Содержание материала

I. Y. Mitoukhlayeva

Orphans are a peculiar category of children. They lost the conditions necessary to the development of harmonious personalities due to different reasons. They did not have examples of normal relations within the family and society and they have difficulties in building connections with other people, become-help- less in everyday life situations. They are lonely among people because there is nobody who loves them just because they exist and close relatives.
Such children especially need psychotherapeutic assistance. Open dialogue can be used in such situations too. It is quite effective in a number of cases. Here are some clinical examples.
Victor A.
He was admitted to the Psychiatric Department because he showed poor progress at school, ran away from the boarding school, unbalanced character, and persistent enuresis.
History of life and case
His parents were divorced. Mother abused alcohol and was deprived of the parent rights. His father lives separately and worked at the
railway station The boy loved his father and was set against his mother. Before they divorced the parents had many quarrels. He was the first child in the family, his weight was 2850 g. when he was bom During one year his psychophysical development was normal. He had measles, scabies, otitis, sinusitis, chickenpox When the mother was deprived of the parent rights the boy was placed into a municipal institution. He lived in one of the boarding schools and studies at the secondary school. The caregiver of the boarding school reported that he had many quarrels with one caregiver, after quarrels ran away. He was touchy and had changeable mood. He showed poor progress in the secondary school because he missed lessons. He had had enuresis since the time when he was 3
Psychic status
He stayed at the Psychiatric Department quietly He talked eagerly and answered questions correctly. He thought that enuresis, quarrels with the caregiver and teacher were the reasons why he was placed in the hospital. He thought that his unbalanced character, his wish to live at home with mother and father were the reasons for the quarrels. He had a good orientation in the environment and on his personality. He knew the multiplication table, could divide and multiply numbers. He made many spelling mistakes.
We gave the diagnosis on the grounds of the history of life and disease, complaints, examination and observation adaptation-adjusting reactions with prevalence of disorders in behaviour Neurosis like persistent enuresis on the background of minimal brain disfunction.
Besides treatment with medicaments and special pedagogic we used open dialogue. Two times we invited the caregiver and teacher the boy had conflicts with to open dialogue meetings Victor’s father, a pedagogue from our Department and Victor’s new friend also came to the first meeting.
During the first half an hour Victor was reserved and shy. He sat near his father, did not trust the caregiver and teacher of the boarding school Psychotherapist started talking. He told the people present at the meeting about the purposes of the meeting, about the wish to help the boy to solve his problems in communicating with people Psychotherapist praised Victor for his progress at the Department, his help to the personnel in taking care of small and weak children, his friendly support to his new friend. Victor smiled weakly several times and remained tense. The presence of the people who had hurt his feelings disturbed him The caregiver of the boarding school said that she was pleased to learn so many positive things about Victor The teacher kept silence so far.
Then Victor’s father spoke He remembered how he and his son went fishing in winter, how Victor was happy when caught fishes, how his son took care of his favourite dog that lived in their family before the parents divorced. Victor showed excitement, flashed, said in a quiet voice that he remembered that. The caregiver also told how Victor took care of the dog that lived at the Department. The teacher of our Department spoke about Victor’s studies. Victor had the capacity for a good progress, but his hot-tempered character interfered with him However she said that in the treatment period the boy controlled himself. Then the teacher from the boarding school spoke. He said that he was glad to come to the meeting and he learnt a lot of good things about Victor, that he and Victor had unpleasant quarrels, however he hoped that after that meeting everything would be changed and the boy would realize his mistakes and he himself would change his attitude to Victor Everybody agreed that the boy had so many positive characteristic features. The caregiver of the Department confirmed that Victor had a very good quality, he loved animals and never forgot to give food to the newly bom puppies. After those words Victor started telling everybody what names he wanted to give to the puppies and said that he wanted to get back to the boarding school. And open dialogue was over on that day.
The teacher from the boarding school, caregiver of our Department and Victor’s doctor psychotherapist were present at the second meeting. The caregiver was the first to speak. She said that Victor quarrels and argues with children at the Department sometimes. Victor did not refuse that he had quarrels because some children call him bad names The psychotherapist tried to explain Victor that those names were not bad but funny and nice and were connected with Victor’s unusual family name
The teacher also remembered that Victor’s feelings were hurt in the same situations The teacher did not think that the names were offensive and they were not worth to be upset about Victor agreed with the teacher and doctor Then he asked his teacher how children in his class were getting on and asked to give them his regards The teacher promised to do that Victor smiled, sat closer to the teacher and asked his doctor when he could leave the hospital
After open dialogue Victor behaved himself, he had a bad mood only on Fridays when other children were taken home for the weekend The boy studied well, learnt the missed material, received only good marks He became softer when communicating with grown-ups and children. When he left the hospital he behaved himself at the boarding school and was never brought to the Department again
Vladimir Yu.
