Play Pride: Sexuality, Gender and Development

by Christine LaCerva

Mark Beauregard & Christine LaCerva

On May 17 the Social Therapy Group hosted a community dialogue on sexuality, gender and development as part of our new “Conversations with Practitioners” series. My guest at the event was Mark Beauregard, a creative arts and drama therapist who has done groundbreaking work using play and performance with his clients. I found our conversation, held in front of an audience of forty, to be extraordinary, and it was very moving to both of us. As therapists, we don’t often have the opportunity to create an open and exploratory dialogue with a community that is committed to creating a new, developmental psychology.

As therapists Mark and I are both madly in love with what we do, and our conversation helped us discover more about our work. We are both passionate advocates in our work with LGBTQ youth, and deeply committed to our patients’ democratic rights to grow and develop — sexually and otherwise. Neither of us make any claims of being neutral, and we both agree that this advocacy is central to growth — the patient’s and the therapist’s. We believe that people have the right to be who they are, as well as to become who they want to be. Our conversation went beyond the usual boundaries of child therapy as we explored our mutual passion for creating a place, an environment, for play and performance. We had a lot of stories to tell.

Mark talked about sessions in which he invites children to play and perform with cards that show archetypes, superheroes with a variety of characteristics. He told the story of a young boy who was struggling with his gender — can a boy wear pink and play with Tinkerbell? What happens if he does? The boy was experiencing disdain and dismay from both children and adults. Mark asked him to choose one of the archetype cards, and he picked the card that said “an ordinary person.” It was striking to me —both saddening and understandable — that a child who is having conflicts around gender has to deal with the limited societal choices prescribed by the gender-specified world we live in. It’s easy to imagine the pull for this child to want to perform as an “ordinary person,” someone who can make his own decisions and not be made to feel as if they are doing something wrong. The question this raises for me is: What is wrong with a culture that negates our capacity to play and perform new ways of being boys and girls (or men and women) together?

This “tyranny of the normal” teaches children very early that boys are not supposed to be into — among many other things — the color pink (yes, that is still going on!) and that girls must behave themselves — not be too loud, too aggressive, and definitely not be in charge. These are the rules and roles that are presented to our children every day. But how can we help young people who can’t, or won’t, or are just not interested in adapting to the existing culture? As therapists, I believe our job is to offer them something different, a new set of possibilities. In social therapy, our offer is the performance of being a “culture maker.”

In my work with families in social therapy, creating environments for this new performance is key. I want to share with you a transcript of this work in helping families learn how to play and perform together as culture makers.

Years ago, I worked with a five-year-old boy I will call Eddie. His parents brought him to social therapy because he was acting out in school and at home; for example, dressing up in a ballerina outfit (a pink one, of course), and prancing around when his sister’s friends came over. The family was horrified, and punished him and sent him to his room. Eddie’s sister wanted him banned from the apartment when her friends came by, and his parents — successful young professionals — told me they were frightened by what their son was doing.

First session

I met with Eddie and his family and I asked the family to share their concerns. They said they felt he was acting out to get attention. Eddie’s mother felt they had spoiled him; his father was worried that this was about Eddie’s sexuality. They said they came into therapy to get the opinion of an expert. I told them that my expertise was in helping families play together and break out of the ways they were performing their relationships that were preventing them from being close. Eddie seemed thrilled by what I was saying — he said he thought he was here because he was “doing bad things.” I asked him what the “bad things” were. He said it was when he wore the ballerina outfit. I smiled and said nothing. The conversation with the family continued for awhile, and Eddie started to seem bored.

Eddie:  What are we going to be doing here?
Christine:  We’re going to get to know each other.

Eddie jumped on my lap and began singing: “Getting to know you, getting to know all about you…” He knew all the lyrics. I invited his parents to sing with us, and we all sang the song together. We were doing a new performance of family, and it was very emotional for all of us. Eddie was delighted.

A few sessions later

Christine:  (To Eddie’s dad) What kind of help do you want?
Father:  I want to know if Eddie is gay.
Christine:  How would that be helpful to you?
Father:  I want to know if there is any way we can have an impact on him.
Christine:  How do you want to impact?
Father:  Do you think he is gay?
Christine:  I have no idea.
Father:  What’s with the ballerina outfit?
Christine:  If what you’re asking is “what is the meaning of all of this?” I think we have no idea. And I think that is, in fact, a good thing. I’m not interested in imposing any meaning or interpretation on you or your son. We can create something together without knowing very much about what anything means.
Mother:  I think my husband is saying he wants you to make sure that Eddie isn’t gay.

