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This session is no child’s play

In this, the third installment of a four-part series about a severely emotionally disturbed boy, Marcus’ mom joins a therapy session and, trying to teach him empathy, stuns everyone with her own brand of shock therapy.

Kym Barrera spots her son in the doorway of the play therapy room. He wears red shorts and T-shirt and an angry stare. She throws open her arms.

“Hey, baby!” she says, “can I have a hug?”

At Spofford, a residential treatment center for mentally ill children, the play therapy room is where it happens — a thin rectangular room with shelves of toys, a white rocking chair, a dollhouse and beige paint on the walls. Here parents and kids gather hoping for some small miracles that can help them manage their lives.

Marcus, the 6-year-old whose disturbed mind and behaviors have kept him inside Spofford for more than two months, glowers, crosses his arms and turns his back.

Family therapy this afternoon is to help him understand that his stay at Spofford is not punishment. It’s about control, his behavior and choices. It’s also about Kym and Marcus seeing the world through each other’s eyes.

“Do you wanna give mom a hug?” Sarah Thibault, the young Spofford therapist, asks.

Night after night, Miss Sarah has been reading texts and papers at home, searching for insights into Marcus’ condition and clues to help him. More than bipolar and attention deficit hyperactivity disorders, Marcus may also have PDD-NOS — Pervasive Developmental Disorder Not Otherwise Specified, a vague neurological disorder related to autism and Asperger’s syndrome. It may explain some of his behaviors, why he seems oblivious to danger and others’ feelings.

Marcus tightens his mouth, pouts and fixes his gaze on the gray carpet. He says nothing.

“Marcus, come here,” Kym finally says. Her tone is impatient.

Head lowered, Marcus walks and stands contrite in front of his mother.

“Baby, come on,” she says. “I think something’s bothering you. I’m thinking you’re a little bit mad at mama.”

She also thinks: “What am I doing to my boy?”

Marcus feels abandoned; Kym knows that. She knows he feels he’s here because he causes trouble.

It’s the way children think — even those, unlike Marcus, whose parents abuse or neglect them. “Children will always blame themselves,” said Joe Beck, Spofford’s director of therapy services.

But Kym blames herself every day.

A few nights from now, Marcus would call and plead with his mom to take him home. They both begin to cry and can’t stop. She has to tell him no.

“I knew it would set him back to see me so upset.”

By her own account, Kym is “a drill sergeant.” She is hard on Marcus, although she wonders if sometimes she’s too hard.

“I want him prepared for adulthood, for what he’ll face as an adult with handicaps. … No one is going to give him any concessions. No one is going to give him a break, especially not me,” she says.

Kym recounted for Sarah everything she still sees in Marcus when he comes home on weekend passes: kicking, hitting, punching, asking for medication “I’m not kidding, 30 times a day.” “It’s ‘Mama,mama,mama,mama,’ ” she says. “He’s grabbing you and chasing you and pushing you and he’ll scream in your face.”

Kym feels overwhelmed.

Her 5-year-old son, Ricky, suspected of being autistic, is getting worse week by week, losing control of his behavior and his ability to speak. He soils his bed. With all she has to deal with — Marcus, Ricky, doctors, therapists, two other children — Kym has had to leave her gas station job. Adrian, Marcus’ stepdad, a boyish Mexican immigrant with a mild voice and manner, works 12-hour days for a landscape company. When Kym works, he cares for the four kids. They’re running low on money. Rosalyn, the 6-month-old, now has a fever and is developing a soft mass under her armpit.

Inside the therapy room, Kym feels a migraine coming on.

“I was wondering,” Sarah says. “Marcus did such a good job the other day — remember how we played in the sand the other day, Marcus? — I want you guys to work on making pictures of your world.”

She points to two sand trays, one for Marcus and one for Kym, at the center of the room surrounded by bins of toys.

“You can use as many toys as you want,” Sarah says.

“What are you makin’, mama?” Marcus asks. He looks cheery, happy that his mother is here.

“You want to see what goes on in mama’s world every day, Marcus?” Kym says.

In her sand tray, Kym has created a Norman Rockwell family scene with dolls and trolls as people seated around a long table filled with food. At one end there is a treasure chest stacked with the money Kym says she is saving to buy the family its own home.

“Here’s Marcus,” Kym says. She points to one of the figures: an ugly, naked troll.

His smile drops. His eyes look hurt, then angry.

“I hate that,” Marcus says. “It looks stupid.” He storms to the other side of the room.

Sarah urges him to use his “coping skills”: Push on a wall; count to 10 …

Kym’s tone grows tense as she describes her life filled with doctors’ appointments, making dinner, rarely being alone with her husband. The phalanx of state case workers who are “good at giving advice, not really good at listening.”