He was placed to the Children Psychiatric Department because of poor progress at the secondary school, motor disinhibition, conflicts with teachers. His reaction to teachers and caregivers’ reproofs was aggressive as a rule he cursed and could throw any object at hand at them.
History of life and case
The boy was a social orphan the parents were deprived of their rights. His mother was pregnant for the fifth time when she gave birth to him, he was the second child in the family. His weight was 3100 g. when he was bom and was breast fed starting with the second day of his life. His psychophysical development was normal during his first year of life and later. He was placed in the orphanage when he was 7. He took the first class twice and was given individual lessons in the second class. In the third class he made poor progress, became hot-tempered, aggressive especially after quarrels with teachers and caregivers. He reacted incorrectly to the reproofs and became angry and stubborn
Psychic status
During the first talk in the doctors room he was reserved. He was sitting with his head bent. He answered the questions reluctantly, very often gives one word answers. He had good orientation in the environment and on his personality. He could not remember the multiplication table, could not multiply and divide figures. His spelling was very bad. He could not find general notions for a number of words, for example, did not know the notion transport. He made a very short story looking at the pictures because did not have enough words in his active vocabulary. He thought that he was placed in the hospital because of his poor progress at school.
We gave the diagnosis on the grounds of the history of life and disease, complaints, examination and observations hyperdynamic syndrome on the background of remote consequences of organic trauma of the central nervous system, adaptation-adjusting reactions with prevailed disorders in behaviour.
At the Department the boy was restless, hot- tempered, made conflict situations with children, did not observe the regime and gave wild affective reactions to reproofs during the first month He slammed doors, spoilt furniture, cursed. He went to school reluctantly When he made mistakes refused to read and write Teachers had to work with him individually.
We treated the boy with medicaments and arranged two open dialogues.
The caregiver of the orphanage, caregiver, social worker and teacher from the Psychiatric Department came to the first open dialogue Vladimir's doctor asked him what he wanted to talk about. The boy said that he did not want to go back to the orphanage, that nobody understood him there, the caregivers treated him badly and punished him without reasons. He said he was not guilty because did not do many things, but the older children, instead, slandered him Vladimir could not control himself, shouted, cursed because of the wounded feelings. In response to those words the caregiver from the orphanage said that he did not know about the negative influence of the older children and that he felt sorry that he punished the boy.  He promised to talk to those children The boy cried but was quiet soon. The teacher of the Department told about the good progress in Vladimir’s studies, that he was more quiet and tolerant to the teacher’s reproofs. The social worker promised to visit the boy at the orphanage.
After open dialogue Vladimir was more quiet He went to the lessons with pleasure and quietly reacted to failures and accepted teacher’s help. There were no affective behaviour anymore His psychic state improved and he left the hospital.
There are many such examples. We arranged open dialogues for 12 orphans. All the children’s psychic state improved, aggression, conflicts, hot-temper disappeared. Children wanted to study again, to come back to the orphanage or boarding school. Orphans al- ways/often have a lack of emotional warmth, friendly support and these children got all that from the participants of open dialogues. Besides, observing and thinking over the dialogue participants’ reaction to their behaviour children learnt how to establish good relations with other people. Orphans’ characteristic feature is sensitivity and we always touched upon only those subjects that children wanted to talk about, we did not talk about unpleasant moments.
In the hard conditions of boarding schools and orphanages children do not have firm relations and do not meet understanding of grown-ups very often. That is why they value every good word addressed to them, positive evaluation of their behaviour that the participants of open dialogue express. Orphans agree to take part in open dialogue more readily than children from families because they are glad to take part in any event. However at the first meeting they are always/ often shy, sometimes tense and reserved as compared to children with parents. After the very first meeting we observe a positive effect. Children change, become quiet, start to trust the personnel of the Department. That is why we think that open dialogue is very productive in the work with orphans.
Our experience shows that this approach to the work with orphans is especially effective when it is combined with art therapy.
The thing is that children on general and orphans among their number have difficulties when expressing their problems and emotions. More over, children growing in boarding schools and orphanages very often have a [very] limited vocabulary. In families parents take care of their children speech development and ability to express their thoughts at least to a certain extent. But in orphanages there is nobody who has time and wish to teach them in our present situation. Very often small “Mouglies” grow there. Children have their problems, hurting experience but do not know how to express all that. We give them paper, paint, pencils for this purpose.
