Case Study

Leaving the Mothering to Mother

Helping a parent become accountable

Nina Shandler
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From the July/August 1994 issue

AS A PSYCHOLOGIST IN AN ELEMENTARY SCHOOL, I AM involved in the day-to-day lives of children, not as someone set apart from their normal routines, but as a person who works, plays and talks with them every day and is part of their daily trials and triumphs. With a job so all-encompassing, the risk of overinvolvement runs high. This is the story of how Ron, a 7-year-old second grader, built a bridge between home and school, teaching me to be his advocate and insisting that his mother be his parent.

AS IS OFTEN THE CASE IN SCHOOL, I HAD HEARD A LOT about Ron before I met him. Teachers, teachers’ aides, the school nurse, the guidance counselor, even the principal had stopped me to talk about him. They told me how, in the lunch line, on the playground, at circle time, even at work tables, other schoolchildren moved away from Ron because he smelled. These children didn’t understand why he stank, but they knew they didn’t want to be near him. Wherever Ron went, he was alone.

Ron peed and defecated in his pants consistently but unpredictably every day. The school nurse and his teachers helped clean him up, but the problem was getting worse. All of them reported that his mother, Pam, was no help. Pam, a single mother who worked in a restaurant and had two older children, refused to acknowledge that Ron soiled his pants even occasionally, much less daily. She insisted his teachers were concocting imaginary accidents because they hated her son and had a snobbish disdain for the poor. When the school nurse suggested that Pam take him to the doctor, Pam refused, saying the nurse wanted only to humiliate Ron.

By early October, I had been called in. My goal was clear: Before Ron’s teachers could teach him successfully, before he could be accepted by his peers, he had to be toilet trained. I would have to take on a task normally reserved for parents. Before I had even met the boy, I later realized, my role was blurred.

I decided to attack on four fronts simultaneously: To rule out medical factors, I arranged for the visiting school physician to see Ron as soon as possible. To educate Ron about toilet training, I designed role modeling and rehearsing sessions. To build his motivation, I set up a reward system for him. But knowing how to deal with the function of Ron’s problem within his family was the most complex part of the intervention. I hypothesized that Ron’s accidents were a way of rebelling against school and were, somehow, part of a self-defeating alliance with his mother. After all, what more potent metaphor for defiance of school and its authority than to literally shit all over it? If Ron’s accidents were an expression of his family loyalty, only an intervention that would enable him to demonstrate a disdain for school by controlling his bowels would be successful. So, I decided to design a intervention; I would trick him into being toilet trained.

I walked into Ron’s classroom, braced to meet a steely, well-armored predelinquent, and was immediately disarmed There stood a fragile little person with angelic eyes and a choir-boy face. I asked him if he’d like to play with me. He nodded. Looking at me with sadness and solemnity, he reached out for my hand. Immediately, he touched the place in me that was as much mother as psychologist.

Hand in hand, Ron and I walked into the playroom a small space, filled with toys where I planned to use a doll to model toileting skills. I offered Ron a doll, which he took carefully, with the cautious, quiet excitement of a child who has few toys. He sat down and cuddled the make-believe baby. In a short time, at my suggestion, we pretended to cook lunch and feed the doll.

Then I exclaimed, “This baby is old enough to be toilet trained. We need to train him.”

We brought the doll to an imaginary bathroom, sat it on the toilet, waited for the baby to defecate, took it off the toilet, showed it how to wipe itself, and then praised and hugged the doll. Ron participated in every stage with quiet fascination.

“This baby might have accidents for a long time. Let’s teach him what to do if he has an accident,” I said. This time, I pretended the baby didn’t make it to the toilet, and that we needed to teach the doll how to clean himself and change his own clothes. Ron played the game with intense concentration, mimicking my forgiveness and encouragement. “It’s okay, small person,” I told the doll. “Everyone makes mistakes. You did a good job cleaning up.” To complete the educational phase of my strategy, I had to move from using the doll as a model to having Ron practice himself. I said to Ron as nonchalantly as I could, ‘You have accidents too, sometimes. Maybe if you have accidents, you can dean up just like the baby.” I chose my words carefully, thinking that Ron’s baby status was precious to him and not wanting to deprive him of a special place in his family. But I did want him to give up soiling his pants and to find a functional place among his peers. He looked at me intently.

I suggested we practice. With the doll in hand, we walked to the bathroom in the nurse’s office. Ron pretended the doll went to the toilet successfully. Then, he pretended the doll had an accident and cleaned up. Next, Ron pretended he used the toilet successfully. Last, Ron pretended he had an accident and cleaned himself up.

