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Family Consultations – Client Example 3 - Connor and his Mum coping with ASD and daytime wetting

Background

Connor is an 11-year-old boy who has been diagnosed with ASD and is the only child in a single parent household. His Mum asked for support with Connor’s longstanding difficulties with daytime wetting. He had undergone all the relevant medical examinations, which identified an overactive bladder, and had also been seen by several school nurses. Unfortunately, he had become increasingly anxious and embarrassed about the incontinence and was so afraid of having an accident at school that he constantly went to the toilet. In doing so, he affected his ability to engage with lessons and the learning around him. The shame in his wetting had resulted in secrecy which only acted to further exacerbate the problem given that now, ‘the body and the brain had stopped talking to each other’.

How many consultations and who attended?

We had a total of five sessions with Mum and Connor, with Connor attending part of these on his own.

What did we do in the consultations?

  1. ‘Mind our language’ – mindful of the potential shaming impact of our choice of language when discussing the ‘problem,’ we invited Mum and Connor to place the problem outside of Connor, such that it no longer needed to define him. As a result of Connor’s ASD we used images and artwork to create a character that embodied ‘the problem’ naming it, Whizz. This playful language liberated Connor from the shame that had prevented any discussions about the problem and had distanced him from his Mum. Connor told us how Whizz leaves him feeling worried, confused, and embarrassed while being the biggest ‘fun spoiler’. Connor was also able to identify when Whizz gets bigger, for example when he is busy gaming, and smaller, when he is bored, which helped him to think about ways to take charge of Whizz.
  2. Therapeutic letters – we wrote therapeutic letters to Connor that summarised our conversations, acknowledged his positive contributions to our work together, highlighted strengths and expressed intentions for change.
  3. ‘Building a team’ – the new language and stories about Whizz enabled Connor to feel safe enough to reach out to Mum and allow her to support him. We agreed that as with any big task, we needed to build a team around Connor to support him to manage Whizz. Because Connor was found to have an overactive bladder, we agreed that Whizz may never completely go away, but that we can ‘turn down the volume’. We brainstormed the skills we needed for our team to help keep Whizz at bay and Connor decided that his Mum, his paediatrician, and his therapist, could bring valuable skills to his team. We learnt about Connor’s fantastic problem-solving skills and we also learnt that Mum is a particularly good detective who can spot the early signs that Connor needs to go to the toilet. Soon several examples began to emerge of Connor and Mum working as a team and ‘outsmarting Whizz’ together.

What did the client have to say about the experience and outcome of the consultation?

Connor told us that he felt more in control of the ‘problem’ and his self-esteem had improved. Sessions are ongoing but so far, wetting has reduced from five times a day to twice a day.