There was a silence.

Christine:  (To Eddie’s mother.) How do you feel about this?
Mother:  I want to be close to my son, whatever he decides to do with his sexuality.
Father:  Okay — now I’m being portrayed as the bad guy. I just don’t want Eddie going out to the ice cream store in his ballerina outfit.
Christine:  How come? What’s the problem?
Father:  He’s being ridiculed. People are snickering as we pass by, laughing at him.
Christine:  I hear you. That sounds hard. I do have a question for you, though. Do you want to be close to your son?
Father:  (Angry) Why are you asking that? Isn’t clear that I love him?
Christine:  I think it’s important to work on how you perform your love for him. Do you want to love him from a distance. or from up close. This is a complex issue for your whole family. If you want to be close to him, then — given who Eddie and you are right now — it’s possible that some new performances are needed.
Father:  (Exasperated.) Uh-huh. Okay, so what do you suggest?
Christine:  Let’s do some exploring right here. If you’re worried about people making fun of Eddie, maybe you could join him.
Father:  Join him? What do you mean?
Christine:  Well, maybe to be closer to Eddie, you could play with him, play with what he’s doing. This has nothing to do with Eddie being gay or not — I have no idea what will come from this. We’re playing around with what matters to Eddie right now.
Father:  How?
Christine:  Well, you could dress up in your wife’s clothes, Eddie could wear his sister’s ballerina outfit and you could go get ice cream together. That’s one way to play that might help you get closer. Your problem would vanish! You wouldn’t need to worry about Eddie in this scenario.

A long silence.

Father:  (Quietly.) What would I wear?

We all started laughing.

Mother:  You could wear my bathrobe and fuzzy slippers.
Eddie:  Yeah, you could wear her pink robe!

We all sat there and let ourselves experience the power of creating a new performance of love and intimacy in family life.

A few days after the session, Eddie and his father went for ice cream dressed in their respective outfits.

They told me about this in the next session, and I became emotional. Eddie asked me what was wrong. I told him nothing was wrong, that I was very proud of him and his dad because they were working hard to be close and show how much they loved each other. Eddie got out of his seat and gave his dad a hug.

My work with Eddie and his family was completed near Eddie’s fifteen birthday. He told me he was ready to leave therapy. He had done a great deal of work on what kind of young man he wanted to be. There had been — and would be — struggles, for sure. He was continuing to explore his sexuality. And he was just fine.

I would love to hear what you think about play and performance and their role in sexuality, gender and development. Please leave a comment!

Is That Gay?

Gay Pride month is in full swing, and its celebration of diversity and creativity in how we perform gender has gotten me thinking about the ways our lives can be shaped by the roles and rules we’re taught for how to be women or men — and it starts when we’re very young. How do we help our children deal with these issues? The exploration of the conventional and cultural expectations of young boys, in particular, is an ongoing dialogue in the field of psychology.

One of the important voices in the field is the very talented child psychologist Dr. Tony Rao. He and I spoke about many of these issues in a public dialogue at the East Side Institute a couple of years ago. His book, The Way of Boys: Raising Healthy Boys in a Challenging and Complex World, gives wonderful support to parents, teachers (and clinicians) who want to create environments that allow boys to be who and how they are, without turning their every hyperactive move into a pathology. (On June 29,  the Institute will show a video of that discussion as part of a webinar entitled “Breakthroughs in Child Psychology.” If you’re interested in participating, you can contact mfridley@eastsideinstitute.org. And you can have a look at the video here: http://vimeo.com/18562495.

Another seminal voice in this area is Dr. William Pollack, the Harvard Medical School researcher who for over two decades has studied the emotional turmoil — the confusion, the loneliness and sadness — that boys can experience. This work is documented in his book Real Boys: Rescuing Our Sons from the Myths of Boyhood, which focuses on how to help boys develop more confidence by challenging expectations of masculinity. Do read it.