When we returned to the playroom, I began the motivational part of my plan. I quickly explained a simple reward system to Ron-, if he got through a whole school day without anybody knowing he had an accident, I would play with him at the end of the day.

Thus far, all was simple, smooth, straightforward. Now, I turned to the complicated paradox that would enable Ron to maintain his rebellion against school, remain loyal to his mom, and stop having bowel movements in his pants. “It’s okay if you have an accident,” I said. “Maybe you can’t help having accidents. You can even have accidents and fool your teachers. You can even fool me.”

Ron burst into a mischievous smile, as if buying into the therapeutic conspiracy. I whispered, “All you have to do is clean yourself up good, then no one will know, and we can play.”

IN THE FIRST WEEK, RON SOILED HIS pants only once. He crept quietly off to the nurse’s office, cleaned himself up and returned to his class. The same pattern was repeated during the second and third weeks. In the fourth week, Ron did not soil himself at all. After three accident-free weeks, I joined his teachers in a premature sense of relief.

During this period, the school medical staff had remained involved with Ron. The school physician found no evidence of a physical problem. Still, the school nurse saw him often. When Ron wanted a break, he’d go to the health room, use the toilet, and visit with the nurse. She became nervous about his attachment. Even though she had seldom helped Ron go to the toilet or clean himself, she wanted to protect herself against the possibility of misunderstanding or a charge of child abuse. The nurse asked the principal to inform Ron’s mother, Pam, who was unaware of our toilet-training program. The principal wrote an enthusiastic letter to Pam, expressing appreciation for her mothering and congratulating Ron for controlling his accidents. I saw the necessity of the letter, but I felt a deep sense of uneasiness; it contradicted my message to Ron. I had never suggested he succeed at school; I had suggested he trick all his teachers. I gave him permission to have an accident and make us think he hadn’t, or to not have an accident and make us think he had. Was Ron’s success really dependent on his maintaining his own conspiracy against school? What would happen? Despite my fears, the letter was sent.

A few days later, Ron had his first accident in three weeks. The next week, he soiled twice. The third week, he soiled every day. We were back where we had started. It looked to me like Ron was proving his allegiance to his family by resuming his old habits.

Not knowing what to do, I reverted to straightforward toilet training and traditional play therapy. I started taking Ron to the toilet twice a day. I celebrated his successes clapping and cheering and giving great hugs and reprimanded his failures. I saw him twice weekly for play therapy. He created games where he was in charge, master of his life and body. He was a loving father giving elaborate gifts, a trainer subduing wild animals, a prince commanding adoring subjects, a trapeze artist walking the high wire. In real life, he remained unwilling or unable to control his bowel movements. I wondered about the meaning of the metaphors was he totally in control or totally in need of control? By late November, the school’s supply of extra clothing had been depleted. I wrote and called Pam daily, asking her to return the clothes the school had lent Ron, but she didn’t respond. So, I did the things any good mother would do I bought him cute, little-boy outfits at second-hand stores. He changed into them after soiling himself, wore them home and never brought them back. I began washing his soiled clothes at school. My mothering had no effect. Ron continued to soil himself daily.

Then one January afternoon, Ron put me in my place. During one of our scheduled sessions, he had a bowel movement in the toilet. Ten minutes later, he returned to class and wet his pants. I reacted with a strange mixture of admiration and frustration. I led him to my office in silence, with uncharacteristic seriousness. “I don’t know what to do next,” I said. “Very few people can do what you did today have a bowel movement, walk back to class, and then pee. That takes incredible control. You have all the power. I want to help you, but I don’t know how. Ron, tell me what to do.” Tears flowed from his eyes. “Get my Mommy to come to school,” he sobbed. I studied his sincere, pitiful face I was looking at truth. He didn’t need a well-intentioned, overly involved, manipulative psychologist to toilet train him. He needed his mother. Ron was clearly torn by his loyalty to his family and to me. Ron was saying, “My mom is supposed to do this. If it’s going to happen at school, my mom should be here.” I looked at Ron and promised, “I will get your mother to come to school.” I didn’t know how I’d keep my promise, but I knew I’d find a way.

EARLY THE NEXT MORNING BEFORE school, I drove straight to Pam’s house and knocked on the door. I waited, knowing my visit would be viewed as an intrusion. I suspected she would see me as an authority out to destroy her, to report her negligence, to question her love, to take her child, to decimate her family. For Pam, I was the embodiment of social control.

