Dr Judith Guedalia

When Sara, Moses and Zvi Banai (not their real names) left my office after their first appointment, they were somewhat "shell-shocked" by what had transpired.  The reason they had come was to get help for their son, Zvi, aged 12 years who had Encopresis and after speaking to me I had entreated Zvi to please, do not stop "leaking" till our next appointment.

Three days later we met again. 

By then I had done some homework and printed out the bracha of Asher Yatzar as well as drawn a "mouth" on a piece of paper.

When they arrived I just spoke to Zvi.  I told him: "I have thought about our visit and the things you said, and I give you a lot of credit."  All six eyes were on me. "Yes," I went on, "you are a very strong and powerful young man."  He showed his arm muscles.  "I know you think I am being sarcastic but I'm serious.  Very few people would be strong enough to do what you do on a day-to-day basis.  I hope I am able to give you some time off and help you out.

"But first I want to say, I know why it is so hard for you to talk about yourself and your problem.  How can the mouth (I point to my picture of the mouth) talk when it is busy saying Asher Yatzar all day long!"

I take out the four copies of the bracha and give one to each of the parties in the room, myself included (http://www.torahtots.com/birchtam/asheryatzar.htm):

"Blessed are You, Hashem, our G-d, King of the universe, Who formed man with wisdom and created within him many openings and many hollows (cavities). It is obvious and known before Your Throne of Glory that if but one of them were to be ruptured or if one of them were to be blocked, it would be impossible to survive and to stand before You (even for a short period of time). Blessed are You, Hashem, Who heals all flesh and acts wondrously."

"Yes, of course your mouth can't talk and speak about the things that are troubling you, it is busy.  It won't be easy, but I am sure, B"H, we can help you out."

"That would be magic!" the father quipped:

"Funny that you say that; but some people may agree with you that I am a 'magician/witch.'" (In Hebrew the word for a female Witch is a VERY uncomplimentary curse word!)  Smiles and snickers from Zvi and an embarrassed look of "got-me" for reading the "shade of aggression" Moses painted into his "that would be magic" comment.

"As a matter of fact I have something I call 'Magic' that will help you out.  But you have to have your parents' permission and help to be able to get the full benefit."

Six eyes with question marks stared at me.

Over the years I have developed a protocol for working with children/families where Encopresis is the presenting problem.  It is a multi-pronged approach using metaphors; changing the nexus of control or agency − of who "owns" the symptom and therefore can "control" IT; by "refocusing" muscles; connecting or re-connecting the "identified patient" with their same sex parent; moving the conversation out of the toilet into a more socially acceptable and less personal room of the house; and a few more cognitive behavioral tools-of-the-trade.

An important aspect of the "whole enchilada" is wearing a "day-liner."  In Hebrew and Yiddish the "day-liner" translates to "something white to keep the whites white" and in 1950's English it would be the same; in today's American vernacular I might say (to boys): "It's Mr. Clean ®."   

"No," I pre-empt the Mom who is especially aghast. "He will never be the husband that 'has' the children.  It is what I call 'Magic' and it will work."

I don't want to give the impression that therapy or psychological interventions are effortless, easy, fast working or even successful.  Hashem and His way, our wonderful Berachot and Halachot are integrated into our personal and professional lives.   I've had many teachers and to just cite two the theoretical and clinical lessons, those of Salvador Minuchin and Milton Ericson are part of the "cholent" that has become my clinical toolbox.

This family helped themselves; they were just more ready to do so than earlier in their lives together. My seemingly laissez faire attitude allowed them to use their energy in a goal-directed and empowering way.  Metaphors are neuropsychologically powerful tools as they engage and enlist many areas of the brain simultaneously.

I met Zvi with his parents three times, and the parents alone, three times. We also spoke on the phone, intermittently.  Within a few weeks the symptom significantly decreased − Zvi was using the Magic and IT was working. At the three month mark, he and his father have "worked-out" together to gain strength and muscles in the "right places"; the parents are instituting clearer boundaries vis a vis "what mouths say"; Zvi has begun to receive specific help in schoolwork and building social skills.  There are still rough spots, but not any of the "other" sort.

Originally published in the Jewish Press on  August 13, 2008.

Tags: Encopresis | Jewish Press | Mr. Clean