Sam came to our session with two wooden cars he had made in occupational therapy. When I asked hi how things were going, he made a few comments about not wanting to return to his father and stepmother’s home. He seemed pensive and sober, but had little more to say. Instead, he seemed to be increasingly absorbed in playing with the wooden cars—one a larger Model T, and the other a smaller “Buggy.”
Like many 12-year-olds, Sam was not especially fond of talking, particularly about the problems that had led to his hospitalization. I made some additional attempts to engage with him verbally, but eventually I, too, became more absorbed in what Sam and the cars were doing. Sam was steering them wildly around the top of my desk. Sometimes one or the other, or both, would come screeching to a halt, right at the edge of the desk, which seemed to be a cliff. At other times, they interacted with each other, and, on a couple of occasions, the little one pushed the big one off the cliff.
As I was drawn more deeply into the drama that Sam was playing out, I began to think about our session somewhat differently. At a minimum, Sam’s involvement with the cars seemed to reflect, among other things, the discomfort he had just displayed about discussing his problems. Maybe the best thing to do was to drop the questions and engage with Sam around the play. I started narrating what the cars were doing: “Hmm! The big one is towing the little one. . . Now they’re spinning around each other. . . Wow! They hit each other that time!”
It felt like Sam and I were more engaged now. But what, exactly, was going on here? The interplay of the cars seemed to be more than a mere resistance or fantasy about driving. What was being played out between the cars was intense—a dynamic and developing relationship of some kind. It appeared that Sam was using the cars to express something emotionally significant in the medium of play. An interpretation seemed to be called for.
Psychotherapists have had mixed feelings about interpretation throughout the history of the field. In the early days of psychoanalysis, Freud and others believed that insight gained through interpretation was the primary curative factor in psychotherapy. It was generally held that in order to be effective, an interpretation had to be accurate in all its details. However, Edward Glover later pointed out that while many of the interpretations reported by earlier authors had probably not been entirely accurate, those same interpretations had often, apparently, been quite effective. Furthermore, evidence was starting to accumulate that a good therapeutic relationship was more helpful to patients than intellectual insight gleaned through interpretation.
Nevertheless, some sessions—like the one with Sam—do seem to involve an alternate form of meaning-making in which interpretation may play a useful role. And so, in this situation I found myself pondering just what Sam might be trying to communicate to me.
Perhaps the little car was Sam and the big car was me, trying to get him to talk. But the intensity of Sam’s play suggested that the dynamics within his family were more likely to be relevant. One possibility was that the big car was Sam’s father—but most of Sam’s conflicts were with his stepmother, whom he resented for taking the place of his biological mother. Indeed, Sam and his stepmother had been colliding into each other and spinning around in circles for years. I ventured an interpretation:
“The little one and the big one are pushing against each other, kind of like you and your stepmom fighting with each other.”
“Mm-hm.”
Not very enthusiastic. Maybe I had jumped in too quickly. Or maybe the interpretation that I had ventured was off the mark. The big car might be Sam’s biological mother. She had been described as physically and verbally abusive, abandoning Sam with his father on several occasions. After custody was given to Sam’s father, Sam’s biological mother had been involved with Sam only sporadically, staying away for long periods of time and intermittently making promises to visit Sam but not following through.
More play. Now, the big car drove headlong off the cliff and crashed into the canyon below. Then, slowly, it returned up a mountain road, back to the top of the cliff.
“Gee, it drove off the cliff and then it came back!”
“No. This is another car.”
“Ahh!” I said. I had the information I needed.
“You know what I think?” I said. “I think what’s happening in your family is like what’s happening with the cars. When the big one went off the cliff, the little one was left alone, like you were left alone when your biological mom went away. Then another big one came, like your stepmom; and now you and your stepmom have to try to get along with each other and help each other, like the two cars towing each other. But it’s really hard because you still miss your biological mom. You don’t know when you’ll see her again.”
“I don’t think I’ll ever see her again.”
“Really?”
“Yeah.”
“It’s hard for a kid to lose a parent.”
“I think the more I don’t see my mom, the more mad I get.”
We talked about this. He expressed anger that when he had recently said he wanted to get in touch with his biological mother, his father and stepmother had replied that this was not a good idea. I suggested we discuss it with them in our next family meeting.
That night, Sam had his first good evening in the hospital, and over the next few days he shared, first, his anger, and then his hurt, about his biological mother’s many failures to visit him.
