“Mommy, which one are you?” the small voice asked, a hand pointing toward the drawings of faces on the wall. The girl scanned them thoughtfully, making a mental note of each one. Angry, hmm, that’s not it. Happy, no not that either. Lonely, no. Okay, no. One face resonated with her and she whispered, “Mommy, I feel afraid.” Her body language seemed to confirm it. She sat close to her mother; they were both seated on the far end of the couch. Her hands were tucked into her jacket sleeves and her eyes remained unblinking as she silently evaluated me. My job was to evaluate her, but I had a feeling that if I didn’t pass hers, the interview would not go far. Attempting to normalize her fear I said, “Yeah, sometimes it’s scary when you meet someone new, have you ever been to counselor’s office before?” Her head slowly swung from side to side, fear seemed to trap her words. She was nudged by her mother, ‘Go on now, talk to the nice lady, she’s asking you a question.” Instinctively she scooted even closer to her mother’s side. More silence. It seemed this intake would go much more slowly than anticipated. The mother, Janice, quickly said, “She told the school counselor that she wants to kill herself”. The tone of her mother’s voice seemed slightly aloof. Perhaps that’s her personality I thought. “You must have been feeling pretty sad to want to do something like that”, I said. A nod. Good. Now we’re getting somewhere. She responded, “Really sad”.
Slowly over the hour, the story of this 10 year old girl unfolded. Her mother’s been in and out of abusive relationships since the girl was a toddler. Referring to the mother’s current boyfriend, the girl said,
“This one doesn’t hit her, but they fight all the time.”
To clarify I asked, “Do they raise their voices or do they scream?”
“They scream, they yell at each other.”
“What do you do when this happens?” I thought she would tell me, but instead she placed both hands over her ears and closed her eyes.
Opening her eyes she said, “I wish they would stop, I just want them to stop.”
My husband and I go hiking quite a bit, we love the outdoors and it's a nice departure from all the concrete and counseling. Here are some pictures from hikes over the last year and a half.
Big Bend National Park, TX
Yellowstone National Park, WY
Mineral Wells, TX
Makapu'u Point, HI
Lost Maples State Park, TXAn 8 year-old came into the office sans medication and excited about the fact that he didn’t have school looming over his head. The result was extra restlessness and energy. His eyes darted back and forth. I keep my office blinds drawn since there are beautiful trees outside, but this presents a problem for my clients who have trouble focusing. He pointed out the window and shouted, “SQUIRREL!” Perhaps too much stimulation, I wish those squirrels would find other trees to live in… I thought.
We made a feelings book together over the hour. He had to draw in the appropriate face for each feeling and give examples of times when he felt that way. He drew crazy purple hair and strange eyes on the face for embarrassed and said, “When we go to the zoo on a field trip and my dad comes and calls me peanut in front of all my friends.” For happy he drew a generic happy face and wrote down, “I would be happy if I was rich forever after inventing a machine that makes money”.
Amazingly he was able to focus and participate enough to complete the rest of the book. When it came time to staple them, his eyes got big and he asked if he could use the stapler. It seems that most of the boys I work with will jump at any opportunity to use the stapler or the motorized pencil sharpener. One client always asks to sharpen ALL the pencils I have at some point during his session. His reason? “I like them sharp.”
So my client stapled his book together, but wasn’t happy with one of the staples. He wanted to remove it. I took out my staple remover; he tried to grab it from my hand, probably drawn to it because of the shiny sharp ends. I showed him how to use it first and then let him have a try at it. After a few minutes of twisting and turning it finally came out. He was holding the remover triumphantly between his thumb and index finger, squeezing it together rapidly when I asked him to give it back. I started to caution him, “Be Care.. Ow!!!!” In the middle of the exchange he managed to clamp the sharp edges of the remover into the tip of my finger, which promptly started bleeding. Thankfully I spared him some rather choice words… it wouldn’t have been therapeutic. This is especially the case knowing that when I get hurt suddenly (ram my toe into the coffee table) or get scared (almost get sideswiped by someone on the freeway) I tend to use expletives. I shouted them in my mind but managed to keep my cool. One day later and my finger is healing nicely.
