The Trauma Behind the Trauma

This presentation was delivered at a morning conference titled Family Matters hosted by Ububele Educational and Psychology Trust, Johannesburg Parent and Child Counselling Centre and Tara Hospital’s Psychology Department in Johannesburg on Friday, 9 October 2015.

Background

A year ago I saw Family N for two sessions that were two weeks apart. In the week in between the older of its two boys, who I here call Older Son, then five, came for a trauma debriefing/play therapy session.

His mother, Dr N, contacted me after an armed robbery in their driveway. She needed Older Son seen to check if the trauma left damage. Dr N thought her other child, who I call Younger Son here, missed most of the incident. Younger Son was 21 months at the time.

Mr and Dr N are professionals in their late thirties. Dr N had four months’ maternity leave after the birth by caesarean of both boys. Her retired dad looks after the children when Dr N is at work mornings and she spends afternoons with them. Older Son went to a play group at three-and-a-half and started nursery school at four. Younger Son was still home with his grandad mornings at the time they came to see me.

Both boys enjoy good health. Dr N spent a few days away from them when they were eight months old, respectively.

In the questionnaire I give parents to fill me in on their children’s background facts, Dr N describes Older Son as having a soft heart which makes him feel sorry for others at the drop of a hat.

She continues: “Deep child who experiences emotions deeply. Quick to feel slighted, will avoid conflict if possible, but will confront someone and stand up for his rights if needs be.”

Older Son gets on well with others and is loyal. At times he is not confident. He loves stories and getting immersed in his own world of fantasy play.

Dr N writes that she cannot yet capture Younger Son’s traits in similar fashion as he is still a bit young, but Younger Son finds life fun. “He is very friendly and draws people to him with his warmth. Very assertive.”

When Dr N confirmed Mr N would accompany her to their initial session which was in the late afternoon, she mentioned it would not be possible to not bring the boys. I took her word for it and invited her to bring them with. It now meant that I would see the family for an initial session.

The Ns gave permission for the use of this material for this presentation provided that Older Son’s identity is protected. Dr N requested a copy of the finalised presentation. I thanked her and let her know that I would welcome their comments.

The three sessions

First session: The Ns arrive a little early. When I speak over the intercom to Mr N, whose car faces my gate, a short driveway and a double garage, I ask him to park on the right, as far to the right as possible. I make this request so as not to block the garage on the left. If I do not expressly ask the people I see to park on the right, they sometimes park in the middle, in front of both garages, which makes it impossible for any other car to enter the property while we are in a session.

As I round the corner of my therapy room to meet the Ns, I notice with surprise that Mr N turned right instead of just moving forward and to the right. He parked in another part of the property where he managed to squeeze in between an already parked car and a palm tree. He parked close to the door of a second garage in this part of the property.

“That’s Mr N for you,” Dr N says as we meet face to face. “If you say as far right as you can, that’s what he does.” As she says this, I wonder who exasperated her most, Mr N or me.

Writing the sessions up for supervision I thought Mr N’s unique response to my request caused friction between him and Dr N. Even the beginning of the session still carried traces of the tension between them. After that I also realised waiting in front of a gate, entering a gate and parking might have been very hard for Mr N. It could have felt potentially life-threatening and frightening.

Dr N fills in the intake form while Mr N looks after the boys. He starts off the talking by saying almost angrily he thought his wife is invincible. Then Dr N recounts what had happened.

She had noticed a motorbike rider in their street as she and the boys came home. The rider was not near when she opened the gate but, when she got out of the car, she noticed he had entered on foot.

The robber held a gun to her head and demanded her valuables and cell phone. He told her not to fight or scream. She had to open the gate so he could leave. His last words were: “Look after your children now”.

Both boys listen with their dad to Dr N’s telling of what happened. Dr N says Older Son saw it all but she’s not sure Younger Son did because he was sitting behind the driver’s seat. The head rest of the driver’s seat may have stopped him seeing a thing.

When I ask whether she has any symptoms from the trauma, Dr N says she has flashbacks of the impact that a bullet would have had if it entered her head. The flashback is a production of her own mind which drew on her detailed professional experience. It is this image that flashed in her mind during the robbery and while she gauged the distance between her head and the attacker’s gun.

Dr N insists that she mostly copes well. She mentions having had help herself in dealing with the trauma. Coming here today her concern is for the boys, especially Older Son, she emphasises. She also underlined this in our telephonic contact beforehand.

In the session Dr N praises Older Son for not saying or doing anything while the robbery was in progress. Afterwards he told her that he could see they were in trouble and that it would be best to stay quiet, she explains.

Mr N regains his composure while listening to his wife and son. He takes an active part in the session. Eventually he praises Dr N for handling the robbery the way she did.

