Family Therapy

Greater Surrey Children's Services

Gemma D. Walker, Ph.D., Psy.D. Psychologist UK License PSY17946

Progress Note: October 8th, 199-

Session#2 Present: Ind, maternal Aunt, Uncle

Treatment Goals: Reduce individual's [ind's] depressive symptoms [sxs] by teaching ind to recognize sxs, use appropriate coping skills to reduce negative feelings. Teach ind to appropriately express negative feelings at least 1x/wk w/ therapist.

Session Goals: Build rapport w/ ind. Begin teaching ind to express negative affect with therapist. Have L[egal] G[uardian]s sign goals contract.

Symptoms: Low mood, poor eye contact w/ th[erapist] in session, undereating, hoarding food, verbal and physical aggression towards same-age cousin, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle.

Interventions & Response: Th presented goals to LGs, who reacted /w anger, expressing concerns that th "not tough enough w/ the little slacker." Th explained to LGs that therapy does not succeed when th is simply "tough" w/o even forming trust relationship w/ ind. Ind silent, eyes rolled up thru interview. Uncle became verbally aggressive w/ th, who excused Uncle from session. Th explained to Aunt that LGs' refusal to sign goals would result in th writing letter to school and possible charges of child abuse against LGs thru school and Public Health system. Aunt signed goals w/ [with] resistance. Aunt dismissed from session. Ind immediately looked up and smiled at th hesitantly. Th played game of "Chutes and Ladders" w/ ind, who remarked that game had "wrong name". Th explained that th is American and is using her own games from America. Th prompted ind to explain differences in game. Ind became cheerful, smiling, good eye contact, drew British version of game board for th. Ind asked if he could bring his own copy of game "Snakes and Ladders" to next session. Th agreed. Ind's mood dropped visibly as th escorted back to waiting room & LGs.

Plan: Continue trust-building work w/ ind. Work on goals, including helping LGs perceive ind's strengths, use at home.

Consultation Progress Note: October 9, 199-

Present: GD Walker, Ph.D.; Jan Schiller, Ph.D.

Reason for Meeting: Dr W concerned that ind's LGs too hostile to therapy, concerns over discrepancies in ind's appearance versus LGs' report that ind overeats, potential for child abuse report to Public Health.

Discussion: Dr W described content of intake assessment, 1^st interview, 2^nd interview, including concerns that ind is wearing oversized clothes, has broken glasses frames, poor quality of relationship w/ LGs, discrepancies between LGs' presentation of ind and ind's own presentation, both w/ and w/o presence of LGs. Dr S & Dr W discussed options, including child abuse report, ways to involve LGs in therapy successfully and help them to appreciate strengths of ind, work w/ therapy.

Plan: Insufficient evidence for child abuse report at this time. Dr W will continue to monitor situation. Dr S suggests that Dr W also maintain personal process notes to document encounters w/ LGs, ind, in case Dr W must report failure of LGs to comply w/ therapy to school, Public Health.

Personal process note, October 10, 199-

If there is a court case, I'll really have to remove this personal process note. But that's okay; in this country, I am allowed to keep these personal notes separate, so even with a subpoena, I can deny the existence of the personal process notes and still keep them. Too bad I can't deny the Progress Notes, so those have to remain cold and clinical.

But I can't get over Schiller! No abuse report? The kid's plainly being kicked around by that fat turkey of an uncle and his stick-ugly aunt. "Insufficient evidence for child abuse report" my white Yankee butt! In California, I would have reported them after the first meeting. The kid looks starved! Broken glasses? In a country with free medical care that gives away glasses?!?

And all that malarkey about the ind picking on his same-age cousin! Ind is so small himself; how could he be physically aggressing his cousin, unless the cousin is really puny? With a family like that, the poor cousin must be absolutely minuscule, if a kid HP's size can aggress him. I'll have to look into that. Maybe ind does hurt the cousin, but if I had to live with that pair for guardians, I'd be kicking some other kid's butt too.

And then there's dear old Doctor Schiller with all his thinly-disguised dislike for Americans, snidely cracking that "We here in the civilized world do not jump on every case of child defiance towards caregivers and label it 'child abuse'". What "defiance"? All I see is the uncle trying to threaten the kid without my noticing, and the aunt being sweetly vicious, and the kid rolling up his eyes.

Why did I accept this international exchange position? I have a license, yet they make me report to that snotty weed Schiller, like I'm some sort of cognitively-delayed intern. I need to go home!