SYLVIA A. THORPE, Ph.D., ABPP

Patient’s Children: “Thank you for seeing me again. A couple years ago you helped me and my husband when we were having trouble. But now it’s my mom — she’s in her late 70’s and getting forgetful. Dad died 8 years ago of a stroke, and she won’t leaver her home or go see a doctor. She says she’s “fine” and still drives. We’re worried.”

Dr Sylvia: “Thank you for your trust. Let’s see what we can do to help your mom. This can be a delicate process, so we’ll proceed with caution and I’ll do my best to earn her trust, too.”

Mom was willing to come in “to help my daughter figure out what to do with her life” She was very cooperative and quite a sweet lady. We met twice and I did a preliminary neuropsychological assessment of her memory, her ability to do her daily activities, and her mood. She did meet the criteria for Mild Cognitive Impairment, but was carefully explained that this may or may not become dementia. In the process we discovered that mom was lifting a few more drinks since her husband died and that she had had “a little accident” with her car that she had not disclosed. She was afraid she might lose her driver's license, so she agreed to see her doctor and cut down on her drinking. Shortly thereafter, she moved in with her daughter and son-in-law. 

Here is a truly unfortunate gentleman. He is in his 60s and has always lived with his mother, who has now passed away. In the past he had a PT janitorial job in a sheltered setting, but the nonprofit has now closed and his own health is deteriorating. His neighbors are trying to help him, as is his insurance company. A care coordinator comes to the appointment with him. 

Dr Sylvia: “Hello. Thank you for coming. I’m happy to meet you, but I am so sorry that you mom has passed away. Please tell me about her. (He begins to do so but gets choked up; he also has trouble expressing himself, has always been in special ed). Do you have any other family or close friends? No? Just your neighbors? Okay. So, how are you doing? Not so good, can’t sleep, bad dreams, drinking too much, spending money on TV offers. (At this point the care coordinator and I begin taking notes of what needs to be done as far as housing, medical care, disability benefits, possibly guardianship, etc) While we are making our lists I ask him ‘do you have enough to eat’? What about heat? Do you get your mail? Are you able to ready it and understand it? You are a brave man. May I see you again, so we can get an update on how things are going for you and what else we need to do? Oh- and before you leave - what was your mom’s favorite color? Blue? Well here is a pretty anemone to remember your mom by… You’re very welcome. I look forward to seeing you again”

Patient: “Sure hope you can help me. I can’t find anyone whose available who takes my insurance, and my pastor says I need to talk to a professional. My mom has gone to assisted living. She’s 93 and I am trying to help her, but it’s frustrating and it’s wearing me down. My husband’s a big help, but I need some tools - to help her, and me, too.” 

Dr Sylvia: “Maybe a listening ear can help. And some simple suggestions too. 

For the first appointment she had brought some Bible passage that she and her mother had shared over the years. She picked out 3 verses (1)  Colossians 3:23, (2) Corinthians 13:4-7, (3) Hebrews 13:5 for them to discuss. But her mother couldn’t remember them or what they had just talked about. She was very upset when her daughter left. Promising to come back the next day, as usual. We brainstormed, and the next time she came she brought a set of scripture cards she had made. A set for her mom, and one for herself. And on the back of each card she had lovingly put photos of their earlier times together. Not only did this amazing lady find a way to help her mom with her memory, but also helped to reassure them both and make their time together more enjoyable. 

Each time they got together they went through the cards. Sometimes there was no recognition, other times there were tears, and sometimes they laughed - but all in all things were better. We also did some practical problem solving for everyday tasks, like hiring a temporary housekeeper, giving the bookkeeping duties over to her husband, and taking some respite time for herself. 

Patient: “This is tough. I didn’t want to come in. The guy at the vet center keeps hounding me for 3 years - “You gotta go see this lady” - and then last month my best buddy died. We’re both vets and have coffee together, for years. My wife says I need help. I feel lost...alone…”

So we met, twice. I listened, I gave him a US flag. I told him “find a little tree - just one - in a pot, then find another flag for your friend’ He did that. He came back and gave me a photo of his tree and the 2 flags, we wept in silence. Then he shared a video he had made of his life service, including Vietnam. “You’re the first person to see this,” he said. 

And we shook hands, right by my grandpa’s 1896 US Army discharge papers. 

Patient: “Tell you right now - I don’t want to be here. I’ve been a military man all my life and come from a long line of colonels 4 generations back. I’ve served my country and my family - but I can’t quit worrying and meddling. My kids say ‘we can handle it, Dad’ and my wife says ‘honey, please-let’s have a life together now, while we can still enjoy it’.” 

This calls for actions. A plan of action. Now. Here is a very resourceful gentleman. Intelligent. Mindful of his troops - at home and in battle. He is strong-hearted, a man of duty and responsibility. He is accustomed to taking charge, making things happen,and having the authority to do so. 

Dr Sylvia: “Well, who am I to tell you anything, sir? Maybe your strategy’s not working, but it’s hard to change...tell you what - write up your ‘saves’ and close calls. Time for you to retire your commission. Write one up, print it out, and bring it here.” 

He did. 2 weeks later handwritten, but in proper military language. And his wife had drawn a heart around the whole thing...a wordless victory. 

Patient: “My son’s grades have really dropped.  I don't know what's gotten into him. He used to do so well.  And at home we don’t get along anymore. He won’t obey the rules, he argues with me and his mother.  We are a Christian family, and he still goes to church with us. What’s wrong? Can you help us?”