I fetch toys for the boys. Older Son spends the rest of the session telling his story, letting me know what he saw. Both boys, especially Younger Son, explore the whole room. In this, they keep their parents busy.

Despite their activity it is quite easy to engage Older Son. He reacts to me in two ways. He identifies with the aggressor by pointing hand and fingers towards me in the form of a gun, demanding to get everything I have. Or, he punishes me by pronouncing sentence over me as if I am the robber.

As this takes place Mr N tells me they curb Older Son when he points his hand like a gun at adults. In turn I indicate that therapy rooms are places where what is not acceptable in social situations can get an airing. It is important, if at all possible, to get a sense of all the different reactions, thoughts and feelings that a child may have.

As the family leaves I realise why Older Son’s parents curb him. All the way back to the car he shoots at me. It leaves me thinking part of him is trying to fight me off, as if I am the robber, but I also realise that even my gentle exploration of what happened for him in the robbery felt intrusive, as intrusive as the robbery was. The robbery shatters everybody’s sense of psychic safety.

I accompany the family to help Mr N with the exit. To my surprise he backs out as fast as he can, before I can say anything. He drives through the flower bed under the palm doing this. I stand thinking how strongly the trauma affected him. He is not dilly-dallying.

In supervision we look at how the trauma affected my language use and writing, especially also in describing Mr N’s speedy exit. I translated the thoughts I had about the driving through my flowerbed in a kind of crooked Afrikaans-English, which David* queries out of interest as it gives more information about the case.

Instead of he is not dilly-dallying I wrote: he is not playing (hy speel nie). In Afrikaans he’s not playing would indicate a desperate sense of urgency in the face of great danger. We decided to highlight it here because it illustrates the tentacles of a trauma. Mr N carries the trauma for the family. My initial and even subsequent writing is infected by the trauma. It is almost telegraphic, full of jolts and starts. We coax it into a fuller narrative which does not underplay what I see and experience.

Second session: When Dr N brings Older Son for his individual session with me she tells me she is happy to wait in her car, in the driveway. She will make calls and catch up on work, she says. I ask her to keep the sound down as she does this so that we will not hear her in the adjacent wooden play therapy hut I use for work with children. I also check that Dr N feels safe in the driveway. She insists that it suits her.

Older Son comes with me to the play room without any fuss or bother. I ask him to give me a sense of what it looked like, the trauma. He sits down and uses the paint to get lines and a shape on the paper. His almost unformed portrayal of the trauma escapes me in the moment. On later inspection, in supervision, it becomes clearer that it perhaps does portray figures and a car.

Older Son gets up to explore the room. “I want everything in this room,” he says, just like when he was in my other therapy room which we used in the first session. When I ask him again to draw what happened, he produces an overpowering if spectral pencil figure, looming between the grass and the sky, with a gun in his left hand. The figure’s toes are especially prominent. While he draws, he tells me what happened. When I look at this drawing now the gun, which is present, is almost stripped of its menacing nature, but the figure’s toes look aggressive. It makes me wonder whether he would have liked to kick the robber but stayed the impulse. It certainly captures the aggression in the robber.

Soon he abandons the drawing. He finds a playhouse on a bookshelf and starts depicting the flight of the robber by dropping robbers from its windows into the sandpit. The window frames are pushed out – I help him with it - so the robbers can get out. Now it is the robbers who are fleeing, it is not the family that is put upon by them. The play is cathartic. It helps him to express what he is thinking about and feeling.

When the time is up, Older Son wants to stay on to cut paper, an activity he seems to have found very satisfying the previous week. He likes the session. We leave the room with me suggesting he does it at home, if he feels like that there. Older Son drags his feet when he gets to the car. Dr N has to negotiate with him to get into the car so they can leave.

Third session: I suggest a third session in which the whole family is together again because I think Mr N may need some space to talk as I experienced him as carrying the trauma for the family. Whilst he might not have contemplated something like this before, the trauma certainly makes him step up. The process of addressing the trauma in all the many ways needed and requested readjusts the family’s model of itself in this and in their own process.

I invite Mr N to talk first. He claims to have no effects from the trauma other than that he is much more careful when he has his family with him. I bring up his disappointment that his wife is not invincible and pointedly refer to how he drove through my flower bed when they left last week. Mr N is surprised and then quite grateful that I mention it, as if he would not have noticed these things himself.

Today the toys are in the room and Younger Son starts playing while Older Son leans back against his dad, asking for milk. A little while later, when I again ask how he is doing, he tells me that he is shy.

