Medium 9781855753457

From Chaos to Coherence

Views: 1415
Ratings: (0)

'...I am flooded with warmth for this little expert on the art of living, who has just realised that even he has the possibility to live a long life. My interpretation is that he trusts he will get the time he needs in therapy to reach, first adulthood, and, then, old age. Right now he believes he will continue to be in therapy for the rest of his life. He cannot imagine that it is going to come to an end. However, I have started to think about when we will have to part and I am not looking forward to it...'From Chaos to Coherence is the true story, told in everyday language, of the adopted boy Douglas and his journey towards adulthood with the help of psychotherapy.Douglas has severe psychic, physical and social handicaps and is also diagnosed with ADHD. He is impulse-governed, aggressive, provocative and unable to interact with other children. He begins psychotherapy at the age of seven and continues weekly sessions for the next seven years.The reader is invited into the child psychotherapy room to follow the work of Douglas and his therapist, the author Elisabeth Cleve. The therapy can be described as physically intense work that evokes strong emotions in both Douglas and the therapist. We get to learn about their inner feelings, thoughts and actions during the different phases of the treatment.The story of Douglas captivates the reader and provides an understanding of what is going on inside a troubled little boy. This beautifully written account of successful psychotherapy is painfully honest at times and manages to bring the therapy sessions to life for the reader. From Chaos to Coherence is an important book and vital reading not only for all involved in children's psychotherapy, but for all of us in search of a humane, informative and touching book.

List price: $28.99

Your Price: $23.19

You Save: 20%

Remix
Remove
 

15 Chapters

Format Buy Remix

CHAPTER ONE: Our first meeting in the waiting room

ePub

How do you do

When I meet Douglas for the first time, I see a tall, brown-skinned, six-year-old boy of African origin who darts around the waiting room in every direction. He has come with his adoptive parents, Margareta and Gunnar, for a psychological assessment, which I am going to conduct.

The boy is hyperactive and lacks a firm posture. He flings himself about and slobbers. He is in constant motion and spreads a strong feeling of agitation around himself. He kicks his feet around, bumps into the furniture, and knocks a flowerpot on to the floor. Suddenly he jumps up and, before anyone has a chance to stop him, he scuffs the wall with his feet. Douglas does not, so to speak, always have his head up and his feet down. He is wearing new clothes, which just hang there on his body. Nothing is buttoned and nothing seems to fit. Douglas seems to have shut off the normal ability to feel in various parts of his body. In all the tumult he is causing, one of his shoes falls off and I notice there is a pebble in it. He has had that in his shoe without showing any reaction of pain. He has not noticed anything. He gives the impression of living in a constant state of pain and thus a little stone in his shoe is neither here nor there.

 

CHAPTER TWO: Douglas’s life history

ePub

During the period of time it takes for Douglas to go through all the testing, Margareta and Gunnar visit Birgitta three times. To her, they describe their son’s life before and after adoption as well as their family situation right now. Margareta and Gunnar have known each other since their youth. They married early and looked forward to having a family. However, Margareta failed to become pregnant. They took a fertility test but it was not possible to determine the cause of their childlessness. After having been childless for ten years, they decided to apply to adopt a child. They were approved as adoptive parents. After a two-year wait, they were asked if they would like to adopt a little boy who did not have any parents.

The boy’s name was Ogar and he had been born to African parents in France. To start with, Margareta and Gunnar received photographs of him and a short description of his first years of life. After they had looked at the pictures, they asked to know more about the boy’s background. By mail, they received some documents prepared during the French adoption investigation, translated into Swedish. They read everything over and over again and had many discussions about whether they would be able to be good parents for this boy, who had suffered such deprivation. Both of them knew all along, despite all the discussions for and against, that they would give a positive reply and receive him as their son. They had a deep longing for a child and had already become attached to the cute brown boy in the pictures. He was said to be three years old. A short time before the adoption they found out that, in fact, he was one year older.

 

CHAPTER THREE: The psychological assessment

ePub

Here we go

Douglas goes through a comprehensive psychological assessment, which I conduct. My wish is to obtain a picture of his psychological and neuropsychiatric status as well as an idea of his intellectual capacities. I use tests that measure several different aspects of his personality. It is necessary to carry out a broad psychological survey in order to illuminate both Douglas’s strong and weak sides. He is tested with so-called projective personality tests, which elucidate unconscious psychological processes. They can provide hypotheses on how mild or severe his personality disorder is. He is also given an intelligence test, which measures his general aptitude. I also test him with neuropsychological tests, which can indicate whether he has brain dysfunctions.

