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Using Strengths to Help Children with ASD's Grow: An Interview with Christine La Cerva
Interviewer: Over the years, as a therapist, you've worked with kids who have some kind of developmental, cognitive or emotional issues. Can you tell me about some of the young people you've seen over the years? Christine: Well, we've seen children starting at the age of four through their teenage years – up to eighteen. But I've worked predominantly with younger children, ages four through twelve. In the last five to ten years we've seen an increase in children diagnosed with autism spectrum disorder. Many therapists will not see these children. Those kids are sometimes referred to behavioral therapists – but not to psychotherapists. They are thought to not have the capacity or the interpersonal skills to be able to function in psychotherapy.
Interviewer: But they come anyway? Christine: People tell us, "I heard you work with Autistic kids. I've been trying to find somebody. I can't get help for them. What do you do?" We relate to everyone as having the capacity to develop. We don't pathologize them. We are going to support the human capacity to perform: to be both who you are and other than who you are. We're working to help the parents see and relate to their child outside of the confines of diagnostic categories and the stated limitations.
Interviewer: Christine, tell us about a recent family that has come to you for help. Christine: Well, one example is a mother and a six-year-old boy who has been diagnosed as "PDD-NOS." When he came for the first session, he was pretty difficult--yelling and screaming a lot. As for anyone coming to therapy (whether they're four or forty) there's nervousness about coming to see somebody you don't know and talking about the intimate details of you life. And of course a child knows that he or she is being brought there because they're a problem. So he's anxious, turning the lights on and off and knocking chairs over. As he begins to talk to me, his mother's telling me some of the history. I try to have him participate with us but he won't sit down.
He kept coming up to me and saying: "I'm a big boy, right?" He said that for pretty much forty-five minutes. And his mother (as she has been taught to do) was trying to get him to stop repeating himself.
I was saying other things to him, like: "It's really nice to meet you; I wonder if you're nervous," and I was asking him questions.
Interviewer: And as you'd ask him questions, he said…? Christine: He kept saying the same thing, which was fine. I didn't have any need for him to answer my questions, but I wanted to relate to him as a member of the community I'm in, that is, as part of a community of people who talk to each other and have conversations. His mother identified the presenting problem being that he could not carry on a conversation and would repeat things, ad infinitum. Interviewer: As you're talking to him and he's saying, "I'm a big boy, I'm a big boy," what was mother doing? Christine: Well, she said "I can't believe you're not stopping him from repeating himself. It's driving me crazy." I said I was glad that she was saying that. I could understand her frustration. However, I don't try to stop anybody from doing anything. And I said to him, "I repeat myself. And it can be annoying to some people, but it's not really bothering me at the moment."
I do tell him that this is my office and he cannot turn the lights on and off and that he can't throw things on the floor
Interviewer: What does he do with that? Christine: He turns the lights on and off and throws things to see what I'm going to do. Then I stood up and bring him over to sit, which he does. So now something has happened in the first session; something unusual for him: Near the end of the session, he said to me, "You don't think I'm a big boy, do you?
Interviewer: He said that? Christine: Yes. After 45 minutes, he stopped repeating. He had something else to say. In the next session, when I saw his mother alone, we talked about the assumptions that she and we all have with children who have difficulties. She said that she was shocked at him for breaking out of his usual behaviors.
She asked me why I kept asking him questions when I knew he wasn't going to be able to answer me. I told her that I thought we needed to talk to him conversationally, so he had a shot at learning what a conversation is.
She cried and said that she realized that in fact she didn't have conversations with him. Basically she told him what to do and what not to do, or that she loved him, but she conducted no conversations with him in any ordinary way. She was focused on his limitations.
I was sick during our fifth therapy session together. He had a game he liked to play with me called "The Bears." I said I didn't think I could play today, because I wasn't feeling well. He kept saying, "No, we're going to play ‘The Bears!'" And I said, "Well, what about the fact that I'm sick?"
I asked him if he cared. He said, "No." And then he started crying and saying, "Please play ‘The Bears!'" After a while he said to me, "Help me stop crying. I can't stop."
I said, "Okay, this is how you do it, you start focusing on something else, and you can sometimes let go of the crying," which he did. And I said, "I'll play ‘The Bears' the best I can. How's that?"
In the course of "The Bears" game, he plays my father and constantly orders me around and tries to stop me from doing what I'm doing – which, of course, is his own life experience.
My character started crying, protesting to him that I didn't want to be sent to my room all the time, and why was he punishing me? And then (this was a big move for him) he said, "I heard you're not feeling well. Why don't I fix you a cup of tea? I think you should rest. I think you're jumping up and down too much. Maybe we should call the doctor."
His entire performance became being extremely sensitive to how I, his son (in this case), was doing. It was a lovely moment. It was a breakthrough. I felt like he had said to me through his activity, "Yes, I am in therapy with you. I'm going to recognize that I have an impact on you."
Interviewer: It's very beautiful what you're saying. I'm wondering what the repercussions of his development have been in his world. Christine: His mom has made a decision to change his school and put him in a more challenging environment. He also has joined a karate class, which people thought he couldn't do. Interviewer: What is your response to, how do you react to, the success of what you're creating here? Christine: I'm very dedicated to continuing to create this and happy to be doing it with more and more people. We've worked with some wonderful families, and helped a lot of kids like Jeremy use their strengths to grow. Interviewer: Thank you for sharing this with us. Christine: Thank you.
Christine LaCerva is a social therapist who specializes in child and family therapy at the Social Therapy Group in Manhattan and Brooklyn. With over 25 years experience in the classroom and the therapy office, LaCerva has helped hundreds of families and children with their growing pains. Contact her at: clacerva@socialtherapygroup.com