Family Therapy

Greater Surrey Children's Services

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

Progress Note: November 19, 1989

Session#8 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] th[erapist].

Session Goals: Review "broken record" strategy w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation.

Symptoms: Low mood, undereating, hoarding food, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou.

Interventions & Response: Ind presented again in more age-appro clothes, new Public Health-issue glasses. Good eye contact, cheerful greeting to th. Ind asked for game of Trouble; th bargained, saying ind c[ou]ld play Trouble if first ind played "Snakes and Ladders" w/ th, using ind's own hand-drawn board from earlier session. Ind agreed. Th used game to prompt ind to think about other ways he cld get around same-age cou[sin]'s attempts to hurt him, destroy his belongings, etc. Ind reports that cou still bullies him, but more subtle, "leaves no marks", destroys ind's belongings, but L[egal]G[uardian]s deny belongings ever existed, no way to prove to anyone else. Th prompted ind to describe feelings around this helplessness; ind shrugged, said, "That's just how it is," did not seem distressed. Th wondered aloud when ind w[ou]ld be able to be apart from cou, LGs. Ind reports that he will be sent to local secondary school at age 11, while cou will attend "public school"--ind explained that "in American" that means "private school". Ind reports that he daydreams constantly about having cou out of house, believes that LGs will ignore him more then. Ind, th made list of ways ind can work on safety, comfort until that time, approx[imate]ly 22 mos from present. List includes ind, th making games out of cardboard, drawing paper, etc. for ind to keep hidden in his room from cou; ind learning & practicing coping skills from th; ind keeping th's card even after therapy stops so he can call th "every now and then" to check in; ind reading favorite library books as possible, so cou can't destroy w/o[without] LGs having to replace; ind making calendar and marking off months as they pass. Ind remarked on fishy odor of th's office. Th explained that th has placed can of salmon cat food on windowsill for cat. Ind exclaimed "but she's rubbing it everywhere!" Th, ind rushed to window; cat on sill, paws covered w/ tinned food. Cat hissed, left sill rapidly, food smeared across sill. Ind laughed helplessly, suggested th try "real salmon, not that tinned tripe." Th explained that cat food less expensive; ind remarked that this was true, but ind wld not eat cat food, no matter what flavor. Th, ind both laughed. Th agreed to try real salmon for cat if ind will report next session re: using coping strategies on cou, LGs. Ind agreed. Game of Trouble as reward for ind.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home.

Personal process note, November 19, 1989

They've got me. The LGs have figured out how to avoid child abuse reports, no matter how clever I am. They've taught Harry not to tell me anything too nasty about life with that whale of a cousin, they've dressed him properly for one hour a week, they've gotten to the school and the teacher somehow, and for some unfathomable reason, weird old Uncle Albus is supporting all this, even if the humongous Cousin Hagrid thinks I am doing a great job with the kid.

Talk about crazy, enmeshed families. Now all that's left is to teach Harry how to make it for another 22 months in that hellhole. At least he'll get rid of the cou for a few months at a time when that day comes. And if buying that damned cat real salmon is what it takes to make Harry work with me, then the cat gets salmon. What I do for my craft!

Progress Note: November 26, 1989

Session#9 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] th[erapist].

Session Goals: Review "broken record" strategy w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation.

Symptoms: Low mood, undereating, hoarding food, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou.

Interventions & Response: Ind presented again in more age-appro clothes, new Public Health-issue glasses. Good eye contact, cheerful greeting to th. Ind asked immediately to see if cat had eaten salmon. Th pointed out that slab of "real" smoked salmon waiting for cat in th's office until ind arrives. Th gave ind piece of salmon; ind carefully laid piece on windowsill. No cat. Th suggested backing away from sill, as cat seems shy. Ind, th sat silently in loveseat across from window; after approx'ly 10 mins, cat came to sill, examined and ate salmon. Ind clapped hands, silently mimed cheering to th. Th wondered aloud if ind has learned to keep all important emotions "silent." Ind admitted that this is how he copes w/ repressive bxs[behaviors] of LGs at home, asked if this angered th. Th denied; fire alarms sounded in hall. As th, ind evacuated building, th admitted that ind's need to suppress healthy affect [emotions] does anger th, but th accepts that this is good survival skill ind has developed. Ind unable to say if need for this skill angers him.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home.

Personal process note, November 26, 1989

Okay, so what I really want to know is this: How the heck did Big Cousin Hagrid call it right about that cat wanting real salmon?

Progress Note: December 3, 1989

Session#10 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] th[erapist].

Session Goals: Review "broken record" strategy w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation.

Symptoms: Low mood, undereating, hoarding food, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou.

Interventions & Response: Ind presented again in more age-appro clothes, new Public Health-issue glasses. Good eye contact, cheerful greeting to th. Ind asked immediately to feed cat more salmon. Th agreed. Ind carefully placed slab of smoked salmon on sill. Cat appeared as soon as ind, th left sill to sit on loveseat. Cat ate salmon slowly throughout session. Th reminded ind that he has agreed to review use of "broken record" strategy w/ th if cat got salmon. Ind agreed willingly, reports that strategy "makes [cou] furious", but cou then escalates, creates lies re: [garding] ind's bxs towards cou. Ind believes that LGs know that cou lies about ind, but still escalate into anger w/ ind. Th taught ind "meet anger w/ nonresistance" strategy, rehearsed w/ ind, who reports that he believes this strategy wld help most w/ LGs. Ind had some difficulty thinking of appro[priate] replies that wld express no anger, but allow ind to maintain his stance w/ hostile adults. Ind, th practiced various replies, settled on "I did not do what he [cou] says, but I'll do whatever you tell me to do." Cat spat, hissed continuously as ind, th practiced this statement, w/ th yelling various hostile, untrue remarks at ind, and ind continuing to repeat same statement in calm, emotionless tone. Th praised ind for sticking w/ difficult rehearsal. Ind grinned, said he wld picture th and hear cat's hisses whenever LGs "being stupid". Th remarked that cat does not like th much; ind laughed and reported that he thinks that cat is "telling off" LGs whenever th pretends to be them in rehearsal.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home.

