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Case Study - Page 2

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I continued to describe what had happened, validating the terror of Jake’s experience and concluding by saying, “How scary, sad, and lonely for you when you were just a little boy! You thought it was because you were a bad boy, and that must have made it even harder.”

As I told Jake’s story, there were tears in my eyes, and the intensity in my voice conveyed his pain and fear. As Jake took in my experience of this traumatic moment, his face softened, and he seemed confused and sad. For a while, he was quiet, motionless, and reflective. As Peter put his arm around him, Jake leaned into him and quietly began to cry. Seeing that Peter also had tears in his eyes, I asked Peter to share his experience. He spoke of how sad he was that his son had been hurt like that, how he’d be sure that no one would hurt him like that again, how he’d never hit him or treat him that way, and how—no matter what Jake does—he’d never think that Jake deserved to be treated that way. Then he pulled Jake even closer and held him for a long time in silence.

When mirroring a child’s unvoiced experience, it’s always important to observe closely how he or she responds. If Jake had indicated in any way that my account didn’t match his experience, I’d have responded differently, and if he hadn’t wanted me to continue, I’d have stopped. Since I didn’t know his father’s motives and wanted to be sure Jake was free to decide for himself why his father had been abusive, I was careful not to express judgment that his father had been a bad man who hadn’t loved him. I simply gave my empathic reaction to that event, hoping to allow Jake the freedom to begin to create his own meanings for that terrifying experience as he was taking in this new, more validating input.

My goal in focusing on difficult past experiences in this way is to expand children’s ability to give expression to how they think, feel, and remember and what they wish for. Whenever they disagree with me, I welcome their reaction and express pleasure that they have the self-awareness to see things differently and the courage to say so. As a therapist, I try to convey how their stories have affected me, so I can help them reexperience the earlier events in the context of much healthier relationships. In this case, Jake’s ongoing relationships with his adoptive parents, and with me, enabled him to see himself differently from how Stan had seen him, not just around this event, but many others as well.

As Jake began to experience himself as less “bad,” he became able to address his current anger and defiance in a more open, puzzled, and remorseful way. He began to see how he often thought that the limits his adoptive parents set confirmed his perceived badness rather than expressed their desire to keep him safe and teach him appropriate behavior. In a later session with Stephanie, his adoptive mother, we talked about an incident a few days before when Jake had sworn at her because she wouldn’t let him go outside. I asked Jake why he thought his mother had said no to him.

“She didn’t care what I wanted to do,” he asserted.

With intensity, conveying a new understanding about his behavior, I said, “Oh, Jake, if you thought that your mom didn’t care about what you wanted, that what you wanted wasn’t important to her, of course you’d be upset with her. As if what you want isn’t important to your own mom!”

After a brief silence, in which he seemed absorbed by what I’d said, I added quietly, “Why don’t you tell her, Jake? Why not say, ‘Mom, sometimes I don’t think you care about what I want. Sometimes I even think that you might not like me. And that’s why I get mad at you’”

He then managed to say, quietly and with anxiety, “Mom, sometimes when you say no to me I think you don’t like me and what I want doesn’t matter to you. And that’s why I get mad. I feel as if you don’t like me, and then I don’t like you.”

Taking his hand, Stephanie said, “If you really think that I don’t like you when I tell you that you can’t do things, then I certainly understand why you’d be angry with me. But it makes me sad to think that you don’t feel how much I love you, especially when I have to say no, even when I know it’ll upset you.”

At this point, Stephanie hugged Jake, and they both became tearful. A few minutes later, Jake quietly described how often he’d heard Stan, his biological father, swear and threaten his biological mother, adding that he was afraid that he was like Stan and would act like him when he was older. After I expressed how difficult I imagined it was for him to believe that about himself, I told him that I saw him as a boy with courage and a big heart, who was learning to love his new parents and allow them to love him. I suggested quietly that he might discover himself becoming more and more like his new dad, Peter, in the days and years ahead.

These two intersubjective experiences shared among Jake, his parents, and me were among the few dozen or so similar experiences within my office that occurred over the next nine months. And these experiences were among the few thousand that occurred during that time at home. Jake’s sense of self became open and alive, receptive to a new kind of relationship with the people who were coming to know and love him. Each new experience reduced the hold of his rigid view of himself, which had emerged in interactions with his abusive parents. The certitude of shame that Jake had used to explain the abuse became riddled with doubt, and he now had room for new discoveries, along with new social, emotional, and reflective skills. Where there had been shame, pride was emerging—and confidence, joy, and love.

Will the Jake embedded in shame return? Under stress, especially threats of conflict or separation from his primary attachment figures, he risks being pulled back into those early years; however, as the new Jake continues to develop meaningful relationships with other adults and friends, the risk is likely to decrease. Therapy isn’t magic, but when it succeeds, it provides new templates, enabling abused children to develop the expectation that they’ll be seen, accepted, and appreciated, rather than carry forward the destructive legacy of shame and self-hatred with which they started life.

Case Commentary

By David Crenshaw

I don’t think it’s possible to read the account of Dan Hughes’s work with 9-year-old Jake without being deeply moved. Every child therapist should take note when Hughes states, “Therapists must work to discover the children under the symptoms—those who lived before the abuse, who survived in the face of it, and who can begin to emerge after being accepted and embraced by those who’ve come to love them” (in Jake’s case, his adoptive parents).

That said, I was struck by a possible contradiction between the stated goal of the therapy and the method employed. Hughes states, “My goal as a therapist is to help children begin to more actively become the authors of their own stories.” But in my experience, young children like Jake need to process traumatic experiences in a manner consistent with their cognitive and emotional level at the time of their original trauma (in Jake’s case, age 4). Often, they’re unable to remember and share these events through a sequential, verbal narrative. When Jake said, “I’m not sure” when asked what had triggered his father’s fury, he was probably correct. With young children, trauma may be experienced less as a specific event than as a sense of overwhelming terror associated with failure of primary attachment figures to provide safety and security.

In helping traumatized children find their own voice and discover the meaning of events they may not be able to put into words, I often rely on nonverbal trauma narratives created by children in the form of pictures in the sand tray, symbolic play in the family doll houses, puppet play, artwork, or dramatic play enactments. Recently, I worked with a traumatized child around Jake’s age so agitated that his teachers allowed him to pace in the back of the classroom the entire school day. Once this child started playing in the sand in my playroom, however, he didn’t move for 45 minutes. The soothing sensory experience of moving his hands through the sand not only enabled him to remain calm during the entire session, but also led him to tell the story of his traumatic removal from his home in depth. While Hughes’s empathy and compassion clearly had a powerful impact on Jake, I was left wondering whether less reliance on verbal communication might have created an even stronger bond and furthered the ultimate aim of empowering Jake to become the author of his own story.

Dan Hughes, PhD, is a clinical psychologist near Philadelphia. He specializes in the treatment of children who have experienced abuse and neglect and demonstrate ongoing problems related to attachment and trauma. He’s conducted seminars and workshops throughout the US, Europe, Canada, and Australia for the past 15 years. He’s the author of several books, including Brain-Based Parenting. Contact: dhughes202@comcast.net.

David Crenshaw, PhD, ABPP, RPT-S, is the clinical director of the Children’s Home of Poughkeepsie and faculty associate at Johns Hopkins University. Most recently, he coedited Creative Arts and Play Therapy for Problems of Attachment with Cathy Malchiodi.

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