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		A New Approach to Aggression, Violent and Destructive Behaviour in Children, Young People and Young Adults Information for General Practitioners What is Non Violent Resistance? NVR is a new therapeutic brief intervention that has been developed within Family/Systemic Therapy to address conduct problems in young people. It utilises strategies that were originally developed by Mahatma Ghandi’s and Martin Luther King’s political movements, to effectively bring about change within the family. How is NVR implemented? Parents and adult helpers of the family are coached in weekly therapy sessions, over a period of up to three months, in resisting the controlling behaviour of the aggressive or violent young person. It is not necessary for the young person to attend him- or herself. As a matter of fact, by requiring parents to motivate their child to attend therapy sessions, they would be subjected even further to being controlled by the young person. By being able to attend independently, parents are already empowered to take first steps without being dependent on their child. In addition to weekly therapy sessions, which at some point may also encompass siblings of the aggressive young person, parents may receive up to two telephone support calls per week, lasting approx. 20 minutes each. Which factors does NVR address? De-escalation: Parents of violent young people generally oscillate between escalating with their child in a futile attempt to reassert their parental control, and then receding from the onslaught of the child’s aggression, feeling helpless, hopeless, and again giving in to the young person’s demands. This process merely reinforces the young person’s propensity for aggression: they take the parent’s anger as justification for their own violent behaviour, and learn that they can control their parents, both by being able to ‘push their buttons’, and to see them eventually give in. In Non Violent Resistance, parents learn to avoid any escalation subsequent to incidents of problem behaviour, and merely manage risk in the immediate situation. They do this knowing that they will be able to take strategically well planned and supported non-violent action at a later time. De-escalation prevents unproductive conflict and unnecessary defeat, whilst reducing overall anger levels in the family. Parental Disobedience: Parents of aggressive, controlling children or adolescents acquiesce more and more to their offspring’s demands. This creates a social environment, in which the young person is rewarded for their anger and aggression, so that aggressive responses become habitual. Parents are initially unaware of the extent of their acquiescence, which is therefore called ‘automatic obedience’. They decide, which of the many ‘taboos’ to ‘break’, such as no longer giving their adolescent child money on demand. In this manner, parents remove the reward for anger and aggression from their interaction with the young person. Of course, parents are initially fearful of this, and it is one of the objectives of the therapeutic process for them to develop greater confidence. Raising Parental Presence: A substantive body of research has linked violent behaviour in young people to a reduction in parental presence. Parental presence does not refer to physical presence alone, but the actual ability of parents to bring their authority as well as their attachment to their child’s mind. Low parental presence is e.g. demonstrated, when parents describe themselves as ‘walking on eggshells’ and losing ‘territory’ in the home, or e.g. in older children or adolescents, when parents become unaware of their child’s whereabouts, do not know who their child’s friends are, etc. Low parental presence can initially develop for a number of reasons, some of which may be depression in parents, divorce or separation, a history of domestic violence against a parent, which has left them frightened of anger in their child – however, whatever may precipitate it, the actual violent or aggressive behaviour will tend to lower parental presence even further, by creating ‘automatic obedience’. NVR raises parental presence by training parents to take deferred action against any form of violence from their child. In the process, they gradually overcome their initial sense of helplessness, whilst increasing their offspring’s awareness of their parental authority. These acts of resistance rely on help from an ever growing support network around the family. Therapy sessions directly address the issue of overcoming the isolation of the family (or the isolation that has developed in regard to the problem), and helpers are invited into sessions, in order to develop the forms of support they can provide, ranging from logistic support for the parents – such as looking after the younger children, while parents stage carefully planned demonstrative acts of resistance - , sending the young person messages indicating their awareness of a recent violent act, being a witness to aggression in the parental home, to acting as mediators between parent and child. Parents also learn to raise their presence with reconciliation gestures, which express unconditional positive regard for their child. What is the evidence base for this kind of work? There is already a substantial and growing body of research evidence supporting the efficacy of family/systemic therapy for a wide range of problems in children and young people, including conduct problems. More specifically, different aspects of NVR, such as reduction in parental helplessness, or effects of the intervention on siblings, have been researched over the past 12 years in conjunction with various projects at the University of Tel Aviv. A recent controlled outcome study for 5-session NVR shows significant improvement in child behaviour, but also on parental parameters such as reduction in parental helplessness, improvement in parents’ mental health, and increase in social support. The study further shows retention of treatment effects at follow-up. The improvement in parents’ mental health is an important effect, as many parents of violent children present with depression or symptoms of post-traumatic stress. Improvement in parents’ mental health also predicts better retention of therapeutic improvement in their children. What other disorders can be treated with NVR? A variety of difficulties are maintained when a person exerts control over their family. E.g., young people with OCD type behaviour will often exert control over their parents and siblings, in order to be able to behave compulsively. These young people also tend to require a variety of behaviours from others in the family as part of their own compulsive pattern. Controlling behaviours then maintain the problematic behaviour. Many young people with anxiety related difficulties develop controlling behaviours, in order to avoid being exposed to anxiety-provoking triggers in their environment. When this occurs in cases of generalised anxiety disorder, phobias, or self-immurement, NVR is very useful in breaking down the barriers to treatment. Often, further individual therapy is no longer required, once the controlling behaviour patterns have been reduced. In other cases, young people become ‘customers’ for therapy and develop motivation to engage in such interventions as Family Therapy or CBT. A modified form of NVR is used for ongoing domestic violence, or when survivors have separated, but still feel controlled by the perpetrator and may be suffering from depression or posttraumatic stress. Who can provide NVR? NVR can be provided by Family Therapists, Clinical Psychologists, or other mental health professionals who have been trained in the use of this intervention. The approach, which has been developed over the past 12 years in Israel, is now being widely used in Germany and some other European countries. We are now training professionals to use the intervention in the UK. To make a referral, please contact us.

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