Ron opened the door, dressed only in a T-shirt. He hugged me and yelled enthusiastically, “Mommy, it’s Nina!” He ran off to the bathroom to fetch her. “Fuck her,” came the spontaneous response. “What’s she doing here? She doesn’t belong here. Why doesn’t she keep the hell out of our business?” Ron protested, “Come on, Mom. Talk to Nina.”

I planted myself on a dilapidated couch and waited. I was not about to be moved. There were clothes strewn about the room and I smelled the unmistakable stench of urine. A cat ran over a pile of laundry, hid in a corner, and peered at me from the shadows. At once I understood yet another source of Ron’s acrid stench.

Pam came out of the bathroom. Shyly, not unlike her timid cat, she peeked around the corner of the room, tears streaming from her face. Ron clung to her leg. Reaching up, he wiped her tears with his small hand. “It’s all right, Mommy,” he said. “It’s Nina. She’s nice.” Involuntarily, pity welled up in me truly pity, not empathy. Seeing her hunched over before me, I found myself saying, “Please sit down,” before I realized I had invited her to sit down in her own home. She lifted her head and glared at me, a flash of rage in her eyes, but she sat.

“I know it’s a shock to have me come here without notice, but I really had to talk with you,” I said. “I need your help with Ron. He’s having accidents every day.” Her sobbing became audible. Ron kissed her repeatedly on the cheek. “I see how much he loves you, how much he needs you. I can tell how much you love him,” I said. As her sobbing calmed, I got to the point. “Will you toilet train him?” Pam exploded again. “He is toilet trained, you ass. You’re all the same. You lie about him because you want to make a fool of him. I’m taking him out of that goddamn school right now. I’m going to teach him at home. I’m his mother. I have rights. I know who you are. You’re the bitch who tries to embarrass him by sending clothes home. You think you’re his mother. Well, I have news for you, lady I’m his mother.”

“You are his mother and you do have rights,” I said. Seizing on an opportunity to keep my promise to get Pam to come to school, I continued, “Home schooling might be possible. I don’t know the rules. You’ll have to talk to the principal.” Pam’s body straightened; she stood up. “Okay bitch, let’s go. I’m going to meet that bastard. Ron, get in the car.”

I got to school a few minutes ahead of Pam and warned the principal that Pam would walk in angry. He asked me what he should say to her. I made a few suggestions, and he agreed. “Good plan. I’ll play the heavy here.”

With Ron in tow, in full view of the principal, secretaries and children, Pam arrived and began to yell at me.

“You fucking bitch! You fucking asshole, keep your rucking paws off my son,” she shouted as I led her, still raging, into the principal’s office. “I’m taking Ron out of school,” she screamed, flush with anger, full of adrenalin. “I’ll home-school him.”

The principal invited Pam to sit down. Then, in a low and authoritative voice, he laid down the law.

“Every parent is welcome to apply to the school district for permission to home-school,” he told her. “I approve several requests a year. However, you must outline a specific course of study for all academic areas, you must supply a list of materials to be used, and you must have your child taught by an adult with a Bachelor’s degree from an accredited college or university. I doubt you can meet those criteria.”

“Even if you could, you would not be allowed to take your child out of school today,” he went on. “You would have to submit your application to the superintendent, and approval takes time. In the meantime, Ron must come to school or the truant officer will be notified.”

The principal paused and stared at Pam, waiting for a response. She crumbled. Her head hung limply; she said nothing.

‘Tour son is in second grade,” the principal went on. “He’s too old to soil his pants. Nina is working hard to toilet

train him. You don’t even return the clean clothes she brings in for him. Now I’m insisting you send two clean changes of clothing a day. Any day Ron comes to school without two sets of clothes, including underwear, we’ll call you at work and expect you to come for him. If you don’t, we’ll consider it a medical emergency and bring him to your work.”

“I expect you to meet with Nina regularly. If you don’t, I fully plan to contact the Department of Social Services and file for the protection of your child.” Pam began to gag. She stood up with her hands over her mouth and begged for a toilet. I led her to the nearest bathroom and she vomited.

When we came back to the principal’s office, I extracted promises from her in front of Ron to meet with me every week, and to send two clean sets of clothes to school. She kissed Ron, and we both watched as he skipped off to his classroom. Then, she slowly made her way to the exit at the end of the hall, making no attempt to avoid me as I walked beside her. “You’re Ron’s mother,” I said. “He needs your help.” She nodded, looked me in the eyes and said, “And you’re not his mother.”

