Family Therapy

Greater Surrey Children's Services

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

Progress Note: December 17, 1989

Session#12 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, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th laughed, returned gesture. Ind praised th for modeling "meet anger w/ nonresistance" strategy w/ind's Aunt prev week at car. Th explained that th teaches ind same strategies that th uses on people. Ind reports that he rehearsed phrase that he & th had worked out ("I did not do what he [cou] says, but I'll do whatever you tell me to do") all week and used several times, w/ appro[priate] variations. Ind reports that this strategy v[ery] effective w/LGs, but LGs escalate into greater anger @ ind when he uses phrase. Th expressed concern that this is not success, but ind able to articulate that LGs confused by phrase, get angry but "they don't know what to do next" and generally send ind to his room "which is better than screaming at me." Ind reminded th that th had agreed to name cat if ind would try strategies. Ind produced list he had made over previous week of names for cat; at ind's own suggestion, ind read names to cat from across room from window "to see if she likes any of them." Ind reports that he thought cat would like Scots name, as she "looks rather northern" to him." Cat ignored list, except spat, smacked window at "McNair." Ind decided cat should be named "Fere", explained this is ancient word for "good friend, maybe in Scots." Th agreed, asked ind where he found word. Ind proudly explained that he sometimes reads dictionary at home, as "nobody would take that from [him.]" Ind then showed th that he is still carrying list of his good qualities made prev session. Th praised ind for good adaptive strategies for home life. Th, ind discussed long break in therapy for Christmas holidays. Th challenged ind to make list of all the "smart things" he does to cope w/ family over hols.

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.

Progress Note: January 7, 1990

Session#13 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, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, baggy overcoat, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind reports that he received no "real" presents for holidays, but was given cou's over-sized cast-off clothes and "an old 2 shilling piece." Ind showed th coin, explained that piece only is worth 10 pence currently, but ind likes bec it's "old and special" compared to most coins and bec "it's a joke on [his] Uncle." Ind explained that Uncle gave coin to ind w/o obvious thought, pulled coin from trouser pocket on Christmas morning, saying that when he [Uncle] was a lad, "we were grateful to get even one shilling." Ind thinks this is special coin, so he believes that he has defeated Uncle's intention of "spoiling" the holiday for ind. Fire alarms sounded. Ind expressed disappointment that he had not had chance to feed cat before evacuation, expressed concern that so many evacuations necessary from th's office. Th agreed, took crayons, heavy paper w/ her as left office. Th led ind to rear of building, after advising supervisor that th, ind had evacuated. Ind, th drew gameboard of Trouble for ind while awaiting "All Clear" signal. Th, ind agreed that ind should "look after" gameboard, helped ind collect appro pebbles to use as tokens, will paint at next session.

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, Jan. 8, 1990

When we finally got back into the building yesterday, Harry's session was long over, so I walked him back to the horse-faced Aunt in her uptight, tense little car. I noticed that the new game was rolled up carefully and hidden inside that beach ball of a hand-me-down coat long before we reached the vehicle. I guess shabby leftover clothes do have their uses. I hate the blankness his face takes on as we approach that hag. I hate sending him back to that cold, vicious pack of hyenas. I hate knowing how he's so alone there all week until our next meeting. I hate I hate I hate. Why doesn't a nice kid like Harry get nice parents? Is that too much to ask of the universe--one sweet kid getting the love he deserves? Blah blah blah and so on, Dr. Walker. I'd be out of a job. And I'd be grateful.

Yeah, okay, maybe I was overcompensating when I tracked down the stupid Cat hiding in the shrubbery and threw her an entire half of a salmon. It still felt good to see someone enjoying an honest treat. Happy Christmas, Cat. At least yours cost more than 2 stinking little shillings.

Progress Note: January 14, 1990

Session#14 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, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind fed Cat generous chunk of salmon, retreated from windowsill w/ appro patience to allow for Cat's shyness. As th helped ind paint pebbles for home-made Trouble game, th processed w/ ind what he feels about getting poor gifts for holidays, birthdays. Ind shrugged this topic off, saying he is used to it and now he knows he can make his own "stuff" from castoff paper, stones. Th gave ind dice for game as "belated holiday gift." Ind acted surprised, said he still had th's gift--showed th list of his good qualities th had given him previously. Ind also showed th "Outsmart List" he had made over holiday break from therapy. List included all the ways ind "outsmarts" LGs and cou, included "broken record", meeting anger w/ low emotion and no resistance, making own games, daydreaming re: cou leaving home, hiding personal belongings in special places around home, "Front Labels". Th asked ind to explain last term; ind described how he stares hard at fam[ily] member who is picking on him and tries to write a word across their "front" [forehead?] that describes them. Th praised ind lavishly, explained that "forehead labeling" is old therapy trick, expressed admirations of ind's shrewdness in figuring this strategy out for self.

