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Powder: therapy notes
Full name: Powder Lane
Age: 12
Presenting Problem: Extreme guilt and self destructive tendencies after accidentally causing an explosion that resulted in the death of her foster siblings (Mylo, Claggor) and grievously injuring her foster father (Vander). He's currently still in the ICU and might not make it. If he were to die, she'd be left with no living relatives, foster or otherwise.
First Session
Had no time to do more than the preliminary assessment. Powder is cooperative and very intelligent, but her case is much more complex than originally expected.
She's showing clear signs of psychosis and is even aware of that fact and admits to hiding symptoms to avoid worrying others. She's also severely depressed and overwhelmed by the situation. She's staying with Silco, a friend of Vander, whom she had barely met before, which only adds to her anxiety and discomfort. “He's not bad, but he looks so scary and cold.” From my experience meeting him, that was a huge understatement.
Conclusions: Psychiatric evaluation urgently necessary, ask legal guardian to keep a record of symptoms and weird behaviors. Set next appointment as soon as possible.
Talk with guardian
Mild success. Flat out rejects medication, wants treatment to be strictly psychological, agreed to a psychiatric evaluation after insisting that she needed to be seen by a doctor to rule out other possible explanations. Might be a problem in the future.
Third Session
Vander is finally out of the induced coma and it all seems to indicate that he will survive. Powder is happy about it, but has a guilt breakdown whenever Silco mentions visiting him. Vander is still too tired and sedated for a proper videocall, but he agreed to do one as soon as he feels capable.
As for Powder, she's becoming more open about her hallucinations since our last session. Their nature seems to remain consistent: mostly her dead brothers or their disembodied voices. Mylo is mean while Claggor's nice but depressing. Sometimes there's hushed voices she doesn't recognize, but that's the extent of it. Powder is fully aware that they are dead, in fact, they often look dead when she sees them. The rest of her perception of reality seems surprisingly intact.
Conclusions: Mending her relationship with Vander could be key to helping her heal quickly. It might be much easier for her to believe her brothers don't resent her in death if she sees that her father doesn't resent her in life.
Call with Vander
Very enlightening. He seems the complete opposite to Silco. Warm, soft and at least four times as wide. He was friends with Powder's parents and adopted her after she was left alone when they died. Powder's mood swings apparently predate the incident, though they were never so frequent or severe. She sometimes did talk to herself or detach herself from reality, but it was within the expected amount for a kid of her age.
Fourth Session
Powder still refuses to visit Vander, but he will be released soon. They moved into Vander's place in the meantime and it seems to be having a positive effect on her.
There's also been a new development in her hallucinations, can't tell yet if it's good or bad. She now sees someone else too, a pink haired girl, she calls her “Vi”. Neither Silco or Vander know of anyone who could fit that description, all seems to indicate she's entirely made up. Powder says she's nice to her and helps her deal with her brothers, cheering Claggor and telling Mylo to “shut up”. She shows up a lot in her drawings, which are still often quite morbid. She's probably just an imaginary friend that she developed as a coping mechanism, but the intensity with which she insists she's real is very unlike her and a bit worrying.
Conclusions: Progress is being made, she needs time. Keep an eye on the imaginary friend in case it's a sign that her psychosis is worsening. See if Vander might be more receptive to medication.
Sixth Session
Progress has stopped completely. She's emotionally quite stable and even happy, but it's because she hallucinates Vi almost constantly. She insists that Vi is real, she even claimed that Vi was in the room with us and laughed when told that we were alone. “Maybe you need to take a better look, she's right there.” It was like she was mocking me for not sharing her delusion.
Her reaction to reminding her she's an only child was much worse. She has doubled down on the idea that Vi is her older sister, saying that she's her only living blood relative and becoming hostile when I tried to subtly help her see the truth. It's like she already knows the truth deep down, but wants to live in delusion.
