Is that Kenzie?’ ‘It is, yeah.’

‘Hello, Kenzie. I can hear you, but I can’t see you.’ My monitor displayed a capital ‘K’ against an otherwise blank, black screen.

‘I’ve got my camera off,’ he explained.

‘Do you want to keep it off today?’ I wondered. ‘I do, yeah, if that’s okay.’

‘Yes, that’s fine. Would you like me to keep my camera on or switch it off?’

‘I don’t mind.’

‘Maybe I’ll leave it on and then you have the choice to look at me or not.’

‘Okay.’

I was reminded of the sense of withholding I’d got from Maria: the withholding of information in the initial referral and her withholding Kenzie from our initial consultation. It seemed as if that particular theme was being played out again in my first meeting with Kenzie, who had chosen to withhold his physical presence from the therapy room by opting to meet online and withhold his image from the screen by keeping his camera switched off. He’d also withheld five of the six letters of his name by displaying only his initial ‘K’. In doing so, Kenzie had denied me the opportunity to witness his physical appearance – his clothes, his posture, how he moved, sat or used facial expressions, which would have provided a lot more information about him than I currently had. There was a lot I couldn’t see and didn’t know.

The ways in which my first meetings with Maria and Kenzie had been set up made me wonder about what might have been withheld in the family system: what might be known and not known, maybe by Kenzie; what he had been shown or told about; what he showed and told, and what might have been kept hidden. My fantasy was that this was a family with a secret. I say fantasy rather than hypothesis because, at this very early stage, all I had to base it on was an instinct, a feeling, which was tenuous but no less significant for that.

Isca Salzberger-Wittenberg, an adolescent psychotherapist influenced by Melanie Klein, said that the fantasies that we invest in a new situation are partly transferred from the past and are modified by ‘inner and outer stimuli’ (Salzberger-Wittenberg, 1970). In other words, as the therapeutic relationship with Kenzie developed over time, new information and behaviour (outer stimuli) would become known and new thoughts and feelings (inner stimuli) would be thought and felt, allowing my initial fantasies to change shape and either dissipate or develop into hypotheses. For now, I was acutely aware of what had been withheld, but I also needed to acknowledge what had been shared.

‘It’s good to hear your voice, Kenzie.’

‘Thanks. You, too.’

‘I’m guessing your mum told you that she came to meet me last week?’

‘She did, yeah.’

‘I’m wondering what she told you about our meeting?’

‘Just about where you live and that you have a nice house and a nice room. And she said she thought you didn’t look like your photo at first because of your hair.’

‘The photo on my website?’ I checked. ‘Yeah.’

‘Have you looked at my website?’ I wondered.

‘Yeah, she showed me. You look like I thought you would.’

This was fascinating. My first thoughts had been all about what I hadn’t seen, while Kenzie’s and Maria’s had been about what they had: what my house looked like, what my room looked like, what I looked like, even what my hair looked like. There was something about the idea of seeing and (not) being seen that seemed significant and that I really wanted to explore. But not yet. First, we had to think about the therapeutic frame.

Therapeutic frame

The therapeutic frame is a symbolic boundary that contains the therapeutic relationship and helps to make therapy a safe space. It incorporates practical things like where and when therapy happens and the start and end times of sessions. It functions as a boundary to contain the creative work within it, rather like a frame around an artwork (Milner, 1952). It’s important for therapeutic boundaries to be consistent, as much as possible, so that any other changes that are observed in behaviour, mood or presentation can be acknowledged as distinct. For example, younger children who are brought to and collected from sessions by different parents, or young people in care who are brought and collected by different residential workers, can present very differently in their mood, demeanour or even in the way they are dressed or whether they’ve been fed. I always make a request, therefore, that, if practicable, the same adult brings the child to their session at the same time each week. That way, I can more confidently attribute any differences I observe to something else.

