Jeremy

When Jeremy was seven years old, he travelled to Toronto with his mother from a war zone in the Middle East. The year before, he and his parents had witnessed six people die in a bomb attack. Adding to his distress, his parents began to have violent quarrels and later separated.

Since leaving his homeland, he had no contact with his dad. His mother had no friends or relatives in this country and they have been very isolated socially. Jeremy’s mother works long hours, anxious to put food on the table and make a better life for the two of them.

Jeremy was referred for treatment by his school principal because Jeremy was hyper active, inattentive, and distracted in the classroom and got into fights with older children on the playground. He had been suspended twice for fighting.

Our therapist, Gretchen, saw Jeremy twice a week in his school and met with Jeremy’s teacher as often as possible to understand what was happening in the class and to explore ways to help him settle and learn. The teacher was quite overwhelmed by the demands of his needy and disruptive class generally and by Jeremy, in particular.

It was six months before Jeremy could begin to play; until then he sat under a table and asked for an assortment of objects to be passed to him after which, he passed them right back. He started at every sound, constantly watched the door, and was prepared to flee at any moment.

After six months, Jeremy began to enact bloody attacks and death scenes with gory and graphic details. At the end of each session however, he declared with relief and satisfaction that “no one died, no one was hurt… not even a little bit!” One can appreciate how reassuring such a fantasy would be for a child struggling to make sense of the terrible violence he had witnessed. Maybe that too was just pretend; maybe no one was really hurt after all.

Gretchen helped the teacher to understand the effects of trauma in children including hyper vigilance, distractibility, preoccupation, and the need to fight or flee whenever threatened. Jeremy was neither hostile nor indifferent; he was terrified.

As is so often the case, the teacher had no idea what Jeremy had experienced and, was continuing to experience. His mother did not want to bring attention to him (or to herself) and was wary of having Jeremy ‘labelled’ in some negative way. As Gretchen began to know Jeremy’s mother, it was clear that she too was traumatized- distracted, fearful, and preoccupied. Gretchen was able to facilitate treatment for mom realizing that without help, she would continue to reinforce Jeremy’s perceptions of a violent and scary world and undo all the benefits of his treatment.

Increasingly, Gretchen and Jeremy’s teacher found it helpful to collaborate, and their communications, which had tended to be ‘on the fly’, became more formal meetings where the teacher brought an agenda of concerns for them to tackle. Together, Gretchen and the teacher found ways to anticipate Jeremy’s distress, reassure and calm him, particularly at difficult transition times, and have someone assigned to assist him in the playground where he felt most unsafe.

Rather than feeling frustrated by Jeremy all the time, his teacher developed empathy for him and found him likeable, as well as smart. As he began to feel safe, Jeremy was able to pay more attention to the ‘here and now’ and process new information. Because he had a place to express his fears and fantasies, including his fears and fantasies about his dad, Jeremy was less preoccupied and better focussed. Jeremy’s mother was relieved that he was able to play by himself sometimes rather than requiring her constant attention.

This case illustrates that although the progress is slow, although there are no quick fixes, when the important people in a child’s life work together, they can repair even the most horrific and challenging life experiences.