Three-year-old Harry’s pediatrician referred him to my behavioral pediatrics practices with the chief complaint that “he whines too much.” In our first visit I learned a complex story that gave multilayered meaning to his behavior. His mother Lisa arrived at the visits alone despite my invitation for his father Adam to join us. She described her husband as “very traditional,” leaving all the running of the family to her. Yet Harry’s sensitive nature especially bothered Adam, who and was easily provoked to anger by his son’s crying.
Lisa described Harry as having a ‘temperamentally low frustration tolerance.” As a young infant he shifted rapidly from an all-out cry to sound sleep in an unpredictable pattern. His high reactivity to many different sensations, including loud sounds, made family outings a challenge. Harry’s expressive language delay added to his behavioral difficulties as he lacked the words to communicate his needs and to express his feelings. When I invited Lisa to elaborate, she told me that Harry’s birth marked the one-year-anniversary of Adam’s brother’s death in a fire. Lisa remarked that Adam had never mourned this loss. She wondered if Harry’s close resemblance to his uncle contributed to the ease with which Harry provoked his father’s wrath.
As the story unfolded I could see the complexity of the meaning of his behavior emerge. Contributing factors included his sensitive nature, his father’s markedly different temperament, and the unmourned loss. I soon learned the meanings Lisa made of Harry’s whining. She blamed herself, willingly taking up the role of responsibility given to her by her husband. “I’m a bad mother,” she told me. We had the opportunity to shift these meanings when in the open space of my office they played out in real time. The hour-long visits allowed us to slow down and observe.
In our second session, while Lisa filled me in on the past week’s struggles around mealtime and bedtime, Harry played calmly and quietly with the wooden train set. At one point the trains got stuck on the connection between the two tracks. Harry expressed a small sound of frustration. Immediately his mother swooped in next to him on the floor to try to fix the problem. Harry’s distress quickly escalated as Lisa made increasingly desperate efforts to distract him and to stop his whining. His play became very disorganized as he abandoned the train set, jumping from toy to toy with increasing agitation.
“Is this what you’re talking about?” I asked. Lisa broke from her intense focus on Harry to look directly at me. I felt that I was in a kind of “transitional space” between her intentions and Harry’s intentions; the separate and different meanings each made of the moment. “What’s happening?” I asked her. “I feel helpless. I’m not a good mother” Following a brief silence she added, “The more helpless I feel, the worse he behaves.” I wondered if there might be any other way to understand his behavior. I noticed that her interpretation led her to feel so bad that she could not tolerate his feelings. She needed to fix the problem in order to assuage her own emotional distress. But her very act of trying to stop the frustration seemed to aggravate the situation. “Perhaps” I suggested,” he wants to fix the train himself?”
As Lisa considered this idea, the intensity of Harry’s distress abated, and he returned to the train set. But still he seemed unsettled, almost as if he wanted to communicate, “there’s more to the story.” Finally he climbed up on the couch next to his mother and began to sob. This cry had a distinctly different quality from his whining. As Lisa held him tightly they both became calm. “Maybe he just needs to feel sad,” his mother said.
In my years of practice it never ceases to amaze me how effectively young children can communicate the source of a problem through their behavior. Of course Harry did not know or understand the role of unmourned loss in his parents lives and in their relationships. But he absorbed the distress and “acted out” as if to say, “I need you to deal with this so you can see me as myself.”
To address the full complexity of the problem, we would need to bring Adam into the work. But at the moment, he felt inaccessible to Lisa. The most we could do was to help her reclaim her sense of competence so she could begin to advocate for Harry and for herself. She offered her own solution to the whining. ” When he does that I need to tell myself, “You’re a good mother. No one ever tells me that.” “Yes,” I replied. I noted the time and attention she had devoted to listening to her son and making sense of his behavior. “You are a good mother.”
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