Sunday, August 31, 2014

You "SHOULD" Feel

(As with all of these postings, critical facts and situations are blurred to protect client confidentiality.)

The fact of the bitter divorce that leaves the parents struggling to be civil to one another in public or private isn't the issue.  The fact that they are continually in court with one another really isn't the issue either.  And being in court a lot requires a lot of determination, anger, bad luck and mostly lots of money, but none of those things seem to fit as a cause.  I could look at the stress of mom's "family of origin" issues - that she was raised in a critical home where despite her intelligence and accomplishments she was never good enough.  But I can't see how that accounts for what I think is just her unwillingness or maybe its inability to accept reality.  I think mom just has not sat down to deeply consider what autism means to her son.  

Mom's upcoming marriage looms broadly on her high functioning autistic son's horizon.  Daniel is 12 and continues to mourn the divorce, struggles with having to shuttle between two homes, one in which dad is happily remarried and his "primary" residence where mom, who never seems happy, but always is in control, has bestowed upon Daniel the high honor of being in the wedding party at mom's upcoming nuptials.   Daniel has been clear from the beginning, he doesn't want the honor.  He is conflicted, about the divorce and is just trying to digest what another marriage means, what kind of relationships he'll have with new step siblings who will now to be present in both places he's forced to call home. Daniel is simply frustrated with his mother's struggles to understand his needs, and his deteriorating behavior increasingly shows it.  

Daniel's autism leaves him with a finite repertoire of emotional options.  On good days he has a hard time managing the demands of his daily schedule, the very expensive private school his parents agree is best for him, extra curricular activities that have been pared down so he can cope with the stress of life better. An now mom's telling him how he should feel to be a part of her wedding party. On good days - and he's had them, Daniel is able to cope pretty well, with the understanding that he needs time outs - which he's learning to self prescribe - and with the help of medications to ease his anxiety.  Additional stresses leave him emotionally and behaviorally spiraling down.  And that's where he's at now.    

Which is not to say that mom doesn't deserve her conjugal happiness, everyone does.  What mom has, and continues to find difficult is that Daniel has, well, a disability.  At best, he has what Ross Greene, author of The Explosive Child describes as "lagging skills" in coping with the flood of emotions he faces with his mother's wedding.  Daniel states, with some, but not perfect clarity, that he is unprepared to face the attention, the sensory flood of faces, noises, smells, activity and the attention that comes with walking down the aisle.  Mom thinks he should be honored.  

Dad understands Daniel's plight but is stuck between a rock and a hard place.  If he encourages mom to give Daniel some room, an "out" from this role to which he should be honored to fill, he is meddling in mom's so special day.  He is expressing his jealousy of mom's moving on.  He is accused of trying to turn Daniel against his mother, and fostering resentment for all that she does for him day in and day out.  Dad is in a no win situation.  

And I?  The therapist?  I'm in a bit of a tight bind as well.  Mom comes faithfully to our sessions with Daniel, but has a very hard time with feedback, regardless of how softly it is presented.  She's declined the individual sessions offered to assist in her "coping" and increase her understanding of kids on the spectrum - she's read the booksthankyouverymuch.  I've told her directly that Daniel's hesitance to participate in her wedding IS how he feels.  She responds by telling him he SHOULD feel honored to participate, even though this is besides the point.  If I had a nickle for how much in the world "SHOULD" be different......I fear mom's needs to save face with her family, friends and community will outweigh her ability to be sensitive to her son's needs.

One of the most important lessons a therapist learns is to "accept the client where the client is."  Daniel's mom is in a place where her needs outweigh his.  I have to accept it, even though I see the hurt in it.  I continue to be available and suggest that she's not really getting his point of view, but that's not "where she is" right now.   

As Daniel's behavior continues to deteriorate in the weeks coming up to the wedding, I can only try to support Daniel, to pry mom's resistance to seeing who Daniel actually is as opposed to who she would like him to be.  I just hope the wedding doesn't end up with a major embarrassing meltdown that ends up in another round of "shoulds" for him. 

Sometimes things are just sad.  And hard.  My heart aches for Daniel.    

Thursday, August 7, 2014

Finding Her Voice

(Note: As with all of these discussions, materiel changes have been made to the descriptions of the people being discussed in order to maintain strict privacy in accordance with all HIPPA and professional standards.)

