Small Winnings


Small Winnings

Learning from a Therapist's Nightmare

November/December 2000


I'm turning 45 in less than a year now, midlife by any definition, and I'm adjusting to it. As the life fulcrum shifts slightly under me, I like to think I'm breathing and seeing more deeply. I'm getting better at being where I am. Details matter more to me--and there seem to be more of them to observe. Racing toward facile solutions doesn't absorb me as much these days. I'm slowing down, and at least some of it's intentional.

So perhaps it isn't surprising that the challenging case that ambles through the thickets of my mind is Brian Stanley, a furious and terrified 11-year-old boy I've known well for six years and am still wrangling with every couple of weeks. Befitting my more deliberate gait, ours is a story of incremental healing and occasions for small hope.

Brian was adopted during his first year after enduring both abuse and neglect. His struggles now result from an unrelenting assault from physical, emotional and behavioral problems. He has had specialists of every stripe evaluate him and he carries multiple diagnoses--Reactive Attachment Disorder, AD/HD, Oppositional Defiant Disorder, various affective and anxiety disorders, features of both Bipolar Disorder and Obsessive-Compulsive Disorder--but none that fully captures his complexity. He has sensory integration deficits, and severe somatic concerns--irritable bowel, allergies, atopic dermatitis, asthma and migraines. He lives almost constantly within a cycle of defiance and shame. He suffers…

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