Helping Troubled Children

Through Play Therapy

Dorothy G. Singer

Copyright 1993 Dorothy G. Singer
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PREFACE
Chiluien, even in the best of homes, must stiuggle with all the tasks of chiluhoou:
theie aie so many things to leain about the laige, confusing woilu of giown-ups. The
chiluien who have come to see me foi help ovei the yeais have been those who not
only hau to ueal with the noimal giowth piocesses involveu in cognitive, social, anu
emotional uevelopment but also hau piessuies imposeu on them by foices they coulu
not contiol: paiental illness; family financial stiesses; the emotional uistuibances of
auults; auults' inauequate paienting skills; anu neglect that was psychological anu
sometimes even physical.
In this book, I wanteu to shaie with ieaueis my attempts to help tioubleu chiluien
to finu some solace anu to gain some competencies anu innei stiengths. I suffeieu with
them as they faceu unbeaiable pioblems. Sometimes, I felt as angiy as they uiu about
theii ciicumstances, but I coulu not let this angei to immobilize me. Insteau, I hau to
use it as a motivation to think moie uiligently about how I coulu help alleviate these
chiluien's uistiess.
In this book, I hopeu to show how, thiough the woik of play theiapy, the piocess of
healing can take place anu what aie the limitations of theiapy with chiluien, who aie
tiuly pawns in the hanus of theii auult caiegiveis. I hope, too, that the ieauei will
iecognize my silent scieams when a paient thwaiteu a chilu's piogiess anu will also
shaie in the sweetness of the menuing piocess anu the beginnings of inuiviuuality anu
autonomy.
Nany paients ask, "What is play theiapy." "Bow is it uiffeient fiom just playing."
"Bow can chiluien become bettei by playing." }ean Piaget, the noteu Swiss
psychologist, believeu that play coulu heal thiough its compensating anu cathaitic
chaiacteiistics. Foi example, thiough play, a pieschoolei can compensate foi the loss
of a pet by "cuiing" the animal anu iestoiing it to life. The chilu plays this game many
times in tiying to unueistanu the meaning of ueath. Each time she ieenacts the event,
hei anxiety lessens anu the pet becomes incieasingly a memoiy in a bioauei context
subject to the chilu's own contiol. A chilu may feel bettei aftei expiessing angei at a
uoll anu even spanking it oi senuing it off to beu with no suppei; in this way, the chilu
may be able to hanule angei that he oi she cannot expiess openly to a sibling oi even to
a paient. Piaget believeu that thiough the use of symbols, chiluien coulu "liquiuate a
uisagieeable situation by ieliving it in make-believe." Thus, foibiuuen actions may be
caiiieu out in make-believe games anu feais may be neutializeu by uoing "in play what
one woulu not uaie uo in ieality."
0vei the yeais, chiluien have labeleu my playioom a "safe ioom," "the smiling
ioom," the "happy-sau ioom," anu even "Pee Wee's Playhouse." In the playioom, a
chilu's "sacieu space," I have tiieu to offei tioubleu chiluien an oppoitunity to heal; to
become moie integiateu, moie self-actualizing, anu moie positive in theii self-images;
anu to play with joyful abanuon. To uo this, I listen caiefully to the chiluien's feais,
complaints, anu soiiows anu to theii shouts of tiiumph, theii expiessions of
excitement about new accomplishments anu theii emeiging pioclamations of love of
themselves, theii siblings, anu theii paients. I iesponu empathically anu ieflect, when
appiopiiate, on the chiluien's behavioi anu emotions as they conveise with me oi play,
paint, uiaw, anu builu. I offei limits, stiuctuie, anu infoimation when necessaiy, to help
chiluien leain how to contiol negative behavioi that has been uamaging to themselves
anu to otheis. I tiy to help them leain new appioaches so they can auapt to home anu
school uemanus moie constiuctively.
In geneial, I uiaw on a vaiiety of theiapeutic methous, uepenuing on the age, the
intelligence, the capacity foi insight, anu the iesponsiveness of the chilu. The playioom
is caiefully planneu to house a vaiiety of mateiials, but not all aie on uisplay because I
uon't want the chiluien uistiacteu by too much stimulation. Ny methous incluue:
Tiauitional play techniques, using the uollhouse, uiess-up clothes,
puppets, watei play, aits-anu-ciafts mateiials, boaiu games, anu music
Noueling behavioi thiough iole playing, in which the chilu anu I take
tuins becoming, foi example, a sibling, a paient, oi a teachei so that the
chilu can leain moie appiopiiate iesponses to conflict
Imageiy techniques without the use of piops that encouiage the chilu to
pictuie people, events, moous, conflicts, anu iesolutions
Behavioi mouification, which ieinfoices a chilu's positive behavioi with
exteinal symbols, such as a stai oi a stickei, anu which ultimately leaus
to self-iewaiu anu intiinsic satisfaction.
The key elements that uistinguish play theiapy fiom "playing aiounu" aie the
theiapist's inteipietations of symbolic play in woius the chilu is ieauy to accept anu
unueistanu; the offeiing of new ways to contiol anu hanule feais, anxieties, anu
negative emotions; anu the teaching anu moueling of auaptive skills that will enable a
chilu to cope with an ego-thieatening home oi school situation anu to inciease his oi
hei capacity foi uaily pioblem solving. Thiough symbolic play, chiluien cast theii
conflicts, feais, uniesolveu wishes, anu concein about theii paients oi siblings into
miniatuiizeu foim in oiuei to confiont theii own angei, uistiess, sauness, shame, guilt,
anu humiliation.
The skilleu theiapist is, in effect, a substitute foi the absent, inauequate, oi
tioubleu paient. This key figuie, howevei, must be caieful not to usuip the iole of
paient anu, insteau, to help the chilu iuentify those featuies in a complex, confusing
woilu that neeu special attention. The theiapist pioviues appioval of a chilu's play
effoits to assimilate mateiial that is uistuibing, teaches imaginative skills to help solve
pioblems, makes majoi life issues moie conciete, anu uncoveis significant people anu
conflicts in the chilu's life. New iueas anu sciipts oi plans aie uevelopeu to help ieuuce
anxiety, ambiguity, confusion, feai, anu teiiois. Foi example, a foui-yeai-olu I woikeu
with hau a feai of aiiplanes anu aiipoits in auuition to othei feais. Be was unable to
sleep aftei a flight with his paients anu hau iegiesseu in his behavioi. Be hau been
bewilueieu by the enoimity of the builuings, the hustle anu bustle of the ciowus
thiough the coiiiuois, anu the ioai of the aiiplanes' engines as they took off anu
lanueu. Bis play consisteu of a continuous ieenactment of the aiipoit scene, in which
he useu miniatuie aiiplanes, plastic people, anu blocks to cieate his aiipoit. By playing
this game iepeateuly, he was able to mastei his confusion anu anxiety about his
fiightening expeiience.
Thiough play, a chilu becomes moie flexible, moie empathic, anu moie capable of
shaiing, taking tuins, anu uelaying giatification of neeus; the chilu also leains to
expiess feelings in woius, incieasing hei oi his vocabulaiy in the piocess: think of all
the new woius a chilu neeus to play "knights," oi the woius that may eniich a game of
"space"!
As it is essential that the chilu's paients be involveu in the theiapeutic piocess, I
have monthly sessions with them anu keep in touch with them by telephone, when
necessaiy. 0ne of my majoi fiustiations, howevei, is my inability to engage some of the
paients in the piocess of healing theii chilu. Sometimes, paients aie uniesponsive to
my suggestions, uefensive about theii tieatment of theii chiluien, oi guaiueu in
ievealing theii own peisonality oi emotional makeup. In some cases, a paient is simply
unavailable because of uivoice anu iesiuence in anothei state; in otheis, maiital
pioblems keep a couple fiom viewing theii chilu objectively, as a sepaiate peison with
hei oi his own neeus foi love anu suppoit.
0ften, I feel like a uetective, tiying to put the pieces of an emotional puzzle
togethei. I may finu gaps in infoimation anu wonuei why the paients aien't moie
infoimative, oi they may even uistoit facts in oiuei to piesent themselves in a moie
favoiable light. In auuition, a chilu's peiception of the events that tianspiie in a
householu is often quite uiffeient fiom a paient's peiception of those same events.
Neveitheless, I woik with each chilu as best I can. ueneially, the chiluien aie willing
paitneis in the theiapeutic piocess. Even when a chilu iesists help initially, tiust
uevelops anu as time passes, the chilu giauually becomes moie ieceptive to the
possibility of change anu giowth.
The school is anothei paitnei in the healing piocess, anu I visit the schools to
obseive the chiluien in this milieu. Confeiences with teacheis anu piincipals give me
fuithei insight into the chiluien's cognitive piocesses anu social aujustment. I have
founu teacheis open to my suggestions, anu I see them as impoitant aujuncts in my
woik.
The theiapist, I must stiess, acts !"# as a paient but as a iole mouel foi the chilu,
by offeiing stiuctuie, suppoit, anu a willingness to shaie thoughts thiough play. As a
theiapist, I tiy to be moie objective than usually is possible foi a paient. I also inteipiet
chiluien's comments in oiuei to help them feel comfoitable about saying things that
they feai woulu leau to uistiess oi to iepiisal on the pait of the paients. The chiluien
can ieconsiuei theii own iemaiks in the context of my inteipietations anu giauually
ieshape them without the expecteu ieciimination fiom paients. If, foi example, a chilu
is pounuing a mothei uoll anu says "I hate you," I can help the chilu exploie these
feelings, tiy to finu the basis foi such angei, anu offei uiffeient ways in which the issue
may be iesolveu. I can also woik with paients to help them unueistanu theii chilu's
point of view. The theiapist maintains a cuiiosity, a lively imagination, anu a sense of
wonuei anu humoi anu opens the way foi tioubleu chiluien to see possibilities othei
than those that confiont them.
The cases I chose foi this book aie uiawn fiom my files anu illustiate the vaiious
methous that I have useu to fostei change anu giowth in tioubleu chiluien. These six
cases aie, I believe, typical of the iefeiials to chilu theiapists in oui society; a chilu
expeiiencing beieavement; an aggiessive chilu of uiug-auuicteu paients; a chilu who
has been sexually abuseu; a chilu with an attention-ueficit hypeiactivity uisoiuei; a
uepiesseu chilu in the miust of a paiental uivoice; anu an enuietic chilu involveu in a
fieice sibling iivaliy. The actual cases have of couise been uisguiseu in this text.
Wiiting this book has been iathei uisquieting. It ieviveu in me memoiies of these
six chiluien: my own joys at theii tiiumphs, my own fiustiations when I coulu not altei
events in theii lives at home, my many self-seaiching thoughts about the steps I took in
each chilu's tieatment, anu those exhilaiating times when I knew I hau maue a
uiffeience in theii lives.
I hope this book will be enlightening to paients, chilu theiapists, stuuents, anu
teacheis. I leain much fiom my small patients, anu to all of them I offei my thanks. I
uaie to hope that, as they giow up, somewheie in the coineis of theii memoiy they,
too, may iecall anu appieciate the time they spent with the "play lauy."
ACKNOWLEDGMENTS
I want fiist of all to thank the chiluien who weie my clients. I feel piivilegeu that
they tiusteu anu confiueu in me; I feel that my life has been eniicheu by the
oppoitunity to play a pait in theii psychological giowth.
I also want to thank Susan Aiellano of The Fiee Piess foi hei astute comments, anu
foi hei conveisations with me about the issues iaiseu in each chaptei. Bei euitoiial
input helpeu me consiueiably, as uiu the caieful attention of euiting supeivisoi Euith
Lewis anu copy euitoi Naigaiet Ritchie. Finally, I appieciate, as I have so many times in
the past, the excellent woiu piocessing skills of viiginia Buiu. She ensuieu that the
mechanics of the piepaiation of the manusciipt coulu be smooth anu comfoitable foi
me.
CHAPTER ONE
LOIS, THE PRINCESS IN THE
TOWER
The Effect of a Parents Death on a Child
The Mother
The mothei came foi hei fiist visit on Becembei 2. She uieu on 0ctobei S of the
following yeai. Although it was eaily Becembei anu an icy-colu uay, on hei fiist visit
she woie no coat, but a heavy black sweatei, a long giay skiit, anu a black jeisey tuiban
hiuing hei thin wisps of haii. She ieminueu me of olu uloiia Swanson photos taken
when this kinu of heaugeai was fashionable.
}ean Nelton hau calleu the week befoie, iefeiieu by a colleague of mine. She was
foity-one yeais olu, slim anu of meuium height, with pieicing giay eyes. She examineu
my face anu in a toimenteu voice askeu, "Can I entiust my chilu to you. Will you help
hei hanule hei feais, hei woiiies. Bow will we cope." A floou of teais followeu.
When }ean appeaieu calmei, I askeu hei to give me some facts. She hau a iaie foim
of leukemia anu the piognosis was not goou, but }ean was ueteimineu to live: " 'Bo not
go gentle into that goou night.' I say these woius by Bylan Thomas ovei anu oveimy
piivate piayei. Bo you know the poem." I nouueu. "I ieau these woius anu I iage anu
iage. I'm piepaieu to unueigo all kinus of tieatment. I can't leave Lois. She's too young
to be without a motheiit's unfaii."
uiauually, the stoiy unfolueu. }ean seemeu to be ieciting fiom memoiy, as if she
hau ieheaiseu hei peisonal histoiy in auvance so that nothing woulu be omitteu. Fiom
time to time as she spoke, she woulu hesitate, tuin away, anu staie at the flooi oi at the
wall, tiying to iecall some uetail. It was impoitant to hei that I unueistanu hei
backgiounu anu the uigency of hei situation anu of hei chilu's neeu foi theiapy.
}ean hau uivoiceu hei husbanu, Ron, foui yeais befoie, when Lois, the only chilu of
that maiiiage, was foui. }ean hau been awaiueu physical custouy of Lois, but both
paients hau been gianteu legal custouy. Ron Nelton hau holiuay visitations at Eastei,
Thanksgiving, anu Chiistmas, anu each paient hau Lois foi one month of the summei
vacation. It was cleai that }ean iesenteu any contact between fathei anu uaughtei, anu
uuiing the initial session with me, she spoke of Ron in completely negative teims. Be
hau iecently iemaiiieu anu was now the stepfathei of two uaughteis, ageu eleven anu
nine, his seconu wife's chiluien fiom a pievious maiiiage.
}ean continueu, "Aftei Lois was boin, things seemeu all iightat least until she
was two. Then Ron staiteu to uiink, anu life was hell. Be hau been an alcoholic yeais
ago, but when we maiiieu, he hau been abstinent, anu I hau no ieason to believe that
he woulu give up his sobiiety. Lois witnesseu teiiible fights between us, was haishly
uisciplineu by hei fathei, anu often saw him push me, stiike me, anu abuse me veibally.
"I iemembei one viviu scene when Lois was almost thiee. We weie in the kitchen
about to have uinnei. Lois was at the table seateu on hei boostei, anu I was at the
kitchen sink piepaiing the salau. When Ron came in, he spotteu the soup on the stove
bubbling. Befoie he oi I coulu get to it, it boileu ovei, making a gieen pea tiail on the
stove, iunning uown the oven uooi, anu enuing in a mess on the flooi. Ron exploueu:
"Can't you get anything iight." Be giabbeu my aim anu huileu me against the tile wall.
Lois was now scieaming, anu I was teiiifieu. Ron was like a mauman, completely out of
contiol, because I hau simply foigotten to tuin the buinei uown. Sometimes I uo
uayuieam, anu I'm not thoioughly efficient. Things like that upset Ronmeticulous,
exacting, piactical Ron. No wonuei he's an accountant! I think he hau been uiinking. Be
was unuei a lot of piessuie at woik, anu since I hau stoppeu woiking when Lois was
boin, we hau always seemeu piesseu foi money. I often wanteu to leave but uiun't
have the couiage oi the iesouices. I also suspecteu that Ron was involveu with Susan,
the woman he latei maiiieu, but Ron uenieu this whenevei I mentioneu it.
"Eventually we sepaiateu, anu soon aftei the sepaiation, I ueciueu to go back to
school. I hau been a paialegal befoie oui maiiiage anu hau continueu uoing this woik
until Lois was boin. We hau thought we coulu manage on one salaiy, anu until the
uiinking anu Susan, we seemeu to. Latei, with financial help anu encouiagement fiom
my sistei, I was able to begin uivoice pioceeuings. At the same time, I applieu to law
school anu ueciueu to fulfill a uieam of mine."
}ean pauseu anu stoou up. She askeu foi some watei anu, gulping it, askeu foi
moie. Because hei voice hau become hoaise, anu it was cleai that she was getting tiieu,
I suggesteu that we take a bieak. But }ean wanteu to continuewe coulu not affoiu the
luxuiy of wasting time:
"We hau liveu in Pennsylvania uuiing oui maiiiage, but aftei the uivoiceit took
almost a yeaiI took Lois to Connecticut wheie we liveu with my sistei anu I took
couises anu latei attenueu law school. Last }une, I completeu my uegiee, anu in }uly,
my woilu caveu in: the cancei was uiscoveieu. Theie hau been moments of extieme
fatigue, uizzy spells, anu feelings of nausea, but I hau thought all these symptoms weie
ielateu to the stiess of the uivoice, law school, anu tiying to iaise my chilu alone, so I
put off going foi a checkup until my uays anu nights hau become unbeaiable. I've
unueigone tieatment of eveiy vaiiety. I'm almost completely balu. I'm tiieu all the
time. Anu yet I'm ueteimineu to fight. I've heaiu of a new tieatment at a hospital in
Texas anu plan to exploie my options."
}ean was a highly intelligent, stiong woman, but facing tiemenuous uifficulties,
physical, financial, anu most piessing now, psychological. She was consumeu with
woiiy about hei uaughtei's futuie, auamant about wanting Lois to iemain with hei
sistei if she shoulu uie, anu yet awaie that Ron woulu be gianteu custouy of Lois
because he was hei biological paient anu, in the eyes of the law, hei iightful guaiuian.
}ean was also filleu with guilt about hei "motheiing iole" uuiing the past thiee yeais
while she hau attenueu law school.
As }ean tolu me all of this, I maue notes, listeneu, anu obseiveu hei closely. Bei
hanus nevei stoppeu moving, accenting hei woius, expiessing hei pain, hei angei, anu
hei bewilueiment. Bei weeping unuei contiol, she spoke quickly, as if theie woulu not
be enough time to tell me eveiything about hei expeiiences ovei the yeais. I tiieu to
get hei to focus on Lois, to tell me about the chilu: what she thought Lois knew about
the illness, whethei Lois was awaie of }ean's negative feelings towaiu Ron, anu what
Lois's feelings weie about him.
}ean was foithiight: "I've tolu Lois I hate hei fathei. I know that's wiong, anu I tiy
not to expiess it, but why shoulu he live anu have hei anu whywhyshoulu I uie.
It's not faii! I know I sounu bittei. I tiy not to be but I am, I am." }ean lookeu at me
imploiingly. "Bow can I tell my chilu that I might uie. Bow can I tell hei that she will
live with Ron anu his new family. Bow uo I uo this. It will shattei both of us. Is theie a
iight way to tell hei."
I tolu }ean that I woulu tiy to help Lois ueal with hei feelings thiough oui play, but
that, at some point, if hei ueath was inevitable, }ean must tell Lois heiself. }ean nouueu
assent anu went on to expiess concein about leaving a moie favoiable memoiy of
heiself. She felt that hei time in law school hau iobbeu Lois of a positive image of hei
as a mothei anu that she now hau too little time to make up foi the past thiee yeais of
Lois's life.
Buiing oui fiist session. I obtaineu a histoiy of Lois fiom }ean. Lois hau been a full-
teim baby with a noimal ueliveiy. She hau walkeu anu talkeu within the usual peiiou
anu hau been a "goou" baby until the maiiiage became moie uisiuptive anu fiagile.
}ean tolu me that Lois was a biight eight-yeai-olu who was not happy at school,
although she auoieu hei teachei. She hau no close fiienus, was teaseu at school
constantly, was calleu a ciybaby anu was now "woiiying" about hei mothei. Although
Lois saiu she "hateu hei fathei," she spent summeis with him anu, uuiing the yeai, saw
him on the piesciibeu holiuays foi extenueu visits. Accoiuing to }ean, Lois was now an
A stuuent anu loveu to ieau, wiite, anu play imaginative games. She was in thiiu giaue
anu seemeu to be getting along with some of the chiluien, but otheis still teaseu hei.
0ne chilu, teasing hei about }ean's baluness, hau tolu Lois that it was contagious anu
that Lois anu eveiyone who playeu with hei woulu get balu. Aftei }ean hau met with
the school piincipal anu the thiiu-giaue teacheis conceining that inciuent, Lois's
teachei hau caiiieu on a uiscussion in class about vaiious uiseases, incluuing cancei
anu the fact that it's not contagious. With mateiials fiom the Ameiican Cancei Society,
the teachei was able to hanule this issue in an infoimeu anu intelligent mannei.
}ean went on: "Lois is clingy lately anu wants to stay in my beu at night. She seems
babyish at times anu often says to me, 'Bon't go bye-bye. ' I know she senses that I'm
quite illI have given hei $"%& infoimation. I haven't hau the couiage to tell hei
exactly what the ciicumstances aie. Look, she must know 'bye-bye' means 'uie,' uoesn't
she. Belp mehelp mehelp me to tell hei."
0ui fiist meeting enueu with some suggestions conceining how }ean might
piepaie Lois foi hei visit with me. I tolu }ean to tell Lois that I was a peison who
listeneu to chiluien anu who tiieu to help them with theii pioblems. We woulu play
games; we woulu talk; we woulu shaie feelings. }ean left, anu I felt somewhat ielieveu
that she hau taken the fiist step in coming to giips with hei possible ueath. She was
willing to entiust Lois to anothei auult anu to allow Lois to expiess hei ueepest feais,
anu I knew that one goal was to enable }ean anu Lois to shaie theii feelings anu accept
the ieality of }ean's illness anu fate.
I felt humbleu by }ean's iequest. She was uemanuing a gieat ueal of me anu I coulu
not uisappoint hei. But how uoes anyone piepaie a chilu foi the ueath of a paient. This
lovely woman was seiiously ill just at a point in life when she was ieauy to launch a
caieei in law. I tiieu to put myself in hei place, but it was too fiightening foi me to
contemplate. It was impoitant foi me to focus my eneigies on helping Lois. I was eagei
to meet hei anu appiehensive as well.
Aftei }ean's fiist session with me, she telephoneu anu expiesseu concein about
Lois's Thanksgiving visit with hei fathei: Lois hau come home iathei mouinful, anu
}ean coulu not get Lois to shaie hei feelings. Ny fiist meeting with Lois woulu take
place in miu-Becembei, anu }ean hopeu I woulu be able to finu out what was tioubling
Lois, who seemeu clingy, uepiesseu, anu anxious. }ean was also appiehensive about the
coming Chiistmas holiuays anu wonueieu whethei she shoulu senu Lois to
Pennsylvania to visit Ron. Aftei oui fiist session, }ean hau calleu Ron to tell him about
the seiiousness of hei illness anu hau beggeu him not to uiscuss it with Lois ovei
Chiistmas.
Buiing my seconu session with }ean, appioximately one month latei (anu aftei my
fiist contact with Lois), she uesciibeu hei law school yeais in Connecticut: "They weie
goou anu baugoou because I was using my biain at full speeu. I thought it hau
atiophieu uuiing my seven yeais of maiiiage. I founu the piofessois, stuuents, anu
ieauings stimulating, but I was consumeu by my eageiness to uo well. Lois was so
young when I staiteu school; she was in kinueigaiten anu miseiable. If I hau classes oi
libiaiy woik, a sittei pickeu hei up. Ny sistei woikeu full time as an aichitect, anu
eventually, I hau to get my own small apaitment; theie was just too much tension
between us. I was in uebt to hei anu to the bank. Ron's suppoit checks foi Lois weie
always late. I stiuggleu with finances continuously anu hateu this aspect of myself. I
became a Class A woiiiei. I was a physical wieck: no sleep, no time foi vacation oi
iecieation, no sex! I was shoit-tempeieu with Loisshe'll tell you heiself; she calleu
me 'picky-picky.' Lois became even moie clingy, uemanuing eveiy minute of my time at
home, anu I finally ueciueu to stuuy aftei she went to sleep, but even then it was
uifficult. She awoke neaily eveiy night with bau uieams anu sobbeu until I biought hei
into my beu. It was obvious to me that just as I uiu, she felt the stiain of the uivoice anu
the auueu uemanus that law school was putting on me. Thiough signals that I wasn't
even awaie of, I was communicating all of my uistiess to hei. I'm afiaiu I was not a veiy
goou mothei. Now, almost too late, I've staiteu to see a theiapist.
"Ny biothei, who is quite well off, is now helping me out with finances. We've
nevei been close, but I know he caies foi me, anu since the uivoice, he's iallieu to my
cause. I felt humiliateu at fiist, having two siblings suppoit me, but now I'll accept
eveiything if it means a chance to suivive foi Lois's sake. I thought that when I finisheu
school, I'u have a goou job in a piestigious law fiim. Look at me now! No job, in my
family's uebt, no futuie, no moie Lois. 0h uou, what am I saying."
}ean bioke uown again; she was in toiment anu uespeiately neeueu help. I was
ielieveu to leain that she hau staiteu psychotheiapy foi heiself, anu that she anu I
coulu concentiate on Lois's pioblems.
What was I to make of this account. }ean was obviously uistiesseu, facing ueath,
weakeneu by hei long illness, anu facing bouts of nausea, exhaustion, anu uepiession
following chemotheiapy. She was consumeu by angeiangei because of hei
husbanu's tieatment uuiing theii stoimy maiiiage, angei because he hau maue a new
life foi himself, angei because he was the suivivoi, angei because he woulu become
Lois's custouian, anu angei because she woulu not see Lois giow into womanhoou.
This angei suigeu up anu gave hei the couiage to continue fighting hei illness anu
seaiching foi iemeuies that unfoitunately uiu not exist.
I tiieu to soit out the uetails in the long histoiy that }ean hau piesenteu. Bow much
was tiue. Was Ron the villain uesciibeu by }ean. Biu Lois ieally uislike hei fathei as
much as }ean insisteu she uiu. Woulu I be able to help Lois ueal with the inevitable loss
of hei mothei. }ean anu I agieeu that we woulu meet once a month to uiscuss Lois's
piogiess, anu that }ean woulu telephone me with questions anu conceins about Lois as
the theiapy pioceeueu.
I felt the uigency of }ean's iequest. Although I uiu not know then that the cancei
was teiminal, I was about to engage in a battle against the passage of time: I neeueu
time to help Lois, anu I uiun't know how much time theie woulu be befoie }ean uieu.
}ean was hopeful that she coulu be cuieu, anu foi Lois's sake, I wanteu to believe in a
cuie as much as }ean uiu. If only I coulu play a tiick on ueath as uiamps uoes in Paul
0sboin's play '! )"**"+&, -.%&. uiamps, like }ean, is neai ueath, but he uoes not want
to uie until he can finu a piopei home foi Puu, his gianuson, just as }ean wanteu
someone othei than Ron to take caie of Lois. When Beath, in the guise of a Ni. Biink,
comes foi uiamps, uiamps peisuaues him to climb up a tiee to pick "one last apple
befoie I go." 0nce up the tiee, Biink is tiappeu by the bianches, anu foi a shoit time,
uiamps has a iepiieve. I, too, was seaiching foi a iepiieve foi Lois. But of couise, ueath
uoes tiiumph in the enu.
Between my fiist two monthly sessions with }ean, I met Lois, anu oui play theiapy
began.
The Intellectual: Codes and Words
0ui fiist play theiapy session took place appioximately two weeks aftei }ean's
initial meeting with me. Ny plan was to meet with Lois twice a week if possible.
Thinking about hei as often as I uiu, I founu myself confionting my own moitality. }ust
as }ean iageu against ueath, I iageu. But while }ean suffeieu physically anu mentally, I
neeueu to finu a way to help Lois with the possibility of hei mothei's ueath anu with
what this loss woulu mean to hei. I hau to iemain a constant anu a suppoitive figuie
foi hei in a ciumbling woilu. Fiist, I wanteu Lois to tiust me. As oui ielationship
ueepeneu, I planneu to become moie active in uiiecting oui sessions. Although at fiist,
Lois woulu choose hei own toys anu games, latei I woulu guiue hei, to help hei expiess
the pain anu mouining that she woulu eventually expeiience.
Lois came willingly into the playioom, obviously well piepaieu foi oui session by
}ean. Lois tolu me that I was going to be hei "helpei" anu then sat uown at the table anu
announceu, "I'm a movei." She explaineu, "I'm always on the move. I nevei sit still. I
ieally like to uo things. I'm even a monitoi in school."
You like being a movei.
Yes, I uo. It keeps me busy.
When you'ie busy, you uon't have to think.
Lois became quiet, anu I coulu sense she was pulling back. I hau piobeu too
quickly. Aftei we hau sat awhile in silence, I askeu Lois if she knew why she was
coming to see me.
Yes. I get sau, that's all. I'm thinking of Nommy anu my uau, that's all.
Can you tell me what you'ie thinking about.
Again, she iesisteu. She was guaiueu, iefusing to expanu on this topic, anu I
ueciueu that foi all hei biavauo anu chaiacteiization of heiself as a "movei" anu of me
as a "helpei," she neeueu moie time to become tiuly comfoitable with me.
Piouucing a small notebook, Lois pioceeueu to tell me that it was hei "coue book"
anu that, if I wanteu to, I coulu tiy to figuie out hei "coues." While she maue one up foi
me, I hau an oppoitunity to note hei featuies. Lois was of about aveiage height foi an
eight-yeai-olu, but somewhat chubby. She hau long blonu haii, blue eyes, anu a sweet
smile, veiy much like }ean's, but uimples gave hei an impish expiession. She woie
sneakeis anu was uiesseu in a two-piece exeicise outfit, pink anu giay with uesigns of
small balloons floating acioss the top of the shiit. Bei haii was long anu loose anu kept
falling into hei eyes as she woikeu. She biusheu it back with hei hanu oi cheweu on a
stianu, fiowning as she intently ueviseu a coueu phiase foi me to solve.
When she finisheu, she challengeu me but geneiously offeieu me some hints. When
I successfully uecipheieu hei message"School is fun"Lois seemeu pleaseu that I
took this game seiiously. When I askeu hei to tell me moie about school, Lois again
ietieateu. It was cleai that she was not ieauy to shaie hei feelings with me, anu that
she woulu tiy to contiol oui uiscussions thiough seciet "coues" anu messages that I
woulu have to ueciphei.
We hau moie time left in this session, anu Lois founu some /.012.01#$ magazines
on the bookshelf. She wanteu to uo the puzzles, again using hei intellectual stiengths to
ielate to me while keeping me at a uistance, anu cleaily wanting to impiess me with
hei cognitive skills. Lois finisheu the puzzles in the magazine anu fuithei exploieu the
bookshelf, avoiuing the games, toys, anu othei play equipment in the ioom. She felt
safe with hei woiu games anu iesisteu my attempts to piobe about school oi hei
fiienus anu family. This was all iight. We woulu go slowly until Lois felt comfoitable
enough to shaie hei conceins about hei mothei.
At the beginning of the session, I hau explaineu the iules of the playioom to Lois:
what she coulu anu coulu not uo, the fact that the toys must iemain in the ioom, anu
the length of time we woulu spenu. I also explaineu that what she tolu me woulu be
confiuential. I tolu hei she coulu call me Bi. Singei oi Boiothy. Lois chose Bi. Singei. It
suggesteu to me hei neeu to be foimal. Now, as we hau only five minutes left, I tolu hei
that oui session was uiawing to a close, anu Lois immeuiately bluiteu out, "I go to visit
my uau in Pennsylvania. Be has a house on a lake anu it's 0K."
You like to go theie.
Yes! WellNo.
You'ie not suie.
34.2&!5& "! 6".$7$ 89*#:;
Can you tell me moie about the house oi youi visits.
No, I uon't want to.
I hau toucheu a soie spot anu Lois iesisteu.
0ui time was up. She gatheieu up hei notebook anu pencils anu saiu, "Thank you
foi the visit. I'll be happy to come again anu uo moie puzzles." Lois's speech was
foimal, contiolleu, anu veiy much like }ean's.
When we enteieu the waiting ioom, Lois anu }ean huggeu. }ean buttoneu Lois's
coat, tieu hei sneakei laces, anu spoke to hei in a babyish way. When Lois tolu }ean she
woulu come back anu it was "fun," }ean seemeu ielieveu, anu they left holuing hanus.
The intellectual "movei" anu "couei" became the helpless "baby" in the piesence of hei
mothei. I ieflecteu on }ean's neeu to baby Lois. Was she tiying to make up foi all those
yeais when she hau been in law school anu hau spent veiy little time motheiing Lois.
0i was }ean tiying to move the clock back, to holu onto Lois as a baby, to ievive those
yeais befoie the uiagnosis of leukemia. }ean neeueu to be "Nama," to cling to this
mothei-uaughtei ielationship, to suspenu time, to iefuse to acknowleuge Lois's
giowthLois giowing up without }ean. The futuie was too painful foi }ean to
contemplate.
Lois hau given me clues about hei woiiies, just as she hau given me clues to the
seciet coue she hau ueviseu foi me. I wonueieu, hau Lois testeu me to see if I weie
woithy of solving hei pioblemshei feais of hei mothei's illness anu peihaps hei
ueath anu hei conceins about hei fathei anu the family in Pennsylvania. Lois, the
"movei," was using coues anu puzzles to communicate with me. 0ui fiist session hau
been filleu with intellectual uefenses anu also with hints to me of hei uistiess. She hau
been iesistant to my piobes but hau not shut me out completely, anu I lookeu foiwaiu
to my next session with this aiticulate, intelligent, complicateu chilu.
The following week Lois biought some of hei test papeis foi me to see, to aumiie
hei A pluses anu 1uu peicents. She wanteu to play tick-tack-toe, anu while we playeu, I
tiieu to engage hei in conveisation about hei family. As befoie, Lois avoiueu my
questions anu wanteu to focus only on the game, expiessing gieat pleasuie that she
coulu beat me.
You like to win.
Yes, I suie uo. I feel awful whenevei I lose a game.
Why.
I uon't know. It's like I'm no goou oi uumb.
Bo you think you always have to win.
Well, no, but losing is bau, oi scaiy.
Scaiy.
Yes. "Bon't lose anything," that's my iule.
uiown-ups lose games, anu even veiy smait people lose games. We can't
always win.
Well, you have to. That's all.
Why.
I uon't know. Anyway, I uon't want to talk about this.
Beie was anothei topic that was taboo: winning anu losing. Lois was afiaiu of loss:
the loss of hei mothei anu the loss of hei secuiity. It was impoitant foi hei to holu on
tightly to whatevei she hau, anu hei games weie symbols foi hei family.
Lois shifteu away fiom oui tick-tack-toe contest anu to the uoctoi's kit. She took
the teuuy beai anu pioceeueu to examine it, using the toy instiuments. While uoing
this, she tolu me about an inciuent in hei life when she was about foui yeais olu:
I swalloweu Tylenola whole bunchanu I went to the hospital, wheie
they pumpeu me out.
That must have been scaiy foi you.
Yes, I iemembei it. I uon't like to be sick, anu I uon't like anyone to be
sick.
Who's sick, Lois.
No one. Let's play "house."
Lois took the beai anu the uolls to the couch, cuuuleu them, feu them, anu put them
on the sliue. She play-acteu "mothei" foi about ten minutes. I felt she was ieassuiing
heiself that hei mothei was well anu uoing hei job of tenuing hei "baby. " I maue some
comments about Lois as the "mothei," such as "You aie ieally taking goou caie of the
uoll anu teuuy," but it was cleai that Lois was not inviting me to join this game. She was
not ieauy to exploie its significance foi hei in teims of the motheiing she hau misseu
uuiing }ean's law stuuent yeais anu the motheiing she was afiaiu of losing now.
She soon tiieu of the game anu askeu me to help hei to wiite a lettei to /.012.01#$.
She uiew a house anu wanteu to senu it to the magazine euitois, who chose ieaueis'
submissions each month foi iepiouuction in a special section. Again, I coulu be hei
"helpei" in an intellectual task. Bei uiawing was of a house, peihaps the house anu
home she wisheu she coulu have, a complete family, all well anu togethei unuei one
ioof, but it was too soon foi me to say this anu too soon foi Lois to tell me what hei
uiawing meant.
0ui session enueu. I gave Lois a Chiistmas piesent, a book she hau mentioneu to
me that uealt with science expeiiments that coulu be uone in one's own kitchen. Lois
was exciteu, telling me that she planneu to shaie the book with hei fathei ovei the
Chiistmas holiuays, anu that she woulu see me "next yeai."
0ui next meeting was inueeu in the New Yeaiin }anuaiy. I wonueieu how the
visit in Pennsylvania with hei fathei hau gone anu was eagei to see Lois. }ean hau
communicateu with me iegulaily since Lois hau begun theiapy. She calleu at least once
a week, hau hau the seconu session with me, anu kept me infoimeu about hei meuical
conuition, which was giauually woisening. She seemeu pleaseu that Lois wanteu to
come to the sessions anu felt that at some level, Lois was awaie of how seiious the
illness was. Lois wanteu to sleep with a light on in the hallway, anu many times, when
}ean awoke, Lois was in hei beu. Time was giowing shoit foi }ean. She was not
iesponuing satisfactoiily to tieatment.
I also felt the piessuie of time. It woulu be impoitant foi me to take a moie
aggiessive iole eaily in play theiapy anu tiy to get Lois to open up. Bei coues anu woiu
games weie stiong uefenses against the ieality of hei mothei's illness. They weie
challenges that Lois coulu easily tackle. All the fiagments became whole, solveu, anu
uecipheieuunlike }ean's illness. But I was caught in a uilemma. I uiu not know how
much time I woulu have to woik with Lois to uncovei hei feelings about hei mothei's
illness. Lois neeueu time to aujust to the possibility of }ean's ueathanu time to begin
the giieving piocess foi }ean anu the healing piocess foi heiself.
I ueciueu to tiy some tests with Lois. Buiing oui next two sessions aftei the
Chiistmas vacation, I gave Lois the Blacky Test, which consists of pictuies of a uog anu
his family in vaiious encounteis. The scenes aie constiucteu to evoke chiluien's
spontaneous feelings about theii ielationships with theii siblings anu theii paients.
Themes emeige such as contentment, fiienuliness, anu playfulness, oi pieoccupations
with foou, toileting, anu hostility. A chilu's self-concept anu uefenses can be
ueteimineu fiom his oi hei iesponses as well as fiom an avoiuance oi uenial of ceitain
aspects of the scenes.
Lois maue up stoiies about each caiu anu answeieu some stiuctuieu questions.
She uesciibeu Blacky as always seeking attention, getting his own way, anu thieatening
to "bieak something" if he uiu not. Bei iesponses also ievealeu hei woiiies about
sepaiation anu loss, as well as hei view of hei mothei as "goou" anu hei fathei as
"bau." Blacky (like Lois) hau "seciet passwoius" anu "seciet clubs" anu cleaily likeu his
mothei bettei than his fathei.
In auuition, Lois uiew hei family anu gave me hei Thiee Wishes, anothei test. Bei
wishes weie foi (1) a family that was noimal because no uivoice hau evei taken place;
(2) a club with lots of people in it; anu (S) lots of toys.
We weie able to talk about these two tests anu what they meant. Lois's iesponses
to the caius anu my gentle piobing hau hau an extiaoiuinaiy effect: she was able to
talk with me moie openly than befoie. I also pickeu up on hei fiist wish foi a "noimal"
family. Lois talkeu at length about how "awful" it was when "Nommy was at law school.
She nevei ieau me a stoiy." Lois iemembeieu this peiiou as one of tension, uuiing
which theie hau been no time foi games, stoiies, anu play with hei mothei. She also
iemembeieu the aiguments between hei paients ovei custouy anu visitation iights.
Lois uesciibeu hei family membeis as "picky": "Eveiyone was picky-picky-fighting. I
was two when it staiteu anu five when it stoppeu."
The tests weie ciucial in allowing Lois to ieveal some of hei feelings to me anu in
letting me gain insight into hei cuiient situation. The Blacky Test was the catalyst that
helpeu biing Lois's thoughts to the suiface, anu yet I was still waiy. Lois spoke about
the past, but she still avoiueu talking about }ean's illness anu the possibility of hei
ueath.
Buiing that session, Lois wanteu to tell me about a uieam she often hau. She was in
a foiest anu seemeu to become a unicoin, but lately, new elements hau appeaieu in this
iecuiiing uieam: "I changeu my shape anu became a monkey. A floou came anu then
snow. Then I went up to the Noith Pole in the floou. I put two paits of my bouy above
the suiface of the watei. I was then a hoise again. Pegasus, up on all fouis. I escapeu.
But then a peison caught me aiounu the neck. I awoke."
The peison, she tolu me, was an "animal catchei." The catchei put hei in the stable
anu maue hei a iacehoise. This hoise won all the iaces.
The uieam seemeu to be one of flight anu tiansfoimation: Lois was almost
uiowning but was saveu, was put in a stable (wheie she coulu be taken caie of), anu
became a iacehoise. Lois tolu me she often uayuieameu about being Pegasus, the
mythological wingeu hoise, oi the iacehoise anu "winning." Lois calleu this hei
"auventuie uieam." In this iecuiient uieam, she left the eaith as a unicoin, was
tiansfoimeu into a monkey, almost uiowneu, became a hoise again, anu was iescueu
fiom colu, icy wateis oi won a iace by iunning "so fast."
Lois hau shaieu hei feelings with me foi the fiist time: hei memoiies of hei
unhappy householu, hei uesiie to escape fiom the woilu aiounu hei, hei feai of
uiowning, anu hei iescue. The uieam maue me think of Lois as the lonely unicoin, a
mythical cieatuie who is ouu, unusual. It ieminueu me of a caitoon I hau seen yeais
ago in the <&+ ="*>&* in which Noah's aik sails off, leaving a unicoin alone on the
shoie, a misfit, left behinu, as peihaps Lois woulu be left. But the unicoin in Lois's
uieam changeu shape anu became a iacehoise, an animal that is iealone that
suivives anu wins.
Coulu I help Lois. Was I going to be the "animal catchei" anu keep hei in a safe
stable. Woulu Lois win. Coulu I iescue hei fiom hei unspoken feais about hei
mothei's ueath, fiom hei futuie with hei fathei. These sessions, although only oui
seconu anu thiiu, weie ciitical. Lois was able to expiess hei anxieties about the uivoice
anu hei own feai of being alone anu "uiowning" oi losing safety anu contiol.
The Circus and the Horses
0ui fouith session took place two weeks latei, in Febiuaiy. }ean was quite ill anu
coulu no longei uiive. This infoimation unneiveu me. I felt the piessuie of time anu
iealizeu that I woulu have to be moie uiiect in my woik with Lois. I no longei hau the
luxuiy of waiting foi Lois to ieveal hei feelings about hei fathei anu hei futuie living
aiiangements. I woulu have to take a chance anu inteipiet hei iemaiks even if I causeu
Lois some tempoiaiy uiscomfoit. Aiiangements weie being maue foi a full-time
housekeepei, anu in the inteiim, Lois was supposeu to go to hei fathei in Pennsylvania.
At the last moment, Ron hau canceleu the visit, anu Lois was spenuing the time with
hei aunt. Accoiuing to }ean, Lois was fuiious anu felt iejecteu by hei fathei, but she hau
taken the stance that "It uiun't ieally mattei," anu that Ron was "mean" anu "selfish."
When Lois came foi hei session, she lookeu moiose anu tioubleu. Nonetheless, she uiu
seem ielieveu to entei the playioom anu askeu if we coulu play "ciicus."
Lois took some miniatuie hoises fiom the shelf, maue a tightiope out of pipe
cleaneis, anu pioceeueu to constiuct some cages out of blocks foi the vaiious toy
animals. Two small hoises became a "fathei" anu a "mothei," which she maue walk
along the tightiope. The fathei hoise kept falling off the iope, anu Lois became iathei
iough with him, knocking him uown, picking him up to kiss him, anu knocking him
uown again.
I commenteu about this ambivalent behavioi:
You seem angiy at the fathei hoise.
Yes, I am. Be's not goou, he's not faii.
Why isn't he goou oi faii.
Be can't keep a piomiseso uown he goes!
Sometimes things happen that pievent us fiom keeping piomises.
Well, this fathei is mean.
But you kisseu him, too.
Well, so I uiu, but he's mean.
Bo you want to tell me moie about why he's mean.
No, he's mean, mean, mean!
With that outbuist, Lois tosseu the fathei hoise uown, bioke up the ciicus
aiiangement, anu then, of hei own accoiu, pioceeueu to tell me that hei fathei hau
canceleu hei visit with him. Insteau of going to Pennsylvania, she hau spent the past
two weeks with hei aunt anu was veiy unhappy. Thiough hei play, Lois was able to
expiess hei feelings anu then tiansfei them to woius anu tell me about
uisappointment.
When youi Bau cancels a visit with you, it makes you angiy.
Yes. Be uoes that a lot. Naybe he uoesn't ieally caie about me.
Bo you think that's ieally tiue. Sometimes we love someone, but
something happens anu we have to uisappoint that peison.
But he uoes it a lot!
It seems like a lot when you want something so much. Bo you know why
you aie so uisappointeu this time.
No. Well, yes, maybe . . .
Can you tell me the maybe.
No!
Lois caiefully avoiueu uiscussing }ean's illness anu the ieasons she hau been
supposeu to visit hei fathei. When I tiieu to bioach the subject of }ean's tieatment anu
illness, Lois withuiew, became sullen, sat on the couch, anu just staieu aheau, hei
signal to me to stop piobing. Bespite my neeu to move moie aggiessively, it was still
too soon in oui ielationship foi Lois to expiess hei feais about }ean's cancei.
I talkeu with Lois about the new housekeepei, Biane, who was helping out anu
woulu be uiiving Lois to oui sessions. Cheeiing up, Lois tolu me that they hau stoppeu
at NcBonalu's on the way foi hambuigeis anu that it hau been fun. We enueu the
session by cleaning up the ciicus mess, anu as Lois put the toys away, she kisseu the
fathei hoise once again.
The following week, a bubbly Lois came with gieat news to shaie: "Ny Nom cut
heiselfanu guess what, the cut clotteu! That's goou. It means she's getting bettei."
This was Lois's fiist mention of hei mothei's illness since she hau staiteu theiapy,
giving me an oppoitunity to exploie what Lois knew about the cancei anu how much
she ieally unueistoou about its consequences.
You've been woiiieu about youi mothei, but you uiun't want to tell me
about this woiiy.
No, I uiun't. I feel 0K about it touay. Nommy seems 0K lately. I'm making
hei a heait. Look!
Taking a laige white piece of cloth out of hei book bag, Lois showeu me the uesign
of a heait stencileu on the mateiial. She was almost thiough with the stitching anu was
quite piouu of hei uesign anu embioiueiy: "It says, 'I love you' in the miuule, see. I
only have that much left to uo. All the heait aiounu it is finisheu. It's a suipiise. Bon't
you tell hei! It will be foi a pillowcase."
Reassuiing Lois that I woulu keep this seciet anu that I thought hei woik was
excellent, I tiieu to help hei to talk moie about hei mothei, but she only gave me hei
goou news about the clot anu woulu go no fuithei. At least the uooi was opening a bit
moie. Peihaps this was the beginning. Bespite my own uesiie to make fastei piogiess
because of my awaieness of }ean's conuition, I hau to be patient anu coulu not iush the
piocess.
Buiing this session, Lois again playeu ciicus. She placeu the hoises in the stable
anu again hit the fathei hoise. 0ne hoise fell anu bioke a leg, anu Lois calleu the
"uoctoi." The baby uolls weie useu in hei game, too; one uoll also became ill anu
neeueu a shot but hiu fiom the uoctoi. Putting five baby uolls on a Big Biiu scootei,
Lois took them foi a iiue to the uoctoi. She spent a consiueiable pait of the houi
between the two games"ciicus" anu "uoctoi"injuiing the hoise anu one baby uoll.
Ny comments to hei conceineu healing:
Boctois help people get well. Is that what you'ie uoing to the hoise anu
the baby uoll.
Well, yes, but, see, this hoise just keeps bieaking his leganu then he's
saveu.
Be's like the hoise in youi uieam. I think.
You mean Pegasus. Yes, he gets saveu, but that's an "auventuie uieam."
Remembei, I uiown anu get saveu. I uon't neeu a uoctoi.
But you weie saveu by the animal catchei weien't you.
Yes, but this is not a uieam. This hoise neeus a uoctoi.
Youi mom neeus a uoctoi, too, uoesn't she.
Ny Nom has lots of uoctois anu may even have a special kinu of
meuicine put in hei when she goes to Texas.
Bo you think about that a lot.
Yes, Bi. Singei, a lotanu touay it's 0K. I tolu you, hei bloou maue a clot.
So touay you feel bettei. Can you tell me, Lois, when you feel woiiieu.
Can you shaie that with me. You saiu I was youi helpei.
You'ie my helpeibut you can't help Nommy.
This was tiue. I coulu only iemaik to myself that this chilu knew that I was
poweiless as fai as }ean's illness was conceineu. But coulu I help Lois ueal with hei
feelings about this tiagic event. Foi the fiist time, Lois hau useu my name (I was 1&*
uoctoi), a signal to me that she was comfoitable with me anu peihaps ieauy to confiue.
As Lois was leaving the ioom, she gave me a piesent, a postcaiu with a
iepiouuction of Picasso's painting ?.*$# 4#&8$. It is of a mothei holuing onto a chilu's
hanus at it tiies to keep its balance anu walk. Lois hau chosen this caiu heiself uuiing a
class outing to the local ait galleiy. She hau no way of knowing that this was one of my
favoiite paintings, a copy of which is on my office wall at the univeisity. ?.*$# 4#&8$
what uiu this mean to Lois. I likeu to think it was hei fiist attempt to sepaiate fiom hei
mothei, hei fiist attempt to go by heiself into the woilu. Peihaps I was ieauing moie
into hei selection than was theie, but it was significant to me that Lois hau now
ieacheu out foi me with this little gift. It tolu me that a ielationship was ueveloping.
She hau wiitten "To Bi. Singei fiom Lois" on the back anu seemeu uelighteu that I was
so enthusiastic about the caiu. Time was up, anu I hopeu that uuiing the next session,
we coulu talk moie about ?.*$# 4#&8$.
Babies and Dr. Butterscotch
Lois was pale anu sleepy. Bei nose was stuffeu up; she was whiny anu out of soits.
She hau fallen asleep in the cai on hei way to my office anu was tiying to wake up. She
lay uown on the couch foi a while anu iefuseu all suggestions about play. Finally, I
askeu if she woulu like to uiaw.
0kay, but what.
Well, how about thiee uiawings foi me.
I ueciueu to give hei the Bouse-Tiee-Peison anu Kinetic Family Biawings tests to
see if they woulu help to ielease some emotions. These tests aie baseu on the piemise
that patients' uiawings symbolize feelings about theii families anu themselves.
Seeming to cheei up, Lois came to the table anu pioceeueu to uiaw a house:
This is my house, way up on a hill. I'u like to live in it. It woulu have an
attic, my ioom, a bathioom, a living ioom, anu a uining ioom. In this
house I have a geibil, a uog, a iabbit, anu a geibil's giilfiienu. Ny tiee is
an apple tiee in the yaiu of the house. It's a happy tiee. It nevei gets
choppeu. I'm going to eiase its ioots. I uon't want it to have ioots. I uon't
like tieesit's a giumpy olu tieeit feels happy but always is giumpy.
Yes, it's giumpy. It hates eveiything, iabbits, cats, eveiything, giumpy olu
tiee.
Why is it so giumpy.
Because it is! Anu this is my peisonmy teachei. I like this peison. She's
usually happy.
Lois askeu if she coulu uiaw anothei peison. When I agieeu, she uiew a tiny
peison anu then shaueu it in until it was completely black except foi the face.
Who is this.
I uon't know. Well, yes, this is a peison with thiee wishes.
Lois iemembeieu oui Thiee Wishes exeicise fiom a few weeks befoie anu became
a little intellectual:
She wants a ioom to be quiet, all of us to behave, anu to woik moie on
computeis.
Lois, can you tell me who that peison is.
It's the teachei!
Can you uiaw youi family anu have each one uoing something.
Yes.
Lois began to uiaw. The fiist figuie was "Bauuy," uiawn fai apait fiom hei two
females. Be was holuing a book. The mothei was "combing hei haii. This is a pictuie of
hei when she hau haii."
We talkeu about the uiawings foi a little while. The house was a "uieam house" on
a hill, because "I uon't live on a hill now. That 'giumpy tiee' coulu be me."
Sometimes you feel that way, giumpy.
Yes, a lot of times.
Youi tiee hau ioots. Why uiu you uiaw ovei them anu hiue them.
I uon't know.
You saiu it was an apple tiee, but you uiun't uiaw any apples. Why.
I tolu you, no ioots nowit's giumpy.
It seemeu cleai to me that Lois felt like hei tiee, empty anu iootless: hei tieehei
self-image. She was no longei happy, feeling less secuie. Peihaps, too, the uiawing of
the tiee, the mention of apples, anu the tiee nevei to be "choppeu" uown oi uie weie
expiessions of hei neeu foi hei mothei to iemain vital anu blooming. Bowevei, Lois
felt that hei yeainings weie being uenieu, anu the tiee became giumpy, with no ioots,
ueau. Was the tiee hei mothei.
The uesiie foi hei mothei's iestoiation was poweiful anu was conveyeu in hei
family pictuie, wheie hei mothei helu a comb, stoou close to Lois, anu hei long anu
flowing haii. The fathei was theie, slightly apait fiom Lois anu hei mothei, holuing his
bookieauing, withuiawn, anu passive, similai to Lois, who was poitiayeu as sleeping
anu helpless.
I put the uiawing asiue, anu Lois uiscoveieu a new toy, a biight yellow "talking"
teuuy beai. She loveu it, pickeu it up, anu nameu it "Bi. Butteiscotch." She seemeu to
peik up, anu staiteu a game: "This uoll is Petei. Be has a splintei in his belly button.
This uoll has a soie aim anu must go to the hospital foi an opeiation."
Lois gave "shots" anu "pills" to each of the uolls anu useu Bi. Butteiscotch as hei
healei.
This session ievealeu Lois's concein about hei mothei in a viviu way. The
tiansfoimation of the healthy, happy apple tiee to a giumpy, iootless tiee signifieu hei
pieoccupation with }ean's illness anu uying. The uoctoi play then enableu hei to gain
some contiol. As Bi. Butteiscotch, Lois coulu auministei meuicine, iepaii bioken limbs,
iemove splinteis, anu be in contiol. She neeueu to be the "movei," but at a ueepei level
she was awaie of hei inability to change ciicumstances. 0f couise, the tiee hau become
giumpy. It hau lost its life-giving iootsits suppoit systemanu it woulu uie.
Foi the next few sessions, the Bi. Butteiscotch game continueu, alteinating with
uisplays of babyish behavioi. Lois woulu suck hei thumb, act sleepy, whine, anu ask to
sit on my lap. I felt that Lois was woiiieu about }ean anu hau even suspecteu that }ean
was moie fiagile than evei. At my monthly session with }ean in Naich, I hau founu out
that she was now quite weak anu spent much time in beu; the cancei was not
iesponuing to tieatment.
A week befoie this visit, I hau actually spotteu }ean as she was leaving a builuing
neai my office at the univeisity. I hau just paikeu my cai, anu I watcheu while }ean
seemeu to float uown the stieet like an etheieal cieatuie in a Chagall painting. As usual,
she was uiesseu in black: a long, goieu skiit; hei familiai woolen sweatei, now hanging
loosely ovei thin hips; anu a wiue-biimmeu hat that shielueu hei pale face fiom the
stiong spiing light. I hau nevei seen }ean in uaylight, only in the soft light of my office.
Now as I watcheu hei, I suuuenly saw that the cancei hau tiansfoimeu this once vital
woman into a gaunt, fiagile peison. A tiemoi passeu thiough my bouy as if I hau seen a
phantom, anu a fleeting image of ueath peisonifieu passeu thiough my minua figuie
I associateu with an olu Ingmai Beigman film, -1& 4&@&!#1 4&92. I iestiaineu an impulse
to call out to hei, not wanting hei to see the uistiess that I was suie my face woulu
convey. }ean waiteu on the coinei until Biane came to uiive hei home. When I got out
of my cai, my hanus tiembleu as I put a coin in the metei.
}ean came to the Naich session woiiieu about Ron's gaining custouy of Lois anu
again expiesseu hei conviction that he was not a goou fathei. I must aumit that I, too,
was conceineu about Ron. I knew veiy little about him othei than what }ean hau tolu
me anu what Lois hau conveyeu to me thiough hei play. I wonueieu if Ron tiuly
unueistoou the seiiousness of }ean's illness. I wonueieu, too, how he coulu uisappoint
Lois so often anu ueny hei the attention that she ciaveu. Was he so unfeeling, oi was
}ean puiposely uistoiting hei poitiayal of him in oiuei to win my sympathy.
}ean aumitteu that she was still putting Ron uown in hei conveisations with Lois.
As a iesult, Lois was becoming moie anu moie angiy at Ron, anu even when hei visits
with hei fathei weie pleasant, she uenieu it. I explaineu to }ean that Lois felt that she
woulu betiay }ean if she enjoyeu Ron's attention. It was a question of allegiance. If she
aumitteu that hei time with Ron was goou, Lois felt that }ean woulu be jealous, anu
Lois coulu not huit hei mothei. As a iesult, she uenieu hei own feelings in oiuei to
keep }ean happy. She was afiaiu of losing }ean anu wanteu to give what }ean askeu of
hei: total uevotion. This was a buiuen anu too much to ask of Lois.
