In my psychotherapy practice, I listen to the stories adults and children tell about their lives and I use my skills to help them reframe their personal narratives. Change the story and often, patients can change the situation that brought them to my office.
In this blog entry, a little boy's fear of things that go bump in the night disrupts his sleep. I describe how I work with his parents to decipher their son's fears and address them in the language that makes sense to him, the language of storytelling and make believe.
Julie, referred by her pediatrician, called, saying, "We are at our wits' end trying to get our 3-and-a-half-year-old Max to bed. We're exhausted." Adding, "He's always been a good sleeper. I don't know what's the matter. He seems terrified."
This call is a common one to a child therapist. While I always keep in mind that sleep disturbances in small children can signal a more serious issue, I suggested that the parents come in to talk about Max and his worries.
"Without Max?" his mother inquired with surprise.
I explained that they, as parents, were the experts, and that my job was to help them figure out what was going on with Max. We could decide about including Max at a later date.
As a child therapist, I see my job as helping the child progress on his or her developmental journey. Doing this generally requires me to empower the parents to think psychologically and thus better understand what is going on. Whether or not I ever see the child, my goal is to help the parents look at their son or daughter's behavior with new eyes, and in that way, enable them to provide the support the child needs to move forward.
After greeting Julie and Jim, I started our session by asking them to tell me about Max. Julie pulled out her phone, proudly showing me a picture of a curly-haired boy with bright blue eyes and a mischievous grin. My aim in this meeting was to get as clear a picture of Max's emotional and physical development as the photo gave me of his smiling face. This included gathering information about his family history, his health and his meeting of developmental milestones. From everything they report Max was a healthy, well developed 3 ½ year old with two parents who clearly adored him.
So, what could possibly have made Max so scared?"
I invited his parents to tell me more about Max's "sleep troubles." They relayed that he was scared of both the dark and monsters. Every night at bedtime, he tearfully implored his mom or dad to stay next to him and not leave once he fell asleep. When he woke in the night he would scream in terror and beg his parents to let him sleep in their room. They had no idea what had caused this fear to erupt. Up until now, Max had been a child who fell asleep on his own with relative ease.
Nighttime fears are common in kids Max's age. We are all familiar with a young child's fears of monsters, dogs and what lurks under the bed. While these sleep-destroying worries can seem irrational, as a psychotherapist, I believe most often they represent a healthy way for a child to express his or her dawning awareness that the world can be a dangerous place. Can you imagine the perils for a child lacking fear?
Listening to Max's history, I decided to begin my work with his parents by providing support and reassurance and by helping them understand the origin of their son's worries.
I suggested that Julie and Jim ask Max what in his room made him feel afraid. When they returned the following week, they reported that Max told them that he was frightened of the monsters living in his closet. Knowing this would certainly not completely resolve the problem, I offered a very simple, yet often successful remedy for those pesky closet monsters: a spray bottle filled with water, labeled "Monster Spray." I suggested they invite Max to join them in vigorously spraying this liquid in his closet and underneath his bed.
Why should his parents engage Max in spraying his closet when they know perfectly well that the only monsters were in his imagination? The answer has to do with how children Max's age think. "Monster Spray" works for the very same reason that Max is afraid of monsters to begin with. Children of Max's age see the world through a lens of their wishes and fears, also known as magical thinking. Children at this age do not differentiate between thoughts and fantasies. They inhabit a world of wonder and imagination ruled by magic. Preschoolers like Max are convinced that their thoughts are powerful enough to create what happens in their world. Just as there are terrifying monsters under Max's bed, there is a magical spray powerful enough to rid the closet of these terrifying creatures. By suggesting that they provide Max with this magic spray and join him in using it, I was inviting them to enter Max's world of make-believe, helping Max conquer the monsters from within.
At our next meeting, Julie and Jim let me know that the "Monster Spray" had worked wonders and that Max enjoyed the power he now held over these monsters. With the pleasure of budding detectives, they reported that Max had offered what they thought was an important clue when he told them that he was especially afraid of his toy dinosaur and NASA missile. These toys had been in his bedroom since he was a baby, but under the sway of powerful magical thoughts, Max now saw them as dangerous. He needed his parents to provide the protection and abstract thinking of which he was not yet capable.
Together we imagined the many ways Max might be transforming these toys into scary objects. I suggested Julie and Jim encourage Max to make up stories about his toys that would allow us to better understand what they had come to represent. From there, we could try to help him resolve these fears through play.
Over the weeks, a clearer picture of Max's worries unfolded. As Max's parents better understood their son's fears -- not just about getting him to sleep -- they were able to help him settle down at bedtime. As their responses grew calmer, so did Max's behavior.
Soon, Max initiated a new ritual each night before he went to bed. In his pajamas, teeth brushed, he carried the dinosaur and rocket down the hall to the guest room. =After a thorough spritzing of his own room with Monster Spray, Max hopped into bed, and for the first time in months, he was able to go to sleep without a parent right next to him.
Upon waking, Max marched down the hall and returned the dinosaur and rocket back to his bedroom. This form of play, initiated by him, indicated to me that Max, with the help of his parents, was gaining control over the things that go bump in the night.
Over the four months we worked together, Max's fears subsided. After a while ,he no longer needed to remove his toys from his room and bedtime ceased to be a problem. His parents came to have a better understanding of their child's inner world. They now saw that his worries could be understood as healthy: Max ingeniously located his fears in objects he could understand, control and literally see -- in this way, he kept his fears from taking over every aspect of his life. Being afraid was also a strategy for keeping his parents close to him at a developmentally stressful moment, ensuring that he wouldn't lose them. Assessing what they had accomplished in therapy, I had no doubt that as Max matured emotionally, he would be able to move from the idea that all dangers are external to an awareness that some dangers came from inside, a manifestation of his own confusing and scary feelings.