This article appeared in the Fall 2011 issue of the Erikson on Children newsletter, under the headline “Push me, pull you.” More from this issue

Dropping Megan off at preschool had become a dreaded routine for her mother, Jillian. Both physically and emotionally exhausting, it usually ended with Megan clutching her mother’s legs and sobbing.

Note: To protect the privacy of the family, names have been changed. Photographs do not depict Center clients.

Margret Nickels
Margret Nickels of Erikson’s Center for Children and Families

Megan’s strange behavior leading up to those moments was even more troubling— and eventually led her school to make a referral to Erikson’s Center for Children and Families.

Each morning began pleasantly with Jillian getting Megan settled in her classroom with a book or activity. But things would fall apart when she let Megan know she was leaving. At first Megan would seem okay, but then she would follow Jillian to the door, making odd squeaking noises and kicking her feet side to side. Sometimes she would wildly flap her arms. When they reached the door, Megan would grab her mother’s legs and hang on her.

Gently trying to free herself, Jillian would say, “Megan, you have to let mommy go or she’ll be late for work.”

Megan’s reply would be to let her head loll back with a roaring laugh. Then her laughter turned into a crying jag as she clung tighter. It usually took help from one of her teachers to pry her off, and then she would fall to the floor in absolute hysterics. It could take more than an hour to calm her down.

This routine was puzzling to Megan’s teachers. Overall, she was a good student who loved her art projects, especially coloring the speckles and swirls on butterfly wings. But her interactions with classmates were also problematic.

“You could see her trying to connect,” recalls one of Megan’s teachers. “But she would do it by stealing their crayons.”

At night, Megan would fight getting out of the bathtub by going limp and becoming dead weight. Because Jillian’s husband, Ted, worked nights, it was up to Jillian to heave the girl out of the water, get her dry enough to dress her, and tuck her into bed. And it was the last interaction Jillian would have with her daughter before getting up the next day and rushing off to their morning break-up.

Jillian knew she needed help and not just with Megan’s behavior.

“A certain amount of resentment began to build on both sides,” says Jillian. “I realized we really needed to work on our relationship, because it had come to be defined as a struggle.”

Getting (re)acquainted

“That first session is about getting an understanding of the general situation,” says Margret Nickels, Ph.D., director of Erikson’s Center for Children and Families and a clinical psychologist. “I discuss the main concerns with the parents, their daily routines and struggles, and their goals for therapy.”

Child's artworkIn Megan’s case, the conversation with the parents and Nickels’s subsequent observation of Megan in her classroom led to recommending a comprehensive assessment. On her first visit, Megan saw an occupational therapist and developmental pediatrician. Their priority was to rule out any physiological disorders that might be causing Megan’s outbursts. For example, sensory integration issues could lead her to crave intense physical sensations, or at the opposite end of the spectrum, feel overwhelmed by stimuli in her environment.

But all the evaluations suggested that Megan was a bright and healthy girl. The consensus was that she needed therapy to help her and her parents understand the reasons for Megan’s behavior and what to do about it. Because the mother-daughter relationship was most strained, Jillian and Megan began attending weekly sessions, which Megan called play dates with mom and Dr. Nickels. She quickly began to look forward to them.

Nickels used the first several sessions to simply observe Megan and Jillian’s interactions during play.

“Play is a young child’s most direct communication of her needs, wishes, and hopes,” says Nickels.

Megan was given total freedom in deciding what to play, and bit by bit, she revealed glimpses of her perspective. “Hide the hedgehog” soon emerged as one of Megan’s favorite games. Giving Jillian the mommy hedgehog, Megan would cram the baby into some small space and watch as her mother and Nickels stooped, crawled, and peered to find it.

“It was a way for her to vicariously feel wanted and pursued by her mother, regardless of how insurmountable the wall between them seemed at times,” explains Nickels. “So we dragged out our searches and she would be absolutely delighted.”

Jillian, Ted, and Nickels regularly met to discuss what was happening during sessions and at home. This gave the parents the benefit of Nickels’s explanation of Megan’s behavior, a perspective that helped them better read their daughter’s cues and respond more effectively. They brainstormed solutions to managing Megan’s challenging behaviors while they worked to understand the deeper issues.

“I could see that Megan had a very intense temperament and she expressed it physically,” says Nickels. “I recommended that Jillian enroll her in ballet classes to give her an outlet for her energy and help her develop a sense of control over her body.”

Megan loved her ballet classes, but after being at odds for so long, Jillian and Megan still had an underlying tension between them.

Breakthroughs big and small

Once, after a particularly bad bedtime routine the night before, Megan got upset in session when it was time to clean up and leave. Her initial grumbling flashed into an all-out tantrum. She began throwing pillows across the room with surprising strength for a girl not yet in kindergarten. As the pillows thudded against the walls, Jillian moved to stop her daughter, but a subtle cue from Nickels invited her to wait and see where this was going.

ButterflyMegan screeched at the top of her lungs—a noise that pierced through the center’s offices. When it was over, Nickels encouraged Jillian to gently ask Megan what was wrong. Megan explained that she was angry because she wanted to keep playing with her mother.

“In that moment, mom was just super,” said Nickels. “She put aside her embarrassment and worry for the sake of getting to know her little girl. She listened and acknowledged Megan’s feelings. And rather than just trying to calm her down and quickly move on, she told her it was okay to feel upset. That was really brave.”

At their one-on-one follow-up session, Jillian expressed how enlightening the moment had been. Suddenly, she saw all Megan’s trying behaviors in an entirely new light: her daughter desperately wanted to be closer to her mother and was fighting for it the only way she knew how.

Nickels assured her that the episode was equally important for Megan, because she learned that there was nothing she could do to make her mother leave her or stop loving her.

“Megan had a lot of conflicting thoughts and feelings,” says Nickels. “She wanted to be with her mother, but she was angry with her for not having enough time for her. And the negative responses she received for expressing her upset feelings were only making her feel worse. She was starting to think of herself as a bad person, so getting all that out was tremendously important for her.”

Not every session included such big breakthroughs. Often progress was incremental and required Nickels’s trained eye to see it.

A fresh start

As the months passed, Jillian and Megan formed a stronger bond, and Megan’s behavior became more even-keeled. At that point, Nickels brought up the possibility of ending their sessions.

“Transitioning out of therapy is very important, as relationships says Nickels. “It is important to give everyone time to express their many feelings about this step, feelings of growth and accomplishment, but also of sadness and apprehension. It is yet another opportunity to learn that difficult steps can be mastered and even cherished.”

ButterflyThey agreed to six final play dates. On the last, a favorite blanket from the sessions. Megan gave Nickels a drawing.

“See, it’s an angry face on one side and a happy face on the other side. So, when you feel angry, you know there is also a happy face, and when you’re happy, you know there can also be anger.”

Nickels gushed about the artwork, but secretly felt far more impressed with the young girl’s emotional growth. She had made incredible progress with identifying, accepting, and coping with the whole gamut of her feelings. Now, when it comes time for Jillian to leave Megan at school and go to work, her daughter walks her to the door, gives her a big hug, and then immediately runs back to her friends.

“She’s absolutely amazing,” says Jillian. “She loves her ballet lessons. I think they brought out some athletic ability, because she’s a monkey-bar champion, always finding new ways to climb. And she’s a walking encyclopedia on butterflies.”

Happy to educate her friends, Megan gathers them around her favorite book to point out the different species of butterflies and explain the profound process of metamorphosis.