This post is based on actual events but the referenced client is an amalgam of people in order to protect therapist-client confidentiality.
“The mom wants me to medicate him but I don’t think there’s anything wrong with him other than a touch of oppositional defiant disorder,” said Dr. Z.
“Can you fit Andrew and his mom in this week?” he asked.
“For you, absolutely,” I replied.
It was an honor to receive another client referral from Dr. Z as he was well-known in the field of psychiatry and for good reason.
When it came to the delicate art of treating children with severe psychiatric issues, he knew exactly what to prescribe to turn brains on fire into brains well-regulated.
He was also known for not prescribing medication if it was not warranted.
An oddity in the field of psychiatry.
On to Andrew…
When Andrew’s file was transferred over to my office, I read through it before his first appointment.
He was diagnosed with Oppositional Defiant Disorder about a year ago when he stole his mother’s car and ran it into a tree.
Andrew was thirteen years old and in seventh grade.
Symptoms of oppositional defiant disorder include a pattern of:
Angry/irritable mood—often loses temper, easily annoyed, often angry and resentful.
Argumentative/defiant behavior—often argues with authority figures or adults, often refuses to comply with requests or rules, deliberately annoys others, blames others for mistakes or misbehavior.
Vindictiveness—spiteful or vindictive. Source
In addition to the car incident, Andrew was getting into altercations at school and his grades had been falling.
Andrew’s mother described him as unruly, disrespectful, and angry.
During our initial appointment, I met with both Andrew and his mom.
Mom immediately explained that she was raising Andrew by herself and she was at her wit’s end. She was close to losing her job because of the number of times she had to leave work to pick up Andrew from school after an altercation, disruptive behavior, or failure to follow the rules.
In addition, Mom reported that Andrew had called her a bitch on several different occasions and thrown items at her, hitting her in the face.
While mom was giving me this information I noticed that Andrew was still, quiet, and avoided eye contact. At times, he appeared frustrated with his mom’s description of events.
Physically, Andrew looked like any other thirteen-year-old kid but underneath, I knew something was brewing.
It wasn’t until our second or third session that I was able to break through to the truth.
I asked Andrew what he thought was making him feel anger toward his mom.
His immediate response:
“My mom told me to clean up my room and I did but when she walked in she said the room wasn’t clean enough.”
Andrew continued, “So I cleaned my room again and she yelled at me even more. It pissed me off that she was yelling at me for doing what she told me to do.”
The gates were open and Andrew was letting the dam waters flow.
“No matter what I do, she yells at me. She told me to set the table for dinner and I did but she yelled because I used paper plates instead of the dish plates.”
“When I asked her why she was yelling at me all the time, she yelled some more and sent me to my room.”
“How does the yelling make you feel, Andrew?”
“Sad and mad,” he replied. “Mostly mad.”
“Then I go to school and the kids are picking on me because my dad left us a year ago.”
“How do you feel about your dad leaving you? Tell me about it.” I said.
“My mom and dad used to fight and argue all the time until one day my dad packed his stuff and left. It’s my mom’s fault. She made him leave.”
Ahhhh. There it is.
“It’s my mom’s fault my dad is gone!”
As he says this, he starts crying. I ask him if it’s okay if I bring his mom into the room.
He shrugs his shoulders.
When his mom walks in and she notices Andrew has been crying, concern registers on her face.
Andrew can’t restrain himself any longer and he yells, “Why did you make him leave? Why is my dad gone?”
A little backstory:
Andrew’s dad was having an affair with someone at work. When Andrew’s mom found out and confronted him, there were a few days of yelling and arguing until Andrew’s mom asked him to move out.
Apparently, this was not his first affair and Andrew had no knowledge that his dad was engaging in this type of behavior.
“Your dad was cheating on me!” Mom yells.
Andrew gasps. The shock and disappointment registered on his face.
“Andrew didn’t know” Mom explains to me.
“I wanted to protect him.”
