John was 7 when I met him, and dealing with more than any child could be expected to endure. For the first years of his life, he had been witness to his father’s alcoholic binges, which often involved shouting, breaking objects and hitting John and his mother. His mother struggled too, with depression and a crack addiction. When John was 5, the state’s Child Protective Services removed him from the home and placed him in a series of foster-care arrangements. Although his father disappeared, never to be heard from again, his mother underwent court-mandated substance-abuse treatment and was later allowed to see John in supervised visits. Eventually, she regained custody — which was right before he and I met.
The state recommended that John receive psychotherapy, and his mother brought him to the outpatient mental health clinic that had recently hired me, straight out of graduate school. In weekly sessions, John sat quietly at first, afraid to move about the office or play with any of the toys, despite my encouragement. History had taught him caution. Trust takes time to develop in any relationship, but especially when the only models you have all end in disaster. In those first weeks and months, he silently stared at the toys on my shelves, watching me color while I waited for him to join me.
But something was happening, even in those early days: John was getting a sense of me as someone who was predictable. Predictability, which is necessary to feel safe enough to interact with others, was not just evidenced by my behavior, but also present in the physical space. I noticed that John vigilantly scrutinized my office. He became anxious if a book or toy was out of place, if a picture hung crookedly, if the area rug was askew. Eventually, he gained the confidence to ask if he could correct whatever seemed out of order and even, over time, to rearrange things more to his liking.
[For more of this story, written by Steven Kuchuck, go to http://opinionator.blogs.nytim...patient-i-abandoned/]
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