Jane arrived at her therapist, Liz Bartlett’s, office about ten minutes early. She was nervous. It was her first appointment since she had gotten angry and walked out in the middle of her session. Now that she was calmer and had had a few weeks to think about what happened, she felt a little silly about the whole situation.
Nearly eight months before, in November, Jane and her mother had been hit by a drunk driver. While Jane escaped with relatively minor injuries, her mom had not been so lucky. The crash took her life and left Jane floundering. She began having nightmares several times a week, which quickly turned into having nightmares almost every night. Then the flashbacks started. Before she knew it, she was having nightmares and flashbacks nearly every day.
And though Jane had begun going to therapy with Liz twice a week in March, she couldn’t bring herself to open up and trust anyone. She felt like she couldn’t talk to anyone about the accident, so she told everyone she was fine and tried to move on, burying her pain in the past. Finally though, after several months, Liz had told her that she (Liz) knew that Jane was not fine. Jane’s temper had exploded. She had walked out of her session and refused to return.
Looking back on the scene now, Jane knew that she had blown the whole thing out of proportion. She felt silly for not realizing that it would be obvious to Liz that she was not fine, especially since Liz was also counseling Jane’s father.
Finally, Liz came into the lobby and walked Jane back to her office. She waited until they were settled in their usual places with their cups of tea before smiling warmly at Jane and saying, “So, how are things?”
“Better, I think,” Jane said. She knew she needed to apologize and she wanted to get it out of the way as quickly as possible, so she just blurted it out. “Liz, I’m really sorry I ran out of our last session. I was scared and I didn’t know what to do. I didn’t really mean what I said to you.”
Liz nodded sympathetically. “Pain and fear can make you do a lot of things. Apology accepted. You know, I was thinking that it might help you trust me if you knew a little more about my background. Like I told you during our first meeting, I help people work through grief in a safe and productive way. But what I didn’t tell you was that the whole reason I chose to go into counseling was that I lost my mom when I was seventeen. She died of breast cancer. It was a slow, painful death and we all knew it was coming. After her death, I ended up doing some of the same things you did to cope. I shut everyone out. I broke off friendships. I started cutting myself. Before too long, I started drinking and doing drugs. Then I ran away from home.”
Jane nodded and Liz continued. “To make a long story short, I spent several years living a shadow life, always drunk or high on drugs to mask the pain. Finally, I decided that life just wasn’t worth it, and I overdosed on prescription pain pills. Luckily, my roommate came home early and found me and called nine-one-one. While I was in the hospital, I ended up talking to a therapist who specialized as a grief counselor. Since I had nothing left to lose, I opened up and started talking to her about my mom’s death and everything that had happened since. That counselor saved my life. Over the next few years, she helped me get sober and deal with all the feelings that I had been bottling up inside. When I was finally able to think about the future, I decided to go into counseling to help other people who had gone through trauma.” She paused for a moment and Jane thought about what she had said.
“Can I ask you a question about your past?”
“Please,” Liz said.
“After your mom died, did you ever get nightmares or flashbacks?”
“I used to have dreams where she would be alive. It was really hard when I would wake up and have to face the fact that she was gone. It was like having to relive her death every time I dreamed about her. That was a large part of why I did drugs and drank. When I was high or drunk, I didn’t dream. The drugs shut my mind off and let me rest.”
“Well, I get bad dreams about the accident. Sometimes, it’s like I’m reliving that day. Other times, I’ve had dreams where she’s at our house but I can never actually catch up to her. Like, I’ll catch a glimpse of her going around a corner or hear her in the next room, but as soon as I get there, she’s gone or the dream ends. The dreams get pretty bad sometimes, but I think what’s even worse is that a couple of months ago, I started having flashbacks when I’m awake. I’ll be just going about my business and all of the sudden, boom, I’m reliving the accident and it’s so real and strong that it’s like I’m hopping through time or something. And the flashbacks are always about the accident. A couple of times, I’ve even remembered some new details. And as soon as the flashback ends my chest gets really tight so it’s hard to breathe and my heart starts pounding really hard and fast. I can’t control it.”
Liz nodded and sat quietly for a while. Finally, she spoke. “Have you ever heard of PTSD?”
“I think on the news. Isn’t that what veterans get when they come back from Iraq?”
“Well, a lot of veterans are diagnosed with PTSD after going to war because war is very traumatic. But anyone can get PTSD. The acronym stands for post-traumatic stress disorder and it happens when you’ve lived through a life-threatening experience, like a car accident or a natural disaster. Most people who are diagnosed with PTSD have symptoms like yours. They have nightmares and flashbacks. They avoid talking about the event that traumatized them. It’s very common for people living with PTSD to isolate themselves and try to deal with the problem alone. Sound familiar?” Liz paused and let Jane absorb the information.
“Do you really think I have PTSD?”
Liz smiled kindly. “Well, it’s a little early to diagnose you. But you do have a lot of the symptoms. In particular, what really makes me think that it may be affecting you are the flashbacks. That’s a classic PTSD symptom. You said that when you have a flashback, it’s like you’re re-experiencing the accident?”
“Yeah. It’s like, I’ll see something that has a connection with that day and suddenly, I’m right back there. And it’s little things, like seeing a carton of eggs in the fridge or hearing someone’s tires screech.”
“So there are triggers that cause the flashbacks.”
Jane nodded. She hadn’t actually thought about naming the things that caused her flashbacks, but now that Liz brought it up, trigger seemed like an appropriate word.
“Can you tell me more about how you feel after a flashback?” Liz asked. “You said that your heart races and it’s hard to breathe?”
“Yeah. My heart beats really hard and fast and it feels like there’s a steel band squeezing my chest. And the only way I can calm down is to sit down and kind of rock back and forth until it stops.”
Liz nodded and jotted a few notes on her yellow legal pad. “Well, I think we’ve got our work cut out for us. One thing we can do immediately is to start working on some coping strategies for when you get flashbacks.”
“Well, there are a number of things. It sounds like you’re having panic attacks after your flashbacks, so let’s talk about some ways to calm yourself down. Some of the easiest calming techniques to learn are breathing techniques. There’s one that I really like because it’s simple and easy to learn. Basically, you find a quiet place and begin counting with each breath. Count to four as you breathe in. Count to four while you hold that breath. Count to four as you exhale, and then count to four again before taking your next breath. Just focus on the counting and breathing, and try to dismiss other thoughts that come into your mind.”
“That sounds so simple,” Jane said. “How does it make you calm down?”
“Well, part of it is distraction. If you occupy your mind with counting and breathing, it doesn’t have time to freak out about the flashback. Human brains don’t really multitask that well. Also, doing some measured, regular breathing is very calming in general, so it can help bring your heart rate down.”
“That sounds like something that could help during competitions,” Jane said.
Liz nodded. “I'd believe it. It's a technique that a lot of people use to stay calm.”
They were silent for a while. “We've got about 20 minutes left,” Liz said. “Why don't I show you a couple more breathing techniques so you can try out a few and see which ones work best?”
Jane nodded and Liz began showing her different ways of controlling her breath.
“How do you feel?” Liz asked when she was finished teaching Jane the last exercise.
“I feel pretty good. It's like I finally have something that can help me deal with all these flashbacks and dreams. Before, I was just scared and I didn't know what was happening. You know, like, I thought I was going crazy.”
“You're not going crazy,” Liz assured, smiling. “Try out those breathing techniques over the next few days. You'll know pretty quickly which ones are the best for you.”
Jane got up to leave but paused at the door. “Liz?”
“Thank you. For understanding about last time.”
Liz smiled her kind smile and squeezed Jane's shoulder. “You're very welcome.”