Psychotherapy For The Gifted
Jerald Grobman M.D.
Madelon Sann L.C.S.W.

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Case Study: Therapy of a Gifted, Entitled 5-year-old child – Isabella

The case of Isabella addresses the concerns that many parents of gifted children have about how much freedom or direction to give their gifted child. This particular case shows how too much freedom can prevent the development of frustration tolerance and in this way undermine the full development of the child’s gifted potential. It also illustrates how a parental philosophy of upbringing can be influenced by the parent’s own past experiences: Isabella’s parents experienced too much parental control, so their parenting style became one of too much freedom.

Presenting Problem: Arrogant Attitudes and Behavior

In School

Isabella was a precocious 4-year-old when she was referred for therapy by her preschool teachers because her bossy stubborn behavior was getting her rejected by her classmates. She was a bright, strong-willed, demanding, and competitive little girl who insisted on playing in the block-building area with the boys, refused to enter the housekeeping area to play with the girls, and wound up being rejected by both groups of children.

At Home

Isabella’s parents were not only concerned about their daughter’s difficulty making friends in school and her refusal to comply with the teacher’s requests, but they were also worried about her refusal to embrace age-appropriate developmental tasks at home. Although Isabella was toilet trained she was afraid to go to the bathroom alone and insisted that someone be there to wipe her bottom. At bedtime, she insisted that one of her parents be with her until she fell asleep. Once asleep, however, Isabella couldn’t get through the night without crawling into her parents’ bed. Isabella had no girlfriends in school and no play dates outside of school. The only interactions she had with her classmates, were limited to parallel play (as opposed to interactive play). Given her very superior intelligence, her parents didn’t know how to account for the lack of friendships and lag in her development.

Parents’ History

Both of Isabella’s intelligent, well-meaning parents were brought up in socially prominent political families. Although physically present, their parents were emotionally distant people who had inflexible, perfectionistic standards and were preoccupied with advancing their careers. As children, Isabella’s parents had to comply with many exacting rules in order for their behavior to be deemed ‘acceptable’. They felt powerless as children. As they got older, they felt that this rigid style of upbringing did little to promote the use of their intelligence, encourage their creativity, or allow them to have fun.

Developmental History

When they discovered that Isabella taught herself to read at 3 years of age, they were determined not to inhibit her precocious intelligence. In addition, Isabella’s parents were determined not to repeat attitudes and behaviors that restricted their own growth and development. Unfortunately, this meant that whenever Isabella should have been moving ahead developmentally, her parents protected her from the pain of these struggles and let her retreat into being ’babied’ like her one-year-old brother.

As a result, Isabella had limited frustration tolerance. She was exceptionally bright, very verbal, and could easily subvert most of her parent’s requests with debates and refusals. When all else failed she got her way with temper outbursts or legalistic arguments. At four years of age, she had managed to derail her parents’ appropriate developmental expectations for toileting, sleeping in her own bed throughout the night, and dressing like a little girl…

By not insisting that she act her age, Isabella’s well-meaning parents had inadvertently given their daughter a ‘green light’ to remain entitled and immature. Superficially, she behaved as if she really enjoyed deciding on the meals she would eat, the clothes she would wear, and what she would choose to do over the weekends. Beneath this façade, however, she was a little girl afraid of the dark, afraid of playing alone, and afraid of making friends. Although she loved books, she was also afraid of reading alone.

Beginning of Therapy

I began my therapeutic work with Isabella several months before she started kindergarten in a new school. My mandate was to help Isabella give up her bossy behavior in school and become more independent at home. This meant helping Isabella face the frustrations of moving ahead developmentally: wiping her own bottom, sleeping throughout the night in her own bed, and taking on age-appropriate academic artistic, and athletic challenges. In the first few months of therapy, it became clear that this mandate would be tough to fulfill; Isabella was used to ‘calling the shots’.

Frequent consultations with her kindergarten teachers indicated that her behavior in class was haughty and condescending. If she didn’t like requests made by either the teachers or her classmates she would simply turn her back and not respond. These school contacts were essential for me to be able to assess what was really happening day to day.

Isabella loved reading and was in the most advanced reading group. Science and math were new subjects for her and mastery of them required intellectual focus and practice. Isabella side-stepped learning them by claiming she was’ bored.’ Similarly, although she seemed to have an innate talent for gymnastics, budding artistic abilities, and was talented in acting and singing she tended to inflate her accomplishments feeling no need to improve and rebel against practicing anything.

The same arrogant attitude existed in her therapy sessions: she would come into my office, announce what game we would play, and cheat if she wasn’t winning. If I asked her why she needed to win so badly or offered some suggestions about her behavior she refused to acknowledge that I had even spoken.

The first six months of therapy with Isabella consisted largely of playing board games (which she had to win), and her dodging any of my attempts to discuss school, weekend activities, or feelings about anything. She came to her sessions in a neutral mood and kept me at arm’s length refusing/unable to establish a friendly rapport.

