Making sense of it – Peter’s formulation
Environment: When reminded of the accident
Peter is a 22 year old guy, currently in a relationship with Sarah but living with his parents and younger brother, in their family home. He was involved in an accident where he was a passenger in a friends car coming home after a night out with other mates of theirs. They were involved in a head on collision where they were both severely injured. Whilst both survived and recovered from their physical injuries, Peter was left experiencing flashbacks of the impact, particularly the noise as they were hit and he often wakes in a panic in the night. He has avoided being a passenger in a vehicle, apart from with his mum, who he describes as a “really safe driver who listens when I tell her to slow down”. He is starting to withdraw from his friendship groups and reports getting irritable with his girlfriend, particularly when she tries to cajole him into going out, even just for a meal at the local pub. He says he’d rather not think about or talk about the accident again and so if he doesn’t see people, he won’t get asked about it. He thinks he’s “pathetic” for not being able to get over the accident and would like to understand his reaction, given that he “should consider himself lucky to be alive”.
The first few sessions incorporated lots of information about trauma and our response to it to help Peter understand that his reaction was not his fault. Initial achievable goals were identified and included:
- to be able to go to the local pub for a meal with his girlfriend once per month
- to be able to manage flashbacks and to begin to discriminate between then and now
- to be able to travel as a passenger with other drivers apart from his mum
- to enjoy the company of friends again and to feel able to handle enquiries about the accident
Treatment for trauma can take place in the form of either EMDR or Trauma-focused CBT. Peter opted for EMDR and was able to process the memories of the accident well over a number of sessions. He was able to increasingly regulate his own anxiety levels and felt less ashamed of his reaction to the accident, subsequently less self-blaming. CBT was introduced to help tackle some of the residual avoidance of travelling as a passenger and by the end of therapy he could not only travel more comfortably as a passenger, but he was able to nod off on one particular journey.