First, I saw this 16 yr old with his parents for an interview, and then I saw him by himself.  We decided to do psychological testing with a battery of tests to explore attention, learning, and possible mood problems. The test results indicated ADHD and dyslexia as well as clinically significant depression.  The results were shared with the school, and we worked together to craft the best accommodations for him. The family doctor was also provided with the results, and medications for ADHD were provided as well as antidepressants.  We did a brief followup, and as his grades and mood improved, so did things at home. He got a job for the summer and planned to apply for college. Counseling was offered, but they declined.  

Patient: “Hi!  I’m a physical therapist in a busy practice, and I love my work.  My husband is wonderful, and my four children are my joy.  But—I keep making mistakes at work, like I’m not paying attention, especially on paperwork, even though I think I’m pretty good at what I do.  A coworker mentioned maybe I ought to be tested for ADHD—do you do that?”

Dr Sylvia: “Sure!  First, we do a complete interview which covers both your childhood and adult history.  That includes college, job, family, life, and medical history. We can also give your husband an opportunity for input.  We’ll take a look at possible previous behavioral indicators for attention problems as well as daily stressors, substance use, and any history of post-partum depression.  After that a battery of psychological tests can be designed to assess for possible ADHD, learning disorders, depressive symptoms, and lifestyle management of stress.” 

So, what did we do?  She decided to come in for the interview and testing, she and her husband completed parallel forms for assessing possible ADHD symptoms, and she participated in the psychological testing.  We found that indeed she had Adult ADHD, mixed inattentive & impulsive type as well as being mildly depressed, due to a tendency to overload herself with daily duties while also being a perfectionist.  Her physician prescribed medications and we did some brief solution-focused counseling for 5 sessions.

Here comes a shy little kid.  He makes no eye contact, and he hides behind his mother on the couch. He is 7 yrs old.  Mom is worried about him, and the school doesn’t know what to do with him. The therapy dog helps him but he has no friends. Sometimes he screams and has meltdowns.  Other times it seems like he’s just not paying attention. The pediatrician “thought he might be Asperger’s.” He’s already taking medications for ADHD.

First things first—develop rapport and trust.  Let him play his video game on mom’s phone while he sits on her lap.  She and I can do the developmental history and initial interview. As it turns out when he was 4 yrs old he fell out of dad’s pickup while horsing around, but then it seemed like he changed. His speech was different, and he had trouble understanding some things. He had some speech therapy, but he still has trouble.  He can’t read yet and he has difficulty putting his thoughts into words. He calls himself “dumb” and cries himself to sleep at night—that is, until the dog hops up on the bed to console him.

I talked with mom about doing a battery of neuropsychological tests to assess for learning/language problems as well as for possible Asperger’s. In addition we both felt it was important to help him with the despair he is experiencing.  We got records from the school and from the pediatrician.

The results of the test battery found that:

• he still has ADHD and should continue with his meds
• he does not have Asperger’s or other PDD
• he does have a specific learning disorder in reading and in written language, but not in math
• he has expressive & receptive communication disorders
• understandably, he is experiencing some childhood depression

The school was very helpful in arranging appropriate accommodations for him and beginning the process of drawing up a more formal learning plan.  He continued with his medications and the doctor ordered an MRI. He started counseling, and he and his dad started to tie flies for high lakes fishing in the summer. And, best of all—he stopped crying himself to sleep, and he loves wordless picture books that he can tell mom, dad, and his dog about what he SEES is happening in the stories.  Reading may be the next step!

Patient: “I’ve gone back to college, but I’m having trouble with my courses.  I’m not doing good, and now I’m on academic probation. I’ve got to keep my scholarship, and the college said I needed to get tested so I can have ACCOMMODATIONS.  In high school I had a 504 or IEP or something, but that was a while ago. Can you do the testing, and work with the college so I can learn in my best way—and so I can be a nurse?”

Dr Sylvia: “Let’s give it a try! Here’s what we can do. We’ll start with a brief interview about how you’ve done in school and where you’ve having trouble now. I’ll ask you what accommodations you believe might help you. We’ll also cover job and sports history, your career goals, pertinent medical history, and a bit about your family. Then we’ll do a battery of psychological tests to look at your memory and cognitive ability, attention & concentration, academic skills in reading/writing/math, and study habits. We’ll also cover test anxiety, time management, and organizational skills. Then I’ll write a report, and you’ll get a copy and so will the college. The report includes scores, explanation and interpretation of them, and specific recommendations for possible accommodations.  It may be that you have a specific learning disorder and/or attention disorder, or possibly a past history of traumatic brain injury—but in any case I’ll do my best to help you and the college.”

Dr Sylvia: “Hello!  So nice to meet you!  I like your little earrings, and the pink rose petal ring you are wearing.  It’s from your grandmother in Germany? WOW! How can I help you and your mom and dad today?. . . what? . . .your mom is dying?  . . . .oh, honey, I’m so sorry. . . . .tell me. . . (we all pass around the Kleenex box)”

This is the first time we’ve met.  She is 11 yrs old, very sweet. Acts older than her age. We all sit quietly, mom and dad holding hands while their daughter wipes their tears.  

Patient: “Mama has cancer, she is going through treatment, Daddy has to work.  I go to school and my sisters are with the babysitter. But I think we need help.  I looked you up in my phone, and I liked what you looked like. Also you said your mom had already died, so maybe you understand.  I told Mama to call you. And she did!”

We don’t have much time.  Right away we start grief counseling. Mom and dad agreed it would be important for the 2 younger girls, ages 5 and 7 yrs, to come, too.  Everybody got a chance to talk. And to cry. And to plan. Every day became precious. Sometimes we couldn’t meet because mom was too sick, so we did the best we could and stayed in contact.  Palliative care was arranged, and at the funeral service pink roses and white daisies were everywhere—just like in the Mama Memory Garden the girls and dad were hoping to plant.