This is a case I am working on now. While some progress is evident in some
ways, the basic problem remains. I have seen the patient three times a week
during the summer with the hope that by the Fall, he would be free of the
problem. I would be interested in receiving some help from my PCT consultants,
the CSG-L group
Description of case: 9-year-old boy, only child in an intact family, shows
fear when parents leave him, bright, athletic, small for age, very serious,
reacts strongly to changes in schedule, attractive looking, this is an
"emmeshed" family, has difficulty getting asleep, doesn't have many friends,
parents think he has an attention/concentration problem, the parents report an
infancy and preshool period which was very difficult--he was very demanding of
attention and very intensely emotional, he has earned a black belt in karate at
the father's urging but has quit karate for now, he dwells on certain thoughts
and has a hard time letting go of them, there are conflicts with his
parents--he wants more freedom to do what he wants, mainly more TV time and
more video game time.
PCT approach: What is the experience which he wants help in learning how to
control better? He wants to not feel so uncomfortable when his parents leave
him. I have been able to determine that he does not want to see his parents
leave the room, with the emphasis on see. It is not comforting to him if his
parents are in the next room and they periodically speak to him. He thinks that
his parents will leave him, get in the car and he will never see them again.
So, what is the reference perception? He want to see his parents are there all
the time, close to him.
Why does he expect this? His parents act mad at him sometimes. He doesn't
think that he is worthwhile enough so that they would want to stay around him.
He doesn't feel well liked at school. Other kids act as they don't know who he
is after he has been in the same class for a year. He is not sure that his
parents love him.
He wants to see that they are there. He will take action if he sees them leave
such as block their pathway, sit in the car. His fear becomes strong and he
will do almost anything to stop them from leaving. They have not been able to
go to a movies or go out to it because of this.
As far as I know, there is no history of the parents actually leaving this
child. There is one instance of the mother being late to pick him up when he
was about five. This may be a significant event. There are two people he has
known who have died. This also may be significant.
There was an incident at my office in which his mother went into the bathroom
and he didn't see her when he looked. He was very upset after she came out of
the bathroom. Since that time, he has shortened the time he will tolerate
being away from her from 15 minutes to 5 minutes. I work with him in the
beginning of the session just the two of us, and when he asks, his parent joins.
The idea was to gradually lenghthen the time interval. Thirty minutes is the
longest so far.
Any suggestions, my consultants?
Thank you, in advance. The check is in the mail.
···
From: David Goldstein
Subject: a psychotherapy case
Date: 08/20/95, 12:23p