Nine year old Malcolm was one of the fortunate clients. Because his family had a very modest income a local counseling center with a sliding fee scale was seeing Malcolm on a pro bono basis. Better yet, the agency was providing free transportation for him on a school bus. His emotional difficulties began two years ago after his parents got a divorce. He was now living with his natural father and his new step-mother.
Treatment seemed to be working well. Then it happened and it changed everything. One day while riding to the agency, he pointed out the window at a very upscale, plush shopping center and exclaimed, "My mother owns that shopping center."
The bus driver (who was trying to talk some sense into the young man) said, "Now Malcolm, that's not true. You know your parents don't have a lot of money and they surely do not own that shopping center. You lied. Now you need to admit to the other kids you a not being honest and apologize."
Malcolm began crying and insisting his family really did own this center. The kids on the bus starting yelling at Malcolm and insisted he owed all of them an apology. The incident ended with Malcolm screaming at the top of his lungs at the children who taunted him.
The bus driver dutifully reported the entire incident to the clinical director of the organization who thanked him and swung into massive therapeutic action. They knew Malcolm was depressed since the divorce, nevertheless, the clinicians had never seen anything resembling this seemingly psychotic like break from reality and tendency to lie, combined with extreme hostility.
The treatment plan was stepped up to a whole new level. Instead of Malcolm seeing only an individual counselor, he would also be placed in group counseling and play therapy. He was also referred for an extensive battery of psychological tests, a medical management session with their psychiatrist, and a session with the neurologist at the agency. He was also referred to a therapist specializing in anger management. Malcolm's progress (or lack of it) would be assessed 30 days later at a case conference in which all the aforementioned psychotherapeutic players would be present.
Finally, it was the day of the big staffing but there was one new treatment player on the field. David, a graduate student serving his practicum at the facility.
The meeting began with the clinical director turning to David and asking, "David, this is a fascinated case. How do you think we should proceed with our intervention with Malcolm?"
"Well sir," said David, "since this is my first day here I haven't had time to read the record. Like everybody else, I just recall that his natural mother is filthy rich. I'm sure we can all remember the firestorm of publicity in the newspaper and on television when she built the upscale giant mall down the street from us. Right?"
The room was dead silent for what seemed like eternity. You could hear a pin drop even if you were using construction worker grade ear plugs during the staffing. Score one for Malcolm!
Since Freud was the master of symbolism, the story goes that around 1920 somebody wanted to know about the symbolism of Freud's own propensity to smoke upwards of 20 cigars a day. The Freudian interpretation at the time was that a cigar was a phallic symbol. When confronted by his fellow analysts about his own behavior Freud remarked, "Sometimes a cigar is just a cigar."
As of late, scholars have come to the conclusion that the famous "sometimes a cigar is just a cigar" statement attributed to Freud is false. Or to put it forthrightly, Freud never said it. My humble two-cents regarding Freud is that even if he never said it, he should have!
But here's the point. If 20 years from now Malcolm is lying on an analyst's couch babbling on about his tendency to smoke cigars, the analyst would do well to keep the notion in mind that sometimes a cigar really, truly is . . . well just a cigar.
File under: The Art of Psychotherapy, Child & Adolescent Therapy
Treatment seemed to be working well. Then it happened and it changed everything. One day while riding to the agency, he pointed out the window at a very upscale, plush shopping center and exclaimed, "My mother owns that shopping center."
The bus driver (who was trying to talk some sense into the young man) said, "Now Malcolm, that's not true. You know your parents don't have a lot of money and they surely do not own that shopping center. You lied. Now you need to admit to the other kids you a not being honest and apologize."
Malcolm began crying and insisting his family really did own this center. The kids on the bus starting yelling at Malcolm and insisted he owed all of them an apology. The incident ended with Malcolm screaming at the top of his lungs at the children who taunted him.
The bus driver dutifully reported the entire incident to the clinical director of the organization who thanked him and swung into massive therapeutic action. They knew Malcolm was depressed since the divorce, nevertheless, the clinicians had never seen anything resembling this seemingly psychotic like break from reality and tendency to lie, combined with extreme hostility.
The treatment plan was stepped up to a whole new level. Instead of Malcolm seeing only an individual counselor, he would also be placed in group counseling and play therapy. He was also referred for an extensive battery of psychological tests, a medical management session with their psychiatrist, and a session with the neurologist at the agency. He was also referred to a therapist specializing in anger management. Malcolm's progress (or lack of it) would be assessed 30 days later at a case conference in which all the aforementioned psychotherapeutic players would be present.
Finally, it was the day of the big staffing but there was one new treatment player on the field. David, a graduate student serving his practicum at the facility.
The meeting began with the clinical director turning to David and asking, "David, this is a fascinated case. How do you think we should proceed with our intervention with Malcolm?"
"Well sir," said David, "since this is my first day here I haven't had time to read the record. Like everybody else, I just recall that his natural mother is filthy rich. I'm sure we can all remember the firestorm of publicity in the newspaper and on television when she built the upscale giant mall down the street from us. Right?"
The room was dead silent for what seemed like eternity. You could hear a pin drop even if you were using construction worker grade ear plugs during the staffing. Score one for Malcolm!
Since Freud was the master of symbolism, the story goes that around 1920 somebody wanted to know about the symbolism of Freud's own propensity to smoke upwards of 20 cigars a day. The Freudian interpretation at the time was that a cigar was a phallic symbol. When confronted by his fellow analysts about his own behavior Freud remarked, "Sometimes a cigar is just a cigar."
As of late, scholars have come to the conclusion that the famous "sometimes a cigar is just a cigar" statement attributed to Freud is false. Or to put it forthrightly, Freud never said it. My humble two-cents regarding Freud is that even if he never said it, he should have!
But here's the point. If 20 years from now Malcolm is lying on an analyst's couch babbling on about his tendency to smoke cigars, the analyst would do well to keep the notion in mind that sometimes a cigar really, truly is . . . well just a cigar.
File under: The Art of Psychotherapy, Child & Adolescent Therapy