As a social therapist, my contribution to this dialogue has emerged from our multi-family groups, in one of which I work with five nine- and ten-year-old boys. Along with their families, we’re exploring how to deal with the ways they feel unsure, conflicted and perplexed about how to be a boy. They often feel enormous pressure and a deep need to turn off their emotionality, toughen up, to act like things don’t bother them, and never express their caring for each other. And at all costs resist having a play date with a girl! (What would the other boys think?) These cultural standards of maleness are the price of acceptance by other kids (and sometimes even their parents).

I have been working with these five boys for over two years. In their school settings the boys find social relationship to be quite challenging. Some have diagnoses, some don’t. They’re quite different from one another, but are all energetic, creative and playful. One boy, Tom, has a particularly difficult time joining the group conversations and performances. He often likes to play with a small set of toys I keep on my desk — puppets, miniature paintings, plastic animals — and once in awhile he’ll join our group activities. We love him and the boys are kind to him — they always invite him in, and accept his difficulties.

One afternoon, in a children-only session, I introduced the idea that we were going to play with how we talk to each other. One child asked if there were any rules. I said yes, the rule is that we are not allowed to make any sense at all.

They became very animated and excited, and began running around the room. One boy asked if I was included in that rule. I said that indeed I was, but now we were breaking the rule — we were making sense! “Oh, no,” he said, and then ran away, laughing. Along with my steadfast co-therapist, Lew Steinhardt, I ran around the room with them.

We began a series of games — speaking nonsense and gibberish, using words “incorrectly.” It was silly. The children were incredibly joyful. I felt joyful with them, and laughed through most of the session. The children created movement, ran all around, and rolled on the floor as they played with the activity of communicating in a new way. We thoroughly enjoyed doing this together. How interesting, I thought. I had not seen them so joyful and so much of a group in awhile, if ever. As we played, we were making up new ways to be together, which were not coherent with the rules and roles for children and adults. The boys became very affectionate with each other. I had not seen them do this so openly before.

Near the end of the session I asked them how the group was doing. They became very sheepish and put their heads down. I was perplexed, and asked them what was going on. One boy, Michael, said it was embarrassing. I asked him what was embarrassing. No answer. Then Michael said the group felt close today. “Close. Yes,” I agreed. Then I decided to push this issue even further.

“I would even say that you really love each other,” I said. They were silent.

Tom, the ten-year-old who has difficulty being a part of the group, said, “Yuck that’s gay.”

Another boy asked, “Is that gay?

I thought about how I wanted to answer. What would be most valuable for them, given the struggles they have with their emotionality ?

I said, “Yes. It is gay to love whomever you want to.”

Tom said, “Gay is disgusting.” The other boys said nothing, and the session ended.

The following week, Tom spoke first, and said, “Christine, I have something to tell you.”

“Great,” I replied. “Tell all of us.”

He said, “I am now in a gay relationship.”

“Really?” I said. I noticed that the boys didn’t giggle. They were curious about what Tom was saying.

Michael asked, “Who are you in a relationship with?”

“Pikachu,” he answered. (For the uninitiated, Pikachu is a well-known character in the world of Pokémon.)

“Congratulations!” I said. “I’m happy for you. What do you love about Pikachu?”

“He’s yellow,” Tom said. Everyone laughed.

“I get it,” I said. “I think I get it. I love yellow, too.” Everyone laughed again.

Another boy in the group calmly said, “You can’t be in love with a fictional character.”

Tom asked me, “What do you think about this?” I assured him that a lot of people are in love with fictional characters. Lew and I laughed.

Tom asked again, “So Christine, how do you feel about this?” I said that I was very happy for him and Pikachu. The boys smiled and nodded. They nonchalantly began to play some floor games. Tom joined them for the remainder of the group play.

I would love to hear what you think about all this. I find these conversations to be quite a provocation, and I think they were wonderfully helpful to the boys and their families. Leave a comment and let me know your thoughts!

Autism in the World

By Christine LaCerva

April is Autism Awareness month. I do a great deal of work with autistic children and those on the spectrum, so I’m all for it. But I think there’s something missing in the Autism Awareness media flurry.

Here’s some of what we’re being made aware of: diagnoses of autism have nearly doubled since 2007 (New York Times); autism is more prevalent in boys than girls (Huffington Post); and along with the usual understanding that autism is characterized by a lack of communication and difficulty being empathetic, there is now a widespread belief that autistic children lack a “theory of mind” (that is, a conceptual understanding that other people have a mind [Asperger Syndrome and Psychotherapy, P Jacobsen 2005]).