We observed changes in behaviour of 5 adolescents. They were all social orphans who unfortunately were not taught to communicate without conflicts. They quarreled, fought with one another at the Children Psychiatric Department. We invited them to paint in one of the rooms once a week during a month. They chose themselves what to paint.
The participants:
Andrey L., 14 years old. Diagnosis: syndrome of run away and vagrancy on the background of residual-organic lesion of the central nervous system; borderline mental retardation; pedagogically neglected.
Eugene I., 12 years old. Diagnosis: socializing disorder in behaviour; episodic intake of chemical substances (glue “Moment”, petrol).
Pavel R., 14 years old. Diagnosis: socializing disorder in behaviour, oligophrenia with light debility.
Vasily K., 13 years old. Diagnosis: syndrome of run away and vagrancy of residual-organic origin; microsocial pedagoic neglect; episodic intake of alcohol.
Pavel M, 13 years old. Diagnosis: reactions of protest in the form of running away from the boarding school.
At the first meeting of art therapy the boys painted the following pictures:
Andrey L. painted a picture “After Winter”. In the picture we saw a black house with closed door and small windows surrounded with a fence, near the house there was a black tree and a car.
Many orphans paint houses because they do not have their own homes. There is much black colour in Andrey’s picture which tell us about the depressive background of Andrey’s mood. The closed door, small windows can be seen indicating unsociable, secretive character of the author. The door is on one side of the house which also support this hypothesis that Andrey was unsociable.
Eugene I. painted a picture “City View”. He depicted houses, a sports ground and boarding school. At first sight the picture seemed to be merry but after closer examination we saw angry “smiles” of the houses, gloomy sun. The boarding school is depicted as a standard city building with many floors and this can be seen as indicating that the boy is reserved and is concentrated on his own problems. The black contours of the school and black windows tell us about the bad mood.
Pavel R. Painted a picture “Railway”. He depicted rails going to the distance. He was always a vagrant, did not study, and travelled by trains to other cities.
Vasily K. painted “Winter Landscape”. There was a lot of red colour in the picture - red house, red clouds, red smoke from the chimney. This can be suggested to indicate his tension, the wish to draw attention to his family because they have much trouble (his father was imprisoned for murder and his mother was imprisoned for theft).
Pavel M. painted “School”. He painted black windows that often is connected with depression and rejection. At the same time he painted the school as his own Home. He did not have any other home.
When the boys finished painting we asked them to express their impressions of the painted pictures. Everybody was silent. Then psychotherapists asked what they saw in the pictures. Andrey spoke first. He said that he did not want to live in the boarding school and ran away looking for his mother who drank and, as he remembed from his early childhood, lived in the city in the house like he painted. The car in the picture should take him to his mother to a better life.
Eugene did not say much and was gloomy. He asked only when he can leave the Psychiatric Department and asked the same question several times.
Pavel P. was smiling when looking at his picture. The doctor asked why he was so happy and he said that he was thinking for a long time what to paint and when he decided to depict a railway going to the distance he remembered how often he left home and sometimes followed the railway. He was glad that he painted that picture.
Vasily said that while painting he remembered his parents, his home where they lived all together, and then the parents were imprisoned, and he felt bad because of that.
Pavel M. painted his house and windows carefully, making black frames. He said in a few words that he wanted to start studying, to stay with his school mates but he was placed into the psychiatric hospital on the “Day of Knowledge” and he did not understand why.
The boys talked about one another’s pictures reluctantly. They mostly were saying: “Great!”, “Your railway is good!”, “Where does the car go!”, “Why is the house red?” most of the questions were unanswered. Eugene did not want to talk about others’ pictures. He was in low spirits.
The psychotherapist asked every participant to tell about their opinion concerning every picture. Pavel P. said that he liked Andrey’s picture, especially the car. Vasily said that he would like to travel by a good car and to take a look at other towns too. Pavel M. asked Andrey why the clouds were so dark. Andrey answered: “Winter is not over yet and snow clouds are coming”.
The Eugene’s picture was discussed. Andrey said that the picture was good, that he wanted to play football on the sports ground, he used to play football. Vasily liked the sun, he said that it was not gloomy at all and its rays seemed to be all over the picture. Pavel M. asked the author what he painted in the centre of the picture - a river or road. Eugene said in a quiet voice that it was a road. Eugene was becoming less tense while the boys discussed his picture, the expression of his face changed for the better. At the end of the meeting he was more active and even smiled.
