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Case Study: Listless Liesel
Liesel Brandt was a 6-year-old girl referred by her pediatrician because of problems with school refusal, anxiety, and social withdrawal. Liesels mother worked as an interior designer; her father was employed as a mechanical engineer. Liesels parents separated approximately 1 year ago and are in the process of divorcing. Her parents live in the same small town, so Liesel splits her time between her mother and father. Liesel has one brother who is 3½ years old.
Liesel was born full-term with no complications associated with delivery. She reached developmental milestones in an age-expected fashion. Her mother reported that Liesel was a fussy baby who cried often and had difficulty eating and sleeping. She often needed her mother to cuddle with her before she was able to go to sleep. Liesel was also described as a shy and clingy toddler who was reluctant to talk with others or wander too far away from her mother.
Last year, Liesel began attending preschool approximately three mornings each week while her mother worked part-time. Initially, Liesel was reticent to separate from her mother. However, by the third week of school, she attended preschool without complaining and began to make friends with other girls in her class.
Liesels school refusal returned at the beginning of this school year, however. The night before the first day of kindergarten, Liesel complained of nausea and stomach pain. When her illness did not subside by the next morning, her mother allowed her to stay home. The following day, when her mother insisted that she attend school, Liesel tantrummed and locked herself in the bathroom. Her mother drove her to school despite protests and crying. Liesels teacher said that she continued to cry most of the morning and remained tearful and reclusive the rest of the day. When her mother picked her up in the afternoon, Liesel looked hurt and exhausted. She clung to her mother and vowed never to return to school again.
Nevertheless, Liesels mother insisted that Liesel attend school. Liesel often reported stomach problems, headaches, and other vague illnesses. At school, she behaved in a withdrawn, listless fashion, rarely participating in activities. Liesel also reported transient fears that something bad might happen to her mother or father while she was at school, that terrorists would attack her school, or that her mother might forget to pick her up and that she would have to spend the night alone in the school building. If Liesel is allowed to stay home she seems content.
Liesels mother reported a significant increase in family stress within the past 6 months, about the time Liesels school refusal and mood problems emerged. She and her husband are divorcing, which causes her considerable stress and financial hardship. She is struggling to care for her children while also building her interior design business to make ends meet. Liesels mother admitted to long-standing problems with anxiety and insomnia that have increased markedly since separation from her husband. A second stressor in Liesels life has been the death of her cat, Tobbie, who was hit by a car outside the family home. Liesel was very attached to Tobbie; she would often hug and pet Tobbie when she was upset. Her mother is considering adopting another cat to replace Tobbie but wondered whether she would have sufficient time and money to care for it.
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