Secret #37: Youth Interpersonal Violence with Carina Simmons
In this episode of Life's Dirty Little Secrets, hosts Emma Waddington and Chris McCurry talk to Carina Simmons, a consultant clinical psychologist from Barts National Health Service Trust, Royal London Hospital. Carina discusses the complexities surrounding youth interpersonal violence, the impact of social media, and the challenges faced by youth in managing emotions and mental health.
Emphasizing a holistic approach, Carina highlights the importance of addressing both individual and systemic factors, the need for early intervention, and the role of emotional literacy in preventing violence. The conversation also explores the unique difficulties faced by young men in expressing emotions and the therapeutic potential of building strong, trusting relationships.
Highlights:
Understanding Youth Violence
Role of Social Media in Youth Violence
Causes of Youth Violence
Male Emotional Expression
Complex trauma in youth
TIMESTAMPS
[00:00] Introduction and Clarification
[00:24] Meet Carina Simmons
[01:05] Understanding Youth Violence
[01:36] Factors Contributing to Youth Violence
[03:56] Approaches in Trauma Centers
[06:14] Complex Trauma and Mental Health
[15:47] Gender Differences in Emotional Expression
[25:29] The Role of Social Media
[34:57] Supporting Emotional Literacy
[50:43] Final Thoughts and Reflections
About Carina Simmons
More about Barts NHS Trust based in the Royal London Hospital
Learn more about London’s Air Ambulance
Learn more about The Major Trauma Centre
I am a Consultant Clinical Psychologist at Barts NHS Trust based in the Royal London Hospital. I lead the Major Trauma Centre's Clinical Psychology Service which aims to integrate psychological and physical healthcare in major trauma for patients across the lifespan. We provide responsive and proactive inpatient and outpatient services and also offer a variety of CPD sessions for our staff. I lead and manage the service as part of the pan-London Major Trauma Network and work closely with St Giles, the After Trauma Team, Police Liaison, Therapies, medical and nursing colleagues to provide the highest standard of joined up care.
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Secret #37: Youth Interpersonal Violence with Carina Simmons
[00:00:00]
Meet Carina Simmons
Emma Waddington: Welcome to Life's Dirty Little Secrets. I'm Emma Waddington.
Chris McCurry: And I'm Chris McCurry. And today we are thrilled and honored to have as our guest, Carina Simmons, who comes to us from the UK. She's a consultant clinical psychologist at Barts [00:01:00] National Health Service Trust, Royal London Hospital. And she leads the major trauma centers, clinical psychological service, integrating psychology and physical health care In major trauma with patients across the lifespan.
Welcome, Carina.
Carina Simmons: Thank you so much, both of you. It's lovely to be here.
Emma Waddington: Lovely to have you.
Understanding Youth Violence
Chris McCurry: tell us about the work that you're doing. There's been a lot of press lately. A lot of interest in youth violence, not only in the United States, but in the UK and I'm sure other parts of the world. We pay less attention to here, perhaps, unfortunately, but what, what is going on in your estimation with youth and violence?
It's a broad question, but please, please jump in and tell us about it.
Factors Contributing to Youth Violence
Carina Simmons: I mean, I think there's lots of factors, really. We could start with social media. We could think about job [00:02:00] opportunities. We could think about financial situations. We could think about lots of different issues to do with when people get involved with perhaps doing drugs and also all of the problems that can come about from being in school if education doesn't go so well, where people kind of end up in different systems.
And I think that a lot of young people have a risk of leaving school without sort of an idea of how to safely manage emotions. But I also think that with social media being as it is nowadays, there can be a kind of increased lack of connection. And so there's going to be probably for some, maybe more attraction to being surrounded by anyone rather than no one.
And that can kind of lead to groups of people who might spend time together that might not otherwise normally spend time together. And then Different behaviors can be quite exposing for some young people. I also think [00:03:00] that the way that mental health services are at the minute, there's obviously quite a long waiting list for certain.
services for young people. And if they did need, for example, a low intensity intervention, they might have to wait for a very long time to get it. If they weren't to get it, they might then be at increased risk of struggling to communicate their emotions, which can turn into interpersonal violence for some people, not for all, but for some.
Those are my initial thoughts anyway. So
Chris McCurry: Well, there's so many factors that go into the trajectory that kids can go on. I mean, starting prenatally, obviously you know, with genetics and everything else. Yeah. It must seem overwhelming sometimes when you're dealing with all these factors of societal, genetic you know, the, the peer group, all that sort of thing.
