Case of Melissa
The following case involves a young person who has been identified as in need of Tier 3 support. Information is provided to assist you in developing one-on-one responses to Melissa’s situation. Prompts are provided to help you think through how to construct the one-on-one dialog you will need to have with Melissa.
Who are you (the student)?
Your name is Melissa, and you are a ten-year-old, White girl in the fifth grade. Your parents have recently divorced, and are engaged in a bitter custody battle for you and your sister, Jessica, age four. Your parents, Jack (age thirty-eight) and Denise (age thirty-six), both live in Branford, Connecticut. Jack is a car salesman, and Denise works part-time at a beauty salon. The judge has recently ordered that you and your sister divide your time equally between both parents, spending alternating weeks at each parent’s home. The school counselor obtained information about current situation through phone conversations with both parents. You are being interviewed in the school counseling office.
How do you behave in the interview?
Your hair and clothes are neat and clean. You sit quietly and speak softly, in a subdued voice. You are cooperative, and it is clear from your efforts to answer all questions fully that you want the counselor to like you. If you are not sure that you know the right answer to a question, you hesitate, apologize, and ask for the question to be repeated. Your vocabulary is good and demonstrates intelligence. You brought a book with you to read in the waiting room before the appointment. If the counselor asks you about this, you say that you love to read and often have a hard time putting a book down if you are really interested in it. If the counselor asks about your living situation and your feelings about your parents’ divorce, you speak even more softly. Your voice may quiver, and your eyes may fill with tears. You may also rub your stomach as if in pain and may interrupt the interview to ask if you can take a break and go use the restroom. You admit that you often feel sad and worried and that you sometimes lie awake at night thinking about your parents’ divorce and wondering if they will ever get back together again. You cry often when you think about this. Your mother has spoken with your teacher at school, and she has been very understanding. She told you that you could leave the room to go talk to the nurse or the guidance counselor any time you felt too upset to stay in class. If asked mental status questions, you deny any suicidal ideation or aggressive impulses. You how no signs of having confusing thoughts or strange ideas.
Why are you seeing the school counselor?
Your mother called to make the appointment for you. She told you she thought you needed someone besides your parents to talk to about the divorce. She had noticed that you were complaining a lot about stomachaches and were not eating or sleeping well. Your stomachaches have gotten so bad recently that you asked your mom if you could stay home from school. She was surprised because you love school and never want to miss a day. The next week, when you were staying with your dad, you had such a bad stomachache at school that you asked the school nurse to call your dad, and he came and took you home. Your dad told your mom about this the next time he brought you back to her house. Your mom took you to your pediatrician, who said there was nothing medically wrong with you and suggested you were “stressed.” After this, your mom told you that she had talked to your father about bringing you to see someone, and that he had agreed as long as he could speak to the counselor on the phone before the appointment and make sure he would be informed of what took place. Both your parents have told you that they understand it is hard for you to be “stuck in the middle” and that they think it might be a good idea if you had someone to talk to who wasn’t on either parent’s side
How do you (the student) feel?
You feel sad and anxious most of the time. It scares you when your stomach hurts because you think there might be something really wrong with you. You are afraid that you might get really sick or even die while you are with one parent and not be able to see the other parent ever again. You get really frightened when you overhear one of your parents arguing with the other over the phone because they scream at each other and say scary things about getting custody of you and your sister and never letting the other parent see you again. You don’t really think they mean this because they always try to reassure you if they notice you have been listening to the conversation, but it is frightening to see your parents become so angry and emotional.
You try very hard not to let either parent think that you have chosen sides with the other. When you are with your father, he often questions you about things your mother has said and done. When you are with your mother, she does the same thing, asking questions about your father. You feel scared that you are going to say the wrong thing and get in trouble with someone.
You don’t want your parents yelling at you the way they yell at each other. Living in two houses is also confusing because your parents have such different rules for you. For example, your mother will make you do homework before you can play or watch television, but your father sometimes lets you do your homework later at night or forgets to ask about homework at all. You have just begun to learn to play the flute, and whereas your mother wants you to practice every day, your father tells you it’s up to you whether you practice. The last time you went to your father’s house, you forgot your flute, and you didn’t want to ask him to go back and get it because he seemed busy and might get mad at you. When your mother realized you had forgotten it, she called and yelled at your dad, who then yelled at you anyway, so he still ended up mad.
You also feel responsible for your little sister, who keeps asking you why you have to live in two houses now, or when mommy and daddy are going to be together again. When you are at your father’s house, Jessica cries for your mother, and you have to comfort her at night so she won’t wake your dad. When you are at your mother’s house, Jessica has tantrums when mom makes her do things that she doesn’t have to do at dad’s house, and you feel you have to try to calm her down so mom won’t get upset. Sometimes you try to correct her behavior so mom won’t have to, and you feel hurt when mom doesn’t seem to appreciate this but instead criticizes you for acting like Jessica’s parent. You don’t blame Jessica, who has a lot of your same feelings and is too little to understand what is happening, but you feel very responsible for helping her through this, as you are the one person who really understands what she is going through.
