I saw this 15 year old while I was working in a special education program for neurologically handicapped children. She was extremely tense and distrustful, and she was especially confused about her disabilities. The latter included near blindness, mild impairment of certain academic skills, difficulty orienting herself in space (remembering, for example, that the door was on her left), and minor difficulty with balance and coordination. During an early session, she complained about being a "failure" and referred to her performance in gym class. After getting her to tell me more specifically what she’d "failed", I commented that "Of course you can’t do those things well; you have difficulty balancing in the first place." 

This might sound harsh, but in fact Claire experienced this comment as a comfort and an anchor. She visibly calmed down and later in the session she told me that after I said this she felt less confused, more centered, more optimistic, and more relaxed.

It turns out that her parents, although entirely well intentioned, were confusing her and making her feel inadequate. They spoke only positively, encouraged her efforts, kept saying how "wonderful" her performance was, but they never spoke honestly and unflinchingly to Claire about her limitations and disabilities. Her teachers, for various reasons including political pressure, behaved the same way. Thus, Claire was never told that it was OK to be different, to fail at certain tasks, to have limits. (Yes, here’s another example of psychological insights sounding hopelessly obvious. [Why psychotherapy?] ) Furthermore, she felt downright crazy which greatly contributed to her tension level. She saw her substandard performance, but everyone else acted like nothing was wrong. She felt like the child in "The Emperor’s New Clothes", but without the belief in her own perceptions. So simply hearing her perceptions of herself stated out loud by an adult was a tremendous relief to her.

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