They harp about her dirty house, tell her to cook better meals, to take showers when the kids are in bed, to watch them more, to bring them in the kitchen when she’s cooking.

“Last time I did that I got second-degree burns down my arms,” she had said.

Still, she feels blessed to have a roof over her head, food on the table and four children and a husband she loves. She’s grateful for the care her boys get and the way the state and feds pay for everything, mostly through Medicaid, even the care at Spofford, which runs about $200 a day.

But Marcus … little Marcus. Will he ever have a normal relationship with kids? Will he ever have a loving relationship with a woman? Will he ever have a normal adulthood?

In therapy, Kym points to the incongruent gray elephant she put at the scene’s center.

“You know what this elephant is? This is my world,” Kym says, her voice tinged with fatigue. “This elephant reminds you that there are always other people around, always little ears, always someone else. … There always seems to be an elephant in the room.”

For a moment, everyone is quiet.

“Do you have any questions, Marcus?” Sarah asks.

Marcus looks at the troll.

“I’m naked,” he says.

They move on to his world.

His bin contains a warthog, a blue cowboy, dolls, three dump trucks, a canoe, a motorcycle, an orange T-rex, a snake and a bulldozer.

“This is my dad,” he says, quiet, sweet and still sad.

Kym leans close.

“… and my brudder and sister …”

Gradually, his face softens, then lightens. He smiles again. As he does, Kym reaches into the sand tray and picks up his toys.

Marcus looks at her — quizzical, momentarily confused.

Kym holds the toys poised above the bin. Marcus stares at them.

In one swift move, Kym plunges and grinds them nose-first into the sand.

Sarah’s eyes widen.

Marcus looks at the toys crammed into the sand. His moaning begins quietly as if far away.

His face collapses, eyes half-shut, in anguish. The sound he makes is barely human, the eerie keening of an air-raid siren.

“Why’d you do thaaaat!”

“Because I wanted to,” Kym says. She is impassive. “Why?” she asks, “Did that make you angry?”

Marcus’ moan grows, but without tears. His face switches from pain to anger. He squeezes his hands into fists.

Sarah can’t believe it. For five minutes, Marcus sat quietly — a huge advancement — he sat quietly and listened as Kym described her world and her frustrations and, then, she literally turned his world upside down.

Sarah knew Kym was going to do something. Earlier Kym told her Marcus didn’t understand empathy, or how much he hurts others when he tips their worlds upside down. She, Kym, wanted him to feel it, to know, to understand how it feels.

Calm then chaos. The therapists at Spofford know Kym cares for and loves her kids, but also they wonder if, in her own way, she is drawn to drama and chaos, creating it, in order to fix it. Kym: prosecutor and savior.

Marcus’ keening grows louder.

“Marcus, Marcus, Marcus,” Sarah says. “Let’s work on saying our feelings. How do you feel right now?”

“Mama made me mad!”

“I’m sorry, Marcus,” Kym says. She is controlled, instructing. “That wasn’t nice of me at all. You know how you sat there and watched mama touch all your stuff and turned it upside down and tried to break ’em? You know how that made you feel angry? Sometimes at home, when you play with all of my stuff, it makes me angry, too.”

Questions race through Sarah’s mind: Was it right for Kym to do what she did just as they were working to understand each other’s worlds?

But this is Marcus’ world. Kym is right in that way. So much of therapy is aimed at teaching mentally and emotionally disturbed kids to find control, to somehow walk the razor’s edge without slipping and to deal with the worlds they are given.

Sarah urges Marcus to refocus, to use his coping skills. He takes deep breaths, but he does not explode. Sarah is proud. He focuses. Slowly, he calms. His fists relax. His breathing slows. Once again, he plops himself in front of his sand tray. Again, he begins. He points out his family: brothers, sisters, dad.

“Is anyone missing?” Sarah asks.

Marcus is silent.

“When you were talking earlier you were saying that you kind of felt like maybe mom and dad abandoned you here. Is that true?” Sarah asks.

Kym interjects.

“There is nothing more that mama wants than to have Marcus back at home,” she says, “and not ever to come back. That’s what I want more than anything.”

“You do?” Marcus says. He looks at his mom.

“Yes, I do. You’re the first baby I ever had.”

“So, Marcus, are you here because your mom and dad hate you?” Sarah asks.

“My mom and dad love me,” he says quietly.

“So much,” Kym says.

“Am I going on pass today?” meaning going home, Marcus asks faintly, hopeful eyes.

“No,” Sarah says. “Not today.”

He looks at the carpet.

As they leave the room, Kym turns to Sarah.

“I noticed he totally left me out of his world,” she says.

Day Three of Four

Top-rate therapy is no guarantee of success. | A9

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