How do you (the student) think?
You are bright and express yourself well, although you worry about giving “wrong answers.”
You do not demonstrate any evidence of disordered thinking. You expect to be able to please others and work hard to do so. You think that if you try really hard to figure out what other people want from you and how to keep from upsetting or disappointing them, you should be able to keep everyone happy. It bothers you when you find your mom crying in her room or when your dad seems preoccupied and angry. You want everyone you love to be happy, and you believe you should try your best to make this happen.
You have noticed some positive changes in your parents since the divorce, and this surprises you when you think about it. For example, your father has started cooking and doing laundry, things you never saw him do when he lived with your mother. Your mother, on the other hand, has begun thinking about opening up her own beauty salon instead of working for someone else. You think it is a good thing that both your parents are making some positive changes, but you don’t understand why they had to get divorced in order for this to happen.
You have mixed feelings about the counselor. On the one hand, it is nice to have someone listen to your side of the story and show an interest in how the divorce and custody battle are affecting you. On the other hand, you are suspicious of how the information you are giving the counselor might be used. After all, you have already been interviewed by a custody evaluator, who told your parents things you had said which you wish they had not known, and by a judge, who told you that the courts would make the decision about where you lived but still wanted to know how you felt about it. You are afraid that if you say anything negative about either parent, that parent will find out what you said and think that you want to live with the other parent. You do not want to have to choose between your parents, but you also do not like going back and forth each week to a different house. You will seek a lot of reassurance from the counselor about keeping your feelings “private” before opening up in the interview.
What do you (the student) like about yourself?
You like that you are a good student and a good reader. You like that you try to help take care of your little sister. You like being a “helper”. You also like being a good friend, and you have several friends at school who trust you with their secrets because they know you would never tell them to anyone
How have you been doing in school?
You get mostly A’s at school. You like school. You enjoy learning new things, you get along well with your teachers and your classmates, and you like the fact that school is predictable and people seldom yell at each other. You feel comfortable going to the school nurse or guidance counselor when you are upset, and you feel your teacher understands you and is “nice.” Recently, however, it has been harder to enjoy school because you get your stomachaches. You don’t want to miss school, but you can’t concentrate on what the teacher is teaching you when your stomach hurts.
How is your health?
According to your pediatrician, there is nothing wrong with you except “stress.” You have stomachaches several times a week, especially at the beginning of a week after you have just transferred from one house to the other or at the end of a week when you are thinking about moving back to the other house. You have no other medical concerns.
How do you relate to others?
You get along well with adults and with your classmates. Your eagerness to please others and “keep the peace” make you very likeable. You are thoughtful and sensitive, and you often notice when someone needs to be cheered up or encouraged. Your friends find you to be loyal and dependable. Your little sister relies on you for security in the moves back and forth between your parents’ homes. Your parents would also describe you as helpful and cooperative. However, your mother has sometimes told you that you are “overresponsible,” and your father has said that you are “too sensitive.” You are not sure why they said these things, as you think these are good things.
How do you view your life?
Your life is currently confusing and upsetting to you. You can’t make everyone happy, and the “rules” seem to keep changing. You wish everyone could just “get along with each other.”
You really wish your parents would get back together, but you don’t see how this can realistically happen with all the mean things they have said to each other. If they can’t get back together, you just wish they could stop fighting with each other. You don’t like living in two houses, but you think you could deal with this if you just didn’t have to worry all the time about making either parent mad by saying or doing something that made it seem as if you had chosen sides. You want things to settle down for everyone, and you want to stop having stomachaches. Most of all, you want to know what you can do to make things better for everybody.
Practice deepening interview with Melissa
- Melissa internalizes her feelings and experiences them in the form of physical symptoms (stomachaches = somatization). Help Melissa become aware of the connection between her emotions and her physical sensations by sensitively commenting on what her nonverbal behavior may be communicating in the following scenarios. Use Melissa’s profile to guide you in making these connections.
Be careful to use developmentally appropriate language. An example has been provided that uses simple vocabulary.
Melissa: I don’t like living in two houses. (Her voice drops, she speaks almost in a whisper, and her eyes fill with tears.) I liked it better when we were all together, except for the yelling and fighting.
Example Counselor Response: I hear the way your voice gets quiet and I see your eyes filling up with tears and I wonder if you feel very sad about living in two houses.
Melissa: When I am at my dad’s, I miss my mom. But when I am at my mom’s, I miss my dad. (She rubs her stomach, as if in pain.) Do you have a restroom here somewhere?
