Although I am inclined to concur with Martha’s discomfort with medication as the first line of defense for overactive boys, I also wonder about the intensity of her response and the scenario she seems to have developed entirely in her mind.
“Have you asked Michael if he’s being bullied?” I enquire.
“No. But what other explanation could there be?”
“Well, I don’t know, but there have been a lot of changes in Michael’s life this past year.”
“Oh, you mean the divorce. That hasn’t affected him,” she says matter-of-factly.
“It hasn’t?” I say, incredulously.
“No. I’m both mother and father to him. And his father was never there anyway. I’m sure he doesn’t miss him.”
I feel my stomach tighten. I have difficulty with a parent interpreting a child’s world for him. “Have you talked to Michael about how he feels about his Dad being gone?” I ask as neutrally as possible.
“He’s my son! I know how he feels. This has nothing to do with the divorce. The problem’s just at school.”
Martha cannot deal with her son as a person separate from her, a person who has his own thoughts and feelings that need to be heard and understood. I feel angry with my patient and sad for Michael, a not comfortable place for me to be. I try another approach.
“Martha, you know this has been a really difficult year for you too. You’ve dealt with a major blow, a major loss,” I begin.
“What does that have to do with anything?” Martha says, interrupting me, clearly annoyed.
I ignore her annoyance and persevere. “Well, given your loss, it’s not surprising that you and Michael would become really close.”
“That’s true, except that we were always close,” she says hurriedly.
“What I’m suggesting is perhaps as Michael is growing up, and perhaps because his father is no longer in the house, he’s feeling a little too close and needing to act out in order to separate from you.”
Martha glares at me. “That’s total psychobabble,” she says contemptuously. “There’s nothing wrong with our being close. He’s my son. And he needs me. Especially now. I suppose you’d also say I shouldn’t let him sleep with me when he gets scared at night and comes into my room,” she says defiantly.
I want to groan aloud, but of course I don’t. I want to scream, “Why haven’t you told me that before?” but I don’t do that either. I want to say, “Well, maybe it would be important to know what he’s afraid of,” but I realize it’s time to turn the session back onto Martha, my patient. I, too, need to keep Martha and Michael separate and to remember that it is Martha who’s my patient.
So I say, very quietly, “I notice, Martha, that when you just told me Michael sometimes sleeps with you, you said it with a very defiant tone. I wonder why that was? I wonder what you felt underneath the defiance.”
It is as though Martha crumples before me. Silent tears stream down her face. “Why did he have to leave me? I’m so alone. And Michael will grow up and leave me too and then I’ll really be alone.”
Now we have something to work on. Now we have a direction.