Working with Extended Family Members

Every child needs to feel a sense of security in the environment. Behavioral changes that are brought about through the course of individual therapy are seldom lasting if the child goes back into a system that requires a different form of behavior or is not supportive of the changes made. The therapist may need to search beyond the nuclear family and empower others if the biological parents are not able to take on the positive, supportive roles the child needs.

Kevin was a 5-year-old child who needed attention, nurturing, and love, and he thrived on getting these things from the therapist. He was scapegoated at home. He did not get new clothes, as did the other children; he was beaten, and he was not fed the same food. He was left at a neighbor’s house when the rest of the family went on vacation to Disney World. Kevin pretended that he did not notice these things, and his defensive approach was to distance himself from others. He detached from family members who caused him stress. I noticed this in my waiting room one day after our session. It was Halloween, so I gave all of my clients that week a treat. Kevin very excitedly ran into the waiting room to show his family. His uncle grabbed the lollipop from Kevin’s hand and plopped it directly into his own mouth. Kevin immediately dropped his head and looked sad, and when I asked how he felt about it, he said he felt fine, and he didn’t care because he really did not want the lollipop. Not surprisingly, Kevin exhibited behavior problems that seemed to invite abuse.

In art therapy, Kevin had a lot of difficulty with the house symbol (Figure 9.4). He repeatedly attempted to draw a house but he was always disappointed with the results. Kevin abandoned these pictures rather than taking them home. Notice how Kevin did not draw a door, and instead there was what almost looked like an umbilical emphasis on the front of the house. His own house betrayed his need for protection and comfort, and hence the house was a difficult symbol for him and one that he was compelled to repeat. Family therapy was attempted but to no avail. Kevin’s mother refused to attend after one session. However, Kevin’s aunt, who brought him to therapy and was involved in some of the caretaking responsibilities, appeared to be a resource for him. The goals of therapy shifted to involve the aunt in the therapy. Techniques such as time-outs were modeled for the aunt so that she could learn less physical kinds of punishment. I suggested behavioral interventions for her to try in the hope that Kevin’s acting-out behavior would decrease. Most important, she was made aware of the psychological damage being done to Kevin because of the uneven treatment he was receiving compared to his siblings and cousins. I made up some simple games for the two of them that led to positive touch and hugs. One such game involved Kevin sneaking up to his aunt and trying to tickle her. His goal was to tickle and run away. His aunt’s goal was to catch him and hug him before he got away. Kevin loved this game, and I suspected it was one of the few

Five-year-old Kevin's house drawing

Figure 9.4. Five-year-old Kevin's house drawing

Six-year-old Kevin's house drawing

Figure 9.5. Six-year-old Kevin's house drawing

times that he was spontaneously hugged. In time, he began to see himself as more a part of the family.

A year later, at age 6, as Kevin drew Figure 9.5, it was apparent that the house was becoming a place of comfort for him. Although the house was still not grounded, it was placed within an environment, glitter made it appear happier, and Kevin was actually pleased with the result, wanting me to hang it in the art room.

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