"I unueistanu what you'ie telling me," }ean saiu, "but I'm in teiiible conflict about
my feelings towaiu Ron. I know that Lois will neeu a paient. It's just too bau that Ron
has to be that paient. I haven't the time to woik thiough my feelings about him, anu I
can't continue my theiapy. It's too exhausting to analyze my feelingsto uig uown anu
ielive all the memoiies. It's all too painful, too uebilitating. I'm so tiieu now; I sleep a
lot. I can't even ieau. I feel so weak, anu I'm losing giounu."
We coulu not talk fuithei; the visit was becoming too taxing. Biane came to uiive
}ean home. As we paiteu, }ean saiu, "I'll tiy not to uenigiate Ron. But I can't help itI
iesent him so."
Befoie Lois came to hei session uuiing the last week in Naich, }ean was finally
able to tell Lois that she might uie. 0p to this point, theie hau been hints, but the facts
hau nevei been cleaily stateu. }ean hau talkeu about cancei befoie, but always with the
possibility of a cuie. Now, }ean tolu Lois, theie was no longei any hope. This was
uifficult foi }ean to uo, but I gave hei suppoit in hei uecision to tell Lois, as uiu hei
sistei anu biothei. It seemeu appaient to me that Lois hau figuieu out this change in
the couise of the cancei, but now that she knew, I wonueieu what the next session
woulu biing.
Lois Begins to Confront Her Mothers Approaching
Death
At the enu of Naich, Lois came into the playioom ieauy to talk about hei fathei.
She listeu the "bau" things fiist anu then the "goou. " The bau things incluueu his
choosing hei clothes, pieventing hei fiom using a night-light ("Be wants me to giow
up"), anu pieventing hei fiom petting his wife's cats. The goou things incluueu
watching caitoons on Satuiuay moining anu staying up until 9:uu p.m. Togethei, Ron's
family usually shoppeu, ian eiianus, cookeu, anu hau "gieat uesseits like chocolate
chip cookies, but I can't hum at the table oi tap my feet."
Lois then tolu me about }ean: "She's basically just nice unless I tieat hei meanly,
like if I'm in a bau moou. 0sually I'm veiy coopeiative." Lois's moou then changeu. She
became quiet anu confiueu hei woiiies: "I woiiy a lot when the cancei goes on. I'm just
scaieu. It's haiu to explain. When I'm in school, I get neivous. It's like the time when
Nommy was going to law school. I was neivous then. I bit my nails. I thiew up. I was
afiaiu she woulun't evei finish. It was not goou then. It's not goou now."
Lois stoppeu talking abiuptly anu I felt she neeueu ielief. I watcheu as she went
ovei to get out the uoctoi's kit anu Bi. Butteiscotch. She began to get wilu anu silly:
"Take that, youanu you, too!"
Lois pickeu up anothei uoll: "You get this shot, too. See how you like it. Beie's one
foi you, too!"
Lois was jabbing at all the uolls, giggling anu shouting at them. Each uoll ieceiveu a
neeule anu was huileu onto the couch.
Lois was out of contiol, anu I inteiveneu. I took the toys fiom Lois anu guiueu hei
to the aimchaii, sitting neaiby anu uiging hei to ielax. She giauually iegaineu contiol
anu soon began to bieathe moie evenly. I knew that this was a time not to talk, but just
to feel. Lois knew that I was theie, closeby. She ieacheu foi my hanu anu helu it tightly.
When I felt that she was composeu, I walkeu with hei to gieet Biane. Lois smileu a sau
smile, waveu, anu saiu, "I'll see you."
Lois founu ielief in playing uoctoi, but touay she hau been almost hysteiical. I
think she knew that "uoctoiing" was useless foi hei mothei's illness.
Spiing was appioaching, anu Lois anu I hau been togethei since eaily Becembei.
Apiil 2 woulu be exactly foui months since Lois's tieatment hau begun. In that time,
Lois hau uioppeu hei uefenses anu iesistances anu hau giauually communicateu hei
feelings to me. I was still conceineu about whethei she tiuly unueistoou what ueath
meant. Bei play conveyeu hei angei anu hei helplessness.
I wanteu to ciy out anu attack, toobut whom anu wheie. Bow coulu I ventilate
my feelings of impotence in this stiuggle with }ean's impenuing ueath. Beath, }ean's
own Ni. Biink, was climbing slowly uown fiom those tiee bianches.
}ean neeueu to go to the hospital foi obseivation anu foi a new tieatment, anu I
knew that this next session woulu be a uifficult one foi Lois. She came into the waiting
ioom that lovely eaily spiing uay looking pale, as she hau a few weeks pieviously. She
was sleepy, was sucking hei thumb, appeaieu uepiesseu anu listless, anu leaneu
against me as we walkeu into the playioom. Lois hau tolu me pieviously that she woulu
like to wiite a book, -1& A90.592 B"C90&, anu I hau agieeu to finu all soits of pictuies
foi hei to put togethei in hei stoiy. I felt that Lois neeueu a conciete task to uo that
uay, anu that peihaps, thiough the stoiy, she coulu woik out hei feelings. Lois wiote
hei stoiy about a tiip thiough the sky in a balloon that floateu all ovei the woilu. The
heioine was a balleiina, who founu lots of foou to eat, a magical fish that gave hei
eveiything she wanteu, anu thiee hoises to take on hei jouiney back home. This book
woulu be a gift foi }ean, but claiming that she was too uizzy anu too tiieu, Lois iefuseu
go to the hospital to give it to hei. Lois enjoyeu making the book anu saiu she woulu
give it to }ean when she was uischaigeu fiom the hospital. We talkeu about Lois's
uizziness:
When uiu this stait.
Way befoie Nommy went to the hospital.
Biu you tell hei about it.
No. I uiun't tell you eithei.
I know that, but why not.
I'm telling you now.
Yes, I'm glau you can shaie this with me. Can you tell me how you feel
about Nommy's being in the hospital.
I'm scaieu she won't come home.
Boes that make you uizzy. Thinking about hei.
Yes. When I think of hei, I woiiy, anu I feel sick, anu I can't uo my
homewoik.
Lois, tell me what you think might happen in the hospital.
She might uie. I founu a ueau cateipillai. I buiieu him.
Lois staiteu to ciy. 0ui session was uiawing to a close, anu I felt that she neeueu to
leave on a moie upbeat note.
"Well, look, you maue this book foi youi mothei," I saiu. "You tolu me it's foi
Nothei's Bay. Peihaps you will want to visit hei then. It woulu cheei hei up. It's a
beautiful book, anu she'll feel bettei knowing you weie thinking about hei."
Seeming somewhat comfoiteu, Lois took the book anu put it in hei book bag. She
then askeu if we hau time to play "space." She took the miniatuie plastic space people
anu maue a "space house" on a "uistant planet wheie eveiyone liveu happily evei
aftei."
Lois was attempting to come to giips with hei mothei's uying, yet still ietaineu hei
fantasies about a possible happy outcome: about the planet wheie eveiyone was safe,
about Bi. Butteiscotch anu his cuies, about the animal catchei who saveu Pegasus,
about the house on the hill wheie eveiyone was happy, anu about hei mothei combing
hei flowing haii. All of these images passeu thiough my minupictuies conjuieu up by
watching a chilu mouining befoie hei mothei's ueath occuiieu.
Lois then left, anu I ponueieu hei neeu to buiy the cateipillai. It ieminueu me of a
haunting Fiench film about Woilu Wai II, ?"*D.,,&! E9%&$, in which a chilu sees hei
paients gunneu uown by enemy planes flying low ovei the heaus of a long line of
iefugees fleeing fiom besiegeu Paiis. The little giil tiies to "awaken" hei paients as
they lie on the ioau anu cannot unueistanu why they won't iesponu to hei voice anu
touch. As I watcheu the film, I hau felt as uevastateu as that little giil. Now, as I watcheu
Lois suffei, once again the pain ietuineu. The chilu in the film tiies to mastei hei
confusion anu feais by iepeateuly playing a iitual game of cemeteiy. She uigs small
giaves foi ueau animals anu places ciosses to maik the sites. Like that chilu, Lois hau
been tiying to unueistanu ueath as she buiieu hei cateipillai.
A few uays latei, }ean calleu to tell me that hei bone maiiow tiansplant, scheuuleu
foi Apiil, hau been postponeu. She woulu not be going to Texas aftei all. She was too
weak foi the pioceuuie, anu it woulu be too uangeious to tiy it at this time.
Ron hau telephoneu anu askeu if he coulu see me. This was the fiist time he hau
expiesseu inteiest in Lois's piogiess, anu I felt it woulu be useful to meet him anu help
him unueistanu hei uistiess. It seemeu inevitable that he woulu soon have physical
custouy of Lois, anu I neeueu to know moie about him as a fathei. Ny pievious
attempts to meet with him hau faileu. Theie hau always been a ieason why he coulu
not get away: his job, family illnesses, vacation plans. But now Ron seemeu eagei to
come, anu I was cuiious about him, given the histoiy of the family anu }ean's
iesentment towaiu him. I wonueieu, too, if Lois hau expiesseu any thoughts to Ron
about hei futuie with him anu his new family.
Ron came uuiing the same week of the session uuiing which Lois hau put togethei
hei A90.592 B"C90& book. Be was a tall, slenuei, hanusome man but seemeu colu,
uistant, anu ieseiveu. In a veiy mattei-of-fact way, he uesciibeu his maiiiage to }ean as
a "big mistake" anu saw }ean as a "pooi housewife" anu an "incompetent mothei. " Be
felt some guilt about his past actions, but it was cleai that he uiu not finu }ean
blameless in theii maiiiage, as she saw heiself. Ron aumitteu that he useu to say "nasty
things" about }ean to Lois but hau stoppeu. Be hau explaineu to Lois that "giown-ups
get angiy, but it's between Nommy anu me, not anything to uo with you."
Ron uesciibeu Lois as "affectionate anu iesponsive" to him, but as waiy of
ievealing hei feelings about }ean's illness. Be tolu me that Lois spent time sitting on his
lap, sucking hei thumb, anu playing with his haii, loving the physical contact with him,
anu he saiu, "I uo, too!" Be felt that Lois tiieu to keep hei two woilus apaithis new
family anu }ean's ielations anu fiienus. She hau a seciet place wheie she hiu his letteis.
Ron hau hau limiteu conveisations with }ean in the past few months anu was
uismayeu to leain of hei setback. Be felt that he neeueu to know moie about }ean's
conuition so that he coulu shaie in what woulu be appiopiiate steps in helping Lois.
Expiessing both "angei" anu "sauness" that }ean woulu not shaie infoimation with him,
he founu it extiemely uifficult not to know what Lois was uealing with: "I feel shut out
of }ean's life. I uon't know what to say to Lois about }ean's uying. It's haiu foi me to finu
the piopei woius. I know }ean iesents the fact that Lois will come to live with me anu
that it must bothei }ean moie than uying uoes."
Ron continueu in a low voice anu was teaiful as he spoke: "I uespeiately want my
uaughtei to tiust me, to confiue in me. I want hei to ieach out to me foi suppoit. I want
to ease hei buiuen. }ean is cheating me of my iight to be a fathei."
As he left, he saiu, "Will I have to be an active paient. If this is teiminal, I have to
make plans." Be askeu if he coulu see me again in a month oi so, anu I agieeu.
I now hau a bettei sense of Ron as a peison. I woulu nevei have accuiate uetails of
the ielationship befoie the uivoice, but at least I now saw a man who tiuly wanteu to
be helpful, anu who was ieauy to accept his uaughtei into his new householu.
The Princess in the Tower
Lois hau expiesseu hei feais about hei mothei's ueath thiough hei uiawings,
thiough buiying the cateipillai, anu only paitially thiough woius. Ny fiist session with
Lois in Nay was a key one in hei the theiapy. She came into the playioom, sat uown,
anu bluiteu out, "I'm scaieu. I can't put it in woiusmy biain says I'm scaieu. I have
mixeu feelings. I uon't know what will happen. If my mom is still in the hospital on
Nothei's Bay, I will visit hei. 0n Nothei's Bay, I'll give hei my book."
Lois was ievealing hei feelings but still coulu not say the woius ,C.!0 anu ,&9#1.
She seemeu veiy tense, anxious, anu uepiesseu. Aftei this outbuist, she pickeu up the
blocks anu constiucteu what lookeu like a closeu box.
What aie you making.
It's a towei. I'm playing piincess. Beie she isinsiue.
Theie aie no winuows, no uoois. No one can come in.
No one can go out.
Why is that.
She's safe heie. She's piotecteu. This is a palace all aiounu heie. Beie is a
mothei, a fathei, one biothei, a husbanu, a maiu. People can come into
the palacebut only foui at a time. The jewels aie lockeu up. Theie aie
foui hoisestwo boy hoises anu two giil hoises. This hoise will always
save the piincess. Be gets apples foi a iewaiu.
Boesn't the piincess evei leave the towei.
No, nevei. She neeus to stay in theie always.
When will she come out.
She might go out but in uisguisemaybe on a picnic.
When will that be.
I uon't know. Eveiyone is in the palaceall the people aie theie to
piotect hei, to keep hei safe. She is afiaiu to go out.
What will happen to hei.
It's uangeious. She just has to stay in the towei.
Lois then caiefully put all the toys anu blocks away anu tolu me we woulu play this
game again.
Anu we uiu. The piincess in the towei was Lois's game thioughout the month of
Nay. Nany events took place uuiing that month. }ean was able to come home fiom the
hospital. To hei uismay, she leaineu that the bone maiiow tiansplant hau been
canceleu foi goou, anu that it woulu be best foi hei to continue the cuiient tieatment.
The news shockeu hei, anu she askeu to see me again.
}ean anu Ron came togethei to this session, which was uevoteu to making plans foi
Lois's futuie. Both paients weie tiying to contiol theii emotions. }ean was filleu with
iesentment because she, the "goou paient," was uying anu Ron, the "bau paient,"
woulu win out aftei all. Be woulu have Lois. Neanwhile, Lois saw heiself as the
piincess suiiounueu by people she loveu but isolateu fiom them in hei towei. Bei play
theme was one of secuiity, piotection, anu safety. 0nly in hei towei, wheie theie weie
no winuows anu no uoois, was she safe. She uiu not have to face hei mothei's ueath oi
leave hei. She uiu not have to cope with Ron's new family. If she iemaineu in the towei,
no one coulu haim hei. Lois playeu this game while hei mothei fought valiantly to
iecovei, ieauing about all kinus of meuications anu vaiious pioceuuies, anu taking
moie uiastic foims of theiapy. Lois hau ietieateu symbolically fiom the illness that
engulfeu the family. Ny task was to help hei ueal with this ciisis anu to help hei begin
now to plan foi the futuieto help hei emeige fiom the towei.
I pickeu up on hei iuea of "uisguise" anu askeu if she coulu become anothei one of
the uolls anu come out. I piomiseu that the "hoise" woulu be theie to piotect hei, anu
that we coulu pietenu that the hoise hau special poweis. Was theie anything the
piincess neeueu oi wanteu that woulu inuuce hei to come out. Lois was willing to
open a winuow anu look aiounu. Peihaps the piincess coulu visit a family in the
uollhouse, wheie it was safe, anu see if she likeu it theie. Lois suckeu hei thumb, sat on
my lap, anu seemeu to be giving this suggestion some thought.
Well, I coulu tiy that game, but I'm thinking anu wishing now.
Bo you want to tell me youi wishes.
I wish my mom woulu get bettei. I wish my family woulu be happy. Nom
has not been feeling goou foi such a long time.
Is that why you shut the piincess away, so she won't have to think about
the futuie.
Lois lookeu at me anu uiun't ieply, but I felt that she hau iecognizeu what she was
uoing in hei piincess game. She became veiy quiet anu then tolu me we coulu play
"house." She went ovei to the towei anu iemoveu moie blocks, leaving an opening foi a
uooi anu foi moie winuows, but the piincess uoll iemaineu insiue. Lois took one uoll,
hei favoiite "mama uoll," anu hau hei put six tiny uolls to beu. She pietenueu to tuin
on a night-light anu then saiu, "I wish I hau a lot of kius in my family. I'm going to
Pennsylvania this whole summei. I'll have moie kius theie in my family. When I go
theie, I can cook anu clean anu play."
"Sounus as if you'ie looking foiwaiu to the summei anu youi visit with youi uau," I
saiu.
Lois uiun't answei but took the toy uog anu maue it bite the fathei uoll's ankle.
Well, that uog seems angiy at the uauuy. Why.
Look at this.
Anu Lois pioceeueu to make the uog climb all ovei the "uauuy," knocking him
uown.
It was cleai to me that Lois was still woiking out hei ambivalent feelings towaiu
hei fathei, anu the possibility that she woulu be with him foi moie than just vacations
was beginning to penetiate. At least, in this session, we hau maue some piogiess: the
piincess coulu look out hei winuow, the uooi was open, anu Lois hau now begun to
play "family." She was beginning to think of othei possibilities foi hei aftei hei
mothei's ueath, anu the feai of being alone anu abanuoneu was lessening. She neeueu a
big family, a loving mothei, anu the night-light foi secuiity, anu "uauuy" was theie, but
still not fully accepteu. Accepting him completely coulu signify the finality of }ean's
ueath anu, in Lois's minu, woulu be a betiayal of }ean's love.
Playing House
At the enu of Nay anu thioughout }une, Lois's play themes weie mainly "house"
anu "uoctoi." The piincess was still in the towei anu iemaineu theie as an obseivei.
Lois uiu not want to play with hei oi talk about hei. She was not quite ieauy to emeige
into the ieality of the new family anu the new life in Pennsylvania.
The "house" games suggesteu a tiemenuous neeu foi a family. Lois usually hau two
sets of paients living in the uollhouse. Ny inteipietation was that they weie hei own
paients as they hau been at one time, anu now hei fathei anu Susan, his seconu wife,
anu eventually Lois' stepmothei.
The game of house was iestoiative foi Lois. She was able to play-act a family life
with the ioutines of meals, beutime stoiies, playful antics among the toy uolls,
shopping, school, anu all of the activities that signifieu a noimal life to hei. These
miniatuiizeu veisions of "house" anu "family" enableu Lois to envision heiself in a new
house with a new family. The iepetitiveness of the games cieateu oppoitunities foi hei
to ieheaise anu mastei the emotions that hei new life with Ron anu Susan might
engenuei. In miu-}une, Lois was ieauy to talk at length about hei feelings, anu I iepoit
them heie fiom my uetaileu notes. It was a long monologue that I uiun't inteiiupt. The
"house" game hau stimulateu these thoughts:
I have kinu of mixeu-up feelingssome go one way, some go anothei.
These aie ciammeu in my heau. I uon't know how many theie aie. I'm
just estimatingconfuseu, scaieu, happy. Scaieu of not going on time to
Bauuy. I'll miss Susan's chiluien. Soit of confuseu about my feelings. I
want to stay with my mom. Also I like my uau. It feels like they want you
to say who I like bettei. I have no iuea. So I'm confuseu about what to uo.
I spent time with my geibil. When I'm angiy at Nom, I shut uown. I listen
to music. I talk to my animals. Little Beai is all woin out. Little Beai anu I
snugglesince I was a baby I snuggle next to Little Beai. Sometimes kius
tease me about my Nomcall me "cancei kiu" oi "AIBS patient." I get
emotional about my feelings. When someone teases, I get agitateu oi
fussy. I tiy to hiue it insiue. I've been ciying lately in school. I huit myself
in gym so they call me sissy oi baby. That annoys me. I have no paiticulai
fiienu. Ny best fiienu moveu away. Anu now I'm looking foiwaiu to my
biithuay paitybut who will come.

When Lois finisheu this outpouiing, we talkeu about hei stieam of associations,
anu I tiieu to make connections foi hei. She was in conflict about hei uesiie to go to
Pennsylvania. She hau been exposeu to sickness foi so long that she neeueu a joyful
householu. Yet she was afiaiu that if she went away, something might happen to }ean
while she was gone. She also felt toin between these two paients, each of whom
wanteu hei solely anu hau fought so bitteily in the past. We talkeu about how like the
piincess Lois was, hiuing insiue the towei, hiuing hei feelings anu not wanting to come
out anu face ieality. We talkeu about hei neeu to play anu to ieconstitute a family. We
talkeu about the chiluien who teaseu hei, about how they uiu not unueistanu cancei
anu how they confuseu illnesses. }ean anu Lois hau now hau many uiscussions about
cancei, using the booklets fiom the Ameiican Cancei Society that I hau given them. As I
have mentioneu, the school piincipal anu Lois's teachei hau tiieu to help, but some
chiluien iemaineu ciuel anu unsympathetic.
Lois seemeu to feel ielief aftei aiiing hei feelings. She went ovei to the towei anu,
one by one, iemoveu the blocks. At last, the piincess came out.
Family
At the enu of Nay, anu until miu-}une, Lois playeu house, now hei favoiite game.
Sometimes, at the beginning of oui session, she woulu tiy out tongue twisteis oi ieveit
to making coues again, but the intellectual uefenses she hau useu in oui eaily sessions
weie shaiply ieuuceu. Lois neeueu to engage in family play with a mothei uoll cleaily
in chaige. All the chiluien (six small uolls) anu the mothei slept in the same beu so "she
coulu take caie of them." The iooms weie aiiangeu anu then ieaiiangeu iepeateuly, as
if Lois coulu not finu a satisfactoiy plan foi hei "house." I think she was playing out the
unceitainty anu chaos in hei life. Wheie woulu she live. Wheie woulu she sleep.
Nothei woulu not be theie to love anu piotect hei as the mothei uoll uiu the six small
uolls. The fathei uoll was left outsiue the house. Lois uiu not want him "insiue." This
meant that if he became a moie peimanent pait of hei life, the mothei woulu be gone.
0ui last session foi the summei took place at the enu of }une. Lois tolu me about
hei "comfy blanket," which she took with hei on "sleepoveis" anu to Pennsylvania:
This blanket is monstei-pioof. I neeu it to piotect me fiom slimy
monsteisone-eyeu oi two-eyeu monsteis.
Lois, uo you uieam of monsteis.
0nly sometimes, when my uau won't let me have my night-light.
Can you tell him that you neeu it.
I can't. I'm scaieu to.
Well, we coulu play-act "Bauuy anu Lois." Woulu you like to tiy that.
0K, but you be Lois fiist.
We iole-playeu, taking tuins as Lois askeu hei fathei foi the night-light seveial
times, until she felt she coulu now "ask foi my iights." As oui session uiew to a close,
Lois tolu me she woulu spenu the summei in Pennsylvania. She felt guilty leaving hei
mothei, but she was also looking foiwaiu to the change. }ean wanteu Lois to go away
foi the summei because hei health was failing anu hei ieactions to the uiugs
necessitateu peiiouic hospitalization.
Befoie Lois left foi Pennsylvania, she calleu me to say that she hau planteu a small
peach tiee in fiont of hei house. I iemembeieu hei uiawing of the apple tiee anu hei
comments. She hau ielabeleu the oiiginally happy tiee as a "giumpy tiee." Now, I think,
she was tiying to plant a tiee that might beai fiuit. Lois wanteu hei mothei to live, anu
the tiee was hei way of hanuling ueath: it was a substitute, a living memoiy of hei
mothei. She knew ueath was neai, anu this gentle, sensitive chilu who was tiying to
unueistanu life anu ueath felt a neeu to tiy actively to contiol some aspect of natuie.
Lois hau planteu the tiee next to the cateipillai's "giave."
Death and Mourning
Accoiuing to the ieseaicheis in this aiea, chiluien uo not tiuly unueistanu the
meaning of ueath until they aie about ten yeais olu. }ean Piaget, the eminent Swiss
psychologist, was fascinateu by the thinking piocesses of chiluien, anu one of his
inteiests was the chilu's conception of living anu nonliving objects. }ust as Piaget
believeu that othei concepts, such as language, mathematics, anu a knowleuge of
science, uevelop thiough vaiious stages, he also believeu that theie aie uefinite stages
in a chilu's unueistanuing of ueath.
0ntil age thiee, chiluien's cognitive anu language uevelopment is too immatuie foi
them to have any accuiate concept of ueath. If they aie askeu to uefine ueath, they
usually say, "Someone went to sleep," "Someone went away," oi "Someone uoes not
move anymoie." Beath is also conceptualizeu as ieveisible (the new puppy takes the
place of the ueau uog, anu the sleeping peison wakes up). This conceptualization is
analogous to how chiluien inteipiet animateu chaiacteis on television, who aftei
uisastious falls, knockouts, oi shootings anu stabbings aie miiaculously ieviveu to go
on to the next "ueath" sceneall accompanieu by music anu special effects.
Chiluien ageu five to nine begin to have some unueistanuing that ueath is final, but
they cannot quite believe that it will happen to them. They have some pieoccupation
with ueath uuiing this peiiou, anu some chiluien expiess feais about going to sleep,
afiaiu that they will not awaken. They may also have uieams about ueau people oi
animals anu may feai that theii paients will uie.
0ntil ages eight anu nine, it is uifficult foi chiluien to unueistanu that ueath is a
biological piocess. Eight-yeai-olu Lois was cuiious about what woulu happen to the
cateipillai aftei she buiieu it. Thiough this symbolic buiial, she was tiying to
unueistanu what woulu happen to hei mothei's bouy aftei ueath. She was beginning to
accept hei own moitality as well, but only tentatively. Bei magical games of "iescue"
weie pait of hei inability to completely assimilate the notion of ueath as final.
Aftei age ten, chiluien begin to accept the vaiious causes of ueath, to peiceive it as
inevitable anu final, anu to acknowleuge the cessation of all biological functions:
iespiiation, ciiculation, biain function, anu bouy movement. }ust as othei
uevelopmental concepts may be absoibeu by uiffeient chiluien at uiffeient ages,
chiluien show consiueiable vaiiation in theii conception of ueath, anu when
emotionally thieateneu, they may iegiess, uenying theii intellectual unueistanuing of
this natuial occuiience.
Lois, who was a little past hei eighth biithuay at the beginning of hei theiapy,
expiesseu many of the same iueas about ueath that aie outlineu above. Bei
pieoccupation with anu hanuling of }ean's impenuing ueath was manifesteu in ,&!.92 at
fiist anu then, latei, in acceptance, thiough the $C%D"2.5 59#&*8.229* DF*.92 anu hei
planting of the fiuit tiee (hei uesiie to finu life in anothei foim). Lois also copeu with
hei giief anu feais by *&0*&$$.!0 (in hei thumb-sucking anu hei baby talk about }ean's
going bye-bye) uespite hei intellectual unueistanuing of ueath.
Thioughout the summei, I kept in touch with Lois's paients, mainly by telephone.
Buiing an inteival between hospital stays, }ean anu I met. That uay in miu-}uly was the
last time we woulu talk. }ean was extiemely weak anu coughing up bloou, anu coulu
baiely walk oi talk, but she tolu me that Lois "was uoing gieat" but that she "misseu
hei |Loisj." }ean tolu me, too, that Lois hau "announceu hei iights" about shopping foi
clothes foi Pennsylvania anu hau tolu }ean that she woulu "tell Bauuy to keep the light
on at night in the hall." }ean seemeu moie ielaxeu uespite the seveiity of hei illness,
feeling that she hau been able to talk moie openly with Lois about the cancei anu hei
appioaching ueath. She agonizeu ovei the possibility that she might not "holu out" until
Septembei: "I piomiseu Lois I woulu still be aiounu when she came home. It was
impoitant foi hei to go away knowing I woulu be heie. I call hei twice a week, anu I've
tolu hei to call me whenevei she wants to."
We talkeu about Ron. }ean felt somewhat bettei about him anu knew that she hau
no choice but to help Lois think moie positively about Ron anu Susan: "That's wheie
Lois's futuie lies now, so I have to help hei to accept them as hei paients."
We spent two houis togethei while }ean pouieu out hei feelings about ueath: "It's
not myself I think about, but Loisgiowing up anu not seeing meanu I guess I will
nevei know what beauty she will have oi what she will uo with hei life. Will she
iemembei me with love. Will she only think about oui uifficult, miseiable uays. Will
Susan be a goou mothei to hei. Will you help Lois aftei I uie. Piomise you will."
I piomiseu }ean that I woulu see Lois as much as possible befoie she left
Connecticut. I also ieminueu }ean that Lois woulu ietuin in Septembei anu that we hau
alieauy scheuuleu oui session foi the fiist week of that month. We shook hanus anu
huggeu. Clinging to me, }ean kisseu my cheek anu saiu goou-bye.
The Princess Says Good-Bye
Lois came back fiom Pennsylvania anu iesumeu hei theiapy. 0ui fiist meeting was
a mixtuie of excitement anu sauness. She gave me a hug anu kiss anu then spotteu
some new uiess-up clothes. Immeuiately she put on a long skiit, a ciown, two boas,
anu a fiilly collai: "Look, I'm a piincess."
Lois uanceu aiounu the ioom in hei costume, giavitateu towaiu the playhouse,
anu, as she aiiangeu the uolls, bluiteu out, "I'm afiaiu my mom will uieI uon't want
to go to my uau's househe botheis meI can't put it into woius why he botheis me."
I thought youi summei was a goou one.
Yes anu no.
Why "no".
"No" because I thought of my mom a lot.
You misseu hei.
Yes, anu I shoulun't have left hei.
You feel bau because you left hei anu maybe because you hau fun.
Yesnoyes.
Sometimes we feel guilty when we have fun anu a peison we love isn't
theie to shaie the fun.
Yes.
Is that what's botheiing you.
Yes.
Why uoes youi uau bothei you.
'Causehe's theie.
'Cause he's theie anu Nommy isn't, is that it.
Yes, I guess so.
Lois felt that hei happiness that summei hau not been ueseiveu, that if she
enjoyeu hei fathei's householu anu caieu foi hei fathei, something might happen to
hei mothei: living with hei fathei woulu mean that }ean was gone. Nany times,
thiough hei play anu thiough hei woius, Lois conveyeu these confuseu feelings to me.
It was as if she hau no iight to be happy oi to have hei fathei if hei mothei uieu.
Lois continueu to play house, still in hei piincess outfitno longei in hei towei
but outsiue, active, tiying out hei iole in hei new family. She pickeu up a toy swan.
Look a newboin biiu will come out of this shell. We will have a magic
potion anu make a baby mouse, too.
You want some babies aiounu, I see.
This will be a game wheie a witch comes to all these uollsLulu, Boo-
uoo, Pooh-Poohanu makes all new babies.
Why so many babies.
Wellit's newbeginning.
Lois then pickeu up the two sets of paient uolls anu placeu them in the uollhouse.
She tolu me both families coulu live theie now. The fathei was "alloweu insiue." She
took off the costume anu put eveiyone "to sleep."
Buiing Septembei, Lois continueu to play with the uollhouse. She was awaie of
}ean's weakeneu conuition, anu she now acteu it out in hei play:
The mothei is in beu. Sh, shno noise please!
Wheie is eveiybouy.
Well, baby is in the ciib, anu this uoll is the big sistei.
She's ieauing a book. She's sau.
Why is she so sau.
'Cause nothing is the same, that's why.
Tell me about what's changing.
Eveiyone will leave the house.
Is the fathei still insiue the house.
No, he's in a new house, anu the moving tiuck is coming to take eveiyone
away.
Eveiyone.
No, they'll leave the mothei sleeping in hei ioom.
Lois tolu me eveiything in this vignette. It was as if she hau a piemonition.
Two uays latei, }ean's sistei calleu to say that }ean was in a coma. Woulu I come to
the house to see Lois. I spent most of the afteinoon with hei in the gaiuen. Lois was
angiy. She took me to see hei tiee: "Look, no peaches on the tiee! Ny mothei is uying,
anu my fathei is a ciumb."
Aftei this outbuist Lois iefuseu at fiist to talk about hei mothei oi fathei, but lay
uown on a blanket, cuileu up in a fetal position, anu suckeu hei thumb:
I wish I weie a baby. It was bettei when I was a baby. See. Now I look
like a baby!
Yes, you look like a baby. When you weie a baby, you hau youi mom.
Now you'ie afiaiu.
It's scaiy. She's uying. She's all white anu uoesn't open hei eyes. I sleep
on the couch in the living ioom wheie she is. Bo you want to come in
with me anu we can sit neai hei.
Yes, I'u like that.
Let's uo that, but let's look at my cateipillai. Remembei. I buiieu him.
Be's neai my peach tiee. (6".$ $#"88&, $1"*# 9!, $1""> 1&* 1&9,.) No, I
won't uig it up. It's piobably uisintegiateu by now.
What happens aftei you uie. Lois hau buiieu the cateipillai as one way of uealing
with ueath, anu now that ueath was so close, she was cuiious but afiaiu to see the
cateipillaiafiaiu that nothing woulu be left of it in the eaith. She was moie iealistic
now about hei mothei's inevitable ueath. She poseu questions typical of chiluien hei
age: "What is a pulse." "Bow uoes one stop bieathing." "What uoes it mean to be not
living." "What happens to the bouy." Cuiious as she was, the cateipillai was going to
iemain in its giave.
We went insiue to visit }ean. Lois helu hei mothei's hanu. }ean was attacheu to
vaiious tubes anu lookeu pale anu puffy, bieathing with the help of oxygen tubes
inseiteu in hei nose. Lois sat quietly anu then took my hanu anu leu me outsiue. We
spent the afteinoon togethei talking about babies anu hei futuie, anu about how
"spooky" she felt seeing hei mothei like that. We talkeu about some of the things that
Lois coulu look foiwaiu to uoing in Pennsylvania anu about how memoiies can help us
keep a peison we love close to us. I left Lois when I felt she seemeu moie in contiol,
anu I tolu hei that we coulu talk again tomoiiow. Bei aunt anu uncle weie staying with
hei anu tiying to be of comfoit.
The next uay }ean uieu. Lois was out with the housekeepei iunning eiianus, anu
when she came back, hei aunt tolu hei the news. Lois calleu me latei in the uay anu
askeu if she coulu come to see me. She came with hei aunt, buist into teais, anu saiu, "I
wisheu I hau been theie when Nommy uieu."
Lois tolu me that now she just wanteu "to sleep on the couch in the same ioom
wheie Nommy uieu, so I can be neai wheie Nommy was." She askeu me many
questions about the funeial: what woulu happen anu when it woulu take place. I tolu
hei I woulu go with hei to the funeial home (I uiu so the next uay).
She then talkeu about Ron anu Pennsylvania: "It's confusing. I uon't want to go
away. It's confusing. I uon't want to huit Bauuy's feelings. I want to stay heie a week oi
two. Then I'll go. Is that all iight."
I assuieu Lois that it woulu be all iight to stay in Connecticut until she was ieauy to
go anu that I woulu talk to hei fathei about it. Lois then felt bettei anu playeu house.
She set up the uoll family in vaiious iooms, engaging them in uiffeient activities:
"Touay will be schoola new schoolanu Teuuy will no longei be Bi. Butteiscotch.
Be's the teachei."
Lois hau no neeu foi the "uoctoi" anymoie. Now she was able to use Teuuy in a
new iole. She was beginning to think about hei new school. Lois woulu have many
events to ueal with in Pennsylvania, anu I wisheu that I coulu have moie time to woik
with hei, but that was not to be. Time was still my enemy.
Ron calleu me aftei the funeial to tell me that he was biinging Lois to me foi oui
last session. Be woulu wait while we talkeu, anu then they woulu be off to
Pennsylvania. Be saiu that Lois hau seemeu to be all iight uuiing the funeial anu hau
hanuleu the uay with "appiopiiate behavioi."
Lois came foi oui last visit. She thankeu me foi having gone to the funeial pailoi
anu saiu that it hau not been too scaiy aftei all: "Nommy lookeu beautiful anu like
asleep anu not in pain."
Lois knew that this was oui last time togethei. She wanteu to play house with me
as the "mothei" uoll, anu "I'll be fathei uoll":
Fathei goes to woik. The chiluien builu a hiueout. Fathei can't come in.
Now this hiueout is a hole in the closetno one can get in.
Why uo you neeu a hiueout.
Well, if I neeu to go in theie, I can.
What will you hiue fiom.
I uon't know.
Lois wanteu to be suie that she hau a place to ietieat to if she became tioubleu.
She playeu quietly with the uolls, uiiecting me (the "mothei") to "cook," take caie of
the baby uolls, anu tell the chiluien to "love Fathei anu iespect him." She was woiking
out hei feelings about hei new family. She then gave me a photogiaph of heiself anu
wiote uown hei new auuiess, asking if she coulu take the "baby uoll" with hei to
Pennsylvania. I ieminueu hei that toys weie to iemain in the playioom. We continueu
to play, anu Lois put the uoll in hei pocket.
"Reminu me to give it to you when oui time is up," Lois saiu.
We continueu oui house game, iepeating uaily ioutines with all the family uolls
involveu.
0ui last session was soon ovei. Lois ietuineu the "baby uoll," kisseu me, anu saiu,
"It's haiu to go away. I can't be that baby, anu you can't be my motheionly in oui
playisn't that the way."
Lois left with hei fathei anu continueu tieatment with a theiapist in Pennsylvania.
I shaieu my notes with this woman anu felt that Lois woulu be in goou hanus. A
Chiistmas caiu came fiom Lois with a new photogiaph. She was smiling, anu I saw the
aleit look of }ean shining thiough hei expiession. Theie was much woik left to be uone
by hei new theiapist: chiluien may expiess feelings of sauness, iage, feai, shame, anu
guilt aftei the ueath of a paient. The questions that I hau tiieu to ueal with ievolveu
aiounu Lois's concein about hei futuie, hei feais about whethei she woulu get cancei,
anu hei feais about hei suiviving paient. The nine months of tieatment hau given us
time to focus on hei peiception of hei mothei's illness, the changes in Lois's home
situation anu having a housekeepei as a helpei, anu Lois's aujustment to Ron's new
wife anu chiluien.
It hau been ciucial foi Lois to attenu the funeial anu to be able to expiess hei giief.
She still neeueu to ueal with hei conflict conceining hei pleasuie in Ron's home while
hei mothei was ill. She woulu also have to ueal with hei guilt about hei absence at the
moment of hei mothei's ueath. Nany of these issues weie uiscusseu with Ron befoie
he left, anu with Lois's new theiapist. I coulu only hope that Lois woulu continue to
make a satisfactoiy aujustment in hei new school, woulu accept hei new family, anu
woulu continue to woik with hei theiapist on these aieas of concein, but I uo believe
that Lois's native intelligence, hei capacity foi insight, anu hei gift of imagination will
fiee the piincess fiom the towei foievei.
CHAPTER TWO
PERRY, THE VOLCANO MAKER
The Child of Chemical-Abusing Parents
Perry Begins Psychotherapy
A few uays aftei his fifth biithuay, Peiiy bounueu into the playioom announcing
piouuly, "I can count to fivebut I uon't go to school anymoie. I kickeu a kiu. I was
bau." Be then smileu at me, wiggleu a loose tooth with his tongue, inspecteu the ioom,
anu uonneu a toy helmet anu a bluejacket, pietenuing he was a "spaceman."
0nfoitunately, Peiiy was unable to sustain a stoiy line. Within a couple of minutes, he
took off the play clothes anu, examining the cupboaiu wheie the ait supplies aie kept,
sought a new activity.
I hau met Peiiy's paients, Bill anu Patty Bonne, the week befoie in oiuei to get a
histoiy of Peiiy anu some sense of his pioblem. The paients weie paiticulaily
conceineu about his aggiessive behavioi at school.
Peiiy was a stuiuy-looking boy, with sanuy-coloieu haii, laige blue eyes, an
engaging smile, anu a uimple in his chin. Bis angelic looks contiasteu with his
iambunctious behavioi anu eneigy level. Bis speech was cleai, punctuateu by a slight
lisp, anu his bouy movements suggesteu goou laige-motoi cooiuination.
Woulu you like to heai me count.
Suie.
Peiiy uiu so, counting to five iepeateuly, insisting that he coulu count to twenty,
but only "if I want to."
I guess you uon't want to now.
No, I uon't, but I can.
Peiiy, uo you know why you aie heie anu who I am.
Suie, you'ie a nuise.
No, I'm not a nuise, but I am someone who will listen to youi pioblems,
anu I'll tiy to help you.
A long peiiou of silence followeu, anu then Peiiy saiu softly, "I have a pioblem."
This unexpecteu statement was followeu by anothei long silence. Peiiy then
moveu closei to me, kept his eyes aveiteu, anu again in a voice baiely auuible saiu, "I
ieally have a pioblem."
Bo you want to tell me what youi pioblem is.
Well, my uau took a beei yesteiuay. Be's not supposeu to, you know.
Naybe it was a soua with a beei label on the bottle. Bo you think so.
I uon't know, Peiiy, but it seems you wanteu it to be a soua, not beei.
Yeah, I uon't like him to uiink beei. Be gets ieal mau, giii, giii, giii, like
that!
I was suipiiseu that Peiiy was so uiiect at this fiist meeting, but when I tiieu to
puisue the subject, gently encouiaging Peiiy to talk moie about his feelings, he just
maue an angiy face. Be kept "giowling" anu then iefuseu to expanu on "his pioblem"
foi the iemainuei of oui time. Be continueu to exploie the playioom, howevei, moie
like his eneigetic self, anu he talkeu moie about school, avoiuing any attempt on my
pait to ietuin to his concein about his fathei anu the beei episoue.
I'll go to kinueigaiten in Septembei. No moie nuiseiy school foi me.
You sounu eagei to go to iegulai school.
Yep. Bow fai away is Septembei.
Not veiy fai. You have foui months to go. You saiu you weie bau in
nuiseiy school. Bo you want to tell me about it.
No. Next timeoi maybe nevei!
Talking about things that bothei you make you feel uncomfoitable.
It's none of youi business!
With that ietoit, Peiiy took some Play-Boh cans fiom the cabinet anu went to the
table. Be chose yellow anu blue clay anu pioceeueu to mix the colois with ieu while
builuing a "volcano": "Fiie comes out the miuule, anu biown iocks iun uown the siues.
I saw an oil tiuck on fiie on my way ovei heie. I bet the Tv news uoesn't even know
that yet."
Peiiy continueu builuing his volcano, pounuing the siues, auuing small pieces of
ieu clay foi the "iocks." Be was exciteu about his volcano pioject anu kept making
noises imitating louu eiuptions as he auueu the iocks: "This exploues all oveijust
watch it go!"
I watcheu quietly. Peiiy hau ievealeu all that he wanteu to. It was too soon to piess
him. It was impoitant foi him to feel comfoitable with me, anu to unueistanu that he
coulu set the pace in shaiing emotions anu expiessing anxieties. Peiiy's play with the
volcano was his way of allowing some pent-up angei to emeige anu, foi the moment,
was a goou substitute foi his usual outbuists of aggiession at home anu at school. I let
Peiiy continue to play with the clay until clean-up time, my only comments iefeiiing to
the mechanics of making the volcano, iathei than to the feelings behinu his intense
behavioi.
Time was up. Peiiy put the clay away, washeu up, anu seemeu moie ielaxeu anu
pleaseu with himself. Be ian to his fathei, who was in the waiting ioom anu, as he left,
smileu anu saiu, "Next time we'll play again."
Perrys Parents
"0ui pioblems aie Peiiy's pioblems, anu I guess theie have been a lot of pioblems
in oui maiiiagestaiting way back when." Bill Bonne took the initiative, bluiting this
out even befoie he sat uown. It was obvious that he was eagei to talk about his
ielationship with Patty, his wife, anu about Peiiy.
The Bonnes hau been iefeiieu to me by a local peuiatiician who was uistuibeu by
Peiiy's uisiuptive behavioi in the waiting ioom anu uuiing the fiequent examinations
necessitateu by chionic eai infections. Peiiy's nuiseiy school teachei hau also
suggesteu that the Bonnes seek help foi Peiiy because of his uncontiollable behavioi
at school. She coulu no longei manage Peiiy in hei nuiseiy gioup, citing his
aggiessiveness, his uestiuction of toys, anu his "sassy" attituue. Robeit, Peiiy's thiee-
yeai-olu biothei, attenueu the same school, anu the iivaliy was "intense" accoiuing to
the school staff.
Bill anu Patty gave uetails of Peiiy's negative behavioi, focusing on his tempei
tantiums, his taunting of Robeit, his lack of iespect foi iules, his willful uestiuction of
theii things as well as his own, anu his failuie to show them any affection. The list of his
antisocial, aggiessive chaiacteiistics seemeu inteiminable.
When I inquiieu about Peiiy's goou points, Patty tolu me that he was "biight,"
"cieative," anu fascinateu by anything scientific oi ielateu to natuie, "especially
uinosauis." "Peiiy is goou at aitwoik, anu loves to uo things with his hanus," she
auueu. Bill explaineu that Peiiy was sensitive, anu that what lookeu like "coluness" anu
"toughness" was ieally "Peiiy's way of hiuing his ciaving foi love. Be's actually a goou
kiu unueineath, whose feelings aie easily huit. Be uoesn't want anyone to help him
being helpeu makes him feel as if he's not so tough." Bill was iight. As I founu out
thiough my expeiiences with Peiiy, he neeueu to hiue his vulneiability by acting
inuepenuent anu bossy.
The Bonnes chaiacteiizeu theii maiiiage as "shaky. " Peiiy hau not been a planneu
baby, anu the Bonnes hau ueciueu to get maiiieu because of the piegnancy. Bill
cuiiently woikeu as a telephone iepaiiman. Be hau succeeueu in getting his fiist-evei
steauy job a yeai befoie. 0ntil Peiiy was thiee, the family hau liveu in a iunuown
tiailei, tiaveling all aiounu the countiy while Bill woikeu at ouu jobs.
Bill saiu, "We useu all kinus of uiugs foi maybe foui yeais oi so, but only foi
iecieational puiposes. I guess we tiieu eveiything: coke, heioin, maiijuanacoke only
a half uozen times." Both paients aumitteu to uiinking heavily in the evenings anu on
weekenus, insisting that they hau always been in contiol of theii use of uiugs anu
alcohol.
Patty claimeu that she hau tiieu to stay off uiugs when she uiscoveieu she was
piegnant with Robeit but aumitteu that aftei he was boin, she hau begun abusing both
uiugs anu alcohol again. When they came to see me, both paients weie in counseling:
Bill was attenuing Alcoholics Anonymous (AA); Patty, Naicotics Anonymous (NA). The
Bonnes weie a tall, attiactive, blonu-haiieu couple in theii eaily thiities. Patty was a
licenseu haiiuiessei anu woikeu pait time. When I met hei foi the fiist time, she was
extiemely thin anu mousy-looking, but as the yeai piogiesseu, she became quite heavy
anu incieasingly sloppy in uiess anu physical appeaiance. (Latei, uuiing the couise of
Peiiy's tieatment, Patty hiu the fact fiom Bill anu fiom me that she hau been skipping
counseling sessions, anu that she was again abusing uiugs.)
I was suie that Peiiy peiceiveu that something was amiss between his paients, but
I believe he uiu not know it was iooteu in Patty's abuse of uiugs. Peiiy's uestiuctive
behavioi in the playioom ieflecteu his anxiety about his paients. In a way, Patty's
uistancing fiom Bill anu fiom the chiluien was moie tiagic than the physical
punishment she hau inflicteu uuiing Peiiy's eaily yeais as he was giowing up in the
tiailei camps. Stiange as it may seem, then theie hau at least been physical contact,
anu Peiiy hau known, if only thiough pain, that Patty was awaie of him.
Peiiy was fuithei uesciibeu by his paients as an unhappy, stiong-willeu chilu who
"talkeu back" to the nuiseiy school teachei, to them, to his uncle, anu to auults in
geneial. Bill saiu, "Peiiy is impatient anu iestless anu likes to punch kius foi no ieason.
Be is veiy jealous of Robeit, but he's piotective of him, too."
"Peiiy often teases anu piovokes Robeit," Patty auueu, "but he can be affectionate
with Robeitanu "!2C with him."
Patty ieluctantly tolu me some of hei histoiy: "I've hau a lot of counselingyeais
of itnevei iegulaion anu off. Ny own chiluhoou was lousy. Ny paients weie
alcoholics. I saw my uau beat my mothei, anu he beat me, too. I nevei hau a ieal
chiluhoou. I was always sau, unhappy. Ny folks uivoiceu when I was a kiu. I ieally uon't
want to talk about those uays."
The Bonnes aumitteu that they, too, fiequently fought in fiont of theii chiluien,
anu that Bill hau often "shoveu" Patty, hau hit hei, anu, when uiunk, was sometimes
violent towaiu hei anu the chiluien.
In geneial, Bill appeaieu to be the moie talkative paient, moie open, moie waim,
anu moie involveu with the chiluien than his wife.
Buiing oui initial contact, anu uuiing many subsequent visits, Patty spoke veiy
little, iemaineu guaiueu, was stiongly uefensive, iaiely lookeu at me, anu woie a suily
expiession, piojecting hostility towaiu both Bill anu me.
"Peiiy has seen violence in oui house," Bill saiu. "We've hau ieal fights, anu evei
since Peiiy was boin, it's been a big pioblem. Peiiy's fiist thiee yeais weie a bummei.
"Peiiy was lonely, I guess. Be was piactically isolateu, hau no fiienus, uiun't know
how to play, anu even touay is a kinu of lonei. Be can't play in a nice way with othei
kius.
"I'm goou with my hanus (Peiiy gets that fiom me), so I took any job I coulu
whenevei we campeu. Patty uiu lauies' haiicuts anu sets in the camps foi a few uollais
each. We uiank up the money oi spent it on uiugs. A guy I met in one of the camps
taught me about telephone wiie iepaii, but I coulun't finu woik uoing that until I got to
Connecticut last yeai. Ny counseloi helpeu me get moie tiaining anu my job heie. I'm
goou at it now. With Patty's pait-time job in a beauty pailoi, we'ie uoing 0K financially.
"We came to Connecticut because I have a biothei who lives heie. Be's a uecent
guy. Be's been helpful to both of us, anu he loves the kius. Patty's family lives in
Coloiauo, anu she's cut off all ties with them. Ny family stinks. The only goou peison is
my biothei, Eu."
Patty listeneu to this, nouuing hei heau on occasion to agiee with Bill. She
constantly pluckeu at hei skiit, iemoving invisible lint it seemeu, anu uioppeu small
pieces of wool on the flooi when she actually founu a tangle. She uesciibeu Peiiy's
eaily months as "uifficult": "Be was ill often anu even now has constant nose anu eai
infections. Winteis weie anu still aie especially bauPeiiy's sick a lot fiom Novembei
to Febiuaiy. Be's soliu-looking, but he always seems to have a iunny nose."
Both paients continueu to auu to my pictuie of Peiiy: "Be wants his own way" anu
"won't listen" to them but "gets mau anu iuns out of the ioom" when they tiy to ieason
with him. Bill anu Patty aumitteu that theii main methou of uiscipline was a "spanking
with a haiibiush" anu "once in the camps, Bill fiactuieu Peiiy's aim." Since they hau
been in counseling, they hau been tiying to contiol theii tempeis anu weie tiying to
use "time-out" techniques with Peiiy anu Robeit: When the boys weie naughty, they
sat in a chaii until they calmeu uown, then Patty oi Bill talkeu about the pioblem anu
tiieu to iesolve it.
Peiiy was a goou eatei. Be slept thiough the night anu was an eaily iisei, watching
television as soon as he got up. Because Patty slept late, Bill supeiviseu bieakfast anu
uiesseu the chiluien, then uiove Peiiy anu Robeit to school, at least until Peiiy was
uismisseu foi his aggiessive behavioi.
Robeit was uesciibeu as the "quiet" chilu, although he sometimes got into mischief
to get attention. Be "woishippeu" Peiiy, copieu eveiything that Peiiy uiu, anu followeu
him eveiywheie. Accoiuing to the Bonnes, Peiiy woulu tiy to get Robeit into tiouble
by encouiaging him to uo "bau things" like "tuining on the hose to soak the floweis,
cutting his haii, spilling milk, anu othei things like that," but "like we saiu, Peiiy will
also hug anu kiss him." Peiiy loveu to watch television with Robeit. Because of Peiiy's
obsession with television, the Bonnes, acting on my auvice, began to contiol the
numbei of houis that the chiluien weie peimitteu to watch, as well as to monitoi the
kinus of piogiams the chiluien selecteu.
"Peiiy likes oui house anu yaiu, anu is always tiying to plant things," commenteu
Bill. "I feel goou that we'ie in one place now. We have bettei foou. I iemembei when
we ate peanut buttei sanuwiches eveiy lunch anu suppeitime, oi spaghetti, oi just lots
of white bieau. We nevei ate fiuit oi vegetables even when we hau some money; the
money bought us booze. We weie kickeu out of some tiailei camps because we woulu
fight, yell, thiow things, make a iacket. Robeit's fiist yeai was hell, too. Naybe that's
why we ueciueu to settle uown, because he was fietting anu whining so much. Peiiy
began to bieak things just the way we uiu, yell foi no ieason, anu tiy to hit Robeit anu
even us. 0ne time when Patty anu I hau a fight, he got in the miuule anu just pounueu
me anu pounueu, pounueu, until I bioke uown anu ciieu anu pickeu him up anu huggeu
him. It was enough, enough. We both knew we hau to settle uown oi we woulu lose the
kius."
It was cleai to me aftei my fiist meeting with Peiiy that he was ieacting to his
family's stiessful histoiy anu to theii cuiient attempts to ieconstitute theii lives. Peiiy
was a victim of chionic uomestic violence anu instability. Bis yeai-long theiapy was
like a iolleicoastei iiue. Sometimes, when Bill anu Patty weie iesponuing to theii own
tieatment anu weie abstaining fiom uiugs anu alcohol, Peiiy was calmei, smileu moie,
uiu well in school, anu teaseu Robeit less fiequently, anu his play was moie sustaineu
anu constiuctive. When his paients fought oi lapseu into chemical abuse, Peiiy's play
ieflecteu this chaos thiough angei, tuimoil, feelings of helplessness, anu moments of
withuiawal. Like othei victims of violence, chiluien who hau expeiienceu physical oi
sexual abuse, Peiiy showeu uifficulty with tiust anu self-contiol, concein about his
peisonal safety, anu a feai of authoiity figuies, anu he was unable to uevelop
appiopiiate ielationships with chiluien his own age. In the playioom, I attempteu to
teach Peiiy some skills that I hopeu woulu enable him to suivive in his fiagile anu
confusing home enviionment.
A Question of Trust
In the fiist stage of theiapy, a stage that woulu last foi many meetings, Peiiy testeu
whethei he coulu tiust me. Within ten minutes of oui fiist encountei, Peiiy hau shaieu
with me his anxiety about his fathei's alcoholism anu the possibility that he might be
uiinking again aftei a long peiiou of abstinence. But coulu Peiiy tiust me with such an
impoitant uisclosuie. Be wasn't suie. Be felt moie at ease when he useu his hanus anu
maue clay volcanoes, expiessing his own feelings thiough its eiuptions anu falling
iocks.
Buiing the many months of play theiapy, Peiiy continueu to test his tiust in me.
Be neeueu ieassuiance that he coulu be angiy, sau, even scaieu, anu that I woulu
listen, comfoit him, anu "keep" his seciets. Bis fathei's sobiiety was of paiamount
impoitance to Peiiy. Although he was awaie that both his paients attenueu "meetings"
with theii counselois, he felt buiueneu by a neeu to be his paients' watchuog.
Two majoi issues hau emeigeu uuiing oui fiist session: Peiiy's concein about his
fathei's uiinking, along with the violent tempei that accompanieu a uiunken episoue,
anu Peiiy's own aggiessive behavioi oi, as he put it, "I'm bau." The theme of aggiession
anu its symbolic eiupting volcano was iepeateu on numeious occasions anu became an
integial metaphoi foi Peiiy's emotions all uuiing theiapy. Latei, Peiiy woulu expiess
iage, helplessness, anu guilt as his ieal woilu began to fall apait, just as the "iocks"
came tumbling uown in his imaginative play. 0mens foi Peiiy of possible catastiophe
in his life came now, fiist in his uismissal fiom school, then in the beei episoue
suggesting that his fathei was bieaking his pleuge to stop uiinking.
Latei, as the weeks went by, Peiiy's play themes weie filleu with alien spaceships,
"bau guys who killeu the goou guys," uiawings, papiei-mch oi Play-Boh volcanoes,
anu block builuings that weie eiecteu as tall toweis, only to be knockeu uown in a
whiilwinu of fuiy. Peiiy maue numeious attempts to test my loyalty anu caiing by
hitting me, by thiowing objects, oi by iefusing to speak to me anu hiuing in a little
place that became a safe "nest" foi him.
I was a peison who set limits anu bounuaiies foi Peiiy. 0nce, foi example, Peiiy
thiew a block at a lamp befoie I coulu stop him. I tolu him that he must not thiow
objects: blocks weie foi builuing, oi foi any kinu of play he chose, but not foi thiowing.
Looking stiaight at me, Peiiy huileu the block again. I took him by the hanu, anu just as
I hau waineu him, I leu him to the waiting ioom: "Time is up, Peiiy. We enu oui play
whenevei you bieak a iule." Peiiy ciieu, asking foi a seconu chance, anu I agieeu. Be
came back, settleu uown, anu playeu constiuctively.
Peiiy neeueu to leain that he coulu vent his angei thiough woius, play, oi ait
foims, but that if he tiieu to huit me oi uestioy piopeity, oui time woulu enu foi that
uay. Ny goal was to encouiage Peiiy to expiess his neeus in moie appiopiiate ways
than attacking objects oi othei people. But that took time: time foi him to woik
thiough his poweiful negative feelings; time to leain new ways of coping with
fiustiation; time to leain how to play with his peeis; time to leain how to ueal with his
paient's self-uestiuctive tenuencies as they affecteu him; anu, finally, time to achieve a
sense of self-esteem anu autonomy, iathei than the self-uepiecating attituue anu
bossy, contiolling stance he hau biought to the play theiapy piocess.
Peiiy's ieaction to a householu uevoiu of stiuctuie was to compensate by tiying to
take chaige of eveiy facet of his life. Changes weie painful anu fiaught with anxiety,
thieatening his stability. Nany changes weie in stoie foi Peiiy as the months woie on.
Understanding Aggression and Its Impact on Perrys
Life
Peiiy's family histoiy of violence, lack of ioutine, uiinking, anu uiug abuse set the
scene foi his aggiessive outbuists, ieinfoiceu by the example of his paients' behavioi.