I had the opportunity to attend a symposium recently which was a nice change of pace. Besides the plethora of sponsors and free posters, there was an interesting seminar about different art therapy techniques. A lot of my sessions usually involve some sort of creative activity, since children are more apt and at ease to express themselves through play and art rather than through structured conversation. However, I learned a new intervention and decided to put it to use. The instructions are simply: 'Draw a person in the rain'. Here are a few examples. 
Some have protection to keep them from getting wet. 'he's all dry and his umbrella is his favorite colors' ~age 6
For this child, the rain is a severe lightning storm that is causing seriously bodily injury. The child has a history of known physical and sexual abuse. 'He's crying out but they left him outside and no one is coming to help'.~ age 7
The most memorable part of my week was trying to convince a petrified six-year old that monsters aren't real, especially the ones in the movies. He happens to be a very inquisitive six year old. This was our conversation midway through the session:
What about the terminator? Is that real?
No.
And the blood?
Fake.
And the wires in his arms?
Not real.
And what about Chucky?
He's not real either.
And his knife, does it really cut?
Nope. Well, maybe. But it doesn't really cut the people in the movie.
How do you know?
I just do.
You just do?
Yes.
Oh. Well, what about the guy with the hockey mask?
You've seen that?
No, but I've seen the commercials. He's not real either?
No, he's made up. He can't hurt you.
Are you sure?
Yes.
What about his knife?
Fake.
And the dead people, are they really dead?
No, they're playing make believe.
The questions continued in rapid fire succession.
After the lengthy discussion (more like Q & A session) I was a bit exhausted, but he seemed satisfied with the answers given. I guess we'll see how many nights he can go to sleep without needing the lights on.
Melancholy seems to suit my personality, not that I don't like to laugh and enjoy life; but I tend to gravitate toward the sad, lonely, and painful parts of life. I'm certain it is of no coincidence that I ended up in this profession. No one goes to a counselor or therapist when things are bright and shiny. However, being melancholy has the potential to cloud one's perspective so that all things seem half empty while the brighter things simply fade away.
Working with so many parents has given me greater appreciation for my own. I've spent so much time thinking about the things I could have done better or what my parents could have done better in raising me. Since I started this job I've discovered how much I've taken for granted the lessons my parents taught me. There are some sessions when I sit with kids and think naively, 'Don't their parents teach them that it's important to tell the truth? Mine did, doesn't every kid get in trouble if they tell a fat lie?' Obviously not.
So here are a few of the many lessons my parents taught me both by their words and actions:
1. It's important to tell the truth so that you can be trustworthy
2. If you tell a lie and own up to it... you can still be found trustworthy
3. Take responsibility for your actions
4. Try your hardest, make an effort to do your best... even in the little things
5. Try not to make promises you can't keep
6. Don't hit your sisters, if you do, apologize to them
7. Learning is important
8. A little yard work never hurt anyone
9. Share with others
10. Love takes many forms... sometimes displayed in hugs, words, a filled gas tank, a warm meal, enforcing discipline, and by simply being present
Thanks Mom & Dad.
While on the subject of feelings, my 10 year old client and I had discussed happy, sad, angry, and confused when we embarked on what it means to feel hurt. He identified times when he's felt hurt as "I fell off my bike and my knee was bleeding" and "I was playing basketball and somebody knocked me to the ground." It's curious that these and the other two examples he shared involved physical hurts as opposed to emotional ones.
"Has anyone ever hurt your feelings?"
"Sure, there were these kids that used to call me names", he volunteered.
"What kinds of names?"
"Oh, I forget now."
"You forgot?"
"I guess it probably had something to do with me being overweight, yeah, that was probably it."
"Do you think you're overweight?"
