This is an account of some work that I did with David and his family at my Psychotherapy practice in the Manchester Institute. I decided to write about this family because when they came to see me, David was a very sad little boy and his mother was having problems coping with his behaviour. Yet, they worked so hard together to solve their problems and never gave up. They stuck with the suggestions I invited them to try, despite some of the difficulties they encountered meanwhile. Week after week they kept on coming back for more, even though things got decidedly worse on occasions. As a result the family have made big changes as to how they are with each other and David is now a much happier child. David is an eight year old little boy who was brought to me by his mother Annie because he presented as an unhappy child who was quiet, withdrawn, aggressive toward his younger brother, wetting his bed and had very poor concentration and memory. At school he was often in trouble for aggressive outbursts for the slightest of reasons and he was constantly losing books, articles of clothing and forgetting to bring his homework home.
We agreed together that I would spend a session with mum to get some family history and some time alone with David to find out what he wanted and some time with them all together to find out what each of them wanted. We then agreed having established what every one wanted to change that I would see David on a weekly basis and also as part of the session see his mum separately to discuss any problems she might have.
When I did my initial history taking it became apparent that David's father was no longer living with them and had been off the scene for eighteen months. Previous to this he had figured highly in David's life and they had been very close. David had not heard from his father since he had left.
During my individual sessions with David it became apparent that he was grieving for his father but was unable to express this or share how he felt to his mum. When I talked about this to Annie, she was aware that he had some feelings about his dad as David carried a picture of his father every where he went, even to bed. But she told me that he never talked about him to her. When I asked her if she ever talked about his father to David she told me he was a taboo subject in the house. The main reason was that her mother, the children's grandmother, child minded them while she was at work and had a high level of involvement in their care. Grandmother hated David's father and would not allow his name to be mentioned. She had a bad marriage herself that ended acrimoniously and she constantly bad -mouthed men. She was also had very strong views as to how the boys were to be brought up and Annie was at constant logger heads with her as she felt undermined by her mother where the children were concerned.
Although I kept in the forefront of my mind David's grief and loss issues and that this would be the main focus of our work; There were some other issues that were also crucial to look at. David's little brother James was a very smart child and always seemed to do the things that David couldn't do and therefore was constantly praised for this. Also both boys were treated exactly the same even though David was James senior by three years. For example they were sent to bed at the same time, and had the same type of clothes. When having disagreements, David was expected to give into James as he was the elder and had to set an example. Unfortunately, as James was so unhappy and lacked motivation it was hard for him to set a good example and was often violent towards his younger brother. His mother got more and more frustrated with him which was made worse by grandmother who would constantly advise Annie that he be punished for behaving so badly. At this point I also became aware that there were some 'script issues' that Annie needed to address in order that she could help her son come to terms with his grief. Our life script is an unaware life- story in Transactional analysis terms. Eric Beme (1966) defined 'Life Script' as an 'unconscious plan'. Each of us in childhood writes a life story for ourselves, which has a beginning, middle and an end. The basic plot is written before we are old enough to talk, and we continue to add to it. By about seven years of age it has been completed, but we can revise it in out teens. We are committed to living out this life story in our adult life with the aim to live out the final scene that we decided on as infants.
During our individual sessions it became apparent as to why David felt so alone and indeed when ever he drew pictures of his family, mum, James and Grandmother would be placed together and he would be to one side all on his own. He missed his father and was grieving for him but felt alone in his grief.
In his therapy as a therapeutic tool, I decided to use a work -book with him called 'When something terrible happens' Marge Heegard (Children can learn to cope with grief and loss). Traumatic events such as loss and grief often leave children feeling confused, insecure and frightened. This book is like a journal to record important events and feelings. In giving David the space to recreate these events on paper, puts him in charge and provides opportunity to share his story, his loss and the experiences about the loss and how it impacted him.