Are there certain things that, that you focus on in particular that uh, I'm just thinking in terms of what do we have [00:04:00] control over? I mean, obviously we don't have control over so much of. What's going on in the lives of the, of, of, you know, young people these days, but you know, where do you, where do you tend to focus in your work at the trauma center?
Approaches in Trauma Centers
Carina Simmons: often we try to take a very transdiagnostic view. Of a person and see them holistically in their own context. And so our pediatric services are very, very systemic in their thinking and their practice. And so when you're looking at a young person who might be in a major trauma center with injuries related to interpersonal violence.
You're not just seeing the young person, you're seeing the network around them that could be made up of families or carers, foster families, different care systems, mental health services, other physical health services, schools, local community services. There's so many things there, so we try and really think about all of the [00:05:00] aspects that could have influenced the young person ending up being in a major trauma center.
And I think sort of trying to pick one approach and having that be the approach is quite difficult because every young person is so different. You can have a fixed idea about how, I guess, the young person might see I suppose, a member of the psychology team coming into their room after they've been involved in interpersonal violence and they've got lots of injuries.
And I suppose that the only consistent thing is you do keep learning as you meet every young, new young person that comes in. I think that there's always a story there and helping the young person to, I guess, tell someone. That story in a non judgmental environment is really, really important because there's going to be lots of systems around them that could be influencing their views on different I guess, professionals.
There could be different contexts as [00:06:00] well with regard to the young person's submission. So, they might actually be in the hospital and there might be police present with them because they might be under arrest. Some young people have been a victim of interpersonal violence. Some young people have been both victim and a perpetrator of interpersonal violence in the same incident and other incidents.
So, it's always, always really, really difficult to say, oh, this is, you know, this sort of one size fits all.
Complex Trauma and Mental Health
Carina Simmons: When you go in and you think about how they've come to be where they are, one of the key things is thinking about all the potentials for complex trauma. Regardless of whether or not they would meet the diagnostic criteria for complex PTSD, there's often lots of complex traumatic experiences that the young person has been through.
And it doesn't necessarily relate to maybe they witnessed a car crash or anything like that. It can be lots of interpersonal invalidation when [00:07:00] growing up. It can be witnessing really difficult experiences between their parents or caregivers. It could be being moved around a lot and not having a sort of a safe base.
There are lots of complex traumatic experiences that young people can go through. And so, we always sort of go in with an open mind, knowing that we're going to learn, hopefully, quite a lot from the young person about what their experiences have been, how they make sense of those experiences, and what they mean going forwards as well.
So, we very much are a fan of thinking about protective factors. But also those early things that could have happened. I mean, some young people, if they have parents who might struggle with addiction, maybe they were around drugs when they were growing up. They could have even been born addicted to a substance.
There are so many factors there. So you need to really think about what the young person is safe to bring to the session, what you can contain. [00:08:00] And also, critically, what you're going to do with it, and then thinking about who else you're going to involve, because there's always a lot of people involved in a young person's care.
Chris McCurry: I could see how that would be therapeutic in and of itself to approach a person saying, you're an individual, you're unique, when the whole west of the world is trying to lump them into various categories. And, and, you know, shorthand and you know, which is efficient, but pretty demeaning and discouraging.
So just saying I'm interested in you and your story and, and your unique circumstances, I think would be a breath of fresh air for some of these young people coming in.
Carina Simmons: I really hope it would be, and at the same time, we're mindful that for a lot of young people, talking about, I guess, even thoughts, let alone feelings, can be hugely threatening for them. Or even when they might try the way that they [00:09:00] might come across might not be suggestive of them wanting to engage in that conversation.
So, I think we always have to be open minded to the different ways in which people might engage. It looks really different across different age groups within young people. But also different within different cultures as well, as well as it could be impacted on, like, if the young person doesn't feel free to speak, if there are two police officers present, for example.
Or if there are lots of people coming in and out of their room, if there's a ward round going on, there are lots of kind of chaotic factors that come into play in a major trauma center. Actually, you know, as a clinician, you don't have much control over, so you have to kind of go with the flow a lot. and take any opportunity you can to create a really safe space for that young person as much as you reasonably can.
Emma Waddington: Gosh, just listening to you, it sounds like such a difficult job that you have. Sounds like it could be really, [00:10:00] it could feel quite hopeless and you could feel quite helpless because there are so many factors that are both barriers to you being able to actually help the young person, but also. To stop the recurrence of violence
Carina Simmons: Yeah. I mean, I guess it could seem like that from the outside, but genuinely from the inside, it's such a privileged position to even be able to go into. young person's bay or room and say, I'm here, even if you don't want to see me, if you want me to come back another time. The other thing that we do within our service is we do a proactive follow up with young people.
