This is a recounting of a client I worked with many years ago, maybe in 2015 or so. As with all posts in this series there are “murals of metaphors” abundant in the original story telling which is left largely intact from my original recounting of the story — which itself has been a few years ago. The final “afterward” is a more modern reflection on my own reflection of the story.
“Play, like dreams, serves the function of self realization.” ~ D.W. Winnicott
“Trauma occurs when there is an encounter with the Real, which denies signification.” ~ Lacan
Sahira’s case is unique in that I encountered her long before I had any intention of writing these essays. Yet, it was a very specific and subtle moment that occurred to me as an intern therapist that remains a point of conversation to this day between the (then) supervising therapist and myself more than 5 years later.
Sahira is five years old when she is enrolled in our Partial Hospitalization Program. She is a particularly violent and volatile youngster. Her small frame seethes with hatred and vile disdain for everyone oozes from her pores. Her straight, dark hair often covers her eyes as she perpetually looks downward. So, to communicate you must play, and to play is to communicate. I watch her draw endlessly obscenely violent scenes in sidewalk chalk. I learn that her step-father had done nothing short of water-boarding her in the bathtub — a generous term for holding a child face up at the bottom of the bathtub under a running faucet. Hence her removal from the home.
One day I’m observing group therapy while the supervising therapist, who I still have a tremendous amount of respect for, facilitates semi-structured recreational time for the five to eight year olds. I am writing notes to myself regarding Sahira’s behavior. With the utmost intent, Sahira seeks out a toy dragon and a medium sized Barbie car. Meticulously, and with great precision, she proceeds to break the wings and legs off the dragon — behavior one might be inclined to think points towards sociopathy.
Rather than berate the child for having broken a toy, the therapist tilts her head, looks confused, and watches on. Sahira proceeds to hold the wingless, legless dragon on top of the car and push it around the room. Playfully the therapist asks Sahira, “Why does a dragon need to ride in a car?” Sahira, in typical fashion, looks up at the therapist in a scowl momentarily, and without saying a word returns to her work wheeling the dragon around.
Perhaps I’m reading too much into the situation, or looking for confirmation for beliefs I’ve already formed. Nevertheless, I write a simple message in my notebook, tear it off, and pass it to the therapist as we clean the supplies and transition the group to the next activity. The note read, “Little fire breathing monsters need a car when they don’t have legs to escape.”
Years later that therapist becomes my manager as I applied for a salaried position. Upon accepting the job offer, I found a note on my desk reminding me that that little message, a simple observation that could easily be overlooked even by a keen, seasoned therapist, had remained on the aforementioned therapist’s desk during the years that have passed.
We all have blind-spots, in our personal lives (which, rest assured spill into our clinical personas) or because by definition our focus can not both be equally precise and pervasive simultaneously. No symbol is too small, particularly in the context of a child’s play. It wouldn’t be until years later that I learned to turn such insights into a therapeutic force for the patient. For Sahira, it was mostly an intellectual insight that served the treating clinicians. But, giving sincere feedback that reflects a genuinely stricken response in ourselves conveys a reverberating message of being heard, or perhaps seen, in a way that is “therapeutic.”
As in “ It’s You I Like “, I’m a bit taken back and honored to see how much I let my patients matter to me and how important I let each case become. It’s easy to get bogged down or desensitized when your every day is walking with someone through their worst.
As I suggested in the last paragraph, the purpose of this reflections isn’t so much to demonstrate a miraculous change in Sahira, but to demonstrate 1) the importance of subtle observations, and 2) how we as therapists ourselves don’t exist in a vacuum. We are implicated in the changes with our patients and our peers.
What did I even know as an intern? Well, enough that paying attention was important… obviously. Parsing metaphors aside, even the most skilled and carefully attuned therapists miss things.
Perhaps the most inspiring part of this story for me as I reflect on it is how much the note I wrote mattered to that therapist. At that time, she had worked with dozens of interns what made that exchange stand out? Furthermore, the exchange stood out enough to remain (literally and physically) with her after I had gradated and as she progressed through the management ranks.
I don’t say all that to try and paint myself as a savant of an intern. I say it to highlight how powerful our interactions with each other, as colleagues, are. It isn’t just our patient’s that shape us. It’s our mentors, anti-mentors, and students as well.
For the record, yes, I was able to locate the toy dragon mentioned in the story and it now lives in my home office.