Relentless (Elisabeth Reinhardt Book 1) (5 page)

“Sorry you had to wait so long,” Elisabeth Reinhardt said, as she opened her office door. It was 7pm and ordinarily she would be headed home, but Gina had been so frantic, she had just told her to come
in. Gina had been sitting in the Starbucks across the street, watching the Bank Building, drinking lattes and fiddling with her blackberry since 2:45. She didn’t care. She had to be here. She had to see her therapist. She had to sort this out. A whole new memory had come up and it scared her to death. In her mind, she saw herself covered with blood and running for her life. She saw men with blood on them chasing her. She couldn’t remember what had happened before that memory in the woods. Why was she covered with blood? What had she been running away from? Why had they been yelling at her? Had she hurt someone? What went on back then? Saying she was ‘coming down with something,’ she had left the hospital and with shaking fingers dialed a number from memory. “I need to see you, something just happened and I don’t understand it,” she said urgently into the message machine. “Please call me back as soon as you can, okay? I really need your help. I think I’m in big trouble.”

Since leaving the hospital assorted fragments
of memory flooded her mind. She remembered the inside of a little chicken coop, the smell and sound of the chickens, bright sunlight, broken eggs, being grabbed and carried roughly through the woods. She remembered pain. She remembered terror.  She remembered wanting to run, struggling to get free and she knowing she was going to die.

Dr. Reinhardt
had seen Gina as she left the Starbucks and crossed the street for her appointment. She knew that that this could be a turning point in her recovery process. Gina was very secretive about her past. That wasn’t unusual. Many trauma survivors lived their lives in silence. ‘Don’t ever tell anyone!’ was the abusers’ threat. So it was not unusual for the therapist to be the first person to hear their patients’ secrets. But there was something else going on here.

Several
weeks before, Gina had been recalling a fairly innocuous story about a time when her older sister called upstairs to ask her sisters to come down and help shuck the corn. She remembered hearing her sister call, “Come on you two! Patty Sue, Re …” and then she had stopped with a stunned look on her face.

Dr. Reinhardt waited a beat then repeated, “Come on you two! Patty Sue…. Re…”

Nothing... The therapist cocked her head, “Patty Sue .... Re…,” she prompted again looking at her patient.

Gina finally raised her eyes and said… “Ah
, Gina.”

“What did your sister call you? What was the name you just stumbled on?” she asked.

“It’s nothing,” Gina had said touchily, “forget it.”

“What is it Gina
? What are you not telling me?” the therapist asked, “Was there some other name, a nickname perhaps?”

Nothing...

After a few minutes the therapist said, “It’s not the name that’s important, but the fact that you feel you can’t tell me about it, now that’s important.”

“
You don’t understand, it’s not that simple,” Gina murmured.

“Okay, set me straight,” Dr. Reinhardt
had replied.

“Can’t we just move on?” Gina asked.

“I’m afraid not. Not now,” the therapist had said. “Now we have this giant, unspoken secret between us. That has to be resolved not ignored.”

“Okay,”
Gina had said, “How about for now we say I used to have a different name, not the one I have now. But, I’m not ready to tell it to you yet, and I’m not ready to tell you why. It’s too soon. Can we leave it at that? Please? Can I just tell you when I’m ready?”

“Not really,” the therapist
had responded. “While I respect your decision about what to say and when and I don’t need you tell me your, I’m assuming here, real name, I do need you to tell me why you have a different name now.”

There was a long silence and Gina said, “I went into a kind of witness protection thing, not exactly but sort of. Can that be enough for now?”

Dr. Reinhardt remembered pausing a moment then nodding her assent, “For now,” she had said.

Now she greeted an anxious Gina at the door, “Come in,” she said,
“tell me what happened that’s gotten you so upset.”

Gina began a breathless,
disordered account of the nightmare and blood and being in the OR and rushing out of the room and worrying that people knew she was freaked out. Dr. Reinhardt urged her to slow down and take a couple of deep breaths while she made them some herbal tea. When Gina was settled and calmer, taking small sips from a floral mug, Dr. Reinhardt led her through a brief retelling of recent events. Then she said, “We have some decisions to make about how best to use our time tonight. 
First
, there are some practical concerns; you need some strategies to manage situations that may come up while you are at work.
Second
, your nightmare triggered a series of traumatic memories and they need to be unraveled, examined and processed, not re-dissociated. Can you say how much of what happened during that series of events you have conscious memory about?”

