Another difficult week

This last week was another tough one for Jeff. Like most of his rough periods, this was brought on by Jeff's perceptual misperception of conversations taking place around him and his very egocentric assumptions of what he has heard.

I had come down to our Adult Program just to visit and was quickly alerted by Sue, the Program Director, that Jeff was very upset because he thought his group home was going to the snow on the weekend. Jeff thought that meant he would have to ski and he doesn't know how. This idea terrified him. Apparently no one at his group home had said anything about skiing; they were merely contemplating a trip to the snow. However, another client in our program had been talking to everyone about her ski trip the previous weekend. Jeff very likely overheard her conversations and made the erroneous connection that going to the snow was synonymous with skiing - and he was petrified. Unable to tease out what was real and what was not, Jeff was swearing and threatening to hit anyone who mentioned snow or skiing. While Sue tried to reassure him and called the group home to get the actual story, Jeff relaxed a bit and I was able to talk with him and explain that these two different activities could be mutually exclusive. I could tell Jeff was trying to understand and at times, it seemed he did get it. But his anxiety over feeling compelled to do something so scary as skiing simply overwhelmed any logical conclusions he could hope to come to and about every 15 - 20 minutes, he would become upset again, requiring constant assurances that there would be no skiing.

Later in the day, Jeff was still distressed about the possible trip, so when I came down to visit, I wrote out on a piece of paper " I do not have to ski - ever!" this despite his staff offering many the same information throughout the day. I had Jeff read the sentence, cut it out, and told him to put it in his jacket pocket. Anytime he started to think about it, I reminded him, just take it out and read it. Seeing it in print seemed to make more of an impression on Jeff and he folded it carefully and stuffed it into his pocket. Then, Jeff came down to my office to listen to some music and with a few reminders, seemed calmer. It was St. Patrick's day as well and throughout the day, we were able to distract Jeff by talking of corned beef and cabbage and singing Irish songs that none of us could remember all the words to. By the time he left the program for the day, Jeff had calmed down considerably.

The following morning, the staff had their usual morning staff meeting and talked about Jeff's anxiety and the group home's plans. Unfortunately, one staff member was late due to traffic and missed the part of the discussion about how the trip was not even going to happen, not skiing, not snow, nothing. As the clients came in, this staff person casually asked Jeff how the plans were going for the snow trip. Big mistake! Jeff went off like Mt. Vesuvius, yelling and shouting and threatening to hit the staff who asked. Jeff had been told by his group home that the snow trip was off, but this question made it all come to life again as if it were imminent. He was still nervous and again needed assurances throughout the day that skiing was not on his agenda for the weekend. But the fragility of his understanding kept the staff on their toes all day and no one talked about snow unless it was to remind Jeff that he wasn't going.

And so this morning, when I came down to visit, Jeff instantly called out " I had a great weekend and I never worry anymore! And my dad made me corned beef and cabbage when I stayed with him on Saturday!" So, we're back to normal, or at least what is a state of equilibrium for Jeff. With his worries behind him, there we will stay until the next misunderstanding happens.