> Sanja Stefanovic is a Child and Adolescent Counsellor at STARTTS.

Background

Jamal, an 11 year old Iraqi boy, was referred to STARTTS by his school counsellor. Jamal presented with disruptive behaviour and anxiety difficulties at school. The school reported he would often run away from school and go home to his mother – when he felt unsafe because of playground fights, or when he became anxious about his school performance. Jamal’s mother reported that he gets overly worried if she is not around (for example, if she goes grocery shopping). On two occasions when this happened, Jamal took mum’s blood pressure tablets and drank dad’s wine. His misbehaviour upset mum, and this in turn made Jamal extremely sad and worried about her.

When asked about Jamal as a baby, mother noted that Jamal was born prematurely - she had a difficult pregnancy and almost miscarried. As an infant - the first boy in the family - Jamal was very small, would cling to mum, and had difficulties settling. When he was 3 years old, Jamal had an operation to remove one of his kidneys, and after this Jamal became very fearful of doctors. When he was 8 years old, and still in Iraq, Jamal’s mother and other relatives were kidnapped by a gang and held for ransom for a week. Eventually being released, the family fled to Jordan and spent 3 years there. They arrived in Australia this year as refugees.

Intervention

In therapy, Jamal presents as an intelligent and self-aware boy who enjoys being challenged and demonstrating his capacity. He likes art (drawing and writing) and is a good soccer player. Counselling initially focused on CBT work: helping Jamal recognise his emotions and thoughts, linking these to behaviour, and learning how to challenge irrational thoughts. Assisting Jamal not to feel over-responsible for his mother’s safety and wellbeing was a focus. Initially, he gave a rating of 10 (the maximum possible) to his feelings of sadness and anxiety when mum was away. As therapy progressed, his distress reduced and he was better able through the counselling relationship to manage being separated from mum.

In turn, Jamal’s mother was given strategies to help her provide a more structured home environment for her son. Issues such as setting limits and implementing rules were shared. An objective here was to develop her capacity to be a containing influence (not to be overwhelmed by Jamal’s anxiety). The mother was also receiving individual support from another STARTTS counsellor.

3 key learnings

The STARTTS counsellor learned the following through this case:

• Insecure attachment can predispose children to react more sensitively to later trauma.
• The importance of working with parents, and the need for sensitive psychoeducation about children’s need for parents to contain their distress – the significance of being held physically and in mind.
• Cognitive interventions can be an effective therapeutic approach, even with primary school-aged children.

> Sanja Stefanovic
Sanja is a Child and Adolescent Counsellor at STARTTS. She completed psychology studies in her native Croatia, where she worked with family and young people in a family community centre.