When I met Nikki she had just been discharged from a local psychiatric hospital having experienced serious thoughts of suicide.  She was a pretty, but clearly sad 16 year old young woman who admitted she had been struggling with depression for a number of months with more recent thoughts of killing herself.  Her parents were concerned, available and admitted that they both came from families that were chaotic, distanced, and organized with lots of guilt as motivators.  Nikki's parents were in their first marriage, having met in a self help group.  I thought their mutual sensitivity a good sign  They were appropriately concerned about their daughter's welfare and the frightening seriousness she had given to suicide.

In the course of the year that followed I have grown very fond of Nikki and her parents.  We've explored both mom's and dad's families of origin, including one of Nikki's grandparent's financial boom and bust, leaving mom's family virtually desolate at the time of her father's (Nikki's maternal grandfather's) death.  The issues of betrayal and rage that Nikki's mom grew up with were quite significant.

Nikki's dad also came from an emotionally challenging history, his parents having divorced and remarried to step parents with whom dad was cordial.  Dad, however, was often caught in the ongoing friction between his biological parents that continued 30 years after the divorce.  Nikki's parents willingly began coming for couple's sessions as well to deal with Nikki's hospitalization - a watershed event in their lives and with the family of origin challenges both brought to this marriage.

Nikki is a smart young woman and despite struggling mightily with her academics in the wake of time missed during her hospitalization and struggles with depression, she pulled out a very strong academic year.  With a lot of support she asked for and received some latitude from her HS re: completing some assignments late.  And yet, despite the accomplishments, she still struggled with feeling just OK (good was too high a bar) about her very significant accomplishments.

In addition to her academic strengths, she was very involved in sports spending many hours pursuing her expertise in gymnastics.  She knew she was not destined for the Olympics and she was OK with that.  But she enjoyed it and took her training and commitment to her team, coaches as well as her parents efforts on her behalf quite seriously.  So when training resumed after a successful summer for the upcoming season, she resigned herself to the many hours per week required for training.  But she worried.

Nikki was good at worrying and continued to struggle with just being happy despite her many strengths and accomplishments.  So recently when she came in and voiced her concern about the upcoming academic load facing her, including a couple of AP classes, we began to explore what her motivation was to continue with gymnastics.  She admitted it felt good to stay in shape, but added that there were certainly other ways to stay in shape that didn't require the degree of training and time that she had committed to. She hated to think that she'd be wasting the money her parents had already spent for her training and coaching.  Her mom had been a pretty good gymnast when she was in high school and Nikki knew her parents both valued her extra curricular efforts.  She worried about her "resume" for college, and that leaving gymnastics would take away from her chances for acceptance to a good college. (I'll spare you my rant about the pressure HS kids have these days, but trust me, I've got one.)  She didn't want to let her coaches down who had been so supportive of her during her struggles last year.  She had every reason to continue except her own desire to do so.  Her motivation to continue was all based on factors other than her own.  The theme of guilt ran strong as a motivator for her.  She didn't know how she'd fit all of the needed time into the day or week to address both her academic and extra curricular load.

So I asked her what it would be like to consider dropping gymnastics - which she toyed with last year - again with her parents to see what their response would be. Communicating her concerns about how many hours there were in a day seemed a reasonable thing for her to do with them.  They were supportive, concerned, available and she didn't have the seething resentment of her parents that some adolescents develop.  She knew they were on her side, she just didn't want to disappoint them.  She was unsure how to proceed.

In our next session, almost a year since her suicidal thoughts had taken root, Nikki came in and hesitantly but with confidence said she had finished with gymnastics. She spoke to her folks and to her coach and all were supportive of her.  Never one for excitement or overstatement, I asked her how it felt and she said "OK."

"OK?, Not 'good?'" I asked.  She let a small smile out and admitted that it was better than just OK.  And then we talked about the role of guilt, the dangers of doing something for someone else's needs without doing it for one's own needs, and the importance of knowing when we were asking too much of ourselves. Nikki's confidence in herself is beginning to bloom.  I suggested to her that she'd turned a corner in comparison to where she was a year ago when she didn't know how to communicate her needs and her parents were unsure what to listen to, or how hard to push her.  She agreed, things were indeed different.  So many of the things she worried about just hadn't come about.  Her parents, her coach, all supported her decision to discontinue her athletics.  I cautioned her in her fear of disappointing one of her teachers - she was changing out of one of the teacher's classes, but didn't want the teacher to feel bad.  I suggested this was the virtually the same issue we'd been discussing - worrying about others' feelings instead of balancing her own needs.  I could see the lights go on.  She's learning how to find her voice, and I'm so proud of her.