"Hey Caleb, how are you, kiddo?" Mr. Josh asks with a smile to the young boy as they walk back to his office. Caleb gives the man a small shrug, hugging his arms around himself. He stares at the wooden floor as they walk down the hall. While he kind of likes Mr. Josh, this place is still new and foreign to him. Today, Mr. Josh has on a blue tie- a pocket of deep ocean tucked primly under slate lapels.
Everyone situates themselves in the office, Caleb's mother on the couch, and Mr. Josh in his chair. Caleb plops down on the ground and instantly begins to play with the Legos, already spread out and ready. He builds a starship, Mr. Josh talks, Mom listens.
"So, in Cognitive-Behavioral Therapy, the goal is to change the mindset of the patient and discover how one's thoughts affect their behavior. With Caleb, and with most patients with anxiety, they struggle with their thoughts running rampant. All it takes is one negative thought, and they begin to spiral endlessly- down into darker and darker thoughts, and all too soon, they're so caught up they can't breathe, they can't think clearly; their mind just magnifies those few negative thoughts over and over again," Mr. Josh explains calmly. Caleb's fingers clench a bit more tightly around the 6 by 1 piece he's holding. Six neat shiny plastic circles atop a skinny brick. He rubs his thumb over each of them. One. Two. Three. Four. Five. Six.
"How do you do that, how do you slow down his thinking?" Mom asks.
"Well, there are several methods. The main goal is to slow down the mind and to change those negative thoughts into positive or neutral ones. Slowing down the mind is actually the easy part. However, changing the thought process itself- doing the work at the core of where it all starts takes much longer," Mr. Josh answers confidently. He uses his hands to gesticulate a few motions, all very professional.
"What are some of those methods?" Caleb's mother asks, furrowing her brows. She leans forward, hands clutching her purse tightly as she stares at the therapist. She wants answers, she needs answers, so she can fix Caleb, so her little boy won't cry anymore.
"Well, breathwork, meditation, identification of negative thoughts, and identification of unhelpful thinking styles are some of the things we can do right now to combat this. I also have some suspicions that he may have a high-functioning form of autism, which would explain why sounds and fast images overwhelm him. There is more that I can discuss in greater detail with you both later, but for now, would you please wait in the lobby, Mrs. Weaver? I want to chat with Caleb a bit," Mr. Josh answers with a polite, gentle smile. Caleb glances up at his mom before turning his attention back to his starship, continuing to build. He's perfectly fine with her leaving- Mr. Josh is nice, and they get to play Legos.
His mother nods and grabs her purse, standing. With a gentle ruffle of her son's black curls, she heads out of the room, gently closing the door behind herself with a soft click.
"How are things going with the clicker, Caleb?" Mr. Josh asks as he moves to sit on the floor, beginning to build with Caleb. The boy's free hand moves to his pocket, ensuring the precious item is still there.
"Good. Mommy showed me how to use it when we got back to the house," he replies as he adds laser-shooters to the wings of his ship.
"How did she show you?"
"Luke was mad at me 'cause I made him late for swim practice, and he was arguing with Mommy, and I couldn't breathe, and she helped me calm down, and she talked to me, and she told me to look for stuff, and I found a thing every time I pressed the button."
"That's very good, did you look for shapes, colors, numbers…?" Mr. Josh prompts as he connects a few bricks together.
"Shapes and colors. No numbers around," Caleb answers calmly, adding on a pilot capsule, so the pilot isn't exposed to outer space.
"So, let's rewind a bit, you said Luke was mad at you because you made him late for practice? How?" Mr. Josh queries, erecting a completed wall of his fortress.
There's a pregnant pause, and Caleb turns the starship over and over in his hands.
"'Cause I had to come to therapy, so by the time we got back, he was late to practice."
"And how is that your fault?"
"I went to therapy?" Caleb replies, his brows furrowing, and his lip pursing.
"Yes, you did come to therapy, but it's not your fault that it went a bit over time, and it's not your fault that you needed to come to therapy; just like it's not your fault that the only available time slot kind of conflicted with Luke's practice. At that moment in time, were you in control of any of those things?"
It's quiet for a long moment.
"I shouldn't have needed to come," Caleb decides, accidentally breaking off a wing of his starship when he squeezes too hard. The lines of his forehead deepen with distress over the setback, and he focuses on that for a moment.
"Not necessarily. A lot of people come to therapy. For a lot of people, it's just as important as sleeping, eating, drinking, and all that, for a very long time. Because I'm going to give you some tools so that you can control your panic attacks, and you can control how you feel. Needing help to become a better person is something everyone needs," Mr. Josh says gently, looking over at the small boy.
"You can't control feelings. Things just happen," Caleb states succinctly, leaning forward and digging for a specific lego piece.
"Mmm, I'm gonna have to disagree with you on that one, Caleb. I think you can control how you feel, and it's all a matter of perspective and your thoughts about something. If you can control what you're thinking, then you can control what you're feeling," Mr. Josh replies. He leans over and hands Caleb a black four by four, seeing the boy needs one for the structural stability of his starship.
"But… you can't control what you're thinking. That's just… you," Caleb dissents, the little boy's lips descending to a frown of frustration as he looks up at Mr. Josh for a moment- before looking back down. He adds the piece to his ship, only to press too hard and have part of the wing break off again.
"Actually, Caleb, you can. Because your thoughts are not you. Think about it. When you get sad and think something bad about yourself, are you actually that thing? If you think to yourself that you're stupid during a panic attack, are you actually stupid? Because what I see is a bright, smart kid in front of me who's thinking about some really big things right now," Mr. Josh says gently. Caleb stares at the ground, frowning and thinking. Why does Mr. Josh think he's smart? All Caleb does is sit and cry all day. He thinks about stupid stuff too. Nobody else has to think about how to breathe. Everyone just knows how to do that. He doesn't notice his hands, crushing the starship in his palms, reducing it to rubble in his stress.
"Does that make sense?" Mr. Josh questions gently after a small moment of patient silence.
Caleb shakes his head and dumps the broken starship on the table.