All the members of the art group gave a positive evaluation to Vasily’s picture. They liked how accurate he painted the details. The picture of Pavel M. was also positively evaluated.
During the discussion the participants brightened up. The boys left the room together discussing the possibility to take the pictures to their wards and decorate the walls. After the first open dialogue with art therapy the boys were consolidated. They did not quarrel so often with one another, communicated quietly and did not fight any more. They came to the next meetings with enthusiasm. At every meeting they were becoming more and more sympathetic to one another. They perhaps for the first time realized that there were not only personal problems but other people experienced problems too. They expressed compassion as much as they could. In that way we were getting rid of the problem and in the end the boys' behaviour improved.
We believe that open dialogue helps to look thoroughly into children souls, encourage the personnel at boarding schools and orphanages to be more attentive to children personalities.
Open dialogue in combination with art therapy can be successfully used not only for consolidation of quarrelling children or improvement of their behaviour but also for diagnosis of children's psychic state with the help of pictures.
Vanya K., 9 years old boy.
He was a social orphan. He was brought to the Psychiatric Department from Naryan-Mar because of poor progress at school, missed lessons, vagrancy, and setting houses on fire.
Case history.
His parents abused alcohol. It was her mother's ninth pregnancy when she gave birth to Vanya. Vanya’s weight was 1700 g. when he was bom. From the Maternity House he was placed into the Children department of the Regional Hospital with the diagnosis premature birth of the I stage, intrauterine hypotrophy of II stage, perinatal posthypo- trophical encephalopathy. His psychophysical development retarded. He had colds very often. When he went to school he did not make any progress in the first form and had to study in the first form two years. He was restless at lessons and did not learn to behave at school. He ran away from school every day. If his mother did not take him to school he could leave home and come only next day. He used to set buildings on fire while hanging around. During half a year he started 11 fires. In those fired people even died.
Psychic status.
Vanya was a frightened, quiet boy. He was oriented on the right place. He could not remember the difference between days of the week and seasons. He could add figures as big as twenty. He knew simple general notions. He did not understand the figurative meaning of proverbs and metaphors. He criticized his wrong behaviour. He could not explain the reasons why he runs away from home and sets houses on fire. Some time later he told us that he liked to look at the fire and how firemen and police worked. He did not feel sorry for the people died in the fire. He seemed to us infantile and weak-willed.
Diagnosis: consequences of organic lesion of the central nervous system (prenatal encephalopathy), low intellect at the level of borderline mental retardation; psychophysical infantilism; syndrome of run away and vagrancy; pyromania.
The patient, caregiver of the Department, medical doctor, the new friend of Vanya’s, and social worker of the Department took part in open dialogue.
Vanya was asked to paint a picture. He painted several houses on fire. Vanya’s doctor started talking to him about his pictures. The doctor asked about every house and how he had set them on fire, whether there were people or not and if they were safe. Vanya told him that those were just houses without people and they just set on fire themselves. The social worker said that a lot of things were destroyed in the fire and even if there were no people they would come back from work and find their houses on fire and would be extremely upset. Vanya nodded his head in agreement. The caregiver of the Department said how difficult it was for the firemen to fight with the fire. Vanya’s friend remembered how they set houses on fire in Naryan-Mar and sometimes he felt sorry for those people who were in the houses and died there. Vanya was looking at the grownups with fear and asked to go out of the room. Open dialogue was over.
A week later we got together again for open dialogue. The caregiver told us about Vanya’s good behaviour at the Department, his good studies. Vanya asked when he can leave the hospital and remembered his mother. The social worker read his mother’s letter where she wrote many good words about her son and that she wanted to see her son soon again. Vanya cried and asked to let him go as soon as possible. He promised not to run away from the boarding school. He was asked to paint something and painted a house without fire and near the house a big fire engine. Later Vanay’s pictures depicted sea, boats, flying birds. That meant that the thoughts about fire and wishes to set fire left the boy’s mind in the process of treatment, open dialogue and art therapy.
Open dialogue helped a girl who refused to eat because children of her age called her fat. Among the patients there was a boy who had had stenosis, the disease was fixed in his memory and in critical situations he had attacks of pseudo-stenosis. We remember twin sisters who competed each other who’s waist would be thinner and got nervous anorexia. Unfortunately only one girl’s state improved after open dialogue. Certainly we know that one should not expect 100% success in treatment of neuro-psychic diseases. It would be selfdeception if we expected a complete victory. At the same time after open dialogues our every patient-orphan are just happy because people talked to them. They start thinking... And this is certainly a positive result.