This is also extended to adults, but that's a side story, but we do those proactive follow ups with young people after they leave hospital as well, because What we see for some young people is they might not want to speak to us whilst they're an inpatient, but when they're an outpatient and they've got more control back [00:11:00] to a degree anyway they might suddenly think, okay, yeah, no, I can tolerate a conversation.
The other thing is, is that some of our young people really do want to speak to us, and they make brilliant use of the session, and so when you think about going into someone's environment, when they are having, you know, the worst experience they could possibly be having, they might be really seriously injured, they might be in a lot of pain.
The pain medication might not be working. They might not have slept for days. If they're under arrest, they won't be allowed visitors. It can be really scary having two police officers sat outside, regardless of how many times you've come into contact with the law. If it's your first time coming into contact with the law, it's extremely frightening.
And there are all these adults around you making decisions. And as best as we try to communicate those decisions to young people young people don't always understand every aspect of their care, and that can be both, you know, [00:12:00] the psychological aspect as well as the physical aspect. So there's lots of work that we do to try and make sure that the communication lines are fully open and that we're really kind of explaining it in a way that the young person can make use of and tolerate.
So I guess we all feel pretty privileged to be allowed to be. In that place where the young person comes in, they're having this terrible experience and we get the opportunity to try and make a difference from the earliest point possible. And we know that we've got the option to then intervene at later stages as well.
If that time in the hospital isn't the right time for the young person and we can catch them and redirect them towards. I guess, a service that might be useful, we might be able to offer our own outpatient service as well. Like, it's, it's a really exciting and privileged position that we're in.
Emma Waddington: and out of, I'm listening and thinking, what are we talking about when we talk about young people, how young are some of the people that the children, [00:13:00] young people that you see,
So, I think we have had I suppose it's probably important to bracket it into You know, some young people have been randomly attacked, and that's without, you know, their control. And I suppose we're also thinking about young people that might be involved in interpersonal violence already.
Carina Simmons: So there are the random attacks that we've got no control over in society, which are really, really terrible. And then we've got all of the social problems that can lead to interpersonal violence as well.
I suppose it'd be really interesting to also think about what I guess the surgeons would say as well, because the majority, I've got to say, you know, 11, 12, that's vast minority. The majority would be the 16 to 17 year olds, I would say, occasionally 15 year olds, occasionally 14 year olds, but the 16 to 17 year olds are the predominant group we see most frequently with interpersonal violence.
And so [00:14:00] the surgeons might say something different because sometimes, you know, young people are involved in interpersonal violence and they're actually treated quite quickly. And so they might be discharged home from ED uh, so the emergency department, they don't necessarily make it up onto the ward.
So our service sees patients who are on the ward because the injuries weren't possible to be safe to go home from the emergency department. And I guess it's thinking about the wider problem as well, so my service might only see the most severely injured, so it doesn't capture the whole problem.
Emma Waddington: it's quite striking because I was, I was thinking about sort of youth violence in general and interpersonal violence in the young and how, you know, we've always had, you know, since the Victorian days you know, a concern about the youth on the streets and what they're up to and a kind of intolerance by adults [00:15:00] to see young people on the streets. but obviously, what we're looking at now is a far greater problem than simply seeing youths misbehaving. It's really as youths finding themselves in incredibly dangerous situations. And it feels like a cycle that we can't break.
Carina Simmons: It's really, really tricky, yeah, to say whether we could break it. I think that there are so many, like we discussed, complex factors that come into each young person's situation. And I think that, you know, we could sort of think about the impact of social media, for example both on interpersonal violence, but also mental health more broadly.
And I, for me, it always comes back to emotional well being, connection and stability. Okay. And those are the three things that people who, young people who get involved in interpersonal violence seem to struggle with the most. So, they might have maybe fallen out of school [00:16:00] maybe they've got a reputation for being a certain character.
Gender Differences in Emotional Expression
Carina Simmons: We know that the majority of interpersonal violence patients that come through to the major trauma center are male. And we know that society might. Reinforce certain kind of behaviors in men more so than in women. So, for example it's much more socially reinforced for a man to perhaps show anxiety as anger or to show sadness as anger.
And when we think about anger anger obviously can, can lead to violence. And dealing with anger is actually really, really difficult for a lot of people because the natural inclination is to run away and escape. And when we think about the message that sends the young person, so say, for example, the primary emotion is sadness or fear, and then that comes out in the form of a behavior that looks angry.
