Case Study: Utilizing the Comprehensive Resource Model with Children and Caregivers

Client:

I was contacted in June 2015 by the mother of a 4-year-old female for therapy.

Presenting Problem:

The mother’s concerns were mainly that her daughter is 4 years old and has not yet potty trained. Mother noted that the child has been approached about potty training, but has shown no interest. The child wore a ‘pull-up’, and was changed regularly by her mother or another adult caregiver.

Summary:

Therapy began in July 2015. During the intake, the mother noted that a medical procedure was performed when the child was 18 months old. Mother reported that the child had a kidney/bladder infection that lingered, so in an attempt to prevent hospitalization the pediatrician catheterized the child to better examine the bacteria. During the catheterization, the pediatrician instructed the child’s mother to hold the child down on the table to prevent movement during the procedure. The mother began to cry and report feelings of guilt and hurt for her child regarding this procedure.

The mother was included in each session. To establish rapport, this therapist utilized play/sand tray with the child client, who always included her mother and eventually invited the therapist into the play. There were a few themes during play, but the consistent theme in each session included taking baby dolls to the doctor because the ‘babies’ were sick.

In August, there was a need for the client’s pull up to be changed during the session. The client became emotional (which mother reported was usual), so the therapist suggested the use of bilateral music to assist in calming the client. This worked well, so the therapist gave this resource to the mother to utilize outside of therapy sessions. During this time, the mother was using a behavior chart at home to reward the client for the times the client sat on the potty.

The next session was spent introducing the client to breathing and utilizing more bilateral music, as we drew pictures of what was upsetting to the client about pottying and changing of her pull up. The client also drew a picture of her happiest place ever (seeing the zebras at the zoo). The client was able to find eye positions for each and began to focus on her picture of the zoo.

In the following session, the client did not wish to work with her pictures, so the therapist enlisted the client’s mother. The client sat in her mother’s lap as the mother built a grid and processed some of her feelings surrounding the catheterization. The client then asked to work with her dolls. For several sessions following, the client began to act as the therapist and work with her dolls to process ‘their trauma’ through CRM.

Finally, two sessions prior to this report, the client agreed to allow the therapist to work with the client and her mother together to reprocess the day of the catheterization at the doctor’s office. The therapist utilized bilateral music and grounding breaths to begin, and then asked the client to build a body grid. The client naturally knew where she was most connected in her body and had no trouble building the 3-point grid. Without prompt, the client reported that the lines connecting her grid were orange. Simultaneously, the mother was following along as well. Both mother and client then found their respective eye positions that anchored them in the grid. The client reported feeling that her body was tight. The mother then stated that she could visualize the exam room in the doctor’s office and that she was standing beside her daughter, who was on the table. The client then spoke up and stated that she could see the ‘spot on the roof’ and that there were airplanes on the walls. (Mother validated this.) The client then stated that there were two mean lady nurses (Mother again validated). The client then began to scream and cry, saying “I’m scared! I’m scared!” The client’s mother was able to console client, yet voice at the same time that mother was scared and sad at the same time. The client continued in her process for approximately 10 minutes, and then collapsed in exhaustion in her mother’s arms. Mother held and hugged client for several more minutes, as mother finished her own processing. Mother and client then bonded together, looking each other in the eyes, with mother telling the client how sorry mother is that mother had to hold the client down. Mother told the client that she understands that it could make client doubt that mother has client’s best interest at heart. Mother assured client that mother only did this because the doctor told mother to, and that mother will never do anything like this again. The client then began to cry and said, “Really, you promise? Never?” Mother insisted and they continued to bond this way for several more minutes. The therapist then asked the client what she noticed in her body. The client responded that it felt better, but that she now feels sad and angry. The checked in with the mother, who stated that she feels relief and love. The therapist then asked the client what she needs to help with the sad and angry feelings. The client stated she needed to get them out. The therapist suggested dragon breaths, which the client and mother began. The client then asked if she and mother could draw a picture. Together, they drew a picture of the doctor’s office, and together, they colored over the picture with their anger and sadness, offering dragon and heart breaths. The client then wanted to rip up the picture, stomp on it, and get rid of it. The client used the vacuum cleaner to make the picture go away. The client and mother then drew a positive picture together, offering heart breaths.

During the last session, in check in, the client’s mother reported that client had been heavily constipated early in the week. The therapist talked with mother and then the client about how the client’s body is really closed off. The therapist then asked the client what her body needs. Client responded with, “I don’t know.” The therapist asked the client to ask her body what it needs, to which the client responded, “It wants to feel free!” Therapist asked the client what would make her body feel free. The client stated “to let go”. The therapist began this process with bilateral music and the client immediately told therapist the 3 body parts she ‘wanted to connect with the line’. The client stated that this time the lines were orange and purple. The therapist attempted to guide client through the process as in the previous session, but the client continued to appear somewhat distracted. The therapist asked the client to ask her body how client can let go. The client stated she needed to draw another picture. The client drew her picture (with bilateral music) of the doctor’s office and scribbled through her anger and sadness, offering dragon breaths. The client then ripped the picture and stomped on it. The client then beat it with a pillow, continuing to use dragon breathing. The client then set the pieces of the picture on fire and watched them burn. The client then stated, ‘my body feels free. I’m good!’ The client then asked for play time in the therapist’s office. During this play, the doll used the potty.

Later that evening, the client’s mother contacted the therapist and reported that the client initiated going to the potty and used the potty twice. At this time, the client has consistently used the potty for the past two days.

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