OVERVIEW OF THE CHILD’S PSYCHOTHERAPY: PRESENTING SYMPTOMS AND FAMILY HISTORY

CHAPTER 1 Discussion Points

In Chapter 2, session #9, discuss the imagery of “superman cape being twisted 1. around his neck…one leg was on fire.”

How do you understand the symbolism? a.i. How would you pursue this with the child and get him/her to further a.ii. elaborate? What constitutes “post-traumatic play,” and is this an example? a.iii.

In Chapter 2, session #21, the patient is reported to say, as he motions to the 2. blackboard, “come on (to his psychiatrist, come up to the blackboard), you’re not afraid of me are you?”

How do you understand this communication. a.i. The child was “fearful of men,” upon his presentation. Now he’s a.ii. asking whether the psychiatrist is fearful of him. What has happened? What is the psychoanalytic understanding of being fearful of men, a.iii. in this case? Literally, there is a fear of a bigger father who has attempted to hurt his mother, and him indirectly. However, the other issue involved in a phobia is the projection of anger onto another. So, the child projects his anger onto all men, displacing the internally experienced anger onto others; but has to contend with the anger directly to be freed from his fear. See Chapter 4, session # 37, when he throws marbles at Superman. 3.

What is happening here? a.i. Who is the child angry with? a.ii. In the moment, the Psychiatrist who is going away, a.ii.1. his new Superman; but he also has the ability to express his anger, rather than simply project it onto another man. In displacement, he is now able to appreciate his anger at men, father’s, psychotherapists, men whom he relies upon, men who leave him, or, disappoint him. Again, in Chapter 2, session # 21, the child says, “When I grow-up, I want to be a 4. ‘fixing doctor,’ no, …when I grow-up, I want to be jackhammer man, jackhammer the streets.”

What is being transacted here? a.i. Is it OK if the psychiatrist couldn’t understand him and ask him to a.ii. repeat himself? What does he mean by becoming a ‘fixing doctor”? How does one a.iii. understand the idea of internalization, of object relationships? And the image of becoming a “jackhammer man…who a.iv. jackhammers the streets.” What is the child’s confusion? Who is he, how does a.iv.1. he feel about important men in his life, and who does he want to internalize and identify with? What of the conflict between “fixing” and “jackhammering”? Both are necessary functions in the world. How does the child see these different functions?

In Chapter 3, session # 29, what is happening when the “men’s dinks are being 5. taken away…they are then thrown on a pile…and turned into tables and chairs”?

How to understand the fact that these male figures are being a.i. castrated? Who is being castrated? Superheroes, even Robin. Who does he identify with here? It is confusing: it seems like the “good guys” are being castrated, turned into tables and chairs (becoming inanimate, truly castrated), and discarded. Also, the “Evil Queen…no…The Evil King” has done this and he’s stomping on the superheroes, so he is evil here. How to understand that? He is now identified with the bad guys – who are more powerful. Perhaps, f his father got thrown out of the house, castrated, maybe the same could happen to even the good guys, too.

In Chapter 3, session #29, he basically answers “yes,” to my question, “did 6. anyone ever touch you?” What is he saying. What should the psychiatrist have said? What would you do with the response he gave. Is he the victim of sexual abuse? Is there any evidence in the sessions to date that would either support the idea of his being sexually abused or not? How should this be handled with regard to mandatory reporting requirements? In Chapter 3, #31, the boy indicates that the house is under threat from an 7. external dragon and he successfully “karates the dragon.” And, the dragon is now small and is no longer invincible.

How to understand this shift in a sense of power? a.i. When he holds himself, after karateing the dragon, what do you a.ii. make of it? And the triumphant tone? a.iii.

In Chapter 4, Session #37. The termination session. Upon being reminded of 8. my vacation, and interruption in the treatment, he runs out of the office, which he hadn’t do for 4-5 months. Compare this to running out of the office, in excerpt #1, session #9.

Why does he run out now? a.i. Is this a “play disruption?” If so, why? What feelings occurred that a.ii. made him disrupt the play and avoid his psychiatrist? Could he be angry and still there’s a tendency to run away and be fearful? However, when he comes back, it is clear that he’s angry. How to understand this.

In Chapter 4, session #37, as he wants to throw marbles at his psychiatrist, he 9. offers the displacement of the Superman puppet. What does it mean that he offers the puppet? He now can actively displace, be deliberate, and symbolize. The psychiatrist supports his throwing the marbles. Is that a good idea? Shouldn’t kids be taught to be safe, not throw marbles. Why is it being promoted here? What is the nature of the expression of affect in psychodynamic psychotherapy? What would CBT suggest here? Is it always best to regulate or to express? This is the treatment of a fearful, phobic boy. Might the psychiatrist suggest something different to a very angry, irritable boy, or not? In Chapter 4, session #37. What do you make of the questions: “you’ll forget 10. me… you won’t forget me?”

What does the psychoanalytic concept of “object permanence” a.i. mean? We hear most about it, its absence in borderline patients. How is the freedom to throw marbles at the Superman puppet a.ii. linked to the direct questions of “will you forget me?” Did you hear the choked-up response of his psychiatrist when a.iii. saying, “no I won’t forget our games…and I won’t forget you.” What is this about? How do you understand the Psychiatrist’s feeling here? Why is he sad? Is it “countertransference” or is it a real feeling. How would they be the same or different? What does it say about the child and the treatment, if in fact, the a.iv. psychiatrist is sad about the interruption too, and assures the child of his importance to him? What if you were told that this interaction is one of many similar “unforgettable moments” in this psychiatrist’s professional life? What does it say about the child, the treatment, the psychiatrist himself?