And [00:17:00] actually what they need is proximity, but the effect of the behavior means the person's run away. And the learning from that of the young person can often, you know, be people leave,
or everyone will leave, or there is no one to protect me, or I'm unlovable. There are so many tricky thoughts that can come up for the young person in response to other people's responses to them when they might desperately be trying to reach out for help and support.
But we also know that reaching out for help and support historically has been more socially reinforced for women than men as well. So we're trying to overcome a lot of gender based differences in how, A, people communicate their emotions, but also how, B, people seek help. So there are lots of societal things there too.
Chris McCurry: I would imagine that, that some of those things that you just described, that the self talk You know, like I'm unlovable, you know, people abandoned me that some of that stuff isn't even [00:18:00] articulated in their minds. That these are just feelings. These are just inchoate, you know, sensations that they have, and to be able to get people to even articulate, I'm unlovable is a starting point to start dismantling those rules or those ideas.
But a lot of it, I think it's just, ah, it's just, I don't even know how to describe what's going on. Or. Or articulate the rules that they're operating under. So our, you know,
Carina Simmons: For sure,
Chris McCurry: is to get people to be, you know, more aware of, you know, the rules that they're playing by and then begin to start questioning the utility of those rules or the applicability of those rules.
And, you know, maybe that worked. In your violent household, but, you know, in this situation, it's just not working you know, what other skills might you be able to employ?
Carina Simmons: for sure. And actually it's really, it can [00:19:00] often be a misunderstanding by the systems. That actually what they're saying more often than not is, you know, what we might describe as almost like a skills lack, like they haven't been taught the skill, but we're expecting them to use them. Which ironically, is quite an unreasonable thing to apply to a young person who's still going through so many developmental stages as well.
You know, if we had an employee in the workplace and we hadn't taught them something, it would be our job as, you know, managers to teach them the thing that we need them to do. Rather than hope that they would mind read and pick it up. But often, for children, if we assume that they have had a particular learning experience, or they've made sense of it in that way, Because often neurodiversity can come into it for some people as well.
How they might process situations, how they might focus, et cetera. There are so many expectations we can place on people that might just not fit. And so it's a really, really diverse population [00:20:00] we're working with here. And it's such a good opportunity to I guess give them a space to learn how to say today.
I felt really sad or today. I felt really scared or today. I felt really ashamed and it's, you know, we do actually see it in both the inpatient outpatient. Sessions where young people come to a realization that they had an emotion, actually. And that, you know, is a huge factor into what was going on for them at the time, regardless of whether that's directly related to the incident of interpersonal violence they experienced.
Emma Waddington: Yeah. It's like, it's a real emotional literacy, isn't it? And you know, what you're describing is you know, what we sometimes think of as primary and secondary emotions, right? We have that prime emotion, but really what we're reacting to is that secondary emotion. Which like you said, [00:21:00] and we know it from the literature that, you know, men do feel safer in anger than in sadness and the more vulnerable emotions and and they don't necessarily have the conversations that we have as women about feelings from a very young age.
I was. I was doing a talk recently what about our boys talking about the difference about with girls and boys and how boys even in utero are treated differently, that we
respond to our baby in utero differently. We caress the females more. We, we label the boys as more boisterous, even before they're born. And when they're born, there was a study in Newcastle. That showed that parents of. Baby boys are more likely to turn the boys outwards and face the world and the girls inwards to place that. And so you can see from a [00:22:00] very, very early age, how our behavior starts to shape their brain, their skills, our expectations of them.
We expect boys to be. Bigger risk takers to jump higher to be brave whilst we expect, you know, girls to need more support and more cuddles and more. We talk more to girls. I mean, it's just from a very young age. We're shaping our boys brains. And we also know the boys brains are very different, you know, the impact of hormones on their ability to self regulate on their reactivity on their impulse control is developed slower than girls.
So I think there are pieces about how we respond to boys that as a community, as a society, we need to reflect on and start to change. From the education from parenting, from within our community, within our [00:23:00] societies that I think are inevitably an influence in this interpersonal violence.
Carina Simmons: Absolutely, I think that it would be such an amazing opportunity for educational systems to, I guess, discuss things like what are the core emotions that we all experience? Okay, how do we notice them in our bodies, in our sort of minds? What sort of words come up when we think about that? What do we typically do in our behaviors in response to those things?
Did that, did that sort of behavioral response work for me? Did it not? What do I need to do differently? Whose help do I need? What should I do in this kind of context for that situation? Those kind of opportunities to get young people to think about their own individual experience of that, because people don't experience emotions in the same way.
And particularly with neurodiversity, they might actually experience the physical sensations differently as well. [00:24:00] So I think that that educational opportunity in schools would be a great way in because then we're not relying on everyone having the same home opportunity. Assuming that parents can definitely do that.