Therapy Progresses

It was only toward the end of the school year, that Isabella began to reveal some feelings. She told me that she felt she was falling behind in her classes. She expected herself to master new subjects effortlessly in the same way she had mastered learning to read. When answers to problems and questions didn’t come easily or when the boys in her class figured out answers to math problems faster than she could, she felt incensed, angry, and dumb… I offered to discuss her worry about math with her teacher to see if she was ‘on track’ or needed some extra work. Her teacher was actually surprised at Isabella’s reactions because she was doing very well in all her courses and was ahead of many of the other gifted students in her class. I shared this information with Isabella to highlight the discrepancy between her actual performance and her feelings of inferiority but she was not reassured.

As our work proceeded, and Isabella felt understood when she brought up her worries, she needed to control me and our sessions less. In one of our later sessions before the summer break, she tearfully acknowledged that she was terribly lonely because the other children didn’t like her. When I asked her “why she thought the other children didn’t like her”, Isabella had no idea. I shared her teacher‘s observation that the other children felt hurt when she turned her back on them or didn’t respond when they spoke to her. I was also able to enlarge on this issue by pointing out that she often treated me the same way, but as an adult and a therapist, I knew there had to be a reason for this behavior and it was part of our work together to find out what that could be. Unlike her classmates I didn’t take it personally nor were my feelings hurt, it was however something we needed to understand. Slowly it began to dawn on Isabella why the other children were rejecting her.

By tentatively letting me see how hurt she was, Isabella seemed to be cautiously reaching out for my help. This marked a turning point in her therapy because she now seemed ready to listen to what I had to say instead of blocking me out.

During the summer between kindergarten and first grade, Isabella attended day camp where her social experiences were quite similar to those in school. On the homefront, however, there were significant changes: Isabella no longer needed help in the bathroom and she could usually sleep in her own bed throughout the night. Her pride in her own growth replaced some of the pleasure she had derived from being able to control her parents, schoolmates, and me.

After we resumed therapy in the fall, board games slowly gave way to drawing during which we could have discussions about her interactions with peers or the occasional playdate. Now we could actually talk about why Isabella needed to control social situations. She was able to discuss her fears that she would become ‘a slave‘ to the other children’s wills (much as she had made her younger brother a ‘slave’ to her will). I pointed out to her that she seemed quite conflicted about relationships: although she wanted to have friends, she still wanted to have her own way and was reluctant to engage in the give-and-take that friendships require.

As Isabella became aware that she had never developed the negotiating skills required for friendships, I helped her to see that her arrogant and condescending attitudes were a cover for her deep sense of helplessness and vulnerability. Fears of becoming a ‘lackey’ to her peers resulted in her either rejecting or bossing them.

This awareness was accompanied by a major change in her attitude and behavior. Isabella was able to talk more in therapy, She was more receptive to learning new subjects and generally more cooperative with her teachers. Her general arrogance and bossiness diminished – as a result, her new classmates became friendlier and began to invite her on playdates.


My work with Isabella illustrates the special methods and benefits of using a psychodynamic approach to enhance cognitive-behavioral techniques for the assessment and therapy of gifted children and guidance for their parents.

Establishing the Family Context for Isabella’s Difficulties.

Because Isabella’s assessment clarified details of the family’s history and their present lives, the underlying origins of her problems could be uncovered, understood, and addressed. This meant that Isabella was not simply diagnosed as a gifted child with an ‘oppositional defiant disorder’. Nor was treatment prescribed that would focus exclusively on behavior modification and ‘reframing negative thinking’.

Isabella’s parents revealed that as children they were subjected to harsh, rigid standards and punished for minor infractions. This meant that their overall development was stifled and the development of their gifted potential was not promoted. Reacting to this damaging and repressive aspect of their own upbringing, Isabella’s parents developed a laissez-faire approach to bringing her up. They inaccurately assumed that her giftedness would result in creativity and maturity. They did not have firm expectations for Isabella’s age-appropriate developmental tasks: taking care of her own bathroom needs, sleeping through the night in her own bed, and engaging in the give-and-take required of friendships. Furthermore, this casual approach did not encourage Isabella to develop her gifted potential beyond her precocious ability to read and write.

Instead of her parents confronting her resistance to moving from one developmental stage to the next regardless of the battles that this would undoubtedly entail, Isabella’s parents allowed her to avoid and act out. This permitted Isabella to deny that she was lonely, to persist in playing games with her own rules, and to demand that she be given what she needed rather than earn it. Isabella also used her giftedness to protect herself emotionally by remaining isolated in the private world of her books where she was in total control. Sadly Isabella’s fear of facing her developmental anxieties and a tendency to avoid pushing herself kept her from making friends and expanding her intellectual interests.

