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Therapeutic relationships and 4 therapeutic pearls of wisdom

May 7th, 2019

“He shares things with you,” the therapist groused, “that he should be talking about in therapy.”  It was true.  My young son often told me things that were on his mind or that caused him pain or fear when we were alone in the car, sometimes on the drive to therapy.  There was something about the combination of road noise, looking straight ahead and knowing the trip would soon end that worked for him.  Sometimes things would spill out and shortly after, we’d reach our destination.  He’d be done and would have no desire to bring up whatever it was again, in therapy or elsewhere.  I described this to the therapist then added, “Maybe you should get two parallel car seats in here. It seems to be a key ingredient.”

What I couldn’t explain was that my son was simply unable to form a therapeutic relationship with anyone.  He would like them and talk about ordinary things, like a television show or favorite food, but that was all.  It wasn’t just that I was his mom and he already had a relationship with me — though that helped — but he didn’t have the bandwidth. He was so overwhelmed with jagged emotions and racing thoughts that he couldn’t process much and was only able to share things in short spurts.  Any longer and he was uncomfortable at best and feeling pained at worst.  He had no fertile space inside to grow a relationship.

Sure, I had lots of little “tricks” up my sleeve. I knew just how to touch his shoulder to redirect him when he was obsessing.  I knew how far to move into his space and what words he could hear in a neutral way.  But what the therapist wasn’t seeing was my son’s inability to form that relationship on anything but a superficial level.  It wasn’t until years later, when someone explained what a therapeutic relationship was to me that I could help nudge my son in that direction.  Just like I encouraged other relationships he had trouble navigating.

That’s how I learned what a therapeutic relationship was and how my son could benefit from it.

There were other pearls of wisdom that his therapists gifted to me over the years that helped enormously.  I’d like to share four of them.

Pearl #1.  When my son was about 8 or 9 and couldn’t explain how his meltdowns happened or how he felt afterward, his therapist told me that at about age 14, children develop the ability to observe themselves and the things around them in a new way, sort of like young journalists.  They can describe and report as if they are watching themselves.  I waited for that day, believing it would make a difference.  It didn’t come in a flash rather, more gradually, but it was there.  What’s more, I could actually see it happen.  This new ability didn’t calm or make sense of his feelings but gave us all a much-needed window on them.

Pearl #2. During another period, when he was in middle school, he became more explosive each week.  One day, his 10-year old brother had had enough of the safety plan where he removed himself, getting out of the path of the storm.  Instead, he provoked the confrontation he knew was coming and it got physical before I could get between them.  In family therapy that week, I despaired, “I don’t think they will ever be able to simply be in the same room with each other.”  The therapist commiserated then offered this: “Your son does pretty well with adults and not as well with children.  When his brother is an adult, they will probably be able to restart their relationship on a positive note.”  Part of me was disbelieving – she didn’t see the horrible fight! – but part of me held on to that idea with both hands.  It turned out to be true.

Pearl #3. A couple of years later, still during middle school, we went through a tough period of medication trials, dosage changes, weaning off and still more trials.  My son had never been on a medication combination that worked well, but until then he’d had periods where his symptoms had lessened, his sleep or focus or moods had improved.  I filled out charts, trying to track whether his mood swings had slowed or his suicidal thoughts had abated.  I concentrated on the medications wondering about their direct impact.  As his medication trials seemed to offer hope, then withdraw it, my hopes soared and crashed as well.

Of course, I kept his therapist in the loop.  One day she remarked, “Medication is intended to be an adjunct to therapy.  In the best of worlds, it calms the mind, sharpens the focus, evens out the mood and helps people be more available to therapy.  So that therapy can be successful.”  I looked at her, light bulbs turning on above my head.  Until that moment, I had measured the success of medication by the relief of my son’s symptoms and hadn’t given this much thought.  Now I did.  When I explained it to him, he got it, too.  I changed my thinking about medication that day and it stayed changed.

Pearl #4.  My son was a little boy, a first grader, when he first blurted out that he wanted to die.  I was horrified and hoped never to hear it again.  But I heard  it again a couple of weeks later.  Soon he said it almost every day and also developed crying jags, meltdowns, nightmares and phobias.  I longed for a day, just one, when he wasn’t sad, scared, angry or unpredictable.  “How do we cure him?” I asked his therapist.  “How do we make him better?”  “It works like this,” she told me.  “We find treatments and things to do that make the outbursts less intense.  We give him care that makes the sad or angry times farther apart.”  I had a difficult time letting go of the idea of a cure.  I wanted to see him not just better, but all better.  But I learned to be glad to see the time between meltdowns grow – even if at other times it collapsed again.  I watched for days when he was less sad and less fearful of a million different things.  I adjusted my idea of what progress looked like.

It wasn’t until he was older and experienced less emotional chaos that my son could form a therapeutic relationship.  But I did.  Sometimes it was his therapists who guided my thinking and coached my approach to him.  Maybe that was just as important.

 

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