Dr N talks about how she notices how much time is taken up with replacing her ring and watch. She touches Mr N lovingly as she says this. This is a very touching moment between Dr and Mr N. It is as if they are re-establishing their rapport with each other.

Still leaning against his father who is on the couch, Older Son is sitting with his back to him while on the floor. Older Son talks about how he would like everything I have. In a tone of warning, which also seems to sum up where he is at, he says to me: “Jy weet nie wat vir jou verwag nie” (You don’t know what’s waiting for you/what to expect).

Older Son uses verwag in Afrikaans in a way that, even in Afrikaans, is oddly constructed. As if he might be confused about how to use the word. Verwag can be expect, it can mean pregnant. Wag is the same as wait. Both Dr N and I have an almost obvious impulse to correct him. I know I indicated to her that we should just let it be, that we should let him say it as it is coming out. His emphatic repetition, then, of his very unique phrasing made me aware of his need to convey something, something that I may be missing in the moment. It is when I write it up for supervision, initially, that I think about all the possible meanings. It is then that it hits me like a bolt out of the blue.

Older Son did not know what waited for them. He would not have known what to expect. By saying it over and over, he tries to let me get a sense of what it was like for him. But, while he is saying this, he is simultaneously almost fighting me off. I reflect mostly this.

Mr N says it has been helpful to see Older Son’s shooting at adults in a different way. I say I also understand why they may be concerned about it.

We end with the Ns resolved to contact me if they need to come again. Just before they leave, they compare Younger Son, who has an excitable, boisterous quality about him, with Older Son who they say is so different from his brother, a more sensitive soul. Younger Son gets an excitement coursing through his whole body when he hears dogs barking quite near. It is as if he wants to go out and embrace the liveliness he hears outside the room. Younger Son is not hyperactive, he is just lively. His parents contain him easily.

Discussion

Older Son’s final description of the trauma in which he apparently mixes up concepts is what every psychoanalytic practitioner would call a real gem. It is a perhaps consciously unintended, but very meaningful Freudian slip. While I did not address it in the moment Older Son at least got it out. He insisted on saying it just like it came out first. He said it emphatically, time and again, as if part of him needed me to really hear it.

Like with his painting which I did not initially read like one can, his summary of what happened to him is profound. It once again brought home to me how much one can miss – or even dismiss - in a child’s communications. It helped me understand what I might have missed if I never saw him with his family.

In Older Son’s relatively short life the birth of his brother had certainly left its mark. This was re-evoked by the robbery itself - even if he was clearly trying to make sense of the robbery in various ways. Older Son’s use of expect/pregnant poignantly illustrates the often cited maxim about the underlying trauma which also gets worked on in a trauma debriefing. He felt robbed, also, of the very precious only-child space that he held in the family. Nothing that he did could have made it not happen.

It is this aspect in Older Son’s work with me that made me ask to present the case at this conference. One can say that he taught me how to listen to him. Some of that I got in our work. The rest came later, as I discussed it in supervision.

In her email in which Dr N gives me permission to use the case at this conference, she says that she has also discussed it with Mr N. They hope that Older Child’s reaction to the trauma and work with me can teach me and my colleagues something. That, I think, is certainly so. We can, I hope, all benefit from the wise words from the mouth of a child.

It is my hope that our sessions together made it possible for Older Son and Family N to deal with both events, even if unconsciously. To me it is as if the second trauma made it possible to also work on the first, even if only in mind.

Both events needed to be addressed and understood. And it is because I know that this is necessary that I welcome the Ns’ request to see the final presentation. I hope that they can use the work done to help Older Son come to terms with his brother’s presence in the world, with his feelings that he lost something, irrevocably.

Working with Family N also made me aware of the need to question whether one or two therapists need to be present so that either could catch what the other does not pick up immediately. I am not convinced that Older Son’s phrasing could be captured just then and there, by one or two therapists.

That highlights why supervision with a senior colleague or even a peer is and stays helpful. Digesting and distilling content still unformed in the session after the fact helps us to possibly catch it the next time it comes around - in whatever form it then presents itself.

Vossie Goosen

Vossie Goosen, a former journalist and co-ordinator/editor of publications in NGOs, is a Wits-trained clinical psychologist. She works with children, parents, individuals and couples and is currently exploring how work with families can assist children and their parents. This exploration into how to assist in the family context is done under the supervision of David Hadley from the United Kingdom who has been sharing his expertise in child work with colleagues in South Africa since 2013. Vossie has been a member of several psychology groups and trainings since starting her practice in 2000. She is a past chairperson of the Johannesburg Association for Child Psychotherapy which celebrated its 20th year of existence in 2012. Currently she is also exploring how to combine her interests in writing and psychology as a member of a writing group for psychologists.

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