I treat a lot of children in my practice and a common complaint parents want
treated is the temper tantrums that afflict their children. As often the case, there are many reasons for such behaviours. Listening to the child and hearing their story allows one to step into their world and try to bring together the threads that help to formulate an image for their needed remedy. Here is a case I hope illustrates how the child’s feelings reflect the challenges she faces at home dealing with a younger sister, attachment insecurities with her mother and the parallel universe that is shown in her dreams.
This is an edited video case for this article to illustrate how the case was understood. I have also included commentary to give the reader an understanding of my thoughts as the case unfolded.
Girl aged 8 years. First seen: 8/10/2013
Presenting Complaint: Her mother brings her daughter for treatment because of her temper tantrums. She has had them pretty much all her life. They can go on for 2 – 3 hours, usually 2 – 3 times a week. They are not responsive. She also had separation anxiety from about 18months of age.
K.A.: So tell me about these then?
Pt.: Mummy tells, not me.
(I am thinking that her response is to deflect to her mother, i.e. her mother can speak for her – suggesting, “I am dependant on you.”)
Her mother says that the tantrums are getting more violent even to self-harming.
I interview the child separately to try and understand her state further. As she talks, what is noticeable is that her speech has a childish quality to it.
(Her tantrums have occurred since she was an infant. It is not something new, so in a sense, we can say that her state has not changed since then. Her behaviour is still as though she was an infant).
K.A.: What’s the feeling that you get?
Pt.: Really sad and angry.
(So we have two types of feelings: Sadness and Anger)
K.A.: So tell me more about that sad and angry feeling?
Pt.: I’m really sad because I don’t get what I want. (Row 3: needs not being met). I don’t get to watch the TV because Kirra (her younger sister) doesn’t let me, she sits in the wrong spot; we have to do the dishwasher and sometimes Kirra doesn’t do it and I have to do it… at night time. Kirra says it’s her turn to choose the book to read, but it is really my turn.
(Again, issues about choice: Row 3. So she is telling me that her needs are not being met – these are issues that relate to the mineral kingdom. It is not an issue of sensitivity relating to the plant kingdom or feeling of being a victim as in the animal kingdom).
K.A.: When was the last time you were angry?
Pt.: I think it was last week when daddy was at work and it was on a Monday because I wanted a cuddle from mummy but she didn’t let me and I kept going on and on.
(Again, she wants a cuddle and does not get it. This is then what upsets her – Row 3 issues of care)
K.A.: And what is that feeling like?
Pt.: I’m sad again.
(The other feeling is Sadness)
K.A.: So if mummy is not really there with you, that makes you a bit angry?
Pt.: Nods. Sad because when she goes out for dinner and doesn’t come back until midnight and that makes me very sad.
K.A.: You like to have mummy around you?
Pt.: Nods. At night-time.
K.A.: Do you pick things up and want to throw them or break things?
Pt.: I don’t want to break things but I do want to throw things. I don’t want to break anything because I know I will get into big, big trouble. Sometimes I break stuff and it is a very special and I want to play with it and it is gone, broken.
K.A.: Do you want to hit or strike out?
Pt.: Hit people but I only want to do it at home. It’s normally my sister teasing me and me getting in trouble instead of Kirra. That happens a lot.
(So the people “I am dependant on disappoint me, it makes me sad and angry”)
K.A.: What’s that feeling like?
Pt.: Makes me very angry.
K.A.: Do you punch or hit?
Pt.: I get really angry and then I tell mummy. She normally believes me than Kirra because Kirra tells lies, goes back to mummy and gets me in trouble. That’s what I don’t like, getting into trouble.
(She needs her mother for help, love and support – Row 3 issues)
K.A.: Describe that feeling to me then?
Pt.: I don’t like getting into trouble because I get screamed at. It makes me feel even angrier.
K.A.: What do you feel when you start to get screamed at?
Pt.: Very sad.
(This is the other side: when she is getting reproached she becomes sad)
K.A.: Tell me what dreams can you remember?
Pt.: Mummy getting taken away.
K.A.: Tell me about that dream then?
Pt.: I have lots of different dreams, but that was one of them a long time ago. Mummy got taken away for a week by a monster. Then the police caught the monster and brought mummy back home. She was taken away at night and in the morning we looked and looked then we learnt that mummy was gone.
(We see the person who she is dependent on and who is supposed to care for her is taken away – a similar experience at home with her mother not giving her enough love)
K.A.: How did the monster come and manage to take your mummy away?
Pt.: He sneaked in through the door or window I can’t remember which one. And without anybody knowing crept around the bed and got her out of the bed and put a dummy and painted it like mummy, but daddy pulled down the covers, then we saw mummy was taken away. He tried to trick us. Then we looked everywhere and we realised that mummy was gone.
(So mummy is taken away by the monster (Kira) who has tricked us)
K.A.: So there was no one there to help her?
Pt.: No we were all asleep. But it never happened.
K.A.: How do you think your mummy felt in the dream when she was taken by the monster and there was no one to help her?
Pt.: Very scared.
(Even though she is talking about someone else in the dream, feelings that occur would be a reflection of her own state – especially as they share a similarity to her issues of separation. Therefore asking her to describe what those feelings might be allows her to indirectly describe her own state.)
K.A.: Tell me about that feeling?
Pt.: She was really scared that she was going to get eaten up by the monster (I’m alone and I’m violently attacked). She tried to get out of the monsters arms, but she was so scared that the monster was opening his mouth pretending to eat mummy but was just tricking mummy. Then the police found her a week after holding mummy and mummy told them where she lived and she came back home.
K.A.: Do you get sad at other times without being angry?
Pt.: Sometimes. But not often.
K.A.: What happens at those times?
Pt.: Sad because mummy has gone out. And she hasn’t said good night to me before she left.
(Like the dream with the monster taking mummy away without her knowing)
I interview the mother now to see if there are any other details she may be able to offer:
K.A.: So when she gets angry, how angry does she get?
M.: Very angry. She kicks and throws things at me and it’s been getting worse. It’s alright when they are 3, but at 8 it’s the same. Everyone kept telling me she will grow out of it; no, she is growing into it. She will attack me, she will hit me, throws stuff. Attacks her sister if her sister comes anywhere near her.
K.A.: So is it just between you and her sister?
M.: It’s between me and Kirra…
K.A.: What else can you tell me about her nature? Is she a quiet sort of child, active or restless child?
M.: She would never talk to adults until she was 4 ½, she was very very shy…
K.A.: Does she want to be around people or be alone?
M.: Around me, she will follow me around constantly. And that has been always, no different between when she was 2 to now. She doesn’t self amuse. She may occasionally, do some colouring, but she generally likes me in the area. So if I am in the kitchen she will do some colouring there, will move wherever I move. If I am in the shower, she will sit on the floor and colour in.