Parents might be, you know, working a lot or they might have different communications styles, or there might be chaos in the relationship between the parents. There could be all of that going on. But if there is that system in schools, I don't think it solves the whole problem of how people end up in situations involving interpersonal violence, but it gives them options for how to respond to emotions and normalizes actually both men and women having emotions, but also from a really young age.
Emma Waddington: Yeah, because we're kind of expecting the parents to know how to do this. And sometimes parents don't have the skills either,
Carina Simmons: No,
and communication styles can be passed down those systems, and then they can spread to other systems, and so I think it's [00:25:00] kind of making sure that we're not making the same assumptions about the child or the parent, actually. So if it does happen in slightly more controlled environments, for example, schools, then hopefully enough young people will have the same awe.
Nearly the same opportunities as each other in that regards.
The Role of Social Media
Emma Waddington: And just wanted to rewind back to this, the role of social media. We haven't talked much about social media, have we, Chris, on the podcast, surprising the
Chris McCurry: It's, it's a dangerous territory. There are a lot of strong, a lot of strong opinions.
Emma Waddington: It's true. But I was reading a statistic about loneliness and social media usage. And actually, to my surprise, the sort of, loneliest cohort, the loneliest group of individuals are the 18 to 22 year olds. So I was expecting it to be sort of the older adult community, but it's not. And it, and it [00:26:00] correlates with those who use social media the most. And I found that quite striking. So here we are the most connected we've ever been in the history of humankind. And yet the most lonely. We've ever been, and there seems to be a relationship between, you know, having access to social media and a disconnect with true meaningful relationships.
And you, you mentioned that as being one of the factors in, in interpersonal violence amongst the youth.
Chris McCurry: Well, it's, it's probably not random. people who, Perhaps have some social issues, awkwardness, whatever, are going to find more you know solace and entertainment in individual activities like video game and then it becomes You know self fulfilling prophecy where, you know, I'm, I'm, I'm doing social media as opposed to [00:27:00] actual interactions with people and it's easier, but I don't learn to improve on my, my social skill.
Emma Waddington: No, I think it's exactly right. I think what you're reflecting on Chris is that, you know, perhaps in the past, somebody who was more socially awkward. May not have had an opportunity to turn away the same way that we have today. You know, if you feel, if you find yourself in a very difficult social situation, you can now turn away and immerse yourself in a world that is simpler, but less connecting, whilst perhaps in the past, we didn't have that choice.
You had to try again
Chris McCurry: Well, well, now we have sort of a quasi social world where I'm, I'm interacting with other people on the other side of the world as we are at the moment. But, you know, I, I've worked with so many kids who, where the parents are complaining, he has no friends. And then I talked to the, you know, [00:28:00] adolescent and he says, I have lots of friends, you know where are they?
Well, one is in Tokyo and you know, one is in, you know, Buenos Aires and we get together all the time, you know, virtually and that's, that's his friendship group.
Carina Simmons: I think the virtual world has potentially discouraged people from going around in person and having that in person time, which could in part explain the loneliness of maybe older adults. And I think that also that's, you know, like you say, it's given young people a forum to connect with.
Whoever, and some of those relationships can be meaningful for some of them. But I think the online world also encourages a lot of comparison that can kind of lead to young people not feeling like they know who they are. And that can also be another version of disconnect. And when everyone is [00:29:00] communicating online, the other sort of spinoff I was thinking about in relation to that is that when young people are going through something, there is a tendency to let other people know about that, perhaps online, and sometimes with certain situations in interpersonal violence.
When a young person has perhaps a disagreement with someone else, and then that disagreement becomes quite dangerous, they can get other people to turn up, and you see what would have been a one to one fight turn into 10, 15 plus people there. And so, instances like that as well are quite concerning as well, because it's becoming more common.
It's yeah, it's quite prolific and it's really heartbreaking when you see the fallout for that, because often there'll be young people involved in that who had never had any contact with interpersonal [00:30:00] violence before, but social media enables people to let others know what they are and then other people turn up and then everyone gets involved.
And it doesn't generally go brilliantly well when so many people are involved in someone else's dispute. So we do see that from time to time and, you know, the young person will be there with the parents and the parents will be saying, I just don't know how this happened. It's never done this before. And, you know, you're comforting and reassuring and validating the parent as much as you are the child, because it might be the first time they're both in that situation.
So it's a very, very complex system really.
Chris McCurry: Oh yeah, this whole cyber bullying and you can get an entire school community to, to suddenly turn on one student and.
Carina Simmons: Yeah
Chris McCurry: It's, it's awful.
