More than Magic

Magical Moments of Change: How Psychotherapy Turns Kids Around
Lenore Terr
W. W. Norton. 304 pp. ISBN: 978-0-70530-0

I must admit, I picked up this book with a certain trepidation. You don’t have to be a working therapist to know that “magical moments of change” are oversold in self-help America.

As a veteran therapy client, I’ve had many ah-hah moments, but, alas, none of them turned into “magical moments of change.” In my own experience, therapy is moving the self inch by inch toward greater stability and contentment, and it’s bloody hard work. So I approached this book feeling like the Scrooge of psychotherapy. Magic, you say? Bah! Humbug!

The book’s author, Lenore Terr, is a clinical professor of psychiatry at the University of California, San Francisco. She begins by telling about a patient of hers, Cammie, an unlikely candidate for magical change, who’s been seeing her for 15 years. Although Cammie was only 29 months old when she started therapy, she’d already suffered horrendous abuse. Her 3-week-old sister had been murdered at home after being shaken and bitten repeatedly. Her father and mother were the prime suspects. Cammie, too, had been shaken, sexually abused, and bitten all over her body.

She was placed in a good foster home with Sandra and Tom Brooks. Still, after a year of “warm and loving care,” she was more animal than human. The toddler acted out by “growling, spitting, sniffing sex organs, hissing, hitting.”

When she first saw Terr, Cammie was “a wild child” and barely spoke, and when she did speak, she growled, “Die baby, got boobies, he bites.” She attacked strangers—adults and children alike—biting, hitting, and vomiting at will. Terr’s assignment was to work with her for an hour a month (her foster parents lived a long way from her office and couldn’t make the trip more often).

Cammie is now 18 and, although she still has plenty of disturbing symptoms, she’s a thousand times better than she was as a small child. Initially diagnosed as retarded and suffering from PTSD, she’s now in school and has been labeled “gifted.”

With Cammie’s story as her centerpiece, Terr weaves together 48 case studies from 33 psychiatrists that feature other “positive turnarounds.” Each of the brief stories has a coda: a “meaning of the moment,” presented as a short commentary. It’s an impressive bit of stitching and writing by any writer, let alone a working psychiatrist.

Being “real” is high on Terr’s list of the therapeutic qualities that lead to clinical “magic.” But what does being real mean? Most therapists are taught to be real, or some such facsimile. For Terr, it means acting from gut instinct, at the right moment. She acknowledges that a professional, almost Freudian, stance of objectivity can be useful at times, depending on the case and circumstance, but because of “Cammie’s sadistic, neglectful, violent and frightening birth parents,” Terr felt more real being “the god of fun” for a young girl whose life until then had been a nightmare. Terr’s office is a child’s menagerie: dolls and playthings are stored everywhere. She used all of these props to engage Cammie, playing Little Red Riding Hood for a while (the child was enthralled with the wicked, dangerous wolf).

The first breakthrough of the therapy happened, however, when Terr extended herself personally—and this is a crucial theme of the book. On Cammie’s first visit, Terr realized they shared the same birthday, and she excitedly blurted this out, hoping, based on a version of the Newton’s physics law, that a human response would produce a separate and equal human response from a previously brutalized patient. It worked, and “all motion stopped” for Cammie, the whirling dervish. Terr had become a person, not just another doctor.

Terr chronicles a range of turnaround points in her work with Cammie. They shared rituals, like having real tea parties, with real china cups and Mrs. Field’s cookies. Terr’s staff also attended. These celebratory get-togethers helped Cammie start choosing civilized behavior over base, animal aggression. Eventually she realized that the predatory wolf she’d initially admired in the story of Little Red Riding Hood was just “weird.” As Terr summarizes this development, when faced with a choice about how to be in the world, the youngster began to choose the normal over the bizarre.

Other moments of change followed. After a visit with Cammie to her baby sister’s grave, Terr writes, “From that time on, she chose good over bad.” A temper tantrum at age 10, when she was in the third grade, led her to prefer being attached to others, rather being a loner. Later that year, she found herself pursued by an overly aggressive playmate. It started with the comment “Let’s get married,” though that soon changed to “Let’s have sex.” Cammie was both enticed and bewildered. So Terr had to tell her about the “facts of life,” and the distinction between forced sex and love. Terr then discussed with Cammie how to deal with the annoying boy. The boy’s mother was brought in, and the nonsense stopped. All told, Cammie started to learn a central lesson: she wasn’t a confused victim, but an active agent in her own life.

