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Dr. K added historical material. D's maternal grandfather died when D was 1½ years old. D's mother was affected by this death, and then became ill herself with multiple sclerosis shortly thereafter. She was treated with high doses of steroids and became psychotic and unable to care for D. D's care was turned over to housekeepers. Furthermore, his mother said things to him like, “You're bad and I'm going to kill you.” Her death was sudden and unexpected, and no one explained it to D. After his mother's death, his paternal grandparents took care of him, and he had a warm and loving relationship with them until his father remarried. Although his father had met his second wife when D was 4 and she was his nursery school teacher, they did not marry until D was 8. Because of acting out behavior, D was referred to a social worker at age 5. He worked with her until age 11 on a three times a week basis. The social worker terminated the treatment because she felt it had reached a plateau. A year later the family consulted Dr. K because of D's continuing problems with school and inability to accept his stepmother.
Dr. K's first period of work with D focused on family secrets. D wanted to visit his mother's grave, but his father prohibited this because he did not want the boy to see the grave of his sister who had died in infancy. Dr. K advised D be told of his sister and her death. Dr. K felt D's father was unable to be in touch with his own guilt and grief, and was therefore unable to be responsive to D. Dr. K recommended to D's father that he seek treatment. She understood his failure to follow this recommendation as a reflection of his fear of obtaining help and of his underlying fragility. Dr. K felt D's stepmother, on the other hand, had invested a lot in both D's treatment