Personal process note, December 3, 1989

Cat, are you spitting at me or at the LGs? How much salmon will it take before I am sure that you are spitting at them, not me? Cat, for the love of heaven, please keep coming to Harry's sessions. Please.

It's you and me, Cat, to keep one little kid going for another 21 months, and for the last 19 of those months, he won't have me, as I still can only have 20 sessions with the kid total. Please stick with us, Cat. You can have all the salmon you want.

I say all this to the windowsill, leaning my head out the window, and, to my surprise, the cat actually appears--crouching on the sill of Schiller's office next door. And I would swear she nods. But I must be losing it, as I would also swear that she has spectacle-shaped markings around her lovely green eyes. Cats don't have markings like that; I know they don't. But somehow the specs look good on her. I must be working too hard.

Progress Note: December 10, 1989

Session#11 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] th[erapist].

Session Goals: Review coping strategies used at home prev[ious] w[ee]ks w/ ind. Teach other coping skills as appro[priate]. Monitor ind's home situation.

Symptoms: Low mood, undereating, hoarding food, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou.

Interventions & Response: Ind presented again in more age-appro clothes, new Public Health-issue glasses. Good eye contact, cheerful greeting to th. Ind fed cat salmon immediately. Cat returned to windowsill as soon as ind backed away, ate salmon throughout remainder of session. Ind asked th to name cat. Th made bargain w/ ind: he could name cat next session if he continues to work on coping strategies at home. Ind agreed, smiled small smile, announced that th "always makes really easy deals." Th processed this w/ ind, who admits that he wld do work th assigns anyway, w/o deals, likes to try new "tricks" on fam[ily], but likes to "win" deals w/ th too. Th, ind processed idea that ind feels as though he never wins anywhere else. Ind able to articulate that cou "always makes [ind] feel like loser" bec[ause] cou "fat, ugly, bully but he always gets everything he [cou] wants." Th gently explained that cou has not "won" w/ th and th does not like cou because cou is "spoiled brat." Ind silent, then said flatly, "It's not really his fault. They all spoil him." Th reframed, saying that cou is real loser, then, since he will not know how to handle problems in life, while ind already has this skill, can see that cou is victim too. Ind doubtful, says he does not think he knows anymore than cou does about handling problems. Th corrected ind's faulty thinking, by th, ind then reviewing list of strategies ind now has to handle probs. Ind wondered if these wld be enough. Th gently pointed out that ind has one more skill that cou lack: ind knows how to make real friends, not based on being bully. Th explained that when cou leaves home and ind is in secondary school, ind will make many "real friends", not just "jerky friends who want bully for buddy." Ind asked for proof; th observed that cat and th already like ind for himself. Th articulated list of ind's good qualities that make th like him. Ind sat silent, wide-eyed thru th's list. Th wrote list as enumerated, then stood, handed list to ind to "keep safe." Ind took silently, hid list in jumper [sweater] then jumped at th, wrapped arms tightly around th's waist, hid face against th. Th gently rested arms on ind's shoulders, did not look at ind's face, avoided embarrassing ind. Sprinklers went off. Th swore audibly. Ind began laughing, rapidly turned face into stream of water, then made "windshield wiper" gestures on his glasses "like [th] did that other time because we both have spectacles!" Th laughed, made gesture back over her own glasses, said, "We'll always remember that about each other!" Th escorted ind to car. Aunt alone in car, began to remonstrate w/ th over ind's wet clothes, faulty sprinklers, fire alarms in th's office. Th said in flat voice, "I did not set off the sprinklers, as you seem to be saying, but I'll do whatever you tell me to do to fix the problem." Aunt snorted audibly. In rear seat, ind fell over sideways, hands clapped over mouth.

Plan: Continue teaching ind coping skills for life w/ LGs' fam. Work on goals, including helping ind perceive ind's own strengths, use at home.

Personal process note, December 10, 1989

When I returned to the office after escorting Harry out, the cat was purring on Schiller's windowsill. For a good five minutes, at least. Well, of course, she'd be over there; the dampness from my office probably bothers her. But I didn't expect a purr, with all that wet.

Look, Cat, if you like Harry so much, for heaven's sake, listen up. Don't get too cozy on that sill over there, okay? That's the office of my supervisor inside that window you're leaning up against. He tried to stop me from helping Harry and took the side of those jerk LGs. Next time you decide to defile an office, could you please make it his, not mine? You do like the kid, right? He did get you the good salmon, you know.

At this point, I almost expect the Cat to do the spectacle gesture-thingie. I have to take more time off.

Consultation Progress Note: December 12, 1989

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

Reason for Meeting: Update on ind's progress.

Discussion: Dr S called to reschedule meeting, due to "animal infestation" problems w/ his office. Dr W offered to meet in her office. Meeting terminated at Dr W's request, after brief summary of recent case history. Ths agreed that Dr W will continue on case through 20 sessions.

Plan: Dr W will continue to monitor ind's situation.

Personal process note, December 12, 1989

Okay, so I take no more grief from Schiller after this morning. The guy actually walks into my office for a consult, smelling of cat pee. I thought I would gag before I managed to convince him that he had to leave.

Geeze, I know they have no sense of taste, after what passes for cuisine around here, but no sense of smell?