Mikey (name changed) is nine years old. He is an engaging boy; bright and articulate, he has good reading comprehension and a sly, somewhat dark sense of humor. His fourth-grade teacher says he is a really good writer although he says he hates to write.
He lives with his grandmother in a small, two-bedroom apartment in one of San Francisco’s housing projects. The apartment is clean but its sparse furniture is largely in need of repair, although the home has cable television. Mikey has lived with his grandmother his entire life — at first in the home of his great-grandmother and then in a shelter for a year when the family lost the home after his great-grandmother died. They moved into the project a year ago.
Mikey does not recall ever having met his father. Mikey’s mother was a drug user long before he was born; he has a half-brother who is 19 years old. Both Mom and Brother have a history of drug abuse and have been in and out of jail for possession and/or theft. Brother is currently in jail; Mom was released late last year and after some months of no contact has recently enrolled in a rehab program in Santa Rosa. Mikey loves to play wrestling video games, which is all he does after school and on weekends, since his grandmother has emphysema and is on oxygen in the home. His brother had successfully completed a drug rehab and vocational training program earlier that year but began using again and stole Mikey’s Playstation and all his wrestling video games. Mikey says he hates his brother.
Grandma is also overweight and finds it difficult to move; she is trying to make sure Mikey eats healthy but he is also overweight for his age/height. The teacher was concerned because sometimes rather than doing his classwork he would just clam up, ball his fists and not respond. The principal was concerned because Grandma was keeping Mikey home from school when his godfather (who lives nearby but has health problems) was unable to drive him.
Though their housing project is across the street from the school, she was concerned for his safety. Grandma was concerned about Mikey’s reactions to upset – talking to his mother used to upset him because she was an unreliable presence in his life, making promises she could not keep – either crying excessively or shutting down completely. She was also concerned that Mikey expressed hatred of little children and babies. Mikey does not articulate his feelings to his grandma and expresses aggressive fantasies, like beating up his teacher.
Mikey was first seen by an Edgewood clinician while he and his grandma were living at the shelter and play therapy helped him let off some steam. Now that he is older, his Edgewood therapist sees him once a week at school. Mikey is learning to express his feelings rather than bottle them up, and he is learning ways to self-regulate, i.e., to manage hard feelings by taking deep breaths, talking with an adult, writing things down, drawing pictures, or getting exercise. Where he once had no friends, he now has a group of friends he plays with every day. Talking with his mom used to upset Mikey but he is happy to be back in touch with her and looks forward to visiting her as soon as her program allows it. His grandmother is now being case managed through Kinship Support Services and will hopefully enroll Mikey in summer activities so he can do more than stay indoors all summer. If all goes well, after this year, Mikey will no longer need therapy.