Re.: a psychotherapy case

First of all, thanks for your ideas/suggestions. This is a hard case.

There have been some developments:

        A behavioral contract, "Sacred Covenant" , failed to comfort
        the boy. The mother put in writing her promise not to do what
        the boy feared. Looking at the paper was not a comforting thing
        when he heard the downstairs door slam. He became very agitated
        and bolted downstairs. The mother'w written promise was not a
        substitute for seeing that the mother was still there.

        The mother has agreed to bombard him with hugs, kisses and " I
        love yous." She indicated that he had resisted these sort of efforts
in the past. When I told him that his mother needed
        to do these kinds of things for her, he agreed to cooperate. I
        was pleasantly surprised to see the mother start to do these
        things immediately in the session ...and he accepted them!.

        I referred the boy to a Child Psychiatrist associate of mine. I
        made the recommendation for a low dosage of liquid Prozac to
        address the obsessive thinking. When I saw the boy's inability
        to stop himself from dwelling on the scary thought, it
        persauded me that it was of obsessive proportions and he would
        need some help. The prescription was written today.

        In today's individual EEG Biofeedback session, the father was
        present. The father recognizes that he himself has a temper problem
and he wants to work on it. At the end of a session we talked about
one particular incident which happened this past
        Sunday. It was a good discussion, a good beginning.

Your comments were all on target. With reference to your specific posts:

        Bill Powers (950821.0840 MDT)--Yes, I am convinced that he
        considers abandonment as a real possibility. The kid does
        consider it to be a problem and wants to get over it. Yes,
        he does consider himself to be defective and inadequate. You
        will note that the hugs, kisses, etc., on the mother's part
        are designed to give him unasked for attention. The parent's
        recognize that they are somehow partly responsible for the child's
        problem and sincerely, want to learn how to do better.

        Avery Andrews (950823)--The boy finds it somewhat easier to
        leave his parents. He can be encouraged to take a bike ride
        over to a friend's house for a limited period of time. When
        a friend comes over, and he is involved in play, he allows the

        Rick Marken (950822.1100)--The goal of the program is to help
        the boy and his parents regain control of their life in certain
        ways at which time everyone will be satisfied enough and the
        need for services like mine will no longer be felt to be

        Hans Bloom (950823)--I think you will see that the movement
        in this case, which I reported in the beginning of my post, is
        directly related to the kinds of activities which you suggested.
        I am working on: parents showing that they love him, discussing
        conflict incidents and asking about interpretations and
        alternative ways of handling it which might have worked better,
        what they want and don't want from each other. It is a hard time
        for all the family members.

Among PCTers, the most controversal aspect of the case's development, I know,
will be in the recommendation for medication. However, all the therapists
involved in this case agree that we should try it. I have put off the use of
medication from the time I started this case in the beginning of the summer.
This boy's fears could easily develop into a severe case of school phobia. If
summer were a little longer, I probably would have waited to see if the other
developments in the case would have been enough.


From: David Goldstein
Date: 08/22/95, 11:10pm
Subject: Responses from Bill, Hans, Avery, Rick