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On May 4, 2009, NYIPT recent graduate Jamillah Brown presented a child therapy case at an Open House to recruit new candidates to the NYIPT Program.

Dr. Tracy Simon offered live supervision from a psychoanalytic perspective.

Ms. Brown was engaging, insightful, humorous and incredibly intelligent. Everyone in the audience was impressed and had a chance to admire what a wonderful clinician she has become.

Case Presentation

Jamillah Brown

The Client:

M is a 10-year old biracial boy with long dusty hair. He was referred to play therapy by his pediatrician due to hyperactivity and difficulty managing his anger. M is an only child, from an intact, middle income family. M is a lively, friendly, likable child who is easy to engage and eager to play. When asked why he was coming to therapy he said because his anger was like a volcano that explodes in ways he cannot control.

Presenting Problem:

M was exhibiting increasingly explosive temper-tantrums at home for two years. He had difficulty sleeping at nights and would get into conflicts with his mother over waking up, dressing, eating and getting to school on time. M was described as being irritable, argumentative, and combative at home. In school he was easily distracted and unable to focus. Despite his distractibility, M was capable of establishing friendships in school.

M’s parents have a long history of explosive arguments and outbursts that M has overheard and witnessed. M would make attempts to be the go-between his parents. M would scold and reprimand his father and he’d often advise his mother on how she should act.

M’s parents were keenly aware that their ongoing conflicted relationship was negatively impacting M.

Family History:

There is a history of alcoholism on both sides, and one of M’s grandparents committed suicide a few years after losing a spouse. M’s father had been informally diagnosed with Intermittent Explosive disorder. His mother has been on disability for seventeen years due to fibromyalgia. She suffers from chronic depression and has had two psychiatric hospitalizations. In 1995, she was diagnosed with bipolar disorder has been stabilized on medication. Neither parent attends therapy M’s dad resents that his wife is unable to work, and M’s mom feels unsupported by her husband for not being actively involved in parenting his son.

The Therapy:

Ms. Brown described the course of her three year treatment with M. In the beginning of treatment, she was most concerned about M’s relationship with his parents and his unhealthy role in the family. In parent collateral sessions, Ms. Brown helped M’s mother understand how her conflicts of being separated from her son often undermined her attempts to set limits with him and often resulted in the battles she found so anxiety-provoking. Ms. Brown helped M’s father see that he was modeling hostile-aggressive behavior as an unhealthy means of coping with conflict. Ms. Brown worked on providing support to M’s mother by delicately acknowledging and giving a voice to some of her fears. The collateral parent relationship was developed by frequent individual and joint sessions with both parents.

By the end of M’s therapy, his father was able to recognize that his support and involvement was needed and, from time to time, he began to assist in the mornings which helped to reduce his wife’s anxiety and the frequency of the morning frenzy. The parents’ communication improved over time and this eventually resulted in them advocating for their. M went through extensive evaluations, and collaborative team teaching classes were recommended for the next year in a new school.

Throughout most of M’s play therapy, he played board games. His playing style demonstrated that he was smart, strategic, witty and quite savvy. He would mostly win “at all costs,” and he celebrated his victories with excitement; however, the times in which it appeared that he was losing, he displayed a pervasive need to win and he “cheated” incessantly without remorse. He needed to maintain the fantasy of always being the victor. To not win seemed to completely deflate his self-esteem to the point of tears.

Ms. Brown came to understand that M was working through his conflicts through his “cheating,” and that it was important for her to allow it. She participated in this process by telling M how she had been made to feel in the play, modeling for M a more effective, healthy means of communicating feelings of fear, insecurity and sadness without anger, hostility or cheating. Over time, Ms. Brown was able to help M strengthen his frail self-esteem and also to help the family lessen the inappropriate role-reversal of M negotiating his parent’s conflicts. She helped them advocate and protect their son. By the end of the three year treatment, M was less distractible and angry, and he was better able to verbalize his feelings.

Live Supervision

Dr. Tracy Simon

Following Ms. Brown’s child therapy case presentation, Dr. Simon praised Ms. Brown’s thoughtful and insightful work with M. Dr. Simon discussed the impact on M of the family’s history of trauma, alcoholism and mental illness. Both of M’s parents had coped with their anxieties via alcoholism, learned and passed down by their own parents, thereby not allowing either parent to develop healthy, effective means of communicating or coping with negative emotions.

Although M’s parents became sober when he was born, they were ill-equipped to manage the struggles and anxieties of raising a child, and eventually the couple deteriorated into blame and resentment. M’s father became withdrawn and angry,
and his mother became ill and unable to separate from her son. M’s initial reason for referral: of tantrums, distractibility and conflict at home, highlighted his protest against the role his parents had thrust him into of having to manage the emotions that each parent could not. This was an inappropriate role for a 7-year-old and led the whole family to pursue getting help.

Over the course of M’s therapy, Ms. Brown did excellent work helping the mother manage her anxiety around allowing M to separate, and to realign with his father as a solid parental figure, allowing M’s father to take on a more involved, parental role, in contrast to his withdrawal or response with anger. As M’s parents developed confidence, security and support as co-parents, the parental unit strengthened, and the parents were able to see the negative impact of their long-standing parental discord on M and improve it.

Via the treatment, it also became clear that M was struggling academically and needed more resources and support. The emotional and academic shifts that occurred for M over the three years of therapy illustrate Ms. Brown’s clinical skills. As M’s confidence increased, his tantrums and distractibility decreased. He was placed in an appropriate school setting and was able to focus on school and friends, instead of mediating between his parents. The parent’s marital relationship improved and so did their confidence and capacity to advocate for their son.

Jamillah Brown, Dr. Tracy Simon, and NYIPT candidate, Rachel Randolf