An important part of the assessment consists of everything Margareta and Gunnar say about Douglas’s earlier and present life, how he functions psychically, his somatic condition, and how he behaves with other people. For children who have had such a difficult start in life as Douglas, it is especially important to know as much as possible about the infancy period. In Douglas’s case, there is a considerable amount of information on how deprived he was from the very start of his life.

 

CHAPTER FOUR: The first year of psychotherapy

ePub

Ugly and repulsive

Douglas is seven years old when he starts the individual psychotherapy that is going to last for the next seven years. His therapy will take place in the same room as the assessment sessions, four floors up in the building. In one part of the therapy room the sand tray and the toy cabinet are placed. There are also drawing paper, paints, play telephones, balls, a few other toys, and games of differing levels of difficulty. In the other part of the room there are a table and two easy chairs, as well as a desk with some of my office material on it.

Six months have passed since the psychological assessment was made. It has taken time for Douglas’s parents and for me to plan his therapy, and a summer has gone by since Douglas was last in the building. When he now returns, he does not seem to recognize the interior, except for the stairs. There are many stairs, from one floor to another and they are not always in the same stairwell. To a child, it can seem like a maze of stairs. Douglas becomes fond of a creaky, narrow, spiral staircase, which winds around and around from the ground floor all the way up to the attic. It is an emergency exit and is seldom used, but Douglas likes to climb it and swing himself around on it. He is not bothered that others are worried that he might fall and hurt himself.

 

CHAPTER FIVE: The second year

ePub

Crash, boom, bang!

Douglas’s eighth birthday has come and gone and he still does not always remember my name. Nothing in his behaviour indicates that he sees me as a person of any particular importance to him. He recognizes my name when he hears it but he never uses it. He still gives me the feeling that it is not especially essential if I or someone else meet him when he comes to therapy. I wonder what Douglas would do if another person stood there one day instead of me. Perhaps he would run up to the room just as willingly or unwillingly as usual, and discover only after the session was well under way that the person talking to him was not me.

His interest in me and in what I have to offer comes and goes. I doubt if he would recognize me if we were to run into each other somewhere else. If I were to say “Hello Douglas” under such circumstances, he would probably recognize me through hearing and seeing. His ability to comprehend is always best when he uses both sight and sound simultaneously.

 

CHAPTER SIX: The third year

ePub

Help! The patient and the therapist need care!

Douglas is nine years old and goes on coming to therapy, twice a week, as faithfully during the third year as he did earlier. Together with Douglas’s parents, I have meetings regularly with the school staff. We want to cooperate in the work with Douglas. They tell us that he shows a positive attitude towards attending the new school. They add, however, that it is necessary to have a teacher near him in order to make sure that he can focus on the task at hand. He is given short, minor tasks so that he can learn to see their beginning and their end. If he takes up a task and tries to do it entirely on his own, neither he nor the teachers know where or how it will end. They also say that he is often involved in conflicts with his classmates, who also have difficulties in relating to others. It has been ascertained that Douglas has severe reading and writing problems.

I participate in various conferences in which Douglas’s schooling and after-school activities are discussed. My experience and knowledge concerning him contributes to making the plans realistic. It is important not to put him in a situation where he is doomed to fail. The personnel who work with Douglas on his after-school activities ask for my supervision and I meet them several times. They are frightened of his rampages and want my help on how to react to him. We also discuss how his problems can be understood in the context of both neuropsychiatric and emotional causes. After-school activities must also be well structured. It is still difficult for Douglas to manage spontaneous activities.

 

CHAPTER SEVEN: The fourth year

ePub

Where’ve you been all summer?

Douglas is ten years old when he returns from his summer vacation and is ready to start his fourth year in therapy. He is upset when he sees that some things at the institute have been changed and modernized. The waiting room has been redecorated and he finds it ugly. A newly employed girl in reception “asks strange questions” and my new hairstyle is the worst thing he has seen.