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.

Progress Note: January 21, 1990

Session#15 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. Begin termination process.

Symptoms: Low mood, lack of peer relationships, poor relationship quality w/ maternal Aunt & Uncle & same-age cou[sin].

Interventions & Response: Ind presented again in more age-appro clothes, glasses. Good eye contact; ind made "windshield wipers" sign to th upon entering office. Th returned gesture. Ind fed Cat piece of salmon, retreated from windowsill w/ appro patience to allow for Cat's shyness. Ind described how he feels like Cat around new people. Th helped ind process this statement, w/ ind articulating that he feels angry and scared at same time, fears that new people see him as weird bec[ause] of clothes not fitting, but also feels angry that new people might reject him, due to his appearance alone. Th reminded ind that th always liked ind, even when his clothes did not fit well. Th helped ind discuss feelings of anger around clothes, cou. Ind listed forehead labels he uses for cou. Th made game of this, w/ th, ind creating list of appro labels for various people each knows, telling why they like or dislike various people. For each negative label, th had ind also develop one positive label for a person he knows. Ind laughed throughout exercise, discussed idea w/ th that he can dislike someone privately w/o hurting them, can even laugh at them privately. Th agreed, w/warning that ind must remember that other person does not know what ind is thinking, so ind must be careful not to make mistakes when he speaks to them. Th explained that everyone feels anger or dislike for some other people, and feelings simply happen, are neither good nor bad. Ind agreed, able to articulate that the important thing is what a person does with his feelings. Th praised ind for good insight. Ind expressed surprise that th "doesn't want [him] to forgive" LGs. Th reflected surprise, reframed, said th is surprised that ind thinks th is "some sort of saint who never gets angry at impossible people." Th reframed ind's situation as him having to live w/ "difficult" people to whom he still owes his chance to have a home, but who willfully make his life harder than necessary. Ind agreed, expressed some confusion over feelings of obligation to LGs while he also feels resentment. Th asked ind to practice thinking about people "more than one way" over next week, explained that healthy humans can feel more than one emotion towards another person all at same time. Th also advised ind that only 5 sessions remain after this one. Ind left office v. quietly.

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. Help ind adjust to idea of terminating therapy.

Collateral contact: January 21, 1990

Th returned to office after escorting ind to Aunt's car, found elderly Cau[casian] woman sitting in th's chair in th's office, holding short stick and release signed by ind's Aunt/LG. Release appro, identified woman as "Great Aunt Minerva". Aunt speaks w/ strong southern Scots accent, good hygiene & grooming, dressed appro if eccentric, as was wearing long plaid over floor-length dress, matching dark green pointed hat, cloak. Th demanded to know how Gt. [Great] Aunt gained entry, as th had locked office. Gt Aunt waved at th v. dismissively, silently handed th stick. Stick made exploding noises, fire alarms went off, sprinklers triggered. Th immediately dropped stick, left office rapidly, forgot releases. Gt Aunt not found at evacuation gathering point, not in building when staff allowed to return. Release filed in ind's chart.

Personal process note, Jan. 21, 1990

I am losing my mind. I am simply losing my mind. I would take vacation time, but dear Doctor Schiller is good enough to point out to me that I have not earned any yet. Still, I have to discuss this all with him tomorrow. It's gotten too bizarre for me to handle alone.

Aunt Minerva just freaked me out totally. She's this peculiar mix of Morticia Addams and a schoolmarm, dark hair pulled back into a bun, and eyes like steel. Oh yes, and she has the personal presence of Genghis Khan. Say "no" to Great Auntie? I'd sooner yank the tail of a 12-foot crocodile. If she hadn't had bad breath (or was I smelling the leftover salmon?), I would not have been sure she was human.

I really had to edit the Progress note, as this whole encounter was just too weird. For one thing, I had left her release on my desk throughout the Attack of the Deranged Sprinklers, and it was not wet at all when I got back in there. For another, I swear, I absolutely swear that SHE wasn't getting wet as that water hit us both. And then she bellows in her nasal, stentorian tones: "a-HA, and you don't even KNOW, do you?" And there we stood, eyes locked, her crazy stick rolling around on the wet floor, letting off steam, and her not getting wet while I did, and she slowly raised her hands to her face and made the windshield wiper gesture. She did it perfectly, just as Harry does it. And she has glasses too. And I am not kidding; she looked, just for a second there, exactly like the Cat.

That's when I screamed and split for the Great Outdoors.

Consultation Progress Note: Jan. 22, 1990

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

Reason for Meeting: Dr S concerned that Dr W screaming in office, possibly in session. Dr W reported events of previous day's sessions w/ ind and collateral to Dr. Schiller as supervisor.

Discussion: Dr W described content of 2 most recent sessions relating to ind, including concerns that ind's Great Aunt is bringing explosives into building.

Plan: Dr W will take 5 days off without pay.