Clinical Commentary

Clinical material

Session 1

Mr and Mrs T came to the room followed by their son Max aged three and a half. The parents are in their mid-30s. Max was on the couch, playing with the toy animals while the parents each sat in an armchair. When asked what had brought them to the clinic the parents looked at one another as though not sure how to start or who should speak first and then Mr T looked at Mrs T and asked who will tell the story, Mrs T decided she would like to begin.

Mrs T firstly commented on how quickly they had been offered an appointment following her phone call to the clinic. She then, in a calm but strained manner, explained that the reason they wanted to talk with someone was because Max didn't sleep through the night. She explained that he had never really slept well and recently the sleep difficulties had become worse. She described how Max was able to fall asleep but on a bad night he woke up at about 1:00 a.m. and from then on until morning she has to attend to Max waking on an hourly basis. On a good night, she will only have to go in to him three or four times. She said that the sleepless nights were becoming increasingly difficult and were now impacting on their relationship and they needed some help. Mr T confirmed everything his wife said.

When asked what thoughts the parents had about what may be unsettling Max, Mrs T became quite anxious and immediately linked his difficulties to her attempts to wean him from the bottle. She questioned whether she was doing the right thing, saying she had read numerous books, naming one in particular. She said she had tried several techniques to wean him but it had always been difficult, as Max had not found any substitutes like his thumb or a blanket to soothe himself. Again, in quite an anxious way she questioned whether what she was doing was right.

She then described how both Mr and Mrs T, with Max, had recently made an agreement that Max could have a bottle at night when he falls asleep and one in the mornin