The room we moved back to during the previous term also has all the shortcomings and defects he can imagine. He has forgotten that we inspected it carefully several times before the summer break. He does not feel at all prepared for these changes and they disturb him greatly. Actually I needed to change the time for one of Douglas’s weekly sessions because my schedule at the institute has been changed. However, I refrain from doing so because it would be entirely too disconcerting for him. Douglas knew the waiting room was going to look different after the summer break, but he has still imagined it would look the same. He blares out, “I hate changes!”

 

CHAPTER EIGHT: The fifth year

ePub

Delicious brownies

In the autumn, as we enter the fifth year, Douglas is eleven years old. During every summer holiday up to this time, I have sent a postcard to him and he has sent one to me. In the beginning, the purpose was to make it easier for him to remember therapy and me. We have continued to send cards even though it is no longer necessary for that reason. I have addressed earlier cards to “schoolboy” but on the last one I used “Mr”. He says of this summer’s card, “That ‘Mr’ thing was awesome.”

Douglas has started to attend a school closer to his home and his school days are longer. He is in a class called “the little class”, which consists of nine boys and one girl. The two teachers have many years’ experience of teaching children with ADHD. To get to therapy on time on Mondays, Douglas has to leave school before a cookery lesson is over. Unfortunately, he has time to bake and cook food but not to stay and eat it with his classmates. He thoroughly enjoys cooking and loves good food. This is without doubt a dilemma and we discuss how we are going to solve it.

 

CHAPTER NINE: The sixth year

ePub

A nerdy old bag or a baggy old nerd

Douglas is twelve years old and into the sixth year of his therapy. He comes as faithfully as ever, twice a week. He is fond of the entire institute and takes over the waiting room and reception when he arrives. He always arrives well ahead of time because he wants to chat with the staff in reception. He likes sitting in the waiting room until time for his session. He prepares for his session both there and during his trip by thinking about something that has happened and that he wants to talk about. On several occasions, Douglas has to stay somewhat longer at school than usual. His parents and he choose to come to their sessions anyway, even if it means half an hour of therapy for the two hours it takes to get here and back.

Douglas is now able to show that he likes other people, especially adults, and does so affectionately. His face breaks into a smile when he enters the building. The reception staff has come to like him very much over the years. They comment on the changes in his behaviour. They cannot believe it is the same boy they met when he first came to the institute. Douglas chats with them about everyday matters in an outgoing and pleasant way. If they have to answer the phone or take care of some small business, he waits until they are free again and then continues to chat.

 

CHAPTER TEN: The seventh and last year of psychotherapy

ePub

I want to talk with you

Douglas has turned thirteen when he starts his seventh and last year of therapy. He is a good-looking teenage boy when he returns from his summer holiday and I enjoy seeing him again. He has grown even more, his legs are longer, and he is quite a bit taller than the average boy his age. He comments on the new term by saying, “Weird how I’m here again. I just keep coming back.”

He has a new, flattering hair-style, which also makes him look older. All the hair on the sides is shaved so he only has a bunch of hair on top of his head.

He is quite appealing as he tells how the hair-style came about.

“Mum cut my hair ‘cause we were gunna go to a party. I guess she wanted me to look good ‘cause she didn’t wanna be ashamed of the family. She usually goes full throttle with the trimmer and shaves off most of the hair. If you’re lucky, you end up with a new hair-style.”

“Well, I suppose you were lucky this time.”

He agrees because he is pleased with the way he looks in his new hair-style. Both he and his parents think that the summer holiday has gone fairly well, calmer than in a long time. He recounts what he has been up to without joking about it or making things up.

 

CHAPTER ELEVEN: Has it been worth it?

ePub

Douglas wants to know if this “therapy thing” really has I been worth it. Yes, that is a relevant question. To identify * -~ which effects various efforts have had on Douglas’s development is naturally not an easy matter. Apart from his parents and me, there have been many other people trying to help. However, in many ways, Douglas himself has shown that therapy has played an essential role in his life. It is my hope that readers have had a chance to form an opinion of their own on this matter, after following the boy through seven years.

I would like to shed some light on the question of whether it has been worth it by comparing Douglas’s way of functioning at the beginning and at the end of therapy.

