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The 911 emergency in the psyche of a 12-year-old boy: Understanding OCD in children with CHD

Understanding obsessiveness and compulsiveness in children with CHD: the psychotherapy series



Obsessions are patterns of thoughts that are repetitious in nature and interruptive. Compulsions are patterns of responses to obsessions which can include mental responses and/or physical, behavioral responses. Obsessions and compulsions, as symptoms of underlying emotional suffering and internal conflict, carry emotional meaning that may not be immediately apparent. Understanding and “breaking” an obsessive-compulsive cycle—a cycle appearing fixated and entrenched—requires resolution of the underlying emotional conflict that the cycle maladaptively attempts to deal with. For a child with CHD, unaddressed heart worries can manifest into obsessive compulsive mental and physical activity. In order to resume normal emotional development, a child must be helped to deal with underlying feelings in order to “give up” the dependence on the ritualized patterns providing some degree of stability within the child’s inner, emotional world. This article will explore the issues of obsessiveness and compulsiveness through the use of a case study of a child formulated from a synthesis of clinical experience. The case is written in such a way as to provide you with the case information on the left and the questions, impressions and thoughts on the mind of the child therapist on the right. You might choose to first read the information all the way down on the left side only (cover the right side of the chart), and then return to re-reading the case information and the right side the second-time through. This way, you can sit with the material as you read and have your own ideas before seeing the ones on the right.

The case of Drew*

During the therapy, Drew’s inner, emotional world and fantasy life came alive in the emergent play. It became apparent that Drew was very worried about his heart and that these feelings pervaded virtually every aspect of his developing personality. A few things came to light:

Over the therapy, Drew was able to more fully experience his full range of feelings, including his heart worries, finding the words to express his fears and integrate a new sense that he did not have to be alone with his big feelings—that there was someone he could “join forces” with that could hear, think with and help him make his big feelings smaller.

Over the course of the separate parent sessions, it became apparent that although the parents could speak of Drew’s CHD diagnosis, they had a difficult time with feelings and had a hard time seeing that Drew’s early heart surgery at two-days old and experiences related to his heart were traumatic and had a tremendous impact on Drew. A few things came to light:

While the CHD diagnosis has intentionally remained ambiguous, it did become known through a review of Drew’s medical file that he had an emergency surgery at 2-days old that was required to save his life. Drew also had a traumatic post-surgery experience and almost died when his heart did, in fact, come close to or effectively did, stop beating. With this history, a stroke of insight was had that perhaps Drew’s behavior of running around and checking his pulse was the only way he had of trying to remember what had happened to him. That by acting out the trauma itself within his life, Drew was repeating important elements of his story in action. Drew was calling out, like one does when calling 911 in an emergency, for someone to take notice, respond and help him to find the words for and make sense of his own story. Having experienced Drew’s parents as hard to reach given their anxieties and cancellation efforts, the therapist may have gotten a taste of what Drew had been experiencing throughout the past 12 years—parents that had incredible difficulty noticing and responding to that proverbial “911 call”. By joining forces with a child therapist, healing from and finding meaning in trauma is possible for children with CHD and their parents. Even when difficulties have felt too painful, insurmountable or confusing to understand, there is a way to break the cycles of dysfunction and restore a path to normal development and connection.

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