Therapeutic Work With the Parents

Regular guidance sessions with Isabella’s parents helped them understand that even though gifted children need the freedom to be creative and develop their own interests, they also require parental push when they are too afraid to move ahead. I empathized with them about how difficult this process would be, particularly in light of their desire to give Isabella much more freedom than they had.

To deal with the sleep problem I helped Isabella’s parents distinguish between what was necessary limit setting and what they feared might be unnecessary cruelty and rigid repression. I explained that by insisting that Isabella not come into their bed in the middle of the night would help Isabella develop her own methods for dealing with her nighttime anxieties. This is a painful but necessary process for all parents who want to help their children develop frustration tolerance and independence as well as their gifted endowment. A milestone in the parent guidance sessions occurred when they realized that their reluctance to have Isabella master some of her own developmental anxieties actually gave her permission to use these anxieties to control and intimidate them. Now they felt sufficiently fortified to stand up to Isabella’s temper tantrums, legalistic arguments and ‘deals’. In time, her parents began to see the benefit of their hard work when Isabella began to manage her nighttime anxieties and become more courageous intellectually and socially.

Consultation With Teachers

Initially, because of Isabella’s demanding, haughty behavior, it was difficult for her teachers to understand that she was not simply another entitled gifted child. When I explained that Isabella’s difficult attitude and behavior were her ways of acting out unresolved internal issues and explained that her parents were also struggling to help her develop age-appropriate frustration tolerance her teachers became more empathic. They then could teach to her intellectual strengths instead of simply setting limits. I expected that this strategy would permit her emotional growth to catch up to her advancing intellectual abilities. It also helped the teachers to know that I was actively working with her parents so we could function as a team.

It was gratifying for everyone to see Isabella slowly apply herself to the new challenges. By the middle of first grade, she could use her laser-sharp intellect to advance in math and science. She became less oppositional with teachers, less rejecting of the other children, and more open to their invitations for friendship.

Isabella’s Therapy

A key factor in my therapy with Isabella was the need to create an accepting environment where her obnoxious behavior could be permitted and understood although not condoned. She resisted me, as she had resisted her teachers and peers with everything at her disposal: she cheated at games, went selectively deaf, turned her back on me, and was downright rude. Throughout all of this, however, she never threatened to leave treatment. Somewhere, Isabella knew that the pain of confronting these issues with me was less than the pain she was exposed to at school. This was a difficult process for me as well. I had to find a way to get beyond her defenses without being harsh and cruel. Working closely with the parents and providing a united front gave me a chance to crack Isabella’s defenses. I tried to align myself with the Isabella she wished she was ( smart, popular) and tried to help her understand how she could become that Isabella.

As a gifted child, she intuitively knew she was expected to talk about her feelings and thoughts in therapy and that therapy was also an interpersonal process. However not only was Isabella reluctant to discuss what she called the “private contents “of her mind. She kept me at arm’s length for many months in many ways: demandingness, silent competitions during our games, and refusing to address me, as she did her teachers, by my first name. I used this element of our relationship to wonder whether she was afraid to get close to me and her classmates.

Our therapeutic alliance strengthened around our interactions with board games where Isabella could usually win, even if not legitimately. Although she liked winning, she and I both knew, however, that she didn’t win honestly. Slowly, she realized that she was not only cheating me, but she was also cheating herself out of the excitement of winning legitimately and the pleasure and pride that are earned with real success.

Isabella’s imperious, arrogant behavior persisted because she had never had to comply with the norms of appropriate social interactions. Although Isabella had been permitted to use her narcissistic entitled behavior, to control her parents and her brother, she was called up short when her teachers and her classmates refused to accept it. This threw her into a conflict: she wanted to hold on to her controlling and rejecting behavior but she wanted friends as well. This conflict became the major focus of the later stages of our therapeutic work.

Board games continued to be requested at the beginning of sessions, but now they rarely were played Little by little she began to share ’the contents of her mind’. Initially, while she only saw friendship in terms of dominance and submission- master and slave, smart and stupid, big and small – I took many opportunities to point out that relationships had more to them than power dynamics. She slowly began to see me as an ally: someone who could help her understand the complexities of relationships and how other kids thought and felt. She played less and less and used our time together to talk about real current events in class and at home.

It was obvious our therapeutic alliance deepened: she and I had become a team working to overcome her fears and worries about relationships and school.

After two years of therapy, Isabella has a better understanding of her conflicting feelings and thoughts and is better equipped to resolve them. This has given her more control over her arrogant behavior. Her terrible feelings of intellectual inferiority have given way to a sense of real intellectual strength as she has faced up to intellectual challenges. As a result of all of these advances, she has been able to modify some of the old ways she thought about relationships and the process of learning. She now has the beginnings of real friendships, genuine pride in her academic work less tumultuous home life.

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Jerald Grobman M.D.

Madelon Sann L.C.S.W.​

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