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CHAPTER NINE: The sixth year

Cleve, Elisabeth Karnac Books 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.

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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 ONE: Our first meeting in the waiting room

Cleve, Elisabeth Karnac Books 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.

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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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APPENDIX 2

Cleve, Elisabeth Karnac Books 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

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