The girl looked very young but there was something about her that chilled me to the bone. She was somewhat smaller than the average ten-year-old child. So at first, I thought she might be younger. She had dark circles under her eyes. Everything about her exuded anger and sadness and defeat. Her shoulders were hunched. Her lips were pursed tightly. She shuffled into my office. She had an expression that looked both defiant and defeated at the same time. It was clear that here was an extremely unhappy young girl. 

I stepped forward and took her hand in mine. Her hand was warm to the touch. Unlike her stare which was cold. “Shall we go into my office and have a seat?”

She walked into my office and looked around and said, “so you’re a doctor. But what kind of doctor are you? Your office doesn’t look anything like my regular doctor’s office where I usually go for a check-up.”

I was somewhat taken aback by her demeanor and the maturity of her question. “Amelia please take a seat. Well, Amelia, your mother has explained to me that you are having a hard time adjusting to school. Is that true? Are you having a hard time getting used to being in school and making friends?”

Amelia looks up at me and then over at the chair and she says, “I ‘d rather stand.”

I responded, “please take a seat, Amelia.”

She glared at me. Are you were having some difficulty adjusting to school? What do you think is the problem?”

“I don’t have a problem. The other kids are annoying. They make too much noise. It’s hard to hear the teacher. They can’t seem to sit quietly in their seats. They interrupt the teacher. One kid is always raising his hand to ask stupid questions that have nothing to do with what the teacher is talking about.”

“So this kind of behavior makes you feel mad. Is that correct?”

“Yes, of course, it makes me angry. What did you think? Wouldn’t it make you angry if your patients kept interrupting you while you were talking?”

“Well, Amelia, sometimes people have to ask questions when they don’t understand what is being said? Or sometimes they ask questions out of curiosity.”

Amelia stared straight into my eyes. And I could tell she was now angry at me because I offered an alternate reason than what she said. In fact, it seemed as if Amelia was having difficulty dealing with authority if they didn’t agree with her point of view. She seemed to have little patience for the less advanced students in her class.

“Amelia, tell me how you feel right now.”

“I feel mad.”

“And what do you want to do when you’re angry?”

“I want to tell you to shut up. I don’t want to talk to you.”

“What happens in your classroom when one of the other students disagrees with you?”

“I get really mad. I want to hit them. Usually, I just sit there and don’t say anything else. And then later if we are out in the schoolyard. I go over and tell them they need to shut up. If they say anything else I hit them or pinch them or kick them in the leg.”

“And then what happens?”

“My teacher or an aid comes over and takes me to the principal’s office and I get in trouble. They call one of my parents and they have to come to the school and take me home. This last time they told my mother I couldn’t come back to school for a week or until she took me to the doctor. I guess that’s why I’m here talking to you since you’re not a real doctor.”

“There are different kinds of doctors Amelia. I am a doctor that treats children and adolescents and sometimes families that are having difficulty functioning in school and at home sometimes. I talk to them and they tell me how they are feeling and what’s going on in their lives. What kinds of things are happening in your life Amelia outside of school? Can you tell me what are things like at home?”

Amelia glares at the doctor. And if looks could kill, he would be dead on the floor just from her look of hate and resentment. “Amelia I know it’s difficult to talk about things that are happening that you have no control over. Can you please try and tell me? I promise that this is just between me and you. And that I will find a way to make things better for you, at school and at home. Do you think you can trust me?”

“No, why should I? No one ever tells me the truth? When I ask my mom or dad if everything is OK they always say, yes. But then later at night, I can hear them yelling at one another. So, I know they’re lying to me. How can I trust someone that lies to me?”

“Amelia, I can understand why you don’t trust them. But they probably think they are protecting you by not telling you the whole truth. Perhaps it would help if your parents came in with you the next time you come to see me. And then you can all try to talk to each other about what is really going on. What do you think?”

“I don’t know, maybe.”

“Amelia, let’s make a deal shall we? Can you promise to try to behave in the classroom if I can have your parents come in with you on your next visit to talk about everything that is happening in your family?”

“I don’t know. They might both get angry at me for telling you what is happening at home.”

“Well, it’s true. They might get mad at first. But maybe after they come here and you all talk together, things will improve at home. We can create a plan to deal with stress and learn how to discuss things without fighting. What do you think? Don’t you think if things at home got better you wouldn’t feel so upset at school all the time?”

