giving any indication of how these related to one another. Moreover, she made these switches so quickly I saw myself struggling to keep up. As soon as I tried to address one problem, she was off doing something else.
Dave said this indicated a “poorly organized personality” and added that this was, in his experience, the precursor to borderline personality disorder. In adults, this emotional disturbance shows itself as a pattern of behaviors that includes poor interpersonal relationships; intense and inappropriate emotions; unstable, often unpredictable moods; and impulsive and manipulative behaviors. So he speculated aloud that this might be what was forming.
We both agreed that Cassandra showed many indicators of having been sexually abused, including her comments about her father’s penis and the graphic description of what she alleged her teacher had done to her. However, there was no way at this point to discern when or where or how the abuse had taken place or what it had involved. Like me, Dave felt there was not much credibility in her allegations against Mrs. Baker, but he was intrigued that Cassandra should pick Mrs. Baker to accuse. Why? he asked. Did Cassandra perceive Mrs. Baker as a threat and was thus attempting to get rid of her? Or was it just the opposite? Did she actually like Mrs. Baker and was using these allegations to make herself appear special to Mrs. Baker in our eyes? Or was she doing it to ensure some kind of connection to Mrs. Baker, feeling that even the negative uproar lies would cause was preferable to having no attention at all? I replied, what about the possibility that she’d simply lost contact with reality? Perhaps in her imagination these things had happened and she wasn’t able to discern that they were thoughts and not actions.
Dave’s and my conversation digressed then, wandering back to the issue of how hard it was to know how to treat someone when the individual’s observable behaviors could be interpreted so many ways. I remarked that the tape reflected well the lack of focus in the sessions and my feeling that I was spending all my time reacting rather than acting. There wasn’t really much more direction in what I was doing than in what she was doing.
Dave replied that we weren’t lacking focus. Her abduction was the source of Cassandra’s difficulties and the focus of our work was understanding how that trauma had affected her and finding a way of helping her deal with that experience.
I hadn’t really needed reminding of this. Indeed, I said, that was half my problem. I’d spent a lot of time investigating the current research into treatment of traumatized children and had made detailed plans for dealing with the issues surrounding the abduction. The problem was that so far I hadn’t managed to squeeze in even one of my planned exercises. Focusing on the trauma of the abduction was what I wanted to do, but that was just never where we ended up going.
Dave smiled gently. “Au contraire, mam’selle,” he said. “I think that’s just where you’re going.” And he rose from his seat, clapping me on the shoulder as he did so. “The trick,” he added, “is fitting what you know to the events, not fitting the events to what you know.”
The day after I’d returned from Quentin, I reported back to Harry Patel regarding my visit to see Drake Sloane. I told Harry that, yes, indeed, Drake was electively mute and the preschool had tried interventions, which had thus far been unsuccessful. I mentioned the possibility of bilingualism as a contributing factor and did say there were a few peculiarities to the case, such as the restrictive nature of Drake’s mutism. My overall impression, however, was of a reasonably well-adjusted child who, given an environment sensitive and appropriate to his needs, would most likely outgrow the difficulty without further treatment.
Which sadly couldn’t be said about Drake’s grandfather, I added. I told Harry how I’d found the old man to be difficult, demanding, and meddlesome and how I suspected that if there were any serious problems, they lay in the family dynamics and not in the boy. Then I mentioned how I’d unintentionally antagonized the old man and he’d stomped out on me. So, regardless of my findings, that was the end of the story.
Or so I’d thought.
Sitting in my office with Dave Menotti, going over the videotape of Cassandra’s session, I heard a quick rap at the door.
It opened and Harry popped his head in. “Oops, sorry to interrupt,” he said, “but I’m just leaving to go over to the medical center, and I wanted to say before I missed you, Torey, that Drake Sloane is coming into the unit on Sunday.”
My eyes widened with surprise.
“Had a call from Mason Sloane, who said they’d had a family meeting and Drake’s parents decided they wanted this problem sorted out.”
Mason Sloane decided, more likely.
As I didn’t work weekends, I wasn’t on the unit when Drake was admitted, but, of course, I was slated for his individual therapy sessions. When I arrived on Monday, I found Drake curled up on the couch in the dayroom watching cartoons, his huge stuffed tiger, Friend, sitting beside him.
“Hi, Drake!” I called as I walked through the dayroom to the nurses’ station. “Remember me?”
He nodded enthusiastically, smiled broadly, and waved, then started to get down to come over.
“You wait there just a second while I talk to Nurse Nancy and then I’ll come get you. Then we’ll go do something fun. Okay?”
Grabbing Friend around the neck in such a vigorous hug that they both toppled over, he laughed and nodded.
Before starting the session, I wanted to find out how Drake had adjusted to his first day on the ward and what Nancy’s general impressions were, so I stepped into the small room behind the nurses’ station and closed the door.
“What a sweetie!” Nancy said. “He’s been just good as gold since he’s come. There were some tears last night. I mean, poor little tadpole. And his mama must have had a very wet pillow last night, too. She lingered so long yesterday. You could just see it in her face.”
This I could imagine. My impression during my visit to Quentin was not only that Lucia loved her son very dearly, but that Drake may have served as a buffer between her and the rest of the world. Indeed, my general sense was that both Mason Sloane and Lucia had more problems than Drake.
Truth was, I was not happy with the Sloanes’ decision to bring Drake for inpatient treatment. Without evidence of devastating levels of dysfunction, the boy was, in my opinion, way too young to be separated from his mother and left for days in an institutional setting. Elective mutism on its own is not indicative of serious pathology. To hospitalize a four-year-old for not speaking at school falls into the category of “burning the house down to roast the pig,” in my opinion. This left me far more concerned about the psychological damage we could do by separating a preschooler from his family and familiar surroundings for days, if not weeks, than what would occur from leaving the elective mutism untreated. Unfortunately, he was not my child and it was not my choice. If parents made this kind of decision and had the insurance or finances to see it through, our hospital unit was designed for diagnostic purposes. So my best course of action was to swallow my own opinions and simply to get on with the job as quickly and straightforwardly as possible, so that he could go home.
I didn’t foresee any problems in this. My treatment essentially involved very little more than arriving as an outsider with whom the child had not already established a silent relationship, setting up the expectations he/she could and would talk with me, and then presenting the child with opportunities to do so. Among children for whom there was no other significant pathology, this “method” had worked very well and my success rate was almost 100 percent within the first session. So I set myself the personal goal of having Drake ready