In the journal he could record and draw pictures on a weekly basis about the work we have done together. I made an agreement with David that the journal is something that belonged to him, but also explained to him that it was important that the family understood why he was so unhappy and troubled. By sharing the work -book with his family, they could begin to understand him, support him and make him feel better. I also included Annie in this by asking her to go over with him at home what he had done in the workbook during the session. Stipulating that she was to acknowledge positively what he had done and not question or criticise his work. This also meant that we concentrated on positive strokes. In T.A. language a stroke is a unit of recognition and strokes are important and necessary to our healthy growth and development. Beme, (1 966). It is important that we continue to receive a healthy supply of strokes all through our lives. Sometimes in response to a lack of positive strokes, or a stroke economy, we may seek negative one's instead. Claude Steiner, (1 97 1), wrote that 'strokes are as necessary to human life as are other primary biological needs such as food, water, and shelter - needs which if not satisfied will lead to death. It was apparent that David was more often in trouble than being good and consequently the things that he got recognition for were the things that he did wrong. What David had decided to do was get negative strokes in response to the lack of positive one's. So his mum made him a star chart with a simple list of things to do; in order to record all the things he had achieved, remembered or got right. David would get a Silver Star for each task he achieved and a gold star for three consecutive silver ones. A gold star meant he received a small treat. This meant that David was given attention and strokes for achieving instead for doing things wrong. We also spent time in our sessions talking about his dad and would invite mum in at the end for him to share what he had been doing. In this way he could safely and freely talk about his dad and mum could join in. Thus, giving him a message that his feelings for his dad were important and acknowledged. This also made it easier for him to share his work- book with his mum at home. He cried a lot in his sessions at first and his mum would report that he would wet his bed the night he came to therapy and his behaviour would deteriorate. I had warned Annie at the beginning of my work with David that this may happen and that he may regress but this was a necessary process on his way to recovery. Annie was willing to weather the storm, but I know it was an added strain for her and gave her a stroke for her dedication.
I also advised mum to make a list of all the things he needed each day to do, so that he could cheek them off before he left the house and she need only remind him to refer to his list. Consequently giving David the responsibility preparing what he needed for school each day. I also advised her to go to the school and let them know what we were doing so that they could help him and have some understanding about his aggressive outbursts and support Annie with the positive star/stroke chart. Another important issue to tackle was getting David to feel part of the family and have a sense of belonging. He needed to know that he was important too. I suggested to Annie that she kept David up a little later than James, as he was younger and that she could use this time as special time alone with David.
Also it was important that James was not used as a comparison for how to get things right because this would only serve to confirm for David how bad he was. We make script decisions about ourselves, and how we need to be in the world at a very early age. Beme, (1966). These decisions constantly get confirmed for us by the way our significant others (parents and carers) respond to us and to our needs.
As the weeks went by and David became more open with his feelings with me, he began to share his feelings with his mum. Annie also spent some time with me and shared with me that she could identify with how David felt and was beginning to understand how important it was for him to talk and grieve for his dad. This is when Annie discovered that there was a family script pattern for dealing with feelings and more particularly, grief and loss issues. When her father left the family when she was a child, she was unable to share how she felt with anyone as her mother never discussed or expressed how she felt about it and never asked Annie how she felt. Annie's injunctions or early life messages about how to be in the world were, Don't be Close,
Don't feel (sadness) and Don't be important. Gouldings, (1976). So, her grief stayed locked inside her unexpressed as she was unable to get close to her mother to share her grief As a result of this she felt that her problems were not important or valid and took the life position of 'You're OK - I'm not OK'. Emst, (1971). She was impacted quite profoundly by her loss and felt angry and resentful towards her father for leaving without any explanation, but was unable to express this. Annie's counter script or Driver, message is, 'Be Strong', which enabled her to cope with her injunctions of 'Don't feel', 'Don't be close' and 'Don't be important'. (T Kahler 1974).
As a result of her early childhood experiences Annie became an under-achiever at school and was shy and reserved and made few friends. When David became withdrawn and sad, she blamed David's father and did not want to be reminded of him because that would remind her of her own father's abandonment of her. Thus passing her own script issues onto her son by not acknowledging his grief and loss.
As a result of this new understanding on Annie's part, she was able to talk to her mother about how she felt when her father left them and how important she felt it was for David to grieve for the loss of his father. She began to make clear boundaries about how she dealt with the children and as a result her mother interfered less with how she managed them and began to respect her decisions. Whilst Annie was very insightful and understanding of David's problems, she also felt guilty about her part in them. It was a difficult time for her as her response initially was to shut off and withdraw from support and help, as she felt so bad. Thus going into her 'Be Strong' driver in order that she could avoid being reminded of the pain and hurt of the original trauma. David remained the focus of her motivation and through his work she was able to accept support and see the positive outcomes. I would often remind her that as a mother myself I may have done things that I have regretted, but I always did what I thought was the best thing to do at the time. It is always easier to make better judgements in hindsight.
David has completed his therapy with me and is now a much happier little boy who has a close loving relationship with his mother and brother. He can now express how he feels with his mother. A strategy he liked best to help him is to write a letter to his dad and then share it with his mother and she talks to him about how he feels. Annie is much more confident as a mother and can talk more openly herself about her worries and concerns and gets supported when she needs it. This is a good role model for her children. I admire her strength and courage to want what's best for her children and herself and I have learnt much from this experience.