"Yes, I mean, what do you think, don't I look overweight?"
Before I could answer the question, he blurted out, "Hey, can you help me with something?"
"It depends on what it is, I could definitely try."
"Can you make me want to eat more vegetables? That would really help."
I guess I could have suggested he douse them with ranch dressing, but that seemed counterproductive to his goal. Is there any easy way to make kids like broccoli?
This morning I pounded the pavement in our neighborhood, maybe it was that free issue of Runner's World that inspired me. I mean, if Will Ferrell can run a marathon, surely I can. We'll see if that happens. A pleasant three mile run was enough for me today, just enough to generate that endorphin high. Running here often makes me miss San Diego. Even though it's spring and everything is brilliant green here in North Texas, there are days when I miss the sound of the waves and the vastness of the ocean.
The year before I moved out here I realized my time in San Diego was winding down, so I took every opportunity I could to be at the beach. I would wake up at 5am (this is unthinkable now), drive ten minutes down to La Jolla and park on Coast Blvd. My almost daily run would start in darkness by these quaint beachside condos. As daylight was breaking I would run past the cove full of seals, down to Wind and Sea beach and then double back. Evening runs were even better, with the added bonus of amazing sunsets. There was something about standing in front of that enormous amount of water as it reached beyond the horizon, it would cause me to think about the grandness of God and the smallness of me. Plus, those sunsets were a beautiful sight to behold.
"Do you have friends at school?"
The six year old nods her head vigorously up and down.
"Do you have a best friend?"
More vigorous nodding.
"What's her name?"
"Mayte." (pronounced my-tay)
"What makes her a good friend?"
"She has this tooth that fell out and now the new one looks funny. I like it."
"I see. What else makes her a good friend?"
"She's interesting to look at."
In graduate school they teach future counselors how to terminate with clients. I've never really liked using the word, terminate, in the same sentence with clients. Not only does it bring to mind images of the governor of California as a vengeful robot, but it's also the root of the word exterminate. I guess it would not sound as professional to teach a course on How to Say Goodbye, or How to Move On to Another Therapist, or How to Know When You've Done Enough.
I've only had the opportunity to address termination issues with three clients. The last two were bittersweet, but positive, because they had progressed through treatment and finished. It was hard to say goodbye, to say that our work together was over. However, I was left with the distinct feeling that they were going to be okay, especially because both had very supportive and stable families.
Thursday night was difficult. Since last October I have been meeting with an 8 year old client, I'll just call him Juan. On the drive to his house I never know what awaits me which I like because it's always a challenge. But there's some lingering sadness on that drive over, because I know his history. Abandonment, abuse, neglect... most likely from the time he was born until not too long ago.
It took us a while to build rapport. During the first visits, everything would be calm and then he would suddenly become angry and yell or swear at me. He would scream, "I hate you, you didn't bring the right crayons, they're ugly!." I would ask him to lower his voice and not swear at me. Over the next few months he was able to tell me what he was angry about rather than throw things, break things, or yell. We were making progress and not without some bumps along the way. Over the past two weeks it seems that his behavior is more erratic than ever, and it has become clear that he needs more intensive treatment than I can provide. Ideally, termination takes at least 3-4 sessions so that the client has the opportunity to process it fully. I suppose that happens in private practice. Ours took 1 and 1/2 sessions on Thursday night.
I started the session saying, "Remember how we talked about getting a new counselor?"
"Yeah, so?!?" I could tell he was already becoming angry.
"Well, she's coming here next week so that she can meet you."
He put his head down and shouted into his chest, "Good! Because I don't care about you! Actually, I hate you! I really hate you!"
"Are you going to hate me forever? That would be a shame... How angry at me are you right now?"
"I hate you."
"You sure seem angry."
"I'm sorry, I don't hate you, I'm sorry I screamed at you."
"I know you don't hate me, but I bet you're real angry with me, and thanks for telling me you're sorry."
"Yeah, I'm angry. The new counselor, will she be nice to me?"