Another important element of the therapeutic frame is confidentiality: that what happens in therapy stays in therapy, with the exceptions of supervision and matters to do with the safety of the child and others. In person-to-person therapy in the room, confidentiality is much easier to manage – control, even – than it is online. I know for certain that what is done and said in the therapy room is only witnessed by the people doing the doing and saying. Therapy online doesn’t carry the same certainties. In the real world, I know that what I’m doing and saying at my end isn’t being witnessed. In the online world, I use a platform with high levels of security. I use a log-in and authentication process that provides a unique link for each client, every session, which enables them to access an online waiting room, where they wait until I invite them in. This is a bit like them knocking at the door at the start of their in-person session and waiting for me to open it. At the end of each session, I delete any online chat (text), as well as the meeting link and the invitation, so that I’m not saving any data whatsoever related to the session.

What I’m saying is, I do all that I can to maintain privacy and confidentiality, in both the real and the online world. An important difference is that, with online therapy, I inform the young person and their parent or carer that it is their responsibility to arrange a private space where they will not be disturbed, interrupted or overheard during their session, and I check in withthem about this every week. But I have no control over it; all I have is their word. I checked in with Kenzie.

‘Before we get started, Kenzie, I just wanted to let you know that I’m in my office on my own, and this is where I will always be when I speak to you online, so I’m not being overheard and I won’t be interrupted.’

‘Okay.’

‘What about you?’ ‘What do you mean?’

‘I just want to check that you are somewhere on your own, that feels private to talk.’

‘Yeah.’

‘That’s good. It’s hard for me to know that when we’re online, so I wanted to check.’

‘Yeah, I’m on my own.’

‘That’s good. I wonder if there’s anything you want to check out with me, Kenzie?’

‘No.’

‘Okay. Maybe you could tell me how you feel about the idea of talking to me – a therapist, I mean.’

‘I’m not sure. It was my mum’s idea.’

‘Okay. Why do you think she wanted you to talk to me?’ ‘Because of what happened…’

‘Because of what happened?’ ‘Yeah. She probably told you.’

‘She told me some stuff when we met. But I wonder if you can say what you mean. I’d like to hear it from you.’ It’s always important for me to hear it from the young person themselves.

‘About the rape.’ ‘The rape?’

‘Yeah. What the girl said I did.’

‘Your mum did mention that, yes.’ There was no point pretending that she hadn’t, no point withholding the fact that I knew.

I commented, ‘It sounds like you’ve had a tough time.’ ‘Yeah, it’s been shit.’

‘I’m sorry to hear that.’ ‘That’s okay.’

‘It’s not okay though, is it? Like you said, it’s shit.’ ‘Yeah.’

‘Can you tell me about how shit it’s been?’

‘Not really. I don’t want to talk about it. I don’t mean to be rude,’ he added.

‘It’s okay, Kenzie, and it’s not rude. I’m pleased you were able to say no. It’s difficult to talk about private stuff when we’ve only just met.’ I cringed internally, worried that I’d pushed too far already. ‘What would you like us to talk about instead?’

‘I dunno.’

‘What about school?’ ‘I don’t go to school.’

I’d put my foot in it again. I knew that he didn’t go to school, but I hadn’t kept it in mind, and I’d relied on a lazy, stock question – you don’t want to talk about the hard stuff, okay, let’s talk about something more trivial like school.

‘Yes, I know, your mum told me that too. Is there any news about when you might start back?’

‘I don’t think so. No one’s said anything to me.’ ‘How is that for you, not being at school?’

‘It’s okay, actually. Better.’ ‘Better how?’

‘I dunno. It just is.’

‘You sound quite chilled. I wonder if it’s more chilled not being at school.’

‘Definitely.’

‘It’s your GCSE year, isn’t it?’ ‘Yeah.’

‘And what comes next?’ ‘Hopefully I’ll go to college.’