Carina Simmons: yeah, that happens a lot, unfortunately, as well. I think it's almost the, the disconnection that happens from the [00:31:00] virtual world. I mean, it's a hypothesis, but people are trying to actually mend the disconnect by getting together and forming some form of identity. And what we see a lot in young people that have come in through interpersonal violence is that the potential loss of identity, if they were to change, for example, their location in order to keep them safe, they just want to go back to where they know they want to go back to where their friends are.
They want to go back to perhaps where their family are and trying to keep that young person safe after they've recovered from their injuries or. They're well enough to go home and recover at home from their injuries. That kind of upheaval in a young person's life to keep them safe, that also is quite traumatic.
And then they get the disconnect from not being in that familiar place with people that they know.
Emma Waddington: It's, listen, I'm just thinking about a previous conversation that we had which is this kind of natural about sort of [00:32:00] the tribes that we want to belong, right? We wanna be a part of a tribe, and it's very. You know, common in young people, particularly to try and figure out who your tribe is, and then really identify with those that are in your little community.
And it sounds like they're using, you know, social media to find that little community and then they don't want to be excluded. And sometimes violence is part of that community. And so they have to participate in the violence in order to stay.
Carina Simmons: Absolutely. And that happens a lot with young people, how they might end up in, in gang sort of networks. They were just looking for their family. It might have been that they were sort of, I guess, lured in. And then, even if they want to leave, the threat to them is too high to leave. But for other people, they might want to stay, even if [00:33:00] maybe what they have to do to stay in doesn't fit with their goals and values.
They would rather have connection than not connection. Any family is better than no family, and that could show up for a lot of our young people as well. And that could be really, really challenging to factor in when you're trying to help a young person be safe.
Emma Waddington: Yeah, I can, I can so see that. And ultimately, if we go back to the piece around social media and this need that we have, you know, as humans to connect and to find our community. and that is so intrinsically important to us. How do we support young people?
Supporting Emotional Literacy
Emma Waddington: To feel a sense of belonging, um, when they are coming from such complex where their belonging in their family perhaps isn't, is inexistent.
Perhaps they have been excluded from school, [00:34:00] like all these different pockets that where they could have felt a sense of belonging have been removed. And they choose, they turn to. A, a gang or a group of young people online that, you know, are behaving in these ways. I mean, what can we do to help?
Carina Simmons: I know that there is no one answer. And there's definitely not an easy answer.
Chris McCurry: you were going to solve this
Emma Waddington: Yes.
Chris McCurry: us.
Carina Simmons: know, I'm sorry. Um, However, I do have thoughts about things that we could do to contribute to reducing both the problem itself, as well as the burden of the problem. And I think it's that early opportunity for finding different ways of learning how to be, you know, yourself.
And also to be well emotionally resourced, and I suppose it takes you back to schools a lot [00:35:00] because then we're not relying on the family being in a certain way. And at the same time, I think that, you know, where we detect, you know, chaos or discord in families where there are unmet needs. I think the societal approach.
would be to, I guess, treat them as a system. So when you see a child or a young person experiencing difficulties regulating emotions or experiencing difficulties managing their behavior in school or it may be against that point and they've had their first episode of interpersonal violence and they're pitching up to a hospital regardless of whether or not it's a major trauma center.
I think it's really important to look outside of that individual. Think about who else they might be involved with. And think about if there are any unmet needs within that network as well. I guess what I mean when I say that is when we're working with our young people [00:36:00] in the major trauma center, often the outpatient work will look at helping both the child And the family member or carer that happens to be involved as well, and we often find that people in that child's immediate network need a lot of support themselves. And so, even if we were to really give the child, the young person, a lot of resources, that might not be enough on its own, because if you go back to the same system that is chaotic or difficult in some way those resources aren't always enough to overcome those challenges. Whereas, if you're thinking about the needs of the system as well as a child or young person, and you're able to try and at least in part address some of those needs, the resources you give the young person have a much better chance of working, not a guarantee.
But a much better chance and it encourages that network of people involved in that child's care to think about [00:37:00] emotional well being and how they can help themselves to on an individual basis is super important. In my view,
Emma Waddington: And I think about the, the, the kind of trajectory of young people, like what we're describing is. Almost the point where it's almost too late, like you're having to react to the situation. I mean, it's not hopefully not too late, but it's much more complicated at that state. And if we think of the journey in early childhood, how we can intervene at you know, with younger children, when it comes to that emotional literacy piece.
When it comes to having role models, people they can count on within schools, within, I know we don't have youth centers anymore in the UK. When I was there, we did have many where you have role models, people they can count on and think about and talk to, [00:38:00] and get sort of support. Thank you. An opportunity to connect in different ways that perhaps they're not connecting at home.