Counselor Response:
Melissa: Could you repeat that question? I’m sorry, I didn’t understand it. (She rubs her hands together, frowns, bites her lip, and looks down at the floor.)
Counselor Response:
Melissa: I don’t like to talk about this stuff. After I talked to the teacher, she told my parents what I said, but she made it sound like I was mad at my dad and mom and that’s not what I meant at all. … (She breaks off, drops her eyes to the floor, and taps her foot nervously against the chair leg.)
Counselor Response:
- Establishing a baseline with regard to Melissa’s symptom of stomachaches in terms of their frequency, intensity, and duration will help you chart her progress in treatment over time.
Generate a list of open-ended and closed questions that will help you obtain more detailed information about her stomachaches using the following prompts. Examples of one open-ended and two closed questions are given for prompt 1.
Prompt 1: Stomachaches at her mom’s house
Example Counselor Response:
What were the stomachaches like the last time you stayed with your mom? How many stomachaches did you have? How long did your first stomachache last?
Prompt 2: Stomachaches at her dad’s house
Counselor Response:
Prompt 3: Stomachaches at school
Counselor Response:
Prompt 4: Times she doesn’t have stomachaches
Counselor Response:
- Melissa has trouble trusting the counselor because, during the custody evaluation, the evaluator told her parents things that made them mad at her. She does not want this to happen again. Use reflective listening in response to Melissa’s comments to help her view you as someone who understands her experience and will be trustworthy. In responding to Melissa, be careful to use simple language that she can easily understand. An example has been provided.
Melissa: I try to help my mom by making sure Jessica behaves. But then mom yells at me and says I’m not the mom. I’m just trying to help!
Example Counselor Response:
You try to help your mom with Jessica but mom just yells at you for helping.
Melissa: The teacher told my parents stuff I said. But she didn’t understand what I really meant. And I didn’t know she was going to tell them, or I wouldn’t have said what I said!
Counselor Response:
Melissa: Everybody keeps asking me where I want to live, with my mom or with my dad. I just want us all to be a family in one house. I don’t like going back and forth, but I can’t choose just one parent all the time and never see the other.
Counselor Response:
Melissa: I have to be so careful what I say, so neither one of them thinks I’m on the other one’s side. Mom asks me about stuff dad says, and dad asks me about stuff that happens at mom’s house, and I don’t want to say anything to make anybody mad.
Counselor Response:
- For each of the following statements from Melissa, respond with an empathic comment that will help deepen her emotional awareness. Use an empathic comment that shows you understand the meaning of her experience, that validates her experience, or that helps her regain emotional control. Use information from Melissa’s profile to guide you in determining what emotions lie underneath the surface of her words. An example has been provided of an empathic comment that underscores the meaning of her experiences.
Melissa: I want my parents to be together. Sometimes at night I can’t sleep because I’m wishing so hard for them to get back together. But then I remember lying awake and listen ing to them fight with each other, and I used to pull the covers over my head and just wish it would stop. I never meant for it to stop like this, though, by them divorcing.
Example Counselor Response: You are torn between wanting your parents to get back together and being afraid of the fighting that happened when they were together. And maybe a little tiny part of you is afraid that somehow by wishing for the fighting to stop, you caused them to divorce?
Melissa: Sometimes I hear my mom and dad yelling at each other on the phone, stuff about getting custody and not letting the other one see us again. And sometimes when my stomach hurts, I get afraid that if something happens to me when I’m at one house, I might never see the other one again. I don’t like saying goodbye to either of them when I go to school. I never thought about stuff like this before.
Counselor Response:
Melissa: When we’re at my dad’s, Jessica sometimes cries for my mom, and I have to comfort her so my dad doesn’t wake up. I don’t want him to feel bad. But I don’t tell my mom when I see her because I don’t want her to worry about Jessica. I just want everybody to be okay.
Counselor Response:
Melissa (after many sessions): It’s weird to see my dad doing laundry and cooking and stuff. His spaghetti is pretty good! And my mom is changing, too. She’s doing a lot of stuff she always let my dad do before. I didn’t know either one of them could change so much. It’s kind of cool, but I wish they could’ve done it without divorcing.
Counselor Response:
- What specifically might you do to enhance your ability to establish an effective working relationship with Melissa?
- What specifically might you do?
- B. Based on what you have read, what are the specific advantages and disadvantages of joint physical custody for Melissa
- Based on Melissa’s profile, what are the advantages and disadvantages of her attending counseling services for herself and what are the advantages and disadvantages of being seen along with her sister Jessica and her parents?
- What confidentiality does Melissa have from her parents?
- Given that there are probably other students dealing with issues related to divorce in your stakeholder community, what are some systemic ways that you might address this concern?
- Tier one:
- Tier Two:
- Tier Three:
- G. Imagine that you are running a small group for children who are affected by divorce. What are some of the signs that you would look for to demonstrate that your group was having a positive impact?