After a stilted start, Kenzie seemed to come alive as he talked about his passion and talent for drawing – he became animated once he started talking about animation. So much so that this is what we spoke about for the remainder of the session. Before we ended, I suggested he might like to show me some of his work in our next session, as it was something we could look at together online. I thought it might be a nice way for me to show I was interested in him and a way for Kenzie to share something of himself in a less intimate way than showing himself. He said he’d think about it.

I’d been primed to meet a boy who was three times accused of sexual assault, currently excluded from school and described as a lazy, out-of-control little shit who needed sorting out. I ended the first session, despite having spent it looking at a blank screen, with a sense of a passionate and talented young man, full of life and potential. The blank screen provided an interesting context, because another way of thinking about what was hidden or not seen was that all other distractions were removed, so that all I had to focus on was Kenzie’s spoken word. I was excited to discover more.

Process and content

The following week, I was feeling very different to how I’d felt in week one as I waited to meet Kenzie for his second session. I don’t usually read back over my notes from previous sessions – not that I had many notes to read yet. Instead, I try to meet each client for every session with as little expectation as possible. As I wait, though, particularly if I have to wait very long, thoughts start to emerge, and it’s important to acknowledge them. When I’m kept waiting after the session is due to begin, my first thought is usually, ‘Have I got the time wrong?’ If it’s an online session, it’s ‘Did I send the correct link to the correct email address?’ Once I’m sure that I haven’t made a mistake, I start to wonder about the lateness, which is what happened here, as I waited for Kenzie to join me for his second session. At first, I wondered if I’d put him off, perhaps by inviting him to tell me about the accusations made against him, or by being clumsy in asking about school. Then I remembered how he’d seemed to settle as the session progressed and how we’d begun to build a rapport in discussing his passion for animation. I hoped I’d be able to explore this with him further and get to know him through his art, which must, I thought, be autobiographical in some way. I think anything that is created must say something about its creator, be that drawing, painting, sculpture or writing. I acknowledge that my writing – what I say, how I say it and what I leave out – must also say something about me. When I recalled my conversation with Kenzie, I realised that he had told me he made computer animations and pencil sketches, the how rather than the what. This led me to think about the distinction between process (how) and content (what), both in relation to art and in therapeutic terms.

The content of art is the picture: a landscape, portrait or cartoon. The content of therapy is what happens in the room, such as what is said or done and by whom. The process of art is the way the picture is created – maybe the medium that’s used: paint, pencil or collage. The process of therapy is the relationship within and between the two (or more) people who come together for the purpose of therapy. When I was training, I wrote copious notes after each session, documenting the content and trying laboriously to record every word that was uttered and berating myself if I missed something out, which I inevitably did. Over time, with the help of my tutors and supervisors, I realised that therapy notes are often referred to as ‘process recordings’ for a very good reason: they record the process rather than the content. By process, I mean the thoughts, feelings, fantasies and hypotheses that I experience during and after the session. Again, as a novice psychotherapist, I remember finding it difficult to process in the moment – all my attention was focused on doing; I didn’t have the capacity to think about what I was thinking and notice what I was feeling all at the same time – and most of my processing happened when I reflected on the sessions afterwards.

As I reflected on Kenzie’s first session afterwards, I thought it was interesting that he’d shared his process with me, rather than his content, and I wondered if that might be something to consider when (if?) we met again for therapy. Psychotherapists, particularly newly qualified ones, can feel a pressure to say something clever and useful in order to illustrate, to their client and to themselves, that they are doing something clever and useful. I think this is a similar pressure to the one I’d felt to write lengthy, detailed notes: to demonstrate, if only to myself, that something useful had taken place. While it can be helpful to document our thinking and share it with clients, sometimes it’s enough just to feel the feeling or think the thought and process it without verbalisation. That way, our clients can have ‘an emotional experience rather than an intellectual one’ (Gray, 2014).