“I don’t know if I remember it all but it seems to be coming back to me, like a flooding river.”

“OK, well we don’t want a flood so let’s come up with some ways to prevent a flood while we are letting the memory unfold for you,” said the therapist. “We need to understand what happened to you and how that fits into the context of your life. Does all of that make sense to you?”

Gina nodded slowly and said,
“I understand what you said. It seems overwhelming. I can’t afford to get out of control at work. If we start digging things up am I going to get worse? Am I going to start acting crazy at the hospital? I can’t afford to lose my job! What will I do if I’m not a doctor?” She began to cry. Softly at first, then the tears erupted into full sobs.

The therapist sat with her saying nothing at first, then in a soft, soothing voice repeated,
“Okay, so that leads us to the first question, the practical management of your symptoms at work.”

“Do you think I can do this?”
Gina looked up anxiously.

Dr. Reinhardt looked at her solemnly and asked,
“Is there some reason you think you can’t?” 

Gina hesitat
ed and looked down at her feet then looking up into her therapist’s face, she smiled slightly and said, “I don’t know but I have to try. Let’s go ahead.”

“You asked some questions a few minutes ago. Let me address some of them. You are right. You can’t afford to get out of control at work. But you do need to do this
recovery work. Memories are coming up and they have to be dealt with. They won’t just disappear. If you can’t take a brief leave of absence, we’ll work out some strategies to help you manage at work. Sometimes working on traumatic material can make a person feel worse for a time. When new traumatic memories trigger other memories, thoughts and feelings they can cascade and that is a lot to handle. I’ll be teaching you some coping techniques and there are some good books I will suggest that will help you understand and cope with your symptoms. Sometimes medication can help. We’ll have to evaluate carefully as we go along. The main techniques to master at this point have to do with grounding- being physically present in the moment, re-orientation to the present to things around you and containment of the traumatic material.” The next fifteen minutes were spent discussing and practicing those techniques. Then they were ready to move on.

“Before we get started on this, we should start with a little family history, so I’ll be familiar with who’s who and I won’t interrupt you to explain things. Okay? So if you can tell me who was in your family, names, and ages and so forth that would be a good place to start,” Dr. Reinhardt said reaching for her notebook. Gina
looked at her for a long time. They both knew she was referring to the time when she had refused to talk about her name or discuss her family of origin before.

Gina sighed and looked at her hands folded on her lap. “I guess I have to,” she said resignedly
, clearly dreading this topic.
I’ll just zip through it quickly and get it over with,
she thought.

“
Well, it will help me be clearer if I’m familiar with the cast of characters,” she smiled trying to avoid a power struggle.

Gina’s
facial expression was grim as she began her life history in a remote, emotionless voice.

“My family live
s near Hurricane, West Virginia on a farm settled by my great, great, great-grandfather back in the late 1800’s. The parents are named Alcott Earl and Hattie Raines. They had 7 children but two of them died. They had two older boys Clint and Dale who would be in their 40’s now and then there was a male cousin named Jake who moved in after his mother died. The cousin is younger than Dale. There were three girls. The oldest Betty Jo is 2 years older and Patty Sue is 2 years younger than …the middle girl.” She paused looking at her therapist.

Dr. Reinhardt looked at her steadily
alert to the odd, impersonal robotic manner of speech. This was an unusual recitation. Now she asked, “Did your sisters go by their first and middle names? Is that how people referred to them, by both names?” By this question, she was connecting with that older conversation and moving toward her area of concern about names.

Gina
looked at her pointedly and nodded slowly. “First and middle,” she said.

“And what did they call you?”
Dr. Reinhardt asked.

There was a long pau
se as Gina wrapped her arms around herself. She slowly raised her eyes meeting Dr. Reinhardt’s as she whispered, “Reggie Lee. My name was ‘Reggie Lee.”

“
Okay,” Dr. Reinhardt continued in a matter of fact tone, “your birth name is Reggie Lee? Is that right? Reggie Lee Raines?”

“
Yes,” Gina whispered, eyes down.