As a social therapist, what’s on my mind is the language being used in so much of this discussion. It’s the language of deficiency, of limitations, and of what’s missing. The limitations are categorized as intellectual, perceptual, and linguistic. The scientific communities of neuropsychology and psychology are involved in research on autism’s organic deficits. Remediation is the only possibility; nowhere in any of this discussion is the notion that people with autism can grow.

In Kiefer Sutherland’s new TV series, Touch, the central character is a young autistic boy. He does not speak and will not allow himself to be touched. But he’s a mathematical genius who mysteriously organizes good deeds, bringing people together to ease their pain and change their lives. The show is sweet and touching — and I would think heartbreaking and probably insulting for parents whose autistic children are unable to be benevolent or mathematical wizards. It seems to me that the ways in which autism is portrayed — either as profound organic deficiency or as a reification of the specialness of the autistic child — are equally problematic, and in my opinion inhumane.

Many years ago I worked with a young autistic boy. He was neither a genius nor was he unable to grow. I was not interested in remediating him — traditional approaches of remediation had failed. My work with him had nothing to do with trying to teach him something he didn’t know how to do, but was based on awareness — the awareness of two human beings working side by side and building something together. Awareness was the activity we did together. I allowed the space and time for our relationship to grow. I was uncertain of how to proceed. I  made decisions to create an environment that was unlike anything the boy and I had ever experienced. I learned a great deal from that work, and I’d like to know what you think about it.

I am happy to introduce you to Matthew, who taught me about awareness and watchfulness and development. I have changed the names of this client and other factual information to protect his privacy.

Matthew, age 6, came into social therapy with his mother. He did not speak, and rarely, if ever, made eye contact. His family had a painful and disappointing history of trying many, many therapies to no avail. His mother wanted him to be able to communicate verbally but he had never done so.

In our first few sessions, Matthew mostly liked to look out the window of our 14th-floor Manhattan office. I allowed him to stand on a chair and do that.

One day I brought in paper and crayons and we drew and colored pictures on the floor. I sat on one side and let Matthew figure out for himself where he wanted to sit or lie down. He went as far away from me as he could get while still staying in the room. He often went under the chairs of the therapy office with his crayons. I offered him no direction.

His mother was quite concerned that I was not demanding that Matthew make eye contact with me. Most therapeutic approaches to autism insist that children make eye contact, on the understanding that looking at someone eventually becomes part of social development. Most autistic children I know hate doing it. Some have told me it physically hurts them to do so.

Matthew’s mother explained to me that she had been taught to cue him by pointing to her eyes and then to his and saying “Look at me.”

I told her I understood why she wanted me to do that, but I was not going to. I did not want to use the tools that Matthew knew from his previous therapies — they hadn’t helped him. I wanted to create a kind of relationship with Matthew that he had never had before — I didn’t want to teach him anything. I wanted to be with him in a new way; to create a new, relational, “form of life” with him. As you can imagine, this was quite challenging for Matthew’s mom. I asked for her support, even though I knew it was extremely difficult for her. With great reservations, she gave it.

For the next six months, Matthew and I had our sessions lying on the floor. I would draw for half an hour and he did, too. He stayed far away from me, and I felt no need to change that. I would talk out loud about what I was drawing, what I had for breakfast, where I was going after work today. I made sure not to look at him since he found it so uncomfortable.

Matthew seemed to be developing an awareness of what I was doing. I could tell he was aware of my talking, since he would pause when I began my chat. One day I talked about the house I was drawing and the little dog that I wanted in my picture. At the end of the session I helped Matthew get up off the floor and noticed that for the first time he had incorporated what I had been talking about in his drawing. I thanked him for doing that. I told him that I thought it was really giving.

One afternoon, Matthew and I were doing our thing. He was drawing, and I was talking and drawing — and he began to talk. He said, “I am drawing a cat. The cat is going for a walk. I think I’ll go with it.” I froze with surprise. Not only had Matthew not spoken before — his family (and doctors) did not know whether he had expressive language at all.

Our sessions continued, and Matthew continued to talk. A few sessions later, he came over to my drawing and made a stick figure of a boy. I thanked him — and we made eye contact for the first time. Our eye contact continued as our sessions — transforming now — went on.