As the time ticked by and Kenzie remained absent from his second session, I wondered about his experience of session one – had it been an emotional experience for him and, if so, was the experience good enough? I also began to wonder about his wider emotional experiences, in the family generally and in response to the allegations made against him specifically. I remembered that, when I’d asked his mother about his response to the accusations, she’d struggled to answer the question, telling me instead that he didn’t do it. Even when I’d offered her an emotion-type prompt, by wondering if he was upset, she’d found it difficult to answer and said only that she supposed so. It was as if she was saying that was how someone would be supposed to respond, rather than how Kenzie actually did react. I wondered if she’d really noticed how he processed the news. Thinking in terms of content and process, my meeting with Maria had been full of content, which made me wonder about her capacity to process her own feelings and to hold Kenzie emotionally. One of the primary tasks of a parent ‘is to learn how to contain the baby’ (Brazelton & Cramer, 1990, p.114). I was left wondering about the extent to which Maria had managed that in Kenzie’s early years and beyond.

I spent the therapeutic hour thinking about and processing my very different experiences with Kenzie and Maria. Towards the end of the 50 minutes, I sent a message to Maria saying I was sorry not to have met with Kenzie for his session and that I hoped everything was okay. The response I received said, ‘He forgot. Can he video-call you tomorrow?’, demonstrating either an inability or an unwillingness to hold in mind Kenzie’s therapy (perhaps Kenzie himself?) and/or the therapeutic boundaries. I sent a short, polite response stating that it was not possible to meet tomorrow, but that I looked forward to hearing from Kenzie next week, and I re-stated the date and time of the session. If therapists agree to ad hoc sessions, or requests to start early or end late, we alter the therapeutic frame and threaten the containing function of therapy. As Gray states, if clients find that the framework is changed to suit them, they ‘will be worried about the therapist’s ability to contain powerful emotions’ (Gray, 2014, p.45).

I’m certain that Maria and Kenzie would not have been consciously worried, but at some level they would sense that the boundaries were loose, which would threaten their sense of safety and containment. This is akin to the child who asks the parent for something – say, a packet of sweets. The parent says no, the child asks again, the parent says no, the child pushes and whines and the parent feels forced to acquiesce. In the moment, the child is delighted that they got the sweets, but what they learn from this encounter is that parents don’t mean what they say, that ‘no’ can mean ‘yes’, which is confusing, and that boundaries are moveable. So, what becomes internalised is a sense of non-containment. If I’d agreed to speak to Kenzie the next day, instead of on the day we’d arranged, he and Maria might have been pleased not to have to wait; I would have been pleased to speak to him too, but they would have got a sense, like the child of the acquiescing parent, that I was unable to contain them. Remember, this was a family with a theme of withholding, so holding the boundary felt especially important. I didn’t give them what they said they wanted, but I believe that I did provide what was needed.

Pushing the boundaries

The following week, Kenzie joined the meeting on time and apologised for forgetting the previous session. Like the first time, he didn’t have his camera turned on and, like before, I checked that this was a conscious decision. It was. I told him that there was no need to apologise for missing the session; he hadn’t done anything wrong. I also let him know that I’d spent the time keeping him in mind, and I wondered what he’d been doing instead.

‘I can’t remember.’

‘Something that took your attention.’ ‘Yeah, must have been.’

‘I’m wondering how you’ve been spending your week. What have you been up to?’

‘Not much… Watching YouTube… Drawing… Hanging out with my mates…’

‘So, some relaxing stuff and some creative stuff, and some time on your own and some time with your mates.’

‘Yeah, I suppose.’

‘That sounds like a nice balance. What do you like to watch on YouTube.’

‘The usual.’

‘I don’t know what “the usual” is for you, Kenzie.’

‘Fails, blunders. There’s also some animators I follow on Insta who post content.’

‘That sounds like a balance too, between fails and successes.’ ‘Yeah, I hadn’t thought of it like that.’

‘It makes me wonder about your fails and successes?’ He said, ‘I don’t have any successes.’