By the time Douglas was seven years old, he had received a long series of diagnoses which had emotional, neuropsychiatric, somatic, and social causes. Because of his impulsivity his parents’ worst fears were that he could be killed in an accident or turn into a grown-up who went about provoking violence. Because of his violent behaviour he was forced to leave both his school and his soccer team. This had happened by the time he was eight years old. Douglas could not distinguish between his thoughts and actions. Indeed, they merged into each other and because of that he could not understand what his actual intentions really were. Other people also did not understand his ways of reacting, resulting in many misunderstandings and horror-stricken moments for the boy.

 

CHAPTER TWELVE: Psychotherapy for children with emotional and neuropsychiatric disturbances

ePub

A letter-combination diagnosis

The number of impulsive, hyperactive children with attention problems has increased during recent years. The causes vary from child to child. In one child, they can stem primarily from neuropsychiatric deviations. In another, psychological deficiencies in child care can be the major cause of the problems. My experience, however, is that in many children a combination of both emotional and neuropsychiatric disturbances contribute to aggres-sivity hyperactivity, and lack of concentration.

These kinds of neuropsychiatric problems often affect emotional well-being. It is obvious that impulsivity and attention problems that stem from a neurological underdevelopment put an emotional overload on both the child and his family. The child’s kindred usually suffer from the endless impulse outbursts and are distressed at not being able to live in harmony with their own rhythm. Instead they find themselves in a never-ending state of stress. This, in turn, naturally has a detrimental effect on the child. Members of the family are often cut off from a normal social life, since their friends find it too exhausting to be around them.

 

CHAPTER THIRTEEN: Concluding remarks

ePub

What to do with boys who have problems similar to Douglas’s is a subject of considerable debate. It is quite probable that many of these boys’ development could be favourably influenced if they were given psychotherapy adjusted to their needs and capacities. At the same time, however, the effectiveness of psychotherapy for them has been challenged and judged as too expensive.

In 1998, a report from a Swedish government-sponsored investigation concerning support and treatment of children and adolescents with emotional disturbances was presented. It came to the conclusion that severe behavioural disorders are difficult to treat when the boys get older. We should therefore think about whether we can afford not to try different types of psychological treatment for those who are in the risk zone for asocial development. Psychological treatment needs to be started for preventive purposes, to avoid costly round-the-clock treatment for the boys at a later stage.

The investigation also showed that, of the money spent by society on children and adolescents with psychic problems, an entire 75% went to a very small number of youths who needed to be taken care of round-the-clock. They live in specially chosen foster homes or at different types of institutions for youths. These are expensive forms of treatment. These youths have severe emotional problems and in most cases have made themselves so impossible that they have been rejected by both various schools and their own families. Their situation has reached the point of desperation. Their parents and others in their immediate environment are terrified by their impulsivity and unpredictability. In the end the parents have not been able to take responsibility for their children’s behaviour. They had needed steady support earlier.

 

APPENDIX 1

ePub

Three types of tests have been used to illuminate different aspects of Douglas’s personality:

•  Projective personality tests

•  Neuropsychological tests

•  Intelligence tests

Projective personality tests

These aim to give an in-depth view of the child’s psyche, even regarding aspects that the child himself is not always conscious of. The test results are interpreted on the basis of psychoanalytic theory.

Materials: two sand trays, 80 x 60 cm in size, one with dry sand and one with wet. A toy cabinet with a selected set of toys. Task: the child chooses toys and builds up a world of his own in one of the sand trays. This task is carried out on three of the test occasions.

(In psychotherapy the child uses the material more freely.)

Materials: paper and pencils.

Task: the child draws two human figures, one of each sex. He then makes up stories about these figures by answering questions regarding them.

Materials: ten pictures showing black and white drawings of animal figures in everyday situations.

 

APPENDIX 2

ePub

DSM-IV is a diagnostic manual in which psychic disabilities and illnesses are classified according to certain stated criteria. Descriptions of impaired psychic states form the basis for the diagnostic classifications. No position is taken on the different theories as to the causes of the psychic impairments. The diagnosis ADHD means Attention Deficit Hyperactivity Disorder. According to DSM-IV, ADHD is a diagnosis that is given when there are severe and extensive dysfunctions in the development of the capacity for mutual social interaction or verbal and non-verbal communication. In order for a child to be diagnosed as having ADHD, the following must hold true: at least six of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level

•  often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

•  often has difficulty sustaining attention in tasks or play activities

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000020611
Isbn
9781780496047
File size
503 KB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata