I first met Rachel about three years ago when she brought her four year old adopted son, Sam, to see me in my pediatric practice because of problem behavior(as always, details have been changed to protect privacy). A story of severe trauma in his early years emerged. He had lived on the streets with his mentally ill mother, then been shuttled between foster homes until he was adopted at the age of three. While he was a sweet and engaging child, Rachel told of explosive rage and defiance at home. She had raised four biological children and was feeling completely undone by this one.
I did not come close to solving Sam's "behavior problems." But I did help Rachel to understand the roots of his behavior. By gradually working with her to think about the effects of this early trauma on his development, I helped to free her from the debilitating self blame from which she had been suffering. She gathered her strength and began the long and difficult task of getting the help for Sam that he needed.
Last week, Rachel called me. We had not spoken for many months. She had a adopted two more children from another country. These children had not been traumatized like Sam, and things were going smoothly. But not for Sam. The intensive therapy Sam had been receiving was no longer covered by their insurance. The only option, one Mom did not feel was a long term solution, was to increase his dose of medication. Monthly visits to the psychiatrist were still covered.
We fell into easy familiar conversation. She shared her moments of despair, when she lost her cool and felt painfully inadequate. I shared my frustration with the insurance situation. At the end of our conversation she thanked me. But for what? I, too, was helpless to get Sam the services he needed. Perhaps what I had done was simply to listen to Rachel. I recognized her experience, and in doing so recharged her in her efforts to be emotionally present with Sam at these difficult moments. I can only hope that this will help to set Sam on a healthier path of development.