‘I find that difficult to believe,’ I countered. ‘It’s true.’

‘It’s easier for you to think about your fails?’ ‘Yeah, there’s plenty of them.’

‘I’m sorry to hear you say that about yourself.’ ‘It’s what everyone says.’

‘Everyone?’ ‘Yeah.’

‘They talk about your fails.’ ‘Yeah.’

‘That’s a shame. I wonder why that’s what they focus on.’ ‘Mud sticks.’

‘What do you mean by that?’ ‘It’s what my mum says.’

I remembered the other phrase Maria had said to me – ‘There’s no smoke without fire’, which seemed to have a similar connotation – and asked, ‘I’m wondering what you think she means by mud sticks?’

‘That I’m a little shit and a useless fucker.’

I heard a noise through the computer speaker that didn’t sound like Kenzie. ‘I heard what you said, Kenzie, but I also heard another noise in the background, like maybe another voice.’

Silence.

‘It makes me wonder if there’s someone else there with you?’ ‘Errr, no…’

‘You’re in the room on your own?’ Silence.

The noise I’d heard sounded like something between a loud gasp and a muffled laugh. The word that came to mind, which is old-fashioned and not one I’d usually use, was ‘guffaw’. It made me feel uneasy.

There was a silence of about 30 seconds, which felt like a really long time, and then a woman’s voice said, ‘Hi, Jeanine, sorry.’

‘Maria?’ I enquired. ‘Yes, it’s me.’

‘You’re in the room with Kenzie?’

‘Yes, but I promise I’m not listening,’ she insisted.

‘It’s really important that Kenzie’s sessions are private and that you can make space for him to access therapy without being overheard.’ If I sounded punitive, it was because I felt punitive.

‘Yes, sorry. I’ll go in the other room.’

I’d explained the importance of privacy and confidentiality, and I felt tricked and betrayed. I’d been kept in the dark, with the camera switched off, so that Maria had been able to intrude into the session without me knowing. While it was important to notice my feelings – tricked, betrayed, intruded upon, kept in the dark, not-knowing – I wondered how Kenzie felt.

‘How come your mum was in the room?’

‘I dunno. She said she wasn’t listening, though.’

‘I think it’s kind of impossible not to listen, don’t you?’ ‘Maybe.’

‘I heard her make a noise when you mentioned her.’

‘Yeah, I think her ears pricked up when she heard her name.’ ‘I’m wondering why she was there?’ I pressed.

‘She asked me if I wanted her to go out.’ ‘And you said no?’

‘I said I didn’t mind.’

‘And so she took that to mean it was okay to stay?’ ‘Yeah.’

‘In your therapy session.’ ‘Yeah.’

I wondered to myself about not saying no meaning yes, and I wondered aloud how much privacy Kenzie felt that he had at home.

‘Not much, really. I have to share a room with my brother. It’s a bit pants, to be honest. That’s why I go out so much when he’s home.’

‘I think it’s important to have some space and time of your own that feels private.’

‘So do I!’

‘And it’s difficult not to have that. Especially when you’re 16.’ ‘Exactly. But my mum doesn’t see it like that. She’s got her nose in everything.’

‘In your business, you mean?’ ‘Yeah.’

‘I think it’s hard for mums of 16-year-olds too.’ I didn’t want Kenzie to feel I was colluding with him against his mum. ‘She really cares about you, and it sounds as if she has her hands full and that the house is quite crowded.’

‘I suppose.’

I also wanted him to know that I was beginning to understand what it was like for him, so I repeated, ‘But it’s still important for you to have some privacy.’ And I tentatively added, ‘Perhaps we can think about how we can make therapy a private space for you? Perhaps you’d like to think about coming here.’

‘Yeah, I’ll think about it. Thanks.’

