TREATMENT OF SPECIAL POPULATIONS

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We treat all ages of patients from infancy to old age.  As an example of treatment in infancy: a patient brings in a four-month-old infant who has gradually stopped eating, stopped sleeping, and is crying all the time.  I look at the baby, she is pale, she is whiny, she has a pinched face, her chest is held.  I asked the mother what's been going on at home.

The mother said she had worked full time as well as take care of the household duties before the infant was born.  Now that the infant is born, she has all of her previous duties plus exclusive care of the infant.  Her husband does not do a thing.  I asked her if she hadn't talked to her husband.  It turns out she has kind of whined to him that she wishes he would contribute a little more, which had no effect.

So I say, "Take the infant in your arms," which she does, and I say, "Now scream bloody murder."  So she starts screaming, and the infant opens its eyes, looks at her, and the infant starts screaming with her, so mother and baby are screaming together.  Of course, the infant is no longer pale.  Her cheeks are red now, her chest is moving, the mother's chest is moving, and the mother goes home.  She has the fight of her life with her husband and lays down the law to him.  Afterwards, he contributes to the workload of taking care of the infant and the problem disappears.

A story about working with a child, this is one of the nicest child stories.  The little girl is named Vicki.  She has become increasingly phobic in recent months.  She started out needing a light in her bedroom at night, then she needed the hallway light lit, then she needed the next room light lit, until the house has to be entirely lit at night now.  And she is becoming increasingly agoraphobic.

Vicki comes into my office.  She is a sweet, polite, bright, lovely little girl.  I put her on the couch.  Her chest is held, her neck is tight and she has a constant, sweet, Sunday School smile.  So we smile at one another and that doesn't affect her one bit.  Then I press on her tight neck, and she keeps smiling.  I say, "Doesn't that hurt?", and she says, "Yes, but I know you're doing it for my benefit."  Now this goes on for about four or five weeks and my hands hurt from the pressure on her neck.  She will do nothing but smile sweetly.  About the fifth week, we are doing this, and suddenly, I have drapes hanging right by my couch which no longer hang there, Vicki ended the drapes.  She pulled down the drapes, turns to me and says, "Drop dead, you rat."  There was a song at that time, " Id like to get you on a slow boat to China," and she said, "Why don't you take a long trip on a slow boat to China?"  I got her to scream and cry, which she does readily.  She sobs her heart out, and I hold her in my arm and the session ends.  My office is next door to my treatment room and I am sitting behind my desk in my office when she walks around my desk where I am sitting, hugs me and says genuinely, "Thank you."

Thereafter, gradually, we had talks.  Her family was as funny as Vicki was.  They were ultra, ultra liberals who, when their oldest daughter started going out with a black boy, the family went crazy, like falseness was the modus vivendi of that family.

The treatment of adolescents : Our general policy is to treat adolescents as little as possible, because it is regarded as a time of hormonal furor, and the adolescents have all they can do to handle what's going on in their world without, let alone, entering into an intensive dynamic therapy.  So what we try to do is handle the immediate problem as simply as possible, then send them back into their world again.  If necessary, they can come back later on when they are over the furors of adolescence and when we can do more intensive work.

The treatment of the elderly: This is similar to the the treatment of the adolescent: One does not do intensive dynamic therapy with old people.  We try to handle the immediate problem and send them out.

An example of that is the mother of a patient.  She is a 78-year-old woman who has just been through major surgery come home from the hospital.  She immediately took to her bed, and each day strayed less and less from her bed, until she refused to move from her bed.  Her daughter was scared because she was just lying rigidly in her bed.

She managed to get her into my office, and I saw the old lady was barely breathing, her eyes were in a fixed stare, looking straight ahead of her, and she is practically immobile.

I gently push on her chest, trying to get her to start to breathe.  Then I ask her to follow my finger, which she could not do at first, like her eyes are fixed.  Gradually she is able to do this if I move my hands slowly and her eyes start to move a little bit, at first, passively.  I move her extremities, her arms and her legs, and then she is able to move them a little bit, and she is able to walk out of the office a little easier than the rigid way that she walked in.

On the second visit, she is kind of relaxed, she walks in the way she did the first time.  We do the work again on the eyes, the chest, and the extremities.  Then we talk about her fear of death, because it's clear to me that she is using a very primitive defense mechanism, as if to say, "If I appear immobilized, maybe the angel of death will not see me, and he'll skip over me."  So, we talk about our fear of death which she admits to very freely.

That gives her a great deal of relief, at least exposed it.  After about two or three sessions, she is moving about the house normally again, and that's in general how we treat old people.