15 Chapters
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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 EIGHT: The fifth year

Cleve, Elisabeth Karnac Books 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.

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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 THREE: The psychological assessment

Cleve, Elisabeth Karnac Books 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.

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CHAPTER SIX: The third year

Cleve, Elisabeth Karnac Books 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.

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