attachment disorder treatment.



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Here's how one Mom described her daughter's reaction to her first meeting with Dr. Art for the evaluation.  Sara is fourteen years old and quite disturbed.  She's been to several other therapists, but with no change in her behavior.  She is a superficial and charming teenager who makes her parents life, "a living hell."   

Dear Doctor Art,

You might find Sarah's reactions to her meeting with you useful in your assessment.  First, the frozen yogurt episode.  She just had a hamburger and fries at Wendy's and left a soda untouched.  On our way out, she decided she needed a frozen yogurt to go.  She was full, is trying to lose weight, and knew she'd be seen you and moments.  Moreover, she normally avoids dairy food, claiming to the lactose intolerant (she frequently complains about physical symptoms) -- but had to bring a dairy desert to your office.  We didn't comment on it.  She warned her dad twice not to touch it, although she's well aware that he eats no suites.  When she returned to the waiting room, she ate it avidly while completing her questionnaire, and protesting occasionally about the test.

On the way to the car, she complained about you.  I was reminded of the boy whose essay you quote in one of your handouts: he said his first counselor was fun and played games with him, but you made him work and made him mad sometimes.  Sarah said you made her feel bad and that she didn't think, "a professional person should make people feel bad."  We asked her in what way, and she said when she couldn't tell you what the best thing was that had ever happened to her, you suggested that she must feel very sad and depressed, and that made her feel bad.  She said you also "made her feel stupid,"  when she didn't have answers to your questions.

It was quite clear that she was blaming you for her painful feelings.  It seemed a promising sign that you might be able to engage her to recognize and integrate those feelings, painful as that process is.

I asked her whether she ever feels that way with Bob, the counselor she is now seeing.  "Never," she said.  "Bob's nice and friendly and he's never mean, but that guy was kind of mean."  "Like what?"  I asked.  "Like if I didn't know what to say, he'd tell me to think."  

John and I had seen how gentle, soft-spoken, and patient you are.  Her reaction said a great deal about her own pain, confusion, defensiveness, and evasiveness from herself.

We'd mentioned that her meetings with Bob generally run to gripe sessions.  Bob buys into these fully.  For all his warmth, in two years of treatment Bob failed to elicit enough knowledge of Sarah's inner life to diagnose a profound depression that she was masking with withdrawal at home and frenetic covering in public.