Featured Review
Case Studies in Child Psychiatry"/>

09th February 2022

Featured Review
Case Studies in Child Psychiatry

Learning from Our Patients

By Graham Martin

Reviewed by Michael Trout

I fear Dr Martin failed to pay proper attention to his classes on clinical and interpersonal arrogance, adherence to method above all else, and devotion to the diagnosis as a thing-in-itself. Instead, much like Winnicott—whose influence is evident in Dr Martin’s work and in his writing—he seems willing to actually palpate. He looks with eyes that are not aloof from his subject, but seem to be full of genuine curiosity and wonder. If the reader is willing to walk into the room with him, and focus on following him (and following the patient), treats await.

Mastery is evident, herein, of the craft of evoking the story, and he is evidently willing to pay the fee for taking such a position: keeping himself calm, finding a way to “hold” the patient (and to allow the patient to feel held), and withholding diagnostic categorization long enough to actually understand what might be happening—indeed, what might have happened that led us all to this moment. He is unfazed at the verbal assaults of an angry child, finding a way to discover why the assault—even the specific words chosen to effect it—might be meaningful. He fails to call security when a child physically assaults him, finding it preferable to look for meaning, and then to pass on that meaning to an apologetic parent.

The sturdiness of this method-that-looks-as-if-there-is-no-method is evident in how Dr Martin treats us, his readers. Repeatedly, he provokes further consideration and study by the reader. We feel respected, seen, as if he might really want to know what we think. My suspicion is that his patients also felt respected, seen. The result is a book that makes an ideal agent to provoke discussion in clinical study groups and graduate family therapy classrooms for those from child and adolescent psychiatry, psychology and social work.

Perhaps some readers will be surprised to slowly unearth the discipline and care that underlies his “method”. He teaches us the rigor of investigation, sometimes to the discomfort of his patients and their family members. He reports (in case we haven’t already caught on): “If you seriously want to change problems in families, then it is best to leave no stone unturned” (p. 23). As stones are, indeed, turned over, his attention momentarily shifts in whatever direction the data seem to point (although his eye is always on the original presenting problem). Without ever giving it a name, he may shift into one of the “treatment via the mother” approaches made famous in the infant mental health literature. This is what happens when one is focused on whatever emerges, and when one is determined to follow it. This can only be accomplished when the devotion is to helping the patient, father than keeping fidelity to a strategy.

However, what if the emerging story seems to have implications evident to Dr Martin but not yet evident to the parent? How can he hold the story for the child or the parent with the gentle persistence needed to support their own discovery, while not humiliating anyone? When Libby’s mom seems oblivious to the connection between her 8-year-old daughter’s problems and the death of Libby’s dad, Dr Martin asks whether mom took Libby to the funeral. Mom is convinced that Libby was untroubled by not having had a chance to say goodbye to her dad. Oddly, mom can acknowledge that she still gets upset when she thinks about her husband, adding that this is the reason she doesn’t “…talk about him much”. With great reserve but equal persistence, Dr Martin asks if Libby knows where her dad’s resting place is. When he learns that dad was cremated, and that the ashes were scattered in a certain rose garden, he asks in the way Winnicott would have—or the way a person’s favorite, sweet aunt would have: “Have you ever taken Libby up to the rose garden? Mom is left to decide what to do now.

Perhaps it is a testimony to what it feels like to be treated by the likes of Graham Martin that a number of patients wrote to him years later, sometimes well into their own adult lives. They didn’t write to praise his method, or his intelligence. They wrote to say he made a difference.

Michael Trout completed his specialized training at the Child Development Project at the University of Michigan School of Medicine, under Professor Selma Fraiberg. He has served as the Vice-President for the United States at the World Association for Infant Mental Health, and as a Charter Editorial Board Member for the Infant Mental Health Journal. In addition to publishing four books, seven book chapters and 13 journal articles, he has produced 16 documentary films in the field that are in use in universities and clinics around the world. He won the Selma Fraiberg Award for “...significant contributions to the needs of infants and their families,” and a Lifetime Achievement Award “for his decades of work with children of loss and trauma” from ATTACh. He is also the author of the book Four Decades in Infant Mental Health: This Hallowed Ground.

Case Studies in Child Psychiatry: Learning from Our Patients is available now in Hardback at a 25% discount. Enter code PROMO25 at checkout to redeem. 

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