More Thoughts on Talk Therapy

April 21, 2011 Angela McClanahan

It seems Bob has officially won this round of "Stump the Therapist."

She admitted today she isn't quite sure what to do with him at this point; that she can't determine how much of his problem stems from impulse control issues, and how much is just an "I don't give a s**t" attitude.

I think it's about fifty-fifty. My husband agrees, and thinks Bob would do well if we could manage to get at least one of those factors under control. The problem is, impulsivity is the nature of this beast, and I have no idea how to make someone give a s**t. I've been trying to figure that one out for the past eight years or more.
As you are already aware if you listen to my audio posts, Bob had his worst rage episode of the last two years Thursday afternoon. Bad enough to earn him a two-day suspension from school (though I still don't really know if that was for his benefit or the school staff's). Bad enough to scare the bejeezus out of the principal and the office secretaries. Bad enough that hearing about it made me cry at work, which I haven't done in almost a year.

To add injury to insult, he's added self-abusive behavior to his repertoire. I've noticed a few times, when he's gotten in trouble at home, he will smack himself in the head. I've always chalked it up to a genetic predisposition to melodrama and told him to stop (and he does). But Thursday, he started banging his forehead against a desk in the principal's office--hard enough that she was concerned he might give himself a concussion. Fortunately, there wasn't even a bruise left behind--but this new addition to his rages freaks me out.

I think it's probably safe to say the lithium and Seroquel combination he's been on for two years now is losing steam. But (believe it or not), things haven't gotten bad enough for me to call his psychiatrist and say, "sure, let's go ahead and completely switch up his medications."

How bad do they have to get? Certainly I don't want him to spiral so far out of control that I have to physically restrain him on a regular basis to keep him from injuring himself or someone else. But one meltdown every week, week and a half--I can't bring myself to completely pull the rug out from under him for that.

There are seven weeks of school left. Forty-three days, counting weekends. Hopefully he can make it just that much longer.

APA Reference
McClanahan, A. (2011, April 21). More Thoughts on Talk Therapy, HealthyPlace. Retrieved on 2024, February 26 from

Author: Angela McClanahan

July, 11 2011 at 12:03 pm

It's really hard to give a sh*t when one is as drugged as Bob is, and it's also damn near impossible to control one's impulses when one's frontal lobe activity is being chemically altered. Do you know what the frontal lobes do, ma'am? That's executive function. As for his new self-injurious behavior...that can happen when a person is so drugged beyond normal feeling that they need to feel something to know they are real. I suggest you sample some of Bob's "meds" and see how torturous these drugs are from the inside. You probably don't even know the real Bob at this point, ans neither will he. There are other ways, Angela, ways that don't involve poisoning your child. There's probably not a damn thing wrong with Bob. Stop trying to cram him into the narrow little space our society makes for people. It doesn't work.

In reply to by Anonymous (not verified)

Angela McClanahan
July, 12 2011 at 2:50 am

"There’s probably not a damn thing wrong with Bob. Stop trying to cram him into the narrow little space our society makes for people."
You're right, Ken. I should stop trying to cram him into the "narrow little space our society makes for people." And the next time he beats up a kid for making "annoying noises," I'll explain to his school principal he was merely "expressing himself." And when he steals the principal's cell phone off her desk and then tells another teacher he "found it," I'll tell the administrators he is simply "spirited." And when he attacks another child with his belt in the restroom for no apparent reason at all, I'll tell that child's parents he is just "reacting to stress in a different way." And before I know it, he'll be crammed into an entirely different narrow little space our society makes for people--a prison cell.

Angela McClanahan
April, 28 2011 at 8:43 am

@bonbon, are we raising the same child? They certainly sound very similar. I feel for you (with you?), believe me. And no, it doesn't make it any easier that it's "episodic," because you feel like you've maybe, just maybe, gotten over the hump and then there you are again. I can't stand thinking Bob will have to endure this cycle for the rest of his life.
We did try Zyprexa before lithium, it didn't really do anything. He takes clonidine now; he took Tenex for several years dating way back to age 3 (useless). Focalin is about all he's been able to tolerate that makes any difference.

April, 28 2011 at 5:03 am

My son just got out of the hospital last week. It's still a bit up and down. He has the same kinds of behaviors that your son does. My son has issues generally twice a year spring and fall. Spring brings the raging mixed episodes and any chance of hospitalization and fall brings anxiety. His baseline behavior is not at all demonstrative or manipulative. He is very disorganized (ADD), but congenial and happy and well-behaved, and I enjoy his company.
You'd think his episodic pattern of behavior would make dealing with the challenging behavior, easier, but it doesn't because there's just no break from it. It consumes my life and I only have about a month's worth of stamina.
I did want to add that Zyprexa has made a difference for us (5mg at night). Also, have you tried Tenex or Clonidine for the ADHD instead of stimulants?
Best wishes

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