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From the desk of

DR. JENNIFER CASEMIRO, M.D.

596 WEST 72^ND STREET, NY 10021

March 15, 2018

Dear Paul and Kimberley,

Further to our call yesterday, please find below my assessment of my first month working with Matthew. Please be assured that I understand your concerns about what you perceive to be a lack of visible progress – I can only attempt to reassure you that such progress rarely occurs at the speed you are (understandably) hoping for and, in my experience, its absence does not signify anything more significant than the issues of trust-building and boundary-testing that are common to the early stages of a professional relationship of this type.

Matthew possesses high levels of intelligence and awareness, and has made it clear that he is unwilling to work with me on the issues for which he was referred. Despite that, I believe significant progress has in fact been made.

His initial statements were that he did not want to talk to me, and that he considered my attempts to induce him to do so to be a violation of his human rights. This grand language is not unusual, especially in teenagers of Matthew’s intelligence. It is a common form of diversion, in which he avoids the issue of why he doesn’t want to talk to me by expanding our conversation to a point of general absurdity, in this case the issue of human rights.

In the last week or so, Matthew’s objections to working with me have changed. He no longer states that he does not want to – he has now repeatedly stated that he does not see any point in doing so. This marks a significant shift, in my experience. He has moved past a dogmatic refusal to talk to me, and has moved onto a more personal objection, i.e. that he does not believe I can help him with what he perceives to be a medical issue. This, although it may not seem so to you, is progress. It suggests a willingness to engage with our process, provided that I can convince him of its potential usefulness. This is what I have focused on during our last two sessions.

As you know, I have asked him to keep a diary. He has apparently done so – he has shown me the pages he has written, although I (obviously) cannot guarantee that he is taking it seriously – although it is clear that he resents it. We have discussed it, however, and those conversations have been illuminating.

Persistent refusal to engage requires a level of self-control that few teenagers possess, and even Matthew, who is both intelligent and unquestionably composed, is not able to neuter his speech entirely. Our conversations have revealed the frustrations and doubts that are entirely common to this period of late adolescence, the period in which most teenagers find themselves caught between the desire to be in charge of themselves and the unavoidable reality of the rules and restrictions that come with living at home.

He makes several references to his belief that you will be disappointed in him if he chooses any career other than the law, so much so that he believes you would actually prevent it by refusing to pay for college tuition in any other field. I do not know whether this is something that you have ever made explicitly clear to him, but it has become a deeply-held belief. I suggest that you discuss this with each other, and then with him.

I am also convinced that his frustration and worry are at least partly responsible for the issue for which you referred him to my practice, i.e. recurrent nightmares and sleeplessness. This is the central issue that I will continue to focus our sessions on.

I hope this sets your mind at rest. There are no reliable timetables for the work that I do, and while I know from long experience that this can be frustrating, I would ask you to allow the process to continue. I can assure you that we are making progress, even if you are currently struggling to see it.

Yours sincerely,

Jennifer Casemiro, M.D.