Throwing away the cookie cutter

One oft-heard tenet of my training is to go with the patient. When working with kids, it means that they chose the activity and direct the play. I, in turn, am a facilitator, an observer and when called upon, a participant in the fantasy world that the child creates. Children's play is often a surprisingly literal enactment of their world. What does their play tell me about their life? Is the play lifeless or repetitive, or out-of-control, or unstable, or full of painful events or hidden perils?

Recently at the beginning of the hour, a woman announced that she was unable to sit down that day. She had to have the door open and the radio turned off. In fact, if she had her druthers, she'd be outside walking. It was a lovely unseasonably warm day, so out we went. She thought she'd only need to walk around the block. I told her about a terrified little girl that had to be walked around the block three, sometimes four times, before she wound down enough to play inside. That day we ended up walking for 50 minutes. Over and over she apologized because she thought her problem was so silly. I corrected her because her difficulties were keeping her from enjoying her life and doing the things she had previously done with no difficulty. In fact, her life sounded pretty miserable to me.

Someone driving by might think we were just two ladies out for a stroll; however she was telling me about her world; a world where she was afraid to be alone, afraid to ride in the backseat of a car, afraid to drive by herself, afraid of being in a room with too few windows, and in constant fear of something happening to a member of her family. Her world is a prison in which she is rarely at peace. We discussed nutrition, the pros and cons of psychotropic medications (she has a cabinet full of them, most unopened), and small steps she might make to gain a bit of control over her life. Mostly she talked, we walked and I listened. This is hardly a by-the-book, standard cookie-cutter approach, but it was a most productive hour. So I've dusted off my walking shoes and will take them in to the office just in case we need to take another walk the next time she comes in. We will continue to walk as long as she needs to.