Family Therapy

Greater Surrey Children's Services

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

Progress Note: October 15th, 1989

Session#3 Present: Ind

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/[with] therapist.

Session Goals: Continue building rapport w/ ind. Begin teaching ind to express negative affect with therapist. Test ind for problems w/ impulsivity as described by LGs.

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: Ind presented w/low affect, head down, shuffling gait, no eye contact on greeting in wait rm. Uncle snarled at th's greeting. Ind sat in th's office, staring at floor, hands limp in lap. Th invited ind to play game. Ind explained that he had "forgotten" Snakes and Ladders game he had offered to bring prev[ious] session. Ind unresponsive to th's prompting to play other games for several minutes, asked th "Is this all we do in therapy?' Th asked ind what ind would like to do. Ind shrugged, stared at floor. Th brought out her Chutes & Ladders game, asked ind to use game board he drew prev session for Brit version of game. Ind became tearful at sight of his drawing, admitted he could not bring game to "any session ever again." W/ gentle prompting from th, ind said game was broken, blamed on same-age cousin, said cou[sin] broke game when cou told ind wanted to take it to therapy session. Th gave ind tissue; ind did not use or allow water to leave eyes but shredded tissue while saying he could not talk about cou. Th gently explained that th does not "need" game from ind, is okay if ind needs or feels like crying in office & promised not to tell anyone. Th explained th would rather just spend time w/ ind. Ind asked, "Are you weird or something?" Office sprinklers went off. Th relocated session to neighboring office, showed ind American version of "Trouble" game. Sprinklers went off in office. Th tried in third office; sprinklers went off upon th's unlocking door. Session stopped to allow ind to leave to get dry clothes. Unable to test ind for level of impulsivity.

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

Collateral contact: October 15th, 1989

Th asked Uncle to bring ind's same-age cou to next session. Uncle refused, saying his son "doesn't hang around with freaks." Uncle raged at th, ind re: being soaked to skin by sprinkler incidents, presence of minute broken glass fragments still evident in corners of building.

Progress Note: October 22, 1989

Session#4 Present: Ind

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/[with] therapist.

Session Goals: Continue building rapport w/ ind. Begin teaching ind to express negative affect with therapist. Test ind for problems w/ impulsivity as described by LGs.

Symptoms: Low mood, tearfulness & poor eye contact w/ th[erapist] in prev[ious] 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: Ind presented w/low affect, head down, shuffling gait, no eye contact on greeting in wait rm. Uncle refused to discuss ind's prev week at home, school, saying "same rotten little blighter as always." Ind showed no response, dragged feet to th's office, expressed relief that office dried after sprinklers prev wk. Th laughed, explained that British building maintenance more effective than American counterparts. Ind asked th to talk about America. Th explained that session for ind to talk about his own world. Ind bitterly remarked that he has "no life to talk about." Th brought out Trouble game to observe ind's level of impulsivity. Ind not familiar w/[with] game, allowed th to explain rules w/ no interruptions. Ind played patiently, good turn taking, good tolerance of th's landing on ind's pieces and returning them to home, no attempts to "pop" game's bubble dice shaker or to take th's turn or rush th. Extremely polite, well-mannered game. No impulsivity evident; indeed, ind shows unusual level of self-restraint for same-age male. Ind asked quietly for another game; 3 games played total. At end of 3^rd game, ind brushed back hair, displayed considerable scar on forehead, jagged shape. Th asked ind origin of scar. Sprinklers in office went off. Ind protected Trouble game inside his coat for th "bec you're my friend now for exactly one hour every week." Th remained in spraying office, played w/ falling water on th's glasses like windshield wipers, and explained that th can be ind's friend whenever ind needs friend, gave ind business card, asked ind to keep safe & phone th if he needs to talk to th. Ind ignored th's humor, held card in water spray until soggy and unreadable, said, "I won't be allowed." Sprinklers in hallway went off. Th removed ind to group room; sprinklers went off. Th terminated session to allow ind to go home for dry clothes.

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

Collateral contact: October 22, 1989

Uncle standing outdoors, as waiting room sprinklers had also engaged. Th asked Uncle to bring ind's same-age cou to next session. Uncle refused, screaming, saying th "irresponsible", making "innocent people wait about in wet offices", threatened to report th to supervisor. Th gave Uncle supervisor's card, invited Uncle to make report if prepared also to explain ind's scar, broken glasses. Ind, behind Uncle, smiled broadly at th, gave "thumbs up."

Uncle attributes ind's scar to car accident that killed ind's pars. Th confronted Uncle re: Uncle's not telling th in intake that ind had been involved in accident. Uncle attributes "little beggar's weirdness" to probable head injury in accident, but also reports that ind never hospitalized after event to Uncle's knowledge. Th confronted Uncle firmly in ind's presence that ind "is not weird, is not crazy, is not cognitively impaired in any way evident " to th or school.

Th demanded immediate referral to physician for examination of cranium for indicators of previous trauma, neurological workup. Uncle refused. Uncle advised that th will make child abuse report. Uncle fumed, reddened, eventually agreed to bring ind's same-age cou to meeting to "show [a] bloody stupid Yank how a proper, manly British child looks." Uncle agreed to have physician make report to th re; potential head trauma, make appointment w/ neurologist for ind.

Collateral contact: October 23, 1989

Male phoned th, claiming to be ind's "distant Uncle Albus." Th explained to caller that, under British Privacy Statutes, th can neither confirm nor deny that th knows of whom "Albus" is speaking and would need a release from ind's LGs to speak w/ any relatives.

Consultation Progress Note: October 23, 1989

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 ind's scar, broken glasses, unreported traffic accident in ind's early childhood, potentially untreated head injury, potential for child abuse report to Public Health.

Discussion: Dr W described content of recent sessions, including concerns that ind is wearing oversized clothes, has broken glasses frames, large and visible scar on forehead, was apparently never treated after car accident or examined for head trauma, 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; however, Dr S advises that report be made if no reports provided from physician, glasses remain broken, clothing not made more appropriate. Dr W will continue to monitor situation.

Collateral contact: October 24, 1989

Male phoned th, claiming to be ind's "long lost cousin Hagrid." Th explained to caller that, under British Privacy Statutes, th can neither confirm nor deny that th knows of whom "Hagrid" is speaking and would need a release from ind's LGs to speak w/ any relatives. Th needed more than 20 mins to discourage caller.

Collateral contact: October 24, 1989

Female, Scots accent, phoned th, claiming to be ind's "Great Aunt Minerva." Th explained to caller that, under British Privacy Statutes, th can neither confirm nor deny that th knows of whom "Minerva" is speaking and would need a release from ind's LGs to speak w/ any relatives.

Personal Process note, October 25, 1989

Potential for kidnap of HP by family to stop therapy threat. Why else are millions of HP relatives coming out of the woodwork? Seriously, if these people cared about the kid, where have they been all this time? What are the LGs up to?

No clients in office today. Found carpet saturated w/ cat feces, urine upon entry this morning. Naturally, Dr Schiller blames me for keeping "an illegal feline" in my office to amuse clients or chalks it up to "innocent collegial prank." If the latter is true, my, what a fun set of colleagues, and what a sweet welcome for the American exchange clinician. I hope that someone in L.A. is positioning my counterpart there in the path of the nearest mudslide...

Told Schiller that I would file Workers' Compensation claim if one more building failure keeps me from finishing my hour with HP this week. Will file Child Abuse report if no positive movement on HP's health issues.