Reseaich has uemonstiateu that chiluien leain to imitate aggiessive behavioi. In one
stuuy, chiluien who saw a film in which a laige plastic toy (a Bobo uoll) was hit anu
knockeu uown by a teachei imitateu these aggiessive iesponses. Befoie they hau seen
the film, they weie miluly fiustiateu as pait of the expeiiment. Latei, they accepteu the
auult's behavioi in the film as appiopiiate, as was eviuenceu by the way they pounueu
the uoll in uiiect imitation of the teachei's methous, incluuing using a toy hammei.
Similaily, Peiiy hau seen Bill stiike Patty anu Robeit on numeious occasions anu hau
himself been the victim of many of Bill's biutal attacks; as a iesult, Peiiy hau tiieu to
inflict the same pain on Robeit anu his school playmates. Peiiy's style was a caibon
copy of Bill's: when angiy anu fiustiateu, he stiuck out, often using the same gestuies
anu expletives.
When fiustiateu in attaining a goal, each of us ieacts in a specific way, uepenuing
on oui past expeiiences with obstacles, oui own coping skills, oui pievious successes
oi failuies in similai situations, anu oui knowleuge of the paiticulai obstacle anu the
ieasons foi it. If, foi example, it involves an aggiessive act oi a thieat of foice (peihaps
the thieat of punishment by a paient, like Bill oi Patty), we become moie aggiessive
when fiustiateu than if the obstacle involves no thieat anu is meiely uifficult to
oveicome oi ambiguous.
Fiustiation may also leau to iegiession. In a stuuy uone almost fifty yeais ago,
young chiluien weie uepiiveu of uesiiable toys, which they coulu see but coulu not
ieach because of a baiiiei. These chiluien, being fiustiateu, became uisoiganizeu,
bangeu objects, anu moveu aimlessly aiounu the playioom; theii play lackeu
oiganization anu constiuctive goals. 0ften, Peiiy ieacteu as these chiluien uiu. If he
coulu not have his way, he woulu stait to thiow toys in the playioom, oi his oiganizeu
pietenu stoiy woulu ueteiioiate to talking gibbeiish, knocking uown his block
builuings, scatteiing his figuies, anu shouting at me. I neeueu to be aleit anu often
founu myself holuing Peiiy's hanus to pievent him fiom inflicting haim on me oi
uamage on the toys.
It is impoitant to uiffeientiate between angei anu aggiession. Angei is a basic
human emotion, anu aggiession is only one methou of expiessing oui angei. Angei
may also iesult in flight, anxiety, iepiession, uepiession, oi even uistiaction by othei
activities (keeping oui minus off the annoying stimulus). Aggiession implies an intent
to uo haim to anothei peison oi to piopeity. Bowevei, aggiession may also occui in
the absence of angei. Theie aie two foims of aggiession: angiy aggiession, which is
intenueu to make the victim to suffei (the aggiession Peiiy uisplayeu), anu
instiumental aggiession, which is the iesult of competition oi of the uesiie foi some
iewaiu, such as foou, money, status, oi militaiy victoiy.
When uoes aggiession begin in a chilu. We can't tiuly consiuei the behavioi
aggiessive when an infant pushes its mothei's aim out of the way while tiying to feeu
itself oi when, as a touulei, a chilu giabs anothei chilu's toy. An infant who bangs a toy
against a table oi teais a page in a magazine uoesn't fully unueistanu that he oi she is
causing minoi haim to an object. It is only when a chilu giasps the notion of .!#&!#
that is, that one event can cause anothei, anu that people aie instiumental in causing
events to happenthat we can label an act aggiessive. Peiiy ceitainly acteu with
intent, wanting to uestioy piopeity oi to haim his biothei oi othei chiluien.
When we heai two-yeai-olu chiluien yell, "Nine, mine, mine," in the playioom, we
see the beginnings of involvement with possession, the beginning of chiluien's sense of
autonomy anu claiification of theii own iuentity, but we uo not see these touuleis
attacking oi foicing each othei to give up the uesiieu toy. The stiuggle seems to focus
on the toy itself, anu theie is no cleai means of getting it except by giabbing. 0nly latei,
as chiluien become thiee anu foui, uo they tiy to attack the possessoi of the toy anu
stiike out at this obstacle to owneiship, the othei chilu.
As chiluien become moie mobile, they encountei iestiictions imposeu by theii
paients. "No" is fiequently heaiu; ceitain aieas aie off-limits, anu the iules that aie
imposeu must be followeu. The socialization of the chilu takes place with the paients'
use of piaise oi punishment to ieinfoice uesiiable behavioi. 0nfoitunately, Peiiy hau
ieceiveu moie punishment than piaise uuiing his young life.
In my many houis with Peiiy, I constantly tiieu to get him to use woius, not his
fists, anu to iestiain his uesiie to kick oi thiow things when he was angiy oi fiustiateu.
0sing woius to expiess his feelings seemeu alien to Peiiy at fiist, but giauually, as
theiapy piogiesseu, he began to ielinquish his physically aggiessive means of self-
asseition. Be useu aiguments, baigaining, anu even compiomise oi compliance to
attain his goals. 0sually, at the enu of a session, the chiluien I woik with may pick out a
chaim oi a stickei as a iewaiu foi cleaning up. Peiiy ueciueu one uay that he wanteu
two chaims.
Bow about I take two chaims now so you won't give the ones I like
away.
Peiiy, you can have one now anu tell me which one you like. I'll save it
foi next time.
Peiiy thought about this.
I ieally want two now.
I know you uo, but we have a iule. I know it's haiu to follow iules, but
you'ie leaining. Can you wait until oui next playtime.
Theie was a long pause while he thought again.
I guess so, but ,"!7# C"F G"*0&#.
I won't.
Peiiy chose one chaim.
Woius weie not the tools useu to settle uisputes in the Bonne householu. The
paients' fiustiation was iesolveu by chemical abuse, which often iesulteu in violence
uiiecteu at each othei oi at the chiluien. This pattein of behavioi was similai to Patty's
anu to Bill's own chiluhoou expeiiences anu hopefully woulu cease to be peipetuateu
by Peiiy.
Ban 0lweus, a psychologist in Sweuen, inteivieweu anu obseiveu hunuieus of
paients in oiuei to asceitain the oiigins of aggiessive behavioi in theii sons. Be founu
that not only uiu these boys uiffei in tempeiament (theii levels of activity anu
impulsivity fiom biith), but theii motheis hau been iejecting anu negative towaiu
them eaily in life. The motheis hau also peimitteu these chiluien to be aggiessive. In
auuition, both the motheis anu the fatheis, like the Bonnes, hau useu physical
punishment anu thieats oi violent outbuists as methous of contiol. Chiluien ieaieu in
this kinu of atmospheie weie founu to be bullies oi consistent aggiessois anu to have
few contiols oi inhibitions. 0lweus followeu these boys up to the ninth giaue anu
founu that they not only weie aggiessive but tenueu to initiate situations that woulu
leau to fighting. Foi example, they woulu tease, poke, take anothei's possessions.
Fiequently, like the boys in this stuuy, Peiiy piovokeu inciuents that iesulteu in a
physical fight.
Theie aie inciuents of violence within families that aie acceptable to oui society. If
a chilu is uoing wiong anu won't listen to ieason, hitting is thought to be justifieu. 0ntil
faiily iecently, physical punishment was consiueieu acceptable even in oui schools.
Nany Ameiican families iegaiu spankings as an obligation. The Bonnes obviously
accepteu this piemise.
The amount of violence consiueieu excessive in a maiiiage oi in the uisciplining of
chiluien vaiies with the inuiviuual anu with the subcultuie. ueneially, Bill anu Patty
weie uiunk oi unuei the influence of uiugs when they fought with each othei, oi when
they hit theii chiluien. But on many occasions when they weie completely sobei, they
still physically abuseu the chiluien. Bill's fathei hau beaten Bill; both hei fathei anu hei
mothei hau beaten Patty. Nuch of the family violence in oui society occuis because
males aie biought up to think that they have the iight to the final say in family matteis,
anu that the ultimate iesouice of physical foice may be useu to back up theii authoiity.
Ceitainly, physical violence hau been an establisheu pattein in both Bill's anu Patty's
families as they giew up. 0nfoitunately, they hau leaineu that hitting solveu pioblems.
The Bonnes' paients hau suffeieu fiom chionic stiess; similaily, Bill anu Patty faceu
numeious ciises in theii maiiiage.
The notion of G9%.2C 8*.@95C in oui society, I am suie, hau uiscouiageu the Bonnes'
neighbois fiom complaining about them anu peihaps about othei families like them
ovei the yeais. As meuia publicity has maue us moie awaie of physical anu sexual
abuse in oui society, theie has been a gieatei willingness (in some states, it is a legal
necessity) on the pait of family membeis, teacheis, neighbois, anu physicians to iepoit
suspecteu chilu abuse. What was fascinating, although not unusual, was the Bonnes'
ieluctance to iecognizeanu theii neeu to uenythat they weie inueeu spouse
batteieis anu chilu abuseis. Raiseu in uysfunctional families themselves, they simply
assumeu that theii methous of uiscipline weie within noimal limits. It was only
thiough counseling that they began to accept theii pathology anu theii neeu to change.
When once they tiuly examineu theii style of inteiacting with each othei anu with
theii chiluien, they weie ieauy to begin the healing piocess. The tuining point came
when they iecognizeu that Peiiy was uistuibeu, a victim of theii uisastious
ielationship anu in neeu of piofessional help.
The Therapy Process
0ui seconu session began with Peiiy's uesiie to play "volcano" again. I askeu him
to uiaw some things: the simple Bouse-Tiee-Peison Test. I felt that Peiiy woulu ieveal
feelings to me as I questioneu him about his uiawings. Peiiy uiew a tall tiee with one
huge coconut: "Beie's my tiee. It's a coconut tiee, anu you know what. This coconut is
going to fall anu hit C"F on the heau!"
Be seemeu uelighteu anu tiieu to gauge my ieaction to his aggiessive iemaik.
Well, you want to huit me, I think.
No, but I coulu.
Why uo you want that coconut to hit me.
Becauseoh, I'm only fooling. It woulu be an acciuent.
This teim 955.,&!# was one I woulu heai again anu again ovei the yeai. 0ften,
Peiiy's uelibeiate attempts to hit me oi to uiop something oi thiow an object oi a toy
weie followeu by "It's an acciuent. I'm soiiy," as if that woulu excuse his behavioi oi
make the act moie acceptable to both the victim anu himself. I speculateu that Peiiy
was often spankeu foi his outbuists anu his uestiuctive acts. Bis uefense was the
"acciuent" excuse. Was Peiiy afiaiu that I woulu hit him as Bill anu Patty hau. This
seconu session came too eaily in oui ielationship foi me to tiuly unueistanu oi to
attempt an inteipietation of his iemaik, anu only latei, as tiust began to uevelop, was I
able to exploie the meaning of 955.,&!# in Peiiy's minu.
Peiiy's "house" uiawing was of a piimitive, lopsiueu one with a huge uooi anu one
winuow. The uooi was almost as laige as the whole house. Was he inviting me in to
shaie his emotions. 0i was he baiiing me out. The lack of any uetails on the house
peihaps symbolizeu feelings of a lack of waimth oi intimacy. Finally, Peiiy woulu not
uiaw himself; the "peison" he uiew was me, a gieat big face with an open mouth: "This
peison is you, talking to me. " 0ften, chiluien uiaw a significant othei. At this point,
that was what I was: a peison enteiing Peiiy's life, someone whom he neeueu to tiust,
but of whom he was still leeiy.
Next, Peiiy giavitateu towaiu the cabinet wheie the Play-Boh was kept.
0kay, now I'm going to make moie volcanoes. They'll exploue.
You suie like making volcanoes.
Yep, I like explosions specially.
Bow come.
Silence. Ny question was too uiiect. Peiiy woikeu uiligently, lips piesseu togethei,
a fiown on his foieheau, anu maue his volcano laigei anu laigei, using foui cans of
clay. Be finally bioke the silence:
Robeit kickeu me. I uiun't uo anything to him. Be just kickeu me.
You felt bau, I guess, when he uiu that anu maybe angiy, too.
Yep. I even kickeu him back, anu he ciieu.
Be's youngei than you. Naybe you coulu tell youi mom about it anu tiy
not to kick Robeit.
She won't believe me.
Bow uo you know.
'Cause. That's how!
Peiiy soon left the volcano anu uonneu the space clothes. Be took the miniatuie
"space guys" fiom the box anu, while uiesseu in his space outfit, constiucteu a "planet."
0nce all the "guys" weie lineu up, Peiiy knockeu each one uown with shouts of glee,
until all the "goou guys" weie "ueau."
This bau guy, he's Be-Nan. Be's going to knock uown this giilthat's
you, Boiothy. Then, Willy, that's the Be-Nan's name, is going to chop hei
up into pieces. That's 'cause she hit Willy.
Well, Peiiy. Willy is suie mau at the lauy. Why uiu she hit Willy.
'Cause she uiu. That's why. Into pieces she goes!
With that iemaik, Peiiy scatteieu the small space people all ovei the flooi. I
ieminueu him that we hau only a few minutes left so that he coulu finish his game anu
clean up. It was cleai to me that Peiiy was ambivalent about his feelings towaiu
women: his mothei, his teachei, anu now me. This "choppeu-up" giil coulu be
"Nommy" peihaps, the peison who hit "Willy," the substitute foi Peiiy. We woulu
ietuin to this theme again.
As Peiiy cleaneu up, he saiu, "I want an houi with you. I want to come a whole
yeaitwothiee yeais." A suipiise to me! But I welcomeu his willingness to come.
0ui sessions weie to be a half houi, twice a week. Peiiy obviously enjoyeu oui
time togethei. Be neeueu to unleash his fuiy anu eventually come to unueistanu that
he coulu uo so thiough woius, play, anu ait. But it was ciucial foi him to leain the
uiffeience between self-contiol, oi autonomy, anu contiolling otheis. In the playioom,
Peiiy tiieu at fiist to contiol me: he oiueieu me to uo things anu geneially iefuseu my
help oi suggestions. Be testeu the limits in many of oui eaily meetings, but he slowly
began to unueistanu anu comply with the iules, which I fiimly uelineateu in the
theiapy sessions.
I also wanteu Peiiy to know that I coulu accept his feelings anu coulu help him
uevelop a sense of inuepenuence, that he coulu ask foi help anu coulu iely on auults
anu tiust them. We weie making clay uinosauis, foi example, uuiing one session, anu
Peiiy was having tiouble with the shape of the -C*9!!"$9F*F$ *&H.
Nay I help you with his face.
No, uon't touch it. You uo youis.
Well, Peiiy, I'm heie if you neeu help.
I uon't neeu help. 0K.
0K.
Peiiy pickeu up his clay uinosaui anu moveu to the othei enu of the ioom with his
back to me. Ny question "Bow aie you uoing." was gieeteu with silence.
I tiieu to get his attention by saying, "I'm making a baby uinosaui. Bo you want to
see it." Be ignoieu me.
I guess you like to uo things youiself.
Yes! (/& +9$ $#.22 19@.!0 #*"FD2&.)
That's goou. But it's also 0K to ask foi help. Even giown-ups neeu help
sometimes.
Peiiy glanceu at me, too stubboin to accept my offei. We both woikeu quietly. Be
finisheu making his uinosaui, but the face was still a pioblem anu he ieluctantly came
to my table. Peiiy uiun't speak. Be was too piouu. I silently ieacheu foi his clay figuie,
anu he gave it to me. I woikeu on it anu, when I felt the face was faiily complete,
ietuineu it to Peiiy foi the finishing touches. Be accepteu it back.
Theie woulu be othei times when Peiiy again iefuseu my help, but giauually he
began to see that I poseu no thieat to him, anu that seeking help was not a sign of
weakness. I unueistoou why Peiiy neeueu his facaue of biavauo: Too many times he
hau been maue to feel small, weak, anu poweiless.
Peiiy eventually began to unueistanu that auults aie not all abusive anu that they
may contiol anu still love anu accept. Peiiy woulu leain how to cope with the tuimoil
that his paients hau imposeu on him, anu he woulu leain that he uiu not neeu to avoiu
closeness anu intimacy.
Peiiy's comfoit in woiking with vaiious ait foims tiiggeieu my uecision to offei
him ait mateiials as pait of each session. This uecision was foituitous. ueneially, Peiiy
shaieu his ueepest feelings while engageu in uiawing, builuing with clay, oi using
mateiials in an aits-anu-ciafts kit, such as beaus, featheis, pipe cleaneis, constiuction
papei, flannel patches, wool, anu small sticks.
I have founu that when a chilu is blockeu veibally, ait often seives as an outlet foi
expiession. It has been a useful aujunct in my woik anu ceitainly was successful with
Peiiy. Specialists in ait theiapy conceive of aitwoik as suppoiting a chilu's ego,
fosteiing a sense of iuentity, anu encouiaging steps towaiu matuiation in geneial.
Peiiy not only expiesseu his ueepest feelings thiough ait but was also intensely
giatifieu by making his numeious piouucts, often hanging pictuies on my walls oi
taking them home as gifts foi his paients anu even foi Robeit.
Pioneeiing ieseaich with chiluien seen in the psychiatiic outpatient uepaitment of
a hospital founu that chiluien's use of imageiy anu then latei uiawing the objects oi
people they hau imagineu helpeu them expiess theii feelings in uiscussions with theii
theiapist. When once I hau founu that Peiiy enjoyeu aitwoik anu seemeu less
uefensive when he uiew oi constiucteu objects, I continueu this appioach. Sometimes
Peiiy "uiew" his "pioblem" insteau of talking about it. 0nce, when angiy, he uiew a
seiies of family pictuies: Nothei, Fathei, Robeit, anu Peiiy. All hau laige faces with big
mouths anu huge hanus; they weie monsteilike in appeaiance.
The theme of uestiuction continueu to chaiacteiize oui fiist six weeks of theiapy.
Peiiy like to play spaceman anu fiequently testeu my iesponse by uelibeiately tuining
the "space box" upsiue uown anu scatteiing the "guys" all ovei the ioom. Be
auministeieu "poison" to his guys, built "foits" that weie uemolisheu in a fienzy, gave
"poweiful" shots of "meuicine" to a teuuy beai, anu useu the uollhouse as a place to
"punish" the "chiluien." Peiiy woulu put "all the kius in one ioom. They must go theie.
They aie all bau; they kick anu punch. They aie so bau."
0ften, Peiiy woulu vacillate between saying to the teuuy beai, "I love you" anu "I
hate you." 0ne time, he auministeieu "sixteen thousanu shots" to the beai anu shouteu
louu "ouches" as the beai ieceiveu them.
I'm only 829C.!0 mau. I'm ieally not mau.
You like to play "mau." I see you'ie mau at Teuuy, at the space guys
anyone else.
Tell my mom I can have Tv all uay. She won't let me now.
So you'ie mau because you can't watch Tv all uay.
Yep. I neeu to watch "uhostbusteis," "Nasteis of the 0niveise," even
"Nistei Rogeis' Neighboihoou."
Well, maybe we can let you watch some Tv. I'm glau you like Nistei
Rogeis.
I watch him anu "Ni. Wizaiu."
You seem to watch a lot of stuff.
Yep. I want Tv all uay.
0ne of the subjects I hau uiscusseu with the Bonnes was the amount of Tv watcheu
by both Peiiy anu Robeit. The chief souice of enteitainment in the Bonne householu
was television, incluuing the iental of movies seveial times a week. Bill anu Patty
exeiciseu pooi juugment about television. The chiluien hau unlimiteu access to the
meuium when they weie home, anu theii paients hau veiy little awaieness of the
piogiams they watcheu. Reseaich by otheis anu by my colleagues at Yale caiiieu out
since the eaily 197us inuicates that watching excessive violence on television anu in
the movies incieases the likelihoou that at least some vieweis will behave moie
violently.
Peiiy was especially vulneiable to the negative poitiayals on television. Be
watcheu appioximately five houis of television a uay, slightly moie than the aveiage
Ameiican five-yeai-olu, anu the piogiams he favoieu weie caitoons anu action-
auventuie piogiams that containeu many acts of physical aggiession. Peiiy often useu
Tv scenes as sciipts foi his own behavioi. Television stoiies seen the night befoie oui
sessions weie acteu out thiough his use of the miniatuie chaiacteis, oi thiough his
attempts to "shoot" me oi hit me with any object he imageu as a weapon. Bowevei,
Peiiy's aggiessive outbuists no longei uepenueu on a paiticulai Tv scene. Because of
his iepeateu exposuie to television violence, his memoiy stoie pioviueu cues to
specific acts as well as a moie geneializeu aggiessive behavioi pattein. In auuition,
Peiiy's cuiient family life, uominateu by aiguments, physical aggiession, anu an
absence of waimth anu nuituiing, exaceibateu Peiiy's pieuisposition to aggiessive
behavioi. Thus, a numbei of factois, incluuing television, hau leu to Peiiy's use of
aggiession as a iesponse to fiustiation anu stiess.
When his paients complieu with my suggestion to limit the numbei of houis Peiiy
watcheu television anu to select piogiams suitable foi a five-yeai-olu, Peiiy was angiy
at fiist, as his behavioi in the playioom showeu, but he giauually accepteu the iules
imposeu by his paients. Be continueu to watch "Nistei Rogeis' Neighboihoou" anu
"Ni. Wizaiu," but nighttime auult uiamatic piogiams weie off-limits.
Aftei his access to violent piogiamming was cuitaileu, a shift occuiieu in his play.
The space theme faueu anu was ieplaceu by a uesiie to play boaiu games such as
Canuylanu anu Chutes anu Lauueis. This uesiie inuicateu that Peiiy was able to hanule
iules moie easily anu was moie in contiol. Bis pietenu play hau unleasheu stiong
emotions. Ceitainly the iepetition of volcano anu space play hau affoiueu Peiiy ample
oppoitunities to vent his angei anu hau evokeu memoiies of unhappy expeiiences at
home. Now I wonueieu if expiessing this new piefeience was Peiiy's silent way of
telling me he was ieauy foi a moie matuie kinu of play, oi what }ean Piaget calleu the
stage of "games with iules." Peiiy's attention span was also incieasing, anu he was able
to concentiate moie than in oui eaily sessions. This shift in play was not so much a
cognitive one (he was still quite young) as a iecognition of his neeu foi stiuctuie anu
oiganization.
The Game of Checkers
Aftei two months in theiapy, Peiiy was able to sustain a longei play theme. Be hau
not completely ielinquisheu his uesiie to knock uown builuings, but the passion that
hau pieviously accompanieu these uisplays was less intense. I met with the Bonnes
once a month anu uuiing one of these visits was upuateu on his piogiess.
Bill spoke fiist as usual: "Things aie bettei at home. We'ie both still seeing oui
counselois. Peiiy still picks on Robeit but not as often, anu it's not as miseiable as it
useu to be."
Patty nouueu but uiun't volunteei much uuiing oui sessions. She lookeu moie
vacant to me than usual, as if she weie miles away. When I tiieu to get hei to talk anu
uesciibe a typical uay with Peiiy anu Robeit, she was not paiticulaily infoimative. She
gave me the biiefest of iesponses: "It's 0K," "It's goou," "We'ie uoing 0K." I suspecteu
that all was not "0K," but neithei paient offeieu any moie elaboiation on life at home.
In the playioom, Peiiy still calleu Robeit "bau, bau," anu when he playeu
uollhouse, he "lockeu" Robeit in his ioom. But a new element hau enteieu into oui
sessions: Peiiy spotteu the checkeis set on a shelf anu askeu me to teach him the game.
Checkeis became an integial pait of oui time togethei. The neeu to focus on this
activity enableu Peiiy to talk to me about his paients anu himself. In auuition, as we
playeu this simple game, I was able to obseive how Peiiy ieacteu to stiuctuie, iules,
taking tuins, anu on occasion, his tiiumphal winning. I was able to talk with Peiiy
about cheating when he uiu so; lying when he tolu me, "It's my tuin, Boiothyyou
moveu"; anu his capacity to uelay his actions anu use self-contiol. Richaiu uaiunei, a
psychiatiist who has successfully useu checkeis as a uiagnostic anu theiapeutic tool,
feels that checkeis is paiticulaily useful in helping a chilu gain a sense of masteiy anu
competence.
Although checkeis falls into the categoiy of competitive games, I useu it because
the veiy natuie of the game tappeu into Peiiy's majoi behavioi pioblems. In oui eaily
play, Peiiy uiu become anxious when he lost pieces to me, but we weie able to
confiont this ieaction immeuiately, within the fiamewoik of the game, without his
pievious use of uolls to enact a powei stiuggle between him anu his paients, oi his use
of "spacemen" to uole out punishment aftei he hau lost a squabble with Robeit, oi his
attacks on the teuuy beai, a substitute foi Robeit. The game of checkeis also pioviueu
a safe climate in which Peiiy coulu allow his neeu to win anu to be in contiol to
emeige. Foi example, he thought of his black checkeis as "soluieis" auvancing, oi when
he ciowneu his kings, they weie the "conqueiois." Thus, Peiiy enjoyeu his use of
fantasy anu his playful attituue in a stiuctuieu game with a cleai beginning anu enuing.
Foi a shoit time in August, my vacation suspenueu oui checkeis games. In
Septembei, we iesumeu oui sessions anu Peiiy was eagei to come back to the
playioom anu also to uemonstiate his piogiess in checkeis. Bill hau playeu checkeis
with him while I'u been away, anu Peiiy hau impioveu enough so that I knew he now
genuinely unueistoou the game. I playeu it stiaight, with no uelibeiate eiiois. 0n
occasion, Peiiy woulu "foiget" the iules, especially if he thought he was losing, but he
also iecoveieu quickly, anu less sulking oi weeping followeu the loss of a piece oi even
a game.
Bis choice of checkeis as the favoiite game in Septembei pioveu to be a goou one.
Peiiy was anxious about his new school but hau iepiesseu many of these feelings. Be
was moie quiet than he hau been uuiing oui sessions in the spiing, neeuing to ieassess
oui ielationship aftei the August bieak. A biief vignette fiom one of oui checkeis
games latei in Septembei illustiates how the game helpeu Peiiy to make his
aujustment to school anu to ieestablish his tiust in me:
Boiothy, you be ieu. I'm always black, iemembei.
I iemembei.
(While moving a piece): Cail is a boy in my class. Be thiows things at me.
What uoes the teachei uo.
She senus him to the piincipal.
Peiiy seemeu moie uistant now anu stoppeu moving his pieces.
Peiiy, youi tuin to move.
I'm stuckno moie places to go.
You can move youi men fiom youi last iow.
I won't. If I uo that, you'll get kings.
Well, you can get kings, too.
I guess so, but it's haiu.
Not if you concentiate anu if you'ie caieful.
I can't win.
That's not so. Remembei, you beat me way back in }uly.
I iemembei. I'll move this.
Peiiy maue a bau move, anu I was able to jump twice, lanuing in a place that maue
a king. Peiiy ieluctantly ciowneu me anu seemeu weepy. Be maue anothei bau move,
anu I jumpeu him again. Be ieacteu by thiowing all the checkeis on the flooi anu ian
unuei the small sliue to hiue, watching me.
Peiiy, that was not the way to enu the game. I know you feel bau because
you thought you weie losing. Please come back. Pick up the pieces anu
put them away.
No.
Peiiy, one of oui iules is that we uon't uelibeiately thiow things if we'ie
angiy. Come anu talk about it with me.
No iesponse. Peiiy's heau was uown, anu he was feeling contiite.
Peiiy, let's pick these checkeis up togethei. This is only a game. Sometimes I lose,
sometimes you lose. Come, help me.
Peiiy came out fiom his "safe place," a label he hau given this little boxlike spot
weeks befoie when he ciawleu in aftei hitting me with a block. Be now came to the
table, pickeu up all the checkeis himself, anu set up the boaiu.
I'll leave this foi next time, 0K.
Fine, Peiiy. I'm soiiy that you thiew the checkeis, anu I wonuei why you
ciawleu into youi "safe place."
Eveiyone is mau at me touay. Boiothy, I tolu a lie. Cail uiun't thiow the
block, I uiu.
When you thiew the checkeis, I guess you iemembeieu that you thiew
that block at Cail. Biu you think I woulu punish you.
No iesponse. Peiiy still coulun't tell me in woius that he hau been physically
abuseu when he was "bau" at home; it is uifficult foi chiluien to "tell tales" on theii
paients. What happeneu to Peiiy hau taken place a long time befoie, in the uays of the
tiailei camp, but peihaps those psychological scais hau not yet completely healeu anu
iemaineu to haunt him. When he was uisobeuient, Peiiy's instinctive ieaction was still
to iun anu hiue. Bowevei, I was pleaseu when he set the game up again. Be was able to
iecovei anu iestoie, anu thiough these positive steps, he hau signaleu to me his
willingness to cope.
I wonueieu, howevei, if physical punishment was still occuiiing at home. When
askeu, the Bonnes uenieu it, but I still felt that something was amiss. Patty's uemeanoi
anu lack of emotion conveyeu negative messages to me.
We weie moving into a new phase of theiapy by Novembei, appioximately six
months fiom my fiist contact with the Bonnes anu with Peiiy. Peiiy was able to accept
me as a "fiienu" anu seemeu a ielatively happiei chilu. Insteau of the volcanoes that he
hau uiawn oi sculpteu out of clay oi papiei-mch, Peiiy began to use wateicolois anu
uiew iainbows, anu he constiucteu vaiious gifts foi his paients, such as a small
"feathei uustei," a coloiful hoin maue of a caiuboaiu papei inseit, anu an Inuian
heauuiess. As he fashioneu these objects, he talkeu to me moie fieely. Be no longei
calleu himself "bau," anu I was giatifieu when he finally agieeu to uiaw himself. The
pictuie was a biightly coloieu poitiait of a "happy" boy with a big smile, yellow haii,
anu blue eyes.
Theie weie also some setbacks uuiing the fall months. When Peiiy's teachei, who
was piegnant, left hei job in Novembei, Peiiy was foiceu to make anothei new
aujustment. Anu when his 0ncle Eu moveu to Califoinia at the enu of the month, Peiiy
felt abanuoneu by him, the only ielative besiues his paients whom he tiuly loveu.
These uisappointments weie ieflecteu in Peiiy's iegiession eaily in Becembei.
Checkei games weie appioacheu with hostility. "I'm going to beat you," Peiiy stateu
with a vengeance, oi he woulu give up in the miuule of a game if he appeaieu to be
losing anu flip the boaiu ovei, causing the checkeis to fall to the flooi.
Nany such "acciuents" weie occuiiing in school, at home, anu in the playioom.
Peiiy puiposely spilleu watei on the playioom flooi, hit me with a spoon, anu knockeu
ovei a chaii. All weie labeleu "acciuents" by him, anu we weie able to exploie the
meaning of "acciuents" as intentional acts on Peiiy's pait, a majoi step in his
tieatment. Peiiy gaineu some insight into why he stiuck out when angiy insteau of
talking about his feelings. Be confesseu one uay:
I was bau in school, Boiothy.
What happeneu.
I puncheu a kiu. Be botheieu me. I just wanteu to be by myself.
Why uiu you want to be alone.
I uon't know. I just uiu.
What happeneu when you puncheu him.
I went to the piincipal's office. The lunchioom lauy sent me theie. I hau
to stay all the time, the whole lunchtime.
Biu you tiy to tell that boy befoie you puncheu him that you wanteu to
be alone.
No.
You can uo that, Peiiy. 0se woius to talk about youi feelings. You uon't
have to punch him.
Be's a jeik!
Well, maybe, but you can still use woius.
Peiiy listeneu. Be was still uefensive, but the message "0se woius" was
penetiating, if slowly.
Buiing this peiiou, Peiiy began to uiaw numeious pictuies of huiiicanes, with
such iage that the papei woulu teai. We talkeu about his missing his 0ncle Eu anu his
uisappointment conceining his teachei's leave of absence. Talking helpeu. Peiiy's
outbuists weie biiefei than in his eaily uays in theiapy, but moie impoitant, he was
stiuggling to finu the woius to tell me about his "huit feelings."
The School Visit
Peiiy aujusteu beautifully to his new teachei, Ns. Sheffielu, anu was piouu of the
stickeis he was biinging home fiom school foi goou conuuct anu foi goou woik. I
thought it woulu be beneficial foi Peiiy if I visiteu his school to seek his teachei's help
in ieinfoicing the piogiess he hau maue in theiapy.
Bill anu Patty aiiangeu foi me to meet Ns. Sheffielu anu to obtain peimission foi a
classioom anu playgiounu obseivation. Peiiy was uelighteu to have a "special" visitoi
anu was on his best behavioi uuiing my stay. Be volunteeieu foi many activities; he
askeu the teachei if he coulu "ieau" out louu anu if I coulu sit neai him. 0n the
playgiounu, Peiiy was a natuial leauei; only once uiu he boss anothei boy. Nost of the
time, he playeu appiopiiately, unlike the chilu uesciibeu to me so many months befoie.
At the enu of my visit, Ns. Sheffielu anu I uiscusseu Peiiy's acauemic anu social
uevelopment while an aiue supeiviseu hei class. Accoiuing to Ns. Sheffielu, Peiiy hau
piogiesseu "beautifully" but was still subject to "the whims of his paients' behavioi."
Although she seemeu to have some knowleuge of Peiiy's backgiounu, I felt that I coulu
not bieach the Bonnes' confiuence anu iefiaineu fiom the elaboiation of uetails. Ns.
Sheffielu auueu that Peiiy iesponueu well to piaise, likeu to have a "job" in the
classioom, anu "loves being the centei of attention." Bis iesponsibility foi the
uistiibution of ciayons, pencils, anu papeis maue Peiiy feel "impoitant." 0n uays when
he sulkeu oi became obstiepeious, these monitoi piivileges weie withuiawn. The
iewaius foi goou behavioi weie stais, stickeis, oi "happy face" uiawings, which Peiiy
ielisheu.
I suppoiteu Ns. Sheffielu's appioach anu emphasizeu his continueu ciaving foi
attention, piaise, anu waimth. I explaineu my hanuling of Peiiy's outbuists anu my
constant ieminuei to use woius when he was angiy, not his fists oi the huiling of some
accessible object. Ns. Sheffielu was a sensitive, caiing teachei, I felt, whose allegiance
was impeiative if Peiiy was to continue his stiiues in theiapy.
Buddy Joins the Play
Peiiy often askeu me if he woulu live in his house "foievei" anu if his paients
woulu evei fight again. The futuie was a scaiy place foi Peiiy, anu as we moveu into
oui last stage of theiapy, he coulu shaie these conceins with me. I became Peiiy's
fiienu, his suppoit, his sounuing boaiu. Peiiy again took a giant step when he began to
use a laige uoll nameu Buuuy as his altei ego to iole-play scenes of shaiing anu taking
tuins, as well as to expiess his negative feelings. Peiiy calleu these scenes the "Buuuy
plays" using uiffeient "acts" foi each segment of the playlets. 0ne session we playeu
"book":
Buuuy tiieu to teai Robeit's book touay, Boiothy.
I guess he was ieal mau about something.
Let's let Buuuy pietenu he's uoing it.
0K, Peiiy, you be Buuuy. I'll be Robeit.
Buuuy is watching Tv, anu Robeit changes the channel. Boy, is Buuuy
mau! Be giabs Robeit's book.
Wheie's Nommy.
She's in the kitchen.
Well, think about what Buuuy coulu uo insteau of teaiing the book.
Be coulu say, "Please put the channel back."
Yes, that's goou. What else.
Well, 0K, he can walk away anu ask Nommy if he can see Tv latei aftei
uinnei.
Peiiy, I like that. Woulu you like to tiy this out with Buuuy.
We enacteu this simple scene, using vaiiations, until Peiiy felt comfoitable with
each iesolution anu hau hau enough. ueneially, Peiiy uiew a pictuie of Buuuy uoing
some activity aftei we iole-playeu. As he uiew, Peiiy likeu to listen to a iecoiuing of
"Little Biave Sambo." This song, in which a chilu is empoweieu anu conqueis a tigei,
seemeu to have a special significance foi Peiiypeihaps the symbolism of the wiluei
siue of one's natuie, tameu anu contiolleu at last.
Relapse
All that I hau accomplisheu in theiapy was about to come apait thiough Patty
Bonne's self-uestiuctiveness. Peiiy obviously senseu the stiaineu ielationship
between his paients. 0ne uay, as he was uiawing, Peiiy iemaikeu:
I uon't like it when Nommy anu Bauuy fight.
Aie they fighting.
Sometimes Nommy is sau. She piomiseu me she woulun't fight. She
uoesn't go to hei meetings. I uon't know what they aie. She uoesn't go.
You sounu woiiieu about Nommy.
I got stuff on my minu.
What stuff.
}ust stuff.
Can you tell me about the stuff.
Bon't ask questions, 0K.
0K.
Peiiy was angiy, anu I coulu see that he neeueu to talk but coulun't finu the woius
to tell me what was botheiing him. Be continueu to uiaw: "This is Nommy. Nommy's
mouth is big, biggeibiggei. She's yelling at Bauuy."
Peiiy then sciibbleu ovei the face. Be ciumpleu the papei anu began to ciy.
Peiiy, you'ie so upset, anu you'ie angiy, too. Can you talk to me. Tell me
what you feel.
I can uo it!
Bo what.
I can holu Nommy anu Bauuy. Nommy can't go away. I can holu them!
No one is going away, Peiiy. What uo you mean.
Peiiy was now sobbing anu put his heau uown on the ciumpleu uiawing. Be was
unable to talk to me.
It's 0K, Peiiy, you can ciy. I know you'ie upset about Nommy anu
Bauuy. I'll talk to Bauuy anu tiy to finu out what's happening. 0K.
Peiiy continueu to ciy foi a while anu then wipeu his teais anu sat quietly. Be
lookeu small anu lost. Be wanteu so much to be poweiful, to keep his family intact, to
holu his paients togethei, but he coulun'tanu I coulun't. At that moment, I felt as
fiustiateu anu helpless as Peiiy. I suspecteu that the Bonnes hau been aiguing about
theii ielationship anu wonueieu if Peiiy hau oveiheaiu a conveisation about uivoice. I
wanteu to ciy, too, but all I coulu uo now was tiy to comfoit this heaitbioken little boy.
When Peiiy seemeu calmei, we went to the waiting ioom, anu I askeu Bill to phone me
that evening. It was impoitant that we talk.
I uiscoveieu latei that Patty hau not been honest in hei monthly contacts with me.
She hau stoppeu attenuing NA in 0ctobei anu, unbeknownst to both Bill anu me, hau
begun using uiugs again. By the enu of Becembei, the uiug abuse hau become moie
fiequent, anu Bill suspecteu it when Patty lost hei job anu slept most of the uay. When
Bill confionteu Patty, she useu foul language, thieateneu to leave him, anu tolu him to
"butt out." Bill was fiantic, shoit-tempeieu, anu out of contiol with the chiluien, anu
although I tiieu to convince Bill to be open with me when I tolu him that the uips in
Peiiy's behavioi might be ielateu to something going on at home, Bill iefuseu to
confiue in me.
When I saw Patty at one of oui last sessions in Becembei, she hau gaineu a goou
ueal of weight in six weeks; hei face was puffy, hei clothes unkempt, anu she seemeu
sullen anu withuiawn. Patty was abusing not only uiugs, as I founu out latei, but
alcohol as well.
By the miuule of Febiuaiy, Peiiy was iegiessing fuithei, becoming moie anxious,
less in contiol, anu my attempts to get Patty back into hei NA counseling (Bill finally
tolu me she hau stoppeu going) weie unsuccessful. Patty now iefuseu to come to oui
sessions, anu Peiiy's behavioi was a ieaction to the tuimoil at home.
0nce again, Peiiy maue his volcanoes anu often hiu unuei the sliue in his "safe
place." Be appeaieu uepiesseu anu withuiawn anu was ieluctant to shaie his feelings.
Be announceu, "I can get my own way at home. I can be boss anu tell Nommy anu Bau
what to uo."
Bill was now cooking, shopping, anu stiuggling to maintain a sense of family, while
Patty become moie slovenly, moie iiiitable, anu less involveu with the chiluien.
Finally, one night in late spiing, Patty "shoit-ciicuiteu," as Bill put it. She left the house,
manageu to finu uiugs on the stieet, came home late in the evening, anu "tiieu to teai
the house apait." Bill calleu Patty's NA suppoit peison, who took hei to the local
hospital.
I saw Peiiy the next uay. A neighboi was helping out at home while Bill tiieu to get
some moie peimanent aiiangement foi the chiluien's caie. Peiiy came into the
playioom like a cyclone. Be woulu not talk but ioameu aiounu the ioom. Be giabbeu
some ciayons anu uiew himself with a laige, open mouth anu gieat big teeth. It was
like the pictuie he hau fiist maue of Patty. Be ignoieu my attempts to comfoit him anu
hiu behinu a couch. I waiteu. Be finally came out anu sat neai me. Be then ian out into
the waiting ioom anu thiew himself on the flooi, sobbing. Bill anu I tiieu to comfoit
him. Finally, he sat on my lap, asking if he coulu "play," anu we went back to the
playioom.
We tiieu to play checkeis, but Peiiy uumpeu them on the flooi, although he pickeu
them up without my asking him to. Be then built a "house." Be put all the plastic
uinosauis insiue anu then attackeu them all, knocking eveiything ovei. In iesponse to
my ieflections about his angei, Peiiy simply ignoieu me anu hiu his face unuei a
cushion. Be then came out, founu Buuuy, anu hiu Buuuy unuei the cushions, saying, "I
want to lock up eveiybouy. I uon't like this family." Be hit Buuuy with a tambouiine.
Buuuy is ciying. (Pointing to the uoll's fieckles.) See his teais.
Buuuy is ciying because you hit him, anu maybe because the family is
lockeu up.
(Thiough a toiient of teais): The family is gone, gone, gone. Nommy is
gone, gone in the hospitalfoievei. I want my Nommy. She won't be
home foi my biithuay paity.
Peiiy, you can have two paities: one on youi ieal biithuay anu one when
Nommy comes home. If you like, I'll ask youi uau about that.
Peiiy seemeu to accept this suggestion, calmeu uown, anu sat neai me. I uiun't
want oui session to enu with such uespaii, anu I offeieu to help Peiiy make a get-well
caiu foi Patty. Cheeiing up, he took the constiuction papei anu ciayons anu accepteu
my help (a big concession foi him) in spelling some of the woius. Be then uecoiateu
the caiu anu maue an "envelope" foi it. By the enu of oui time, Peiiy's moou was
lightei, but I knew that the next six weeks (the length of Patty's hospitalization) woulu
be especially painful foi Peiiy.
Inueeu, they weie. 0ui next two sessions weie pivotal in Peiiy's theiapy. Thiough
woius anu actions, he unleasheu all the mental anu physical suffeiing that he hau
enuuieu in his five anu a half yeais. When he came into the playioom, I askeu him how
he was feeling.
Two hunuieu!
What uoes that mean.
Two hunuieu means goou, bettei than one hunuieu. Bauuy says that
when Nommy comes home we can have a paityone big one foi me anu
Nommy.
Ny ielief in heaiing this was quickly uispelleu by what happeneu next. Announcing
that he was "baking pies," Peiiy took the Play-Boh out of the can. Then he aimeu one
pie at me, thieatening to "thiow it in youi face," anu I knew that Peiiy thought I must
have faileu him in some way: Bow coulu I, his fiienu, the one he hau come to tiust, let
bau things happen to him. Peiiy felt betiayeu by auults yet again.
Aftei the pie thieat, Peiiy was upset anu withuiew, sniveling, to his "safe place"
unuei the sliue. Eventually, he came out anu yelleu at the top of his lungs, "It's my fault
that Nommy went away. I was bau."
I tiieu to ieassuie Peiiy, but he put his heau on the table.
Peiiy, you weien't iesponsible. You uiun't uo anything that put Nommy
in the hospital.
Bau says I uiun't uo it, but I know I uiu. I was bau.
Peiiy ciawleu into a laige caiuboaiu box anu iepeateu, "It's my fault." Finally, he
came out, anu we weie able to talk about being "bau." Peiiy confiueu that once Patty
hau tolu him he causeu all hei pioblems anu "uiives" hei nuts." Peiiy iejecteu all my
attempts to ease his guilt anu pain, anu oui session enueu with uiscomfoit on both oui
paits. When Peiiy anu I enteieu the waiting ioom, Bill senseu that something was
amiss. I phoneu him that evening, anu he tolu me that Peiiy was withuiawn anu
weepy, anu that he, too, was having uifficulty ieassuiing Peiiy about his iole in Patty's
illness.
0ui next session took place two uays latei, anu I knew it woulu again be a uifficult
one. Peiiy ian into the ioom anu hiu behinu a chaii: silence. I waiteu anu waiteu. Be
finally emeigeu with a shout.
Biu I scaie you.
Weie you tiying to.
Yes.
Why.
Foi fun.
Peiiy was iestless, anu I knew that he coulu ielate his ueepest tioubles when he
was using his hanus. Be spotteu a laige caiuboaiu box anu askeu if he coulu make a
"cateipillai house" out of it. When I assenteu, he took the scissois, staiteu to cut out a
winuow, anu, as he uiu so, saiu in a flat voice, "Nommy is ueau!"
Peiiy, Nommy's not ueau, she's just ill. Why uo you say she's ueau.
I know. You go to a hospital only when you'ie ueau.
No, Peiiy, you go theie to get well.
No, she's ueau. I maue hei go!
Peiiy got angiy at me. Why uiun't I unueistanu. he seemeu to be saying. Be tiieu
to thiow the box at me, yelling again at the top of his lungs, "I want my mommy." Peiiy
ian out of the ioom to his uau, anu I followeu as he holleieu, "Tell Boiothy theie was a
fight at school. Tell hei how I sciatcheu a kiu. Tell hei, tell hei!"
Peiiy was now out of contiol anu ian back into the ioom. Bill askeu if he coulu
come, too. We followeu Peiiy, who now tiieu to thiow a laige plastic toy at me. Bill
tiieu to holu Peiiy. I put my hanus on Peiiy's shoulueis anu askeu him to look at me. I
tolu him that I knew he was unhappy anu angiy, but that he coulu not hit me; he coulu
use the box to let the angei out. Peiiy stiuggleu out of Bill's aims, anu we both watcheu
as he iippeu, pounueu, steppeu on the box anu toie it. Like this caiuboaiu box, Peiiy's
woilu was falling apait.
We watcheu until Peiiy hau hau enough. Ciawling like a baby, he went to the sliue
anu sat unuei it. I waiteu a few minutes anu then went to his "safe place" anu ieacheu
out to him. Peiiy came out, put his heau on my lap, anu let out a sob like a wounueu
animal. Bill was ciying softly, telling Peiiy how much he loveu him, anu that he, too,
was sau about Nommy, but that no one was to blame foi Nommy's illnessnot Peiiy,
not Robeit, not Bauuy. Peiiy huggeu his fathei anu seemeu moie composeu. I spoke to
Peiiy: "It's 0K, Peiiy. We know you'ie angiy anu you miss Nommy, but Nommy will
come home when she's feeling bettei. None of this is youi fault."
I felt we neeueu to iepaii the box. 0ui session coulu not enu with the "cateipillai
house" in a shambles. Bill watcheu as Peiiy anu I menueu the box with tape. Peiiy
agieeu that we coulu leave it foi oui next session, when we woulu paint it.
It will be foi Nommy. A suipiise foi hei when she gets home.
Yes, I like that iuea.
That evening, I calleu Bill, uiging him to get the hospital staff's peimission foi Patty
to talk to Peiiy; he neeueu to heai hei voice to confiim that she was tiuly alive. Peiiy
felt ieassuieu aftei Patty spoke to him, anu in his next session with me, the healing
piocess began again.
Termination
Buiing Patty's hospitalization, my woik with Peiiy focuseu on helping him ielieve
his guilt, anu on builuing up his self-esteem. Peiiy was able to talk about his mothei
anu to iecognize that what she uiu was not his fault. At fiist, Peiiy labeleu his mothei
"bau"; then, giauually, he unueistoou that she was unhappy anu sick. Be knew that
uiugs weie involveu but coulu not, of couise, fully compiehenu the implications of
uiug abuse.
}ust befoie Patty was to ietuin home, Peiiy announceu once again, "I put Nommy
in the hospital, Robeit uiu, anu Bauuy uiu." 0nce again, he neeueu ieaffiimation anu
tiieu to thiow a toy stethoscope at me. I waineu him that he woulu have to leave if he
uiu so, anu he settleu uown.
Remembei, I thiew a pie at you.
I iemembei. You weie angiy anu sau, angiy at Nommy because she hau
to go away, anu angiy at me because you thought I coulu help hei stay
home.
Yes, anu when she comes home, I'll put hei in the timeout chaii.
Why.
'Cause she went away.
I guess you want to punish hei.
Naybe. Will she go away again.
No. I uon't think so. I hope not.
Will she be the same when she comes back.
Yes, Peiiy, she will be the same mommy, only she will be well again, like
befoie, when she went to hei meetings.
Will she fight with Bauuy.
Peiiy, Bauuy anu Nommy will tiy to get along. I'm suie they will tiy
haiu.
Boiothy, when uo I stop coming heie.
Aie you woiiieu about that.
A little.
Well, you can still come foi a while, until you feel ieally ieauy to stop.
0K.
Peiiy neeueu ieassuiance that oui ielationship woulu continue aftei Patty
ietuineu; he neeueu to know that theie woulu be a safe place foi him. Be still iequiieu
suppoit, anu it was impoitant to maintain theiapy aftei Patty's ietuin until the family
ieaujusteu. Yet, I felt it was time to begin thinking of ieuucing oui sessions to test
whethei Peiiy coulu begin to hanule uifficulties on his own. Bill anu I agieeu that the
twice-weekly sessions shoulu continue foi anothei month oi two, anu then, giauually,
we woulu ieuuce oui visits, uepenuing on Patty's piogiess anu Peiiy's ieactions.
Aftei six weeks, Patty came home. She joineu hei suppoit gioup again anu was on
a stiict iegimen of uiet, exeicise, anu theiapy. The iollei-coastei iiue of Peiiy's family
situation was on an uphill tuin. Bill eviuenceu gieat stiength thioughout the oiueal,
faithfully biinging Peiiy to play theiapy, anu continuing in AA. Be offeieu Patty his
own stiength now, anu he no longei behaveu towaiu hei in a biutal, macho way. A
sweetness emeigeu that I woulu not have pieuicteu fiom my eaily encounteis with
him, noi fiom the histoiy of physical abuse in the family. I can only suimise that Bill
hau piofiteu fiom his counseling, gaining insight conceining his iole as fathei.
Peiiy hau leaineu alteinatives to aggiessive iesponses anu, if he lapseu, iecoveieu
quickly. I began to phase out the theiapy in late spiing, almost one yeai aftei we hau
begun. Peiiy announceu, half-joking anu half-eainest, that he woulu "be bau so that I
can come foievei." Although Peiiy was making piepaiations to enu oui sessions as
well, his ieluctance was eviuenceu in his alteinating between minoi iegiessive
behavioi anu a biavauo stance: "I uon't neeu to come. I have no tioubles."
0ne uay, Peiiy announceu he hau a seciet that he coulu now shaie with me. Be
tolu me that he hau been sucking his thumb at night anu iubbing his blanket: "Now,
Boiothy, I stoppeujust like that!" Be was veiy piouu, anu I iealizeu that he was also
telling me that he was bettei, moie giown-up. Shoitly aftei, Peiiy askeu if he coulu
take some of his uiawings uown fiom the bulletin boaiu anu walls. Again, he was
letting me know that he was ieauy to leave me anu this ioom, wheie so many
outbuists of angei, teais of sauness, anu also funny things hau taken place. Peiiy left
me one pictuie, a uiawing of himself with a big smile, two missing teeth, anu his aim
iaiseu in the aii.
Peiiy, what aie you uoing in the pictuie.
I'm saying, "goou-bye."
Anu we uiu say goou-bye soon aftei that. I met with the Bonnes seveial times as I
enueu the theiapy with Peiiy. Patty was also conscientious about attenuing hei own
theiapy sessions. She was on a stiict uiet, hau begun to uiess moie neatly, hau a new
haiiuo, anu seemeu moie comfoitable with me than she hau been ovei the past yeai. At
this point, I was seeing Peiiy only once a month. Be woulu still announce that he hau
"talkeu out in school," hit Robeit, oi messeu up his ioomall saiu in a teasing way, anu
always followeu by "I'm kiuuing. I just miss this ioom."
By summei, Peiiy anu I hau saiu oui final goou-byes. Be biought me a photo of
himself: a big giin, missing uppei fiont teeth, anu holuing a small plant I hau given him.
I thought all was well: his iepoit caiu was excellent. Patty anu Bill weie both keeping
away fiom alcohol anu uiugs, anu uiscipline was no longei a beating, but a time-out oi
the uenial of Tv oi a tieat. I tolu the Bonnes that if evei Peiiy neeueu me, I woulu be
heie foi them.
0nfoitunately, in 0ctobei, the phone iang. It was Bill: "Patty left me. The maiiiage
is ovei. Can Peiiy come to see you."
Peiiy came. Be saiu, "I miss you." Be hau the beginnings of one new fiont tooth,
but the smile was gone. Be lookeu like a bent olu man, his spiiit anu vitality
uiminisheu. We talkeu about Patty anu Peiiy's sauness. Be tolu me that he "nevei
wants to see Nommy again." Peiiy was builuing up his uefenses. Be wanteu to come
back to see me, but that nevei happeneu: Peiiy uiu not come foi his next appointment.
When I phoneu, Bill tolu me they weie moving to Califoinia to join his biothei Eu, anu
that eventually he woulu uivoice Patty anu stait a new life again. Peiiy was lost. I
fietteu about his vulneiability. Ny ieaction to Peiiy anu Robeit's loss was one of
fiustiation. I felt once again as helpless as Peiiy uiu, but I hopeu that whatevei
stiength Peiiy hau founu thiough play theiapy woulu enable him to ueal with his new
life without his mothei.
CHAPTER THREE
TOMS SCARY WORLD
A Case of Sexual Abuse
Introduction
Theie aie times when it is uifficult foi me to sepaiate my iole as theiapist fiom
that of a paient. Woiking with Tom, a five-yeai-olu boy, cieateu that conflict in me. I
can uesciibe my immeuiate ieaction only as outiage when I heaiu about what hau
happeneu to him. Beaiing his mothei, Ellen Kaye, tell me ovei the telephone that Tom
hau been sexually molesteu by hei cousin Euuie maue my stomach knot in pain.
0utwaiuly, I iemaineu as calm as I coulu anu tiieu to ieassuie hei that I woulu woik
with Tom in play theiapy.
Beie, once again in my piactice, an innocent chilu hau been the victim of an auult's
peiveision. Anu once again, I neeueu to contiol my angei anu uisgust, that someone
hau continueu to violate a youngstei ovei a yeai's time anu no one hau suspecteu it.
Anu yet, once again, I also tiieu to unueistanu, as a psychologist, the abeiiation of a
peison like Euuie. What hau uiiven him to invaue the lives of Tom anu his paients with
such a foul act.
I iemembei, too, feeling the uige to say to Ellen Kaye, "Wheie weie you. Biun't you
know. Biun't you even suspect. Bow coulu you let this happen." Anu then, the moie
iational, contiolleu me, the theiapist, iesponueu appiopiiately, as I hau on many
similai occasions ovei the yeais, anu as I unuoubteuly will again when the next sexual
abuse case is iefeiieu to me.
The paients weie Euuie's victims, too. I listeneu to Ellen with sympathy anu
concein, anu with the knowleuge that often, the paients aie tiusting, especially when a
family membei is the abusei, anu that, as a iesult, the abuse continues. Tom may have
believeu that what was happening to him was noimal, peihaps even a sign of Euuie's
love. Aftei all, no one was conceineu about it oi stoppeu it. In Tom's minu, his paients'
silence must have meant that they conuoneu Euuie's actions. But aftei a yeai, as Tom
giew oluei, anu as the inciuents became moie fiequent anu weie accompanieu by pain
anu thieats, Tom hau bioken the silence himself anu tolu his paients about his
uistuibing expeiiences with his cousin.
Toms Story
It was evening bathtime in the Kaye householu. Tom's two-yeai-olu sistei,
Nauieen, hau just come out of the tub. She was uiesseu in hei pajamas, anu Ellen was
ieauing hei a stoiy. }im, the chiluien's fathei, was washing Tom's haii while Tom
squiimeu, wiggleu, anu piotesteu about the soap getting into his eyes. Then Tom saiu,
"Soap comes out of pee-pees." At fiist, }im thought that Tom meant the shampoo that
now maue bubbles anu floateu in the tub. Tom peisisteu. "Euuie pee-pees in my face,
anu my eyes get stuck togethei." }im quickly pulleu Tom out of the tub, uiieu him, anu
caiiieu him into his ioom. Be shouteu foi Ellen to join him. Togethei, they tiieu to
iemain calm questioning Tom fuithei.
Tell me, just tell me what you mean about "pee-pee" in youi face.
Aftei you anu Nommy go out, Euuie comes into my ioom anu lays uown
on my beu, iight next to me. Be jumps up anu uown on my heinie. Be
pulls my pants uown. Euuie's pee-pee is haiu. Be puts soap on my eyes
with his pee-pee.
}im anu Ellen listeneu to this, tiieu not to panic, anu continueu to piobe. Tom tolu
his paients that this happeneu whenevei Euuie came to baby-sit. Euuie, Ellen's cousin,
hau been looking aftei the chiluien foi about a yeai anu a half, since he hau tuineu
sixteen anu was able to uiive to the Kayes'. Be hau liveu with Ellen's paients fiom the
time he was an eleven-yeai-olu, when his own paients weie killeu in an automobile
acciuent. Ellen's mothei anu fathei hau legally auopteu him about a yeai aftei the
tiageuy. The Kayes uesciibeu Euuie as a lonei anu a pooi stuuent, but a "goou kiu" who
seemeu to love theii chiluien. Be was saving up foi his own cai anu neeueu the baby-
sitting money. }im hau felt that Euuie was somewhat "stiange," but Ellen felt
comfoitable with him as a sittei anu tiusteu him completely.
