Too Afraid to Talk

¶ … Afraid to Talk

The case study examined for this paper involved a seven-year-old girl who had been a witness to her 18-month-old sister dying after her stroller was struck by a car. The seven-year-old, Kathy, was also present at the hospital and saw her sister, Kim, when she died. The bulk of the case study involves Bruce St. Thomas, the psychiatrist, working with Kathy over a long series of sessions to resolve her emotional issues. The diagnosis for Kathy was post-traumatic stress disorder (PTSD), and the doctor used play therapy and other techniques geared toward the counseling of young children to allow the child to work through her emotional issues. This paper looks at the diagnosis and its accuracy, the method of therapy and its true effect, and whether there were any personal disagreements with the case.

For many years it was believed that PTSD, and other mental health disorders, could not adequately be diagnosed, or used with, children because they were diagnoses that had been formulated using research in which only adults participated. However, the DSM includes children's diagnoses, and they are for many of the same disorders that plague adults. Of course, the first question, whether the consumer is an adult or child, is relative to functioning and how the supposed disorder affects the individual's life. In the case of PTSD, one of the main criteria is emotional distress and this seems to be the case with Kathy.

The diagnosis is difficult to dispute given the facts of the case. Kathy was present and saw her younger sister struck by the car. Kathy watched Kim die in the hospital room and was present for the funeral. All of these could have added to the trauma she felt, and, especially, the feelings of insecurity that she experienced afterward. However, there are a few elements that the case study does not explore.

It is obvious from the play she engages in and the responses she gives that Kathy is a very gifted girl. This gives rise to some questions that the therapist did not seem to adequately explore. The counselor's intent seemed to be completely honest, and his methods were above-board, but dealing with a gifted child can be difficult. It seemed in some of her responses that she was playing with him. He responded as the concerned adult and he admits that she was very uncomfortable when they did not have a session. The reason that this seems to be a child playing with an adult rather than making a breakthrough was because she was not getting the needed attention at home, and a child will find an avenue for this where it is available. Kathy needed someone to pay attention to her, and the doctor was there to do just that. Her dad was distant and her mom was in and out of psychiatric care. The fact that the mom seems to have been histrionic could also tell the doctor something about the child. The mother's need for constant care and attention (which, admittedly, was, probably in large part, due to the death of her daughter) could have resulted from an axis II diagnosis. This was never mentioned by the doctor, but it could have influenced the daughter's actions also. The reason this is possible is that axis II diagnoses are learned behaviors that the child could have been picking up.

But, assuming that the diagnosis was correct, it could also be that the therapist read too much into the play and drawings of the child. The first drawing he shows, has the child drawing her and her mother as the same size. True, this could be from the fact that the child believes that her and her mother are equals; but, it could also be from the fact that children, especially seven-year-old children, are not accurate at depicting size in their drawings. Her dad seems not to be on the same plane as the two other characters. If he was on the same plane he may have been the same size. Also, the fact that Kathy did not draw Kim in the picture does not have to be as significant as the therapist thought it to be. Kathy seems to understand that Kim is gone and this could be the whole reason for the omission. It does not matter that she does not have a complete understanding of death, no one else does either, she can still realize that it mean that the person is no longer a physical part of the family.

The play therapy seemed to go too far in some instances also. Much of the regression the child experiences could be laid at the feet of the counselor. Kathy, being a bright girl, sees what he wants from the reactions he gives when she acts a certain way. It is not uncommon for a child her age to talk like a much younger child because they are in a psychosocial transition phase at the point of their young lives anyway. Thus, the baby talk seemed to be less significant than he tried to make it in the write up.