After the session, I received an email from Maria, apologising for being in the room and assuring me it wouldn’t happen again. She seemed anxious to placate me, but I wondered what else she might be anxious about: possibly about what Kenzie might share with me, or what might become un-hidden? Why else would she need to eavesdrop on his therapy session? She also said in the email that there was ‘some other stuff ’ she thought I should know. We had already arranged to meet in week six, to think about how therapy was going for Kenzie and whether he wanted to carry on. I asked if Maria felt the ‘other stuff ’ could wait until then and she said it could.

Being in synch

Kenzie attended his next two online sessions on time and on his own. He switched on his camera and scanned the room to prove to me that there was no one else there. This demonstrated that he had internalised the importance of keeping the boundary, but also, more significantly perhaps, it illustrated that he was letting himself be seen by me. I wondered what else might be revealed or become un-hidden or un-withheld. He said his mum had offered to walk the dogs, so that she wasn’t in the house during his sessions and couldn’t be tempted to listen in. Evidently, Maria was thinking about the boundaries too.

It was nice to see Kenzie. He was a pleasant-looking, well-presented young man, who seemed to take pride in his appearance: his hair was styled, and his clothes looked clean and ironed. The words that came to my mind were that he looked like someone who took care of himself. The other thing I noticed about Kenzie was that his skin was darker than Maria’s and I wondered if he was mixed race. Maria hadn’t mentioned it; perhaps that was something else that had been withheld. If so, I wondered why. Kenzie spent the sessions talking about and showing me his animations. They were fabulous in terms of the detail, and his talent was obvious. Ifound myself making lots of congratulatory, impressed-sounding noises, because I was very struck by his skill and his dedication to something that clearly took hours to create. But I had a sense it might be too much for Kenzie. He seemed pleased, but a bit awkward, as if what I was saying to and about him, or how I was saying it, felt unfamiliar and uncomfortable.

I remembered Maria’s description of her son as ‘a little shit’ – while it was said affectionately, it wasn’t complimentary – and noted that Kenzie would have picked up on that and internalised it. He’d told me of his sense that his mum thought he was ‘a useless fucker’ and his description of her as having ‘her nose in everything’ – which sounded mistrustful and intrusive. I also recalled the comments about mud sticking and there being no smoke without fire, which felt so out of synch with the young man I was starting to get to know. I began to hypothesise about what Maria’s attunement with the baby Kenzie once was, because that’s where in-synch or out-of-synch-ness begins. Mothers (usually) learn the rhythms of their babies by watching, responding and prolonging their attention. They look for cues, such as smiling or crying, moving towards or away from, and they match their responses accordingly, so that the rhythms of the mother become synchronised with those of the baby (Brazelton & Cramer, 1990).This is a rewarding experience for both parties in the mother–infant dyad: the baby learns that s/he is loved, known and understood, which forms the foundations of its capacity to love, know and understand her/himself; the mother learns that she is loved by her baby, and is inclined to keep loving her baby back because it feels nice to be loved. In this way, the beginnings of our earliest attachments are formed – attachments that go on to shape all the relationships that follow.

According to the psychologist, psychiatrist and psychoanalyst John Bowlby (1979), there are both short- and long-term benefits of early attachment. The most immediate short-term benefit is that of survival: if a baby isn’t loved and attended to by a loving and attentive mother, it will die. Those relentless cries of a ‘needy’ baby are expressing its deepest fears. As Melanie Klein observed, what the baby is communicating in its cries is, ‘I need you, I must have you all the time… I cannot survive without you’ (Salzberger-Wittenberg, 1970, p.57). Longer-term benefits of attachment are to do with the way that they shape our relationships through childhood and adolescence and into adulthood. Bowlby suggested that babies develop an internal model that is based on the attachment with their mother, which gives them a sense of self and is a prototype for all other relationships, including intimate relationships. So, if a baby develops a secure early attachment, their model of self is of being lovable and they are more likely to go on to form secure intimate relationships. If, on the other hand, a baby has a less than good-enough experience of attachment, perhaps because its mother is out of synch, preoccupied, inconsistent or absent, it develops a negative sense of self. In future relationships, those ‘babies’ might be overly dependent on others and preoccupied with intimacy, perhaps to make up for what they lacked in infancy; or they might avoid intimacy and keep themselves to themselves, because they have learnt that they can’t depend on others to meet their needs (Bartholomew & Horowitz, 1991). I had a sense of Kenzie as an avoidant kind of ‘baby’, out-of-synch, avoidant of intimacy, and taking care of himself. The first therapy review would put all of my fantasies into context.