He continued to cycle in and out of anger, sadness, and curiosity. His real life seems to mirror the chaos within him. Our session was abruptly interrupted by a squealing siren that seemed to get closer and closer. A marshall police car arrived, its siren blaring, with the client's uncle handcuffed in the backseat. He had been driving around in an unsafe car and they there to impound it. No one seemed too surprised or concerned with the arrival.
We resumed the session and said our goodbyes. Before I left we played a game of tic-tac-toe and Juan asked if he could give me a hug goodbye. I left knowing that he would be receiving the treatment he needs, but also left wondering what will happen to him. What will become of this boy is five years? Ten? I found myself praying (which has been significantly less frequent these days) on the way home. I prayed that God would intervene in this little boy's life in a major way, to give him the hope and strength to rise above all the horror that he has known.
One of my newer clients responds quite well to behavior charts. Actually, it's more likely that his response coincides more with the $5 allowance that comes with completing the tasks on his chart. He's 10 years old and his exemplary behavior has earned him a cool $20 over the past month. This last visit, the first thing he told me was,
"I did great on my chart, I'm going to get my allowance tomorrow, I'm so excited!"
"Really? That's wonderful! Ooh... five dollars, that's a lot of money, what are you going to do with it?"
"I already spent it."
"You did? On what?"
His eyes lit up as he reached to gather the glittering chain around his neck, "On this. Isn't it awesome?"
I looked down to see some serious bling. The sparkly chain reached almost to his waist, attached was a jewel encrusted medallion the size of a credit card.
"Wow, that's really sparkly."
"No, that's not the best part, look..."
On the medallion was the familiar face of Al Pacino as Scarface.
"And Miss, that's not all."
He angled the medallion and the picture changed to Al Pacino holding a machine gun.
"Wow, how much did you spend on it?"
"Fifteen dollars."
"Have you seen Scarface?"
"No, but my cousin really likes the stuff and my cousin's pretty cool".
Machismo, noun: A strong or exaggerated sense of masculinity stressing attributes such as physical courage, virility, domination of women, and aggressiveness.
I became familiar with the term during my two year stay in Mexico City, my Mexican friends would explain a variety of behavior by blaming it on machismo. This included parents who wouldn't let their college age daughters out after 8pm, yet let their sons stay out all night as long as they stopped by to say hello in the morning. Girls would congregate on the soccer field sidelines to cheer on their boyfriends, but rarely enter the game or play a game of their own. The only people my American friends and I could find to play soccer or basketball with were either guys or girls who didn't have boyfriends. My absolute favorite act of machismo (please note the sarcasm) was the undeterred and unashamed catcall or whistle. Any time this happened, I would think to myself, stupid machismo, women aren't objects, I hate machismo. This is not to say that machismo is only present in Mexico or even in Latin America, but this is where I became familiar with the term.
I've found that while working with many Spanish-speaking, primarily Mexican families, I've been operating under the assumption that most of my clients' fathers have machismo tendencies. Perhaps this is due to the fact that so few of them make it to my office, which often leaves my assumptions (false as they may be) uncontested. To date, I have met 5 fathers of the 60+ clients I have had since October. I met the fifth one earlier this afternoon.
I usually work with the client and his two siblings, their mom comes in at the beginning of the session to let me know how the week went and what things they did well. Today she told me that their father, her husband, would be coming in to talk with me later in the session. I had an immediate sense of trepidation, was he going to confront me for something I discussed with the client? I felt like I was in trouble because she said "he needs to talk to you", I immediately started thinking of ways to resolve the anticipated conflict.
After I worked with the client and his siblings, I had their mom and dad come in. My fears soon vanished when their dad sat down and said, "I really care about my kids. Soon they're going to be teenagers and I don't want them to resent me and run away because we have a bad relationship. I can be, well, I can get really angry sometimes and I say things that I don't mean, I yell at them and can't seem to control myself when I yell. I think I need help with my anger problem because it affects them. What can I do to be less angry?" My jaw about fell to the floor and all the preconceived machismo notions I had about this man disappeared. There has only been one other time that a parent has admitted he/she might need to change, instead of just expecting the child to "behave".
