Thanks to Bill, Mary and Martin who responded to one aspect of the
developments in the case, the use of the drug Prosac, 5 mg. liquid per
day.
What do I want from the use of the drug? There is some evidence that
it helps a person with obsessive thinking to let go of a thought easier,
sometimes. I concluded that this boy gets the thought that: My parents will be
leaving me if I don't carefully watch them and if I am not prepared to do
something to stop them.
This thought is accepted as a fact by him. I have not found a way to
unconvince him of this fact. A verbal promise by his parents didn't work. A
written promise by the parents didn't work. There is no prior history
of his parent's leaving him. Remember, this boy is only 9 years old.
The mother came across to me as somewhat cold and not expressing very much
affection towards this boy. So, I started the hugs, kisses and " I love you "
program by the mother. The boy tells me she is doing it, maybe too much now.
The father reports that the mother is " exhausted " by the problem.
The father came across to me as too involved with the boy and too angry in his
displays sometimes. That is why I suggested that the father work on anger
issues individually.
If the boy can let go of the fear producing thought even a little bit, maybe
other thoughts might be able to come to awareness such as: My parent's wouldn't
do this; I am a kid worth keeping; I have recently handled a situation in
which I was separated from my parents by accident--I called 911. My parents
called 911. We were back together in no time.
What is the PCT approach for handling obsessive thinking? Throw awareness on
the control system involved and hope that reorganization takes place. Raise
awareness to a higher level and hope that reorganization takes place. This is
hard to do with an adult, never mind a 9 year old boy.
The nondrug approaches may have worked in the long run by themselves. I will
continue to use them. I was sensing a wearing down of the parents,
the boy and the rate of progress was too slow for them. I delayed the
introduction of the drug as long as I thought I could. I could have gone on
much longer, but I don't think that they could have. Even if it does nothing,
the idea that " We are trying everything which we know might work " may be
important to the parents. It is unlikely that 5 mg of Prosac is going to do
anything terrible but I will monitor for side effects as well as to see if it
modulates the obsessive thinking. By the way, I do not only mean for the scary
thought.
In many difficult conditions, for example, major depression and schizophrenia,
the combination of drugs and psychotherapy is thought to
be more effective than either alone. Why might this be the case? How would we
explain it in terms of HPCT? Some of the ideas that Martin was presenting may
be part of the answer.
Mary's idea of going slowly when withdrawing the drug is very interesting. The
drug is often as thought of as normalizing the biochemical state. It is making
up for a deficit of some chemical. A person may have to take the drug for life,
as in the case of Insulin. The only way to find out is withdrawal after a
period of time. If the symptoms return after being drug free, the drug will
probably be reintroduced.
···
From: David Goldstein
Subject: Re.: a Psychotherpay case--use of drugs
Date: 08/25/95, 11:15pm