Ghosts of the past

Maria arrived a few minutes early for the therapy review. As with the initial consultation, she came alone. I usually encourage young people who I’m working with to attend their therapy reviews for the simple reason that they are their therapy reviews and I have a belief that they should be privy to what is being thought and said about them. Some young people opt out, for a number of reasons, and I respect their choice to do so. Maria was keen to talk to me without Kenzie present and Kenzie was keen not to come. He’d decided to ‘take a break’ from therapy; perhaps it was beginning to feel intimate and perhaps he wasn’t ready for intimacy yet. I respected his decision. I hoped he’d internalised a good-enough experience of psychotherapy to be able to come back if and when the time was right for him. Before ending, I asked Kenzie if there was anything in particular that he didor didn’t want me to share, and we agreed that I would focus on the process rather than the content of his therapy: how he’d begun to share things with me, show me his art and show me himself. I was pleased that Maria agreed with me that we should still meet, to mark the end of her son’s engagement in therapy. I clocked that she was early and sensed some anxiety, the source of which became immediately apparent.

‘There’s something I didn’t tell you before that I think you should know.’ She seemed in a hurry to get it out.

‘I’m listening,’ I assured her. ‘I was raped.’

Oh, Maria. I’m so sorry to hear that.’ ‘By Kenzie’s father.’

I have an expressive face that can’t hide how I feel, and I know that my eyes widened and my eyebrows raised.

Maria registered my alarm, but continued, ‘We’d been hanging out for a bit. He was okay. Well, not really okay, but you know…’

‘Okay but not-okay?’ I wondered.

‘Well, more not-okay as it turned out. He was mates with some people I knew. I didn’t know him that well. He was older, early20s. I was only 17. He was good looking. Exotic. His mother was from Bangladesh. I realised he liked me, but I wasn’t sure.’

‘You weren’t sure how you felt about that?’

‘I wasn’t sure how I felt about him, but I knew how I felt about him liking me. It sounds awful, but I suppose I was flattered.’

‘It doesn’t sound awful, it sounds ordinary. It must have been nice to feel that a good-looking, older man had noticed you.’

‘I don’t think I led him on or anything. Or maybe I did. I hardly spoke to him, really. We never went out or anything.’

‘It sounds like you’re trying to make sense of what happened to you; work out whether you were responsible.’

‘That’s what I’ve been trying to do for the last 17 years!’

‘I don’t know what happened, Maria, and I don’t need to know. But what I do know is that you are absolutely not responsible forbeing raped. Kenzie’s father is wholly responsible for what he did to you.’

I noticed a tear begin to form in her eye, but quick as a flash it was sucked back in and she was back in control.

‘He doesn’t know,’ she whispered.

‘He doesn’t know?’ I asked.

‘He doesn’t know he got me pregnant.’ ‘I’m wondering if Kenzie knows.’

‘No.’