Cammie’s last magical moment of change occurred when Terr convinced her to write a letter to a judge against her brutal father (who, in the meantime, had been released from prison and had killed another child in Oregon). She was frightened of this diabolical man and with good reason—in addition to his horrendous treatment of her as a baby, there was some evidence that he was stalking her. In writing this letter to the judge, says Terr, “she gave up believing she was a prisoner of her genetics and chose, instead, her environment and her Ôwill’ as the most important factors in her future. This put a new positive direction to Cammie’s quest for identity.”

Terr has many lessons for therapists in her 15-year adventure with Cammie: follow your gut, be a person, and emphasize the independence and agency of your patient. Other lessons include, when you can, step lightly and speak with humor. Also Terr warns us there can only be one cook in the kitchen, one boss of a treatment team. Cammie had myriad doctors and specialists, but Terr let it be known she was in charge. Terr had seen other cases botched because of confusion or control issues, so her advice to other doctors and therapists is: make sure there’s a clear line of authority and that everyone knows who has the final word.

Terr integrates so much good material and has so many engaging vignettes with real therapeutic value that I don’t want to shortchange her narrative. But many of these stories also make me wary because they bring up that old bugaboo about “instant change.” Terr’s notion of a magical moment, a turnaround, isn’t the equivalent of a religious conversion from on high, however. We know Cammie had no instant transformations in her life—all her changes were magical, but in a human sense. Actually, they were more like steps, and all of them were embedded in a therapeutic framework of dedicated, deliberate work.

A crucial theme resurfaces constantly: the spontaneity of the moment and the risk a therapist has to take to replace a professional mask with the face of a real human being. Remember the old social worker-101 advice: start where the client is? Many of Terr’s collected vignettes seem to be reteaching this lesson. We read of a psychiatrist who takes his sullen, adolescent patient for spin in his red Corvette, creating a breakthrough with a kid who only seemed to care about cars.

One 8-year-old boy was having difficulty in the bathroom, so he’d often foul his pants. His shrink began accompanying him to the toilet and coaching him from the next stall. More than a few of their early weekly sessions were spent “relearning bathroom dynamics.” Treatment became a kind of therapy by toilet training: expressions of rage against the boy’s father would follow a successful bowel moment.

And here’s one of my favorites: another 8-year-old boy, James, couldn’t sleep. When he did, he had terrible nightmares about Freddy Krueger, the murderous character in the slasher movie Nightmare on Elm Street. In James’s dreams, Freddie would murder his parents and then come to kill him.

The boy didn’t seem to be that troubled, except for these nightmares. So what did the psychiatrist do? He rented the movie, researched it, and then wrote to Wes Craven, the author and director. Surprisingly, Craven wrote back a long letter detailing his terrible childhood and the scary fights between his parents. His artistic oeuvre had been the result.

The good doctor showed the letter to James, and as he read it aloud, “James almost puffed up to the size of a comfortable boy.” In the follow-up commentary, we’re told that “on the few later occasions that James’s nightmares returned, his parents cut the cycle short by again reading to him from Mr. Craven’s letter.” Is it too late for me to write a favorite novelist or moviemaker—Francis Ford Coppola or Saul Bellow? (Unfortunately, he’s dead).

It’s easy to make fun of some of these vignettes (I just have). I suspect I’m not getting the whole story from Terr’s contributing psychiatrists. Or because of my temperament and therapeutic history, the entire idea of what constitutes a magical moment of change is just too good for me to believe.

Cammie herself might agree that these moments aren’t always so instantaneous. But magical moments did take place in her world: in the sheer, splendid humanity of her foster parents and her doctors and helpers. By taking off their masks, breaking roles, and becoming more human, they performed magic: they gave more than even they could have imagined to a fellow being. As a result, a brutalized child who seemed wild, abandoned, and hopeless found a way to create a normal life for herself. What’s magical is how some people are willing to work that hard for another person. This sets a lofty (and lovely) bar for every therapist.

I understand that magic requires real work. But part of me still wants to cut to the chase and just write my letter to that great whomever. Yes, and get a magical response back that’ll change my life, too.