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When the realities of practicing psychotherapy with children without the approval, cooperation, and involvement of the parents are recognized, auxiliary methods may have to be adopted to help them.
In the following case, in which I treated Lennie for eight years, I had just barely Mrs. King's tacit, grudging acquiescence of my “trips” with her son. I discovered early that her involvement with her four sons was minimal, punitive, uniformly destructive, and disastrous. I felt I could salvage one, perhaps, and I wasn't even sure of that. My goals at the outset were minimal. The principles were to provide some restorative parenting and support, encourage self-esteem, reduce depression and ensuing self-hate, prevent acting out or suicidal behavior, and in the process provide for myself an experience in auxiliary motherhood, using psychoanalytic experience and training.
As our twice-a-month outings progressed, I was more able to formulate for myself both short-term and long-term goals. I have found that even intermittent but steady involvement in a child's life, providing learning and pleasurable experiences, can counteract and “turn around” the developing neurosis to a considerable degree. The story of that process follows.
I was first drawn to Lennie King (not his real name), then nine years old, when he accompanied his brothers to my pediatric office in Harlem for physical examinations. Lennie and two of his brothers had asthma, and I treated them all. That was eight years ago. What distinguished Lennie from my other pediatric patients was his sad expression and his passivity. The impression I got, confirmed by later observations, was that he was essentially a depressed, withdrawn, introverted, and relatively incommunicative child, presenting a psychological syndrome that cried out for help. I got a history that his brother William, eight, had tried to jump out of a window to commit suicide. I referred William to a psychiatrist who accepts Medicaid patients Black children