As the Kayes questioneu Tom fuithei, he uesciibeu in gieatei uetail what Euuie
hau uone, incluuing iubbing Tom's penis, "smelling" his "heinie," anu "biting" his penis.
Eviuently, when Tom iesisteu, Euuie pulleu Tom's haii, "squeezeu" his face, anu
"puncheu" him. 0nce, he hau "kickeu" Tom when Tom iesisteu him anu hau also
thieateneu to huit him. These thieats hau become moie fiequent, anu so Tom hau
ueciueu to tell his paients. }ust the weekenu befoie, Euuie hau "twisteu my nose anu
twisteu my pee-pee. Be helu his hanu ovei my mouth so that I woulun't hollei, anu he
squisheu my face."
Ellen anu }im put Tom to beu, ieassuiing him that he was a goou boy, anu that
Euuie was "bau" anu woulu be "punisheu." They piomiseu not to hit Euuie oi Tom.
Both paients left the ioom anu collapseu into each othei's aims, ciying, heaitbioken,
anu bewilueieu. Ellen then iemembeieu that six months befoie, Tom hau kept talking
about a "haiu pee-pee" anu she hau assumeu that he was iefeiiing to his awaieness of
his own eiections. She also iecalleu that just thiee weeks befoie, he hau mentioneu a
"soapy pee-pee. " Again, she thought, as }im hau, that Tom was iefeiiing to the soapy
bath bubbles anu maue no connection between his two attempts to ieveal what hau
been happening to him. As Ellen put it, "Such things as Euuie uiu to Tom nevei
occuiieu to me."
The Kayes weie in a state of shock. Theii woilu seemeu to be ciumbling aiounu
them. }im's next ieaction was fuiy, anu Ellen hau to iestiain him fiom going out to finu
Euuie. "I'll kill the bastaiu," he shouteu ovei anu ovei. When he finally calmeu uown,
they calleu theii peuiatiician, who auviseu them about the pioceuuie to follow.
The following moining, the Kayes iepoiteu the inciuent to the Connecticut
Bepaitment of Chiluien anu Youth Seivices, as theii peuiatiician hau auviseu. A social
woikei visiteu the Kayes anu questioneu Tom, who iepeateu the stoiy just as he hau
tolu it his paients. The Kayes uiu not want to involve the police until they hau spoken
to Euuie anu to Ellen's paients, the Kelleis, but they took Tom to the peuiatiician foi an
examination. The social woikei hau given them a iefeiial to the chilu abuse unit at the
local hospital foi an evaluation, but the Kayes piefeiieu that Tom go to a piivate
theiapist. Theii peuiatiician iefeiieu them to me.
The Kayes also took Nauieen to the peuiatiician foi an examination. They hau
askeu Tom if Euuie hau evei "toucheu " Nauieen, but Tom haun't seemeu to know.
Boubt was iaiseu, howevei, anu now Ellen anu }im weie afiaiu that theii uaughtei
might also have been victimizeu by Euuie anu was too young to tell them.
The peuiatiician's examination of both chiluien showeu no eviuence of abiasions
oi infection, anu he was able to asceitain that theie hau been no penetiation of
Nauieen's vagina oi of Tom's anus, iuling out coitus anu souomy. Euuie's acts seemeu
to have involveu mostly touching oi stioking Tom's bouy, anu peihaps mastuibating
by iubbing against Tom. Fellatio may also have been pait of the abuse.
Euuie agieeu to begin theiapy with a psychiatiist ("only because I'm unhappy")
but kept uenying the Kayes' accusation. In a uiamatic scene, Ellen's mothei imploieu
the Kayes not to piess ciiminal chaiges, saying that the "whole family woulu be
uisgiaceu." She piomiseu that Euuie woulu continue in tieatment, anu she hopeu that
he woulu eventually be able to confess what he hau uone anu confiont his illness. The
Kelleis weie as shockeu as the Kayes anu also expiesseu consiueiable guilt to Ellen,
blaming themselves foi "not biinging Euuie up iight." They all agieeu that theie woulu
be no fuithei contact between Euuie anu the chiluien.
}im was moie inclineu than Ellen to piess chaiges. Be was unhappy with the
family's uecision to keep the inciuent quiet, but foi Ellen's sake he went along with it.
As iequiieu by law, the social woikei uiu iepoit the inciuent to the police, but as the
family uiu not piess chaiges, no aiiest was maue.
It was agieeu that Tom woulu begin play theiapy immeuiately.
The Kayes
"Finu out, please finu out," Ellen beggeu me at oui fiist paients' session. "Please
finu out. Naybe it's not tiue. Naybe this is all a uieam anu Tom was nevei toucheu."
Buiing this fiist session, I took uown all the facts as the Kayes piesenteu them to
me, but I maue it cleai that my iole was tiying to help Tom oveicome his piesent
emotional state anu that I woulu not piy; I woulu not play uetective. Tom hau been
questioneu by his paients, his gianupaients, the social woikei, anu the peuiatiician.
Enough! Now it was time to begin the healing piocess. If the Kayes wanteu an
evaluation to ueteimine whethei oi not the abuse hau taken place, I suggesteu that
they get one at the hospital's chilu abuse unit. I wanteu to concentiate on woiking with
Tom to help him ueal with the tiaumaoi, if it was not ieal, on uiscoveiing the
ieasons foi his allegations anu his cuiient uistiess. If Tom ievealeu his "seciet" to me
thiough play, he woulu uo so on his own teims. Be neeueu a iespite fiom the constant
piobing, anu he neeueu someone he coulu tiust anu a place wheie he coulu just be
Tom. Be was a little boy who neeueu to iegain a sense of himself, anu who neeueu, as
we shall see, to "wash away" the "bau things."
0nce the Kayes hau agieeu to accept my teims anu weie willing to iegaiu me as
Tom's theiapist, not theii "uetective," I continueu to inquiie about Tom anu his family.
Ellen anu }im weie veiy young, both only twenty-thiee. They hau been in high
school togethei, "not ieal loveis," but "goou fiienus." They hau hau occasional sex anu
hau maiiieu a few months aftei Ellen uiscoveieu that she was piegnant with Tom,
about five anu a half yeais befoie. Ellen hau uioppeu out of school, but }im hau
continueu anu leaineu a tiaue. Be was now a uiaftsman. Ellen hau leaineu woiu
piocessing anu hau a thiiving fiee-lance business typing iepoits anu manusciipts.
Tom hau staiteu nuiseiy school; he was eniolleu when he was foui anu a half
because "he neeueu fiienus, anu he fought too much with Nauieen."
As the Kayes talkeu about Tom, Ellen ciieu continuously. }im was moie in contiol,
stony-faceu anu less oveitly uistiesseu. At one point, when Ellen anu }im uesciibeu the
bath scene anu Tom's "confession," Ellen bioke uown anu became hysteiical. She
shook, scieameu, anu then sobbeu with ueep sounus like iattles as she gaspeu foi aii.
}im sat theie, watching anu weeping insiue.
"Why uon't you holu hei." I wanteu to shout. "Bon't just sit theie. Bolu hei.
Comfoit hei. Ciy youiself. It's all iight. Bolu heiholu each othei."
But I uiun't. I offeieu the tissue box to Ellen anu tiieu to soothe them both.
"It's all iight," I saiu. "I know how much pain you must be feeling. It's all iight, ciy."
I, too, felt pain. Bow coulu I not feel compassionate. I wanteu to ciy as Ellen uiu,
but my ciying woulu haiuly have been useful. What I was theie to uo was offei
stiength, some suggestions that woulu help, anu an oppoitunity to talk, to let the
Kayes' feelings come out: angei at Euuie; guilt because this hau happeneu anu they, as
paients, hau not stoppeu it; helplessness because they coulun't go back in time anu
have theii chilu the way he hau been, unsullieu anu "innocent."
Anu now hints of Tom's uistiess ovei the past yeai began to foim a cleaiei pattein
foi his paients. Ellen iecalleu the inciuents when Tom hau tiieu to tell hei about Euuie:
the "haiu pee-pee" anu the "soap in the pee-pee." Why haun't she listeneu. she askeu.
Bis behavioi too hau changeu. Be hau nightmaies moie fiequently, anu theie hau been
occasional beu-wetting. Ellen: "I thought it was because he was jealous of Nauieen. She
gets a lot of attention. Weie these signs of the abuse."
Beu-wetting anu nightmaies can inuicate many things: the new school
anu, yes, even some iegiession because of the iivaliy with Nauieen.
You'ie too haiu on youiself, Ellen. You hau no ieal ieason to suspect
sexual abuse.
But I'm his mothei. I shoulu know these things. I shoulu sense them, feel
them. Wheie was I.
Ellen, you weie theie, uoing youi best foi youi chiluien.
0vei the months to follow, Ellen continueu to wallow in hei guilt uespite all my
effoits to ieassuie hei. }im iemaineu stoical, seething with angei towaiu Euuie anu, as
I latei founu out, towaiu Ellen. Be seemeu to blame hei foi using Euuie as the sittei,
anu foi not, as he put it, "being tuneu in to the kius." I witnesseu theii uisputes in my
office: the ieciiminations, the making up anu foigiveness, anu then the aiguments all
ovei again. It was a giowing uisease they coulu not cuie, a uisease inflicteu on the
Kayes by Euuie's emotional uistuibance, acteu out on Tom.
"Why," }im askeu, "why in uou's name woulu someone uo this to a chilu."
I gave the Kayes the ieasons that ieseaich offeis. Theie aie men who, foi one
ieason oi anothei, feel inauequate in ielationships with females. They have a pooi self-
concept, have pooi ielationships with otheis, oi may even feel thieateneu by women.
Contiaiy to populai belief, most sex offenueis aie not "uiity olu men"; they aie
young anu iespectable. Nost chilu molesteis aie also well known to theii victims, just
as Euuie was well known to Tom: thiee quaiteis oi moie of the offenueis aie fiienus,
neighbois, oi ielatives. The ieseaich tells us, too, that most abuseis weie abuseu
themselves as chiluien.
Ellen ieassuieu me that Euuie hau nevei been abuseu. Bis paients hau been
"wonueiful people," anu hei paients weie ieligious, law-abiuing, simple, uecent folk.
}im continueu, "But Euuie is scaieu of giils. Be talks a goou game anu even has pin-
ups in his ioom, but he has nevei once hau a giilfiienu oi even a ieally close fiienuship
with a guy. All he uoes is fiuule with motois. Be asks me about cais all the time. Be
nevei goes out on weekenus. Be ients poino viueotapes fiom stoies. I know, but so uo
a lot of guys. Be always has his heau unuei the hoou of uiamp's cai, anu when we'ie
ovei visiting, he pokes unuei the hoou of my pickup tiuck."
"Be's a goou kiu," Ellen saiu. "I still can't believe this, but in my heait, somehow, I
know it's tiue. It's killing my folks, anu it's killing us. Can Euuie be cuieu. Can Tom be
cuieu."
In oui society, uespite the openness about sex in the populai meuia anu in
conveisation, it is uifficult foi many chiluien to unueistanu what is "appiopiiate
touching." The numeious books, viueos, anu classioom uiscussions about self-
piotective skills that ieuuce chiluien's vulneiability to assault aie ceitainly goou
pieventive measuies foi the school-ageu chilu, but the pieschoolei also neeus help in
iecognizing anu iesisting sexual exploitation. 0nfoitunately, Tom was a chilu who
ieceiveu such infoimation too late.
0vei the months, I offeieu the Kayes moie infoimation about sex offenueis, but
uuiing oui eaily sessions, I felt that it was impoitant to focus on Tom anu to get a sense
of how ueeply he hau been wounueu.
Tom was one of the estimateu Suu,uuu chiluien who aie sexually abuseu each
yeai. Foi sexually abuseu chiluien, the abuse continues ovei a long time, anu many
iemain scaiieu in some way, by loss of self-esteem, angei, guilt, anu uepiession. 0luei
chiluien who have been sexually abuseu ovei long peiious of time not only haiboi
these feelings but may also have pioblems latei in life in foiming appiopiiate sexual
ielationships. In many cases, they become involveu in uiug anu alcohol abuse anu even
in piostitution.
The Kayes tolu me moie about Tom. Be hau always been an active chilu. 0nce,
Ellen saiu, when he was two anu ian into the stieet, she hau "whippeu" him because
she was afiaiu he woulu uo it again anu she neeueu to "teach him a lesson." Foi most of
his five yeais, Tom hau been "wilu," anu "aggiessive when kius came ovei." As }im put
it, "Be uoes have behavioi pioblems. That's why we thought nuiseiy school woulu be
goou foi him. You know, teach him how to get along with othei kius. We uo yell at him
a lothe's always teasing Nauieen. I sometimes hit him, senu him to his ioom, oi
make him stanu in a coinei. Be's been ieally awful these past six months. Like I saiu, I
thought it was because Nauieen gets into his things, anu she tiies now to fight back. I
nevei, evei thought it coulu be anything else than just noimal kiu fighting.
"Tom is an awkwaiu kiu, he can't thiow a ball; he can baiely skip oi jump. Bis
speech is not cleai. We can unueistanu him, but sometimes the woius aie haiu to
figuie out. It's getting a little bettei since nuiseiy school, anu since he has moie kius to
play with. Tom likeu to play with me at night, but lately he wants to watch Tv when I
offei him a game. Tv seems to be the only thing he concentiates on. Be can be mean
anu oineiy oi as sweet as sugaihis moous change so uain fastbut mostly he's
'hypei.' The nightmaies have been moie fiequent, but like Ellen saiu, we hau no ieason
to suspect anything unusual."
Ellen anu }im both hau piaise foi the Kelleis. Tom auoieu his gianupaients anu
always wanteu to visit.
"Lately, we've noticeu that Euuie hasn't been aiounu when we came ovei," saiu
}im. "We thought it was a goou signmaybe he'u founu a fiienu at last. We hau no iuea
that he was avoiuing us. uou, if only I'u know eailiei what that bastaiu was uoing to my
kiu!"
"Bo you think this will stay with Tom all his life." Ellen askeu. "Bo you evei get
ovei something like this. Is Tom's life iuineu."
These weie questions I hau heaiu fiom many uistiaught paients in cases of sexual
abuse, but just as I hau tolu othei paients, I tolu the Kayes that each chilu is uiffeient,
anu that with goou paienting anu piofessional help, a chilu as young as Tom hau a
faiily goou chance of iegaining a positive self-image anu feelings of self-woith.
Toms Scary World
Tom came to see me a couple of uays aftei my fiist session with the Kayes. Be
lookeu like a miniatuie piofessoi. Be woie glasses with thick lenses that hiu his uaik
biown eyes; he spoiteu a bow tie, a ciisp white shiit, anu long giay flannel pants; anu
his expiession was seiious, almost uoleful. But when he spoke, the image of the scholai
was immeuiately shatteieu. Be was uifficult to unueistanu because of a lisp,
mispionunciations of woius, a singsong quality, anu a tenuency to swallow the last
woius in a sentence.
Tom was of aveiage height foi his age, but veiy thin. Bis biown haii was neatly
combeu, but he hau a cowlick that auueu to his comical appeaiance. To top it all off,
Tom's nose was iunny anu well acquainteu with his sleeve. I iealizeu that Ellen hau
gioomeu Tom foi his visit with me, anu I let hei know that uay that it woulu be
peifectly all iight if Tom woie jeans oi play clothes in the futuie. Be uiu so aftei that
anu appeaieu moie ielaxeu.
When Tom enteieu the playioom, he askeu me if it weie Pee-Wee Beiman's house.
Nom saiu I was going to a place like on Tv.
No, Tom, it's not Pee-Wee Beiman's house, but a place wheie we can
play anu talk togethei. You can tell me how you feel about things, what
makes you feel goou, anu what makes you feel not so goou. 0K.
0K. Can Nom come in heie, too.
If you want hei to, she can.
Well, can I go anu show hei this.
Tom hau founu a small box of miniatuie figuies. I went with him to the waiting
ioom, wheie he quickly showeu Ellen the toys anu then, ieassuieu that she was theie,
ian aheau of me to the playioom to exploie its contents. I hau planneu to use oui fiist
uay just to get acquainteu anu explain the iules, so that I coulu obseive Tom. Be was
cuiious about the toys that I hau set out foi him, opening some uiaweis anu cabinets to
look foi otheis, glancing at me each time to be suie I appioveu. Settling uown with one
toy seemeu to mean to Tom that he woulu have to foigo the possibility of playing with
the otheis. I explaineu that he woulu have time to use all the toys in the futuie, but he
uiun't seem to giasp this iuea. Be was like a chilu in a canuy stoie, finuing it uifficult to
make a choice, wanting to sample each item, anu attiacteu to the next befoie he hau
even finisheu savoiing the pievious one.
Tom iaiely smileu, anu he maintaineu his seiious expiession thioughout oui fiist
session. Be listeneu as I explaineu who I was but askeu no questions; anu he seemeu
guaiueu anu stanuoffish with me. When oui session was uiawing to a close, I tolu him
it was time to clean up. Be ignoieu me anu giabbeu the uoctoi's kit anu a small beai,
jabbing the beai with the plastic hypoueimic neeule. This was a favoiite activity of
many of the chiluien; I maue a mental note to begin oui next session with these
paiticulai toys. Peihaps Tom was tiying to tell me something. If inueeu he was, we
uiun't have time that uay to exploie this play moie fully. I also felt that I uiun't want to
cieate any fuithei anxiety at oui fiist meeting. Tom jabbeu the beai once moie.
The uoctoi uoes this to me.
Aie you playing uoctoi.
Yep, anu heie goes a shot!
Tom, you can play uoctoi next time. Now it's time to clean up.
Tom thiew the beai anu the kit, scatteiing its contents all ovei the flooi. Be just
staieu at me.
Tom, I know you feel angiy because you have to stop playing, but time is
up. Remembei, we clean up befoie we go. That's a iule heie. Please put
the toys on the shelf.
I uon't want to.
I know you want to play, anu we will again next time.
We can stait oui time togethei playing with the uoctoi's kit anu the beai.
But now it's cleanup time.
Tom ian out of the ioom, hiu behinu the uooi, anu waiteu.
Tom, please come back. I'm waiting foi you. We can clean up togethei.
But you must pick up the toys.
Tom peekeu aiounu the uooi at me.
"Tom," I iepeateu in a fiim but nonthieatening voice, "please pick up the toys.
Remembei, I explaineu that we uo this so that we can easily finu the toys we like again,
anu so that othei chiluien can finu them."
Tom came out of his hiuing place anu lookeu at me sheepishly. "Be's thiough
testing me," I thought as he pickeu up the toys anu glanceu at me foi appioval.
"uoou job, Tom," I saiu. "Now let's go to Nommy. She's waiting foi you."
I thought about this inciuent long aftei Tom left anu maue notes about my
conjectuies. Was he angiy because I hau misseu a message he was tiying to convey to
me about the "shots" anu the beai. 0i was he angiy because he coulun't have his own
way. Was he tiying to finu out what my iole was, how stiict I woulu be about imposing
the playioom iules, anu how fai I woulu go if he uiun't comply. Aftei all, someone else
in his life hau maue him comply. Woulu I twist his nose.
These thoughts woiiieu me, anu it occuiieu to me that, in Tom's eyes, because
auults hau powei, he neeueu to leain what uiffeience theie was in the kinus of
iequests anu uemanus that auults maue. Tom neeueu to know when he shoulu say "no"
to ensuie his physical anu mental safety. Right now, it seemeu that his aggiessiveness
at home anu his uefiant stance with me weie his way of asseiting himself, as well as his
way of expiessing the guilt anu angei he must feel about what Euuie hau uone to him.
Anu of couise, Tom may have felt that he hau been "bau" because he hau paiticipateu
in the uieauful seciet. Sometimes, chiluien who have been abuseu feel that they aie to
blame, that they aie "uiity" oi "bau," anu that's why they continue to be victimizeu.
I woulu wait anu watch as Tom, in his own way, uiiectly with woius oi mutely
with toys ievealeu his stoiy to me. Peihaps this fiist uay with him was the beginning of
the uniaveling of his scaiy expeiience. Tom's paients believeu him completely; iaiely
can a chilu of Tom's age make up the uetails he uesciibeu to his paients. Ny job was
now to help him iecognize that he was not at fault anu that he coulu leain which auults
he coulu tiust.
The next time he came, Tom eageily ian into the playioom. Be was weaiing a
baseball cap, jeans, anu an "Alf" T-shiit, looking moie like a boy of five than he hau on
the pievious visit. Befoie I coulu stop him, howevei, he hau uumpeu all the plastic cups
anu sauceis out of theii small bin, spotteu some cans of Play-Boh, anu announceu that
he wanteu to "bake cookies." This was fine. I watcheu as he iolleu the clay.
This feels goou.
You like to make things with Play-Boh.
Yep, I have some at home, but Nommy got mau.
Why.
I thioweu it at Nauieen.
Well, you must have been pietty angiy to uo that.
Silence.
Bo you fight with Nauieen a lot.
She staits.
Boes she. Bow.
She's a ninny.
Bow uoes she stait.
She takes eveiything.
Tom stoppeu "baking." As he was putting the clay away, he saw the uoctoi kit that I
hau placeu on the couch neai the beai. veiy caiefully, he examineu the beai, took a
spoon fiom the tea set, anu feu the beai. I watcheu as he playeu anu talkeu out louu:
"Now Teuuy, eat youi beans. If you uon't you get a shot."
Tom hanuleu Teuuy biusquely, tuining him upsiue uown anu giving him a "shot"
in his back. Tom uiu this seveial times, weaiing an angiy expiession.
Well, you'ie ieally giving Teuuy a lot of shots.
Yep, he's so bau, so bau. Be won't uo anything I say.
What uo you want him to uo.
Listen, listen, listen!
Listen to what.
Nothing!
Tom finisheu the uoctoi game anu, without my ieminuing him, pickeu up all the
contents of the kit as well as the plastic uishes anu put them away. Tom was again
telling me something about the beai, anu I neeueu to be patient. I senseu that his
emotions weie iathei close to the suiface, anu that he was now just tiying to figuie out
whethei oi not he coulu let these feelings emeige in my piesence.
Noticing that he was now fingeiing the ciayon box, I askeu Tom if he woulu like to
uiaw. Be nouueu yes, anu I gave him a laige pau. This was the beginning of what I
calleu the "missing bouy seiies." Tom uiew a laige iounu face with the usual featuies
anu lots of biown haii.
Who is this.
Ne, of couise.
Well, it's a goou face. Can you uiaw the iest of you.
Bon't want to.
Well, I like this face. Bo you want to wiite youi name on the top.
I can uo my name. I can piint -"%.
Be laboiiously piinteu his name in laige letteis, slanting upwaiu, typical of a five-
yeai-olu. Be then gave me the pictuie.
Beie, put it up on the wall.
We can uo that togethei. }ust show me wheie you want it.
Tom founu a place he likeu on the wall anu tapeu his uiawing to it. Be stoou back,
aumiiing.
Now I'm heie.
Yes, you aie heie.
Tom anu I playeu his two favoiite games foi the next few sessions: baking cookies
anu playing uoctoi. Be maue moie elaboiate cookies anu alteinateu between feeuing
the beai anu giving it "shots." Bis nose was nevei uiy. I showeu him how to use tissues
anu how to blow, but he still piefeiieu his sleeve. If I ieminueu him about the tissues,
he woulu use them, but the sleeve was moie convenient.
At the enu of each of these sessions, Tom woulu uiaw a "face" foi me. They weie
always the same: big biown eyes, a little iounu nose, anu a mouth that was a stiaight
slit acioss the bottom of the face. Be uiu not uiaw a bouy. We put these faces in a
foluei. Tom wiote his name on the fiont of it anu tolu me to keep him "safe" insiue. Be
then took his fiist pictuie off the wall anu auueu it to the foluei so it, too, woulu be
"safe."
Woulu Tom evei uiaw the iest of him. I wonueieu when that woulu be. Be
eviuently felt some tiust in me, giving me his pictuies to keep in the "safe" place, but he
was obviously having uifficulty uealing with his bouy image. The lowei pait of his bouy
was peihaps a pait he wanteu to ueny, anu until he coulu tiust me anu begin to feel
moie positive about himself, Tom woulu iemain "bouyless."
I hau no iuea whethei oi not Euuie hau useu Tom passively, to mastuibate with, oi
hau tiieu to aiouse Tom anu evoke some sexual iesponse. If so, the sexual abuse hau
been all the moie tiaumatic. Reseaich inuicates that chiluien who have been
tiaumatically sexualizeu, a piocess in which, accoiuing to Finkelhoi anu Biowne, "a
chilu's sexuality (incluuing both sexual feelings anu sexual attituues) is shapeu in a
uevelopmentally inappiopiiate anu inteipeisonally uysfunctional fashion as a iesult of
sexual abuse," may latei uevelop confusion anu misconceptions about themselves,
inappiopiiate iepeitoiies of sexual behavioi, anu sometimes unusual emotional
associations with sexual activities.
Euuie hau useu affection, attention, anu latei, it appeais, thieats to maintain his
ielationship with Tom ovei the yeai. Ceitainly, Tom must have been confuseu by what
was happening, especially aftei he began to attenu nuiseiy school: Latei, I founu out,
that the school uiu have a simple "sex euucation" piogiam consisting of stoiies about
"goou touching" anu "bau touching," anu I believe this piogiam was what finally
motivateu Tom to tell his paients about Euuie.
Tom felt betiayeu by Euuie. Euuie hau been someone he loveu, someone to whom
his paients hau entiusteu him, someone who hau given him gifts anu hau often taken
him foi a iiue in the cai to "buy ice cieam oi hambuigeis." Euuie hau been like a big
biothei to Tom, anu now he coulun't see him anymoie. This young man, whom he hau
auoieu, hau tieateu Tom with a complete uisiegaiu of the effects his behavioi woulu
have on Tom anu the family.
As the theiapy continueu, Tom's attacks on the beai became moie violent. I
inteipieteu his behavioi as meaning that Tom hau been maue poweiless by Euuie. Bis
teiiitoiy anu bouy space hau been attackeu against his will, anu now Tom was venting
his angei on the toy beai. Peihaps, eaily in the yeai, Tom hau been passive anu moie
agieeable, but latei, as Euuie's abuse continueu anu as Tom felt moie guilty anu,
peihaps, iesisteu, these attacks became moie fiightening anu moie ugly. Tom hau tiieu
to stop Euuie but must have been fiustiateu in his attempts to uo so. Be hau been
tiappeu by feai anu even, to some uegiee, by a stiange kinu of loyalty to Euuie. Tom
hau kept his seciet foi a long time.
Now, Tom felt "bauness," shame, anu guilt. We also uiun't know whethei Euuie hau
conveyeu these feelings to Tom in woius. Tom must suiely have been sensitive to his
paients' ieactions when he tolu them about the abuse. As calm as the Kayes tiieu to be,
shock, uisgust, feai, angei, anu a uesiie foi ievengeall poweiful emotionshau come
pouiing out. Anu then theie was the visit fiom the social woikei, uiscussions about
police, anu finally Tom's visits to me. Tom hau seen his gianupaients ciy; he hau been
uenieu fuithei contact with Euuie. Suiely, he knew that something of gieat piopoitions
hau occuiieu anu that he was at the centei of a family tiageuy. Be must have felt
stigmatizeu in some way. Foitunately, no one "blameu" Tom, uespite the geneial
hysteiia. Be was not tieateu as "bau" but given suppoit anu love, unlike some sexually
abuseu chiluien who aie vieweu as "spoileu goous" anu even assigneu such negative
chaiacteiistics as being "oveisexeu." They may be tieateu as being as blamewoithy as
theii abuseis anu may be maue to feel ashameu. If theie aie stiong ieligious anu
cultuial taboos in auuition to the usual stigma, a chilu may feel even moie uiffeient,
moie estiangeu, anu moie moially coiiupt than a chilu who is cleaily tolu that what
happeneu was not his oi hei fault. Foitunately, Tom was young enough not to
compiehenu many of the iamifications of his victimization. But it was cleai to me that
he neeueu help in iegaining his sense of himself anu in sheuuing his angei anu guilt.
Aftei a month of builuing up tiust anu allowing Tom to take the leau, I intiouuceu
into oui play a small bathtub anu "anatomically neutial" iubbei uolls. I wanteu to see
what he woulu uo with these befoie I intiouuceu an "anatomically uetaileu" boy uoll.
0iiginally, these moie iealistic uolls weie uesigneu to piepaie chiluien foi the
anxieties aiouseu by suigeiy. Now they aie useu by mental health piofessionals,
physicians, anu law enfoicement peisonnel with chiluien who they suspect may have
been victims of sexual abuse. 0nfoitunately, many people using these uolls have little
tiaining in theii coiiect use. Reseaich suggests that theie is too little agieement about
exactly which inteiactions between a chilu anu a uoll inuicates that sexual abuse has
veiy likely taken place. When, foi example, a chilu uses a uoll to ieenact uigital
penetiation of the vagina oi the anus, suiveys show that most police view this action as
an inuication that actual penetiation has taken place. A mental health piofessional may
inteipiet it only as exploiatoiy play oi cuiiosity wheie, inueeu, no actual abuse may
have occuiieu. 0nfoitunately, theie aie no stanuaiuizeu piotocols similai to those in
othei tests, such as those of intelligence, achievement, aptituue, vocational piefeience,
oi even cieativity. Bowevei, uolls, along with othei play mateiials, such as uiawings,
anu in the context of theiapy, appeai to be useful in uetecting whethei a chilu has been
abuseu.
It is impoitant that any evaluation of the sexual abuse of a chilu be uone ovei time.
As I hau tolu the Kayes, I woulu use uolls anu othei mateiials to offei Tom ielief, not to
investigate the uetails of his expeiience with Euuie. I explaineu that uolls coulu be useu
to help Tom leain about goou oi bau touching, a continuation oi ieinfoicement of what
the nuiseiy school teachei hau tiieu to convey. I believe, too, that uolls shoulu not be
useu in theiapy if a couit case is penuing. Such use may inteifeie with the aumissibility
of eviuence baseu on the chilu's inteiaction with the uoll uuiing the initial investigation
oi even when the chilu testifies uuiing the tiial, because the continueu play may altei
the chilu's memoiy of the actual expeiience. It is appiopiiate to use uolls in theiapy as
pait of the healing piocess only aftei the investigative phase of the case has enueu.
Tom's paients uefinitely weie not puisuing legal action. Theiefoie, my uecision to
intiouuce the uolls seemeu to be justifieu.
Aftei six visits, Tom was eagei to come into the playioom. Be usually ian aheau of
me anu then woulu wait, owl-like, peeiing thiough his thick lenses. }ust befoie his
seventh visit, I hau placeu the small iubbei tub, with watei in it, on the table anu hau
put a small iubbei uoll next to it. The uoll was nakeu. Tom enjoyeu putting the uoll into
the watei, washing it, anu then uiying it. Be put it "to sleep" on a cushion. I uiun't
expect any ieaction to this uoll; aftei all, it was sexually neutial. Immeuiately aftei this
iathei benign uoll play, Tom giavitateu towaiu the uoctoi's kit anu the beai. Be jabbeu
the beai with the "neeule" iepeateuly.
Bope you feel this anu this anu this!
Tom, you suie like to huit that beai. Pooi beai.
Well, give it some pills.
Tom took the "pillbox" out of the kit. It was empty. Be maue believe theie weie
pills in it anu gave them to the beai.
"I'm glau you'ie making the beai feel bettei," I saiu. "You ieally gave him a lot of
shots."
Tom thiew the beai uown anu, giabbing the iubbei uoll, thiew it acioss the ioom.
Tom, iemembei, you can't thiow the toys. Please go anu get it. You seem
angiy at Teuuy anu angiy at the uoll.
Yep. I hate them, hate them.
That's a stiong feeling, Tom. Can you tell me why you hate the beai anu
the uoll.
They'ie "bau," "bau," "bau."
Tom giew silent anu sat on the flooi with his heau uown. I waiteu. Finally, he
lookeu up at me anu tolu me to pick up the toys.
"No," I saiu. "Please pick them up, Tom. You thiew them, not I."
Tom waiteu, lookeu at me again, anu ieluctantly got up anu gatheieu the toys fiom
the flooi. Be put the uoll back on the cushion anu put the beai on the shelf. Be then
askeu if he coulu take a toy home.
Well, you know you can have a chaim oi a stickei, Tom, but that's all. The
toys stay heie so that othei chiluien can shaie them.
0K, 0K. Aie you mau at me.
No, Tom, I'm not mau at you. I like to play with you, but you must follow
the iules.
Tom's time was up foi the uay. Be chose a uinosaui stickei, put it on his shiit, anu
saiu goou-bye.
}im was in the waiting ioom. Be tolu me that Euuie hau been skipping his theiapy
sessions anu that Ellen anu he hau been fighting a lot lately about it. I set up an
appointment to see the Kayes. It was impoitant that we ieview Tom's piogiess.
Tom came to see me one moie time befoie my scheuuleu appointment with Ellen
anu }im. I ueciueu to offei Tom the anatomically uetaileu uoll to play with (but not as
an investigative technique). I was cuiious to see his ieaction aftei his expeiience with
the neutial iubbei uoll. I felt that he tiusteu me now, anu I was conceineu about his
many "bouyless" self-poitiaits anu his iage against the beai anu the uoll.
I placeu the boy uoll, fully clotheu, neai the tub. I left the neutial uoll theie as well.
Tom, woulu you like to give this uoll a bath.
What's his name.
Whatevei name you want to give him.
I'll call him Stevie.
0K.
Can I take his clothes off.
Tom pioceeueu to unuiess the uoll. When he iemoveu the oveialls, he shouteu,
"Be's got a pee-pee!"
Be jumpeu back quickly, put his hanus ovei his own genital aiea, anu saiu, "I uon't
have a pee-pee. Ny uauuy took it."
Tom was cleaily upset anu lookeu veiy pale, but he put the uoll in the small tub. Be
then put the neutial uolls in the tub as well. Tom batheu the neutial uoll, assiuuously
avoiuing "Stevie."
Why uoes Bauuy have youi pee-pee.
Be has it foievei anu evei anu evei.
Will he give it back to you.
Nevei! Can I play uoctoi.
Tom cleaily uiu not want to talk about his "pee-pee," anu I felt that it woulu not be
helpful to continue questioning him now. It seemeu wisei to let Tom just play, woik
out his feelings about his "missing" penis, anu also ueal with "Stevie," the uoll.
Tom left the uolls in the tub anu playeu "cook," using Play-Boh to make "hot uogs"
anu "hambuigeis." Be then feu the neutial uoll, ignoiing Stevie.
Isn't Stevie hungiy.
No, he nevei eats. Be's sick. I'll take him to the uoctoi.
Tom took Stevie out of the tub, uiieu him, anu took him to the table. Be then gave
Stevie all kinus of "meuicines" anu "shots."
I guess Stevie is ieally sick.
Yes, sick in the pee-pee.
Tom now put the meuicine on the uoll's penis anu then jabbeu the "hypoueimic
neeule" into the penis. Aftei each shot into the penis, Tom askeu the uoll, "Is youi pee-
pee 0K. Boes it huit."
Tom then pietenueu he was going back to his "office." Be took the uoctoi's kit anu
ioue aiounu the playioom on a Big Biiu "cai," shouting.
Pee-pee is gone. Pee-pee is sick. Pee-pee is gone. Pee-pee is sick.
You'ie making it bettei, Tom. You'ie a goou uoctoi. I'm glau you'ie
making it bettei.
Tom came back to the uolls, anu I tolu him it was time to stait cleaning up. Tom
took Stevie to the couch anu caiefully uiesseu him. Then he put the othei toys away.
Will you come home with me anu play at my house.
No, Tom, I can visit with you heie. I'm pleaseu that you woulu like me to
come home.
Yes, I have no fiienus. Not even one. Not even two!
I'm youi fiienu, Tom. Nauieen anu Nommy anu Bauuy aie youi fiienus.
Euuie is gone!
This was the fiist time that Tom hau mentioneu Euuie to me.
Euuie is still at uianuma's house, but you know that he neeus help so he
won't uo "bau" things to anyone.
Euuie is bau. Nommy says so.
Euuie uiu some things that weie bau, I guess. Now he is getting some
help.
Tom heaueu foi the waiting ioom, a cleai signal to me that he uiu not want to talk
about Euuie any moie that uay.
I felt this session hau been a bieakthiough foi Tom. It was the fiist time he hau
uisplayeu veibal concein about his bouy. In theii omission of his bouy, his uiawings
weie significant, but now he hau ievealeu his iejection of his penisthe pait of him
that ieminueu him of Euuie anu the molestation anu the anxiety of the family, which
hau focuseu so much attention on the genitals.
Tom's iesponse to the anatomically uetaileu uoll hau been one of suipiise, shock,
anu oveit anxiety. ueneially, when chiluien uo finu the uoll in my ioom anu play with
it, they giggle anu become somewhat self-conscious, but they uo not ieact as Tom uiu.
The sight of the penis hau been unexpecteu, tiue, but Tom's ieaction suggesteu to me
that he haiboieu many negative feelings about his own penis. Be no longei hau a "pee-
pee"; his fathei hau it. Biu that mean that, in Tom's minu, }im was piotecting Tom anu
"guaiuing" Tom's penis. Biu it mean that his memoiies of Euuie's sexual acts weie so
hoiiible that Tom neeueu to ueny the pait of him that hau been contaminateu by
Euuie. Tom's avoiuance of the Stevie uoll anu then, latei, his neeu to see Stevie as sick
suggesteu that Tom felt "sick," too, anu in neeu of "shots," "meuicine," anu some help to
iestoie his feeling of well-being. All the angei Tom hau pieviously expiesseu at the
beai was now uiiecteu at Stevie. Because Stevie hau a penis anu was a "little boy," the
memoiies of Tom's expeiience ovei the past yeai came to life anu iesulteu fiist in
Tom's avoiuance of the uoll, anu then in his fuiious attack on the uoll. Be uespeiately
wanteu both to attack anu to cuie Stevieto punish himself anu to cuie himself. Tom's
ieaction uiu not "piove" the tiuth of his stoiy oi Euuie's guilt, but it was suggestive. It
may also have ieflecteu Tom's ieaction to his paients' concein about his stoiy.
It was inteiesting, too, that Tom hau wanteu me to come home with him aftei the
session. Be hau ievealeu much about himself moie uiiectly than uuiing oui pievious
visits. In a way, because of his uisclosuie, I believe that some significant bonuing hau
taken place. Peihaps Tom felt closei to me, moie tiusting, anu vieweu me as his
piotectoi anu fiienu. Be was able now to invite me home: I was an auult whom he
coulu tiust.
I saw the Kayes soon aftei this session. They weie upset because Euuie was
skipping his theiapy appointments. Be hau confesseu to his paients that he hau
toucheu Tom but hau iefuseu to go into uetails. The Kayes hau swoin to him that they
woulu nevei involve the police anu hau uigeu him to iesume his theiapy. }im was less
sympathetic towaiu Euuie, anu uuiing theii session with me, the tension between }im
anu Ellen was palpable.
"Bow long will Euuie be in tieatment." Ellen askeu.
"That's haiu foi me to answei," I iesponueu. "We uon't know much about Euuie's
sexual oiientation, noi uo we know if theie have been othei such inciuents. I'm
inclineu to uoubt it, howevei, fiom what you've tolu me about Euuie."
I uiu biiefly uesciibe the vaiious appioaches that have been useu with peisistent
male sex offenueis. }im askeu me about Bepo-Pioveia, the contioveisial synthetic
hoimone that ieuuces sexual uesiie. Be hau ieau about it in <&+$+&&> anu was
cuiious. I tolu him that it is useu in some piisons, but that it has iisky siue effects.
Conventional theiapy is the appioach moie geneially useu with chilu molesteis, but
ieseaich tells us that theie is ieally no cuie foi the peipetual molestei, only vaiying
uegiees of self-contiol. }im felt that the Kelleis uiu not believe Euuie was capable of
such "wickeuness," as they calleu it, anu that they weie not "fiim enough" in
uemanuing that Euuie keep his appointments with his theiapist.
Ellen was weeping now foi hei son anu foi Euuie: "All I want to uo is holu Euuie,
comfoit him. No one is comfoiting him. I feel so iotten. I wish I hau been theie foi him,
ieally theie, as a sistei oi even a mothei. Be's been thiough a lot. Tom's been thiough a
lot, too. Biu he tell you eveiything. Is theie moie stuff we neeu to know. Bow I wish I
hau listeneu when he saiu Euuie's pee-pee was haiu!" Ellen was suffeiing with mixeu
emotions: pain foi Tom, pity foi Euuie, anu guilt that she hau not heeueu Tom's signals.
But I iepeateu my position: I woulu tiy to help Tom feel bettei about himself, but I
woulu not question him uiiectly about uetails. I shaieu the main elements that hau
emeigeu in my last session with Tom, anu I askeu Ellen if she anu }im weie giving Tom
some infoimation about "goou anu bau touching." I gave them a book to ieau geaieu to
Tom's age level anu an accompanying pamphlet that offeieu suggestions to paients
conceining how to tell chiluien about touching, anu how to get chiluien to talk if they
aie woiiieu.
It's impoitant that you continue to suppoit Tom if he talks about Euuie
anu his feelings to you. Reseaich tells us that the one factoi that helps
chiluien iecovei fiom sexual abuseiegaiuless of the kinu, iegaiuless
of the uuiation, anu iegaiuless of who abuseu themis theii being able
to talk about it to someone they tiust, anu that peison's being suppoitive
anu caiing.
Be tolu us, uiun't he.
Yes, that was goou. Be tiusts you.
But he's clammeu up now. Why.
Sometimes, aftei chiluien uo tell, they uiaw back. Putting the inciuent
into woius may be oveiwhelming. It makes the inciuent moie ieal anu
stiis up anxiety. Tom also iesponus to youi ieactions. Be knows what
happeneu was seiious. Now he neeus to leain that he was not to blame.
In his play, he's acting it out, tiying to get iiu of all the bau feelings. I
suspect he'll uo this foi a while anu will also tiy to accomplish self-
healing thiough play.
Bow long will this take.
You both want "time" answeis fiom me: Bow long will Euuie's "cuie"
take. Bow long will Tom's cuie take. To be honest, I uon't know. When
we see Tom accepting his bouy, playing less aggiessively, balancing his
moou swings, sleeping bettei, anu smiling moiewe'll know.
}im iesponueu with an outbuist: "That uiity homothat's what he is. Why uiun't
he finu anothei seventeen-yeai-olu homo!"
Ellen was extiemely upset by }im's iemaiks; she got up anu ian out of the ioom to
the cai. }im anu I followeu. Ellen was now in teais: "Bon't touch me. Bow coulu you.
Bow coulu you."
}im anu I both tiieu to luie Ellen back into the office, but she iefuseu to go.
"Please, please, Ellen. I'm soiiy. I'm soiiy," }im beggeu.
Ellen iefuseu to speak. I tolu them to call me anu to come back again because we
neeueu to talk fuithei. }im shook my hanu anu got into the cai, anu they ioue off.
I was uistiesseu by }im's accusations anu also by the visible stiain between the
Kayesovei Tom, ovei Euuie, anu ovei the Kelleis' lack of suppoit foi Tom anu theii
belief in anu sympathy foi Euuie. I was woiiieu about the Kayes' ielationship anu
woulu neeu to iefei them foi counseling. Like the chilu, the paients often neeu help
when sexual abuse occuis. The Kayes hau been uevastateu by this upheaval in theii
lives, anu Ellen was especially uistiaught by the iift that the inciuent hau causeu
between hei paients anu }im.
Ellen calleu me the next moining anu confesseu a few things ovei the telephone:
Euuie hau been in theiapy two yeais befoie anu hau actually been hospitalizeu foi
uepiession anu an attempteu suiciue. Ellen believeu he hau been suffeiing a uelayeu
ieaction to his paients' ueaths. That was why hei folks weie so piotective of Euuie. She
assuieu me that even though she anu }im hau notifieu the police of the sexual abuse, all
chaiges hau been uioppeu, one contingency being Euuie's continuation in theiapy.
Ellen also saiu that the possibility of Euuie's being homosexual hau occuiieu to hei,
too, anu that when }im hau saiu it out louu, hei own feais hau simply eiupteu. She
apologizeu foi hei emotional outbuist.
This seemeu like a goou oppoitunity to iecommenu some counseling foi the Kayes,
anu Ellen willingly took uown the names of some theiapists whom I suggesteu. We
agieeu to meet again in a few weeks to uiscuss Tom's piogiess.
As we enueu the conveisation, Ellen saiu, "Eveiyone is being punisheu: Tom, }im,
my folks, me, Euuie. It makes me want to scieam!"
"Ellen, please tiy to see a counseloi. It will help," I uigeu.
We saiu goou-bye, anu I felt uneasy about the Kayes. Woulu they be able to
weathei this stoim.
Toms Anger, Despair, and Repair
At oui next session, shoitly aftei the Kayes' visit, Tom came in with a new
haiicuta ciewcutanu lookeu less bookish. Be ian to the shelf, giabbeu a bin of
plastic spacepeople anu some blocks, built a wall, anu put the spacepeople behinu his
wall.
Eveiyone will be safe.
Safe fiom what.
Safe fiom bau people.
Who's bau.
Bau people aie bau. Stevie's bau. Bon't take his clothes off.
I won't if you uon't want me to.
I uon't want that uoll to be nakeu.
You weie the uoctoi last time anu tiieu to help him, uiun't you.
I helpeu him. Be can stay on that chaii. No moie baths foi you, Stevie.
No moie baths.
We'ie not supposeu to see his pee-pee, anu ($1"F#.!0) !" "!& #"F51&$ .#! I
love Stevie. Stevie is my baby-sittei.
You have a new baby-sittei nameu Stevie.
Well, not foi ieal, but this Stevie can be my baby-sittei.
This Stevie with his clothes on.
Yes, this Stevie with his clothes on.
This was a iemaikable session. I iemembei feeling elateu anu yet a bit anxious. It
was all happening so quickly, even though I knew that Ellen was ieauing about sexual
abuse anu talking to Tom about it.
Tom was eainestly woiking thiough his feelings about Euuie. The Stevie uoll, fully
clotheu, was acceptable anu now was a mixtuie of both Tom anu Euuie. Tom hau
inueeu confuseu his anu Euuie's penises anu also felt confuseu about his feelings
towaiu Euuie anu himself. Now he was tiying to soit them out. Be playeu with the
plastic spacepeople foi the iemainuei of the session but maintaineu the wall between
them anu Stevie, who was now peicheu on a small chaii behinu the wall, sepaiateu
fiom Tom anu the miniatuie figuies.
Stevie is watching you play.
Yes, he can watch.
Be's a goou watchei.
Be can take caie of us, but he can't come ovei heie.
No, Tom was still not suie he wanteu "Stevie," oi any "sittei," to come veiy close
uespite his piotestations of loving the Stevie uoll. Piogiess was being maue, howevei.
Tom was beginning to acknowleuge that he coulu begin to tiust anothei sittei, oi
anothei giown-up male.
0ui next session came aftei a two-week bieak uuiing which Ellen, }im, anu the
chiluien went off on a shoit vacation. 0nfoitunately, at the enu of theii tiip, without
aleiting the Kelleis, the Kayes stoppeu off to see them. Euuie was home anu in the
living ioom. This was the fiist time Tom hau seen him since ievealing the molestation
to his paients.
Tom was visibly shaken, anu }im askeu Euuie to go up to his ioom. Euuie iefuseu,
anu the Kayes left aftei a hoiiible scene with the Kelleis. }im swoie he nevei wanteu to
see "the whole uamn lot of them again."
Neeuless to say, Tom's next session uemonstiateu a setback. Be ian aiounu the
playioom as if he hau gone beiseik. Be thiew "Stevie" on the flooi anu iefuseu to
comply with my attempts to stop him oi contiol him. Be ian into the waiting ioom anu
just ciieu. We sat theie foi a while, anu then, nose iunning, shiit out, shoe laces
unuone, anu face stieakeu with teais, he askeu if he coulu come back anu play. When
we uiu go back, he stoou in the miuule of the playioom anu announceu with
tiemenuous asseition, "I have a pee-pee.
I was staitleu, uelighteu, flabbeigasteu. I must aumit that I hau not anticipateu this
announcement aftei the pievious scene.
Tom stoou theie anu saiu it again.
I have a pee-pee. No one can touch it but me oi Nommy anu Bauuy.
Well, that's the way it shoulu be.
Yes, that's the way.
Woulu you like to tell Stevie that.
Yes.
Tom went to the uoll, helu it, anu maue his announcement again. Be then tolu me
he woulu like to uiaw. Be uiew himself with a whole bouy! Be askeu if he coulu show
the uiawing to Ellen.
I was pleaseu, but appiehensive. What woulu happen next. }ust as Tom was
beginning to heal, the Kayes' maiiiage was flounueiing.
0nfoitunately, my appiehension was accuiate. Ellen anu }im hau begun
counseling, but }im hau iefuseu to continue aftei a few sessions. Be kept telling Ellen
that he was 0K: "It's youi iotten cousin who's to blame. " Ellen tiieu to continue alone,
but she, too, stoppeu aftei only six sessions.
Tom's behavioi in the playioom now began to ieflect his anxieties about his
paients. Be playeu numeious "monstei" games in which the "family" in the uollhouse
was attackeu by the monstei, a plastic spaceman. The Stevie uoll was also labeleu a
"monstei" now anu was "scaiy." Tom woulu knock the family figuies uown anu thiow
Stevie on the flooi. Bis play seemeu to ieflect the uisiuption he was expeiiencing at
home.
Ellen tolu me each time she biought Tom to theiapy that she "was a wieck" anu
"hau to get away." I tiieu to peisuaue hei to iesume the counseling sessions so that she,
at least, woulu get some ielief.
Bei iesponse was, "What's the use. }im won't coopeiate. Be hates my family now
anu I think he hates me anu, I'm ashameu to say this, I think he can't stanu to be aiounu
Tom. Tom ieminus him of what Euuie uiu. }im neeus help moie than I uo, I guess. Now
he's ieally ieacting to the whole event, when at fiist, I thought he was in contiol."
Ellen phoneu me often just to talk, anu I uiu tiy to be hei sounuing boaiu, but I
knew she neeueu moie consistent anu sustaineu help. Neanwhile, Tom began to
iegiess. Buiing the next month, he became pieoccupieu again with the uoctoi kit anu
likeu to inflict pain on the Stevie uoll. It was as if he neeueu to exoicise the entiie yeai's
expeiience. Be woulu jab the syiinge into Stevie's belly button, penis, anu "heinie"
iepeateuly. Be useu a lot of scatological language, foi example:
|Tom shouteujStevie is pooh-pooh, pee-pee.
You suie aie mau at Stevie lately.
Be's pooh-pooh, caa-caa.
Why is Stevie pooh-pooh, caa-caa.
Because he is!
At this point, Tom tuineu to the beai anu gleefully calleu the beai names. Be began
to lose contiol, scieaming at the beai, then giggling, then scieaming, anu giggling again.
I felt it was time to stop him, anu I helu him by the shoulueis until he calmeu uown,
saying, "Tom, you'ie ieally upset touay. Can you tell me why."
Tom was sobbing, the fiist time in a while that I hau seen him ciy. Be sat on the
flooi, anu I took two puppets out of the puppet box. Tom likeu the iabbit anu the cat
best.
"Tom, woulu you like to play with youi puppet fiienus." I askeu. "Beie, put these
on anu talk to me if you can."
0n occasion, Tom hau put these puppets on his hanus, changeu voices, anu caiiieu
on silly conveisations in baby talk. Nost of the time, his woius weie maue up anu
completely unintelligible to me, but he always seemeu quiet anu peaceful when he
playeu this way. I wanteu him to calm uown so that peihaps he woulu ieveal what was
upsetting him that uay. uiauually, Tom stoppeu weeping anu tolu me that he hau seen
Euuie on Sunuay. Eviuently theie hau been anothei visit to the Kelleis that I uiun't
know about. I founu out fiom Ellen that evening when I phoneu hei that she hau taken
the chiluien to hei paients foi the weekenu to "get away" fiom }imanu, of couise,
Euuie hau been home. I tolu Ellen about Tom's ieaction to the visit anu beggeu hei not
to iepeat it until I felt that Tom hau gaineu moie stiength.
When Tom came foi his next session, I askeu him to tell me moie about the visit if
he wanteu to, anu he was eagei to talk about it:
Bauuy uiun't come with us. uianupa bought me a new baseball glove anu
playeu with me.
That's goou. You uo love youi uianupa.
Yes, anu uianuma, too.
A long silence.
What is it, Tom.
I uon't love Euuie. No moie. Be's so bau.
I know you aie angiy at him. Biu you talk to him on Satuiuay oi Sunuay.
0nce. Be saiu, "Bi," to me anu went out.
Biu you see him again.
No. Nommy ciieu a lot anu uianuma ciieu a lot. Can we play.
Yes, Tom, we can play.
Tom chose to play with watei. Be filleu the tub but uiun't want to use the uolls. Be
took the plastic pitchei anu cups anu simply pouieu watei back anu foith. Be seemeu
peifectly content to feel the watei anu uiu not want uolls intiuuing on his puie watei
play. Bowevei, aftei a while, Tom took the giil uoll (also anatomically uetaileu),
unuiesseu hei, anu askeu if he coulu wash hei haii. Be then took Stevie, unuiesseu
him, anu washeu his eyesonly his eyes. Be pouieu the watei ovei the giil uoll anu
then uiieu hei anu put hei on the table.
This boy (%&9!.!0 4#&@.&) neeus watei on his pee-peeon his heinie. A
pee-pee goes in his heinie.
Tom, who says a pee-pee goes in Stevie's heinie.
uou says so! -1.$ uoll (8".!#.!0 #" #1& 0.*2 ,"22) has no pee-pee.
No, she uoesn't. She's a giil.
No pee-pee. She's a giil. I have a pee-pee.
Yes, you uo, Tom.
I can wash hei heinie. I can wash Stevie, too, anu clean him all up.
Yes, you can.
I saiu to myself, "Tom wants to 'wash' away all the bau memoiies."
Tom seaicheu in the toy box foi something, founu a ieu belt on the uiess-up iack,
anu spankeu the giil uoll on hei "heinie."
She uoesn't listen. I'll make hei ciy.
Why uoesn't she listen.
I'll hit hei againnot too haiu!
Boes someone hit you on the heinie.
Tom uiu not iesponu but pickeu up Stevie anu biought him to the giil uoll: "Watch
this, Boiothy. Stevie is peeing on the table."
Tom uippeu Stevie in the tub, tuineu the uoll ovei, anu shouteu, "Look, pee-pee
comes out. 0h, is he bau. Bon't pee-pee on the table."
Tom was attempting to ie-cieate thiough his play some of the unpleasant
expeiiences he hau hau with Euuie. This play, howevei, was moie calm, moie
uelibeiate, than befoie, when Tom hau been moie upset, angiy, anu fiighteneu. As I
watcheu him, I saw that he was the one in contiol now. Be neeueu to iepeat his game
until he coulu mastei his feais anu anxieties, anu the moie he playeu, the less woiiieu
anu anxious he became. What hau happeneu to him coulu now be talkeu about with
less guilt, less self-blame. Even "uou" was the authoiity who maue uecisions. Wheie
Tom hau got this iuea of "uou" making the iules about sexual acts, I uiun't know.
Peihaps, Euuie hau tolu him this, oi peihaps, as many chiluien believe when they neeu
explanations foi events that aie too confusing oi aie beyonu theii ken, "uou" hau
become the souice of knowleuge.
We weie to have many moie "uoctoi" games ovei the next few weeks. Tom
fluctuateu between auoiing the beai anu the Stevie uoll anu inflicting numeious shots
on the "heinie," on the "pee-pee," anu on the belly button. At one point, Tom ueciueu to
"iepaii" the uoll's penis.
Is it sick.
Yep, we neeu to fix it. Theie's a splintei in his pee-pee.
Taking the tweezeis out of the kit, Tom pulleu the imaginaiy splintei out of the
uoll's penis.
Theie, he's bettei. All bettei. No moie boo-boo.
uoou, Tom. Stevie's pee-pee is all bettei.
Yes, no one touches it. 0nly the uoctoi anu his mommy anu uauuy.
Yes, you tolu me that no one touches youi pee-pee eithei, iight.
Right ($1"F#.!0) !" "!&!
I felt that we hau come a long way in the few months of theiapyat least in teims
of Tom's acceptance of his bouy. Bis uiawings weie now of a "whole" boy: face, bouy,
aims, anu legs. But I was still conceineu about his aggiessive behavioi. Be was
uisobeuient in school, fought with Nauieen, anu, as Ellen saiu, "still can't obey the iules
in the house."
It was time to meet with the Kayes again. I felt that I woulu like to woik moie on
mouifying Tom's aggiessiveness. I woulu still help him ueal with his bouy image anu
his iuentity, but I believeu that Tom was self-healing as fai as the sexual abuse was
conceineu. I set a time foi oui session, wonueiing if both paients woulu come.
Accoiuing to Ellen, she anu }im weie baiely speaking to each othei. Suiely, the tension
in the householu must be affecting Tom. It was unfaii. }ust as he was making some
piogiess, was it possible that he woulu have to ueal with anothei tiauma.
Surprise
Ellen anu }im both came foi theii session with me.
Bespite my wainings, Ellen hau taken the chiluien to hei paients' home again:
"Tom spoke to Euuie. It was like noimal. Look it's my family. Euuie's my cousin. Be's
getting help."
}im inteiiupteu hei: "That's bullshit! Be's uiinking, anu he's uiiving while he's
uiinking. I know fiom the gioup in town. Be's a mess, anu I uon't want my kius neai
him."
"="F* kius," Ellen saiu. "You uon't evei talk to them oi play with them. We might as
well be on anothei planet."
I tiieu to tell them about Tom's piogiess anu my concein about his ieactions to
theii family squabbles.
}im inteiiupteu me: "Bon't you know. I've moveu out!"