Was this magic? Well, there were no rabbits, no hats, and I didn’t wave a wand. But yes, it is a kind of magic — the magic of human beings creating a relationship that’s not governed by rules and roles; of a revolutionary reorganization of how the adult/child relationship lives and breathes. Magic, for sure.

Social therapy works to explore, to investigate, to play, to enhance the socialness of what it means to be a human being. It is unscientific, fundamentally creative and not knowing. It is full of the awareness of the complexities of a human being’s social-relational capacities. The success of this work with Matthew comes from this awareness — not of autism, but of relationality, of the human capacity for growth.

My sessions with Matthew were a search for method — not knowing how to proceed and doing so anyway allowed something new to emerge. What was it? An awareness, a non-imposed awareness of the other. And by participating in creating it, Matthew was able to develop. He is still autistic, but now he can speak. He can be with people, he can participate in social relationships, and he can be in the world.

Growing is for Parents, Too

by Christine LaCerva

Christine LaCerva

Over the past few months, I’ve introduced you to my multi-family group, and you’ve met some of the children and their parents. Every four weeks, I have a session with the parents only, to give them an opportunity to talk about how they are doing in their lives as adults. Here’s a glimpse into our last parent group.

Joan started the session by talking about our relationship, which we have worked very hard together to build. “I just want to say that I understand better now why we do the group with both parents and kids,” she began. “As you know, I always felt that when you lead the group with only the children it’s better. But maybe what I really thought was that it’s better for me to have time away from my daughter — a break — an hour without having to deal with all of it. That it’s better for both us to have some time away.”

Joan continued. “I didn’t in the beginning, but I trust you more now. You’re honest with us and the kids. That was hard for me — I really hated the time you said my daughter was spoiled. I mean she is, but she couldn’t handle hearing it.” She paused. “Maybe I couldn’t handle it.”

Adoption Day

By Christine LaCerva

In my last post, I introduced you to Josh, a ten-year-old patient in my multi-family group, and shared some moments from our first session, with his mom. Here’s a scene from a session with the whole group.

Elena, Josh’s mom, was very agitated, and was the first to speak: “I can’t stand it another minute — it’s him or me,” she said. “I can’t bear him. He’s so difficult. He won’t listen to anything. I just wanted to kill him last week. We bought him a neurofeedback machine to help him focus and he got frustrated and broke the damn thing. I screamed at him for hours on end. I just can’t do this anymore. I need a different life — one without Josh.”

Other parents sympathized. “Oh, I know how you feel — I feel that way sometimes. It’s so frustrating. Don’t feel bad about it.”

Elena began to cry. “You don’t understand. I’m serious.”

The Land of Spoiled Boys

by Christine LaCerva

I want to introduce you to “Josh,” a ten-year-old boy I’ve been working with in my multi–family group. The group currently has five families — five mothers and five kids aged 9-13. Josh has been diagnosed on the autism spectrum, and goes to a special education school in New York City.

Josh and his mom (I’ll call her “Elena”) started therapy last spring, and I met with her first to learn about him, their family and what they want help with. Elena was attracted to the idea that Josh would be working in a multi-family therapy group. Like many parents, she can feel overwhelmed by raising a special needs child.

Next, Josh and Elena came in for an intake session. They took seats in the therapy room, and I asked how I could help.

The Hamburger Syndrome

Dr. Anthony Rao

by Christine LaCerva

(Click here to access this article in Chinese.)

A few weeks ago, I participated in a fascinating panel discussion in midtown Manhattan called “Breakthroughs in Child Psychology.” Joining me was child psychologist Anthony Rao, Ph.D. and Lois Holzman, Ph.D., director of the East Side Institute for Group and Short-Term Psychotherapy, who interviewed both of us on how we work with children and families.

Dr. Rao is a cognitive behavioral therapist who works with young boys experiencing learning and emotional problems. He is a strong challenger of traditional approaches in the field, as am I. Although our approaches are quite different, we share a humanistic outlook and a belief in the innate capacity of children to develop if put in environments (in this case therapeutic) that are nurturing, loving and challenging – without first resorting to medication.  Dr. Rao has just published an excellent book about his work with boys, entitled The Way of Boys: Raising Healthy Boys in a Challenging and Complex World. It’s a great read by a caring (and daring) clinician, one that I can’t recommend highly enough to parents and colleagues alike.