Panic (Not Mine)

This afternoon I was working with a family where the mom always likes to remind me that her kid has Conduct Disorder (aka--a perjorative term for a kid who has been through a lot in his short life and is externalizing emotions). There is no doubt that he is potentially on the road towards a misery of antisocial behavior and its ramifications...I just don't like that term. Anyways, school's starting, he has terrible sleeping and social habits, and we were trying to figure out a plan to get prepared for school so truancy doesn't become an issue this year.

I start to suggest limiting his time at the computer by a simple equation of he has to do something productive for an hour a day or he loses an hour of computer time (he spends over 10 hours a day on it). The poor kid FLIPED OUT.

He jumped up, stands in his mom's face, yells expletives at her and his body positioned like he might hurt her. I got up, yelled at him to back off, and moved to separate them (which was probably stupid). Before I reached them he had already left the room and went outside, breaking the screen door on his way out.

That part wasn't a big deal. Sure it got my heart pounding and I was thinking, OK so if he hits her, what do I do? But I've had to intervene in situations like that before. Teenagers get really pissed sometimes. I get that.

The saddest part was 15 minutes later...I finished calming things with his mom and wanted to check on the kid (14) and get him to do a UA for me (yes, I have to collect pee for a living).

The poor kid was curled up in the fetus position on the back swing. I asked him what he was thinking and he just loses it. Starts heaving heavy sobs...I let him cry for a moment but started to worry this was something else when he starts gasping for air and saying he feels funny all over.

From that point on, I just treated his behavior like a panic attack. I've never had them, just heard and read about them, so who knows what was effective. I sat next to him on the swing, patted his sweaty back (does that break the personal space boundary for the therapist of a 14 year old boy?) engaged him in some breathing and counting exercises and told him what was going on in his body and why he was probably feeling what he was feeling. He cycled in and out of his sobs and choking for breath several times, but he eventually calmed. Whew.

When it was over, he let out his Beavis and Butthead laugh and kept muttering comments like "This is probably the most akward thing ever for you, isn't it?" "Wow, you've probably never seen anything like that before, huh?" or "I guess I'm just a pissed off little kid" "I don't know where that came from...I'm really sorry" etc. Embarrassment. The stoic 14 year old trying to make a comeback. I assured him that I've seen much worse and was glad it happened in front of me because I now I know what emotions are really running through him. We created a plan for if something like that happens again and I was gone.

I guess I'm writing about this because it was a little shocking. I'm still so green at this job that I haven't seen it all yet. He's a tall lanky kid, wears a lot of black, and has a way of glaring and rolling his eyes that you would not believe. Sometimes I've wanted to pull a Homer Simpson move by ringing his neck and saying "Why you little..."

But then the contrast of tonight. The fetal position and tears. Hearing him talk about the only reason he's living where he's living is because his dad beat the sh** out of him and he didn't want to deal with that anymore. Can you blame him?

So...now I am trying to figure out what our next step is. How do we address his anger, his anxiety, his need for control while not letting him get away with everything?? Teaching his mom to be the comforter instead of me? Thank goodness for supervisors and team members. My work is cut out for me.