FOR THE REMAINDER OF THE SCHOOL year, I remained Pam’s vigilant enemy. When Ron came to school in thin cotton pants, with no socks, on a snowy day with a wind-chill factor below zero, the principal and I filed a neglect complaint with the Department of Social Services. When she did not come to our weekly meetings, I went to her home. When she failed to send clean clothes, I brought Ron to the restaurant where she worked. She had declared herself Ron’s mother, and I was insisting that she act the role. She had exposed the ineffectiveness of my surrogate mothering, and taught me to advocate for Ron in another, more effective way.

By the time the school year was finished, Pam was sending clothes regularly, and Ron was toilet trained.

That summer, Ron and his family moved to a nearby town. Later in the next school year, I contacted his new school and learned he had no further problems with toilet training. I never saw him again except once, the summer after our school year together ended. I was riding on a bus with my daughter, when Ron and Pam got on. Ron paid no attention to me. He ran up to my daughter and sat down next to her. He reminded her she had read to him in a buddy program at school. Pam motioned for Ron to sit next to her, but he protested “I want to sit with my friend.”

Pam looked at me self-consciously and said, “Aren’t you going to say hello to Nina?”

“Oh. Hi, Nina,” he said, and went back to his conversation with my daughter. Pam smiled at me.

I shrugged, and said, “Kids.”

At that moment, we were both just mothers.


THANK YOU, NINA SHANDLER, FOR presenting a cautionary tale about the dangers of playing with other people’s children. While most children in individual play therapy do not express their inevitable confusion about what is going on, Shandler was fortunate to have as a client someone as articulate as Ron. He underlines the problem at the core of this case with unmistakable clarity when he says, “Get my mommy to come to school.”

In retrospect, of course, it is easy to see that the actions ultimately taken by school personnel should have been taken at the outset of this case. The question is, why did it take so long? What preconceptions kept them from holding Pam accountable for Ron’s personal care?

At first, I was stunned by Shandler’s elaborate hypothesizing and treatment planning before she even had met Ron. Certainly rapid assessment and intervention are important, but, all too often, I hear about school psychologists making treatment plans without ever meeting a child. Just because Freud did it with Little Hans doesn’t mean it’s good practice.

Therapists who have had training in individual child therapy often develop a habit of using indirect play interactions instead of more direct conversation. After all, the tradition of play therapy is built on the premise that children cannot express themselves in words. But, in my experience, this indirection often is unnecessary. In fact, play therapy may be most useful in helping both adults and children practice what has already been talked about.

Shandler clearly illustrates one pitfall in working with small children thinking for, rather than with them. Even with children as young as 3 and 4, I have found that discussing the problem and clarifying what adults are concerned about helps the child to participate more fully in the treatment plan, as Shandler found out when she finally asked Ron what to do.

Increasingly, school personnel feel saddled with responsibility for children who come to school hungry, dirty or improperly clothed. The school personnel’s response in this case is not atypical. They initially tried to involve Ron’s mother, and when she balked at cooperating, they then assumed total responsibility for solving the problem. As Shandler vividly describes, Ron and his mother then proceeded to show the futility of an approach not based on an explicit agreement between parent and school. Certainly there are situations in which parents who do not have the means to provide adequate clothing for their children may accept assistance from the school. But when the school undertakes these efforts in the face of obvious parental indifference or neglect, they cross a line, further alienating already sensitive parents and confusing already vulnerable children.

So what can be done? Ron’s mother presents a familiar challenge and articulates her position more clearly than many parents. “I am unavailable,” she says. “This is not a problem. If this is a problem for you, it is of your own making. You are trying to embarrass my son and humiliate me.”

In the end, Shandler and her colleagues discover a last-resort approach that works. The child can be sent home or to the parent’s place of work to be cleaned up. The mother can be called to come in and clean her child and to teach him how to be clean. Ron’s mother can be directed to provide the school with what is necessary to care for the child in school (e.g., clean clothes). When all else fails, child protective services can be involved. While this approach may be tough, it is not mean, and, ultimately, it is respectful, because it holds the parents accountable for their children’s healthy development rather than assuming that they can’t or won’t be responsible. In those rare instances when parents either can’t or won’t be responsible, child protective services should step in and the school must avoid putting itself in the position of protecting parents from this outcome.

Nina Shandler says that this case taught her to be an advocate rather than a substitute parent. It is a fine lesson, beautifully illustrated. Anyone who works with children should keep it in mind.