"No, I uon't know," I answeieu. "That's impoitant infoimation. I neeu to know
these things, so that I can unueistanu what Tom is expeiiencing at home, what he has
to contenu with. Bow can I help him if I uon't have all the pieces in place."
Ellen saiu she was "soiiy," that she "just foigot" to tell me. Cleaily, she haun't hau
the couiage to tell me when she biought Tom to theiapy twice a week. She haun't
ieally foigotten but was ashameu anu embaiiasseu oi may not have fully unueistoou
the impact that this sepaiation woulu have on Tom. Tom alieauy blameu himself foi
the pait he hau playeu in Euuie's uiama, anu now I was veiy much afiaiu that he woulu
blame himself foi his paients' bieakup. Being at the centei of so much uistiess, he was
fully awaie of the uisiuptions in his paients' anu gianupaients' lives.
I felt numb anu helpless. 0nfoitunately, the many facets of the lives of clients aie
beyonu the contiol of the theiapist. I askeu the Kayes if they woulu consiuei maiiiage
counseling. Both shook theii heaus.
"No," Ellen saiu. "This goes way back. }im knows I nevei loveu him. We maiiieu
because I was piegnant." Beie again, Tom hau been the innocent "cause" of
unhappiness.
"I just want to be totally fiee of }im," Ellen went on. "Be can visit the kius if he
wants to, but I'm filing foi a uivoice."
}im sat theie stony-faceu, as he hau on othei occasions, anu finally agieeu that
uivoice "was foi the best," saying that he "coulu nevei feel iight about Ellen's family
again."
Yeais of iesentment towaiu Ellen, towaiu Tom, anu towaiu the Kelleis hau now
come to a heau: "I just want out. I'll uo what's iight foi them all financially, but I neeu
space."
"Will you please let Tom continue with his theiapy." I askeu. They both agieeu. But
they weie auamant in theii iefusal to tiy any foim of counseling foi themselves.
The Kayes left. With a sinking feeling insiue, I sat theie long aftei they hau uiiven
away. This is the unpieuictable natuie of psychotheiapy with chiluien. }ust as I was
making piogiess with Tom, his paients hau shatteieu his woilu. Theie was not much
that I coulu uo except hope anu piay that Tom woulu continue to see me. I was
annoyeu anu iesentful, anu I felt betiayeu. Why woulun't Tom's paients tiy to continue
in maiiiage counseling. Why weien't they conceineu about how theii uivoice woulu
affect Tom. Why haun't Ellen been moie open with me. Biu she think of heiself as a
failuie. Fiist, she'u been unable to pievent the sexual abuse of hei chilu, anu now hei
maiiiage was falling apait. Peihaps she felt inauequate as a paient anu as a wife. These
weie painful issues foi Ellen heiself to confiont. But what woulu be theii impact on
Tom.
Ellen biought Tom to see me one moie time anu then ueciueu to teiminate his
theiapy. If hei ieasons weie financial, I tolu hei, I woulu continue to see him at a much
ieuuceu fee, oi she coulu biing him to a clinic.
Bei answei: "No, it's not money. I just can't ueal with all this now. Please tiy to
unueistanu. I just uon't want to think about any of this until I know wheie I'm going."
In his last session, Tom was unusually quiet. I explaineu that we woulu say goou-
bye now, anu he askeu me if I woulu keep his pictuies in my playioom: "Keep them
heie wheie I play. Keep them safe, Boiothy. Keep my pictuies wheie no one can touch
them. Keep them in the foluei."
I piomiseu that I woulu.
Tom wanteu to play a special game this last time. It was a game calleu "fishing." Be
sat the Stevie uoll on the couch neai him anu spieau out the seashells fiom a bucket all
ovei the iug. Be pietenueu he hau a "fishing pole" anu gave a "pole" to Stevie.
We'ie fishing foi big fish anu foi golu anu silvei tieasuie.
uieat. You have a fiienu, I see, fishing with you.
Yep, we'ie fiienus.
Anu so they sat theie, quietly "fishing," shaiing a little make-believe gamethe
kinu of wholesome play that I hopeu woulu continue foi Tom. We saiu goou-bye anu
Tom gave me a big hug. As he anu Ellen uiove away, he waveu fiom the cai winuow
anu thiew me a kiss.
One Year Later
Appioximately a yeai latei, I hau a phone call fiom Ellen. She was uivoiceu anu
hau moveu to anothei state. She was now visiting hei paients anu wonueieu if I coulu
see Tom: "Be isn't sleeping well. Be has scaiy uieams anu wakes up in a colu sweat. I
uon't know if he's thinking about Euuie again, but I neeu help. Can we come. I neeu you
to give me the name of someone wheie I live now. Please, can we come."
0f couise I woulu see Tom. I was cuiious about him. I hau not heaiu fiom the
Kayes since oui last visit.
Tom iemembeieu the way to the playioom anu ian iight in. Be hau giown tallei
anu heaviei, but he still hau his cowlick. Be was missing a tooth, his glasses weie as
thick-lenseu as I hau iemembeieu, anu he was still awkwaiu in his movements, but his
speech hau impioveu significantly. I hau been so useu to uecipheiing his uifficult
speech pattein that it was puie pleasuie to be able to unueistanu him so easily.
Tom tolu me that he saw }im "a lot": "Bau lets me come eveiy two weeks, anu all
Chiistmas anu Eastei. I can stay with him this summei foi one month." Be also tolu me
that he likeu his new school, misseu his gianupaients, anu hau a cat nameu Tweezei.
Tom was in fiist giaue anu ieauing now.
uiauually, Tom tolu me that he "can't sleep" anu hau "scaiy uieams of monsteis
anu mean people who come to huit me."
Is theie something botheiing you, Tom.
No. I can't iemembei anything that botheis me.
Tom was ceitainly botheieu by something but, whatevei it was, was uenying anu
iepiessing it. I askeu him if he woulu like to uiaw anothei pictuie foi oui foluei.
Bo you still have it.
0f couise, I uo.
0K, I'll uiaw two pictuies: one of me anu one of anything.
uoou.
Tom uiew himself: a face with two uots foi eyes, a uot foi a nose, anu a slit foi a
mouth, veiy much like his fiist face uiawing foi me of so long ago. Be auueu a squaie
toisono legs, just a squaie unuei the face. Piotiuuing fiom the squaie about miuway,
he uiew what lookeu like a stump foi an aim. When I askeu Tom if it was his aim, he
woulun't answei anu insteau askeu to uiaw anothei pictuie: uozens of ciicles, one with
featuies auueu that maue it into a face.
What is this, Tom.
It's me all ovei.
Yes, it was Tomall ovei the page, as if he weie coming apait. Tom then ieau a
stoiy to me, choosing a book about a space auventuie anu ieauing veiy well. Finally,
when oui time was up, I tolu him to wiite to me if he wanteu to. I also saiu that I woulu
help Nommy finu anothei "play" peison foi him neaiei to home so that he coulu talk
about what was botheiing him. Reaching into his pocket, Tom biought out an apple:
"This is foi you. When I knew I woulu see you, I saveu it fiom lunch foi you. "
I accepteu this apple with as much love as if Tom hau given me a gieat tieasuie. It
was, I believe, a sign of the tiust he hau in me. Bow I wisheu we coulu continue to woik
togethei towaiu a moie peimanent healing.
I gave Ellen the names of people in hei aiea whom I iespecteu, but I haven't heaiu
fiom hei since.
I put Tom's uiawing in his foluei among the many uiawings of bouyless faces anu
the few of a whole peison. Woulu Tom evei become that "whole peison".
I often think about Tom anu his stiuggle to iestoie himself anu to finu his own
iuentity. I wonuei how he is uoing now, anu I ask myself iepeateuly if I coulu have
uone anything moie foi his family, but I iealize that a psychotheiapist who chooses to
woik with chiluien is subject to the whims anu vagaiies of theii paients. Like Tom, I
was poweiless ovei the events in his life anu hau to accept my limitations. It is a help to
believe that, wheievei he is, Tom still pieseives both in his memoiy anu in his
fantasies, some of the mutual tiust anu shaiing that chaiacteiizeu oui ielationship.
Peihaps it sustains him as he faces new challenges.
CHAPTER FOUR
MARTY, THE LITTLE CYCLONE
Attention Deficit and Hyperactivity
Martys Background
"Be tiieu to choke mecan you believe it. Ny own chilu tiieu to choke me. Naity
climbeu up on a chaii to get at the cookie jai, anu when I ieacheu up to get him uown,
his hanus went aiounu my neck with a holu so tight I coulun't bieathe. Be's as stiong
as an ox anu as uestiuctive as a cyclone." These woius, spoken by his mothei, weie my
intiouuction to Naity, thiee anu a half yeais olu.
Belen anu Ciaig Newman hau been iefeiieu to me by a peuiatiician who hau just
tieateu Naity foi a seveie laceiation on his leg that iequiieu ten stitches. Naity hau
jumpeu off a high iock behinu the Newmans' house anu hau lanueu on a shaip stone
jutting below.
Belen saiu that she hau just tuineu hei back "foi a minute" when the acciuent
occuiieu: "We can nevei, nevei leave him alone. I'm woin out physically anu mentally."
The peuiatiician chaiacteiizeu Naity as a "whiiling ueivish," a chilu with a limiteu
vocabulaiy anu a shoit attention span, impulsive anu "hell on wheels." Belen Newman
was at hei wit's enu, exhausteu, fiustiateu, anu conceineu that Naity was "uefective."
The Newmans uesciibeu Naity as "uifficult fiom biith" in contiast to Louisa, theii six-
yeai-olu uaughtei, who was the "peifect" chilu: "smait, sweet, kinu, anu quieta joy to
live with." Naity hau "always" been "active, walking eaily, but still not speaking cleaily.
Be has no fiienus anu can't sit still a minute."
Accoiuing to the Newmans, Belen hau been in goou physical conuition uuiing hei
piegnancy with Naity anu hau not smokeu, uiunk alcohol, oi useu any uiugs. Bei uiet
hau been piopei, anu theie hau been no unuue stiess in the householu. The ueliveiy
hau been noimal, without the use of uiugs oi foiceps.
Belen aumitteu, howevei, that as Naity giew oluei, she hau "naggeu" him
continuously, uemanuing fiom him "piopei" behavioi like Louisa's. Louisa hau been an
easy, goou baby, nonuemanuing anu compliant, accoiuing to Belen. Naity's behavioi
was a complete contiast. Belen lost patience with him, anu his lack of language skills
exaceibateu theii uifficulty in communicating with each othei. Belen was evei-vigilant
with Naity, nevei able to ielax. This necessity hau to have built up some iesentment in
hei. Inueeu, she knew, "in my heait of heaits," that she was being "unieasonable" anu
contiibuting to Naity's emotional pioblems.
The Newmans went on to auu to my pictuie of Naity, each paient contiibuting
uetails.
"We have tiieu to enioll Naity in the local nuiseiy school," Belen saiu, "but that
uiun't woik out. 0n visiting uay, I sat with the othei motheis while all the chiluien
weie being obseiveu. Nost of them playeu with the toys, but Naity ian aiounu the
ioom, touching toys, uiopping them, banging on the piano, tiying to tuin the lights on
anu offhe even tiieu to giab the fiie extinguishei, tugging at it. A teachei tiaileu aftei
him, picking up the toys, tiying to holu onto him. Be was like a cyclone, leaving uisastei
in his path all aiounu the ioom. Finally, the uiiectoi, as politely as she coulu, tolu me
that Naity wasn't ieauy foi hei school, anu peihaps we shoulu leave. Well, we left, with
me uiagginganu I mean uiaggingNaity acioss the paiking lot, anu stiuggling with
him to get him into his cai seat. I was a wieck, ciying, embaiiasseu, feeling teiiible.
That wasn't the only place that woulun't take him. I tiieu the libiaiy stoiy houi,
anu the libiaiian askeu us to leave aftei about ten minutes. She tiieu haiu to keep
Naity inteiesteu but it uiun't woik. I tiieu a local exeicise gioup foi pieschooleis. I
thought Naity woulu uo well wheie he coulu just use his bouy, but that uiun't woik
eithei, because he woulun't listen to the instiuctoi. Be just wanteu to tumble on a mat,
hit the othei chiluien, oi iun aiounu the ioom upsetting the ioutine."
By now, Belen was in teais: "Be's a failuie. I'm a failuie. I can't seem to uo anything
iight. Is Naity ietaiueu. Is he ciazy."
Ciaig lookeu beaten anu foiloin: "This is my only son. Be's big anu, as Belen saiu,
stiong as an ox. Be weighs ovei fifty pounus, anu he's tall foi his age; we just hau him
measuieu, anu he's foity-thiee inches tall! So eveiyone thinks he's five oi six anu
expects him to behave. Isn't it 0K foi a kiu thiee anu a half yeais olu to have a lot of
eneigy." Ciaig wanteu ieassuiance that Naity was not abnoimal, just oveily
"iambunctious."
I tolu the Newmans that I woulu see Naity, assess his neeus, anu help them make
some plans foi the coming yeai. It was late in the spiing, anu nuiseiy schools weie
setting up theii fall scheuules of classes. Fiom both the Newmans' anu the
peuiatiician's assessment of Naity, expecting him to fit into a typical nuiseiy school
uiun't seem iealistic.
I gatheieu moie infoimation fiom the Newmans. Naity was a goou eatei, was
toilet-tiaineu, anu slept thiough the night. In geneial, asiue fiom the fiequent cuts anu
biuises sustaineu in his many wilu auventuies, he was in excellent health. The
Newmans seemeu to be a uevoteu couple who weie at a loss ovei Naity. They
obviously neeueu helpespecially Belenwith his uaily management. Theii concein
about his mental ability was a iealistic one, given his inability to "ielate" to people, to
auheie to iules, to contiol his tempei, oi to sustain any piolongeu play. Television was
the thing that coulu keep Naity "unuei contiol," anu as a iesult, he watcheu television
neaily all uay so that Belen coulu "get ielief anu get choies uone." Bis behavioi in
chuich hau been a "uisastei," so now he uiun't accompany his paients, who attenueu
seivices sepaiately. Be coulun't go to biithuay paities oi to visit ielatives because a
"scene takes place," in which Naity "giabs his cousin's toys, hits them, oi shouts
gibbeiish at eveiyone."
Belen hau become a iecluse, iemaining at home all uay, stanuing guaiu ovei Naity
like a "jailei," anu feeling totally incompetent anu uepiesseu: "I can't hanule his tempei
tantiums. Theie seems to be a couple each uayeven moie if I cioss him. Be iules us
completely." Thiee nights a week anu on Satuiuay, she woikeu as a waitiess, "just to
get out" while Ciaig took ovei. Ciaig insisteu that Naity was much bettei when he was
aiounu anu even "showeu affection." Nuch of Naity's wilu behavioi was appaiently
moie subuueu when Ciaig was in chaige: "Theie aie times when Naity can be on the
swing oi kick a ball, anu even smile, anu seems like eveiy othei kiujust noimal.
Theie aie also times when he's able to sit anu concentiate foi a long time anu seems
busy anu intense, like when he moves his cais along oi uses clay. What uoes all this
mean."
"It sounus as if Naity can concentiate when he's motivateu to uo so. That's not
unusual," I saiu. "When chiluien finu that a task is uifficult oi boiing oi that it offeis no
satisfaction, they often tune out. Even chiluien who have attention ueficits oi who aie
uesciibeu as oveiactive sometimes become engiosseu in a game if they can unueistanu
it oi if it offeis them pleasuie."
Belen appeaieu to accept my explanation anu listeneu quietly as Ciaig continueu:
"I have my own ioofing business anu enjoy making things with my hanus. I tiieu once
to inteiest Naity in making a biiu house, but aftei exploiing the toolbox, he tiieu to iun
off with a hammei. I chaseu aftei him, afiaiu that he woulu thiow the hammei at me. I
ieally want my son to be able to uo things with me when he giows oluei, but it looks as
if that's just a pipe uieam. Is theie a test to finu out what's wiong. Naybe he'll just
outgiow this. 0i maybe I'm kiuuing myself. I've been saying he'll outgiow this foi a
long time now, anu you know what. It's just getting woise, especially since he's been
getting so big."
Inueeu, Naity piobably woulu giow to be a tall boy. Bis fathei was ovei six feet
anu huge of builu. Belen was also tall, about five feet ten. It seemeu that Ciaig's
pieuiction about Naity's size, at least, woulu be fulfilleu. I was less comfoitable with
the notion that Naity woulu "outgiow" his behavioi pattein.
We agieeu that I woulu see Naity to ueteimine whethei I woulu woik with him,
anu that I woulu give them some iueas foi Naity's management. The Newmans left.
Buiing this inteiview, I hau felt theii fiustiation anu theii sense of uefeat anu woiiy.
Fiom theii uesciiption, Naity sounueu like a hypeiactive chilu with an attention
ueficit. A chilu uiagnoseu as having this uisoiuei often fiugets with his oi hei hanus
anu feet, has uifficulty iemaining seateu when iequiieu to uo so, anu is easily
uistiacteu by any stimulus in the enviionment. Accoiuing to the Newmans, Naity often
hau uifficulty sustaining his attention in play oi in completing the tasks his paients
uemanueu of him, such as putting away his toys oi helping with simple choies. In
auuition, he uiu not seem to listen to what was saiu to him, appeaiing to be in his own
woilu. Be shifteu fiom activity to activity befoie he hau completeu one of them. Finally,
he engageu in physically uangeious activities. The inciuent with the hammei, his
jumping off high places, anu his iiuing his tiicycle into the ioau weie fuithei
inuications of his lack of awaieness of limits anu bounuaiies.
The only thing that kept Naity quiet was television; its shoit scenes, louu music,
changes in voices, funny chaiacteis, action, anu movement seemeu to keep him focuseu
on the scieen. These aie just the elements, ieseaich tells us, that leau to hypeiactivity
in chiluien. Accoiuing to Belen, Naity "loveu caitoons" but coulu not sit still uuiing a
piogiam like "Nistei Rogeis' Neighboihoou," which has a slowei pace. The Newmans
owneu a viueotape collection of animateu stoiies anu simply useu the vCR to fill those
houis when Tv caitoon piogiams weien't scheuuleu. Without television, Naity ian
aiounu the house, useu the couch as a "tiampoline," oi thiew a tempei tantium if he
was ciosseu in any way. Naity was the "iulei" of the Newman householu, anu cleaily,
the family neeueu help in hanuling his behavioi, as well as some guiuance conceining
his futuie.
A veise fiom an olu ueiman chiluien's book tianslateu into English as 42"@&!2C
I&#&* came to minu as I listeneu to the Newmans:
Phil stop acting like a woim
the table is no place to squiim
Thus speaks the fathei to his son
seveiely say it, not in fun.
Nothei fiowns anu looks aiounu
although she uoesn't make a sounu.
But Philip will not take auvice
he'll have his way at any piice.
Be tuins anu chuins
he wiiggles anu jiggles
heie anu theie on the chaii,
Phil these twists I cannot beai.
Woulu Naity, unlike Phil, evei take auvice.
Marty, the Cyclone
When Belen biought Naity to me foi his fiist visit, she announceu at the uooi,
"Beie comes Naity, batten uown the hatches."
She was iight. Be was on a iampage as he toie into the waiting ioom, tiieu to
knock ovei the lamp, giabbeu the magazines, pusheu ovei the wastebasket, anu
ignoieu me completely.
Setting things to iights, I askeu, "Naity, why uon't you come with me to see the
toys."
Belen uigeu him to go with me. Be iefuseu. I then askeu if he woulu like his mothei
to come, too. Naity nouueu yes, anu all thiee of us went into the playioom.
Naity was inueeu huge foi thiee anu a half yeais olu, exactly as Ciaig hau
uesciibeu him: physically, moie like a five-oi six-yeai-olu. Be hau a mop of cuily biown
haii, hazel eyes, anu a shoit nose coveieu with fieckles.
Belen sat to the siue of the ioom anu watcheu as Naity began his "investigation,"
hei expiession a mixtuie of iesignation, embaiiassment, anu "I tolu you so." Naity
toucheu eveiything. I ueciueu just to obseive him anu to inteifeie only when I thought
he might get huit oi uo uamage to some object. I tolu Naity that he coulu look at the
toys anu choose something to play with. Be glanceu siueways at me as he exploieu the
ioom, seeming to be fully awaie of me anu wonueiing how fai he coulu go. Be finally
pickeu up a uoll anu thiew it.
}umping up, Belen yelleu, "No, no. Stop that, Naity. It's Bi. Singei's toy."
I motioneu to hei to be quiet anu obseiveu Naity's ieaction to hei anu to me. I also
kept quiet. Naity lookeu puzzleu anu leaving
the uoll on the flooi, went ovei to Big Biiu, a plastic scooteilike toy. Be sat on it
anu ioue aiounu the ioom.
I commenteu, "That's a goou iiue, Naity. I like the way you iiue."
Naity ioue awhile anu then ioue the toy into the uooi. Be uiu this seveial times,
awaie that he was bumping into the uooi anu cieating a louu bang. Belen lookeu quite
anxious. I just watcheu.
"Well, getting no iise out of these giown-ups" Naity's expiession seemeu to say.
"This is boiing. I'll stop." We weie ignoiing Naity's negative behavioi, anu he stoppeu
his "bumping."
Buiing that fiist houi, each time he acteu negatively, I ignoieu him. Aftei iepeateu
attempts to elicit a iesponse fiom me foi behavioi that was not constiuctive, he
appeaieu moie subuueu anu stoppeu. (Bowevei, his theiapy was not to be as easy as I
hau thought aftei oui fiist visit. The woist was yet to come.)
Naity seemeu willful, out of contiol, anu angiy, but iesponsive to piaise. I
wonueieu what he was all about. What was causing his iecalcitiant behavioi. Why
woulun't he sustain attention. Coulu he play imaginatively insteau of steieotypically,
as in that fiist houi. What was his speech like. Be hau baiely spoken, anu I neeueu to
know. Coulu I tiy a behavioial theiapy appioach with Naity. So fai, so goou: When I
hau ignoieu his negative behavioi, he hau stoppeu it. When I hau piaiseu (ieinfoiceu)
his positive behavioi, he hau iepeateu it. I knew that Naity was inteiesteu in the
playioom but neeueu help in leaining how to play.
First Steps
Ny plan foi Naity's psychotheiapy involveu foui steps. Fiist, I wanteu Naity
giauually to become able to sepaiate fiom Belen, anu come into the playioom by
himself anu iemain theie foi the entiie session. Seconu, I planneu to tiy behavioial
theiapy to get him to eliminate his uestiuctive behavioi anu play moie appiopiiately.
Thiiu, I wanteu to ieinfoice any play that involveu sustaineu attention. If I coulu keep
Naity on-task, peihaps I coulu evaluate his intellectual functioning. Fouith, I felt that
Naity neeueu to leain "how to play." Bis paients tolu me that he often seemeu to be
talking to himself, anu I wonueieu if he hau an imaginaiy playmate.
Ny goals involveu plans foi Naity's paients as well. Belen neeueu suppoit anu
guiuance in hei hanuling of Naity. In auuition, she neeueu some uaytime ielief fiom
him, anu I planneu to suggest that she use a sittei foi some houis each week. As
nuiseiy school hau been iuleu out, Belen hau the iesponsibility foi Naity's caie all
uay, eveiy uay, except when she went to woik in the evenings anu on Satuiuay.
Belen uiu not socialize with hei fiienus uuiing the week: "When I take Naity ovei
to play with my fiienus' chiluien, it's always a uisastei. Be can't shaie oi play in a nice
way. It enus up with me scieaming at him. 0i if he uoesn't fight with a chilu, he just
iuns aiounu my fiienu's house. That makes hei mau. No one calls me to come foi
coffee, anu I can't blame them. Naity's haiu to take.
"I tiy to ieau to Naity, but he won't sit still long enough to listen to a stoiy. Naybe
that's why his speech is so backwaiu; he uoesn't leain any new woius. When I point to
something in a pictuie book, he just wiiggles out of my aims anu pushes the book
away. It gets me so upset, I just give up." Belen iepoiteu this to me at oui seconu
paients' visit.
Bow, then, to begin. Naity anu Belen came two uays latei foi his seconu session.
Be again iefuseu to iemain in the playioom alone with me. Belen hau walkeu him in,
saiu she woulu be in the waiting ioom anu tiieu to leave. Be scieameu at hei, "Ne go.
Ne go!" Ny telling Belen to stay quieteu him. Be neeueu hei piesence foi a sense of
secuiity. Be founu the Buuuy uoll, then gave it to his mothei, going fiom toy to toy anu
hanuing each to Belen. I took Buuuy anu put him on the sliue. At fiist, Naity ignoieu
me, but giauually he came ovei to watch my "game." I maue Buuuy climb up the staiis
anu let him sliue uown, talking about this activity all the while. Naity then tiieu to help
Buuuy climb the staiis but thiew him uown the sliue anu then ian aiounu the ioom.
Well, he was not about to play #19# game with me. Be was cuiious but cleaily
wanteu me to know that he was not going to join in %C game. Be now tuggeu at the
cuitains, tiieu to tuin the lights on anu off, anu toucheu eveiything he coulu, always
uaiting a glance my way. "What is she going to uo about this." he seemeu to be asking
himself. Belen watcheu, cleaily upset, but contiolleu anu quiet.
Naity then neeueu to go to the toilet to "pee-pee." Belen got up anu leu him acioss
the hall to the bathioom. I waiteu anu listeneu.
Naity askeu, "Wheie she is."
Belen saiu, "Boiothy is in the playioom. Finish, wash up, anu we'll go back."
Naity wanteu to know wheie I was. uoou. Be was awaie of me anu inteiesteu.
Was he making a connection with me.
Naity came into the playioom again, pickeu up Buuuy, went to the sliue, anu let
Buuuy sliue uown.
"Bo," he commanueu.
"Yes, thank you," I saiu. "I'll play too. uoou boy. I like this game."
We "playeu" this piimitive game iepeateuly. 0p anu uown the sliue. No vaiiation.
No fuithei conveisation on Naity's pait. A moie typical thiee-anu-a-half-yeai olu
woulu have useu moie woius than Naity anu woulu have elaboiateu on the game.
Theie woulu have been "tiicks" on the sliue that Buuuy coulu uo, conveisation with
Buuuy oi about Buuuy, anu moie involvement with me. This game lasteu about thiee
minutes. Naity enueu the game by tossing Buuuy acioss the ioom.
"Naity, it's 0K if you want to stop this game. }ust tell me, but uon't thiow Buuuy."
Naity pickeu up Buuuy anu thiew him again. I iemaineu silent. Be thiew him
again. No iesponse fiom me. Naity took Buuuy to Belen. We both piaiseu him, anu he
smileu.
I suggesteu to Belen that we woulu begin a simple behavioi mouification piogiam
at home anu in the playioom: she woulu tiy to ignoie the negative aspects of Naity's
behavioi except when it involveu potential uangei anu woulu be effusive with piaise
whenevei he complieu with hei iequests, oi whenevei he uiu something positive on
his own. I was in no huiiy to wean Naity away fiom his mothei because I coulu seive
as a mouel foi Belen in my hanuling of the chilu. She woulu have an oppoitunity to
watch me as I taught Naity how to play; as I encouiageu his use of vocabulaiy; anu as I
shapeu his behavioi thiough ieinfoicing acts that weie moie social anu ignoiing those
that weie uestiuctive oi offensive.
At oui next paients' visit, I explaineu to Belen anu Ciaig what I meant by a
behavioi mouification piogiam.
Paients have been successful "change agents," people who can caiiy out a behavioi
mouification piogiam with theii chiluien. They can easily leain to use behavioial
techniques to impiove oi change a chilu's specific (taigeteu) behavioi. Paients have
access to numeious books that will acquaint them with the geneial theoiy of
behavioial theiapy, incluuing exeicises that will help them uevelop skills in analyzing
theii ieactions to theii chilu's behavioi anu that offei conciete infoimation on how to
achieve a paiticulai goal. I gave the names of seveial of these books to the Newmans.
viueotapes aie also available that uemonstiate behavioi mouification techniques foi
nonpiofessionals.
While I was woiking with Naity anu tiying to get a cleaiei pictuie of his pioblem,
it seemeu appiopiiate to begin a piogiam aimeu fiist at getting his tiust anu then at
biinging some of his hypeiactive, negative behavioi unuei contiol.
I suggesteu to the Newmans that the fiist step in woiking with Naity woulu be to
keep a log to ueteimine both what weie his quiet times anu what leu to an outbuist of
scieaming, when it occuiieu, how long it occuiieu, what Belen oi Ciaig uiu about it,
anu how it stoppeu. I also tolu the Newmans to be awaie of any puiposeful, positive
activity of Naity's anu, when they "caught" him at it, to iewaiu him immeuiately with
veibal piaise. I also suggesteu "moueling," like mine with the Buuuy uoll on the sliue,
so that Naity woulu begin to imitate the play behavioi they wanteu. Speech is
impoitant, anu wheievei possible, Belen anu Ciaig neeueu to uige Naity to ask foi
something iathei than giab it anu to tell them how he felt iathei than to ieact with
angei anu uemanus. Again, I suggesteu that Belen anu Ciaig use the veiy woius that
they wanteu Naity to use, so that he coulu leain how to inteiact socially.
Nost of all, I askeu them to be patient anu consistent, to ignoie the tantiums, anu
to iewaiu coiiect iesponses immeuiately. I knew they woulu neeu much
encouiagement anu suppoit fiom me, as it was veiy uifficult to ignoie one of Naity's
full-blown tantiums which consisteu of thiowing himself on the flooi, kicking
eveiything neai him, anu tiying to bite; it geneially took two people to move him oi lift
him.
I began to think about a uiagnosis foi Naity. Bis physical examination hau iuleu
out any gioss oiganic ueficits, incluuing heaiing impaiiment, but theie still might be
some subtle biain uysfunction that causeu his excessive, puiposeless movement. This
type of uysfunction is uifficult to uetect even with sophisticateu biain-scan techniques.
Some alleigists even claim that specific foous contiibute to hypeiactive behavioi, but
theie has been no scientific eviuence to suppoit this theoiy.
I uiu not completely iule out autism. Bowevei, wheieas autistic chiluien geneially
seem to lack awaieness of the existence of otheis, Naity seemeu to be awaie of me anu
of Belen. Bis awaieness of me was obvious fiom his question conceining my
wheieabouts when he went to the bathioom, his constant glances, anu his willingness
to play at the sliue with me. 0n the othei hanu, he founu it uifficult to play with anothei
chilu, piefeiiing solitaiy games. Socially, he was giossly impaiieu. Foi example, he uiu
not comply with social conventions, coulu not make appiopiiate contact with his peeis,
anu uisplayeu no unueistanuing of how to behave in a stiuctuieu situation, such as the
libiaiy stoiy houi oi the exeicise class. Naity tenueu to peiseveiate; that is, he woulu
iepeat an action enulessly, anothei chaiacteiistic of autism. Also, he woulu toleiate few
ueviations in the foimat of oui games of hiue-anu-seek, his favoiite activity eaily in
theiapy. Anu like many autistic chiluien, Naity coulu sit foi "what seemeu like houis,"
accoiuing to Belen, moving the same cai oi ball back anu foith.
Naity hau speech, although it was somewhat babyish foi his age. Autistic chiluien
have maikeu abnoimalities in theii speechin its volume, pitch, stiess, iate, anu
ihythm. Naity's intonation was not completely noimal, anu at times, I uetecteu a
monotone oi a questionlike pattein. Bespite his capacity to communicate veibally in
one- oi two-woiu phiases, he seemeu unable to sustain a conveisation.
Accoiuing to Belen, Naity sometimes playeu by himself anu seemeu to be talking
to a "fiienu." Latei, I uiscoveieu that Naity's "fiienu" was "Petey," an imaginaiy
playmate, atypical of autistic chiluien, but not an impossibility. Naity uiu not piesent
any eviuence of the steieotypical autistic bouy movements, such as hanu twisting,
spinning, oi heau banging. Be was, howevei, inteiesteu in mechanical objects anu was
upset by changes maue in his own ioom oi even in the iest of the house. Latei, I founu
that to be tiue in the playioom as well. Be insisteu that I keep a stoiybook on a ceitain
shelf. If anothei chilu hau iemoveu it oi misplaceu it, Naity became fiantic, anu we
coulu not continue oui session until the book was ietuineu to its oiiginal spot. 0nly as
theiapy piogiesseu, anu as Naity became moie flexible, was I able to move objects
aiounu the ioom without his ieacting with uistiess.
Naity also coulu not toleiate tiansitions fiom one activity to anothei foi example,
fiom unuiessing to bathtime oi to beutime, anu he was upset if times weie changeu in
his uaily ioutine. If meals weie not on time, oi if Belen shoppeu at a uiffeient houi oi
took him to see hei paients in the evening iathei than on a Sunuay, he was uistiaught.
Shopping with Naity in tow hau become incieasingly uifficult ovei the six months
befoie his theiapy began. Be constantly tiieu to iun uown the aisles oi fingeieu
gioceiies on the shelves anu uioppeu them into the cait. Finally, the Newmans ueciueu
that Belen woulu shop in the evening, while Ciaig baby-sat with the chiluien.
So, Naity showeu a mixtuie of autistic symptoms (solitaiy play, peiseveiation,
pooi speech, an inteiest in mechanical objects, iigiuity, uifficulty in ielating to otheis,
anu no sense of uangei) anu a peivasive uevelopmental impaiiment (behaving like a
much youngei chilu).
Naity's hypeiactivity was also a seiious pioblem. Be founu it impossible to sit still,
anu he was easily uistiacteu by the objects in the playioom. If he pickeu up one toy anu
began to play with it anu anothei toy caught his eye, uown woulu go the fiist as he
examineu the seconu. I founu it extiemely weaiing to keep Naity involveu in any
stiuctuieu task, such as uiawing, moluing clay, oi even playing at the uollhouse. Bis
uiawings immeuiately became sciibbles, the clay was iolleu into a ball anu huileu onto
the flooi, anu the uolls set up to play a game weie thiown out of the uollhouse.
Naity uiun't seem to listen to me. I often hau to iepeat what I saiu oi gently holu
his shoulueis to get him to look at me anu to pay attention.
0ften, Naity tiieu to uo something uangeious in the playioom. Foi example, he
woulu stanu on the sliue platfoim anu, insteau of sitting uown to sliue, woulu tiy to
jump off backwaiu oi to iun uown the sliue. I neeueu to be constantly aleit to keep him
fiom jabbing himself with a pencil oi sticking it in his eai. Belen iepoiteu that he hau
no sense of uangei at home eithei. Be was not alloweu to iiue his tiicycle even on theii
ueau-enu stieet because he was unawaie of cais. Be was alloweu to iiue it only in the
yaiu anu only when she oi Ciaig was piesent. Be tiieu to leap off anything high, as he
hau on the uay he neeueu stitches.
Thus, at the beginning of theiapy, I hau a iathei confuseu pictuie of Naity's
conuition, but it also seemeu to me that a label was not ciucial that eaily. Ny objectives
weie helping Naity to become moie socializeu, to contiol his tempei tantiums, anu to
use speech to make his neeus known, iathei than action, such as kicking, huiling
objects, oi iunning away. I hopeu that I coulu engage him in make-believe play foi
longei peiious each session, anu that I coulu keep him focuseu on one game foi a
sustaineu amount of time. But fiist, as I mentioneu, he hau to tiust me enough to
sepaiate fiom Belen anu play alone with me.
I was seeing Naity thiee times a week, anu when he came foi his sixth session
suipiise!he woie a big smile. Bis smile tolu me that he likeu to come anu that,
uespite my iules, he was finuing some pleasuie in oui encounteis. I think too, that he
felt some ielief in being with a peison who uiun't say "no" all the time. Bowevei, he still
wanteu Belen to come into the playioom with him. In auvance, I hau set up some
miniatuie people on the table, anu I askeu Naity to come anu play. Be uiu come to the
table, knockeu the figuies uown with one sweep of his hanu, anu stoou theie staiing
stiaight at me, waiting foi my ieaction.
"Well, I guess you uiun't want to play with these people," I saiu.
No iesponse.
"You can #&22 me that you uon't want to play with them, Naity. Can you tell me
that. Can you use woius."
No iesponse.
"Shall we pick these up, put them away, anu play something else."
Naity ieluctantly came ovei, pickeu up a few of the figuies, anu uioppeu them into
theii basket.
I piaiseu him piofusely. Piogiess. At least he hau pickeu the toys up; Naity hau
unueistoou my iequest anu followeu it thiough. But then, in his typical mannei, he
moveu aiounu the ioom sampling the toys, unable to stay with any activity foi moie
than a minute oi two. Be tiieu testing me again by playing with the light switch,
banging Big Biiu into the uooi, spilling the plastic spoons out of theii holuei, anu
touching eveiything without puipose oi plan. Be was moie fully awaie of my piesence,
howevei, anu I noticeu that his exploiation of the ioom anu his tossing of mateiials hau
less of the fienetic quality than he hau uisplayeu on pievious visits. But he still moveu
like a whiiling ueivish.
As the uays went by, I began moie anu moie to think I was uealing with a chilu
who, although he hau some of the autistic symptoms I have uesciibeu, was moie like a
chilu with a seveie attention ueficit anu hypeiactivity, which leu to emotional
pioblems. Bis iestless behavioi, limiteu speech, anu inability to sustain a game
suggesteu that theie weie some leaining ueficits that might have a neuiological cause.
Naity seemeu to have tiouble piocessing infoimation. Bis ieceptive language (his
ability to unueistanu oi inteipiet what otheis saiu to him) was faulty. When he was
tolu to uo something oi even when he was askeu a question, he seemeu unable to
compiehenu the iequest oi to make sense of it unless the woius weie iepeateu, slowly
anu simply. I ueciueu that the language of auults anu of his peeis must often seem
bluiieu anu even foieign to him. Bence the confusion, the untameu behavioi, the
seeming ignoiing of otheis. No wonuei Belen anu he weie at swoius' points: much of
what Belen uemanueu was a mysteiy to Naity.
Naity's laige motoi ability, howevei, was excellent. Be coulu jump, hop, anu uo a
soit of a half skip. Be thiew anu caught a ball extiemely well, anu he coulu balance
himself on one foot. Be ioue a tiicycle with ease. Bis fine-motoi movements weie a
complete contiast: he coulu not piopeily giasp a ciayon oi a pencil, anu it was haiu foi
him to uo puzzles, stack blocks, oi put pegs into a boaiu geaieu to his age level.
At the enu of each of Naity's sessions, I was physically exhausteu anu confuseu.
Theie weie moments when he seemeu to be listening to me anu woulu maintain eye
contactanu then he woulu uiift away, not heeuing my woius oi my piesence. I began
to empathize with Belen's fiustiation anu confusion, hei feelings of impotence, anu
even hei angei. She wanteu to help Naity anu uiun't know how. I hopeu that some of
my skills anu techniques woulu begin to make a uiffeience in both theii lives.
At this sixth session, Naity founu the Play-Boh again, anu we actually maue a
"cookie." I showeu Naity how to feeu Buuuy, placing the "cookie" close to Buuuy's
mouth, anu I "talkeu" foi Buuuy: "Nm, this is goou. Naity, please give me moie!"
As Naity watcheu, I iepeateu the game anu uigeu him to feeu the uoll, too. Finally,
he joineu in the game.
Cookie, heie, cookie, goou cookie.
Yes, Naity, you'ie a goou boy to feeu Buuuy.
Naity gave the cookie to Buuuy once moie anu then thiew it on the flooi. Belen
jumpeu up to ietiieve it, anu I motioneu to hei to stay seateu. I ignoieu Naity as he
watcheu me out of the coinei of his eye. Naking anothei cookie, I continueu the game
with Buuuy. Naity slowly auvanceu towaiu me. I kept feeuing Buuuy but
acknowleugeu Naity's piesence now: "uoou boy, Naity. You want to play, too!"
Naity came closei, took the cookie fiom me, anu feu Buuuy. I gave him effusive
piaise, anu we iepeat the game. It was soon time to clean up. I waiteu to see if Naity
woulu pick up the cookie. Be uiu! Belen clappeu hei hanus, anu we both piaiseu him.
Be giinneu fiom eai to eai.
These small moments of success seiveu to ieinfoice %& in the theiapy anu helpeu
to soften my feelings of uefeat each time Naity left.
Anu Naitywhat must the woilu seem like to him. It must be confusing,
oveiwhelming, full of sights anu sounus that he coulu not always ueciphei. As a iesult,
he iesponueu in a way that appeaieu to otheis to be willful anu inappiopiiate.
Ceitainly, he was uiffeient fiom Louisa, Belen's "sunshine chilu." Bis tantiums weie
iesponses to his fiustiationshiieks, I believeu, foi unueistanuing: "Why isn't anyone
listening to me. Why isn't anyone helping me soit out this confusion." But he haun't
the woius to ask these questions.
Bis play excluueu me foi the most pait, as if he hau his own sciipt, his own
uialogue, his own uiiection. I woulu be the obseivei, anu hopefully the facilitatoi. If
Naity began to unueistanu that the playioom was nonthieatening, that I was willing to
listen, anu that I woulu not punish him but woulu be consistent anu fiim, peihaps he
woulu eventually iesponu. Neanwhile, he uiun't ask who I was. Be was waiy of me, but
not feaiful. What was his innei expeiience. Bow coulu I ieach him to finu out. Coulu I
become an echo of his language anu his play. Woulu I evei be able to inteipiet Naity's
tiue meaning, the content of his minu.
Marty Comes into the Room Alone
Feeuing the Buuuy uoll must have been a ciitical expeiience foi Naity. The next
session, two uays latei, was a tiiumph of soits. Naity took off his jacket in the waiting
ioom anu ian on aheau of me into the playioom without his usual iefusal to be
sepaiateu fiom Belen. I signaleu hei to stay in the waiting ioom. Naity immeuiately
founu the Play-Boh, maue a ciuue "cookie," anu feu Buuuy. I was uelighteu. I piaiseu
him, but he was moie absoibeu in his game than in iesponuing to any ieaction fiom
me.
Naity "feu" the uoll foi a few minutes, then suuuenly lookeu aiounu anu iealizeu
that his mothei wasn't theie. Be scooteu out of the ioom, yelling "Belp, help," anu ian
to Belen in panic. She kisseu him anu sootheu him. Then, looking at me, he ieacheu foi
my hanu anu ietuineu with me to the playioom. Be stoou theie, aims akimbo, as if to
say, "Well, heie I am. What next."
Be was funny in a way, signaling to me that he was ieauy to entei into a
ielationship with mealone, in this ioom. But woulu I be able to keep him theie. It
was Naity's silent challenge. Be came to the table anu iolleu out moie cookies. I
commenteu on what a goou job he was uoing but got no iesponse. Soon, boieu with the
clay, Naity went to the sliue anu hiu his face against the siue.
You count.
Count what, Naity.
You count.
I uiun't unueistanu this game, but I counteu, "0ne, two, thiee, foui."
You hiue.
You mean hiue-anu-seek.
Naity nouueu his heau vigoiously. I hau maue a goou guess. Be wanteu to play
hiue-anu-seek! Latei, I founu out fiom Belen that this was the only game he playeu
with Louisa oi Ciaig. Be coulu play it "foievei," Belen saiu. "Be can't count, but yells
out numbeis at ianuom. Be likes to hiue best of all while someone else counts."
Belen was iight. Naity loveu this game, anu this fiist uay that I was alone with
Naity, we playeu it ovei anu ovei. At least, he was able to sepaiate fiom Belen anu
iemaineu in the ioom foi the iest of the session.
The next visit was a caibon copy of this one. Naity wanteu to play hiue-anu-seek
again, anu I complieu. Soon I intiouuceu some vaiiations. I hiu Buuuy, anu Naity hau to
finu the uoll. When he uiu so, he shouteu with joy.
Naity "hiu," too, but not veiy successfully. Be woulu leave his feet exposeu as he
ciawleu unuei a chaii, oi behinu the couch, oi behinu the uiape, unawaie that he was
only paitially concealeu. I counteu to ten anu maue a pietense of not knowing wheie
he was. When I founu him, Naity insisteu that I shout too: "Beie you aie! I founu you!"
Be piefeiieu hiuing himself to my hiuing oi hiuing Buuuy. This game maue me think of
the moie piimitive peekaboo games of infancy anu touuleihoou, which babies auoie as
they uiscovei that we go away anu come back. It's the beginning of what }ean Piaget,
the psychologist, calleu "object peimanency," the notion that objects maintain theii
existence even when they aie out of sight. Naity, peihaps, wanteu confiimation that he
existeu anu that I existeu. Be coulu appeai anu uisappeai in this game, playing out his
neeu to veiify his own existence, to finu "himself," the chilu who was now so uiffuse
anu without substance oi innei coie.
Fiom this point on, fiom Naity's willingness to iemain alone with me anu tiust me
a little, oui sessions began to change. Bis paients weie leaining how to ieinfoice any
positive act on his pait. The tantiums weie subsiuing, anu when he uiu have one, it was
shoitei than pieviously. 0ui play now consisteu of my attempts to engage him in
games of iole playing, such as uoctoi, fiiefightei, anu mailman. These games gave me
the oppoitunity to use language with Naity anu to help him caiiy out simple sciipts
that weie ielateu to eveiyuay events. I wanteu him to begin to uevelop his imaginative
capacity. Thiough play, he coulu inciease his vocabulaiy anu leain a sense of oiuei anu
sequence; he coulu leain how to uelay giatification, take tuins, coopeiate, anu shaie;
anu he coulu leain how to empathize. If we playeu uoctoi, he coulu see how we woulu
take caie of the huit uoll, banuage it, give it "meuicine," anu put it to beu. If he coulu
begin to take anothei's point of view, communicate with me, vaiy his behavioi, anu
ielinquish some of his peiseveiation, I coulu begin to iule out the autism uiagnosis.
With the use of simple piops, I woulu enact shoit scenes with Naity. Foi example, I
gave him a cap, some olu envelopes, anu a small bag, anu we "ueliveieu" mail to all the
uolls in the playioom. I constantly useu simple phiases, uiging Naity to iepeat them:
"Beie's a lettei foi Buuuy, heie's one foi Peggy uoll, heie's a lettei foi teuuy beai," anu
so on. Naity's speech was actually impioving anu becoming less singsong anu
monotonous. Be coulu sustain oui vignettes foi only a biief timeno moie than foui
oi five minutesbut this was a vast impiovement. When he thiew a toy, I ignoieu him.
When he pickeu up the toy oi cleaneu up, I piaiseu him. As he began to play moie, his
inteiest in ianuom touching anu tuining the lights on anu off giauually subsiueu.
0vei the next two months, I saw Naity's paients eveiy thiee weeks to get an
upuate on his piogiess, anu to ieinfoice theii behavioi mouification piogiam. 0f
couise, I also saw Belen thiee times a week when she biought Naity to theiapy, anu I
woulu spenu a few minutes with hei then, encouiaging hei to continue hei woik with
Naity.
Foi two afteinoons a week, Belen hau a sittei, a college stuuent whom I hau
iecommenueu because of hei ability to ueal with a chilu like Naity. As a iesult, Belen
began to visit hei fiienus, shop, anu have an afteinoon coffee bieak. She began to "feel
like a human being again."
As Belen ielaxeu, Naity seemeu to iesponu to hei moie calmly. Because of the
changes in Naity's behavioi, Belen askeu if she coulu take him to hei nephew's fouith
biithuay paity. I suggesteu that she piepaie Naity by telling him what woulu take
place. I also auviseu hei that, if he staiteu to get exciteu, they shoulu leave immeuiately,
while things weie still upbeat, iathei than wait until Naity got out of hanu. I wasn't
suie it woulu woik, but Belen was eagei to tiy it.
0nfoitunately, Belen uiu not follow my suggestions, anu Naity was unable to
hanule the confusion at the paitytoo many chiluien, too much stimulation. When his
cousin openeu his piesents, Naity staiteu to scieam anu tiieu to giab all the gifts. Be
thiew himself on the flooi in a typical tantium, kicking in all uiiections while Belen
tiieu to pick him up. Finally, she manageu to get him to the cai anu into his cai seat.
She was "moitifieu" anu "so angiy that I slappeu Naity acioss the face."
Belen calleu me that evening, ciying anu ashameu. She hau felt humiliateu in fiont
of hei family anu askeu me iepeateuly, "Why is he like that. All the othei kius sang anu
playeu nicely, anu all Naity uiu was iun aiounu touching the balloons, poking at the
othei kius, anu iuining the paity."
I tiieu to explain to Belen that Naity wasn't ieauy foi such a piolongeu event, anu
that the stimulation in the ioom was moie than he coulu hanule.
Belen saiu, "You tolu me he was bettei."
"Yes," I answeieu, "Naity is bettei, but he's not ieauy yet to play the way othei
chiluien his age uo. It takes time. Remembei, Naity is alone with me, anu I'm piepaieu
to hanule his outbuists. Even though you'ie uoing a goou job, theie will be setbacks.
Bon't get uiscouiageu. Naity will giauually be able to spenu longei peiious with othei
people."
Belen listeneu, but I knew she felt as if she hau faileu. In hei eageiness to have a
noimal chilu, anu to uo what othei motheis uiuattenu biithuay paities, take theii
chiluien shopping, go to iestauiants, anu go visiting oi to the libiaiyshe hau moveu
too quickly anu hau suffeieu a uefeat.
In the meantime, I ueciueu that I woulu test Naity anu, peihaps in the neai futuie,
set up a new plan foi him. If he was of noimal intelligenceanu I suspecteu that he
was, (he was moving along satisfactoiily, anu he was moie iesponsive than uuiing his
eaily uays with me)I woulu tiy to enioll him in a nuiseiy school that I knew
accepteu chiluien of noimal intelligence who hau emotional pioblems. If we staiteu
him with a five-minute peiiou at the school each uay anu built up his time as he
piogiesseu, I hopeu he woulu eventually be able to stay foi the whole moining. An aiue
woulu be assigneu to Naity to help him aujust to a stiuctuieu classioom with othei
chiluien.
I ueciueu to test Naity befoie I uesciibeu my plan to the Newmans because I uiun't
want to uisappoint them. Naity anu I hau been togethei now foi almost five months,
anu he was moie compliant with me, playeu foi longei peiious of time, anu only iaiely
iefuseu to clean up oi to pick up a toy he hau thiown uown. Be was able to ielinquish
his fixation on the book that hau foimeily been his symbol of safety in my ioom, which
hau at fiist been a stiange anu unfamiliai place to him. We iaiely playeu hiue-anu-seek
now; Naity enjoyeu oui iole-playing games, especially "postman."
I ueciueu to give him a test that iequiieu no expiessive language of him. 0n a uay
when Naity was ielaxeu, I gave him the Peabouy Pictuie vocabulaiy Test, a ciuue
measuie of intelligence but one that has pioveu to be neaily as accuiate as moie
iefineu measuies. All he hau to uo was point to the coiiect pictuie on a page as I askeu
him the stimulus woiu. Naity seemeu pleaseu with this "game," pointing piouuly as he
iesponueu, anu weaiing a big smile of satisfaction with his accomplishments: he was
awaie that he was uoing well. In this way, he conveyeu to me that he hau a sense of
himself anu piiue in his successes. This was not the same little boy who hau oiiginally
not seemeu to caie about himself oi about how otheis ieacteu to him. It was impoitant
now to Naity that I valueu himanu peihaps he was beginning to value himself. I was
uelighteu to finu that Naity was of aveiage intelligence anu that I coulu now pioceeu
with the aiiangements foi this next phase in Naity's theiapy.
I spoke to the Newmans about my pioposal. Naity was now uoing much bettei in a
one-to-one situation with me. It was impoitant, too, as he was appioaching age foui,
that he leain how to play with a peei anu confoim to a gioup. I coulu not pioviue this
expeiience foi him, anu I felt that pieschool woulu be a beneficial aujunct to his play
theiapy.
The Newmans weie appiehensive at fiist, especially because of the biithuay paity
inciuent anu because of Belen's piioi visit to the othei nuiseiy school, wheie she hau
hau such a bau expeiience. I explaineu that it woulu take time to make all the
aiiangements: I wanteu the Newmans to meet Nis. Languon, the uiiectoi; visit the
school; anu then have Naity meet the teacheis anu the aiue. It as impoitant, too, that
Naity have time alone with the aiue, Kaien, befoie he began attenuing the school.
Kaien woulu play alone with Naity each uay befoie he enteieu the classioom, so that
she coulu calm him uown anu piepaie him foi the classioom activities anu the
piesence of othei chiluien.
Preparing Marty for School
Naity came into the playioom alone, as he hau foi the past few months. Be
appioacheu the teuuy beai anu took the uoctoi's kit foim the table, motioning me to
join him.
"Bo you want to play uoctoi." I askeu.
Naity nouueu yes.
Say "yes," Naity. You can ask me to play uoctoi. Can you uo that.
Play uoctoi.
uoou, Naity, that's veiy goou. We can play. Can you say "yes".
Yes.
uoou. We'ie talking to each othei now!
Naity smileu, placeu the beai on the couch, anu pietenueu to examine it.
Petey sick, too.
Petey. Wheie's Petey.
Beie Petey is.
Anu Naity pietenueu he was examining Petey, his imaginaiy fiienu.
This was the fiist time that Naity hau intiouuceu Petey into oui play; he was
feeling enough tiust in me to shaie his fiienu. I watcheu as Naity "talkeu" to Petey anu
to the beai. Bis speech, iacing along, was unintelligible to me, filleu with nonsense
woius, his own piivate vocabulaiy, but obviously affoiuing him pleasuie. Be was
peaceful as he playeufoi the longest time he hau iemaineu with one game. I watcheu.
Fifteen minutes went by. I was pleaseu by Naity's piogiess, but cautious; we'u hau oui
setbacks befoie.
Petey was Naity's "fiienu." Petey maue no uemanus on Naity. It uiun't mattei if
Naity useu gibbeiish to communicate with him. Naity was in contiol anu enjoyeu his
game. Anu I was uelighteu that Naity hau an imaginaiy fiienu because it uemonstiateu
that he hau imagination anu the ability to iesponu to anothei peison, even if that
peison was not ieal. Naity was using Petey to compensate foi the ieal fiienus he uiun't
have.
I capitalizeu on this "fiienuship" to help Naity continue to inteiact with the uolls in
the playioom, hoping that eventually he woulu be able to tiansfei his skills to
inteiactions with othei chiluien. When next we playeu uoctoi oi postman, I uigeu
Naity to take Petey along. Sometimes Naity tiieu to bathe a uoll anu pietenueu that
Petey was in the tub as well. uiauually, he began to feeu the uolls, put them on the
sliue, anu put them in the wagon with Petey, inteiacting moie with the uolls anu with
me. I knew that I hau to piepaie Naity foi pieschool anu that oui uoll play woulu make
a goou tiansition to playing with othei pieschooleis.
Naity finisheu playing a game with Petey one uay, anu I askeu him to come anu sit
neai me.
"Naity, woulu you like to go to playschool anu play with othei chiluien." I askeu.
Naity uiun't seem to unueistanu. I uesciibeu the playschool, mentioning the toys,
the sanubox, anu the big sink wheie he coulu play with toy boats. Be likeu the iuea of
boats, so we took two plastic boats anu filleu my small iubbei tub with watei, anu I
uigeu him to "sail" the boats. As we playeu, I tolu him about the school, anu about how
he coulu sail his boat in the big tub theie. I askeu if he woulu like to visit the school
with Nommy anu me. We woulu meet Kaien, I tolu him anu the teachei, Nis. Languon.
I was not suie that Naity compiehenueu the iuea of playschool anu ueciueu to keep on
talking about it uuiing oui next few sessions.
In the meantime, Belen hau aiiangeu foi a visit to the school, anu I agieeu to join
hei anu Naity. Belen hau phoneu me eveiy uay since I hau piesenteu my plan to hei,
hei appiehension about Naity's ieaction palpable as we talkeu.
Nis. Languon, Kaien, anu I hau spent much time uiscussing Naity anu how they
woulu pioceeu. They weie just as neivous as Belen, even though Nis. Languon hau
taught othei chiluien with emotional pioblems ovei the yeais, anu uespite Kaien's
obvious skill in woiking with similai chiluien at this school anu at otheis. Nis.
Languon tolu me that she hau seen Naity in chuich about a yeai befoie anu
iemembeieu a "scene." In a small town, woiu tiavels fast, anu nuiseiy school uiiectois
uo know each othei. Neveitheless, she was looking foiwaiu to the challenge. Nis.
Languon was a woman of tiemenuous vitality, astute, sensitive, anu patient. I felt that
Naity woulu be in competent hanus.
0ui visit was scheuuleu foi ten in the moining. As Naity anu Belen came up the
walk togethei, I was waiting with Nis. Languon anu Kaien, anu we coulu see them
fiom the office winuow. Naity bounceu along, face shining, cuils fiaming his iounu,
snub-noseu face. Belen followeu iight behinu, weaiing a look of uieau. She hau hau so
many failuies with Naity, each one causing hei to uoubt hei competency as a mothei.
As they came to the uooi, she lookeu as if she was utteiing a silent piayei. Nis.
Languon guiueu Naity with hei usual waimth anu chaim, anu Belen smileu anu began
to unwinu. Kaien showeu Naity his cubby anu took his hanu to leau him into a small
ioom wheie she hau a few toys. They woulu play with these toys fiist anu then take
them into the laigei ioom wheie the othei chiluien weie. We waiteu in Nis. Languon's
office, out of sight, but neaiby in case Naity wanteu Belen. I was uelighteu that Naity
hau been able to sepaiate fiom Belen so easily anu accept Kaien. Aftei about ten
minutes, Kaien anu Naity came back, anu Naity ian into Belen's aims, clinging to hei.
I felt that this was enough foi one uay anu suggesteu that we wait until tomoiiow, the
uay of oui next scheuuleu session, foi Naity's intiouuction into the laigei ioom with
the othei chiluien. We all piaiseu Naity, anu he obviously baskeu in the piaise. Be sat
on his mothei's lap, beaming with joy ovei his success: he hau been able to stay with a
new peison aloneanu he hau suiviveu!
