The second chapter is set out in the same way as the first - written as psychologist notes during a counselling session. Please take a minute to leave some feedback at the end - it is very much appreciated and gives me an indication as to if I should keep going with this story. Thanks.

Friday, October 15, 2004

Second consultation with Timothy Speedle.

Tim tired and reserved again today. Remains quietly spoken and appears naturally introverted. Managing well to date on sertraline however states has been feeling 'a bit weird' and likens it to being almost in a dreamlike state and feeling nauseated at times. Reassured both common side effects of SSRI treatment and will subside. States continuing to struggle with poor sleeping but has been reticent to try alprazolam to date as feels it will resolve by itself. Reminded of importance of good sleeping habits when combating PTSD and encouraged to trial same while in hospital.

Continues to have limited interest in talking about himself. Remains difficult to draw into conversations. Focused on his family today. Again, Tim visibly uncomfortable with this topic. Forced the issue and, under sufferance, Tim opened up about his childhood.

Childhood:

Parents - Margaret and Peter Speedle

1 sibling - Matthew, 13 years Tim's junior.

Parents married approx. 33 years.

Father - owns 3 restaurants (2 in Queens, NY and 1 in Syracuse, NY).

Mother - social worker.

Tim speaks in an almost detached manner when the topic of his parents is raised. Very little emotion and displaying subconscious physical responses (arm scratching and tapping of fingers against his knee) when reciting family history.

Tim states his family lived in comfortable neighborhood in Queens, NY. States family home was 'upper middle class' and his parents financial status allowed them to send their children to 'good schools'.

States did not have a traditionally close relationship with either of his parents. According to Tim, his father was often absent managing his restaurants - long hours and and regular trips to Syracuse - and appeared emotionally disinterested in his son when he was physically present. His mother worked full time as a social worker for the Department of Social Services in Queens, NY dealing with abused and neglected children. Tim states his mother was passionate about her job and would often work after-hours and on weekends in addition to volunteering for community programs until he turned 13. Up until this time, Tim had been an only child. Three weeks before his 13th birthday, his mother gave birth to his younger brother, Matthew. Tim describes natural feelings of ambivalence and slight resentment towards his younger brother and states he always felt that he had 'little in common' with Matthew due to the significant age gap.

Tim talks about desire for rebellion against his parents when in his teenage years. Although he continued to excel with his grades, he speaks about experimenting with cigarettes and alcohol from age 13 and truancy from school - primarily to annoy his parents. Tim is able to reason that his behavior was likely a combination of normal teenage desire for independence from his parents in addition to the arrival of his younger brother into the family unit.

Tim describes feelings of loneliness and social isolation as a young child. Unable to name more than 3 close friends from age 5-12. Attended St Marks private elementary school in Queens. Tim states he 'hated' elementary school as 'didn't fit in' and describes classic indicators of poor social skills and introversion - not wanting to socialize with peers out of school hours, feelings of stress when forced to socialize.

States enjoyed reading and found solace from school by going to library and reading during breaks in class. States always felt 'safe' when he was by himself reading.

Attended John E. Morrow High School, Queens, NY. States similar to Elementary and Middle school - describes few friends and naturally independent. Despite feelings of social isolation, however, Tim admits he did date 'on and off' throughout high school and into college, but no one serious girlfriend before arriving in St Petersburg as a 20 year old.

Reluctantly talked about having one best friend from age 14 (Ben). Both boys shared similar interests, particularly science. Tim talked about experiencing family holidays in Florida with Ben's family and associated good memories with St Petersburg in particular. Tim states he had never had holidays up to that point and felt, for the first time, that he was part of a functional family.

The boys remained friends up until Ben's death at age 19 from complications post a snow mobile accident 18 months earlier - witnessed by Tim. Ben had apparently suffered severe spinal injuries resulting in full quadriplegia.

A marked increase in agitation and anxiety levels was apparent as the conversation continued regarding Ben and it was clear that Tim has spend the intervening years successfully developing certain defense mechanisms to cope with his friends paralysis and subsequent death. There are elements of both repression and suppression. There are certain specific memories of the accident itself that he is unable to recall and large periods of time that are unaccounted for. It is my opinion that Tim has repressed certain particularly upsetting memories of the accident and the arrival of Ben's family and of his own family. When questioned about specifics, he stated he 'doesn't know' why he does not have memories of the immediate aftermath of the accident when he has very clear memories leading up to the accident and once they had arrived at the hospital. His agitation levels increased markedly when pushed to concentrate and to try to remember the details. It is my opinion that Tim has buried the memories too deeply to access spontaneously.

Tim became emotional when remembering the events leading up to his friend's death. When questioned further, it became clear that Tim harbors deep seated guilt that his friend was gravely injured and endured major suffering up until his death when it could have 'just as easily been [him]'.

Conversation switched to his family dynamic in relation to the accident. Tim states he could not remember what his parents reactions were when they arrived at the hospital. He states he cannot remember their reaction to his obvious distress during the time of Ben's hospitalization and only remembers their insistent that he continue on to college as planned. Tim states he did not feel comfortable in discussing his feelings about his friends accident to his parents nor does he remember ever talking with them about changing his preference from medicine to biology and chemistry majors. He expressed his rationale for changing his preference in terms of wanting to 'do something constructive to help Ben and to cure him'. He also spoke about his feelings of despondency and failure when Ben died and he realized 'it was all for nothing'. Despite encouraging Tim to explore this statement in more depth, he became emotional once again and asked for the session to end.

Based on Tim's interest in reading and drive for understanding, I have devised a plan of treatment including psychological journal articles so he can better understand how his mind has compartmentalized his memories as a mode of self preservation.

PLAN: Continue sertraline treatment as prescribed in first consultation.

To trial alprazolam while still an inpatient to re-establish good sleeping patterns.

To follow up with counseling session Monday prior to discharge.