Suddenly, the themes and fantasies I’d been holding in mind over the few months since Maria made contact started to join up. The withholding of information in the referral, withholding Kenzie from our initial consultation, Kenzie withholding his physical presence by opting to work online and withholding his appearance by switching off the camera. I remembered his words in our first session, ‘No one’s said anything to me,’ and my fantasy about a family secret, which had now been revealed to me and which no one had said anything to Kenzie about. I recalled feeling tricked, betrayed, intruded upon and kept in the dark, as well as all the experiences I’d had of not-knowing. I also remembered the first conversation I’d had with Maria. One of her opening statements was ‘mud sticks’. It struck me now that this was historic mud, mud from the rape that had stuck to Maria and been passed on to Kenzie and stuck to him. That’s what she’d said when she’d told me about the allegations of sexual assault that had been made against her son, which had precipitated the referral to therapy. She’d also told me ‘It’s not the first time’, and I wondered now whether she’d been thinking about her own experience. I wondered if, when she’d said ‘They cry rape’ about Kenzie’s accusers, she’d been projecting onto them the way she thought others might perceive her. I also wondered whether she’d told anyone about what had happened to her and I remembered her saying, ‘We get over it. We move on.’ She’d also said, ‘He’s gonna end up locked up,’ and I reflected on the locked-up, muddy secret that Maria had carried for 17 years – Kenzie’s entire life – and wondered if the man who raped her had ever been locked up for his crime.

Those three small words ‘I was raped’ carried so much meaning: for me, for Maria and, even though he had no conscious awareness of it, for Kenzie too. He was a young man who had been conceived through rape, who hadn’t been told, but had somehow got caught up in a repeated pattern of allegations of sexual assault, where not saying no could be interpreted as yes. Freud proposed an innate tendency to repeat both pleasurable and painful experiences, which he called the repetition compulsion (Freud, 1920). Could it be that these compulsions could be re-enacted across generations? And if the struggle between love (of self and other) and hate (of self and other) is inherent, could it be that baby Kenzie had internalised a sense of himself as ‘bad’ – a little shit, a useless fucker – because he was born out of ‘badness’? And what about the literal meaning of ‘useless fucker’ in the context of rape? Kenzie’s biological father was the worst type of useless fucker: he was an abusive fucker.

Selma Fraiberg, a child psychoanalyst and social worker, coined the term ‘ghosts in the nursery’ to refer to the repetition of the past in the present (Fraiberg et al., 1975). Fraiberg’s ghosts include the parents’ own traumatic experiences and the ways in which they themselves were parented, which come into play in the present narrative – the ghost story, as it were. Kenzie’s ghost story began with a rape and that terrifying, abusive, intrusive ghost must have been omnipresent throughout Maria’s pregnancy, right up to the present day, casting a dark shadow over the mother–child relationship and obscuring, if not obliterating, Kenzie – the actual, in-his-own-right Kenzie – from view. But how? How can an experience that happened to someone else, before Kenzie was even born, get re-enacted in him/by him years later? I don’t have a definitive answer, but I and many others have witnessed it time and again, and it’s an area of ongoing research. If eye colour, hair colour and a talent for tap dancing can be inherited, why not experiences? I explore the theme of ghosts in the nursery in more detail in Chapter 7.

Child and family psychiatrist John Byng-Hall has shared his observations of working with families who repeat destructive patterns almost as if they are following a predetermined script. But he also suggests that repetition can be the ‘launching pad for change’ (Byng-Hall, 1995). I would develop that statement further by saying it is the acknowledgment of family scripts and ‘ghosts in the nursery’ that precipitates change. I wonder if, at some level, Maria had sent Kenzie to therapy on her behalf – he’d said ‘It was my mum’s idea because of what happened’ – to begin the process of acknowledgement vicariously through him, just as he had been acting out her story vicariously during his adolescence. Either way, they had found their way to where we were now and I had every faith in them to keep going on their own, together, and maybe, in time, with further therapeutic support. Was Kenzie’s fate mapped out at the moment of conception, and was it inevitable that the past would play out in the present? I don’t believe so. In my experience, history doesn’t always repeat itself, but quite often it rhymes.

Stop F*cking Nodding: and Other Things 16 Years Olds Say in Therapy by Jeanine Connor is published by PCCS Books and available at www.pccs-books.co.uk