Because ultimately what we're saying is that some of these skills, when it comes to being able to label your own emotion, recognizing what your, what is truly important to you, Our skills that we develop through, you know, throughout, you know, childhood into early adulthood. It's not that, you know, we suddenly know how to do it aged 14, 15.
It's something that we continue. And some of us are still learning. But you know, it's, it's an evolution that starts from very, very young. So the earlier we can start to think about, even with our own children, their ability, especially our boys, their ability to label their emotions Permission to have vulnerable feelings helping them to reflect on what they really want the kind of friendships that really bring them [00:39:00] meaning and connection.
All of those conversations could be had throughout the journey of life that are really important. And protective protective and also, you know, help them to, to, to live life as close to their ideal as possible.
Carina Simmons: it makes me think about all of Brené Brown's work on how vulnerability is a strength and. How I wish that was, you know, a book assigned to young people in school. And I think that would be a great addition to the curriculum. But I also think, you know, you can see a young person in what appears to be a hopeless situation.
And I suppose, you know, my encouragement to Other clinicians in the field would be to never underestimate what you can do in that situation. So if, for example, you take a situation where a young person might be going to Young Offenders Institute you might think, Oh, God, what am [00:40:00] I going to do?
And I can't really do very much. But say you identify a need that that young person has, maybe they're struggling with attention. Maybe they're finding social communication really hard. Maybe they really struggle with intense and overwhelming emotions. You can have an opportunity, actually, even within our service to reach out to, for example, probation service and make sure the young person's probation officer is aware of their needs, so that can try and be addressed even in the system.
And thinking about stuff like that, when you think about what might have happened before when maybe there wasn't psychological services in physical health services. It's such a missed opportunity. So I always encourage my team to think about all the things that we can do and where we might have influence.
It's not always in, you know, the one to one conversations we might have with a young person or a family member. It's beyond, it's the system, it's beyond the [00:41:00] immediate network and really thinking about how am I missing something? Have I covered everything? What else can I do? And that's really rewarding trying to identify our blind spots and put in the work there.
Emma Waddington: Yes. It feels really important, doesn't it? To think about what is it that I could actually influence because it's, it's like you said. It's easy to get to feel helpless and hopeless. Like I said at the beginning and it reminds me of the conversation we had with my sister on moral injury that, you know, those of us who, well, I'm now in private practice, so I have a very comfortable clinical experience, but.
You know, working in hospitals, working in in communities like the one that you're working and it's very, it's very easy to find yourself experiencing moral injury, burnout, compassion fatigue, because. We do feel that we sometimes can't have an impact to make a difference. [00:42:00] Thinking about the areas in which we can, we had a conversation with Amy Beddoe's on victim blame.
And, you know, similarly that we find ourselves when we're working in. Communities where there has been violence that you know, we can start to focus on too much on assigning blame and responsibility instead of really thinking about what can I do that could help however small she was talking about offering biscuits and tea can make a huge difference. And it may feel sort of a bit meaningless, but actually. These are the small things that could make a huge difference to the service user, but also to their sense of humanity and what humans can do, that humans can be. Good people, they may never have had that experience of warmth and care. And I think with interpersonal violence, a lot of, some of these young people have [00:43:00] never felt really careful, haven't felt that somebody actually wanted to listen or wanted to hear what they had to say, and instead have experienced a lot of rejection and interpersonal violence, you know, themselves.
Carina Simmons: Absolutely, and I think that as professionals it's our job to try and decode what we're seeing. It might be quite easy to see a behavior and You know, do that human thing of trying to label it because it's cognitively more comfortable to do so we can put it in a nice little box and walk away, but thinking about all the possibilities associated thinking what's really going on here and almost forcing your mind to go into places and be curious because it can be hard to do that.
Even as an experienced clinician, if there is a lot of, for example, uncomfortable behavior. If people are raising their voices if there's lots of gesticulation, swearing threats, it's really difficult to actively feel, you [00:44:00] know curious, where am I going to go with this? And at the same time, you know, that sort of translator, how that decoding role that we need to adopt when we're seeing the behavior, we've got to really think about what is that communicating to us about their experience right now.
And, you know, am I missing an opportunity to do something differently to what the system may have done before when that young person's shown that behavior?
Emma Waddington: That's really inspiring. sometimes I talk to my couples. It reminds me of some of the work that we have to sometimes do with couples and I call them Jedi skills, our ability to see past the behavior with curiosity, because we are going to get flooded. We're going to get upset. We're going to feel threatened.
