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Sister Joan was referred to SLI for severe depression following a car accident eight months earlier. During evaluation, she was diagnosed with Major Depressive Disorder. Her history included harsh treatment by her father and the diagnosis of History of Psychological Abuse in Childhood was indicated. Strong compulsive traits were noted in her tendency to be perfectionistic and avoid mistakes.
Individuals come to SLI with many presenting issues that may initially seem unrelated to trauma. Typically, these include alcohol, depression, anger, and poor relationships.
Increasingly, the mental health field understands many presenting problems of adults as adaptations to an unsafe environment or attempted solution to troubles experienced as children. Survival by adaptation is prioritized over the developmental learning of play, emotional regulation, and relating to others. Addictions can be understood as attempts to self-soothe when relationships are absent or punishing. Depression and anxiety disorders often have a basis in early experiences of terror, rage, and helplessness.
Early in treatment, Sister Joan met with our psychiatrist for a medication evaluation; she started a recommended medication and found this helpful. In therapy groups she seemed very sensitive to criticism and appeared hurt when given feedback, that made giving her feedback very challenging.
Staff noted that Sister Joan related to others easily and was very compassionate, but she had great difficulty tolerating her own mistakes. In exploring her referral issues, the car accident loomed large. She was fearful of driving and had avoided driving since the accident. Her self-esteem seemed very vulnerable, which was why hearing feedback was so difficult for her.
Given the trauma of the car accident and possible earlier developmental trauma related to verbal abuse by her father, Sister Joan was referred for EMDR therapy. The therapy started with psychoeducation about trauma and the brain to build on what she already learned in the treatment program. After assessing her readiness for trauma work and strengthening coping resources, work began on the car accident. It became clear Sister Joan blamed herself for the accident, which undermined her already fragile confidence. In the EMDR processing, her accident-related distress lessened, but remained significant, pointing to earlier contributing experiences.
Sometimes clients recognize that early painful experiences have been traumatic. Often, a child experiences their environment as “normal” no matter how violent and chaotic, and the adult might not identify their background as having lasting influence on them. Psychoeducation helps individuals understand how past events contribute to current problems. The emphasis in trauma therapy is not on the events that happened, but on the implicit learning that came from the events, such as whether the world is a safe place or not and whether relationships will be helpful or hurtful. This unconscious learning is the basis for the individual’s approach to life and relationships.
In exploring earlier times when Sister Joan felt a lack of confidence, she recalled her father’s negative comments when he taught her to drive. “You’re never going to get this right,” and “I’m wasting my time with you” were typical. She also recalled multiple times as a younger child when his criticism stung, and she tried very hard to avoid mistakes. At times she eschewed an activity she wanted to do, like roller skating, to escape his negative judgment.
In the EMDR processing of early memories with her father, Sister Joan was able to comfort her younger self with her adult self’s compassion. She experienced that it was her father’s lack of patience and judgmental style that was the problem and not some defect of hers. This process is different from blaming her father, as her adult self could understand the stresses he carried. What had been missing was understanding and compassion for her younger self.
Going back to the accident after working on the earlier memories, Sister Joan realized there was nothing she could have done to avoid the accident and gradually recovered her confidence as a driver. Work on her difficulty with feedback and making mistakes remained challenging, but with the emotional understanding of why this was hard for her, she was able to accept that mistakes are a normal part of new learning. Her progress was supported by her therapists and community peers, who connected with her more deeply as she became less defensive.
Regardless of their presenting problems, clients at SLI have a great opportunity to develop their ability to manage emotions and to improve relationship skills. These skills are often underdeveloped, since as children dealing with trauma, they had to prioritize survival over learning about themselves. Progress in healing is realized as individuals become less emotionally reactive to present triggers, less defensive, and more open to feedback.
For confidentiality, reasons, names, identifying data, and other details of treatment have been altered.
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