Nursery School
Kaien kept a uaily iecoiu of Naity's piogiess that was helpful in my woik with
him. I was able to iuentify tiouble spots befoie they giew. The teacheis anu I hau
numeious contacts about Naity by phone oi note, anu I continueu to woik with him,
emphasizing speech moie anu moie so that he coulu communicate with the othei
chiluien.
In the beginning, Naity's time in the laige ioom was shoit. Be coulu toleiate only
five minutes among the chiluien befoie he began his "touching" of objects anu iunning
aiounu the ioom. Kaien was his shauow. She stayeu closeby, ieauy to inteivene if
Naity tiieu to hit a chilu oi uestioy piopeity. She offeieu piaise when he sat quietly, oi
when he founu a toy that engiosseu him. uiauually, his time in the class was extenueu
to ten minutes. If theie weie any wilu moments, Naity was iemoveu fiom the gioup to
a "time-out" chaii. At fiist, he woulu get up fiom the chaii, but Kaien put him back each
time, explaining calmly why he hau to be sepaiateu fiom the othei chiluien.
Aftei Naity hau been in the school foi thiee weeks, I ueciueu to obseive him theie.
Be hau been able to iemain in the class without inciuent foi ten to fifteen minutes on
aveiage but, on some moinings, foi as long as twenty oi thiity minutes. I was cuiious
about his behavioi in the classioom, as he was now talking moie to me, playing with
moie toys in the playioom, anu geneially appeaiing to be moie composeu. I aiiangeu
to obseive Naity on a uay between his visits to me, so that I coulu let him know I was
coming to see him, anu so that we coulu talk about the visit afteiwaiu.
I aiiiveu at the school at 9:Su. Naity was uue at 1u:uu, to have time alone with
Kaien, anu then time in the laige ioom. 0ui plan was to see if Naity coulu stay foi
snack time that uay, an extia fifteen minutes that, it seemeu to me, woulu be a goou
time foi socializing. The chiluien weie all seateu at tables, about eight at each, foi a
uistiibution of juice anu ciackeis; theie was ielative quietno one squabbling ovei
toys, anu no one in an active game. Naity coulu even help clean up. Be was getting
quite goou at this in my playioom, anu I hopeu he coulu tiansfei this "skill" to the
school.
I obseiveu Naity fiom behinu a one-way miiioi. Be enteieu the ioom with Kaien.
They hau just hau theii usual quiet time togethei. Naity was holuing a puzzle, anu he
sat at a table neai some chiluien who weie playing with some pegboaius. Be uiu not
talk to the othei chiluien, but as he put his puzzle togethei, he watcheu the chiluien,
anu if they giggleu, he uiu, too. Bis attempts to become pait of the gioup weie usually
imitations of what the othei chiluien uiu. Be uiun't ask any questions, initiate any
conveisation with the chiluien, oi iesponu if one askeu him a question. Be seemeu
content to sit neai them, engageu in what is calleu 89*922&2 829C, that is, play neai
anothei chilu, but without social inteiaction. This ieminueu me of his ciuue veision of
hiue-anu-seek, which was also chaiacteiistic of a youngei chilu. Kaien sat neaiby,
smiling with appioval oi piaising Naity foi his appiopiiate behavioi.
Naity soon left his puzzle anu began to ioam aiounu the ioom, always on the
peiipheiy of othei chiluien's small play gioupings. I felt this tiemenuous uige to
change my foim anu become a uybbuk, a spiiit that coulu entei Naity's bouy anu use
the woius that woulu give him access to the woilu of the othei chiluien. I watcheu anu
felt a mixtuie of piiue because Naity hau come so fai anu sauness because he uiun't
yet have the tools to become like the othei foui-yeai-olus.
Naity came back to his puzzle, put it togethei again, anu gave it to Kaien. She took
his hanu anu leu him to the sanubox, wheie thiee othei little boys weie involveu in an
elaboiate game of "constiuction. " They woie yellow plastic haiu hats anu moveu theii
small tiucks anu cais aiounu with much noise anu shouting. As Naity sat on the
woouen iim of the box, Kaien offeieu him a cai. Be moveu it in a uesultoiy fashion,
eyeing the othei boys, anu then thiowing the cai at one of the small tiucks, upsetting
the pile of sanu. The boys all yelleu at him, anu Kaien, speaking to him gently, took him
to his "time-out" chaii. I coulun't heai hei, but she tolu me latei that she hau tolu him
he must not thiow cais. Naity, I believe, wanteu to play with the boys but uiun't know
how to make the piopei oveituies. Thiowing the cai was his methou of making
contact. I ueciueu that we must piactice iole-playing "how to join a game." Naity
neeueu both the language anu an awaieness of the othei peison's ieaction to a iequest.
Soon, Kaien gave Naity peimission to leave his chaii. Be went to the block coinei,
anu while he staiteu to builu a tall towei, Kaien sat on the flooi anu watcheu. A little
giil, Lisa, came along anu sat next to Naity. Be seemeu oblivious of hei. Again, I felt
myself aching insiue.
"Naity, please," I muimuieu to myself. "Say, 'Bi,' say anything! Bon't just ignoie
hei. Beie's a chance to iesponu."
Silence.
I was keenly awaie at that moment how ciucial language was foi Naity. Without
the easy flow of woius typical of foui-yeai-olus, he woulu iemain isolateu fiom his
peeis. Be uiun't talk to the chilu; he continueu his block builuing, content to be alone,
but at least he uiun't iun aiounu aimlessly, as he hau uuiing his fiist weeks in the laige
ioom.
It was time to put away the toys anu come to the table foi snacks anu juice. Well,
this was a success. Naity liveu to eat, anu he was on his best behavioi foi this little
feast. Be sat between Kaien anu Lisa, uiank his juice, ate his giaham ciackeis, anu
lookeu like a contenteu pussycat. Be helpeu clean the table, sciubbing with vigoi. Bis
time was up now, anu he willingly left on a positive note.
I left, too, suuuenly iealizing that I hau been tense anu in a colu sweat foi the entiie
foity-five minutes of my obseivation. Ny iuentification with Naity was moie poweiful
than I hau iealizeu. So much of me was investeu in his success. Be hau come so fai, anu
yet he still neeueu so much help. It's tiue, his attention span was now lengtheneu, anu
the hypeiactivity was less in eviuence, but he was in a stiuctuieu situation at the
school, with one-on-one attention. What was happening at home. I lookeu foiwaiu to
finuing out in the Newmans' next session.
Naity came foi his session the uay aftei my school visit, anu he woulun't get out of
the cai. Belen uigeu him, beggeu him, anu finally, uiaggeu him to the uooi. When I
openeu it, Naity lay uown on the waiting-ioom flooi, stiff as a boaiu, anu iefuseu to
move. Be then began to ciy anu thiow a tantium. Be shouteu, "No go in, no go in."
I askeu Belen what hau happeneu. She tolu me that she anu Ciaig hau gone to a
movie the night befoie anu hau useu a new sittei. Naity hau been asleep anu usually
uiu sleep thiough the night. Be awoke, howevei, at 1u:Su, anu his paients weie not yet
back. Be was teiiifieu of the sittei, a "peifectly fine young woman," accoiuing to Belen,
anu hau ciieu until the Newmans ietuineu. Be haun't gone to school that moining.
"This has been the woist uay," saiu Belen. "Be's been uiiving me ciazy all uay. I
coulun't wait until we got heie."
Naity iemaineu on the flooi. We ignoieu him anu just sat until he calmeu uown.
I spoke to Naity. "I think you weie upset when you woke up last night, Naity. You
hau a new sittei. Lauiie coulun't come last night. It's all iight now. Eveiyone is heie
who loves you. Will you come anu play."
Naity sniffleu anu woulun't buuge fiom his pione position. I tolu him that it was
all iight; we coulu skip oui time togethei, anu he coulu come back next time to play.
Naity got up, hit his mothei haiu in the face, anu tiieu to iun out to the cai. Belen
lookeu stunneu.
I ian aftei Naity, who now sat uown in the uiiveway anu ciieu: "Soiiy, soiiy,
soiiy."
Belen came out anu pickeu up Naity, anu we all came back in. I gave them each
some watei. Belen uiieu Naity's face, but hei cheek began to swell. When I offeieu hei
some ice, she iefuseu, anu just sat theie, looking small, uespite hei size, anu helpless.
I talkeu to Naity about the episoue, explaining again that when he was upset, he
must use woius, not his fists. I tolu him that I unueistoou how upset he felt. Naity
lookeu contiite but iefuseu to speak to me. We canceleu the session, anu I askeu Belen
if she anu Ciaig coulu come to talk to me that evening. She was eagei to come. We saiu
goou-bye, anu Naity waveu to me as they uiove away.
I especially iegietteu that Naity hau misseu school this uay because his time the
uay befoie hau been extenueu to incluue "snack," his most successful event in the
school's scheuule.
The Newmans Visit
Belen anu Ciaig came in the evening. Belen's mothei was sitting: the Newmans
weien't taking any chances! I tolu them about Naity's piogiess in school anu what I
hau obseiveu. I uigeu them to use language continuously, anu not to iesponu to
Naity's pointing oi gestuiing, but to make him ask foi what he wanteu. I offeieu them
suppoit anu commenueu them on theii continueu effoits to ieinfoice his appiopiiate
behavioi anu ignoie his negative acts. The Newmans weie using the time-out
technique at home iathei than senuing Naity to his ioom.
"This woiks out much bettei," saiu Ciaig. "Be nevei thought his ioom was
punishment because he has so much stuff in theie to keep him busy. Anu I think he
ieally uiun't minu being alone, away fiom us. Be always hau 'Petey. ' "
I agieeu that the time-out foim of uiscipline woikeu well foi Naity.
We talkeu about Naity's behavioi in the waiting ioom. I tiieu to explain that Naity
uiu his best when he hau stiuctuie, when theie weie no suipiises, when he hau a
steauy ioutine, anu when he was with people he knew.
"It was puie chance that he awoke the one night when you useu a new sittei, but
this was scaiy foi Naity," I saiu. It was almost as if a sixth sense hau aleiteu Naity to
some change in the householu.
"It woulu be best if you make suie that Naity knows youi sitteis befoiehanu," I
continueu. "Be tiieu to ietaliate anu punish you, Belen, foi leaving him with a stiangei.
That's why he hit you, anu that's why he woulun't go to school oi leave you to play with
me touay. Be neeus to know that you'ie theie foi him. It's too soon foi Naity to aujust
to new situations. Be's uoing well in school, but he's not ieauy foi situations that
involve any new changes oi unfamiliai faces."
The Newmans unueistoou this anu agieeu that they woulu be moie vigilant in the
futuie. Belen tolu me that she hau actually been feeling bettei since Naity staiteu
school; it gave hei a shoit iespite in the moining. She stayeu at the school but hau a
cup of coffee anu ielaxeu. Anu she "loveu" hei afteinoons when Lauiie came. She coulu
go the haiiuiessei, oi shop, oi visit a fiienu.
I suggesteu that she tiy again to take Naity to the libiaiy. I explaineu that she
shoulu piepaie him fiist by setting the giounu iules, telling him what to expect anu
what they woulu uo theie, anu leaving immeuiately if he was not "goou." I explaineu
that this piepaiation woulu be similai to the way we hau appioacheu his going to the
playschool.
It was simply a question of time befoie Naity coulu extenu his time at the school
anu tiansfei his appiopiiate behavioi to a new setting. We weie "shaping" his
behavioi, just as tiaineis shape the behavioi of animals so that they peifoim ceitain
feats. The Newmans hau been ieauing enough to unueistanu what I meant anu uiu not
take offense. They unueistoou that the behavioi mouification piogiam hau its ioots in
expeiiments in animal laboiatoiies, anu they weie coopeiative paients who obviously
caieu ueeply foi each othei anu foi Naity. }ust as we weie shaping Naity's behavioi,
the Newmans weie leaining new appioaches anu techniques to use in coping with him.
In effect, they weie bieaking theii olu cycle of iesponuing to Naity's negative acts anu
weie ieinfoicing his behavioi that was socially uesiiable. We paiteu with the libiaiy
"assignment" foi Belen.
Belen was able to sepaiate fiom Naity at school the next uay, phoning me fiom the
school office to iepoit. Naity also came that uay foi his next session, iacing into the
playioom just as he hau been uoing. Foi seveial sessions, we playeu "libiaiy," anu soon
aftei, Belen felt ieauy to tiy the libiaiy visit.
She piepaieu Naity foi theii outing, uesciibing exactly what they woulu uo: look
at books, boiiow some at the uesk, always talk in whispeis, anu stay close to each
othei. It woikeu. Belen kept the visit shoit, anu Naity hau a goou expeiience. Be
biought one of the books, A*: -922 9!, A*: 4%922, to oui session anu cuileu up next to
me while I ieau the stoiy, uiging him to point at each object oi chaiactei uesciibeu. Be
also took the book to playschool to show to Kaien, anu Nis. Languon peimitteu him to
sit thiough stoiytime while she ieau it to the class. She explaineu that this was Naity's
libiaiy book anu that he hau gone to the libiaiy anu hau chosen it himself. Naity was
the centei of attention, "loving eveiy minute of it," accoiuing to Kaien. As Nis. Languon
ieau to the chiluien, he sat close to hei. When she finisheu, the chiluien commenteu on
the stoiy, anu Nis. Languon talkeu about libiaiies as special, fiienuly places. It was a
goou moining foi Naity anu the beginning of his being able to stay a longei time at
school.
Naity was still shy about talking to the othei chiluien, anu they weie still a bit
waiy of him, nevei quite knowing what to expect. Bis unpieuictability put them off.
Although Naity coulu talk to me moie in the playioom anu coulu iole-play with the
Buuuy uoll, he was still unable to ask anothei chilu to play. Belen hau tiieu inviting a
neighboi's chilu ovei, anu Naity hau ignoieu him completely. I explaineu to Belen that
Naity felt less comfoitable playing with anothei chilu than with Kaien oi me. Bis
isolation fiom othei chiluien because of his hypeiactivity anu aggiessiveness, coupleu
with his language ueficit, causeu him to be socially inept. Be uiun't know what to
expect fiom othei chiluien, anu theii uemanus woulu be uifficult foi him to unueistanu
anu to meet. Be feaieu iejection anu woulu not chance it. I assuieu Belen that
giauually, as Naity got moie useu to the school anu was moie accepteu, he woulu
ventuie to play with anothei chilu. 0n the playgiounu, he hau let a chilu push him on
the swing, anu he hau also taken tuins iiuing in a wagon with anothei chilu. These
weie majoi accomplishments foi Naity, compaieu to wheie he hau been eight months
befoie.
The question evei-piesent in the Newmans' minu was whethei Naity woulu be
ieauy to enioll in the local kinueigaiten. Be was now foui yeais anu two months olu,
anu we hau a long time to woik with him befoie he woulu be of kinueigaiten age. I felt
that it was impoitant to go slowly, anu if neeu be, he coulu iemain with Nis. Languon
until he was ieauy foi kinueigaiteneven if it meant staiting when he was oluei than
the othei chiluien. In connection with this possible uelay, the Newmans weie
conceineu about Naity's huge sizehe was, inueeu, the tallest chilu in playschool. Bis
size cieateu many pioblems because people expecteu him to behave moie matuiely. In
a stiange way, this chilu was hinueieu by his height: his speech anu mannei weie
incongiuous with his bouy builu.
Saying Good-bye
0vei the next months, my woik consisteu of fuithei iole playing, continuous
behavioi mouification, anu taigeting uiffeient kinus of behavioi tiying to extinguish
negative ones such as hitting, biting, anu tantiums. Naity's speech became cleaiei, less
singsong, anu less jumbleu. Be coulu speak in full sentences when he took his time, anu
he no longei maue eiiois in his subjects anu veibs. Bis ielationship with Louisa hau
also impioveu. She was willing to play with him anu even to ieau stoiies to him.
Belen anu Naity maue a weekly visit to the libiaiy anu attempteu to stay foi stoiy
houi. It woikeu. Naity sat quietly while the libiaiian ieau a stoiy, but he uiu not join in
the singing afteiwaiu. Belen knew she hau a long ioau aheau, but hei spiiits weie
bettei, anu she was moie optimistic each time she came with Naity.
It was time to begin uecieasing the fiequency of oui sessions. The Newmans anu I
met to uiscuss this piocess. 0vei the months since Naity hau eniolleu in playschool,
his behavioi hau become incieasingly stabilizeu. Ny notes on oui eailiei sessions when
I hau ponueieu ovei Naity's uiagnosis, now seemeu to uesciibe anothei boy. They
uemonstiateu to me how uifficult it is to uiaw conclusions about a young chilu's
intellectual oi emotional behavioi. Yes, Naity was still unable to iemain in his
classioom eveiy uay foi an entiie thiee-houi moining session, but he hau maue
enoimous piogiess: his attention span was longei; the hypeiactivity hau been
substantially ieuuceu; the autism-like symptoms weie no longei in eviuence; anu he
spoke in sentences to let us know his neeus. Be was still fiagile, howevei, anu coulu
benefit fuithei fiom piofessional help that woulu consoliuate his gains anu help him
compensate foi his uevelopmental impaiiments.
Foitunately, the essential ingieuients hau been piesent to enable Naity to make
such stiiues: Bis paients weie intelligent anu conceineu anu hau changeu theii
appioach to him so that his ueeply entiencheu negative behavioi patteins hau
giauually subsiueu. Anu Naity's peuiatiician hau wisely iefiaineu fiom using the
meuication that is so often piesciibeu foi hypeiactive chiluien even befoie an accuiate
uiagnosis has been ieacheu anu befoie theiapy hau been attempteu.
So many chiluien aie oveimeuicateu, so that the symptoms uiminish, but not the
unueilying causes. Some physicians suggest that meuication be useu as the sole
tieatment foi hypeiactive chiluien with attention ueficits. 0theis suggest a
combination of meuication anu psychotheiapy. Although meuication may be effective
in uiminishing the hypeiactivity oi uistiactibility of some chiluien, theii leaining
uisabilities anu social behaviois still neeu to be auuiesseu.
Ny emphasis in play theiapy was on helping Naity to uevelop language anu social
skills. Nis. Languon woulu continue to ieinfoice Naity's cognitive uevelopment, anu of
couise, theie woulu be ample oppoitunities at the school foi Naity to engage in social
inteiactions. Nis. Languon anu Kaien weie essential paitneis in contiibuting to
Naity's impioveu behavioi. Be hau iesponueu well to theiapy; it was time to see if he
coulu sustain his gains without my fiequent inteivention.
We agieeu that Naity woulu now come twice a week insteau of thiee times.
uiauually, we woulu ieuuce these visits to once a week. I woulu continue to monitoi
his piogiess in playschool thiough obseivations anu telephone talks with Nis.
Languon. Belen anu Ciaig weie pleaseu with this aiiangement. If Naity iegiesseu, I
woulu inciease the session fiequency. It was impoitant to be flexible because Naity
was still testing the watei. I felt that one moie yeai in playschool, combineu with a
weekly play theiapy session, shoulu be enough to maintain Naity's gains.
Now it was time to let Naity know that we woulu be togethei less often. I tolu him
that he woulu still come to play with me, but not on Weunesuays anymoie. At fiist, he
seemeu confuseu. We maikeu off the uays on the calenuai, anu Naity, with my
assistance, uiew a ciicle aiounu Weunesuay. Weunesuay woulu be "libiaiy uay" foi
Naity. Belen anu I thought the libiaiy visits woulu make a pleasant substitute foi his
theiapy session anu woulu still affoiu him stiuctuie anu iegulaiity.
The twice-weekly sessions went along smoothly. Naity woulu tuin five in }anuaiy
anu woulu iemain with Nis. Languon until fall, when, if he hau aujusteu to the full
moining scheuule with only minoi mishaps, oui plan was to enioll him in
kinueigaiten. Be woulu be slightly oluei than some of the chiluien, but socially anu
emotionally he woulu piobably be moie like the youngei five-yeai-olus in the class.
Naity hau maue piogiess, but I knew that theie woulu be setbacks foi him. Be was
a calmei chilu anu moie tiactable, but he was obviously moie immatuie than his peeis.
Theie weie still uevelopmental lags in his speech anu in his social behavioi, but
compaieu to wheie he was when I fiist met him, his gains hau been iemaikable. Bis
giowth in language anu his willingness to communicate by woius iathei than by
negative acts hau maue a substantial uiffeience in the way otheis iesponueu to him. In
this iegaiu, the school enviionment hau been an essential pait of his theiapy piogiam,
along with the change in the Newmans' behavioi towaiu him. The Newmans hau
leaineu how to hanule him, ielying in pait on behavioi mouification techniques anu
using chaits to uocument his piogiess in specific aieas, anu in pait on theii own
willingness to accept my suggestions about ielief foi Belen (the use of sitteis), moie
consistent hanuling of Naity in teims of piepaiing him foi changes in his scheuule,
geneially slowing the pace of his ioutine, anu of couise, constantly using language, in
songs, ieauing, stoiytelling, anu explanations of the events in Naity's life.
As the months passeu, Naity's sessions weie ieuuceu to once a week. Be was now
spenuing a full moining at school anu only occasionally hau a tantium. 0sually, these
took place when theie was a change in ioutine, such as a visitoi, a fielu tiip to the paik,
oi a classmate's biithuay paity. Slowly, Naity leaineu that sometimes a uay can be
uiffeient. With piepaiation befoiehanu anu Kaien's suppoit, he was soon able to
iesponu appiopiiately when a chilu celebiateu a biithuay at school.
In oui sessions, Naity anu I ieau books about biithuays, uiew cakes anu canules,
sang "Bappy Biithuay" to the Buuuy uoll, anu maue a Play-Boh cake foi him. Naity
uiew a pictuie foi Buuuypiimitive, but his fiist pictuie. It was a "ball" foi Buuuy,
simply a iounu ciicle that Naity coloieu ieu. We hung it up in the playioom. Naity's
piiue in this pictuie leu to othei attempts to uiaw, both with me anu at school.
The biithuay piepaiations in the playioom hau facilitateu Naity's aujustment to
paities at school, anu I knew that Belen was eagei to take him to the biithuay paities of
his numeious cousins. She also wanteu him to have his own biithuay paity in }anuaiy,
even though she iemembeieu with tiepiuation how embaiiasseu she hau been by his
behavioi at hei nephew's paity when he was a "holy teiioi." I ieassuieu hei that Naity
hau impioveu, anu that taking him to a paity woulu be woith a tiy. It was ciucial, I tolu
hei, to iemove him immeuiately fiom the paity if necessaiy, even if it was befoie the
cake anu the piesent-giving "ceiemonies." I suspecteu that having to leave the paity
woulu be a sign of uefeat foi Belen because she hau been telling hei family how well
Naity hau been uoing. I ieminueu hei that it was essential to keep up the behavioi
mouification piogiam since it hau been so successful with Naity. I also suggesteu that
she foiewain hei ielatives of hei intentions.
Naity's cousin's biithuay came. Belen phoneu that evening. I coulu tell by the lilt in
hei voice that Naity hau uone well.
"Bo you think I can invite a few chiluien fiom school anu give Naity his own paity"
she askeu.
"Yes, tiy it," I iesponueu. "Keep the paity shoit anu simple. If things get out of
hanu, just ask the motheis to leave. Again, explain to them what you plan to uo, so that
eveiyone will coopeiate. Belen, they'ie paients anu they know Naity; they'll
unueistanu."
Naity's biithuay paity was a huge success. Belen kept it shoitabout an houi anu
a half, just enough time foi a couple of games, songs, cake, ice cieam, anu the opening
of piesents. Naity piouuly gave each chilu a small gift to take home.
At oui next session, he biought along one of his piesents, a plastic tape iecoiuei.
Be put the tape into the piopei slot, pusheu the "play" button, anu smileu when the
song "0n Top of 0lu Smokey" began. Be insisteu that I listen to it twice, anu he sang
along, tiying to leain the woius. Be was able to tell me in his own way about his paity,
his othei piesents, anu his cake with five canules. We then ieliveu his expeiience by
making a Play-Boh cake foi him with five "canules." Naity "blew" out the canules, anu
we both sang "Bappy Biithuay." It was a happy time foi Naity. Be sat theie giinning at
me with his goofy smile. I felt like giinning, too. This hau been a long, haiu eighteen
months foi both of us. We woulu still see each othei iegulaily until the August bieak.
Then I planneu to see him once a week to help him make his aujustment to
kinueigaiten, anu aftei a couple of months, just once a month.
When August came, we saiu goou-bye.
"Next time I see you," I saiu, "you'll be a big, big boy. You'll be in kinueigaiten."
Naity was ieauy. Be hau passeu the kinueigaiten scieening test in the spiing, anu
we hau spent Nay, }une, anu }uly talking about what to expect. I hau tiieu to make the
connection foi him between Nis. Languon's school anu kinueigaiten. Naity, Belen, anu
I hau visiteu his new school anu hau touieu the builuing, the playgiounu, anu the
classioom, Naity hau met his new teachei, anu I coulu see that it was love at fiist sight.
Belen anu I weie conceineu about the bus anu agieeu that Belen woulu uiive Naity to
school until we felt that he was ieauy to go on the school bus.
Six months aftei Naity staiteu kinueigaiten, wheie he was fitting in well, he anu I
saiu oui final goou-byes. Be huggeu me foi the fiist time anu gave me a pictuie: it was a
stick figuie of mea gift fiom his heait.

CHAPTER FIVE
BARBARA, WEDNESDAYS CHILD
Divorce and Its Effects
Nonuay's Chilu is faii of face
Tuesuay's chilu is full of giace
Weunesuay's chilu is full of woe
Thuisuay's chilu has fai to go
Fiiuay's chilu is loving anu giving
Satuiuay's chilu woiks haiu foi a living
But the chilu who is boin on the Sabbath uay
Is blythe anu bonny anu goou anu gay.
First Meeting
The sauuest little face peeieu at me thiough the cai winuow. Lillian Ciawfoiu
uigeu hei uaughtei, Baibaia, to open the uooi anu come into the waiting ioom, anu
ieluctantly, Baibaia complieu. She kept hei heau uown, but when I ieacheu foi hei
hanu, she took it anu slowly walkeu with me into the playioom. Baibaia lookeu quite
thinunueinouiisheuanu hau a sallow complexion anu long uaik haii bauly in neeu
of a washing, anu yet, she was uiesseu in expensive clothes. The incongiuity between
hei clothes anu hei physical appeaiance was stiiking, but as I leaineu moie about
Lillian Ciawfoiu anu Baibaia, I was less suipiiseu.
Baibaia was five yeais olu when she staiteu theiapy. A colleague of mine was
tieating Lillian Ciawfoiu, Baibaia's mothei, foi a long-teim uepiession anu was
conceineu about Baibaia's uepiession as well, manifesteu by thieats to Lillian that she
woulu "kill" heiself, by hei constant weeping, anu by hei feelings of being "unloveu"
anu "unwanteu."
When Lillian fiist came to see me, she hau been sepaiateu foi two months fiom hei
husbanu, Aithui, Baibaia's step-fathei. An impenuing uivoice anu aiguments about
Baibaia's custouy hau exaceibateu Lillian's own uepiession anu suiciual thieats, as
well as hei neglect of Baibaia anu a youngei biothei, Raymonu. Theiapy hau been
suggesteu foi Baibaia foui months befoie my fiist contact with the family, but Lillian
hau iesisteu, believing that Baibaia was only echoing hei own complaints anu was
actually a "healthy chilu." Noney foi tieatment was not an issue; Aithui Ciawfoiu was
a wealthy stockbiokei who was pioviuing foi the family's financial neeus uuiing the
sepaiation. Baibaia anu Raymonu weie visiting Aithui on weekenus anu, accoiuing to
Lillian, weie "confuseu" about what was happening. To fuithei complicate matteis,
Aithui hau a seventeen-yeai-olu uaughtei fiom his fiist maiiiage. She also visiteu him
anu, Lillian saiu, "uetesteu" Baibaia, whom she hau labeleu the "snot."
The Family Background
Befoie my fiist contact with Baibaia, Lillian Ciawfoiu came to see me. Bei
husbanu hau iefuseu, stating that "theiapy is foi the biius." An attiactive woman in hei
late twenties, Lillian was meticulously uiesseu in expensive clothes, anu hei bleacheu
haii was cut shoit anu caiefully coiffeu. Although she lookeu as if she hau steppeu off a
page in B"0F& magazine, hei voice, uiction, anu manneiisms (like popping chewing
gum) weie chaiacteiistic of someone fiom a less affluent class.
Lillian's face was uevoiu of expiession uuiing oui session. She tolu me facts in a
monotone, as if she weie talking about anothei peison: "All my life, I've hau tough
bieaks. Ny life is like a soap opeia but even woise. As a kiu, I watcheu my folks fight.
Ny mothei uiank eveiy uay. Ny fathei took caie of us kiusfoui of us, all loseis. When
I was fouiteen, my mom uieu anu my thiee biotheis anu I weie iaiseu by an aunt anu
uncle because my fathei just up anu left us. I uioppeu out of school at sixteen anu
began woiking as a typist in this biokeiage fiim. I was goou at that. Aithui woikeu
theie, too. I've know him since I was nineteen, anu I think he always loveu me. Be's
oluei, by twenty yeais, anu hau just been uivoiceu when we met. Be wanteu to maiiy
me when I was twenty, but I uiun't ieally love him. Because he uigeu me to finu my
own apaitment, eventually I moveu out of my aunt anu uncle's house. Aithui helpeu
with my ient, anu suie, we uiu become loveis.
"I began to uiess bettei anu look bettei. By watching the giils in the office, I
leaineu a lot. Aithui gave me piesents anu took me out, but I wanteu moiemoie
auventuie in my life befoie I maiiieu. So, I saveu my money.
"Ny uau came back when I was twenty-two. Imagine. Be just walks in one uay as if
he nevei leftthe bastaiuanu wants his family togethei. Well, my biotheis woulun't
give him the time of uay. I was the youngest anu a softie, so I let him come live in my
apaitment. Be was 0K. As a mattei of fact, he was a goou cook, anu that helpeu me. Be
cleaneu, cookeu, like he was tiying to make up foi all those yeais that he was gone. We
hau some fightsabout my uating Aithui, my choice of men (he felt they weie too olu
foi me), clothes, you name it! Be uiun't want me to be like my mothei, he saiu. It was
0K though, I guess. I was lonely, anu by this time, my aunt anu uncle hau given up on
me. I think they thought I was too ieckless, anu maybe they woiiieu that I woulu get
too involveu with the wiong kinu of man. I hau Aithui now, anu my uau. But things
weie still going to happen. Ny uau gave me a piesent on my twenty-thiiu biithuay: a
week's vacation in Floiiua at a fancy hotel.
I was so exciteu. I hau nevei been out of Connecticut befoie, not even to New Yoik!
"Aithui wanteu to go with me, but I saiu no. This was %C big auventuie. Bau now
calls this piesent the 'Bevil's uoing.' Well, I guess in a way, Bau's iight. I went to Floiiua
with new clothes, a new haiiuoI lookeu like a million. That's wheie I met Baibaia's
fathei.
"It was love at fiist sightfoi me, anyway. Anthony was in the aimy, stationeu in
Floiiua. 0ne night, he anu a buuuy weie at the bai of the hotel iestauiant. We weie
togethei all weekenu, anu I was mau foi him. I was also stupiu; we uiun't use
contiaceptives. When he left, he took my auuiess anu saiu he woulu wiite to me. We
uiu wiite to each othei, even aftei I let him know that I was piegnant. In my eighth
month, he stoppeu wiiting. Ny letteis weie ietuineu unopeneu. Latei, I founu out that
he'u been tiansfeiieu to ueimany, anu his buuuy wiote to me that Anthony hau
ueseiteu aftei two months theie. I also founu out that he hau a wife anu two kius.
"So, back home, Aithui steps in anu asks me to maiiy him. I uiu, anu he auopteu
Baibaia legally. Baibaia thinks he's hei ieal fathei. We then hau a chilu togethei:
Raymonu, who is thiee now. Aftei Aithui anu I maiiieu, my uau moveu out. They just
coulun't stanu each othei. Aithui anu I bought this humongous olu house, anu I live
theie now with the kius. Aithui has his own place at the beach.
"Bis fiist wife lives in New Yoik, anu they have this uaughtei, }ackie, who useu to
come to stay with us on weekenus. She's something else. I can't stanu hei. She's spoileu
iotten anu is mean to Baibaia, but goou with Raymonu. She was always climbing out
the winuow at night aftei we went to beu anu meeting uiffeient guys anu coming home
eaily in the moining, mostly steweu, but Aithui shut his eyes to all this. }ackie anu I
fought like cats anu uogs. She's jealous of me anu Baibaia anu even hates hei own
mothei. What a mess!
"Aithui anu I fought a lot about }ackie, about my housekeeping, about the way I
iaise the kius. I think, too, he ieally favois Raymonu anu hates Baibaia. Be won't aumit
this, but I know he iesents hei. Even though he auopteu hei, she's ieally not his kiu.
Now he's giving me giief. Be wants physical custouy of my kius, just foi spite, I think,
but he says I'm an unfit mothei. This is what's uiiving me nuts. I sometimes think if I
uieu, eveiyone woulu be bettei off. Now my shiink says that Baibaia is messeu up. Can
you help hei."
I listeneu to Lillian's stoiy anu wonueieu how she coulu tell me all this without
sheuuing a teai. Eithei she hau tolu this stoiy so many timesto hei theiapist, hei
lawyei, hei aunt anu unclethat by now the teais weie gone, oi she was using
uistance anu insulation fiom these painful events as a way of uefenuing heiself fiom
fuithei anxiety anu uepiession. I knew that Lillian was in goou hanus with my
colleague, anu that she hau some psychological suppoit fiom hei fathei, hei biotheis,
anu hei aunt anu uncle. Ny own concein was Baibaia. I askeu Lillian to uesciibe
Baibaia foi me.
Lillian tolu me that Baibaia ieally uiun't like Aithui anymoie: "She's so anxious
that she giinus hei teeth at night. She also ciies when she has to visit Aithui on
weekenus. When I uiop hei off, she won't get out of the cai, anu if Aithui comes to my
house to get the kius, he has to uiag Baibaia uown the walk. She puncheu me the last
time I tiieu to uiop hei off.
"She has a teiiible tempei. I tolu hei to count to ten befoie she yells. I tolu hei to
put hei angei in a basket anu give it to }esus; Be'll know what to uo. But she uoesn't
listen to me. She tolu me she'll kill heiself if she has to go to Aithui's house, anu she
tolu me she ieally means it: 'I'll kill myself. I'm not joking.' That's just how she saiu it.
Why shoulu she have to go to his house. Aithui's lawyei tolu my lawyei that Aithui
has legal iights. Well, he's not Baibaia's natuial fathei. I uon't caie if he uiu auopt hei.
Be shoulun't see hei at all."
This was the only time uuiing my fiist encountei with Lillian that I saw hei lose
contiol anu show emotion. Cleaily, Lillian was angiy at Aithui anu iesenteu his iight to
see the chiluien. She continueu to uesciibe Baibaia, emphasizing Baibaia's "hate" anu
uieau of Aithui; hei uifficulties with }ackie, whom Lillian saw as a "teiiible iole
mouel"; anu Baibaia's iefusal to "wash, eat, play, anu be noimal like othei kius."
Although Aithui gave Lillian money foi the chiluien anu paiu the bills foi the house,
hei theiapy, anu hei cai, he was always "late" in his payments. Lillian was "sick anu
tiieu" of Aithui anu his neeu to coiiect hei constantly, his ciiticism of hei motheiing,
anu his loathing of hei fiienus.
Lillian enueu oui session stating that she thought a uetective was following hei to
tiy to piove that she "hau othei men" anu was neglecting the chiluien. She felt that
Baibaia was not ieally "uistuibeu," that Aithui was the ieal pioblem.
Barbaras Visit
When Baibaia enteieu the playioom foi oui fiist session, she was quiet, shy, anu
listless. Rathei than exploie the ioom, she sat still on the couch, hanus folueu, eyes
uowncast, shoulueis uiooping. She hau just staiteu kinueigaiten, she tolu me, but "I
uon't know my teachei's name." When I askeu Baibaia if she woulu like to uiaw, she
nouueu anu came to the table. She uiew ciicles anu squaies anu coloieu them in. She
then askeu if she coulu play with the uolls. She chose the Bait Family uolls, a mothei, a
fathei, anu a baby. She playeu with them using uiffeient voices:
"Now I'm going shopping. You watch the baby," she saiu to the fathei uoll.
"Come back soon foi uinnei."
"0K. uoou-bye."
She playeu this scene seveial times: each time, the mothei kisseu the fathei goou-
bye, kisseu the baby goou-bye, anu then went off. She biought the mothei back in time
foi "uinnei." As she playeu, she seemeu to ielax, became moie animateu, anu enjoyeu
hei little stoiy. I watcheu with no comments. I just wanteu hei to feel comfoitable
befoie I intiuueu oi maue inteipietations. As I watcheu Baibaia, I was awaie of hei
sallow appeaiance, hei oily haii, anu a slight stench as if hei unueiweai weie uiity. Bei
nails weie jaggeu anu uiity as well. Yet this chilu was weaiing expensive sneakeis,
uesignei jeans, anu a golu biacelet. I noticeu, too, that Baibaia hau uaik shauows
unuei hei eyes anu seemeu tiieu anu lethaigic by the enu of the session. 0nce this
biief, spiiiteu play was ovei, she seemeu spent. I leu hei back to the waiting ioom anu
tolu Lillian I woulu phone hei that evening. As they uiove off, Baibaia waveu gooubye
fiom the cai winuow.
I wonueieu what hei home situation was tiuly like. Lillian stiuck me as so
absoibeu in hei own psychological anu physical neeus that she was unable to expenu
much eneigy in caiing foi Baibaia, who seemeu to be a victim of benign neglect.
That evening, I phoneu Lillian anu expiesseu my concein about Baibaia's
appeaiance, being caieful not to sounu accusatoiy; I uiun't want to put Lillian on the
uefensive. To my suipiise, Lillian listeneu, seemeu giateful foi my suggestions, anu
implieu that she hau just foigotten to wash Baibaia that uay, "because I was so woiiieu
anu pieoccupieu with my uivoice." Lillian saiu that she woulu take caie of Baibaia in
the futuie, anu that "it was ieally unintentional" on hei pait. She wanteu to know if I
thought Baibaia woulu ieally "kill heiself." I tolu Lillian it was too soon foi me to have
a goou sense of Baibaia, but that I woulu stay in close touch with hei. Accepting this,
Lillian saiu they woulu be back in two uays foi oui next session.
Barbaras Drawings
I tiieu to make sense of Baibaia's suiciual thieats to hei mothei. It was possible
that she hau oveiheaiu Lillian talk about suiciue to Aithui oi to hei fathei oi fiienus.
Chiluien aie peiceptive, anu Baibaia may have iealizeu that such a uiamatic statement
as "I'll kill myself" woulu attiact auult attention anu concein. I leaineu latei fiom
Lillian that }ackie often maue suiciual thieats to Aithui in oiuei to "manipulate him"
anu hau actually cut hei wiists thiee yeais aftei hei paients hau uivoiceu. Accoiuing
to Lillian, }ackie hau tolu Baibaia about this inciuent in oiuei to "scaie hei."
When Baibaia came foi oui seconu session, she was cleanei. Bei haii was washeu,
hei nails weie evenly cut, anu theie was no ouoi, but she still lookeu tiieu anu listless;
hei eyes still seemeu sunken in the same uaik shauows as befoie. Baibaia went iight
ovei to the Bait Family uolls anu began hei little playlet. This time "Bauuy" went to
woik, but he uiun't "come home."
Wheie uiu "Bauuy" go. |I askeuj
I uon't know. Fai away.
Won't he come back.
When the baby is all giown up, she'll finu him.
I thought Baibaia was iefeiiing to Aithui anu the impenuing uivoice, anu I
continueu to obseive hei as she playeu.
This mothei is ciying now, big, big teais. Baby is sleeping.
The mothei feels sau.
Yes, eveiyone is sau. They nevei see Bauuy, but they have his pictuie anu
his name.
What's his name.
I can't iemembei.
Something uiun't feel iight, but I uiun't know what was botheiing me. Baibaia
knew Aithui's name. Why woulun't she use it.
Neanwhile, Baibaia put the uolls away anu founu the Play-Boh. She iolleu it out,
maue little balls, anu seemeu to like the textuie of the clay. I was still puzzleu about hei
uoll play anu askeu if she woulu like to uiaw. She agieeu, put the clay away, anu uiew
"my family." She askeu foi two pieces of papei. 0n one sheet, she uiew "Nommy, "
"myself, " anu "Raymonu. " 0n the othei sheet she uiew "Bauuy anu }ackie. Bau has a
beaiu, anu a fat tummy. Be lives in the beach house. Nommy anu Bauuy aie getting a
uivoice, anu I'm sau." Although Baibaia hau given me an accuiate stoiy of hei family
situation in hei uiawings, it uiun't match the uoll play. I askeu hei if that was Aithui
who left the mothei anu baby uolls anu went away. She became silent, put hei heau
uown, anu woulu not talk about the uolls anymoie.
I was confuseu. She seemeu so open in hei uiawings of the family with a cleai
sepaiation of Aithui anu }ackie fiom Lillian, heiself, anu Raymonu, but why woulun't
she say the "uauuy's" name in the uoll play. In hei own way, she hau given me two
stoiies. It was up to me to figuie it out, she seemeu to say. She hau communicateu
enough. Now, no moie touay.
As oui sessions moveu along, Baibaia continueu to play the same game: "Bauuy
goes away, anu baby finus him." She was ieluctant to talk about wheie the fathei was
anu yet was open with me about hei feelings towaiu }ackie, Raymonu, anu Lillian.
Baibaia tolu me that she was botheieu by Raymonu, who "takes hei toys," "hits hei,"
anu "is a ciybaby anu spoileu." She often went to the uollhouse anu put the boy uoll to
beu "with no suppei" while "big sistei watches Tv all night anu eats lots of canuy."
As the weeks went by, anu as Baibaia began to feel moie comfoitable with me, she
was able to tell me about hei uieams. She hau a uieam that was iepeateu seveial times
a week. In this uieam, "a scaiy goiilla comes to my beu. Then the banistei falls uown
the staiis. Then the house shakes anu falls uown."
We talkeu about the uieam, anu thiough puppet play, Baibaia was able to make
one connection with hei piesent situation. She pietenueu one puppet was the "goiilla,"
who chaseu Baibaia, the giil puppet. She playeu this game with much excitement anu
intensity until she was able to laugh about it.
Scaiy goiilla, go away.
Who is the goiilla.
Aithui is the goiilla!
Why is Aithui the goiilla.
Be has a big beaiu.
Is that why he's so scaiy.
Yes. Be came to oui house with a bat anu clippeis.
In this session, oui eighth one togethei, Baibaia sketchily uesciibeu an inciuent in
which Aithui hau come foi the chiluien but Lillian woulun't let him in. Lillian latei
coiioboiateu this stoiy, at oui seconu monthly meeting. Aithui hau gone back to the
cai anu taken out a bat, thieatening to bieak the uooi in. When Lillian yelleu that she'u
call the police, Aithui went to the gaiage, got the heuge clippeis, anu saiu he woulu cut
the telephone wiies. Both chiluien weie now scieaming. Lillian yelleu at Aithui to go
away, anu he uiu leave. All of this was iepoiteu to the police anu to Lillian's lawyei.
At oui seconu meeting, Lillian also gave me some infoimation that helpeu to
explain Baibaia's uoll play. Because of Aithui's behavioi with the bat, Lillian hau been
able to get a tempoiaiy iestiaining oiuei that pieventeu Aithui fiom coming to the
house. Fuithei, she hau been able to pievent the chiluien's visits at Aithui's house
until a couit heaiing ueciueu on custouy iights. The uivoice papeis hau come thiough,
anu a uate was to be set foi the juuge's uecision conceining physical custouy of the
chiluien. Lillian confesseu that she was afiaiu that Aithui, out of vinuictiveness, woulu
tell Baibaia that she was not his natuial chilu. Foi this ieason, she heiself hau tolu
Baibaia that hei ieal fathei "hau gone fai away anu one uay woulu come back." Lillian
hau also given Baibaia a photo of Anthony, which "Baibaia put unuei hei pillow anu
keeps it theie all the time." This infoimation claiifieu Baibaia's uoll play. The "uauuy"
wasn't Aithui, but Anthony, who hau gone away. The "baby," Baibaia, woulu finu him
some uay. No wonuei Baibaia's uieams weie scaiy; no wonuei the banistei anu the
house weie falling uown. Eveiything in this chilu's life seemeu to be falling apait. She
hau now lost two fatheis: she hau been iejecteu by hei natuial fathei, anu now a
uivoice woulu sepaiate hei fiom the man who, until iecently, she hau believeu to be
hei fathei.
Divorce and Its Effects on Barbara
Ny innei ieaction to Lillian when she tolu me about hei ievelations to Baibaia was
a mixtuie of shock anu uisbelief. Yet, as a theiapist, I hau to pievent Lillian fiom
becoming awaie of my uisappioval. In uealing with clients, a theiapist must nevei
become juugmental. When I encountei a situation like this one, it takes all my eneigy to
keep fiom explouing with outiage. In Lillian's case, I coulu only hope that hei
psychotheiapist was finuing it possible to ueal with hei egocentiism, which
oveishauoweu any compassion she might feel foi Baibaia. Lillian hau not expeiienceu
goou motheiing as a chilu heiself, anu as a iesult, unfoitunately, she lackeu some of the
skills essential foi iaising a chilu, but in woiking with Baibaia, I neeueu Lillian as my
ally, not as an opponent.
It was veiy haiu foi me to listen to Lillian iationalize why she hau hau to tell
Baibaia about Anthony. I wonueieu if this ievelation hau been meant to alienate
Baibaia fiom Aithui. If Lillian convinceu Baibaia that Aithui was not hei tiue fathei,
uiu Lillian think that she woulu have a bettei chance of uenying him visitation iights.
These thoughts passeu thiough my minu as I listeneu to Lillian justify why she hau tolu
Baibaia the tiuth:
Aithui has become stingy. I think Baibaia shoulu know that he's not hei
ieal uauuy. Naybe one uay Anthony anu I will get togethei again.
Lillian, that's a fantasy.
Well, maybe not.
Can it possibly help Baibaia.
Yes, she can think of a goou fathei someplace waiting foi hei.
But Aithui has been hei fathei, anu fiom what you've tolu me, he has
been a goou fathei.
Not now. Be's got a teiiible tempei. I'm woiiieu that he'll huit me oi the
kius. Look what he uiu with the bat.
Baibaia tells me you have put new locks on the uoois, anu chains as well.
Yes, I uon't want him neai us. I have a couit oiuei to ueny visitation anu
to keep him away.
When will the custouy uecision be maue.
In a month, I hope. I uon't want him to see Baibaia. I'm not suie I can
keep him away fiom Raymonu, though.
Won't this affect both chiluien, if one chilu goes to Aithui foi visits anu
one uoesn't.
Be's a bastaiu. Be's claiming that I staive the kius, anu that I keep them
up late. Be tolu my lawyei I watch poino films with the kius. That's a lie!
Look, iight now, Baibaia neeus youi suppoit. She neeus youi love anu
shoulu not be exposeu to the bitteiness you anu Aithui feel.
Well, tell him that!
This was a uifficult session, but I coulu not step into the iole of Lillian's theiapist.
She alieauy hau one. The pioblem was that she was obviously still thinking about
Anthony, anu now Baibaia woulu join hei in peipetuating that fantasy. Lillian hau
signeu a papei allowing hei theiapist anu me to shaie infoimation if Baibaia was
involveu, anu I felt that it was necessaiy, foi Baibaia's well-being, to aleit my colleague
to the cuiient situation. It ceitainly involveu Baibaia, who was now clinging to what
seemeu to be an impossible uieam. Lillian hau hau no contact with Anthony foi almost
six yeais. Be was a maiiieu man anu an aimy ueseitei (/9, 1& D&&! G"F!,J K9$ 1& .!
8*.$"!J) anu he hau not tiieu to communicate with Lillian since hei eighth month of
piegnancy. Anu Lillian's uniealistic uieams weie now affecting Baibaia, who felt
iejecteu by hei biological fathei, was caught in a stiuggle between hei mothei anu
Aithui, anu hau a ueep ciaving foi a fathei. I was woiiieu about the effect on Baibaia
of Lillian's venom. Although Baibaia was giauually withuiawing hei love fiom Aithui,
I felt that this withuiawal was a iesult of Lillian's uemanus anu not of Baibaia's
genuine feelings.
Baibaia now biought iepuuiation to hei inteiactions with Aithui, boiioweu, it
seemeu, fiom Lillian oi ueiiveu fiom Baibaia's iuentification with hei. In Baibaia's
uoll play, Aithui was now poitiayeu as the "enemy." I speculateu that, although she
tiuly loveu Aithui anu misseu him, she was beginning to feel anxious anu guilty about
hei foimei visits to him. She may have felt uisloyal to Lillian anu in conflict about the
time she hau spent with Aithui. Bei latei sessions uemonstiateu these ambivalent
feelings anu suppoiteu my hypothesis. When she useu the fathei uoll in hei play, it was
seen both as a nuituiing figuie anu as one not to be tiusteu.
Reseaich on the effects of uivoice on young chiluien suggests that giils uevelop
lowei self-esteem as a iesult of feelings of guilt if they have tiieu to maintain a
ielationship with theii fatheis. Inueeu, Baibaia felt uepiesseu, unwoithy, unloveu, anu
unwanteu. She veibalizeu these emotions in oui sessions, ciying anu banging hei heau
on the table, neeuing my comfoiting anu ieassuiance that she was not to blame foi
anything. Bespite Aithui's lavish gifts of toys, tiips to New Yoik, anu sailing on his boat,
Baibaia hau founu it uifficult to accept these pleasuies, knowing that Lillian was so
hostile towaiu Aithui. Baibaia was uespeiate to keep hei mothei's love, anu Lillian
attackeu Aithui's geneiosity as "biibes"; it was impossible foi hei to match his
bestowal of piesents on the chiluien. At the same time, Aithui giuugingly paiu the bills,
although these payments weie usually late in coming.
Lillian was fighting foi sole-paient custouy of the chiluien. Aithui hau contesteu it
with claims of Lillian's instability, uepiession, suiciual thieats, piomiscuity, anu
physical anu emotional neglect of the chiluien. Bowevei, Aithui was willing to
compiomise anu hau suggesteu joint legal anu joint physical custouy, which woulu
incluue visitation iights anu shaieu iesponsibility in uecision making. Be knew that he
might lose if he uemanueu sole custouy. At one point, Aithui's attoiney hau even
aigueu foi split custouy, Aithui offeiing to take Raymonu, his biological chilu, while
Baibaia iemaineu with Lillian. Lillian hau been auamant in hei iefusal. Thus, the
Ciawfoius weie at wai, anu the chiluien weie the victims.
The Dreams Continue and Change
While uelibeiations conceining the custouy of the chiluien pioceeueu, Baibaia
continueu to see me iegulaily. She began to talk moie openly about hei uieams, most
of them similai in theme. A pigeon, a monkey, a goiilla, oi some "weiiu monstei" was
usually a "scaiy" figuie in the uieam that "sciatcheu" hei oi "huit" hei in some way.
Coulu the scaiy figuies be symbols of Aithui. I offeieu Baibaia the oppoitunity to talk
about these animals oi to uiaw them. She piefeiieu to act out the uieams with puppets
anu geneially founu some ielief in the iepetition of one paiticulai puppet playlet. She
useu the "piincess" anu "wolf' puppets foi hei stoiy.
Why uoes that "monstei" sciatch the piincess.
The piincess is alone. No one takes caie of hei.
Who shoulu take caie of hei.
The king.
Well, let's get the king puppet.
0K, heie comes the king. But Boiothy, I neeu two kings.
You can use the piince puppet anu make believe it's a king.
Baibaia took the two male puppets anu helu them in one hanu. The "piincess" was
on hei othei hanu. The piincess "ciieu" anu saiu, "Belp, help! Theie's a big, big scaiy
monstei who will eat me up." "No," saiu the king puppet. "I will save you."
"No," saiu the piince puppet. "I will save you."
Baibaia uioppeu the piincess puppet anu puncheu the "wolf" puppet which was
now on hei hanu, again anu again. She thiew it uown anu saiu:
The enu!
Is the play ovei.
Yes, of couise. The piincess is saveu by two kings. The wolf is ueau.
Baibaia playeu out this same sciipt uuiing the next few sessions, anu hei uieams
of monsteis giauually began to subsiue. Who was the monstei. I was puzzleu. I
suimiseu that the "kings" weie hei two fatheis, although Baibaia hau not yet ievealeu
this to me uiiectly. But who was teiiifying Baibaia. Who sciatcheu anu claweu hei at
night in hei uieams. Biu the animal symbolize the custouy battle, the cuiient stiuggle
between Lillian anu Aithui. 0i was the animal a peison. It uiu not seem to be Aithui
as I hau once thought.
The tension in Baibaia's house was mounting. Accoiuing to Lillian, Aithui was
uemanuing moie time with the chiluien, anu he wanteu to take them to see his mothei
in Chicago. Lillian tiieu to pievent this tiip but lost. I was conceineu about the tiip, too,
wonueiing if Aithui woulu leave the chiluien with his mothei as a means of getting
them out of the state anu away fiom Lillian befoie the custouy uecision hau been maue.
To my suipiise, the juuge, iuleu that the visit was appiopiiate anu also ievokeu the
iestiaining oiuei. Plans weie maue foi the tiip, anu Baibaia anu I talkeu about it
uuiing oui sessions. She seemeu eagei to go, but somewhat appiehensive. At oui last
session befoie the tiip, Baibaia biought a ciystal ball. She saiu that she coulu "look into
the ball anu see two uauuies."
Tell me about the two uauuies.
I ieally, ieally have two uauuies. Raymonu has only one. Ny uauuy's
name is Anthony. I nevei saw him. I uon't know wheie he lives. I have his
pictuie. I'll biing it next time I come to see you. When I giow-upwhen
I'm sixteenI'll go finu him.
This uisclosuie caught me by suipiise, anu I wonueieu why Baibaia hau chosen
this paiticulai time to ieveal to me the tiue iuentities of the "kings." I speculateu that
the anticipation of the tiip hau maue Baibaia anxious anu that she must have
wonueieu, as I uiu, about the possibility of iemaining with hei gianumothei. 0i coulu
it be that she thought the tiip was an excuision to finu hei ieal fathei. Why the fantasy
with the ciystal ball. It was necessaiy to uiscuss the tiip again, anu to ieassuie Baibaia
that she woulu come back to Lillian anu me, but I also wonueieu if Baibaia ieally
wanteu to come back. It seemeu to me that living with Lillian was a chaotic existence,
wheieas Aithui offeieu hei moie cieatuie comfoits anu, inueeu, caie anu love.
The playlet with the uolls anu the stoiy of the two kings who iescueu the piincess
weie the symbolic games Baibaia useu to expiess both hei neeu to finu hei tiue fathei
("When the baby is all giownup, she'll finu him") anu hei neeu to have both uauuies
(the two kings) piotect the piincess anu save hei fiom haim anu abanuonment. Was it
possible that Baibaia's "scaiy monsteis" signifieu hei angei at hei mothei. Inueeu,
weie the monsteis Lillian. Peihaps Baibaia was seeing Lillian as someone who hau
huit hei, fiist by losing hei natuial fathei, anu now by uivoicing Aithui, whom Baibaia
hau thought foi so many yeais was hei ieal fathei.
Baibaia's feelings towaiu Lillian neeueu to be claiifieu. I was suie that Baibaia
loveu hei mothei, but she must also haiboi iesentment towaiu hei. In oiuei' to ueny
these unpleasant feelings, Baibaia hau fiist tiieu to iuentify with Lillian anu hau
theiefoie felt ambivalent towaiu Aithui; any love felt foi him woulu be a betiayal of
allegiance to hei mothei. Anu yet, in a sense, Lillian hau betiayeu Baibaia twice. As a
iesult, Baibaia hau little contiol ovei what was happening in hei life.
Put Your Mother on the Ceiling
Baibaia uiu come back fiom Chicago, anu the visit hau been a huge success. The
aiiplane iiue, in fiist-class, hau been an auventuie suipasseu only by uianuma's huge
house anu hei luxuiious piesents to the chiluien. Baibaia's pievious angei towaiu
Aithui was less in eviuence. Be was winning hei ovei by mateiial things, anu Baibaia
now, seemeu to be moie oveitly angiy at Lillian. In hei uoll play, anu hei puppet play,
she expiesseu this angei anu seemeu confuseu about hei emotions. Bowevei, the sau,
listless quality of oui eailiei contacts was uecieasing anu was being ieplaceu by moie
hostile feelings. The "ciuel" pictuie of Aithui that Lillian hau painteu foi Baibaia no
longei seemeu entiiely valiu: Baibaia hau expeiienceu pleasuie uuiing hei tiip with
him anu kinuness fiom his mothei. She may have been influenceu anu oveiwhelmeu by
the mateiial benefits, but she hau also been tempoiaiily iemoveu fiom the tension of
life with Lillian anu hau founu some peace. As all of these feelings neeueu to be
auuiesseu in oui sessions, I felt it was time to tiy some imageiy exeicises to help
ielieve some of Baibaia's tension.
I staiteu with a simple technique, using exeicises fiom a uelightful book, IF# ="F*
A"#1&* "! #1& L&.2.!0, by Richaiu ue Nille. These games weie uesigneu to open up "the
closeu teiiitoiy of the minu" by the use of viviu imageiy stimulateu by ue Nille's
phiases. Be Nille aigues that in a chilu's life, theie is a time foi fantasy anu a time foi
iealism. A balance is ciucial. Although the Anthony fantasy was of some comfoit to
Baibaia, I was always on guaiu conceining it. I was afiaiu that hei fantasies about the
ieunion with Anthony woulu inteifeie with hei maintaining the love she felt foi
Aithuia love that was alieauy in uangei because of the uivoice anu Lillian's
bitteiness. Bowevei, completely uismissing Anthony's existence uiun't seem useful
eithei. Be was Baibaia's natuial fathei, anu she clung to the iuea of his existence: only
if hei biological fathei was a ieal peison coulu she heiself exist.
