Sunday, February 27, 2011

Creativity

Avey certainly has the creative gene. She seems able to turn just about anything into a toy. For example, a couple of weeks ago she and I found a marble while we were out on a walk. She held on to it, and during a meal grabbed some clothespins and began to carry on a dialogue between the clothespins and the marble. I offered to put faces on the clothespins, which excited her. She chose the colors and the kinds of faces. Here are "[left to right] Marble, Frown Red, Silly Black, and Happy Blue."

At most meals these days, she will pick up her new toys and begin enacting a scenario. From what I've gathered, it usually follows the same pattern; Marble will roll away from the group, often toppling onto the carpet from the table, which is why Frown Red is sad. She and Marble apparently have a close relationship, and Marble's unexpected departure lunges Frown Red into a melancholy. Luckily, however, Happy Blue and Silly Black empathize with Frown Red's plight, and they comfort her until Marble returns (with the assistance of yours truly).

Avey has enjoyed her new toys so much that we've even made efforts to improve their images:
If this pattern persists, we won't need a Christmas or birthday budget of more than a few cents!

Avey has felt much better for the past week - thank you all for your sympathy. Unfortunately, I'm down with something right now, and it's no fun at all. It's not affecting my tummy, but I sure don't feel like doing anything. Avey's been a very helpful aide to me, providing unlimited hugs and kisses, so I should be on the mend soon. Kira's been kindly attending to me as well, although she's got some weird ideas about chocolate chip cookies not being the cure-all.

Sunday, February 20, 2011

Ms. "R"

DATA: Client is a 3 year old Caucasian female, self-referred to clinic, with a chief complaint of what she described as "my tummy is not happy." Ms. R declined to elaborate upon further inquiry, but instead sucked her left thumb and leaned her head upon the co-therapist. From this point on, she responded only to close-ended questions. The interviewer was able to gather that Ms. R did not feel physically well at the time of the interview, and that she did not want to use the "potty." The co-therapist offered Ms. R some refreshment, and several minutes later, Ms. R vocalized discomfort, placed a hand at her midsection, and vomited. She reacted with crying, and requested to be embraced by the co-therapist, which was permitted. After she was composed, Ms. R spent the remainder of the session lying on the couch, sucking her thumb, and watching videos of talking/singing puppets. Later in the day, Ms. R was found passed out asleep on her kitchen floor. Upon waking she was unable to recall how long she had slept, but witnesses estimate that she was unconscious for approximately 2 hours (see below).
ASSESSMENT: Ms. R was alert and oriented to person and place at the time of the interview, but was unable to estimate the time of day, month, year, and could not name the current or any former president of the United States. She was unable to describe her mood, but appeared dysthymic. A review of her file revealed that she has slept approximately 11 to 12 hours nightly for the last year. She denied a history of substance abuse or head trauma, and stated that she had never been treated for mental health issues previously, although her file indicates that she has been prescribed hugs and kisses daily for various psychological symptoms. There is even documentation that she has been placed in timeout for inappropriate behavior. No criminal history is noted. Her speech was staggered, eye contact was appropriate, and her thought process was fixated (on her "unhappy tummy"). Thought content was concrete, though peppered with anthropomorphic statements, usually applying emotional characteristics to some section of her bowels. She denied symptoms of psychosis, however, considering her disoriented state, her staggered speech, practice of thumb sucking, and ascribing human characteristics to non-human things, psychosis cannot be ruled out as of yet.

Possible diagnoses at this time include (a) traumatic brain injury, (b) drug induced psychosis - perhaps explaining the vomiting as well, (c) other psychotic disorders, (d) somatoform disorder with vomiting resulting from internalizing outside stressors - perhaps work or personal relationship struggles, or (e) being 3 years old and sick.

PLAN:
  1. Build therapeutic and parental rapport throughout indefinite remaining sessions.
  2. Encourage use of client's "words" to describe her emotional/physical discomfort.
  3. Encourage periodic intakes of low impact, nutritious foods until vomiting behavior subsides.
  4. Encourage napping as needed.
  5. Cuddle client when requested.
  6. Cuddle client when not requested.
  7. Kiss client's soft little cheeks until therapists' lips are chapped and sore.

Sunday, February 13, 2011

In Real Life

For a few weeks now, Avey has been picking up on some of the subtle idioms and figures of speech we use. For example, lately she begins many of her questions with "In real life..." She might say something like, "Dad, in real life, do we eat vegetables?" It's been funny to hear her ask questions as if most of the rest of her day is imaginary.

Here she is, apparently pretending that her own face is a canvas:
For another example, the other day during dinner, she requested that I ask her "animal questions." So I asked her what kind of animal Snow White thought the logs were in a certain scene of the movie. After we established that they were alligators, Avey gave an empathetic expression and said, "And those alligators were sad because they couldn't eat her." I suppose that if the logs had been alligators, and the movie had not been a cartoon, and the story had been historical, the alligators may have, in fact, been disappointed to have lost a meal. Forgive me, but I find it hilarious that Avey puts herself in the head of a cartoon princesses' hysterical hallucination. And on top of it, she feels bad for its insatiable craving for human flesh. Don't get me wrong, she's on Snow White's side, but isn't it cute that she wants everybody to be happy?

Sunday, February 6, 2011

Floaters

We had an interesting day yesterday. We have local hot springs that we've wanted to visit for some time now (basically since we moved), and we finally made time to do so yesterday. We had taken Avey to some hot springs in Idaho a couple of years ago, and she absolutely loved it, but it had been so long and she loves to swim so much that we figured we should make the trip. Not to mention we have all been quite stressed of late, what with my job, Avey's potty training, and Kira's work and church responsibilities.
It turned out to be something quite new to all of us. You'll notice the title of the post. Luckily, I'm not referring to any accidents that Avey had - she did very well. That title refers to our fellow patrons. If you look on the spring's website, you may notice that suits are optional on Saturdays. We were a bit hesitant because of that, but decided that it probably wouldn't really be much of an issue, or we could avert our eyes anyway. Well, let me just sum it up by saying I saw more flesh yesterday than I care to recall. And not because it was that many people - it was a handful of very large people. I'm not sure why we had to pay to get in - enduring those sights bordered on torturous.

We, of course, opted to bathe clothed, and were in the minority, so we wondered if the others thought we were squares. Luckily, after a few minutes another younger couple came with their small child, and they were all clothed too.

On the whole, it was enjoyable and relaxing. Avey had a blast and didn't even seem to notice that the other people forgot their suits. I guess we dodged that traumatic experience but maybe we'll go when it's darker next time.