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Case Study - Page 3

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Within a few weeks, it seemed time for Ella and her mother to process the trauma more actively. Over a six-month period, I worked with them using stories as well as fear-reducing and symbolic play-based, expressive, and cognitive behavioral techniques. Generally, I pulled her mother in as a helper. For example, when Ella revealed she thought the assault was her fault, I read a story about self-blame, and then identified a puppet that blamed himself for getting hurt. Afterward, I asked Ella, “Is it his fault? Why not? Who should’ve been in charge? Why do you think he’s blaming himself? I wonder what you could tell him to give him the facts and show him he’s not at fault.” Then Ella and her mother came up with a list of reasons why it wasn’t his fault. Together, they talked to the puppet and corrected his faulty beliefs.

Taming the Alligator

Metaphorical stories and puppet play (modeling and enactment) were powerful change agents for this dramatic, engaging child. I provided a story or theme idea for most play sessions, and Ella’s creativity propelled the action, in which she revealed her feelings and concerns. As Ella opened up through stories and puppets, her mother showed increasing empathy and offered more verbal encouragement and affectionate touch.

During a particularly pivotal session about three months into treatment, Ella asked to do a puppet show and took charge of it. She selected an alligator perpetrator, a kangaroo caregiver, a small multicolored frog victim, and a colorful rainbow dragon as a helper. The characters helped her tell and process her trauma story, and the parallels to her family were obvious. In her show, the alligator puppet promised to be nice, but then started biting the other puppets.

Ella shook her finger at him: “You need to tell the truth and stop telling lies. You have an anger problem! You need to change and be nice.” She then wrapped his long snout in duct tape. Turning to her mother and me, she said, “He has an anger problem. He needs to calm down and control his temper. We should put him in jail for biting.”

Ella’s mother agreed, and together they put the alligator in jail. We agreed that we should not be mean to him; rather we could feed and talk to him from a safe distance.

When I asked Ella how the alligator could learn to control his anger, she replied, “Let’s teach him to calm down.” She handed her mother and me one stone each and said to the alligator, “You need FIVE stones. You have BIG ANGER!” Shoving five stones inside the taped snout, she then taught him how to breathe and rang the Tibetan bell bowl. “Close your eyes and relax,” she instructed. When the ringing stopped, Ella announced, “The alligator can stay in jail until he decides to be nice.”

Later in the session, Ella looked up from drawing on the dry erase board and said, “I’m going to the jail to tell my dad to stop being mean. Then he’ll change and be nice.”

Ella clearly had ambivalence about her own anger at her dad since, even though she feared him, she still loved him. To help her make sense of this ambivalence and gently challenge her magical thinking about change, I commented, “Ella, I know you love your dad and want him to change. Sometimes people change, and sometimes they don’t. They have to be sorry for what they did and really want to change.”

Ella went over to the cage where the alligator was being held. She asked him, “Are you sorry for what you did? Do you want to change?”

I spoke for the alligator and said, “Please let me out. I’m sorry I bit you. I promise to be nice this time.”

Ella said to me, “He says he’s sorry, and he promised to be nice. Can we take off the duct tape and let him out of jail?”

I decided to pull in Ella’s mother at this point and asked what she thought. She took Ella’s hands and said, “It’s too soon to do that. I don’t think he’s sorry. He doesn’t think he did anything wrong. He promises to be nice, but he doesn’t change. I don’t think he really wants to change. I’m going to keep you safe, and I won’t let him hurt you.”
Ella thought for a minute and said matter-of-factly as she crawled into her mother’s lap, “He’s always been mean. He needs to stay in jail. And leave the duct tape on. He’s not ready to come out yet.”

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