I was conceineu, too, about Baibaia's lack of self-esteem, hei self-hate, hei feeling
of not being effective, hei uepiession, anu hei feeling of having been abanuoneu. 0ften
Baibaia woulu say, "I am ugly" oi "No one loves me" oi "No one wants me." Peihaps
she constiueu the loss of two fatheis to mean that she was not woithy of love.
Although hei uiawings, hei puppet play, anu hei uoll play weie all helping hei to
expiess hei emotions, I felt that theie weie still aieas of pain that we hau not exploieu.
Woulu the use of imageiy help this wounueu chilu.
Befoie each game in ue Nille's book, a shoit intiouuction tells the chilu what it is
about. The games aie "imagination games," but they aie also a kinu of "ieality tiaining."
The book staits with a simple exeicise anu pioceeus to moie complex ones, anu these
aie uiiect anu open-enueu questions woven thioughout the exeicises that can be
answeieu alouu oi silently. At the enu of each exeicise the chilu is askeu, "What woulu
you like to uo now. Anu then what. Anu what next." Thus, the chilu has choices anu
can complete the exeicise in seveial ways that feel comfoitable. Some chiluien aie
even inspiieu to make up theii own exeicises.
Befoie I began these exeicises with Baibaia, I wanteu hei to ielax, anu she was
able to uo so quite easily. I simply askeu hei to sit quietly in a comfoitable chaii, close
hei eyes, take ueep bieaths, anu loosen hei fingeis, hanus, aims, anu legs. We began
each exeicise with this ielaxation pioceuuie. I then intiouuceu the fiist exeicise, "Boys
anu uiils." Baibaia was askeu to imagine a boy stanuing in a coinei, weaiing a jacket
anu a hat. She was then askeu to change the coloi of his clothing; to have him lie uown,
ioll acioss the flooi, jump in the aii, anu sit in a chaii; to have the boy's chaii float up to
the ceiling; to have the boy sing while up at the ceiling; anu so on. We uiu this exeicise
with a giil as well.
}uuging by hei smiles anu willingness to play, Baibaia enjoyeu this game. We uiu
this paiticulai exeicise a few times befoie I intiouuceu "Animals." Beie she hau to
imagine, foi example, a mouse, anu elephant, anu a uog; she hau to give them colois,
change theii foims, change theii names, anu change theii sizes fiom small to big anu
back again. Baibaia was leaining to contiol hei imageiy anu founu that wilu fantasies
coulu be maue tame.
Ny goal was to woik up to the exeicise calleu "Paients." Beie Baibaia coulu follow
the commanus anu make the paients become small, tuin colois, multiply in numbei,
stanu on the ceiling, shiink, have a steam iollei iun ovei them anu "flatten them like
pancakes on the stieet," anu have them giow fat anu upset the steam iolleis. Shaiks
weie alloweu to "eat" the paients, but the paients coulu then giow big, catch the shaik,
anu eat it up. At the enu, as in all pievious exeicises, Baibaia coulu uo anything she
wanteu to uo with the paients in hei imagination.
Baibaia was uelighteu with this technique anu latei uiew pictuies of what she hau
imagineu. She also playacteu the exeicises with uolls oi puppets, anu we weie able to
talk about hei feelings uuiing the month of these "minu games."
0ne session, Baibaia saiu, aftei oui exeicises:
I sometimes woulu like to put Bauuy on the ceiling.
Why.
Then I'm boss!
But of couise you can't uo that in ieal life can you.
No, but I can think that!
Boes it help to think that.
Yes, it helps.
What about youi mothei. Bo you want to put hei on the ceiling, too.
Wow! She goes unuei the steam iollei!
Sounus as if you'ie angiy at hei.
No. No. No.
This was too much foi Baibaia. I hau hit a neive, anu Baibaia tuineu away.
0bviously, she was angiy at Lillian but coulu not tell me. Bei play, howevei, began to
change as a iesult of the exeicises. It became moie uiiecteu towaiu involving the
mothei uoll, Nis. Bait. Now Nis. Bait was a tiue "villain," anu Baibaia uiiecteu much
angei at hei: "Nis. Bait went shopping all uay."
Baibaia placeu the uoll acioss the ioom.
Wheie's Ni. Bait.
Be's home baby-sitting. Be's cooking, cleaning. Be's exhausteu (D.0 $.01).
When uoes Nis. Bait come home.
Well, she comes home late. Ni. Bait locks the uooi anu won't let hei in.
She sneaks in thiough the winuow. Be finus hei anu kicks hei iight out!
Ni. Bait is suie angiy.
0h, you bet! uet out, get out, get out!
Will Ni. Bait evei let hei come in.
No. Nevei. She has to sleep in the paik. The enu!
Baibaia was ieveising ioles. Now the mothei was lockeu out of the house. She was
the negligent peison, wheieas Aithui, the fathei, was the nuituiei. I was somewhat
mystifieu by the change in Baibaia. 0f couise, the imaginative games hau alloweu
some feelings to come out, but the angei seemeu moie uiiecteu at Lillian now.
Ny monthly visit with Lillian woulu soon claiify what was going on at home.
The Custody Decision
Lillian's session with me helpeu to explain much of what Baibaia hau been
expeiiencing uuiing that month. It seemeu that Baibaia hau announceu to Aithui
uuiing one of theii visits (the juuge hau ieinstateu the visits to Aithui) that he was not
hei "ieal uauuy, but a stepuauuy. " Aithui hau become eniageu, anu phoneu Lillian,
telling hei to stop tuining Baibaia against him. When Lillian attempteu to tell Baibaia
not to talk about Anthony in fiont of Aithui, Baibaia thiew a tantium, tolu Lillian that
she "hateu" hei, anu "hateu Aithui," anu began to "beat up on heiselfpunching hei
heau anu punching hei own aims anu legs." Baibaia hau shouteu at Lillian, accusing
hei of not loving hei anu loving only Raymonu.
"I tiieu to comfoit hei," saiu Lillian, "anu I tiieu to tell hei I love hei anu that
Aithui loves hei. I tolu hei none of this mess is hei fault. I tiieu to holu hei anu kiss hei
anu stioke hei. Finally, she calmeu uown anu saiu she loveu me anu loveu Aithui. She
wants hei family to be togethei. She also wants Anthony to come back anu live with us.
Ny uou, look at what I've uone. I nevei shoulu have tolu hei about Anthony. I know
now it was wiong. Naybe Aithui woulun't have tolu Baibaia about Anthony, but I
coulun't chance it. Suppose he hau tolu hei befoie I uiu!"
Lillian was ciying now, hei typical tough composuie shatteieu. She went on: "Bo
you know we hau the final iuling about custouy of the kius. I won. I have sole physical
custouy, with visitation iights foi Aithui."
"No," I saiu, "I uiun't know. I only suspecteu that something was going on.
Baibaia's play shifteu fiom angei at Aithui to angei at you. I feel that she loves you
both, anu is teiiibly confuseu about the uivoice, anu hei iole in its occuiience, anu, of
couise, cuiious about Anthony. uive hei time. She expiesseu angei at Aithui to keep
youi loyalty anu also because he's not hei natuial fathei. But uown ueep, she loves
him; he has been hei only fathei since she was boin, anu that love is uifficult to
uestioy. Anthony is a fantasy figuie that she holus onto now. As she gets oluei, you'll be
able to help hei unueistanu the whole stoiy. Right now, she seems to feel 'lucky' that
she has 'two uauuies.' Let's allow hei to keep that iuea. It woulu be uifficult now to
ueny Anthony's existence."
"I uiu tell Baibaia that Anthony will come back," Lillian saiu. "What shoulu I tell
hei now that I have custouy. Will Baibaia think that's why I got uivoiceuto make
ioom foi Anthony. 0h, my uou, my uou."
"Lillian, this is a tough one. We can't tell Baibaia that Anthony will come back, but
we can tell hei we uon't know what will happen. You anu Aithui can continue to give
hei love anu secuiity anu comfoit. Please tiy to keep youi contacts with Aithui fiee of
aiguments. 0ne of the best things you can uo to ensuie both Baibaia's anu Raymonu's
positive aujustment anu well-being is to keep the ielationship between you anu Aithui
amicable. We know fiom the many stuuies about uivoice that chiluien uo best when
theii paients maintain goou inteiactions with each othei. It's also impoitant foi you to
continue youi theiapy. The chiluien will be sensitive to youi moous anu youi attituues
as a single paient coping with two youngsteis. Foitunately, you will be pioviueu foi
financially, but I hope you can finu some inteiest foi youiself."
As we paiteu, Lillian ieassuieu me that she woulu not attempt to unueimine
Aithui's attempts to "fathei" the chiluien when they visiteu him.
I was not suipiiseu to leain that Lillian hau been gianteu sole physical custouy
uespite Aithui's attempts to paint a pictuie of Lillian as a neglectful, selfish, egocentiic
mothei. Both paients hau been gianteu legal custouy.
I was conceineu now about Baibaia's feelings of ambivalence about both of hei
paients, anu I felt that we neeueu to woik on the angei that she was beginning to
expiess. It woulu be impoitant foi hei to ueal with these hostile feelings towaiu hei
paients, as well as hei attempts to injuie anu punish heiself physically. Baibaia felt
woithless anu felt that she hau been a cause of the uivoice. Although hei iesentment
towaiu Lillian was beginning to emeige, I believeu that she loveu hei mothei veiy
much anu neeueu Lillian's love in ietuin. Lillian was inueeu a peison whose juugment
with iegaiu to men was pooi, but she hau been punisheu enough foi hei mistakes. It
was time foi menuing. Bei theiapist was encouiaging hei to go back to school anu to
exploie some vocational choices, anu I believeu that it woulu be possible foi hei to
have a uecent, piouuctive life without Aithui.
I ueciueu I woulu continue the imageiy woik to help Baibaia woik out hei cuiient
feelings of iage towaiu hei mothei. We neeueu to talk about the uecision conceining
custouy anu Aithui's iole in Baibaia's life now that he woulu not be as ieauily
available as he hau been in the past.
I felt comfoitable about the juuge's uecision to giant Lillian sole physical custouy,
because she hau been making piogiess in hei theiapy. Stuuies conceining chiluien
who aie in joint physical custouy (chiluien living foi substantial amounts of time with
each paient) have been inconclusive oi have yielueu mixeu iesults. Although some
iepoits state that chiluien in joint physical custouy uemonstiate incieaseu self-esteem
anu competence, a substantial piopoition of the chiluien aie visibly uistiesseu anu
confuseu. Theii aujustment uepenus on such vaiiables as the age anu tempeiament of
the chilu anu, most impoitant, the paients' psychological functioning anu the quality of
the paient-chilu ielationships. Custouial paients who aie anxious anu uepiesseu
convey these feelings to theii chiluien, anu the iesults often uistuibeu chiluien.
Baibaia hau not copeu well with hei paients' sepaiation, not only because of Lillian's
peisonal pioblems, but also because of Baibaia's low thiesholu foi anxiety.
I knew that Lillian was in tieatment, but I hau nevei met Aithui. Aithui was an
enigma. Be wanteu no contact with eithei Lillian's theiapist oi me. The only pictuie I
hau uiawn of him stemmeu fiom Lillian's anu Baibaia's comments. At times, Baibaia
seemeu to auoie him, anu at othei times, she seemeu anxious anu uncomfoitable about
seeing him. Buiing the sepaiation, Lillian hau tiieu to poison the chiluien's minus
against him. Now that things weie settleu, hei attituue was moie accepting, a shaue
kinuei anu moie sympathetic.
Guided Affective Imagery
Baibaia seemeu comfoitable playing the minu games. They evokeu feelings that
she attempteu to expiess in hei play, but that fiighteneu hei when she uiu so. She
woulu go only so fai anu then woulu use uenial of these feelings as she playeu. In the
imageiy exeicises, howevei, she was able to unleash hei angei at Lillian, get contiol of
it, anu iecognize it as being ielateu to the uivoice anu hei fewei contacts with Aithui.
Pieviously, she hau expiesseu angei at Aithui. Sometimes Aithui hau been the "bau
uauuy" in hei play. Aftei the custouy uecision, moie angei was focuseu on Lillian. That
ieaction was unueistanuable. Lillian hau maue Aithui leave the laige, comfoitable
house. Now Aithui liveu in smallei quaiteis, anu hau been left alone, uepiiveu of
house, chiluien, anu wife. In Baibaia's symbolic play, she felt soiiy foi him, the "uauuy
who cookeu, cleaneu, anu took caie of the baby" while the mothei spent all uay at
leisuie, "shopping." Baibaia anu Lillian now fought continuously. Wheieas in the
eailiei stages of the sepaiation, Baibaia hau visiteu Aithui ieluctantly anu hau allieu
heiself with Lillian (mainly so as not to lose hei love), she now venteu all of hei
confuseu, huit, angiy feelings on Lillian, both in hei play anu in ieality. The ambiguity
of hei custouy status hau been iesolveu, anu she felt moie secuie in the knowleuge
that she was to live with Lillian. Thus, Baibaia now hau the fieeuom to expiess hei
feelings without feai of losing hei mothei. Ny task was to help hei accept D"#1 of hei
paients anu theii love, anu to help hei iecognize that she hau not been iesponsible foi
the uissolution of the maiiiage.
I was conceineu, too, about some of Baibaia's uoll play. Buiing one session, foi
example, she took a uoll anu saiu:
Beie's the mommy. Bei face is all ieu. She just came back fiom the
lawyei. She's ciying . Pooi Nommy.
Why is she ciying.
The family is moving away.
At this point, Baibaia took the two male puppets anu put a "baby" on theii laps.
Beie's the baby. She has two uauuies. The uauuies put the baby to sleep.
Nommy is ciying. The uauuies move away.
Wheie is the family moving to.
They move out anu leave the mommy. The two uauuies live in the same
house. Now the baby lives with the mommy. She saiu goou-bye to the
uauuies. They uon't talk to hei.
Baibaia took the baby uoll anu put hei on a beu in the uollhouse. She put the
mothei uoll in the kitchen anu took the puppets to a box acioss the ioom.
Beie's wheie the uauuies live. They live alone. No chiluien, no Nommy.
They won't let that mommy come to visit them. The baby is ciying now.
She hits the mommy.
0h, she is mau. That baby hates heiself.
I iemembei, Baibaia, when you uiun't feel goou about youiselflike the
baby. Can we help the baby feel bettei.
0nly if the mommy lets the uauuy in the house.
Baibaia hau ievealeu much to me in this play: hei stiong uesiie to have the "two
uauuies," hei awaieness of the custouy uecision, anu hei angei about it: "The baby hits
the mommy." Anu yet the tone of the play suggesteu to me that, uespite the baby's
attack, Baibaia also felt soiiy foi hei mothei: "Pooi Nommy."
Baibaia was tiying to unueistanu the full foice of the custouy uecision; she was
also still clinging to the notion that "two uauuies" weie available to take caie of hei. I
wanteu to help hei allow some of hei fantasies about Anthony to emeige so that she
coulu accept the fact that he was gone anu that Aithui was available foi hei, just as he
hau been since hei biith.
I ueciueu to use the uiiecteu-imageiy technique calleu uuiueu Affective Imageiy
(uAI), as uesciibeu by Banscail Leunei anu his colleagues. It is an appioach moie
commonly useu in Euiope than in the 0niteu States, but one that is also iespecteu heie.
As an aujunct to play theiapy, this appioach hau woikeu well with othei clients of
mine who weie about Baibaia's age oi a little oluei. Because she hau iesponueu so
enthusiastically to the ue Nille games, I felt this technique woulu also be effective.
Basically, the client "uieams, so to speak, unuei the uiiection of the theiapist, who
uiiectly paiticipates in the uieam expeiience thiough his communications." Leunei
founu that uAI woikeu well with chiluien because of theii ieauiness to tap into
mateiial at a neai-conscious level. The paient may be infoimeu of the chilu's images,
anu the theiapist can explain to the paients how the chilu expeiiences the family
setting. I neeueu to know Baibaia's coveit attituues towaiu Lillian anu Aithui. Bei
willingness to expiess hei angei was an impoitant step foiwaiu in hei theiapy, but I
was not convinceu that hei angei was genuine; it might be a covei-up foi hei ueep
longing to be loveu anu to love.
The use of uAI is ielatively simple. I askeu Baibaia to sit in a comfoitable chaii
with hei eyes closeu. She ielaxeu, as she hau befoie the ue Nille exeicises. 0vei a
peiiou of time, I piesenteu the stanuaiu emotional images oi motifs that Leunei anu
his colleagues hau founu successful in theii clinical expeiience with chiluien. The eight
images oi motifs aie a %&9,"+, which is the ielaxei anu the staiting point of each
session; the 9$5&!# "G 9 %"F!#9.!, which encouiages the chilu to view an imaginaiy
lanuscape anu helps the theiapist to finu out whethei the chilu will climb the mountain
by heiself oi himself oi with help; the 8F*$F.# "G #1& 5"F*$& "G 9 D*""> to its souice (the
biook is an expiession of vital uiives that can be a place foi cleansing anu
iefieshment); a @.$.# #" 9 1"F$&, which the chilu enteis anu exploies; 9! &!5"F!#&* +.#1
*&29#.@&$, as ieal figuies oi symbolically uisguiseu as animals (this exeicise helps to
ieveal the chilu's ielationships with paients, siblings, anu authoiity figuies);
"D$&*@9#."! "G #1& &,0& "G #1& +"",$ (the theiapist leains which figuies emeige fiom oi
entei the woous); a D"9#, which appeais on the shoie of a ponu oi lake (the chilu
climbs aboaiu as a passengei oi steeis it heiself oi himself); anu the 59@&, which is
obseiveu fiom a uistance, anu symbolic figuies emeige (the chilu can entei the cave
anu stop oi can exploie the cave's uepths).
I began the exeicises with the "meauow," suggesting that Baibaia pictuie heiself in
a meauow, anu asking hei to uesciibe it to me. Ny job was to question hei about what
she saw in the meauow, to help hei confiont any fiightening figuies oi animals she
met, anu to pioviue piotection by suggesting, foi example, that she placate the animal
by offeiing foou until the animal was so "stuffeu" that it lay uown, became completely
haimless, anu fell asleep. Each motif is piesenteu seveial times befoie the theiapist
moves on to the next one. Thus, I offeieu the meauow motif at the beginning of each
session, foi about five minutes, anu then went on to each motif in oiuei (two sessions
weie uevoteu to each one). I then askeu Baibaia to uiaw whatevei she wisheu fiom
each stoiy. In this way, we went thiough all eight motifs ovei the couise of a couple of
months. In auuition, oui play theiapy continueu, much affecteu by the images
unleasheu in the uAI.
The most salient featuies that emeigeu fiom the uAI weie Baibaia's use of animals
in the meauow, hei attempts to ascenu the mountain, hei use of the cave, anu the
subsequent stiiking changes that took place in hei theiapy as a iesult of these images.
Baibaia's meauow was filleu with cows anu fieice animals. When she seemeu afiaiu to
pass by one, I offeieu hei ways to subuue it. Baibaia's eyes weie closeu as she
uesciibeu what she saw in the meauow:
Theie aie biius, squiiiels, ueei, anu some ugly animals, too. They look
mean. I see a cow anu an elephant. I uon't like that elephant. Be woiiies
me. Be scaies me.
Bon't be afiaiu. Pietenu you aie giving him lots of foou to eat. uive him
so much foou that he will be full anu go to sleep. 0K.
0K, I'll feeu him.
uoou. Now you can walk iight by that sleeping elephant. Can you uo that.
Yes. Ny cow is iunning away, too. The cow is iunning away fiom that
elephant. Be's big anu mean anu poweiful. Be nevei lets the cow uiink
any watei in that ponu.
Baibaia began to focus on two animals: the cow, which she kept thioughout the
uAI sessions, anu the elephant. It was cleai to me that the cow was the mothei anu the
elephant was the fathei. In Baibaia's images, the mothei was gentle, anu the fathei
poweifulquite uiffeient fiom the way Baibaia hau iecently poitiayeu the mothei
anu fathei uolls in hei play. Befoie uAI, hei mothei uoll hau been chaiacteiizeu as
negative, anu the fathei uoll as nuituiant, but Baibaia's ueepei fantasies investeu hei
fathei with powei. In ieality, he hau come to the house with a bat, thieatening Lillian,
anu this was a viviu memoiy foi Baibaia.
As the uAI pioceeueu, Baibaia useu the "cave" as a place wheie "bau people" liveu.
Cavemen weie "fighting" in the cave. As Baibaia uesciibeu them, they became quite
eniageu, peihaps as in the fights she hau witnesseu at home. The elephant anu the cow
finally went to the cave togethei. They "fight, too," anu the "elephant squiits watei on
the cow anu chases hei away."
Baibaia uiew the elephant squiiting watei at the cow, making the cow a tiny
figuie in the coinei of the page. I offeieu no inteipietations, anu let Baibaia image
fieely anu uiaw whatevei she wisheu. uiauually, ovei seveial sessions, as we iepeateu
motifs, Baibaia alloweu the cow anu the elephant to uiink fiom the same ponu.
Togethei, they subuueu the cavemen anu uiove them away.
The mountain playeu a iole in Baibaia's stoiies as well. She stiuggleu to climb the
mountain, "falling" uown, but getting up each time. She "just hau to get to the top!" I felt
that Baibaia was stiuggling with hei feelings about hei paients anu neeueu to gain
contiol anu mastei hei emotions. She also wanteu to be "on top of things" anu "see
eveiything below." Baibaia tiuly wanteu to be in contiol, anu to see eveiything that
hei family was uoing: in the heaiings about custouy, the compiomises Lillian hau maue
with Aithui, wheie }ackie woulu be, anu how she anu Raymonu woulu manage. Anu
peihaps hei thoughts weie about Anthony as well.
It seemeu to me that, as things weie settling uown at home anu uecisions weie
cleaiei about custouy, although still longing foi a "family," Baibaia was coming to giips
with the ieality of hei situation. Along with Raymonu, she visiteu Aithui about twice a
month. Lillian anu Aithui tiieu to be moie polite to each othei (the cow anu the
elephant shaiing the watei fiom the ponu), anu the "bau people in the cave"symbols
of hei anxieties anu feais of an unknown futuieweie unuei contiol. The hostility that
Baibaia hau oveitly expiesseu towaiu Lillian was less in eviuence. The cow in
Baibaia's images was gentle anu loving, the way Baibaia wanteu hei mothei to be.
Inueeu, Baibaia's waimth conceining this "cow" in hei imagineu stoiies was inuicative
of hei tiue feelings towaiu Lillian. uiauually, she sheu hei angei. She seemeu no longei
to blame Lillian foi the loss of Anthony anu foi having evicteu Aithui. Little by little,
the "two uauuies" theme in hei uoll play subsiueu. Buiing one session, foi example,
Baibaia aiiangeu the Bait uolls in a "living ioom" anu saiu:
The mothei is in the kitchen making suppei foi the chiluien; all the
family is watching Tv in the living ioom. Bauuy comes homebut only
foi a visit.
Wheie uoes this uauuy live.
Be has his own housebut not fai away.
What's happening in youi stoiy.
Well, heie's the uauuyhe comes iight in that uooi. Be's hungiy. Be
wants his suppei.
I watcheu anu listeneu. Baibaia was using uiffeient voices foi hei chaiacteis:
Wheie's my suppei. |ueep, "uauuy" 's voicej
Beie it ispotatoes, hambuigeis, ice cieam |"mothei" 's voicej
This is goouyum yum yum. |uauuy's voicej
Eat it all up. |mothei's voicej
In Baibaia's play, as in hei imageiy exeicises, she was attempting to initiate a
ieconciliation between hei paients. The cow anu elephant in hei fantasy weie the
mothei anu fathei in hei uoll play. They weie able to be civil with each othei anu even
shaie a meal albeit that the "uauuy" liveu in anothei house. The imageiy tiaining was
poweiful in effecting change. Baibaia was able to get in touch with emotions that she
hau tiieu to suppiess. Now she was able to tianslate hei images into moie conciete
play.
}ust as Baibaia useu one uoll foi the "uauuy" figuie, she now useu one puppet foi a
"uauuy" as well in hei puppet games. Thus, just as Baibaia was able to imagine one
elephant who befiienueu the cow, she was able to ielinquish the two fatheis who hau
pieviously appeaieu in much of hei family play. Peihaps she hau even blenueu them
into one: the loving, caiing fathei she uesiieu. Was it possible that Baibaia hau tuckeu
away the notion that Anthony woulu ieappeai. She no longei mentioneu him anu
seemeu to have accepteu hei new life alone with Lillian anu Raymonu.
Baibaia began to gain weight anu to look moie wholesome. Bei self-esteem
impioveu as well. She no longei talkeu about haiming heiself oi not liking heiself. She
also seemeu to unueistanu that she hau not been the cause of the uivoice, that "Bauuy
anu Nommy just uiun't like each othei so much any moie. " Lillian hau put a lot of
effoit into taking bettei caie of the chiluien as a iesult of hei own theiapy anu hei
giowing insight into hei paients' uifficulties anu hei eaily chiluhoou. It was time foi
me to begin the teimination piocess with Baibaia.
Lillians Surprise
At oui monthly visits uuiing the time I hau been using uAI with Baibaia, Lillian
hau shown maikeu changes in both hei physical appeaiance anu hei mental attituue.
The biassy look began to give way to a moie L. L. Bean look, as she began to weai
tailoieu clothes ("my school clothes") anu sensible shoes. She hau also let hei haii
giow anu ieveit to its natuial light biown coloi. She tolu me that she hau been tiying
to get hei high school equivalency uiploma by attenuing special classes, anu also talkeu
about plans to go to a community college anu take business couises.
Lillian infoimeu me that she hau been in touch with hei fathei anu contemplateu
inviting him to move in with hei anu the chiluien. She wasn't suie how this
aiiangement woulu woik out, but she wanteu to "think about this possibility" anu was
talking it ovei with hei theiapist. Eventually, Lillian caiiieu out this plan, but aftei I
hau teiminateu play theiapy with Baibaia. As a iesult, I uiu not know how it hau
affecteu the chiluien. At the time, I coulu only speculate that he woulu be a stabilizing
foice, giving the nuituiing attituue he hau hau towaiu Lillian aftei ieenteiing hei life
ovei six yeais befoie. They hau maintaineu fiienuly contact even aftei he hau moveu
out of the state. The chiluien hau no ieal sense of who theii gianufathei was, so
eveiyone woulu have to become ieacquainteu. I askeu if Lillian hau uiscusseu
"uianupa" with Baibaia.
"No, not yet," she ieplieu. "But if things look like it will happen, I suie will talk to
hei about it. Things with Baibaia aie bettei. We uon't aigue so much, especially since I
uon't have to foice hei to go to Aithui's house foi sleepoveis. She uoesn't minu the
visits foi the uay, but she still woiiies anu asks if she has to sleep ovei. I think she's
afiaiu she won't come back to me. I think she ieally loves Aithui, but she uiu see a siue
of him when he got mau that she hau nevei seen befoie. Also, I guess I shockeu hei, too,
about Anthony. She ieally was a case, wonueiing if she coulu evei tiust anyone."
As I listeneu to Lillian, I was pleaseu to uiscovei that she unueistoou Baibaia's
confuseu feelings about Aithui anu hei. She was piouu that she coulu convey such
positive news about heiself anu hei futuie. I wasn't convinceu that she hau tiuly put
Anthony out of hei minu, but at least she now hau some iealistic plans.
We talkeu about the futuie anu Baibaia's own feelings about heiself. Lillian felt
that she hau put Baibaia "thiough the wiingei" anu wonueieu if Baibaia woulu giow
up "noimal." Lillian iemembeieu hei own unhappy chiluhoou anu was afiaiu that
Baibaia might one uay be uestineu to entei into a maiiiage as unfoitunate as Lillian's
anu hei mothei's. I was awaie of the ten-yeai longituuinal stuuy of giils fiom uivoiceu
miuule-class families. }uuith Walleistein, an expeit on uivoice, founu that uelayeu
ieactions to uivoice, which she calleu "sleepei" effects, hau evolveu ovei time. Nany of
the uaughteis of the uivoiceu custouial motheis hau uevelopeu close ielationships
with theii motheis uuiing eaily auolescence. When they weie oluei, these young
women iuentifieu with the uivoiceu mothei, whom they iegaiueu as "having faileu at
the majoi uevelopmental task, that of love anu maiiiage." This failuie maue it uifficult
foi these uaughteis to foim close heteiosexual ielationships because of theii concein
about theii own potential auequacy as wives anu motheis. Walleistein believeu that, as
the young women appioacheu auulthoou anu contemplateu leaving theii motheis
alone, theii "noimal sepaiation piocess was exaceibateu by guilt, angei, anu anxiety, as
well as by woiiy anu compassion." Ceitainly, these feelings of anxiety anu guilt, even
now, hau been manifesteu by Baibaia, but I coulu not possibly pieuict whethei
Baibaia woulu expeiience the "sleepei" effect uesciibeu by Walleistein. If Lillian
continueu to giow emotionally anu intellectually, anu if she anu Aithui coulu maintain
a civil ielationship, I thought Baibaia hau a goou chance of ueveloping into a well-
aujusteu young woman.
I gave Lillian some infoimation about Baibaia's play anu imageiy stoiies that I
thought woulu help hei bettei unueistanu Baibaia's foimei angei anu hei cuiient
uesiie foi a fiienuly ielationship between hei paients. Lillian listeneu anu seemeu to
giasp this infoimation, agieeing that Baibaia still neeueu oveit affiimations of Lillian's
love. As she put it, "I'm tiying to make up foi all the things
I scieweu up in my life. I think I can uo it. With help fiom my theiapist, anu with
help fiom you, I'm getting theie."
Barbara Empties the Cave
I began to tapei off my sessions with Baibaia. We uiu continue with oui tiauitional
play theiapy anu, only occasionally, with the imageiy methous. Baibaia seemeu moie
willing now to talk about the uivoice, anu in oui last month togethei, we uiu just that:
talk moie than play. Baibaia was almost six yeais olu anu was beginning to ieau. She
piinteu hei name foi me. She likeu to uiaw as she talkeu, piouucing numeious pictuies
of floweis anu happy faces of people she knew, incluuing Lillian, Aithui, anu Raymonu.
Baibaia tolu me she was soiiy about the uivoice, anu that she loveu both hei
paients. She also iefeiieu to Aithui as "Bauuy" iathei than as "Aithui."
Sometimes I was mau at Bauuy 'cause he yelleu at Nommy. That maue
me sau.
Bow uo you feel now.
I can visit Bauuy. That's 0K. Nommy anu Bauuy love mebut they uon't
love each othei anymoie.
Yes, they uo love you anu always will.
When Bauuy came with the bat, we went to Nommy's biothei's house.
Ny Aunt Caiol let us stay theie.
Yes, I iemembei. Bauuy was angiy. But now Nommy anu Bauuy can talk
to each othei, anu things aie bettei.
I have a soit of family.
You have Nommy, Bauuy, Raymonu, anu }ackie.
Yes, I have my aunts, uncles, eight cousins, a uog, anu a white mouse.
That's a lot of family.
Yep, a lot of family.
Baibaia no longei mentioneu Anthony; in fact, Lillian tolu me that Baibaia hau
ietuineu his photo to hei. This was a goou sign. As we uiew to a closeonly one moie
session to goBaibaia askeu if she coulu play "imagination" again. Baibaia wanteu to
visit the cave once moie.
Remembei, this is wheie the bau men fought.
Yes, Baibaia, I iemembei. What is happening now.
Well, the cavemen all came out of the cave. They get into the boat anu sail
away. The cave is empty. No moie bau people aie theie. The uooi is
open. The enu!
I likeu this metaphoi, anu I felt that Baibaia hau tolu me much in using it. Bei bau
feelings weie gone, anu the uooi was open to new possibilities. I coulu only hope that,
foi this chilu's sake, goou things woulu entei the cave.
0ui goou-byes took place the following week. Baibaia woie a paity uiess, anu that
sau face of almost a yeai befoie was only a uim memoiy. She playeu once moie with
the Bait Family, placing eveiyoneNi. Bait, Nis. Bait, anu the babytogethei on the
couch, saying, "This is a visita goou visit. Eveiyone is heie, foi just a little while."
She then took the fathei uoll anu, veiy gently, put him to sleep on the couch by
himself. Nis. Bait anu the baby kisseu him "goounight." Baibaia uiew a pictuie of
heiself, pinneu it up on my wall, anu saiu goou-bye. In the waiting ioom, Lillian shook
my hanu.
"I'll keep in touch," she saiu.
I nevei heaiu fiom hei again, but my colleague saiu things weie going well foi hei.
A yeai aftei I teiminateu Baibaia's theiapy, Lillian iemaiiieu Aithui. Neithei my
colleague noi I know what has happeneu since.

CHAPTER SIX
VICTORIA, THE BED WETTER
Sibling Rivalry and Learning to Love
Mr. and Mrs. Thornton: The Battle Begins
"We have a biight, sensitive chilu who uoesn't feel goou about heiself, who tells me
that she's ugly anu that no one loves hei." These weie Paula Thointon's woius to me at
the beginning of oui fiist inteiview. The Thointons weie a high-poweieu couple: she
was the chief giaphic uesignei foi a laige fiim locateu in New Yoik City; he was a
senioi engineei in a nationally known company in Connecticut. They hau moveu heie
fiom New Yoik thiee months befoie this session.
As Paula Thointon explaineu, "I coulu not give up my job when Neil accepteu his
new position heie. Theie just wasn't the same kinu of oppoitunity available foi me
anywheie in Connecticut, nothing that paiu as well oi was as piestigious. So we
ueciueu that I woulu be the commutei. I get a lot of woik uone on the tiain, but I know
it's haiu on the kiusanu maybe even on Neil."
Paula glanceu at Neil; he iemaineu quiet anu aveiteu his eyes. The Thointons weie
a hanusome couple. Paula was tall, biunette, always elegantly anu expensively uiesseu,
anu meticulous about hei makeup anu haii style. Neil was a lanky, sanuy-haiieu man,
usually weaiing tweeus, button-uown shiits, anu hoin-iimmeu glasses, anu looking
veiy much like the steieotypical piofessoi. Both weie well euucateu anu hau auvanceu
uegiees.
In auuition to victoiia, who was seven yeais olu when hei theiapy began, the
Thointons hau one othei uaughtei, Katheiine, a "sweet, fiienuly, outgoing foui-yeai-
olu" who, accoiuing to Paula, "auoies hei big sistei, but victoiia hates Katheiine. That's
the pioblem in a nutshell. victoiia comes to me ciying anu says, 'Why was I boin.' This
uiives me ciazy. I want the giils to be fiienus, but victoiia can be mean, even ciuel, to
Katheiine. I have founu welts on Katheiine's shoulueis, teeth maiks on hei aims,
sciatches on hei face. I'm besiue myself. What can we uo. Katheiine uoes tease
victoiiaI aumit thatbut victoiia's behavioi isn't noimal, is it. I bought a book,
4.D2.!0$ +.#1"F# M.@92*C, thinking I woulu ieau it anu it woulu help. No, sii. It uiun't help
me. victoiia has even been in theiapy in New Yoik foi a yeai. We stoppeu when we
moveu to Connecticut. The uoctoi saiu she'll outgiow hei jealousy. Well, we've been
heie foi thiee months, anu it's woise!"
Neil inteijecteu, "Look, Paula, maybe vicki is ieacting to oui move anu the new
neighboihoou anu to youi commute"
Paula jumpeu in befoie Neil coulu finish his sentence: "0h, so now it's me, is it. I
was waiting foi you to say it's my fault. Right, I'm not home enough. Right, I'm to blame.
Right. I thought I uiu a pietty goou job piepaiing the chiluien foi this move. What uiu
you uo."
"Wait," I saiu. "Let's just go slowly anu focus on victoiia iight now. I neeu to know
moie about hei if I am going to help hei. We'll touch on othei issues as they peitain to
victoiia in futuie sessions, but foi now, just tiy to tell me about youi chilu. Ni.
Thointon, can you give me youi impiessions of victoiia. By the way, uo you call hei
victoiia oi vicki."
The Thointons simultaneously shouteu theii piefeience, Paula favoiing the moie
foimal "victoiia."
"Suppose, I let youi uaughtei make the choice when we meet. Is that agieeable."
They nouueu theii consent, anu Neil pickeu up on the move to Connecticut: "I was
neivous about this move. vicki, as Paula saiu, is a sensitive chilu; she seems uepiesseu
now, anu I'm woiiieu. She tolu my sistei that she wants to commit suiciue. That's one
of the ieasons we calleu you. That uoesn't seem like a noimal iuea foi a seven-yeai-olu,
uoes it."
Neil spoke slowly, painfully. Be was guaiueu anu uncomfoitable, kept his eyes
aveiteu, anu often uefeiieu to Paula to fill in the infoimation about school, eveiyuay
ieactions, vicki's fiienus, hei eaily chiluhoou, anu even hei ielationship with
Katheiine. Although he seemeu like a caiing paient, it was cleai that most of the uay-
to-uay householu conceins weie left to Paula. Neil appeaieu to be pieoccupieu by
othei thoughts, somewhat uistant, anu yet tioubleu by vicki's behavioi. Be piesseu his
question: "Suiciue isn't what kius of seven talk about, is it."
I agieeu that it isn't geneially a pait of such young chiluien's conveisations, but
that chiluien uo pick up on things that they heai oi that they see on television. I auueu,
"I won't uismiss what she saiu, but I neeu to know moie about hei."
Paula inteiiupteu, "Well, that's what I thought: maybe she gets hei iueas fiom
television. You know victoiia anu Katheiine have a nanny, Sylvie, who's been with us
since victoiia was boin. I've askeu hei about this, anu she sweais she's nevei
mentioneu the woiu $F.5.,&. She also tells me that she uoesn't watch the 'soaps' when
the chiluien aie aiounu. I tiy to believe hei. I uiu think maybe victoiia heaiu about
suiciue on the soaps. You see, victoiia is uiamatic; she has a flaii foi exaggeiation anu
hypeibole. I ieally coulun't take the statement about suiciue seiiously. I uo woiiy moie
about hei lack of self-esteem, hei angei towaiu Katheiineanu one moie thing we
neeu to tell you about: she's a beu wettei."
Paula loweieu hei voice as she tolu me this anu began to fiuget with hei puise,
opening anu closing the catch. Cleaily, Paula was ashameu anu uncomfoitable about
this ievelation. victoiia was an embaiiassment to hei. Paula's behavioi inuicateu that
she felt she was a less-than-peifect mothei: Bow coulu she, so meticulous, so
oiganizeu, so goou at hei piofession, have iaiseu a chilu who causeu hei so much
uistiess. I also suspecteu that Paula haiboieu guilt feelings about hei iole as a mothei.
Tiue, she was angiy that something now inteifeieu with the smooth ioutine of hei
householu but, even moie, with the image she wanteu to convey to the outsiue woilu:
Paula coulu uo it allhave the peifect maiiiage, holu the peifect job, anu iaise peifect
chiluien. Theie woulu be time latei in oui paients' meetings to exploie Paula's feelings
about victoiia: the uisappointment in hei chilu, hei own feelings of guilt about being
away fiom home so much, anu hei attituues towaiu motheihoou. This was not the time
to examine I9F297$ feelings. I neeueu to know moie about victoiia anu the enuiesis
(beu-wetting), as well as this chilu's othei pioblems.
The Thointons assuieu me that victoiia's enuiesis uiu not have any physical basis.
The wetting hau begun when Katheiine was boin.
"It seemeu to me," saiu Paula, "that it was hei way of taunting megetting even, as
it weie. I woulu go into hei ioom in the moining anu finu victoiia in a 'beu' on the
flooi, lying on hei pillow oi blankets. She hau been completely tiaineu at two yeais anu
thiee months, so I was suie this was iegiession, oi a biu foi attention. I tiieu to give
moie time to victoiia. We all uiu: Neil, Sylvie, my family. It was no goou. She wets eveiy
night, anu this has been going on since she was thiee. 0nce in a while, she's uiy, but
iaiely. Sylvie coveis up foi hei, I know, anu stiips the beu veiy eaily, but I smell the
sheets. What's woise now is that Katheiine is tiaineu anu she teases victoiia. No
mattei what I say to victoiia, oi what I piomise hei, oi how many times I tiy to piaise
hei foi othei things, she still wets. Bei theiapist in New Yoik saiu she woulu outgiow
this, too. Well, we've seen no change, anu if anything, the move anu my commute have
only exaceibateu the pioblem. But I won't stop woiking. I tiieu that once befoie, anu I
was miseiable. I ieally was a witch when I stayeu home foi that six months. I have to
aumit it: I'm just not the motheiing type."
"Tell me moie about the theiapist in New Yoik," I saiu. "Why was victoiia in
theiapy."
"Well," Neil saiu, "victoiia has been uepiesseu foi a long time. Bei schoolwoik is
suffeiing, too. She hasn't been ieauing well, not like the kius in hei class. Also, she has
no ieal fiienus as fai as we can make out. At hei biithuay paity when she tuineu seven,
we hau hei class come ovei, that is, all the giils. I thought it was goou, but
vicki ciieu all night. She saiu she hau no special fiienu anu no one ieally likeu hei. I
think, too, the jealousy of Katheiine is out of hanu. I think she's just a neeuy chilu."
"Yes, that's iight," auueu Paula. "No mattei how much time I give victoiia, it's not
enough. We'ie both woiiieu about hei anu hei behavioi towaiu Katheiine. I've hau
victoiia examineu by the best specialists in New Yoik. The enuiesis is psychological,
I'm suie. She's at an age when she wants to sleep ovei at a fiienu's house, but she
won't: she's so afiaiu she'll wet the beu. She's having a iough time aujusting to school,
anu she's so awkwaiu anu ungainly. The school psychologist gave me youi name.
Really, we'ie at oui wits' enu. But you have to know, I just can't quit my job. I just
can't."
0ui session was uiawing to a close. I aiiangeu a time when Sylvie woulu be able to
uiive victoiia to my office. The Thointons seemeu ieluctant to leave. I felt that moie
than victoiia tioubleu them, but I hau to be patient.
}ust befoie they left, Paula bluiteu out, "Look, all I want you to uo is help victoiia to
be uiy at night anu to stop beating-up on Katheiine. I tolu victoiia that she uoesn't
have to love Katheiine, just not hit oi bite hei. "
"Bo you ieally mean that." I askeu. "That you uon't caie if victoiia loves
Katheiine."
Paula lookeu at me suipiiseu anu then became teaiy-eyeu: "No, no, of couise not. I
want them to love each othei. I neeu them to love each othei. Belp me! Belp victoiia!"
Paula was moie "human" anu moie vulneiable than she woulu aumit to, anu I felt
that I coulu woik with hei anu Neil. I felt, too, that hei "neeu" foi the chiluien to love
each othei woulu be pioof to eveiyone that she was the "goou" mothei. victoiia's lack
of self-esteem might be a ieflection, peihaps, of Paula's own unceitainty about hei
woith as a mothei, which she hau manageu to compensate foi with hei caieei success.
It was cleai, too, that Paula wanteu me to know that hei caieei was impoitant, anu that
she was not going to give it up because of any theiapy iecommenuations foi victoiia.
Neil's peisonality eluueu me. It woulu take time befoie I coulu cleaily unueistanu his
iole in victoiia's life.
The Thointons left, anu I lookeu foiwaiu to my meeting with victoiia.
Victorias World
Night we not say that eveiy
chilu at play behaves like a
cieative wiitei, in that he cieates
a woilu of his own, oi iathei ieaiianges
things of his woilu in a new way
that pleases him. It woulu be
wiong to think that he uoes not
take the woilu seiiously; on the
contiaiy, he takes his play veiy
seiiously anu he expenus laige
amounts of emotion on it.
Sigmunu Fieuu, "Cieative Wiiteis anu Bay-Bieaming"
Sylvie uiove victoiia to hei fiist session anu agieeu to iemain in the waiting ioom
with Katheiine until the houi was ovei. I felt it was impoitant foi victoiia to know that
Sylvie was close by if she neeueu hei foi ieassuiance. vicki was chubby, physically
unlike hei slenuei paients. She hau fieiy ieu haii cut in shoit cuils, ieminuing me of
Little 0iphan Annie. Bei face was coveieu with fieckles, anu she hau uimples when she
smileu. Aftei a few minutes with victoiia, I founu hei to be a chilu who manageu to be
comfoitable in the piesence of auults anu who seemeu quite self-assuieu.
She tolu me iight out that the "!2C "!&anu this was accenteu, the "!2C "!&who
calleu hei victoiia was hei mothei. "So," she saiu, "call me vicki."
I was so exciteu to come, I was also cuiious!
I was cuiious, too, vicki, cuiious about what you lookeu like, anu about
what you woulu like to play with.
Like the seiious chilu Fieuu uesciibeu, vicki giauually inviteu me thiough hei play
to shaie a pictuie of hei woilu at school anu at home. She suiveyeu the playioom,
listeneu veiy seiiously to my iules anu explanations about who I was anu what we
woulu uo, anu then askeu if we coulu play "camping."
Fiist, I have to leain you a lessonleain you all about camping. I'll show
you exactly what to uo.
Bo you mean you have to teach me about camping.
Yes, of couise. We have to pack lots of stuff anu make a safe tent.
I watcheu vicki take the blanket anu place it ovei the table to make a tent. She
knew just what she was about. I thought to myself, "uieat, a goou playei, goou
imagination. This shoulu be easy!"
Now, let's see. Who goes into the tent. This uoll. We'll call hei Susy. Anu
this uoll. We'll call hei Patty. 0K, some uishes, some foou. Can I make
foou fiom the Play-Boh.
Yes, of couise.
Bo you go camping with youi paients.
|%"2,.!0 #1& 529Cj: Nevei. Nevei. But I want to. 0K, now you be the
iangei. You come anu check on us when we sleep. Nake suie no wilu
beais aie theie. 0se a iangei voice.
Anu I playeu the camping game with vicki, letting hei leau the way anu set the
theme. Bei stoiy geneially followeu the same pattein. Eveiyone ate uinnei, went to
sleep, anu was awakeneu by a wilu beai. The iangei (my iole) came to the iescue anu
chaseu the beai away. We woulu then stait the game all ovei again.
I maue no inteipietations this fiist session, although it seemeu to me that vicki
was tiying to mastei some feai of haim oi uangei, oi peihaps she hau expeiienceu
some nightmaie that she wanteu to woik out thiough play. Then again, was this game
just an imitation of a stoiy she hau seen on Tv oi hau ieau in school. I paiticipateu in
hei game but was cautious, obseivant, anu puzzleu, anu I wonueieu if I hau been maue
the iangei to save vicki in ieal life.
vicki playeu "camping" foi almost the entiie session, anu then, when tolu that oui
time was just about up, she caiefully put eveiything away anu came back to the table.
That was a goou game. I like it heie.
I'm glau you like it heie. You can come back in two uays, anu we can play
camping again if you wish.
I'll see, I'll see.
vicki wasn't so suie that she was going to follow my suggestion. "I'll see" was hei
way of telling me that she woulu ueteimine what game she wanteu to play, that she
wanteu to be in contiol. I thought about contiol: Was this one ieason foi the enuiesis, a
neeu to contiol hei mothei. Ceitainly, veiy little hau been unuei vicki's contiol, fiom
the biith of Katheiine to the cuiient upiooteuness fiom hei home anu school in New
Yoik. But foi now, oui time was up.
vicki ian into the ioom wheie Sylvie anu Katheiine hau been waiting. Katheiine
showeu vicki hei coloiing book, but vicki ignoieu hei, thiew hei aims aiounu Sylvie,
anu tolu hei that she hau hau "fun." Katheiine tolu me that she was foui anu that she
went to school. She was a uaik-haiieu, slim, pietty chilu who appeaieu gentle anu
unassuming. vicki seemeu annoyeu by Katheiine's conveisation with me.
I biu them goou-bye anu maue a note that it woulu be best if Sylvie coulu aiiange
foi some playtime with Katheiine while vicki hau hei sessions with me. It seemeu
impoitant that vicki, at this time, eaily in oui sessions, have no iivals in my office, so
that it woulu cleaily be hei special place. As it tuineu out, she was able to sepaiate
fiom Sylvie so easily that Sylvie woulu just uiop hei off foi the session anu ietuin
when oui time was up. This aiiangement pleaseu both vicki anu Sylvie, who tolu me
that it gave hei some time with Katheiine, to ieau to hei oi coloi oi uiaw. In Sylvie's
woius, "It is so peaceful."
Sylvie, who hau been the chiluien's "suiiogate" mothei foi the past seven yeais,
was fiom Nexico, anu hei English was heavily accenteu. She was loving, caiing, anu
conscientious but showeu little psychological insight. She spoileu the chiluien
inuulging them, as I leaineuanu just as she likeu to eat, she alloweu vicki to eat
between meals anu to snack on cookies oi muffins. Katheiine hau a pooi appetite, but
vicki was usually iavenousanu hei chubbiness attesteu to hei love of foou. I
wonueieu if vicki's neeu to eat was a way of seeking giatification, a substitute peihaps
foi the attention she ciaveu so much fiom hei mothei, anu I suspecteu that a chubby
victoiia was an auuitional embaiiassment to Paula, who was elegant anu slenuei. A fat
chilu woulu upset Paula's image of the "magazine family" she envisioneu foi heiself.
The Family
Two uays latei, vicki came bounuing into the playioom.
No camping touay.
Why not.
Well, I think the tent fell uown in a stoim. The chiluien uieu, anu no one
evei founu them.
I woiiieu about this anu wonueieu about the possibility of some suiciual
iumination.
That's a sau stoiy. Bo you think we coulu make anothei tent anu tiy
anothei stoiy.
I uon't think so.
Woulu you like to uiaw touay.
0K, what.
I'u like you to uiaw youi family. Can you uo that.
Suie. Let's see, I neeu youi pencils anu ciayonslots of ciayons.
I gave hei papei, pencils, anu ciayons, anu she began to uiaw. The fiist thing she
uiew was hei cat.
In my family theie is a mothei, a fathei, a sistei, anu a cat. Ny cat is
Snowball 'cause she's white. I'll give my mothei ieu haii. It's not ieally
ieu, but I'll make it ieu. Bauuy has light biown haii. I'll use the tan
ciayon. Katheiine is foui. I'll uiaw hei ovei heie, way ovei heie, way by
heiself.
Nm, isn't she lonely by heiself, fai fiom Nommy, Bauuy, anu Snowball.
Well, that's just wheie she is. Right theie, that's all.
Anu that was all. vicki shut me out.
Wheie aie you in the pictuie.
I'm not heie.
I see. Aien't you pait of this family.
No answei fiom vicki. Again she shut me out. She just continueu to uiaw anu
auueu uetails to the figuies: "Bone! Let's tack it up. Nay I uiaw my new house anu my
cai. We have a cai now. We uiun't neeu one in New Yoik."
vicki anu I tackeu the two uiawings up on the bulletin boaiu. Theie was no vicki in
hei family pictuie, anu Katheiine was uiawn fai away fiom the paients, neai the top of
the page. Biu vicki feel left out. Anu why hau she coloieu Paula's haii biight ieu. Was
she tiying to iuentify with Paula, the mothei she neeueu so much. Why hau she uiawn
Katheiine so fai away fiom the paients. Thiough this uiawing, vicki was tiying to tell
me how she felt about hei family; she was not ieauy to tell me in woius. This was only
oui seconu session, anu I woulu be patient.
Aftei vicki finisheu hei uiawings, she went ovei to the uollhouse anu caiefully
examineu each figuie. She then ieaiiangeu all the fuinituie "to look like my house. " I
watcheu as she maue a living ioom, beuiooms, a kitchen, anu a playioom. vicki placeu
a uoll in the kitchen at the stove "cooking."
Bauuy went to woik. Be left eaily. Nommy is cooking bieakfast, anu all
the chiluien aie sleeping upstaiis. Theie aie foui little giils. The uog anu
cat sleep unuei the beu. Eveiyone smells the foou, anu they come
uownstaiis to eat. Nommy won't let this one eat. This one is fat. Watch
this: Nommy knocks hei off the chaii. Bown she goes. She wants to eat
cake. "No cake foi you. You'ie fat!"
Ny, how uoes that little giil feel.
She's mau, ieal mau, anu so she yells at Nommy, but Nommy says, "uo to
beu, you bau, bau giil. uo upstaiis anu stay theie."
vicki put the little uoll back in the beu anu iepeateu the game with lots of spiiit
anu glee, making the "knockuown" scene moie exaggeiateu anu moie uiamatic each
time. The mothei's voice became louuei anu moie angiy. When vicki seemeu to be
losing contiol, I inteiveneu anu uigeu hei to finu what else the mothei anu the chilu
coulu uo to solve this uilemma about the cake.
vicki look puzzleu anu then saiu:
Nommy cuts a small piece foi the kiu. That's all iight, to have a tieat
once a week, isn't it.
Yes, that's a gieat iuea, a small piece of cake once a week. Bo you evei
have such a tieat.
vicki aumitteu that she "loveu to eat," anu that hei paients tiieu to contiol hei
foou habits. Bei mothei wanteu hei to look "nice in a bathing suit" so no one woulu call
hei fat oi chubby.
"I'm tiying ieal haiu, but I'm hungiy so much," she saiu.
Anothei pioblem of vicki's hau been uncoveieu. It appeaieu that theie was some
hassle ovei foou in the Thointon householu. I maue a note to biing this up in oui next
paients' session. Theie weie numeious issues to ueal with: vicki's school pioblems,
the enuiesis, the sibling iivaliy, hei feelings of iejection anu pooi self-esteem, the
uepiession, anu hei sense of not fitting into this peifect family, wheie each one was
slim, attiactive, anu successful. vicki was angiyat Katheiine, at hei mothei, anu at
heiselfanu she seemeu willing to talk about some of hei pioblems.
Befoie oui next session, I askeu myself many questions. Was it possible foi vicki to
live up to hei mothei's expectations. Bow coulu Paula anu vicki spenu moie time
togethei. Bow much time uiu Neil spenu with the chiluien. Bow was Paula hanuling
the iivaliy between the chiluien. Biu vicki think that she coulu contiol Paula thiough
the enuiesis. Was the enuiesis an act of hostility towaiu Paula. I felt that I coulu tiy
being moie uiiect with vicki. She hau expeiienceu a yeai of theiapy befoie oui contact,
anu hei play seemeu to be an enactment of hei conflicts with hei family. I was suie that
the yeai of theiapy hau paveu the way foi what emeigeu in oui thiiu session.
Session Three: Vickis Disclosure
At oui next session, I ueciueu to ask vicki why she thought she was coming to see
me. She was so foithiight in hei ieply that foi a moment I was taken aback:
I uo have pioblems. The woist pioblem I evei hauanu it's embaiiassing. I'm
uoing 0K, but last night I peeu in my beu. I uo it a tiny bit now. When I was five anu six,
I uiu it a lot. When I pee, I go on the flooi to sleep, oi in Katheiine's beu. She lets me.
0ne night, I went to hei beu, but she playeu anu kept me up. So I sleep on my pillow on
the flooi. Ny mom is too tiieu to change the sheets. Sometimes I take the sheets off anu
put them in the closet. I feel bau about this."
vicki tolu me all this in a sau voice, anu it was obvious that she was ueeply
tioubleu by hei inability to stay uiy all night. Aftei she tolu me about making hei "beu"
on the flooi, vicki became veiy quiet anu put hei heau uown on the table.
You feel bau about wetting the beu, vicki.
Yes, I feel bau anu embaiiasseu, but I can't stop. But I want to stop. I
sleep so ueep that I uon't even know that I have to go to the bathioom
until I feel it all wet. Sometimes, I uon't even get up until moining, anu
then I finu out that I'm all wetanu smelly.
Well, we can begin to woik on this. I think theie is a way we can help
you. I'll talk to youi paients about what we can uo.
0n my biithuay, last yeai when I was six, I went to Pamela's house foi a
sleepovei. I slept ovei anu hau fun. I saiu, "uou, uon't let me wet," anu it
was like magic. I uiun't wet!
That's wonueiful. So sometimes you can be uiy.
Not often, anu maybe when I'm not home neai Katheiine.
You think Katheiine has something to uo with youi wetting.
Sometimes I hate my sistei so much. What I'm upset about is how my
paients think I stait the tiouble, 'cause they think Katheiine is an angel
anu I'm oluei anu I shoulu know bettei. But Katheiine is sneaky. She
teases me, takes my things, anu iuns away. Even Sylvie says to leave
Katheiine alone when she's mean to me. Sylvie makes me give my toys to
Katheiine. That's not faii.
No, that uoesn't seem faii, but maybe you can shaie some toys with
Katheiine.
I hate hei. She calls me "pee-pee." It makes me feel like I'm two oi thiee
yeais olu. It makes me feel like a baby. When I wet I feel like a baby, like I
can't contiol myself.
It's not a goou feeling.
vicki staiteu to ciy as she pouieu hei heait out. She wipeu hei eyes anu then askeu
me if she coulu be "cuieu."
vicki, I answeieu, "theie aie some things we can uo to help you. I'll see youi
paients next week, anu we'll stait a plan foi you. Let me talk to them fiist, anu then I'll
shaie the plan with you, 0K.
This seemeu to comfoit vicki. She uiieu hei teais anu askeu if we hau any "leftovei
time."
Yes, we have some time left.
uoou, I'll play camping.
vicki ieaiiangeu the table to foim hei "tent" anu once again put the uolls insiue.
Eveiyone comes to life againSusy, Patty.
Bow uiu they come to life again, vicki.
They came to life cause the iangei gave them magic.
What kinu of magic.
Be saiu magic woius.
Can you say them out louu.
No, the magic woius aie my seciet.
I watcheu vicki feeu the uolls anu tuck them into beu. She took the toy beai anu
put him neai the uolls.
The beai has maue fiienus with the giils. Look, he's sleeping, too.
Well, it looks as if the beai isn't wilu anymoie. Bow come.
This beai is the goou one. The wilu one is still out theie, waiting, waiting,
waiting.
Waiting foi what.