And how do we regulate ourselves? Enough to try and, like you said, decode or make sense of why is this person behaving in this way? Is there, you know, that, that [00:45:00] primary emotion, what could that be? That sort of the secondary emotion, you know, that the dominant behavior is coming sort of loud and vast, but what could be behind that that could be more useful and more important to attend to?
Carina Simmons: Sure. And also, Trying to, I guess, remind ourselves that as much as we know about the young person, we never sort of truly know, you know, their experiences and what they've been through. Even if they tell us quite a lot, there's always going to be things that we don't know. There might be things about, you know, ourselves as clinicians things that we're doing or saying that we're not paying attention to that can be triggering for the young person.
And it's all of the possibilities thinking, where can I do? Differently, what can I create in this moment that's actually going to be useful, helpful and critically say.
Chris McCurry: And to recognize that you're not going to do it perfectly. So whether [00:46:00] you're a clinician or you're a teacher or you're a parent and you, and you say something that's maybe not triggering, but just makes the person that you're talking with, you know, a little uncomfortable or a little tater. To be able to recognize that and do the repair work and say, oh, you know, I can tell from your face that there's something about what I just said that didn't go over so well.
Can you tell me more about that? And that's an opportunity to be. You know, what the analyst would say is, you know, you're a new object, you know, you're, you're responding person in a, in a way that they're not accustomed to. And it's like, this, this is interesting. This person's, you know, actually caring about me or showing some compassion and wanting this to work.
And hopefully. You know, maybe not the first time or the fifth time, but at some point they'll respond to that and start creating a new, new paradigm in their mind [00:47:00] for how interactions can work.
Carina Simmons: I think that's such a good point. And I also think, you know, the context of being in a major trauma center, it's incredibly busy and chaotic and noisy, and there's lots going on all of the time. There's never a moment where it's, it's quiet. And sometimes I suppose it can feel like there's a lot of pressure to get all of these strategies in an intervention and delivered really quickly.
But what I'm always encouraging my team to do is actually. You know, forget strategies for the minute, if they can focus on the relationship, building the rapport, building the trust, because without that relationship there, without that trust, it doesn't matter how many, you know, incredible strategies you've got, they might well fall on deaf ears.
And so really trying to build that proximity and that trust, that safe base within. You know, the room, even if it's only for one off meeting or a brief a session it doesn't matter how limited [00:48:00] it is, the time that you've got or the space that you've got. Or the privacy that you've got actually particularly if you're not in a side room, but you can always do something with that moment when the relationship and really prioritize that and make sure that the young person knows.
Thanks. That is top of the agenda.
Chris McCurry: So
parting thoughts,
parting words of wisdom we've, you know, it's, it seems like such A huge, complicated, and, and overwhelming issue. Though we have touched upon some things that we can do as individuals and as, you know, teachers or therapists or whatever, but any, any, any sort of summary thoughts, Carina,
Carina Simmons: I think from my perspective I'm a big fan of dialectics, things being opposing but true at the same time. And in the face of all of the hopelessness we might detect. There will always be hope somewhere. We've just got to find it [00:49:00] or be more creative with how we approach it. I think that there is always something you can do, no matter how small and you can make it meaningful for that person, no matter how old they are.
Good to
Emma Waddington: lovely that and I think what I'm taking away is thinking about my male clients, sort of at the other end you know, they may not have engaged in violence, but how hard they find it to talk to others. And I had a client tell me the other day that I'm the only person they speak to, and that's quite heartbreaking.
And I, I hear that quite regularly from my male clients. And so, you know, thinking about the community you work with, and stretching it further into adulthood, it's, it's, it's the same problem. That we find where our males our men in our society are feeling very lonely and unable to share and perhaps never.
Being able to share it's not that they're not able to [00:50:00] today. It's something that they haven't learned how to do. And one of the things my takeaways from today is our responsibility. I think as women too, to think about the men in our environment, the boys in our, in our world and how we support them to label their emotions, to feel safe, to want to connect, to believe that connections can happen.
Even when you're feeling really scared and upset. That you don't need anger to get your needs met. You don't have to be a Sigma. It's, I think it's really important as a community in our education system that we start sharing that message that we can, there is hope in every movement that we do as well, even when we're not working in the communities that you're working in we can spread the word.
Chris McCurry: Alright, let's go spread the word.
Emma Waddington: Well, thank you what beautiful work you [00:51:00] do.
inspiring. And I'm glad that there are people like you that are there to, to hold onto the hope and think about those little moments and to not lose sight of them.
Thank
Carina Simmons: you.
Such a pleasure.