In the next session with his parents he called his stepmother “Mom” for the first time. At the end of that meeting he gave her the big car and said, “You can take this home.”
File under: Child & Adolescent Therapy
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Like many 12-year-olds, Sam was not especially fond of talking, particularly about the problems that had led to his hospitalization. I made some additional attempts to engage with him verbally, but eventually I, too, became more absorbed in what Sam and the cars were doing. Sam was steering them wildly around the top of my desk. Sometimes one or the other, or both, would come screeching to a halt, right at the edge of the desk, which seemed to be a cliff. At other times, they interacted with each other, and, on a couple of occasions, the little one pushed the big one off the cliff.
As I was drawn more deeply into the drama that Sam was playing out, I began to think about our session somewhat differently. At a minimum, Sam’s involvement with the cars seemed to reflect, among other things, the discomfort he had just displayed about discussing his problems. Maybe the best thing to do was to drop the questions and engage with Sam around the play. I started narrating what the cars were doing: “Hmm! The big one is towing the little one. . . Now they’re spinning around each other. . . Wow! They hit each other that time!”
It felt like Sam and I were more engaged now. But what, exactly, was going on here? The interplay of the cars seemed to be more than a mere resistance or fantasy about driving. What was being played out between the cars was intense—a dynamic and developing relationship of some kind. It appeared that Sam was using the cars to express something emotionally significant in the medium of play. An interpretation seemed to be called for.
Psychotherapists have had mixed feelings about interpretation throughout the history of the field. In the early days of psychoanalysis, Freud and others believed that insight gained through interpretation was the primary curative factor in psychotherapy. It was generally held that in order to be effective, an interpretation had to be accurate in all its details. However, Edward Glover later pointed out that while many of the interpretations reported by earlier authors had probably not been entirely accurate, those same interpretations had often, apparently, been quite effective. Furthermore, evidence was starting to accumulate that a good therapeutic relationship was more helpful to patients than intellectual insight gleaned through interpretation.
Nevertheless, some sessions—like the one with Sam—do seem to involve an alternate form of meaning-making in which interpretation may play a useful role. And so, in this situation I found myself pondering just what Sam might be trying to communicate to me.
Perhaps the little car was Sam and the big car was me, trying to get him to talk. But the intensity of Sam’s play suggested that the dynamics within his family were more likely to be relevant. One possibility was that the big car was Sam’s father—but most of Sam’s conflicts were with his stepmother, whom he resented for taking the place of his biological mother. Indeed, Sam and his stepmother had been colliding into each other and spinning around in circles for years. I ventured an interpretation:
“The little one and the big one are pushing against each other, kind of like you and your stepmom fighting with each other.”
“Mm-hm.”
Not very enthusiastic. Maybe I had jumped in too quickly. Or maybe the interpretation that I had ventured was off the mark. The big car might be Sam’s biological mother. She had been described as physically and verbally abusive, abandoning Sam with his father on several occasions. After custody was given to Sam’s father, Sam’s biological mother had been involved with Sam only sporadically, staying away for long periods of time and intermittently making promises to visit Sam but not following through.
More play. Now, the big car drove headlong off the cliff and crashed into the canyon below. Then, slowly, it returned up a mountain road, back to the top of the cliff.
“Gee, it drove off the cliff and then it came back!”
“No. This is another car.”
“Ahh!” I said. I had the information I needed.
“You know what I think?” I said. “I think what’s happening in your family is like what’s happening with the cars. When the big one went off the cliff, the little one was left alone, like you were left alone when your biological mom went away. Then another big one came, like your stepmom; and now you and your stepmom have to try to get along with each other and help each other, like the two cars towing each other. But it’s really hard because you still miss your biological mom. You don’t know when you’ll see her again.”
“I don’t think I’ll ever see her again.”
“Really?”
“Yeah.”
“It’s hard for a kid to lose a parent.”
“I think the more I don’t see my mom, the more mad I get.”
We talked about this. He expressed anger that when he had recently said he wanted to get in touch with his biological mother, his father and stepmother had replied that this was not a good idea. I suggested we discuss it with them in our next family meeting.
That night, Sam had his first good evening in the hospital, and over the next few days he shared, first, his anger, and then his hurt, about his biological mother’s many failures to visit him.
In the next session with his parents he called his stepmother “Mom” for the first time. At the end of that meeting he gave her the big car and said, “You can take this home.”
File under: Child & Adolescent Therapy