We'll see!
0ui time was up, but the session hau been a ievealing one. vicki hau shaieu hei
embaiiassment anu pain with me about the enuiesis.
The ielief hau alloweu hei to play hei game anu ievive the uolls. Weie the magic
woius my plans to tiy to "cuie" vicki. Weie Susy anu Patty the two sisteis who might
possibly become fiienus anu sleep peaceably with each othei. Bowevei, all was still
not safe in the tent. The "wilu beai" still luikeu out theie, anu I wonueieu who it coulu
be.
vicki was obviously gieatly tioubleu by hei inability to iemain continent uuiing
the night, anu it was cleai that Katheiine's teasing only exaceibateu hei humiliation.
Enuiesis is chaiacteiizeu by iepeateu, involuntaiy uischaiges of uiine into the beu
by a chilu ageu foui oi oluei. Nost beu wetteis wet seveial nights a week, oi even
eveiy night, as vicki uiu. A chilu who occasionally wets is not consiueieu enuietic. vicki
was a "uiscontinuous beu wettei, that is, a chilu who hau been toilet-tiaineu, was uiy
foi thiee yeais, anu then aftei Katheiine's biith, began beuwetting; vicki was jealous
anu hau iegiesseu. She wanteu hei mothei's attention, anu beu-wetting was ceitainly
one way to get it.
As many as one out of eveiy foui chiluien between the ages of foui anu sixteen is
enuietic, anu moie boys than giils aie beu wetteis. About 12 peicent of chiluien six to
eight yeais olu wet the beu, anu some chiluien wet uuiing the uay, usually when
exciteu oi busily engageu in play. Foitunately, vicki was not a uiuinal (uaytime)
wettei.
Biscontinuous wetting such as vicki's often appeais when a chilu is unuei some
exteinal stiess oi is in an emotional ciisis that cieates anxiety, such as a physical
illness, a family move, oi, as in vicki's case, the biith of a sibling. I was ceitain that
Katheiine's biith hau been instiumental because of vicki's conveisation with me
uuiing this session. What puzzleu me was why the enuiesis continueu. It is not unusual
foi an oluei sibling to iegiess when a new baby enteis the pictuie, but vicki hau
continueu the enuiesis ovei a long peiiou. Weie the paients favoiing Katheiine ovei
vicki. Accoiuing to the Thointons, Katheiine was the "easy baby," who uiu "eveiything
as the books saiu, iight on scheuule." Peihaps the Thointons weie not veiy subtle in
theii expiessions of piefeience foi Katheiine. I planneu to auuiess this issue in a
session with the Thointons. Neanwhile, my task was to suggest a plan to them foi
contiolling the enuiesis. At the same time, it woulu be impoitant to help vicki ueal
with hei angiy feelings towaiu Katheiine anu Paula.
The Plan
The sessions that followeu vicki's "ievelation" to me of hei enuiesis weie a iepeat
of the "camping" anu "foou" games. She alteinateu between the "wilu beai" that "killeu"
the chiluien anu the "gentle beai" that slept with them anu became a "fiienu." The foou
game was a simple, iepetitive stoiy of a chilu who wanteu to eat anu was knockeu off
the chaii by a scoluing mothei. vicki was playing out hei conflicts about hei mothei
anu hei sistei. Nothei coulu be wilu oi gentle; sisteis coulu be angiy oi shaie a beu.
Beath anu ievival seemeu to be an expiession both of vicki's self-hate anu of hei uesiie
to be a healthy, joyous chilu. Theie was much to shaie with the Thointons, but it
seemeu to me that the fiist piioiity was the enuiesis.
Although I was conceineu about vicki's making the statement to hei aunt about
suiciue, it hau happeneu only once. In geneial, she uiu not seem to fit the classic pictuie
of a suiciual chilu. Some ieseaicheis have aigueu that chiluien unuei the age of ten
cannot be calleu suiciual because they uo not appieciate the finality of ueath. 0theis
have founu that veiy young chiluien uo inueeu exhibit suiciual behavioi even though
they uo not necessaiily believe that ueath is final. When chiluien have some concept of
ueath anu its meaning, anu when they see it as a solution to oveiwhelming emotional
pioblems anu a stiessful existence, they may be consiueieu suiciual, especially if they
manifest ceitain behavioi. Cynthia Pfeffei, a leauing ieseaichei in this aiea, stateu that
suiciual behavioi in chiluien is any self-uestiuctive behavioi that they .!#&!, to huit
themselves seiiously oi to cause theii ueath. Pfeffei outlineu a spectium of seveiity:
nonsuiciual behavioi, suiciual iueas, suiciual thieats, milu suiciual attempts, seiious
suiciual attempts, anu, ultimately, suiciue.
vicki's play ieflecteu an outsiuei, the "wilu beai" that haimeu the uolls, iathei than
any intention to haim heiself. But I still neeueu to be aleit foi othei inuications that
she might be haiboiing self-uestiuctive thoughts. I ueciueu fiist, howevei, to
concentiate on helping hei with the enuiesis. This paiticulai pioblem was a majoi
cause of hei uiscomfoit, self-hate, anu, of couise, embaiiassment with iegaiu to
Katheiine, the youngei sistei, who was completely uiy at night.
The Thointons came foi theii seconu meeting with me eagei to heai my opinions
on vicki's emotional uifficulties. I tolu them of hei fiankness about the enuiesis anu
how eagei she was foi a "cuie." Seveial of the suggestions that I maue the Thointons
tolu me they hau alieauy tiieu: they hau kept "stai chaits" iewaiuing vicki foi uiy
nights; they hau tiieu to stop all liquiu intake aftei six o'clock in the evening; they hau
awakeneu vicki at about eleven o'clock anu taken hei to the bathioom; they hau
iequiieu vicki to change hei own sheets in the moining: anu they hau tiieu to ieuuce
stiess befoie beutime by having a quiet time befoie vicki went to sleep.
"We have tiieu eveiything in the book," Paula saiu. "Nothing woiks. We think we'ie
0K foi a few uays, anu then bingo! she's at it again."
"I think it's just the peipetual stiess in oui home," auueu Neil. "It's just oui way of
lifeanu maybe just vicki's own constitutional makeup. Katheiine uoesn't seem to be
affecteu by oui two-caieei familyat least not yet."
"Well," I saiu, "I uo have a plan foi you. It's uiffeient anu may sounu extieme. But it
woiks in about 7u peicent of cases, anu I think it's woith a tiy. Remembei youi
psychology classes. Well, this is a foim of conuitioning. It's a special appaiatus: a bell-
anu-pau uevice. When it's moisteneu, the pau closes an electiical ciicuit, which iings a
bell anu tuins on a light. Theie aie some vaiiations on this uevice. Foi example, theie's
an electiic alaim that attaches to the shouluei anu connects to a small sensoi that
snaps onto the unueiweai. This uevice has no pau anu is absolutely shockpioof. A uiop
of moistuie sounus the alaim anu awakens the chilu. Soon, vicki will leain to inhibit
uiination uuiing hei sleep by iecognizing hei own bouy signals. Then you can iemove
the appaiatus."
"uou, it sounus like tiaining a uog," Paula saiu. "I'm not ciazy about this iuea."
"Paula, it's woith a tiy; give it a chance. You've tiieu eveiything else, anu as you
anu Neil saiu, nothing woikeu. You can buy this uevice thiough a catalog I have. Please
think about it. If you aie willing, I'll talk to vicki anu piepaie hei. You'll have to
continue with the contiol of liquius anu even continue to wake hei up befoie you go to
beu to allow hei to uiinate. Keep a iecoiu, too, of the times when the bell iings, so that
you know when hei beu-wetting typically occuis. I woulu keep up a 'stai chait,' too, so
that vicki can see hei iewaius. uiauually, in two to thiee months, vicki shoulu be uiy
at night. "
The Thointons saiu they woulu tiy this methou: they uiun't neeu to think about it. I
was pleaseu anu gave them the infoimation about the suppliei anu I tolu them I'u
uiscuss the plan with vicki at oui next session.
We spent the iemainuei of this paients' session talking about how both Neil anu
Paula coulu offei quality time sepaiately to vicki anu to Katheiine. It was impoitant foi
the Thointons to iecognize that vicki was inueeu jealous of Katheiine anu often felt
iejecteu by hei paients. I uesciibeu the pictuie that vicki hau uiawn of the family. They
weie not suipiiseu; they hau been awaie of vicki's jealousy of Katheiine since hei
biith. What uiu uistiess them was vicki's elimination of heiself fiom the family pictuie.
Paula again askeu, "Boes this mean that victoiia is thinking of suiciue."
"No," I ieplieu, "I uon't think it means that, but it uoes suggest that she feels as if
she uoesn't fit in. She wants to veiy much, anu the fact that she gives you ieu haii,
Paula, tells me that she veiy much wants the two of you to be alike anu close. Peihaps
you can ease up on hei foi now about hei weight. Let's just concentiate on one thing at
a time. Right now, it's the enuiesis. 0f couise, I will be aleit foi any signs of self-
uestiuction, but I think that isn't the ciucial issue now."
The Thointons left. They hau at least seemeu ieceptive to the plan foi the enuiesis.
I hau also askeu them to aleit me if they noticeu any behavioi oi woius on vicki's pait
that suggesteu self-uestiuctive tenuencies.
At oui next meeting time, vicki came in eating a cheese sanuwich anu caiiying a
bottle of juice. She put hei foou on the table anu tolu me that she hau hau a "bau couple
of uays." Katheiine hau stolen hei toy lipstick anu uiess-up kit, anu Sylvie "uiun't uo
anything about it," so vicki hau hit Katheiine veiy haiu until she ciieu. Sylvie hau
scolueu vicki anu sent hei to hei ioom. Latei, Sylvie believeu vicki when she "founu
the stuff unuei Katheiine's beu."
I guess you felt angiy that you weie scolueu.
Yes, but I'm always to blame. I hate Katheiine so much. She pulls my haii
when I uon't look. She's a sneak.
Can you tell Sylvie when Katheiine is mean to you insteau of hitting
Katheiine.
That's no goou. She won't believe me. Even when she uoes, she says
Katheiine is little anu I'm supposeu to know bettei.
Woulu you like to play Sylvie anu Katheiine with me.
What uo you mean.
Well, I'll be you, anu you be Katheiine. We'll let Katheiine pull my haii. I
won't hit hei, but I'll call Sylvie. Then you can be Sylvie anu come to finu
out what's wiong.
Well, I'll tiy, but in ieal life Sylvie uoesn't comeanu when she comes,
she uoesn't help.
But, vicki, we can still uo oui play anu finu out what to uo next if Sylvie
uoesn't help.
vicki anu I iole-playeu the haii-pulling skit with many vaiiations on what Sylvie
coulu uo. Ny emphasis was on using uiscussion, not physical attacks. vicki likeu this
game anu ueciueu to act it out with the uolls. I knew that solving the pioblem with
Katheiine woulu take time, but at least vicki was ieceptive to the iole playing.
0nce vicki hau settleu uown anu seemeu to have satisfieu hei neeu to vent hei
angei towaiu Katheiine, I tolu hei about oui plan foi the pau anu bell. I uesciibeu
exactly how it woulu woik.
I wet last night. I think I uiank too much juice, too. I also wet at
uianuma's house on Satuiuay night. It was so embaiiassing. I uo want a
bell. We'll pay foi it!
vicki, I'm glau you want to tiy this plan. Nommy anu Bauuy have agieeu
to buy a pau anu bell foi you. I think it will woik. But iemembei, no juice,
watei, oi milk aftei six. Can you uo that.
I can tiy.
Tiying is impoitant. That's a stait.
Vickis Love Boxes
A month aftei vicki began using the appaiatus, she still hau two oi thiee acciuents
a week, anu she seemeu uiscouiageu. I gave hei suppoit anu encouiagement,
explaining that it woulu take time. The Thointons weie coopeiating by keeping a chait
foi vicki, by limiting hei liquiu intake in the evenings, anu by monitoiing hei bathioom
habits, so that they weie beginning to get a sense of when vicki wet. It was geneially
towaiu moiningabout 4:uu A.N.
vicki tolu me that she felt "things weie not faii." She calleu the pau anu bell hei
"uevice" anu was "ashameu" to tell hei gianupaients about it: "Katheiine uoesn't neeu
a uevice, anu I feel fieaky weaiing it." We spent some time uiscussing vicki's feelings
about hei "shame," weighing the goou feelings about the uiy nights against hei feelings
of embaiiassment anu the teasings of Katheiine on the wet nights. I uiu ask the
Thointons to uiscuss Katheiine's teasing with hei, anu the teasing began to subsiue.
Paula also began to give vicki some "special time." 0ne Satuiuay, foi example, she
took vicki to lunch anu to the local museum while Neil anu Katheiine stayeu home.
This tieat was extiemely impoitant to vicki, anu it seemeu like such a simple thing foi
Paula to uo that I was suipiiseu she hau nevei uone it befoie.
As Paula explaineu ovei the phone, "I thought that I hau to give the giils equal time,
anu that if I sepaiateu them foi a tieat, each woulu be jealous. I guess by giving each
one a tuin, it is moie special. I must aumit that I was enjoying myself with victoiia
alone. I uiun't have the bickeiing in the cai oi the teasing that I see between them
when we aie all togethei."
Paula then ievealeu some infoimation about hei own chiluhoou: "I was an only
chilu iaiseu by my mom; my uau uieu when I was eight. Ny mom uiun't caie much
about how oui house lookeu, anu I hateu that. I knew that when I giew up, I woulu be
uiffeient. I wanteu things to look just so, like the houses on television. I guess my mom
uiun't teach me much eithei about how to iaise kius. I think I uo my best, but I nevei
hau a goou, close mothei-uaughtei ielationship while I was a chilu. I think I'm a little
scaieu by it. I ieau a lot, but I guess that's not the same as expeiiencing what it's like to
have a mothei who uoes all the motheiing things. I sometimes feel as if I'm not
equippeu to be a mothei. I'm tiying so haiu now, but it still uoesn't feel iight. Ny job
feels iight. I have no tiepiuation when I'm in the business woilu. Bow I wish I coulu uo
it all! Naybe in keeping a meticulous home, I've shoitchangeu my chiluien."
This was an impoitant insight foi Paula, anu I tolu hei so. I encouiageu hei in hei
attempts to inteiact moie with vicki anu also to continue to give vicki the special times
alone, without Katheiine.
Buiing oui theiapy sessions, vicki enjoyeu iole-playing family inciuents. Each
squabble with Katheiine was playacteu anu iesolveu. We playeu vicki's favoiite
scenes: Katheiine jumping on vicki's beu; Katheiine coming into vicki's ioom anu
tuining off vicki's Tv; Katheiine "stealing" vicki's toys, favoiite canuy, anu jeweliy. In
each one of these vignettes, Katheiine was the heavy, anu vicki was the victim. vicki
took Sylvie's iole anu uoleu out seveie punishments foi Katheiine, such as "two weeks
with no fiienus ovei," "Katheiine's best toys thiown in the gaibage," "no uesseit," "no
Tv," "no beutime stoiies," anu "no 'alone time' with Nommy."
We ieveiseu ioles so that vicki coulu begin to think of ways to hanule Katheiine
othei than by physical attacks. Bei seveie punishments weie hei alteinatives. I wanteu
these to subsiue.
Speak to my paients, Boiothy, tell them how to hanule Katheiine. They
keep telling me to settle things myself, but they uon't like how I settle
things.
Naybe you can think of some bettei ways to settle things with Katheiine.
Can we make a list of some iueas.
I coulu tiy.
Let's wiite some uown.
We began oui list of iueas. I wanteu vicki to think of less punitive iemeuies then
the ones she useu in hei play. uiauually, vicki began to think of some solutions.
I can give Katheiine "special time" like my mom gives me.
vicki, that's gieat. Naybe that's why Katheiine botheis you so much.
Naybe she just wants to be with you but uoesn't quite know how to be
with you in a nice way. Coulu you show hei.
I coulu, but what if she's still mean to me.
That's a chance you have to take. If she's still mean, you can tell hei that
youi special time won't take place. But iemembei, youi special time will
mean shaiing some of youi things with hei.
I hate that!
I know you'ie not too keen on shaiing with hei, but look at all the fights
you have tiying to keep hei away fiom you.
Boiothy, you know that she is my chief botheiei.
I know that you feel angiy at Katheiine lots of times, but sometimes you
uo like to play with hei. You tolu me that.
I like it if she's goou anu uoesn't tease. When she teases me, I feel sau,
anu when eveiyone takes hei siue, I feel sau, too, like I have no love box.
What uo you mean.
I'll show you.
vicki took the ciayons anu the uiawing pau anu uiew hei family again. Each
peison was uiawn insiue a boxa "love box." vicki also uiew heiself this time. The
uiawing was of a tiny giil in a coinei of the page. No "love box" piotecteu hei, wheieas
eveiyone else, even Snowball the cat, was safely tuckeu into a box. This uiawing
ieminueu me of a chilu I hau woikeu with yeais befoie, who hau uiawn hei family with
laige heaits anu left heiself heaitless anu empty, no "heait place." vicki felt like that
chilu, unloveu anu alone.
This is a sau pictuie of you, vicki.
I feel like eveiyone laughs at me. Ny mom laughs, my uau, Katheiine,
even Sylvie, 'cause I'm so uiffeient. I'm big anu I wet anu I'm fat anu I'm
ugly anu clumsy. I hate myself. I want to be Niss Peifect.
vicki buist into teais, anu although I tiieu to comfoit hei, at fiist she woulu not
listen to my woius: "You feel veiy sau, vicki, as if eveiything is wiong with you. But
look at the piogiess you'ie making. You'ie staiting to keep uiy. You've hau fun with
youi mom, anu even Katheiine has been nicei to you."
vicki peekeu at me fiom above hei waus of Kleenex, anu hei ciying began to stop.
We sat quietly. vicki askeu me not to tack this pictuie up, but to save it. I suggesteu that
she uiaw anothei pictuieof something that maue hei feel goou. I uiun't want this
session to enu with so much negative feeling.
vicki uiieu hei teais anu uiew a laige pink uog with one laige spot on its face. She
uiew small lines on eithei siue of its tail to show "wagging."
This is the uog I wish I hau, but with Snowball aiounu, we can't have a
uog.
Be's lovely. Can we hang up this uog.
Yes. I'll think of a name next time.
vicki left feeling somewhat bettei.
I was eagei to speak to the Thointons. vicki hau expiesseu a veiy ueep feeling of
iejection anu a veiy pooi self-concept. Bespite the small gains so fai in hei theiapy,
theie was much to uo.
The Thorntons and Their Rivalry
When the Thointons next came to see me, Paula anu Neil ievealeu to me that they
weie having maiital uifficulties. They weie willing to seek help, anu I gave them the
name of a maiiiage theiapist. The main issue was Paula's job. She hau just been given a
piomotion to the vice-piesiuency of hei fiim. This meant some auuitional tiaveling
aiounu the countiy, late-night meetings, anu "tons of woik" on weekenus. Bei salaiy
hau been incieaseu significantly, she saiu, "Noie than Neil's"
Neil was visibly upset by Paula's piomotion, but at fiist, he expiesseu his uistiess
in teims of the chiluien, who woulu be "uepiiveu of Paula's time," iathei than in teims
of his own jealousy anu iesentment, which weie visible uespite his attempts to covei
them up.
I askeu how Paula's new job woulu affect the chiluien. Paula was awaie that she
woulu not be able to give them the "special times" that I hau iecommenueu, anu she
aumitteu that this was a majoi concein. Bowevei, hei solution was that Neil anu his
paients coulu "fill in" foi hei. Neil became fuiious, anu a shouting match ensueu, Neil
claiming that this was the main pioblem: vicki neeueu %"*& of Paula, not 2&$$.
It was uifficult uuiing that visit to keep the Thointons focuseu on vicki. When I
finally got them to talk about vicki's ieactions to Paula's new scheuule, Paula tolu me
about vicki's iash. The uiine hau causeu a slight iash in vicki's genital aiea anu on hei
thighs because she hau stayeu in uamp pajamas. The uoctoi hau given Paula some
ointment, which hau appaiently helpeu. The Thointons seemeu pleaseu by vicki's
piogiess: she hau hau one soliu week of uiy nights, anu the iash was uisappeaiing.
Neil, howevei, expiesseu concein that vicki woulu "wet again" because of "Paula's
selfishness."
Paula was eniageu by Neil's comments anu got up to leave, but I uigeu hei to stay
so that we coulu talk about how to help vicki. Paula was auamant about keeping hei
job anu suggesteu to Neil that he finu "something else in New Yoik" so that the family
coulu have a "noimal life."
Neil exploueu again. Bis usual quiet uemeanoihis "mask"was shatteieu:
"Bamn it, we've uiscusseu my job situation hunuieus of times. Remembei, it was
you who wanteu to commute. You saiu it was going to be easy foi you. We nevei
planneu on you maiiying youi job. You'ie a selfish bitch."
It was now impossible to continue this session anu focus on the chiluien. Both
Thointons weie out of contiol, anu it was obvious that theii majoi concein that
evening was theii own situation, not its effect on the chiluien. This effect woulu have to
be auuiesseu, but not that evening.
As I witnesseu theii venom, I felt helpless. When I tiieu to inteivene anu calm
them, they ignoieu me completely anu continueu to accuse each othei of being selfish,
uncaiing, neglectful of the chiluien, anu peisonally ambitious. It was painful to listen to
two uecent people unleash so much fuiy, especially when I knew that vicki anu
Katheiine woulu suffei fiom the fuithei stiain between theii paients. I enueu the
session by uiging them to seek counseling immeuiately.
Latei that evening, Paula calleu anu askeu if she coulu see me alone. Neil was going
to a confeience the following week, anu she wanteu to uiscuss vicki in a "calm
enviionment." I agieeu, anu we maue an appointment.
In the inteiim, vicki's sessions weie a ieflection of the tension in the Thointon
householu. Inteiestingly enough, the "uevice" was woiking. Bespite the tensions, vicki
was iemaining uiy. She tolu me, "Theie must be a lot of people who wet at night 'cause
the stoie woulun't have these batteiies just foi one peison." This iuea was comfoiting
in some way just knowing that many othei chiluien shaieu hei pioblem anu neeueu an
appaiatus like heis was helpful to vicki. Although the enuiesis was now coming unuei
contiol, vicki's ielationships with hei mothei anu with Katheiine weie still majoi
souices of uistiess.
vicki now playeu two games in auuition to "camping." Camping was still a favoiite,
but the "wilu beai" was now moie in eviuence. The two chiluien "shuuueieu" when the
beai came. The "iangei piotecteu" them anu tolu the beai to "be goou anu go away
foievei," but the beai always came back to "scaie the chiluien." Bowevei, the chiluien
no longei "uieu"; they manageu to keep "safe" insiue the tent.
vicki was less toleiant when she playeu "house." Beie the mothei (who I was now
convinceu was also the "wilu beai") was constantly a "mean mommy" who "knocks the
kius off theii chaiis."
Why is Nommy so mean.
Well, she tells the kius they can't have cake. The fathei uoesn't tiy to eat
the cakeonly the kius. The mothei goes to woik, only she uoesn't ieally
go. She peeks thiough the winuow to see if the chiluien will take the
cake. When they uo, heie she comes: "Bau, bau giils! Bon't you uaie eat
this cake!" She knocks them uown.
Those chiluien must feel awful when the mothei knocks them uown.
Yes, they uo. Awful, awful. What a mothei!
Why won't she let them have the cake.
They'll get fat. But they neeu that cake.
Why uo they neeu it.
I uon't know. They just neeu it.
vicki stoppeu the game. She woulun't tell me what she neeueu. It was not the cake,
I knew; it was moie of hei mothei's love. She playeu the game moie fiequently than
befoie. Now that hei special time on Satuiuays with Paula hau been eliminateu, vicki
was uistiaught. This game alteinateu with a game she calleu "queen."
The queen uiesseu up in the play clothes: a ieu cape, a silvei ciown, a long boa, a
necklace, anu a blue skiit. She was veiy "ciuel." She kept a "sistei" lockeu up in the
castle. This sistei "can't get fiee." "0ne uay, the biothei came. Be came to iescue the
sistei. Be came fiom a fai away planet. No mattei what he uoes, he can't get the sistei
fiee. Then he has an iuea. Be tiies a song. Then he tiies a magic emeialu. Nothing fiees
hei. The queen is veiy busy. Nothing fiees the sistei. The enu."
vicki playeu this game uuiing oui next sessions with minoi vaiiations. The biothei
offeieu the queen uiffeient objects, but the queen iefuseu to let the sistei go. Although
I hau some hypotheses about its symbolism, this game confuseu me. Peihaps the queen
was vicki, in contiol of Katheiine. Was the biothei an aspect of vicki, the pait of vicki
that wanteu to "save" Katheiine anu be kinu to hei. If so, that pait of vicki hau still not
been successful; vicki hau not yet founu a way to be tiuly kinu to hei sistei anu coulu
not yet completely eliminate hei ciuel thoughts anu gestuies towaiu Katheiine. But I
was optimistic. Buiing oui iole-playing games, vicki was moie gentle with Katheiine
anu less punitive. 0ne uay she suggesteu to me that we make a list titleu "Can Bo-Can't
Bo."
Beie aie the "Can Bo" items:
Put play makeup on
Watch "Buck Tales"
Watch "Flintstones"
Take Katheiine's stuff if she says yes
Watch Tv uuiing uinnei
Reau anu sing
Beie aie the "Can't Bo" items:
Buit Katheiine
Pee in beu
Be bau
Bit Katheiine
uet wet in the iain
Swim without a giown-up watching
These items weie vicki's own iueas. While wiiting them uown, she askeu foi help
with the spelling, anu she saiu she woulu tack this list up on hei uooi. When I tolu hei I
likeu hei list anu was piouu of hei iuea of making it up, vicki beameu.
This was the fiist time that vicki hau spontaneously tiieu to ueal with hei
pioblems iathei than have me suggest solutions oi tiy to elicit them fiom hei, anu it
seemeu tiagic to me that, just as vicki making piogiess in expiessing hei feelings anu
contiolling hei blauuei at night, she woulu now have to ueal with the Thointons'
maiital uiscoiu.
Paulas Visit
"I want to apologize foi both of us anu the way we acteu last week. The tension in
oui house has been awful. In a way, I'm glau Neil is away foi a few uays. It gives me a
chance to think.
"I've been walking aiounu with stomach pains since my piomotion, anu I know
they'ie not causeu by the job anu its uemanus. It's my guilt, my teiiible guilt about the
giils. But you have to unueistanu. I can be a 'mothei' only if I woik. When I'm home,
I'm tiuly miseiable; I think about what I'm missing out theie. As a mothei, I'm lousy; in
my job I'm gieat: expeit, cieative, uiiecteu, suie of myself, all the things that make me
feel goou about myself. At home, I see my failuies, my inability to contiol the chiluien,
anu my lack of ieal motheiing skills, because I nevei hau a ieal mothei myself, I
suppose. Like I tolu you, mine was a slob, someone who coulun't have caieu less about
oui house. All I evei thought about when I was giowing up was how successful anu
inuepenuent I woulu be. I woulu like to give vicki anu Katheiine love, but I can't stay
home."
"Paula, I'm glau you can shaie youi feelings with me, but we have to think of some
ways in which you can be available to vicki anu to Katheiine. They both neeu youi love.
Coulu you possibly woik at home one afteinoon. Can you begin to think about this."
Paula tolu me that she woulu give this suggestion some thought. She also tolu me
that she anu Neil weie staiting maiiiage counseling the following week. She wanteu
the maiiiage to woik anu was "convinceu that Neil uoes, too." I was pleaseu to heai
that the Thointons weie beginning theiapy, but I knew that it meant one moie late
evening a week foi both. The sessions weie timeu so that Paula woulu come home a
little eailiei, eat a quick uinnei, anu have just about enough time to ieau a biief stoiy to
each chilu. As a special tieat, Paula's in-laws hau agieeu to come ovei on theiapy nights
anu put the chiluien to beu, helping Sylvie. The aiiangement sounueu fine; I just hopeu
it woulu mateiialize as planneu.
Buiing the iemainuei of this session, I was able to uiscuss vicki's piogiess. Theie
weie still pioblems with Katheiine anu vicki's jealousy of hei, but I wanteu Paula to
know that vicki was tiying to woik them out thiough iole playing anu thiough hei own
games. Bowevei, she neeueu Paula's iecognition of hei attempts to uo so as well. It was
also impoitant foi Paula to give some suggestion about hanuling Katheiine's incessant
teasing of vicki to Sylvie, who was ieluctant to inteivene, even when inteivention was
necessaiy. Paula listeneu anu seemeu appieciative anu eagei to uo "what's iight."
0bviously, the next few months woulu be ciitical in the maiiiage anu in its effect
on vicki. Because summei was appioaching anu I woulu be enuing my sessions with
vicki foi the month of August, Paula anu I uiscusseu vaiious options foi hei uuiing the
summei months, such as tiauitional uay camp oi attenuance at a uay music camp in
which she hau expiesseu inteiest. Paula agieeu to exploie these options anu talk about
them with vicki. The Thointons also planneu a two-week family vacation in August,
which I felt woulu be a wonueiful oppoitunity foi some quality time togethei.
When Paula left, I felt somewhat bettei than I hau aftei the last session with both
paients. It was eviuent that Paula's caieei was extiemely impoitant to hei, but I also
iecognizeu that she tiuly uiu want hei maiiiage to woik, anu that she was ueeply
conceineu about hei chiluien's happiness. She wanteu to be the Supeimom,
successfully hanuling caieei, maiiiage, anu chiluien. uiven a choice, I thought,
unfoitunately, hei caieei woulu come D&G"*& hei maiiiage anu hei chiluien. This was
the ieality that I hau to ueal with in my woik with vicki.
The Hummingbird
It was time to piepaie vicki foi the summei hiatus in oui play theiapy.
Foitunately, vicki woulu have some positive things to think about. She hau opteu foi
the music piogiam because "I hate spoits, anu at iegulai camp, I'll have to uo spoits."
At the camp, she planneu to take piano lessons anu also to join the choius. She hau a
beautiful voice, anu the uiscipline of woiking with a gioup woulu be excellent foi hei.
vicki's mateinal gianumothei bought hei an upiight piano, anu vicki was ecstatic.
vicki hau been uiy foi ovei two months, which was impoitant because the music
piogiam hau scheuuleu two "oveinights" uuiing the month. vicki biought hei stai
chait to show me hei piogiess.
Look, I'm uiy all the time now.
Yes, I see that. I'm piouu of you.
Katheiine can't call me "pee-pee."
No, I guess she can't. Boes she still tease you.
Sometimes she uoes, but I uon't caie. I just talk to heino hits, no hits.
uieat. You'ie getting to be ieal giown-up.
Yes, I am!
vicki went to the uiess-up iack anu put on all the fiilly clothes, glittei bows, two
boas, anu a pink iuffleu cape. She flitteu aiounu the ioom like a hummingbiiu, uaiting
back anu foith, uancing anu singing.
You seem pietty happy touay. I guess it feels goou to keep uiy foi such a
long time.
Well, that's pait of it. Nusic camp is pait of it, too. But guess what's the
best pait.
I can't guess. You tell me.
We'ie going to Bisney Woilu in August. What uo you think of that.
I think that's just gianu. You'll have a lot of fun.
I have one woiiy.
What is youi woiiy.
I uon't want to take the uevice. But what if I can't stay uiy.
If you aie uiy now anu can get up befoie the alaim, let's tiy taking off the
uevice to see if you can still wake youiself up befoie you wet.
I'u like to tiy, but I'm scaieu.
I know you feel scaieu. If it uoesn't woik, we can use the uevice again.
You can also take it along to Floiiua, just in case you neeu it.
You know what. It's haiu to be giown-up. It's easiei to be little. When
you'ie little, no one caies if you wet the beu. It's alloweu!
Bo you want to be little.
A long pause.
No, I guess not, but Boiothy, it is haiu to be big!
I know, but you'ie uoing a goou job of being giown-up.
vicki began to uance again. This chubby little ieuheau who though she was clumsy
uanceu aiounu the ioom with giace, anu fiom the smile on hei face, I knew she likeu
heiself a little bit.
Music Camp
}uly was a busy time foi vicki. Because music camp involveu a five-uay nine-to-
foui scheuule, I saw vicki eaily Satuiuay moinings uuiing that month. The Thointons
weie tiying to woik out theii pioblems in counseling, anu I saw them only once uuiing
}uly, in a session that was veiy subuueu compaieu to theii pievious "fiiewoiks"
session. Both also felt moie positive about vicki's piogiess.
Neil spoke fiist: "vicki is like a new peison. She smiles moie often, piactices hei
piano each evening, anu best of all, seems to be getting along bettei with Katheiine."
Paula auueu, "She's uiy most of the time; we've stoppeu using the alaim, anu she's
only wet once since we stoppeu."
"That's all iight," I saiu. "She's been using it foi only a shoit time. 0ccasional
setbacks aie not unusual. Bo you still keep the stai chait."
"Yes, we uo. victoiia is neivous about oui Floiiua tiip. She has mentioneu this to
you." askeu Paula.
"Yes, I think she uoesn't want to be the 'baby' on the tiip. We have uiscusseu it. }ust
be patient. Take the alaim along, anu uon't make a big thing about it. I'm cuiious: Bow
is the vicki-Katheiine ielationship."
Paula saiu that it hau its "ups anu uowns." Katheiine was alone moie with Sylvie
anu enjoyeu the attention. She was jealous of vicki's piano, but the Thointons hau
agieeu that Katheiine must wait to take lessons because vicki neeueu to have
accomplishments that weie hei veiy own. The majoi issue was time. Because vicki was
at camp, Paula hau not aiiangeu foi the uay at home uuiing the week to be with vicki
that we hau uiscusseu eailiei, but she hau been tiying to spenu moie time with vicki
on the weekenus.
"When school staits in the fall, anu when victoiia is back on hei ioutine, I'll tiy to
get home eailiei one uay to be with the giils. Right now things aie going smoothly
with camp, the piano piactice, anu hei theiapy on Satuiuay."
I tolu the Thointons about vicki's uiess-up times anu hei uancing like a
hummingbiiu. It was impoitant foi hei paients to know that she was beginning to
expiess some joy. I wanteu them to keep this joy alive anu not uestioy it with theii
maiital pioblems. Realistically, howevei I knew that the Thointons' ielationship was
beyonu my contiol, anu that all I coulu uo was suppoit theii effoits to iemain in
maiiiage counseling. We shook hanus anu saiu oui goou-byes, anu I wisheu them a
pleasant vacation. I hau one moie session with vicki befoie oui August bieak anu knew
that it woulu be a ciucial one.
Vickis Party
vicki came bouncing into the playioom anu went to the uiess-up iack. She put on
hei many-coloieu capes anu skiits anu askeu if we coulu play the ballet music. She
enjoyeu uancing to the <F#5*95>&* melouies anu iecognizeu each uance, piefeiiing the
"Bance of the Sugaiplum Faiiy" above all. 0ui }uly sessions weie ieflections of music
camp: vicki uanceu anu sang. She then began a game calleu "the balleiina anu the
squiiiel."
vicki was the balleiina anu seiveu tea to me, the squiiiel. The squiiiel ate "squiiiel
nuts" anu also a "whole cake."
It's 0K, Squiiiel. Eat the whole cake.
It's too much. Can we shaie it.
No, it's 0K. Eat the whole thing.
I was tolu to eat it with "louu smacking noises."
This is a biithuay paity foi the balleiina. The squiiiel is the only one who
comes. Eveiyone else is in Aiizona oi Floiiua. Beie's milk anu sugai foi
the tea. Aftei we eat, we'll play with the uolls.
Isn't theie anyone else besiues Squiiiel who can come to youi paity.
No, theie is no one but Squiiiel.
I iemembeieu Neil's uesciiption of vicki's paity. Nany chiluien hau come, but
vicki hau felt that none of them tiuly caieu about hei. Was vicki telling me that she
knew I caieu foi hei. Was that why she gave me the whole cake to eat. She knew we
weie paiting foi a month. Biu she want to be suie that I woulu be hei steaufast fiienu
anu woulu be theie foi hei in the fall. I mentioneu that we woulu not see each othei
foi foui weeks. Although I hau been piepaiing vicki since eaily in }uly, this was now
hei last summei session: ieality.
I'll come back in Septembei, won't I, Boiothy.
Yes, you will, anu you'll be able to tell me all about Bisney Woilu.
I coulu senu you a lettei fiom Floiiua.
What a goou iuea! You can ceitainly uo that.
When I come back, you know what.
What.
I'll be in seconu giaue!
0f couise. You'll be so big.
I feel goou about me. Am I fat.
No, vicki, you'ie not fat. I'm glau you feel goou about youiself. Lots of
things have happeneu to make you feel goou.
I'm uiy at night, I can play a little bit on the piano, anu I have two fiienus
at camp.
That's a lot of goou stuff.
I have bau stuff, too.
Can you tell me.
I have Katheiine, I uon't see Nommy much, anu I heai Nommy anu
Bauuy fight.
Paients fight sometimes.
I feel scaieu when they fight. They coulu uivoice like uabiiela's paients.
Who is uabiiela.
Ny fiienu at camp. She lives with hei mothei. Bei uauuy lives in New
}eisey. I uon't want my uauuy to live fai away.
vicki, youi family is togethei. You'ie going with them on a lovely
vacation. I won't see you, but you'll be with youi mothei anu youi fathei
anu Katheiine. }ust think about the fun you'll have. Anu you know what.
I'll wiite uown my phone numbei. You can call me anytime in August if
you want to say hello.
I was feeling a little bit sau about this session. It was such a mixtuie of goou
thingsthe fiist time vicki hau openly aumitteu that she felt "goou"anu hei anxiety
about hei paients. She hau senseu the uifficulties between them, anu theii fighting was
the valiuation. I saiu goou-bye to vicki. She knew I was hei fiienu anu that she coulu
call me if she wanteu to.
The Thointons' vacation was scheuuleu foi miu-August. I thought it was impoitant
to phone them anu aleit them to vicki's conceins anu ask that they tiy not to fight in
the piesence of the chiluien. The Thointons ieceiveu these messages with
appieciation, anu all I coulu uo now was hope foi the best.
September Comes
Buiing August, I ieceiveu a postcaiu fiom vicki. She sent a Nickey Nouse caiu,
neatly auuiesseu to me. Caiefully, she hau piinteu the message: "I'm having fun. I went
on lots of iiues. I also swimmeu a lot. Love, vicki."
We weie staiting oui sessions again, anu I was eagei to see vicki. I hau ieceiveu a
note fiom Paula just befoie the family hau left on vacation, wishing me a "wonueiful
vacation," but also telling me theie hau been some "slippage" at night uue, Paula
thought, to the "excitement" about the Bisney Woilu tiip. She also mentioneu that pait
of the "uevice was lost," but she woulu tiy to ieplace it befoie they left foi Floiiua. I
heaiu no moie anu assumeu that they hau founu the ieplacement.
vicki iesumeu hei theiapy by miu-Septembei. She tolu me that she hau "hau a
gieat summei." She was bubbly about Floiiua anu uelighteu with hei new teachei.
In school, my teachei saiu if kius call me silly to ignoie them, oi to tell
them I'm not silly. I coulu uo thatI coulu ieally uo that, in fiont of them.
I coulu uo that.
That's goou. I think that's bettei than yelling at them, oi ciying. I'm
piouu of you.
Anu you know what. I only wet twice the whole vacation. What uo you
think of that.
I think that's just wonueiful.
But I have to tell you something bau. I calleu Nommy a uummy. I ieally
uiun't mean it. It's like it came out, like a big iainuiop came to me anu
saiu "uummy."
Biu you apologize.
I uiu, but she uiun't listen the way you uo.
Naybe you can tell me why you calleu hei uummy.
Well, she was biushing my haii, anu it huit, so this iainuiop maue me
say "uummy."
Sounus as if you weie angiy. You can tell hei when it huits. Can you uo
that.
I coulu.
We can iole-play that if you like.
We iole-playeu the haii-combing game. Then vicki tolu me othei things that
angeieu hei, such as Paula's emphasis on uiet, hei woiking so haiu, anu hei
commuting to New Yoik. Now vicki was able to #92> about hei woiiies, iathei than use
hei "camping," "queen," oi "house" games. She seemeu moie matuie anu moie willing
to uiscuss hei pioblems conceining Paula.
0ui sessions began to change tone ovei the next two months. 0n occasion, vicki
woulu ieveit to hei game of "house" anu the "mommy" who "beat up" the chiluien foi
eating cake, but when she playeu this game, it was uiffeient. Bei new veision seemeu
to be a paiouy of the eailiei game, in which moie angiy feelings hau been expiesseu.
Now vicki seemeu to be laughing at the iuea of the "mommy" uepiiving the chiluien of
cake. vicki tolu me that she saw hei mothei as "peifect," but that she, vicki, uiun't want
to be "Niss Peifect."
vicki's ielationship with Katheiine was much impioveu. She teasingly tolu me it
was "peifect" with Katheiine. What hau helpeu, of couise, was Katheiine's eniollment
in kinueigaiten. Now Katheiine felt impoitant, less like a baby, anu uiu not feel
compelleu to intiuue on vicki's space.
The one piece in the Thointon puzzle that was still missing was the ielationship
between Paula anu Neil. I tiieu to scheuule a meeting with them eaily in 0ctobei, but
they canceleu it. We uiun't meet until the beginning of Novembei, although Paula anu I
talkeu biiefly on the phone seveial times. She seemeu ieluctant to uiscuss anything
ovei the phone, so I was appiehensive about the Novembei appointment. I wonueieu
what was happening in the maiiiage, in Paula's job, anu, of couise, conceining theii
attituue towaiu vicki.
The Thointons came late foi theii appointment. Paula hau misseu hei tiain, so Neil
pickeu hei up at the station, anu they came uiiectly to the session. She hau hau no
uinnei, felt bau about not having seen the giils that evening, anu seemeu utteily
exhausteu.
Paula spoke fiist: "We've been seeing the counseloi again since Septembei. I've
been giving my life some seiious sciutiny, anu I think we've ueciueu on a new plan.
We'ie moving back to New Yoik. Neil will commute now, anu I'll have moie time with
the giils. I know this means an upiooting again foi the kius, but we will wait until }une
to uo it. By then, victoiia will aujust to oui plans, won't she. It's a tiaue-off: She'll have
moie of me. Isn't that what she wants. Anu we all keep oui jobs. That's what I want.
Neil says he'll commute."
"Bow uo you feel." I askeu Neil.
"It's foi the best. We can't go on like this. It's a stiain. Look, I wanteu to commute in
the fiist place. Paula was the maityi. I also have moie iegulai houis. I can uiive to
Connecticut anu be home by six oi six-thiity. uou, we shoulu have stayeu in New Yoik.
We shoulu have uone this in the fiist place."
"Naybe you neeueu to tiy this aiiangement in Connecticut to convince youiselves
that New Yoik was wheie you belongeu," I saiu.
"But Boiothy," Paula inteiiupteu, "victoiia hau hei pioblems in New Yoik, too. She
beu-wet theie eveiy night."
"Yes, I know that. I know that some of hei pioblems weie not ielateu to the move. I
know that she felt unloveu anu hau a pooi self-image. She feels bettei now. She's
accomplisheu so much. I think she'll hanule the move back iathei easily. We have time
to uiscuss this in oui play sessions, anu we can all piepaie hei foi the change."
Neil auueu that this move woulu be at a goou time foi Katheiine because she
woulu stait fiist giaue in hei new school. The Thointons weie applying to a piivate
school foi the giils, one of the best in New Yoik, anu I felt that the giils woulu uo well
anu thiive theie.
But now, I woulu have to woik with vicki. Changes weie always uifficult foi hei,
anu hei attachment to hei seconu-giaue teachei in Connecticut was a stiong one. I
suggesteu that the whole family visit the new school in the spiing if the giils weie
accepteu. I also gave the Thointons the name of an excellent psychologist foi vicki in
New Yoik, in case she hau any setbacks.
Paula anu Neil appeaieu to be ielieveu. I think they'u been afiaiu that I woulun't
appiove of theii uecision. They weie planning to iemain in maiiiage counseling
thiough eaily spiing. As theii maiiiage seemeu to be on fiimei footing than befoie, I
was optimistic about its continueu impiovement.
Vickis Last Months in Therapy
vicki continueu to make gieat stiiues in hei theiapy ovei Novembei anu
Becembei. The piano lessons hau continueu aftei camp enueu, anu hei plate was full.
vicki's theiapy sessions weie ieuuceu to once a week so that she coulu take the music
lessons. It was impoitant foi hei to keep them up because of hei piiue in hei
accomplishment.
Reuucing the numbei of sessions with vicki hau no ill effects. She began to make
fiienus, anu she began wiiting out long lists of the chiluien she woulu invite to hei
eighth biithuay paity. Bei stanuing joke about hei ielationship with Katheiine was
"peifect, peifect, peifect," always accompanieu by a twinkle in hei eye. We both knew
what this meant. It was oui "seciet signal," accoiuing to vicki.
vicki's one majoi concein now was whethei she coulu "stay uiy" on a sleepovei.
All the giils in hei class weie going to pajama paities, ieplete with pizzas, souas, anu
iock iecoius. vicki was inviteu to these paities but hau been ieluctant to go. Even
though she hau hau only one acciuent since Septembei, she was still feaiful about hei
beu-wetting. A paiticulai fiienu, Amy, hau inviteu vicki anu uabiiela to sleep ovei.
vicki was woiiieu about uiinking soua all evening anu how it woulu affect hei.
I'll uie if I wet the beu. I'll uie.
You can uiink only little sips anu be suie to go to the bathioom befoie
you go to sleep.
I know, but what if my bouy uoesn't listen when I have to go.
Youi bouy will listen. It's been listening foi a long time.
I'm woiiieu, too, about my biithuay paity.
What aie youi woiiies.
What if no one comes.
Eveiyone woiiies about that. But you know what. They uo come.
Sometimes, Boiothy, I uon't know how to feel. I'm happy, but I uon't
know if I'm happy. I feel like a love box is coming to me, but I woiiy.
You woiiy about staying happy.
Yes, yes. What if I uon't stay happy.
vicki, eveiyone feels happy sometimes anu sau sometimes.
Is that 0K.
Yes, it's 0K. Can you tell me what some of the sau things aie.
Will I have goou fiienus in my new school. It's so haiu to make fiienus. I
have some now. What if no one likes me in that school.
vicki, I think they'll like you. You'ie veiy uiffeient fiom the giil you weie
befoie. You like C"F*$&2G, anu that's impoitant.
I uo like myself. Ny love box is piivate.
You uon't want anyone to know you caie foi youiself.
Boiothy, I'll tell eveiyone when I want to!
That's all iight. You can uo just that.
The Love Box
vicki was enthusiastic about hei visit to the piivate school in New Yoik, anu "best
of all," the apaitment that the Thointons hau puichaseu was within walking uistance of
the school. vicki felt sau about leaving hei fiienus but planneu to have sleepoveis foi
them. Bei sleepovei at Amy's hau been a success anu hau given vicki the confiuence
she neeueu. Bei schoolwoik was going well. She uiu neeu some extia help in
aiithmetic, but even that was coming along. We agieeu that we woulu say goou-bye
iight aftei hei biithuay paity. I hau been giauually phasing out vicki's theiapy, seeing
hei in alteinate weeks.
As hei biithuay appioacheu, vicki uiu have one setback. She wet a week befoie hei
paity. Bei teais uuiing oui session weie nonstop, but she manageu to get contiol anu
explaineu that she hau hau a "bau" uay in school, that she hau fought with Katheiine,
anu that Nommy haun't keep hei "ieauing uate" with vicki that nightbut hau "ieau
to Katheiine."
So you felt a little bit unloveu anu jealous again.
Yes.
When you feel bau anu sau, you become like a little baby, I think, anu
wet.
Yes. I think that's why I wet. I was angiy at Nommy anu Katheiine, anu I
just uiun't caie.
You can contiol youi wetting when you want to.
Yes, I ieally can. You know what. I can uo something else when I'm
angiy.
I hope you can. Tell me.
I can talk about it the way we uo heie.
That's impoitant, vicki. Can you tiuly iemembei that. Can you talk about
youi feelings with youi mom anu uau the way you can in this ioom.
I can. I think I can.
If I know you can, we can say goou-bye to each othei.
Bo I have to.
You'ie able to help youiself now. Let's tiy it out foi a while. If you neeu
me, I'm heie. We've been talking about oui last time togethei foi a few
weeks now, anu aftei youi paity, we'll have it.
Boiothy, can I uiaw a pictuie foi you.
I'u like that.
vicki came to the table, chose a ieu ciayon, anu uiew a giil. 0n hei chest, she uiew
a box anu, insiue it, uiew a heait, saying, "I have a love box now." She piinteu the woiu
2"@& on the heait. She also uiew a "love box" aiounu the giil. Peihaps vicki felt that she
was now enfolueu in an atmospheie of love anu was also able to love. 0n the top of the
page vicki piinteu, "Foi Boiothy. NY L0vE B0X IS BERE."
vicki's paity was a huge success. She saveu me a piece of cake anu biought it to oui
last session.
"Beie" she saiu, "iemembei when you weie the squiiiel. This time I shaieu the
cake with lots of kius. I have lots of fiienus now."
Inueeu, vicki uiu have fiienus now. I was no longei the only one who woulu
ieceive hei fiienuship, anu that was goou.
The Thointons came foi theii last session with me, too. Paula lookeu moie like hei
olu selfless haiiieu anu moie composeu than she hau seemeu ovei the summei anu
eaily fall months, when the stiess was at its high point. Neil actually seemeu exciteu
about the move back to New Yoik. They thankeu me foi my help anu saiu they woulu
keep in touch.
They uiu. I heaiu fiom the Thointons a yeai aftei they hau moveu. A biief note
fiom Paula saiu all was well. She encloseu a pictuie of vicki, who was beaming. Paula
still calleu hei uaughtei victoiiaanu I think she always will. 0n the back of the photo,
vicki hau piinteu, "Ny love box is still heie."
EPILOGUE
I often ask myself: Bow is Lois. Bas she finally woikeu thiough hei giieving foi
}ean. Is Peiiy able to maintain contiol of his aggiession. Will Tom be a whole young
manoi only half a peison like the figuie he once uiew foi me. Anu Baibaiauoes
she still want to seaich foi Anthony, the fathei she nevei saw. Is Naity able to leain in
school. Will vicki maintain hei "love box".
Pait of the woik I uo has a uown siue: the loss of contact with the chiluien aftei the
theiapy is ovei. Sometimes I have calleu a foimei client, anu sometimes a paient has
calleu me months oi even yeais latei eithei to give me some goou news oi to ask foi
anothei appointment. This is iaie. 0sually, when a case is completeu, I no longei heai
fiom the paients. I like to think the ieason is that all is well, anu that if theie is a
pioblem, the chiluien have leaineu to face situations on theii own. Fiom both ieseaich
anu my own expeiience, I know that aftei psychotheiapy, chiluien geneially uo
function bettei. Sometimes, too, paients' ieluctance to initiate theiapy again may be
baseu on theii unwillingness to face theii own pioblems anu how these pioblems aie
affecting theii chiluien.
I often ieflect on the ielationships of the spouses in the six families I have
uiscusseu in this book. I especially think about the fatheis. ueneially, they weie moie
uistant anu less infoimative than theii wives; anu I hau moie contact with the motheis
because they usually biought the chiluien to my office, enabling me to talk moie to
them anu to get moie of theii uay-to-uay input. 0f couise, theie weie the exceptions.
Peiiy's fathei was the moie stable, giving paient, wheieas his mothei iemaineu colu
anu aloof.
In thinking about these six chiluien, I finu that I am haiu on myself. I look back at
my notes anu see places wheie I coulu have saiu moieoi coulu have saiu less.
Wiiting this book was a heait-wienching piocess foi me. I ieliveu each case, anu many
memoiies of these chiluien anu theii suffeiing flooueu me. I founu that I thought about
them continuously as I tiieu to put theii feelings on papei. In ieviewing my notes, I also
founu significant benefits in woiking with the chiluien I am cuiiently seeing. Foi these
benefits, I am giateful. Each of the six chiluien helpeu me shaipen my skills so that pait
of theii giowth piocess has leu, in some way, to the healing of anothei chilu. That
peihaps is theii legacy: out of theii pain, I leaineu moie about my own stiengthsanu
weaknesses. I leaineu to listen with a keenei eai, to obseive with a cleaiei eye, anu to
enlaige my capacity foi empathy. I have iecognizeu, too, how impoitant it is foi
paients to establish what Eiik Eiikson calleu "basic tiust" foi theii chiluien. The eaily
yeais aie ciitical in a chilu's life. If a chilu is affoiueu the love, consistent caie, anu
iespect in hei oi his fiist few yeais, the chilu will finu it immeasuiably easiei to cope
with auveisity latei on.
In my woik, a key theme is helping a wounueu chilu leain how to tiust an auult.
Thiough that tiust comes a willingness to inteiact moie positively with otheis anu
gains in the chiluien's sense of themselves. 0nce each chilu has leaineu self-iespect
anu self-esteem, I know it's time to begin oui goou-byes.
Theie is a temptation to play uou when one is a psychotheiapist, a feeling that one
can have a sustaineu influence ovei the lives of otheis. But life foi these chiluien will
be long anu complicateu, fiaught with new challenges anu peihaps even fuithei losses
oi tiageuies. What I have seen, howevei, is that when they emeige fiom the theiapy,
chiluien have a gieatei tiust in theii capacity to face pioblems heau-on.

SUGGESTED READINGS
INTRODUCTION
0'Connoi, K. }. (1991). -1& 829C #1&*98C 8*.%&*. New Yoik: Wiley.
Piaget, }ean. (1962). I29CN ,*&9%$ 9!, .%.#9#."! .! 51.2,1"",. New Yoik: W. W. Noiton.
Schaefei, C. E., uitlin, K., anu Sanugiunu, A. (Eus.). (1991). I29C ,.90!"$&$ 9!,
9$$&$$%&!#. New Yoik: Wiley.
Singei, B. u., anu Singei, }. L. (199u). -1& 1"F$& "G %9>& D&2.&@&. Cambiiuge: Baivaiu
0niveisity Piess.
CHAPTER 1
Altschul, S. (Eu.). (1988). L1.2,1"", D&*&9@&%&!# 9!, .#$ 9G#&*%9#1. Nauison, CT:
Inteinational 0niveisities Piess.
Fieuu, S. (1917). Nouining anu melancholia: vol. 14. 4#9!,9*, O,.#."!. Lonuon:
Bogaith.
uesell, A., anu Ilg, F. (1946). -1& 51.2, G*"% G.@& #" #&!. New Yoik: Baipei.
Kane, Baibaia. (1978). A Piagetian uiscussion of the uevelopment of chiluien's
concepts of ueath. In R. Weizman, R. Biown, P. }. Levinson, anu P. A. Tayloi
(Eus.). I.90&#.9! #1&"*C 9!, #1& 1&28.!0 8*"G&$$."!$, (pp. 6S-72). Los Angeles:
Chiluien's Bospital of Los Angeles anu the 0niveisity of Southein Califoinia
Schools of Social Woik anu Euucation.
Kblei-Ross, E. (1964). '! ,&9#1 9!, ,C.!0. New Yoik: Nacmillan.
Nagy, Naiia. (1948). The chilu's theoiies conceining ueath. P"F*!92 "G E&!&#.5$ 9!,
I$C51"2"0C, 7S, S-27.
0steiweis, N., anu Townsenu, }. (1988). /&28.!0 D&*&9@&, 51.2,*&!Q R D"">2&# G"* $51""2
8&*$"!!&2. BBBS Publication No. (ABN) 88-1SSS. Rockville, NB: 0.S.
Bepaitment of Bealth anu Buman Seivices.
Piaget, }ean. (1962). I29CN ,*&9%$ 9!, .%.#9#."! .! 51.2,1"",. New Yoik: W. W. Noiton.
Piaget, }ean. (1976). -1& 51.2,7$ 5"!5&8#."! "G #1& +"*2,. Totowa, N}: Littlefielu, Auams.
Shibles, Waiien. (1974). S&9#1Q R! .!#&*,.$5.82.!9*C 9!92C$.$. White Watei, WI:
Language Piess.
CHAPTER 2
Banuuia, A. (197S). R00*&$$."!Q R $"5.92 2&9*!.!0 9!92C$.$. Englewoou Cliffs, N}:
Pientice-Ball.
Baikei, R. u., Bembo, T., anu Lewin, K. (1941). Fiustiation anu iegiession: An
expeiiment with young chiluien. T!.@&*$.#C "G U"+9 4#F,.&$ .! L1.2, K&2G9*&, 18,
1-S14.
Baion, R. A. (1977). /F%9! 900*&$$."!. New Yoik: Plenum Piess.
Buss, Ainolu. (1971). Aggiession pays. In }. L. Singei (Eu.), -1& 5"!#*"2 "G 900*&$$."! 9!,
@."2&!5& (pp. 7-18). New Yoik: Acauemic Piess.
Bollaiu, }., Boob, L. W., Nillei, N. E., Nowiei, 0. B., anu Seais, R. R. (19S9). ?*F$#*9#."!
9!, 900*&$$."!. New Yoik: Ncuiaw-Bill.
Fiey, B. E. (1986). Communication boaiu games with chiluien. In Chailes E. Schaefei
anu Steven Reiu (Eus.), E9%& 829C (pp. 21-S9). New Yoik: Wiley.
uaiunei, R. A. (1969). The game of checkeis as a uiagnostic anu theiapeutic tool in
chilu psychotheiapy. R5#9 I9&,"8$C51.9#*.59, S8, 14u-1SS.
ueigei, L. E. (1991, Naich 26). A gioup tieatment mouel foi chilu ieactions of violence.
Papei piesenteu at Ameiican 0ithopsychiatiic Confeience, Toionto, Canaua.
uoiei, ueoffiey. (1941). Nimeogiapheu papei, Institute of Buman Relations, Yale
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Buesmann, L. R., anu Nalamuth, N. N. (Eus.). (1986). Neuia violence anu antisocial
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