"What do you want to be when you grow up?" It seems like I ask this question frequently. Yesterday the answer from a 17 year old was, "I'd like to own a gas station, it seems like there's a lot of money to be made in gas stations". That's pretty original. I usually hear the typical answers like fireman, policeman, doctor, race car driver, basketball player, store clerk, president and teacher. Then there are the atypical ones like truck driver, car dealership president and WWE Smackdown wrestler (maybe that one is more common than I think). It makes me wonder what they'll grow up to be and makes me reflect on what I wanted to be at various stages in life.
Pre-school:
High School:
College and beyond:
My day started off non-eventful and rather mundane, with the added bonus of our note-writing computer application being on the fritz. This meant I had more time to catch up on phone calls and treatment plans instead of doing the tedious work of documenting sessions.
After sending out some emails, I went to greet my first client of the day. I knew the hour might be quite demanding when I stepped into the lobby and waited for my client and his mother to walk up the stairs. A man who had been waiting in the lobby with them walked passed me, looked me straight in the eyes and said, "You're seeing him? Whew, good luck with that one!" I looked back to the stairs and noticed that my client's mom was holding his shoulders so that he wouldn't make a quick escape, nudging him up the stairs. After I said hello, he answered me with a grunt, no, more of a growl. He continued to growl as we walked down the hallway. Once in the office, there was more growling and some innovative hissing sounds. I calmly asked the client to "use his words" as he tore around my office. In less than five minutes he had jumped on the couch, hid under both tables, ran around in circles in the middle of the room, and finally sought rest under a chair where he continued to make animal sounds. I sat on the floor next to him and asked,
"Are you mad?"
The animal sounds suddenly stopped, he looked at me and said,
"Yes. My mom wouldn't get me that toy."
"Oh, that's too bad."
"Yeah."
"Remember last time you were in here?"
"Yes."
"We practiced looking at each other when we're talking, remember?"
With his eyes toward the floor, he was trying hard not to make eye contact with me. Still looking at the floor he stood up and shouted,
"I'm evil! I'm the devil!!!"
"Oh, you are, are you? What does it mean to be evil?"
"Run around! Be bad! I'm bad!!!," he raised his arms into the air, making his hands into claws and growled like a lion.
"I don't think you're evil."
He sat back down, "You don't? Oh."
Perhaps I took all the fun out of his theatrics, it probably wasn't the reaction he wanted. He was fine the rest of the session, only running out of the room once and he didn't throw a temper tantrum like he usually does. Progress comes in such small steps sometimes.
It's always a nice change of pace to work with my girl clients since there are so few of them. I'm not exactly sure why 80% of my clients are boys, maybe they "act out" more, or maybe just more noticeably than girls. Today I was working with a 9 year old; she loves Bratz dolls, makeup, and anything with glitter in it. We were talking about how we should treat other people when she said, "We should say nice things to people". I told her it was a good example and asked her to draw a picture of it. She chose a bright pink piece of paper and drew these two stick figure girls with big hair and big lips. Over one of heads she wrote, "You rock!". Over the other one she put, "You too!".
I sat with a client last night who has endured a lot for being a mere eight years of age. When I visit his home, we sit together at the dining room table. He sits with his legs folded beneath him to give him added height in the chair, propping up his chin with his small arms. He's experienced a lot of turmoil recently, more than any child should have to withstand. Aside from the recent chaos, he lost his mother two years ago, though she never had custody of him. His father comes in and out of his life for months at a time, leaving the client and his siblings to live with their grandparents when he can't handle the stress of taking care of them. It's been four months since my client last spoke with him.
