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Case study – Shelly

*Name changed for confidentiality reasons*

Shelly was a 16 year old female who I worked with for a period of approximately 6 months. The aim of the provision was to support her integration at a new part time college placement that was different from her usual school. She was placed at the college due to her struggling to manage at the school full time, and was close to being transferred due to not being able to meet her needs. Therefore it was incredibly important that her integration at the college worked out.

Shelly was a young person who suffered from complex trauma, mainly related to incidents involving childhood abuse and neglect. She was put into foster care around the age of 6 with her twin sister. Shelly would sometimes identify as a male and develop attractions towards members of the same biological sex as her. 

Shelly would generally present herself as an amicable person, but would frequently exhibit bouts of extreme rage that would arise from any perceived injustice and could become violent towards her peers. Shelly would also be prone to anxiety, self harm and suicidal threats, regularly contacting child line stating she was going to commit suicide.

Shelly exhibited aspects of fantacism, sometimes appearing to have conversations with people or entities that were her ‘imaginary friends’ as she put it. Shelly had an extremely vivid imagination and by no means lacked intelligence. She had a good understanding of trauma but would often use this to her advantage, often to make up elaborate stories about why she could not do something (which were usually school work related). 

One time she mentioned that she could not draw a circle because it reminded her of a bubble, and a bubble reminded her of being aged 6 witnessing abuse in her house, during which time, she would imagine a protective bubble around her. (This was all avoidance to doing school work, as I had seen her draw circles on numerous other occasions).

During my time with Shelly assisting her at college, she made massive progress in terms of her ability to emotionally regulate, along with her engagement with her education.

One of the main strategies that was used with Shelly was remaining extremely consistent when it came to enforcing boundaries and expectations. Shelly would often attempt to manipulate staff that worked with her by using an array of methods. There were 3 main behaviors she would use to try and achieve this. The first was by being very charming (usually after being in trouble and wanting to get out of it), the second was crying and apparent emotional breakdowns and the third was anger and insults. These could also be exhibited in any combination and any order and in any time frame.

These behaviors would often arise due to fairly minor situations, such as wanting to use her i-pad (which became a useful tool for issuing consequences) or not wanting to go to her lesson.

Whether she would try to use charm, anger or sadness to get her way, the boundaries set and expectations were still upheld. This was done by remaining calm and centered along with providing empathy to her feelings, whilst remaining firm to the outcome expected, so that she would learn that whatever she threw at me, it would not take me off my center. This allowed for her trust to grow in me as a capable adult she could depend upon to lead her through the trials and tribulations of life she faced. I would also at times make use of humour to either elevate her mood, and even to get her too situations from a different perspective.

To begin with there were numerous situations where Shelly would not be happy at not getting her own way, but over time she began to understand that I would not be swayed by emotional manipulation and her behavior became much more balanced and stable. (Note: This is not to say she consciously chose these behaviors, but more that they were learned in order to get her needs met as she grew up).

Other scenarios would occur where she would do things such as show off scars on her wrists or flash a razor blade she had stolen from a pencil sharpener, boasting (with a smirk on her face) how she was going to use it to cut herself. I soon recognised and understood that much of her behavior was mostly linked to gaining attention and reactions. My method for dealing with this was not to provide much reaction at all. I would still tell her that seeing her hurt herself was not funny or cool to me, and to remove the razor blade off her if she had one, but to generally give it no further attention. Again over time instances such as this became less frequent.

When it came to situations that involved helping her to process her trauma I used methods such as drawings/cartoons and brainstorming to help understand and figure out what she was feeling and to put things into perspective. A large part of the work around this was done on helping her to let go and move on from the past. She had a lot of unresolved feelings regarding her relationship with her birth mum, and was unable to visualize a positive future whilst she clung to the past. I helped her to step outside of the mother/daughter relationship paradigm through which her perception was tainted, and instead see her mother and an individual who probably had a difficult upbringing herself, and was an individual with her own issues and floors. This helped Shelly to begin to remove her lack of self worth from how she was treated by her birth mother.

I identified that she displayed what is known as psychological ‘splitting’ which is a form of black and white thinking. This is generally where someone thinks of someone else as either ‘all good’ or ‘all bad’ depending on the circumstances and can change numerous times throughout the day depending on the circumstances. This tends to be a behavior prone to people with personality disorders such as Borderline personality disorder (BPD).

In order to de-escalate or diffuse emotional outbursts before they began, I employed techniques from the which is a communication style aimed at disarming verbal confrontations from people who suffer from BPD. (I would like to mention that BPD was not officially recognised in people under 18 until recently, and Shelly has no diagnosis of it, but regardless her behavior was congruent with that of someone who suffered from it, and the techniques for helping to manage it worked.) Using the techniques shown in the Nicola method enabled me to not get drawn into the numerous attempts at starting an argument she often tried to start. It also enabled me to remain calm and unswayed by the things she said to me.

I also performed some mini workshops with her focussing on subjects around emotional intelligence and self management. To complement this I taught her ‘Emotional Freedom technique (EFT) which involves tapping various pressure points around the body, whilst simultaneously repeating a positive mantra of affirmation, and help the person to release the emotional energy trapped in the body. 

The final aspect I worked on with Shelly was helping her to manage/overcome her anxiety and not let it control her life. This was mainly done by encouraging her to act with courage and to take small steps outside of her comfort zone, gradually taking bigger ones as time went on. Shelly made massive progress with this over the course of 6 months, from initially not being able to bring herself to attend any lessons without me supporting her, or being the center of attention in a social setting (such as talking to a group) to being able to attend all lessons without me and even playing a small part in circus performance put on by her school.

Shelly successfully integrated into her college placement, and since went on to attend there full time after my intervention ceased.

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