Jarod is a 14-year-old Caucasian male who was brought for therapy a week after he had attempted suicide. Jarod swallowed a bottle and a half of aspirin and then drank a large amount of prescribed histamine liquid. Based on the reports of Jarod, his mother, and the attending physician in the emergency room, Jarod had attempted to hurt himself following a heated argument with his mom, consuming the substances in her view. Jarod’s mom and the emergency room physician concluded that the suicide attempt was not a serious attempt at fatal self harm, given the spontaneous nature and the methods used. However, they felt that Jarod required counseling to deal with his depression and increasing anti-social tendencies. I saw Jarod for therapy sessions at the medical school outpatient clinic where I work as a graduate intern. At our first appointment, Jarod was slouched in his chair in the waiting room. He was dressed appropriately for his age, in baggy jeans, a black T-shirt, and heavy black boots. His hair was cut short, and it was apparent that he hadn’t bathed in the last few days. His affect was flat as I approached him, and then it changed to more of a smirk or a grimace as I called his name. He walked slowly back to the office and then assumed the same slouched posture on the office sofa. This behavior was not that unexpected for a reluctant teenage client being forced by a parent to come for therapy. However, what was unique about Jarod’s behavior during that first interview was his stare. He fixed his eyes on mine and remained fixed on my face without saying a word.
Given this initial posture, I was actually surprised by his relative openness to discussing the events of the past week that had compelled his mother to demand counseling for him. It became apparent as he began to disclose various pieces of his life’s puzzle that, even though he would not admit it, he was grateful to finally have somebody to talk to about what was going on inside him, and that his stare was an attempt to scan me and this environment to determine if I could be trusted.
At the conclusion of this first session, one of the psychiatry residents assessed Jarod and decided to start him on a trial of anti-depressant medication. Jarod reported that his taking of the aspirin and the histamines was merely a gesture to worry his mother and make his point following their volatile verbal argument. After a bit of probing, he shared that his overall point was that he didn’t need her, his father, or anybody else. As mentioned above, those around him had decided that he was struggling with a form of depression. Over the next few sessions, it was discovered that this diagnosis was due more to a collection of specific events that had occurred in Jarod’s life, than to his specific behavior. He was in his third middle school in two years, the three guys he considered his best and only friends in the world had moved away one by one over this time period, his parents had decided to split up, and though he had intelligence scores that placed him in the genius range compared to his same age peers, he was flunking out of school due to his unexcused absences. After these initial sessions, it appeared that Jarod’s real issues did not revolve around a clinical depression as much as a deep seeded anger. Those around him perceived his depressed mood and isolative behavior as depression and considered his displays of anger as simply co-morbid features, or a manifestation of his depression. I learned however, that Jarod did not display many of the standard criteria for a diagnosis of depression. For instance, he did not present with day long fatigue, or a diminished interest in pleasurable activities, or overwhelming feelings of worthlessness.
Rather than withdraw to his bedroom and sit depressed in a darkened room (as his mother thought he did), he would find pleasure in rebuilding bicycles. Instead of displaying an inability to concentrate or focus, he would spend hours at the computer calculating over his auction bids on the Internet. Rather than feeling worthless, Jarod simply felt left out. His outbursts of anger were not necessarily symptoms of his depression, but rather, demonstrations that he in fact maintained the energy and concern about his situation to actively respond to his perceived threats in the only way he knew—through the aggression that resulted from his inner anger. Dr. Gary Oliver and Norm Wright discuss the emotions of hurt, frustration, and fear as the variables that, if left unchecked, contribute most significantly to damaging anger.1 A brief review of Jarod’s recent history revealed how each of those variables of hurt, frustration, and fear of more future pains had gone unexamined in his life and left him with an unhealthy anger. He was much like a wounded animal that corners itself in a tight space and then lashes out at anyone attempting to help. His anger had left him unable to trust anyone. And the more we focused on these primary issues of his hurt, frustration, and fear, the more he reacted with the only emotion he felt safe with at that time—anger.
Through my sessions with Jarod, I was challenged by and reminded of the drawbacks of working with a client in a non-Christian setting. For instance, even though Jarod and I were able to discuss on an intellectual level the secondary nature of the anger he felt and the specific primary reasons for this anger, his reinforced and concrete sense of being alone and unable to really trust someone left therapy limited from progressing to the next level of his emotions. I know that a Christian therapist working in a secular setting doesn’t necessarily need to be verbally specific in communicating godly principles to clients, however, I believe that with Jarod it would have been helpful in many ways. For instance, the freedom to share Christ’s love, commitment, and devotion for him, as well as Jesus’ ultimate trustworthiness, would have provided him with the hope and perhaps curiosity to allow therapy to move to the next level. Also if I’d seen him in a Christian setting, with Christ as a focal point of the therapy, I believe I would have been able to get his family members to join in his treatment. This would have provided us with the chance to point out the particular issues that led to Jarod’s angry behavior, and substantial efforts could have been made to see healing of much of the hurt, frustration, and fear with which he was wrestling. After our sixth session together, Jarod and his mom had begun to experience his desired mood changes produced by the medication trial. Mom reported that he wasn’t as moody and that the fights around the house had decreased greatly. I told her that I was glad to hear about the improved behavior, but that the medication’s effect might be masking his real issues surrounding his inner anger. Regardless, it became apparent that she was satisfied with the results of the medication, and she had Jarod’s pediatrician write his next prescription.
Since then, Jarod’s visits to the clinic have become more and more infrequent, and I was instructed by supervisors to terminate his case due to noncompliance. This has been another difficult lesson to learn regarding treating kids in a secular clinic. Though I believe medication, when prescribed and monitored appropriately, is a vital and useful tool in overall mental health, patients (and parents of patients) are often more interested in the “quick fix” provided by the medication. Jarod is an example of this. The hurt, frustration, and fear that led to his anger were never adequately addressed in our therapeutic relationship, and will likely continue to control him…and he will likely continue to be misunderstood.
Kenneth B. Jones, M.Div., M.A., is an ordained Presbyterian minister, finishing his Ph.D. in clinical psychology while completing his graduate internship at the psychology consortium at the University of Tennessee (Memphis) college of medicine, department of psychiatry. Endnote The more we focused on these primary issues of his hurt, frustration, and fear, the more he reacted with the only emotion he felt safe with at that time—anger.