“Andrew, do you blame your mom for your dad leaving? Do you blame your mom for the divorce?” I ask.
“Yes!!!” he cries.
“Even though your dad was doing something hurtful and wrong to your mom?” I ask.
“I know. It doesn’t make any sense.” he cries.
“Could you really be angry at your dad but you’re taking it out on your mom because she’s the one around?” I ask.
Andrew looks at his mom, looks at me, and then nods his head, “Yes.”
It was about a month after his dad left when Andrew’s behavior started to change.
His mom admitted that she didn’t pick up on the change because she was trying to process her own feelings.
She said she “turned inward” and felt sorry for herself and that didn’t leave any room to think about how the change might be affecting Andrew.
“I’m a terrible Mom” she cries.
“I’m so selfish. What have I done?!” she asks.
“You’re not a terrible mom” Andrew exclaims. “I just wanted you to pay attention to me. After Dad left, I worried you might leave me too!”
“You’re always going to be my son. I would never leave you but I couldn’t let your father stay and disrespect me any longer.”
“I understand Mom. It’s just that I miss Dad sometimes.”
“I do too, Andrew. I do too.”
A divorce in the family is a life-altering event. Not only does it change the dynamics of the family but it can also affect a family’s socioeconomic status, mental health, and emotional well-being.
An adult can often identify and verbalize how a divorce has affected him/her but a child often acts out his/her feelings behaviorally. I’ve seen this happen in children as young as five.
Some children exhibit sadness while others exhibit the mads.
Despite what you might hear on the media, or watch on the TV screen, there is no "right" way for children to feel when their parents are going through a divorce.
Reactions may vary, too.
Ways children might react:
School-aged children:
Moodiness (sadness, anger)
Temper tantrums or fighting
Lower school performance
Worry about loyalty to both parents
Strong wish for parents to get back together.
Adolescents:
Depression, withdrawal, anger
Aggression
Engaging in risky behaviors (involved in sex or drugs)
Worries about finances
Trouble focusing in school.
Over the course of six months, I worked with Andrew and his mom on the following:
Communication:
Be specific. Instead of telling Andrew to “clean his room,” tell him that you want him to clean his room by picking the clothes up off the floor, throwing away the trash, organizing his books and games on the shelves, etc., No generalities. Be clear, concise, and specific.
Take time to talk to each other. Andrew and his mom worked out a time every night when they would just sit with each other and talk about their day. The point of this exercise is to keep the lines of communication open. Mom should also continue to encourage Andrew to talk about his thoughts and feelings.
Boundaries:
Mom struggled with feelings of guilt and how the divorce was affecting Andrew. In order to be an effective parent, we worked on processing that guilt and learning to set it aside so she could set limits with Andrew. There should be consistent, healthy boundaries with Andrew, without emotional manipulation.
As previously stated, Andrew’s mom tried to protect him from learning about his father’s affair. Once Andrew learned the truth, Mom had a tendency of making off-handed comments about Andrew’s father and this often led to Andrew feeling hurt and confused.
As a result, I explained to Mom that it’s important for children to be spared unnecessary information about her ex-husband’s behavior.
To continue maintaining boundaries, Andrew’s Mom and Dad went to mediation and were able to work out a custody schedule. Andrew adjusted really well to the new routine.
“Kim, it’s Dr. Z. I just wanted to call you and tell you that I’ll no longer be seeing Andrew and his mom. He doesn’t meet the criteria for Oppositional Defiant Disorder anymore. His grades have improved, his relationship with his mom has improved, and he’s no longer getting in trouble at school. Thanks for everything that you did.”
“It was my pleasure, Doc.”
“Oh, Kim. One more thing. Before Andrew and his mom left my office, I asked Mom, “Aren’t you glad I didn’t medicate your child?” She gave me a big smile and a resounding yes.”
Dr. Z then hung up before I had the chance to tell him:
I’m glad too, doc.
Not everything requires a prescription.
Sometimes a little therapy can go a long way.
Be well, friends,
Kim