Our best session

I have a client I have been seeing for about two months now.  She comes every week, and I would be lying to you if I said that I thought we had made progress.  In the initial session I had with her and her 3 year old son, the child was so out of control, I had to take all of the furniture out of the room and we concluded the session on the floor.  He was aggressive and disruptive and destroyed property.  His mother has a 7th grade education, a cognitive impairment, a mental illness, and a huge heart.

Last week, in an effort to try something different, I decided to try to teach her how to play with her son.  Armed with some zoo animals and Legos, I went into session with an outline and a plan.  I talked to her about imitating his speech and his sounds.  I showed her how to imitate his play.  I asked her to describe what he was doing, and I demonstrated this for her by describing what she was doing.  I asked her to praise him for playing and for all of his appropriate behaviors.  She expressed understanding every time I checked in, but I knew she wasn't listening.  She was far too busy eyeing those Legos.

"You know what?" I said, abandoning my plan.  "Let's do this.  Let's all get down on the floor and play together.  I'll show you what I want you to do, and I'll tell you what to say sometimes, too.  How does that sound?"

"Good," mom said, as she plopped herself on the ground.  She picked up the Legos and started building.  And building.  And while I'm praising Kiddo, and imitating their play, and reflecting his sounds, mom's still building.  "Hey look," she said, finally.  "I built a robot."  The smile she had on her face was the biggest I had seen.

At about 5 minutes over session time, I realized this wasn't going to wrap up on its own.  "Hey guys, let's play for two more minutes and then put the toys away," I said. 

"Okay," said mom.  Kiddo started putting the blocks in the bin. 

"Nice job putting the blocks away," I said.  "I love the way you're helping."

At the two minute mark, I said, "Okay, let's get the rest of those blocks in the bin here, mom."

"Just one more minute," she said, rooting through the blocks already put back in the box, looking for a small yellow one.  She caught herself and looked up at me with something in her eyes that I couldn't quite put my finger on.  Fear?  Anxiety?  "Can I have one more minute?" she asked sheepishly.  "I just want to finish building my dinosaur."  

I left the session feeling a mixture of success and failure that I wasn't sure how to navigate.  In terms of objective measurement and goals achieved that I could put into my progress note, there were none.  I educated mom, and she didn't hear it.  I demonstrated for mom, and she didn't get it.  But she sat on the floor and she played.  Clearly, this was something we had to do first.  Mom left smiling, and I knew for a fact that she would be coming back.  Perhaps that is success, I rationalized.  Perhaps that is what we were meant to do today.

                *****

The next week, I went into session with a plan.  We were going to be structured.  We were going to get things done.  We were going to get everybody on board and do some serious work.  I went into that session determined to make some change happen.

"Hey," said mom.  "I need to call his doctor, because he's got his asthma real bad, and I have to give him his medicine, but I don't understand.  Can I call here so you can help me?"

I looked at the kid -- at the dark circles under his eyes, and the slight wheezing I could hear, and the runny nose he wiped all over his hand, and his face, and his shirt. 

"I need help," mom said.  "I've gotta call because he's sick, but I don't always understand because I'm not a good understander and nobody helps me."  She picked up the phone.  "So I thought 'Dr. Auto  will help me with this.  Dr. A will make the phone call for Kiddo.'"  I smiled outwardly and sighed inwardly, abandoning my session.

"Since I've been coming to see you, I've been getting things done," she said.  "It's like I feel like I can get things done now because I have somebody who wants to help me.  So we can make this phone call, right?"

"Let's call," I said.  And we did.  When mom got off the phone, she said, "I can't get him into the Head Start.  Won't nobody call me back, and I'm just getting angry because they tell me they'll call me back and then they don't, so I yelled at'em real good the other day.  I tol' them if they ain't gonna help my son, then...you know...somethin's WRONG with them."

"Did you call the number I gave you last time?  Those are people who can help you."

"No, because see, I'm not a good understander when I call places like that, so I want you to help me.  I've got the number right..." she began rooting through a plastic grocery bag filled with papers that she brought with her.  "It's right in here somewhere," she said.

And so we called.  Halfway through the conversation, mom got frustrated, shook her head, and handed me the phone.  "I don't understand," she said, anger rising in her body.

"Hello?" I said.

"Hello...what happened...who is this?" said the voice on the other side.  We talked, and I clarified, and handed the phone back to mom. 

"You're doing great," I said.  "You've got this."  She smiled and continued the conversation. 

When she got off the phone from that conversation, she said, "And now I want to get my other two kids in therapy."  She almost giggled.  "We're getting so much done!" she exclaimed.  So we called that number, too, and we scheduled therapy appointments for her other children.  When she didn't understand, she handed me the phone.  When I saw her getting flustered, I told her how well she was doing, to take a deep breath, to ask for clarification in a calm voice.  As she was leaving, we stood together scheduling the next appointment and she said again, "I feel really good about this.  Since I've been seeing you, things are getting better because I'm getting things done.  We got a lot done today.  And I get to come back next week, too, and talk to you again about Kiddo.  That's what I be tellin' people.  Ain't nobody helpin' me.  Sometimes I just don't know what to do and I don't understand so good."  She leaned in to me slightly, and said softly, "if we get him into Head Start, I want to try to get my GED.  You think I can do that?"

"I think that's a fantastic idea," I said smiling.  "I'm so proud of you and all the changes you're making.  I love the way you're asking for help, and you are figuring out how to tell me what you need."

"Yeah," she said.  "I feel really good about this.  I think this was our best session yet."

"Me too," I said.  "I feel really good about this, too."

**All identifying information has been changed, and this represents a number of clients I have seen over the past several years, not one particular individual**