Sam lives with his mother and younger sibling. Mum had requested counselling due to his behaviour at home and Sam’s teacher confirmed that he had concerns over his behaviour in school as he had recently become more and more withdrawn and uncooperative and was also having difficulty with peers. Sam was prone to anger outbursts at home.

The total score assessed by the Strengths and Difficulties Questionnaire (SDQ) completed by mum was 25, with particularly high scores for emotional distress, conduct and hyperactivity. Sam’s teacher scored his SDQ as 22 with high scores for conduct and hyperactivity.

Meeting Sam’s mum

The counsellor met with Sam’s mum and took a full history of Sam’s early years and recent behaviour changes. Mum shared that she had had post-natal depression when he was born and that this had affected their bonding together. Sam had formed a strong bond with his dad but dad had left the home when Sam was 2. Sam had had minimal contact with his dad over the intervening years, but contact had recently been established again. Mum and Dad did not have a good relationship and Sam had recently witnessed some heated arguments between them.

This history was very useful and indicated an early attachment rupture between Sam and his mum, and then the secure attachment he had formed with his dad was also broken when he left. Sam had feelings of insecurity related to his mum and dad and this seemed to have been triggered by the recent contact again with his dad.

Early sessions with YP

During the first session with Sam, a confidentiality contract was agreed. He was encouraged to select from the materials in the room. He chose the sand tray and seemed to use the materials as a means of soothing. Sam was largely verbally uncommunicative during these early sessions; it was rare to detect changes in verbal tone and facial expressions. It was as if Sam wore a mask covering up any emotional expression. The counsellor saw this as a defence for him to protect himself against experiencing more distressing emotions and was therefore respectful of his need to feel safe at this point.

YP CORE score at the beginning of therapy was 23/ 40.

Sam was seen weekly over a period of 5 months. The counsellor took an attachment approach to therapy and worked hard to build a trusted relationship. The pace of the sessions was set by Sam. The media he chose more and more to use was art work, he was interested and gifted in drawing and art work so by using this skill as a means of communication and building trust the relationship developed. Sam used the sand tray, sometimes depicting idyllic scenes in one and barren, desert-like scenes in the other sand tray. Sam seemed to be symbolically working through a history of his young life with the loss of the secure attachment and the empty, barren attachment from his early years.

Parental involvement

Contact was maintained with Mum, and the counsellor often brought her in to see the art work and talk about Sam and general home life. By offering emotional support and understanding to his mum the counsellor was also helping Sam. A key turning point came during a phone call to Mum when she described how she had been able to listen to Sam talk about his feelings and she had been able to show empathy by sharing that she sometimes felt anxious too and how she coped. This new dialogue about emotions between Sam and his mum seemed to strengthen their relationship.

Ending counselling

Sam and his counsellor agreed a gradual process of ending by moving from weekly sessions to fortnightly catch-ups. The fortnightly catch-ups then moved to occasional drop-in sessions over lunch. YP CORE score at ending was 0/40. Sam completed an evaluation form at the end of counselling and said, “It felt good to have somewhere to go where I could talk and share my feelings.” Sam’s mum and his teacher also noticed a big improvement in Sam’s behaviour, with their SDQ scores dropping to 5.

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