NINA SHANDLER DESCRIBES A scenario that takes place daily in public schools: A child misbehaves, the flow of teaching is disrupted, school staff feel increasingly beleaguered, and parent(s) are called in for a meeting about their child that results in a confrontation about faulty parenting. The family mirrors the attack by insisting that the school is doing a lousy job and that all is well at home. In the ensuing stalemate, the school assumes a rigid hierarchical position, threatening the parents with the child’s expulsion, special class placement or being reported themselves for abuse and/ or neglect. If that doesn’t work and there are insufficient grounds for such drastic measures, an expert, such as a school psychologist, counselor or social worker, is called in to fix the problem through individual work with the child. Often, at this stage, the child will be evaluated and labeled “emotionally disturbed” or ADHD. Finally, if the child’s difficulties persist, the sequence once again begins, with renewed attempts at family involvement, albeit with potent memories of an already scarred relationship.

I wish that Shandler’s final realization that she and Pam were both just mothers had been the guiding principle in her work from the get-go. The primary goal then would have centered on building a working relationship with Pam, and other interventions in Ron’s treatment would have flowed from that. Unfortunately the connection with Pam was too little and too late, and ended up shrouded in coercion and threats. Even though Ron improved, nothing changed in Pam’s perception of the school as hostile to her and her child.

Early on, Shandler recognizes her overinvolvement with Ron and the enraged reaction that this was likely to trigger in Pam. The question some readers may have is, “With all her awareness, what prevented her from conducting a more collaborative, family-school based therapy?” In fact, Shandler’s approach in this case says a lot about the conflicting roles and expectations experienced by many therapists working in school settings Schools see their mandate as attending to the needs of the entire student body. Deviance from the norm, in this case, Ron’s encopresis, becomes an obvious problem. The initial solution to alert Pam was experienced as accusatory, and Pam defensively denied responsibility and counterattacked. The school decided it couldn’t work with her and called in its specialist to bypass Pam and to “cure” Ron. The adversarial relationship between the school and Pam was then played out through Shandler’s interventions. Paralleling that power-unbalanced relationship between the school and Pam is the position of the psychologist within the school. Shandler’s job title is school psychologist, not family therapist, and it is unlikely that she would have the power to challenge the focus on “fixing” Ron without being viewed as uncooperative, or incompetent, by the principal, teachers and nurse.

The political context of public education, particularly in schools that deal with poor families, exacerbates these imbalances. Private schools and wealthier public school districts allow parents to be consumers of a product in a competitive market economy. They are empowered to challenge existing beliefs within the school, and family-school discussions have relatively equal amounts of give and take. But for poor families, schools are part of a larger service economy. Parents especially single parents are in a perpetual one-down position. If they do not accept what’s provided to them and their children, they are labeled “resistant” and “hostile.”

So what might have been done differently in this case? The family-school rift was clear from the start: “All reported that his mother was no help,” and “She [Pam] insisted his teachers were concocting imaginary accidents because they hated her son and had a snobbish disdain for the poor.” I would assume that both statements were true and would proceed accordingly. The school’s and Pam’s divergent realities each need to be valued and respected. Shandler certainly succeeded with the school by wholeheartedly accepting their definition of the problem. But, in so doing, she excluded Pam from the equation.

So how does one go about developing a relationship with someone like Pam, who probably has had a troubled history with schools? First of all, to ease her suspicious-ness, someone has to listen nondefensively to her charges of classism and discrimination and to accept that as at least a partial explanation for what is going on. I would telephone Pam fully prepared for a verbal barrage after all, in her mind, I am not a representative of the school, I am the school. I would need every ounce of clinical detachment in my repertoire to not react defensively. After listening quietly while Pam vents, I might say something like, “Pam, the bottom line is that you have absolutely no reason to trust me. I am a complete stranger to you except that you know that I work for the school. You’ve made it clear that, as far as you’re concerned, the school is down on you and Ron. You might be right. We both know that not all kids and mothers are treated equally by teachers and principals. But now we have a problem we need to tackle. The school has asked me to figure out a way that Ron can be in class without messing his pants. I understand that you don’t believe that he’s doing that, but we still have a problem. If he is soiling himself, we need to figure out how to help him so that he doesn’t get teased by the other kids. If he isn’t and the school is lying, we need to figure out who and why so that Ron can start being treated fairly. What I am asking for is that you give me an opportunity to prove that I really am interested in seeing Ron do well in school. If I’m fake, you’ll pick it up pretty quickly and I would expect that you would let me know that in no uncertain terms. Ron has a big problem he’s either messing himself, being mistreated, or maybe something neither of us have considered. We owe it to him to figure it out.”

