Advertisement My creation made a recent appearance in the case of a 5-year-old boy who had taken to scratching his arms and legs until they bled. He claimed they itched, but his pediatrician ruled out any skin conditions. His mother told me he would get her attention by breaking open a self-inflicted wound that was beginning to heal and then showing it to her. She had tried everything from casually telling him to wash and bandage his wounds to scolding him. Nothing had worked and she was, she said, “at wits end.’’
It seemed like a perfect fit for my imaginary friend, so I told Mom to sit her son down when the proverbial iron was cold — in other words, when a scratching incident had not recently happened — and tell him, with great solemnity, that she had spoken to The Doctor about his scratching. The Doctor had said that when a child scratches himself a lot, and especially when he often makes himself bleed, it means he’s not getting enough sleep. The prescription: For the next two weeks and maybe longer if he was still scratching, itchy-boy had to go to bed right after supper — in bed, curtains drawn, lights out. In addition, every time he scratched himself he had to go to his room and lie down, curtains drawn, for an hour.
Even if the scratching stopped before two weeks was up, he had to go to bed right after supper for the full “treatment’’ period, at which time Mom would give The Doctor a progress report. I told her to tell her son that she truly hoped he would only have an early bedtime for two weeks, but that it all depended on The Doctor’s judgment.
This approach accom-plishes several things. First, it redefines the problem. Scratching is replaced by lack of sleep as the primary issue. Second, the gain of being able to get attention by scratching is hopefully outweighed by the desire to restore normal bedtime. Third, authority over the issue is assigned to a dispassionate third party, thus effectively neutralizing the emotions that have become attached to and are fueling the scratching.
I told Mom that if at the end of two weeks her son had stopped scratching to tell him that The Doctor was very, very proud of him and had given him back his normal bedtime. If it hadn’t stopped, then go another two weeks and then give me a progress report. I was, by the way, fully prepared to recommend that Mom ask her son’s real-life doctor for a referral to a therapist in their area with a good track record when it comes to working with children, but my prediction was that after two weeks of early bedtime, this little fellow would be itching to have his normal bedtime restored.
And that is precisely what happened. A month later, Mom writes: “We took action the day we heard back from you and it seems to have worked. He had a couple of relapses early on, but we simply sent him to his room to lie down for an hour, as The Doctor prescribed. At this point, his skin is healing well.’’
That Doctor — what a guy!
Family psychologist John Rosemond answers parents’ questions on his Web site at www.rosemond.com.