Vander and Silco are trying their best but are completely overwhelmed. Powder engages with her hallucinations openly, which they find both very unsettling and a source of conflict in school. They have also heard Powder saying worrying things when talking to Vi. She seemed to be replying to Vi wanting to hurt someone, maybe one of her classmates. They say it could also be something innocent, but they are worried that it has happened three times already.
School incident
Vander called to see if the next session could happen sooner. Things have reached a boiling point and Powder is getting constantly bullied in class but also provoking her classmates. Teachers don't want to expell her since she's the victim, but say it might be the only way to actually stop it.
Silco is not helping, he has given up on therapy and pushing for “alternative” remedies. Vander hates going against his wishes (which is weird, Silco is just his friend, right?), but he agrees that we're well past the point where we should try antipsychotics.
Seventh Session
The session happened or regular schedule, a week and a half after Vander rushed to get Powder on medication. It's not looking good. She looks empty and lost. Vander has had arguments with Silco over how it seems to be turning her into a zombie and it's impossible not to agree. It was hard to even get her to talk, which is extremely unlike her. The good part is that she's no longer antagonistic, speaking with Vi out loud or getting into trouble in school, though her academic performance dropped significantly. Vander wanted to stop but I suggested against it. It hurts to see, but it's a necessary evil until the psychiatrist finds the right thing for her.
“The pills are disappearing”
Vander doesn't know how it keeps happening, he even suspected Silco for a while. He says it can't be Powder, that he tried storing them at a friend's place and they still disappear within hours of buying them. It's obviously a lie, he's simply refusing to give his daughter the medication, but I can't blame him seeing her state. I reminded him that it was dangerous to drop dosages suddenly.
Tenth Session (Vander)
The violent mystery friend who beat up Powder's bullies a while ago has made a reappearance and there's now several people confirming that she does look like Powder's imaginary friend and that she goes by Vi, Vander and Silco are yet to see her. The question now is if she is the source of the hallucination or taking advantage of Powder's delusions.
Either way she's a bad influence. A child delinquent that skips school, gets into fights and has a habit of breaking into homes. Vander has called the police several times and even installed a very expensive alarm system, but it's no use. She finds a way to sneak in and Vander often only notices when she already left. It's not Powder helping her from the inside either, Vander came home one day only to find a note from Vi saying that Powder had fallen asleep at Ekko's and would be spending the night.
She hasn't stolen anything so far, but this girl is dangerous, especially because Powder trusts her blindly.
11th Session
This needs to be cut off from its root. We can't help Powder with a bad actor fanning the flames of her psychosis. I spent all the session trying to get as much information from Vi as possible. Powder doesn't even know where she lives or her number. “She always finds me when I need her, she's never far away.” She said it proudly, like Vi stalking her was a sweet thing to do.
It took some effort, but I managed to convince her that I needed to talk to Vi, that just like I sometimes talked to Vander and Silco, I needed to talk to her sister in order to help her. She asked to the air what she thought then said she had agreed.
VI called
That little psychopath called me in the middle of the night. I had already given up, I keep seeing Powder less and less and her guardians seem to be too preoccupied with Vi's antics to remember about therapy. The recent murders are probably not helping either. Still, Vi called, asking for an appointment. I tried to get her full name. “VI is enough.”
She was not how I expected, she didn't sound like a teenage scumbag, but rather serious and polite. Which in retrospect actually tracks with how Powder and others had described her. I should go back and check those notes. She also asked if Powder had to come too or if it could be just the two of us and she sounded oddly cooperative and responsible, to the point that she reminded me of her foster father (Vander).
16th Session
Her insight was priceless. I knew that after our session, but I couldn't grasp the scale of it until I put it in practice. She truly knows Powder like no one else. I've never had a session this seamless in my life, all because she had perfectly predicted how Powder would react and what I should say instead. For the first time since this all started, I feel like Powder is truly happy and healing. She barely even hallucinates anymore.
After today's session, VI was waiting outside to pick her up, just like she has been doing since her sister's first appointment. Powder is lucky to have such a caring older sister.