This kind of approach, of course, is only effective if the clinician believes it. It won’t work if I view this merely as a strategy to get Pam into treatment. My goal is to offer the promise of an honest relationship and differentiate myself enough from the school so that the parent will give me the opportunity to work collaboratively and neutrally. If I am successful, Pam will be open to another phone call, or better yet, a meeting, scheduled at a time and place that recognizes the difficulty Pam has as a working, single parent in fitting into the ordinary school schedule.

I would encourage Shandler to examine two aspects of her work. First, she should discard the concept of “the function of the symptom” as she works with more families. This is the family therapist’s version of the DSM-III, and it places the therapist in a one-up position with clients, i.e., “I know this about you you somehow need your child to act out so that you don’t have to deal with your marital problems.” Frankly, I don’t know whether symptoms have functions. What I do know is that when a family gets blamed, the opportunity for a healthy relationship is decreased.

Secondly, Shandler should be willing to throw away any definitions of the problem that a client is not accepting. With Ron, the problem was framed as “toilet training,” which Pam rejected as a legitimate problem. She accurately viewed it as an attack on her parenting. I would never mention “toilet training.” Beyond the ongoing necessity of forging a positive relationship, the next most important issue is to develop a shared definition of the problem. Without it, you have a chaotic therapy of differing agendas.

Had Pam been included as a key part of Ron’s treatment throughout, the school probably would not have had to play the “heavy” by being agents of social control. Pam would have been empowered and would not have had to automatically defend herself or Ron in knee-jerk fashion. And if she did, Shandler would be able to invoke the strength of her therapeutic bond with Pam as a motive for sorting through the conflict. I am reminded of the words of a former trainee in her work with a diagnosed paranoid schizophrenic mother, when she failed to show up for sessions following some minor gripes about the therapy, “Barbara, what’s this about? I thought we had a relationship.” That one sentence, following months of difficult, but deeply committed work, was enough for her client to reevaluate her stance, despite severe psychopathology, and to exercise her all-too-new choice of testing and persevering with a relationship over time.

I am not minimizing the severity of Ron’s circumstances. Pam still might have been reported for neglect. However, as her trust in Shandler increased, she might have allowed Shandler greater access to other helpful people in her life, including neighbors, extended family and friends. Once the circle of support grows, there is often not as much need for external policing. Clients become less isolated, and are able to accept offers of assistance and to even ask for it without fear of being judged.

Finally, for all this to occur in public education, schools need to commit themselves to become more family-friendly and to encourage parental involvement in a multitude of activities not just when a child is doing poorly. We also need systemically trained professionals in the schools, including teachers, administrators and human service providers. Increasingly, schools are utilizing family therapists as consultants to work with children and families as connected parts of a larger system, but we are just at the beginning similar to where family therapy was in the mental-health system

30 years ago. Yet, only when schools engage in what Howard Weiss refers to as “climate building” a long-term restructuring that includes families will the destructive gap between children’s two most important socializing contacts begin to narrow.



IN THEIR COMMENTARIES, LEE Combrinck-Graham and Bruce Buchanan offer some valuable insights. Combrinck-Graham reminds us that children are capable of conversation and worthy of respect. Buchanan’s treatise on how schools should work with families sounds uncannily like my own admonitions to my interns, graduate students and colleagues. While I find no need to take exception to details of their analysis or argue points that can be seen from multiple perspectives, I do find the tone of their comments distressingly typical of attitudes toward school professionals.

Those of us who work on the front lines involved in the day-to-day lives of children who forsake traditional weekly sessions and discard standard therapeutic roles are too often treated as part of the problem rather than respected as capable professionals. Combrinck-Graham and Buchanan appear to be looking for a neat and tidy illustration of water-tight psychological theory and practice. This case is not meant to be neat or tidy. It is not an example of perfect practice or an illustration of flawless theory. It is about the messy business of real life where sincere mistakes often lead to genuine successes. It is one person’s honest telling of a study about three human beings a psychologist, a child and a parent who all shared a difficult predicament and all learned to be more competent.

Nina Shandler, Ed.D., is «licensed psychologist and certified school psychologist who has worked in the Amherst public schools and taught at the University of Massachusetts. 

Lee Combrinck-Graham, M.D., is a child and adolescent psychiatrist who lives in Connecticut. 

Bruce Buchanan, MA., M.S., is director of the Families, Agencies and Schools Together Program at the Marriage Council of Philadelphia.