His behavior has been unruly and rebellious lately, which is pretty normal for his situation. Yet he still needs limits and boundaries, so I ask him what things he needs to work on this week. He starts to name them off, "Listen to my grandma, do my homework, go to bed when they tell me to..." I ask him to write them down so he can remember them throughout the week. Instead, he starts drawing a large heart and writes I love with my name written next to it. He looks at me with a huge smile. Then he looks back down at the paper and contorts his face as if something isn't right and adds next to my name, is my mom. I can feel the ache in my gut and I have to hold back the tears. I try to tell him gently,
"I'm your counselor, not your mom. Do you remember your mom's name?"
"Yeah."
"What was it?" He tells me.
"Do you remember what she looked like?"
He quietly says, "No, I can't remember." He then switches the subject, "Did I tell you about the new four wheeler we got?"
So I'm sitting with my funniest client (see previous post) and he tells me he's been having problems with his brothers lately.
"What kinds of problems?"
"Oh, fightin' and cussin', you know!"
"Are you calling your brothers names?"
"No, they call me names all the time."
"Like what?"
"Man, like, the B word! I can't say it here", he starts to whisper, "because it's not nice to say it, but I'll spell it for you..."
"That's okay, you don't have to, I think I know what you're talking about."
"No, really, I'll spell it for you. You know, B-E-A-C-H. I don't think he should be calling me that!"
Thankfully I have a job that I enjoy and is often entertaining because I work with kids. Yesterday I met with a client who is 8 and very talkative. I frequently have to redirect him back to what's pertinent to his therapy, but we end up on tangential conversations anyhow. This time he asks me,
"Man, where did you learn Spanish?" (I speak with his mom in Spanish, and I'm not sure why he refers to me as 'Man').
"I learned it while I lived in Mexico for a couple of years".
"Well, where did you learn English then?"
"In California."
"Oh. Hey, man, do you know French?"
I decided to not let those nine years of studying the language go down the drain and replied,
"Parlez vous francais?"
He became quite animated and nearly shouted, "HEY! You must be CHI-NESE!"
Needless to say, I was very confused by his comment but it was pretty entertaining.
Later that same hour...
Suddenly and completely off the topic of anger management he asks, "Hey, do you know who the Master of this earth is?"
"No, who is it?"
"You know- the MASTER of this earth!"
"Who are you talking about?"
He hits his forehead with his hand and shakes his head disapprovingly, "YOU DON'T KNOW?! I'll give you a hint, it starts with a G".
"Oh, you mean God?"
"Ye-ess! Do you know who is the master of, you know..." His eyes shift downward as he points to the floor. "You know, man." He continues to emphatically point his finger to the ground as he mouths the word 'hell' over and over.
It's hard for me to keep a straight face, "No, who is it?"
"You know...", he continues to mouth it, hoping that I'll say it aloud so he can tell his mom that the counselor said a 'bad word'.
I continue to look at him, but say nothing.
He says, "Man, c'mon you know, the devil! Sate."
"Sate?"
"Yeah, Sate."
"Do you mean Satan?"
"Oh yeah, that's it."
Boa Constrictor
by Shel Silverstein from Where the Sidewalk Ends
Oh, I'm being eaten
By a boa constrictor,
A boa constrictor,
A boa constrictor, I'm being eaten by a boa constrictor,
And I don't like it-- one bit.
Well, what do you know?
It's nibblin' my toe.
Oh, gee,
It's up to my knee.
Oh my,
It's up to my thigh.
Oh, fiddle,
It's up to my middle.
Oh, heck,
It's up to my neck.
Oh, dread,
It's upmmmmmmmmmmffffffffff...
If I think back long enough I can still picture my third grade class. Mrs. Harrison was an excellent 3rd grade teacher, with silvery white hair and a kind smile. My favorite part of the day was when she would call the class to come sit on the reading rug where she would take requests for our favorite Silverstein poems. It was probably against school policy for her to read us Dreadful, but she did anyhow. Why would Shel Silverstein write about eating a baby anyway?
