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CHAPTER TWELVE: Psychotherapy for children with emotional and neuropsychiatric disturbances

Cleve, Elisabeth Karnac Books 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.

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CHAPTER SEVEN: The fourth year

Cleve, Elisabeth Karnac Books 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!”

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CHAPTER THIRTEEN: Concluding remarks

Cleve, Elisabeth Karnac Books 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.

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CHAPTER ELEVEN: Has it been worth it?

Cleve, Elisabeth Karnac Books 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.

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APPENDIX 1

Cleve, Elisabeth Karnac Books 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.

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