Amelia looked at me and nodded her head up and down. And a tear rolled down her cheek and down her chin. “OK Amelia, I’m going to ask you to go sit in the waiting room while I call your mother in and I have a little conversation with her. Don’t worry she won’t be mad at you. She wants things to get better for you. Or she wouldn’t have brought you here to talk to me.”

Amelia looked at me and I could see a glimmer of hope come into her eyes as she nodded her head up and down. The next time Amelia had an appointment her parents came in with her. I spoke to her parents first. They both related how much they loved Amelia but that she could be a difficult child. Because she was so moody. They also admitted that as a couple they had their own difficulties.

Their problems were complex and would take a long time to overcome but I believed it was possible. We discussed different tactics they might try to resolve their issues. This included couple’s therapy. They also related that there were financial problems that evolved over several years. When one of them had to stay at home with Amelia before she was old enough to attend school. And they couldn’t afford child care and didn’t have family who could care for Amelia while they worked.

I gave them a name of a family financial advisor who would help them set up a budget and they could start paying off some of their long-standing bills including credit card debt. They had only been paying the minimum payment each month and their debt would never be resolved. They blamed each other for the debt. But in reality, they both used credit cards whenever they ran short of money.

The next time I saw Amelia she seemed less stressed and less angry. “How are things at home Amelia?”

“I guess it is getting better. My parents aren’t fighting as much. And my mother found a job that pays more and my dad was able to change from his night shift job to day time. So they see each other more. They still have arguments, but not every day and they aren’t screaming anymore. They are trying to talk to each other when they are not tired.”

“And how are you doing in school?”

“Well, I haven’t gotten in trouble since the last time I saw you. I still don’t have any friends. I don’t know how to make friends. I don’t think anyone likes me. I’m trying to do all my school work. But sometimes I need help because I don’t know how to do the math or spell.”

“Alright Amelia, it seems like things are getting better. And that is great. I know that you are doing your best. I believe I will talk to your teachers and your parent about getting a tutor to help you catch up with your work. Especially the subjects you struggle with like math and spelling. What do you think?”

“OK, but I don’t want any of the kids to know how stupid I am. I don’t want them to know I have to have a tutor. They will make fun of me. They hate me.”

“No one will know about the tutors except your parents and teachers. And they are not allowed to tell anyone else about it. Does that make you feel better? And finally, I want you to know that the other kids don’t hate you. But it will take time for you to make friends with the kids in school. Why don’t you find one kid who doesn’t have any friends and talk to them.”

“Well, there is one girl who just started going to school there. She doesn’t know anyone yet, maybe I could try being friends with her. Her name is Samantha. She came from another state. Her father is in the military and they have to move around a lot,”

“That seems like an excellent idea, Amelia. I’m so proud of how well you’re doing. Keep up the good work. Can you ask your mother to come in? I would like to talk to her for a few minutes before you go?”

“OK, bye Doctor Freedman. See you next time.”

“Good morning. how are you? Amelia seems to be doing much better in school and she is being cooperative with her treatment. She has agreed to have a tutor to help with her school work. I think once she starts doing better in school her negative feelings about herself will start to resolve. She is a bright young lady but she has low self-esteem and she believes all the kids hate her.”

“I know doctor, but her behavior has improved immensely and she is being more cooperative in school. Her grades are going up a little. I have been trying to help her with her homework and studying. I think a tutor would be a big help. Thank you for arranging for that.”

“You’re welcome. How are you and your husband doing?”

“Since we are on a budget now. We are slowly getting the bills paid and even some of the credit card debt. My boss says that my performance at work has improved and he is considering giving me a better job and a raise. So now my husband and I are not so stressed out about money and we rarely have arguments at all. We try to discuss things calmly instead of yelling at each other.”

“I have to say I am impressed by how much progress you have all made. I think if things continue in the direction you are going Amelia will not have to come here to speak to me as often. Perhaps you will only need to come once a month for the next six months. And then maybe every six months unless she develops some new issue she needs to talk about.”

“Really doctor, that’s wonderful. I can’t thank you enough. Amelia is like a new girl. She hasn’t gotten in trouble at school for weeks, she is doing her homework. And best of all she doesn’t seem so sad and angry anymore.”

“I’m so happy to hear that. I want you to know that if any problems arise that you need to discuss please feel free to contact me at any time. Please tell your husband that he can call me at any time as well. Take care until I see you next time.”

“Thank you doctor for all you’ve done.”

“You’re welcome, but the fact is that you and your husband and Amelia love each other and did all the hard work yourselves. But I was so happy to help you in whatever way I was able to. Take care. I’ll see you soon.

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