Book Review: Emotional Orphans by Cate Shepherd

The holidays always mean for me a few extra moments to read for pleasure. One book which I considered a treat is Cate Shepherd’s Emotional Orphans, Healing Our ThrowAway Children. Though Emotional Orphans reads like fiction—it is a fictionalized account of Shepherd’s journey as a contemporary psychoanalytic therapist, and of the stories of treatment with some of her most courageous, loveable, sometimes infuriating, adolescent patients-- its truth is evident to therapists who dedicate themselves to their patients. The reader will come to admire and even love, as Shepherd did, these obstreperous adolescents. Like a beloved character in a novel or television series, I missed at each chapter’s end the kids she describes. I would even wait a day in order to savor what I had just read before beginning the next chapter, believing each time that the one I had just finished was my favorite.

Just as her child patients are fictionalized, so are her mentors, some of whom are given to speak the words found in the writings of Winnicott, Bacal, Beebee, Bowlby, Bromberg, Kohut, Shane, Lachmann, Bion, Brandchaft, Ogden,  Shengold, Solorow, Teicholtz and others. Everywhere are allusions to her breadth of her and her reading, without Shepherd ever devolving into jargon or an academic treatise.  Pearls of contemporary psychoanalysis abound, tucked in between compelling accounts of children struggling to be seen.  [She quotes Winnicott: “It is a joy to be hidden, a disaster to not be found.”(p.59)] Shepherd so seamlessly describes complex ideas that young psychotherapists will not have to struggle to grasp them.  In describing her patients:

Reverie              

Mario saw his true reflection in the eyes of people who cared about him (p.69)

Pathological accommodation

It’s a crazy-making role-reversal in which a child is used to serve the needs of the parent while sacrificing her own developmental needs. (p.72)

I was caught in the same dilemma as Angel, compromising my own truth to maintain necessary ties (p.177)

Attachment  

If they can attach to you, they can make use of you (p. 115)

Everything you’ve invested in these kids is theirs to keep (p.71)

Therapists are not interchangeable for the same reasons that mothers are not. (p.205)

 As a young child, Jesse never had a chance to form the kind of secure attachment that fosters the development of empathy and self-regulation. As a result, she could not regulate her emotions, and she felt little empathy for her caregivers. (p.22)

Dissociation (p.38):

“…because no one validates his experience.”  “…Dissociation shields him from unbearable pain, but it is also a way he accommodates to an environment in which there is no space for his pain to exist.” (p.176)

And when adolescents push our buttons, perhaps the hardest to hold onto:

Patients act aggressive because they feel vulnerable. (p99)

…outrageous behaviors as messages to be decoded rather than crimes to be punished. (p147)

As long as there is aggression, there is hope (p.81)

Pearls even in Sanford Shapiro’s Foreword:  “a teenager’s anger comes from an instinct of self-protection”

Trauma and dissociation:

Kids could survive horrible injuries, losses, and despair if they didn’t feel alone. (p.132)

needed outrageous behavior to preserve his soul. His father was a soul killer. (p.79) [Shengold; Miller]

“He experienced a disruption in his connection with you,” …”This left him feeling isolated and dysregulated.” …”The vandalism was a part of his attempt to right himself..” (p.170) …vandalism as organizing activity (p.175) The vandalism is not the symptom. The dissociation is the symptom. (p.176)

Note the unobtrusive symmetry of the two paragraphs [the therapist’s need for validation, the child’s need for validation. Lovely.]:

 When I saw similar pain in Jesse, I felt validated. If Jesse’s suffering was real, mine could also be real. If her circumstances could elicit empathy, maybe mine could too. ... (p.31) [Intersubjectivity (seeing the subjectivity of the analyst)]

Parents who scapegoat their children can induce a special kind of desperation. While other children find comfort and support, the scapegoated child is deprived of a clear mirror for her emotional experience. The absence of validation can produce more trauma than the injury itself.

On procedural learning:

Children learn what they live (p.113)

Self-disclosure:

I was honest with Angel. I answered his questions when I could, and guarded my privacy when I needed to. (p.182)

       

Procedural Learning

…when he pushed against my boundaries and watched me enforce them, he learned to construct boundaries of his own (p.182)         

Winnicott’s survival

… a therapist who does not abandon or retaliate, but remains available and responsive in all circumstances… (p187)

Our indestructibility is their only security. (p.39)

The importance of keeping out of the way of the patient’s agenda of healing; [though no mention of negotiating competing agendas]

…try to stay out of the way, and find out how he needs to use you (p.168)

Some I just plain liked:

Staying calm is half the battle. The other half is staying connected. (p.220)

Or a saying on needlepoint:

We are not here to see through one another, but to see one another through. (p.121)

While many of the similes did not excite me or were too well worn, the two times she described kids’  like “popcorn” made me smile with its familiarity. Sometimes her angry at the absurdity of agency workings sounded understandably embittered and Shepherd is honest about the stress and time-limited ability to withstand agency work. She advocates for the therapist’s own therapy, as well as avocations [hers in this tale is martial arts] that provide “a strong counterbalance to the stress of our work.” (p. 78). Emotional Orphans is a very readable and moving account of relationship with patients, and I recommend whole heartedly.