“
When did you change your name to Gina Reynolds?” the therapist asked.

“Well, that’s a bit of a story in its own right,” Gina said with a sigh, less robotic now.

“We have time,” the doctor said glancing at her watch, “I put 2 hours aside for you tonight.”

“
Thank you,” Gina said.

Silence.

“So, when did you change your name to Gina Reynolds?”

Gina looked at her directly with a sly smile now. “Well, that’s not quite the way I’d put it.”

"Oh? How would you put it? " the therapist asked.

"I'd say I became..."

“
Became
is different from
changed your name
?” the doctor inquired following the train of thought. “Actually, yes,” Gina said, “to keep it simple, I was in a sort of foster home for a while and at that time I changed my last name to the foster family’s name, it was Baker. I was called Regina Baker, Gina for short. Then when I went to college and was more on my own,
I changed my whole name
.”

“
I see,” said Dr. Reinhardt, “so when did you
become
Gina Reynolds?”

“
Well, that was more of an internal identity thing I think,” Gina said.

“I see
,” said the therapist slowly.

“After the name change I evolved into
this identity. I sort of left Reggie Lee Raines and Regina Baker behind and grew to become who I am now.”

“
Okay, so
become
represents an identity evolution? You moved from one name/identity to another over time. Is that what you mean? It’s not just a name change which represents some kind of external identifier, it’s deeper than that. Is that it?”

“
Well, I think that’s mostly it,” Gina smiled.

The therapist started to nod when she saw a momentary expression fla
sh across her patient’s face.

That’s interesting
, Dr. Reinhardt thought, making a mental note.
There’s something else going on here. I’ll have to keep my eye on that. But not now,
she thought. 

“Okay, good,” she said. Taking a deep breath she repositioned herself in her chair and re-focused the session.

Elizabeth A. Reinhardt, PhD

Great Lakes Bank Building

Suite 315

Chicago, Ill
  60601

CLINICAL PROGRESS REPORT

Patient’s name:              Gina R                                                                      Date of Contact: ___11/10/2012___________

Nature of
Contact:              Office Visit _X___ Phone Call ______Email ______Other __________

1. Reason For Contact:              Scheduled_____ Practical _____Update _____Emergency __X___ Other _______
   
2. Presentation:
                 Normal _____Depressed/Low Energy _____ Upset/Agitated __X___ Frustrated/Angry ______ Dissociated/Detached ___X___ Anxious/Panicky __X____ Obsessive/Worried ____X___ Overwhelmed __X____ Desperate/Dependent ______ Confused ______ Guarded/Defended ______ Aloof/Distant _____
   
3. Urgency:
                               Suicidal _______ Self-Destructive ______ Homicidal ______Other _______
   
4. Requires hospitalization:
                 a) Yes_____ specify plan_______________________________________
   

b) No ___
X_____________________

1. Appearance:
                 Neat __X_____ Disheveled _______  Inappropriate ______________________________
   
2. Substance Use/Abuse:
                 Yes ______ No ___X____ Specify ____________________________________
   
3. Orientation:
                 Oriented:    X                Disoriented:               Time ________ Place ________Person _________
   
4. Areas of Concern
   :               Self/Symptoms ___X__ Personal Relationships ________ Work __X____
   

Finances ______
Health _______ Safety _______ Functioning __________ Moral/Spiritual ____________

1. Session Narrative:
                 Flashback at work, traumatic content, worried about her ability to function on job, worried that her mental health is deteriorating, some information about family history/relatives, it appears there was legal action taken to emancipate or name change during teen years; patient reluctant to discuss, avoidant and anxious about past information.
   
2. Diagnosis:
                 Axis I: PTSD, GAD_______________
   

Axis II
: none

1. Recommendations:
                     self-management techniques discussed. Suggested readings on PTSD and its treatment
   
2. Referrals if necessary: ____________________________
   
3. Clinical Impression:     Continue to evaluate dissociation, degree of fear/anxiety vs real world safety considerations
   
4. Treatment Plan:
                 Begin trauma work and support coping strategies at work.
   
5. Appointment Scheduled:
                 Yes __X____ No ________
   

Elisabeth Reinhardt, PhD:   
Elisabeth Reinhardt, PhD

Date:  11/10/2012__________________________________________