Authors Note: Wow, this chapter is massive, before my author's notes and the chapter titles and point of view was a total of 5362 words, which is more than double the normal chapter length. I know I was talking about speeding it up but I am really not good at this. However I really hope you enjoy this chapter and PLEASE REVIEW, I am desperate for feedback and I really don't want to hold updates hostage over feedback but I might have to start doing that because I want to know what my readers think.

Chapter 33:

On the Same Page

Andromeda POV:

It was nine in the morning when I arrived at the practice I shared with my husband. I originally trained as a mind healer but decided to pursue a muggle certification after realizing that most magicals who needed help were far too proud to seek the help that they needed. My husband Ted is a psychiatrist; we got married after he finished his five-year degree in medicine. His parents had insisted on him completing his work for a muggle education by correspondence while we at Hogwarts and sitting his exams over the summer. It was helpful as it meant he begin medical school as soon as he graduated from Hogwarts. It's nice that I can consult with him about the more complex cases. I sat down at my desk and looked over my schedule for the day. I was surprised to see that I didn't have any patients before Hermione at eleven. It would be an unusually slow day for me, not that I minded. I had several things to do before Hermione's session. I pulled out her file and my copies of the ICD-10 and the DSM IV. As a psychologist I cannot make an official diagnosis, but having a tentative diagnosis will help me to more effectively treat Hermione. I knew before even reviewing the file that Post-Traumatic Stress Disorder was definitely part of her diagnosis, but I was fairly certain that there was more to the diagnosis. After reviewing the notes that I took as well as the assessment that she filled out, I reached the conclusion that while there were clearly signs of a depressive episode, it would be difficult to make a definitive diagnosis due to the fact that she is pregnant making it impossible to distinguish the physical symptoms of pregnancy from the characteristic somatic symptoms of a major depressive episode without more information. Not one to give up I decided to check with the receptionist if Ted was free to chat. I picked up Hermione's file and walked over the receptionist's desk.

"Joan, could you please check if Ted is in with a patient right now?"

"No, his first patient just left and the next patient won't be arriving until ten."

"Thanks Joan"

I knocked on Teds office door, and opened the door.

"To what do I owe the pleasure of my lovely wife visiting me at my office?"

Normally I would have played into this game but I was a bit on edge given the complicated nature of this diagnosis. "I have a patient that I am trying to determine the diagnoses for, so that I can offer the most effective therapy for this patient."

"Well I have half an hour before my next patient, so tell me what makes her case so complicated?"

"My patient is a seventeen year old female who was sexually assaulted two months ago and a half months ago. She didn't report it or seek medical care in the immediate aftermath. Last week she took a pregnancy test from the chemist that confirmed that she is in fact pregnant with the child of her rapist. Her parents disowned her, at the time she had no living grandparents that she was aware of, so she approached the head teacher of her boarding school to see if she would still be permitted to continue her education there, however her parents had already informed the head teacher of her relationship with a local boy, which she emphatically denies ever happened and she was expelled. Her former chemistry teacher witnessed her rapist telling his acquaintance about the rape and her recent kidnapping. At which point he intervened to bring her someplace safe until he could figure out how to help her. Fortunately as it turns out, the girl's biological grandmother was one of his colleagues. Apparently the grandmother was also a teen mum, who gave her son up for adoption. Since shortly after she moved in with her grandmother she has been displaying symptoms of PTSD as well as exhibiting self-harming behaviors and suicidal ideation. The issue is that while a major depressive episode or if it persists major depressive disorder would generally fit, I would be hesitant to even unofficially diagnose it given the fact that several of her symptoms that would fit into the diagnoses could be associated with her pregnancy. I just wanted a second opinion."

"Well Andy, pregnancy doesn't rule out the diagnosis of major depressive disorder or a major depressive episode, however I agree that it is potentially clinically significant, lets stick solely to the non-physiological symptoms listed in the ICD-10. Did she or someone who is close to her report that she is struggling with reduced concentration and attention, reduced self esteem and self confidence, ideas of guilt and unworthiness, bleak and pessimistic views of the future, or ideas or acts of self harm or suicide, in addition to depressed mood, loss of interest and enjoyment and reduced energy leading to increased fatigability and diminished activity? "

"Yes, but the issue is the determination of the severity because without including the physical symptoms she would not meet enough of the criteria for a diagnoses of a severe depressive episode without psychotic symptoms. However given the potential suicide attempt and the self harm I would think it would count as severe."

Ted cast a silencing spell before responding. "Suicide attempt? When was this?"

"Yesterday, but I have an appointment with her at eleven. I visited as soon as I got word of what happened, but since she was still unconscious while I was there, I was unable to assess the situation. I gave her guardian strict instructions and I will assess the situation when I see her today. If I think she poses a danger to herself, I will contact you immediately."

"Andy, you should know how serious this is. When you just said suicidal ideation, that's fairly normal for the diagnoses and unless she has a real plan, would not warrant hospitalization, but after an actual attempt, why are you still treating her when she should be on a psychiatric hold? You need to report this Andy! "

"Even if I did report it to the proper authorities, it wouldn't do any good, she lives somewhere that they would never find her. She has already escaped from the round the clock care and supervision of a medical professional and I have a session with her and her grandmother today at eleven to discuss the current issues that they are working through together as well as her individual therapy. I cannot tell you more without breaking confidentiality, just please understand that if there were a suitable inpatient option, that would have been the preferred option however there are factors that I am not at liberty to discuss that have influenced these decisions."

"Andy, I cannot let you risk your license, this is outside the scope of your qualifications. At least allow me to accompany you to speak to the physician who is managing her care wherever she is located."

I was about to try and deflect when a familiar snowy owl started tapping on my husbands office window. I opened the window and the bird, who I recognized as belonging to Harry Potter, delivered a letter to me before flying off. I opened the letter and read.

Dear Andromeda,

Professor Snape has asked me to inform you that Hermione has requested for your session to be held in Professor Snape's sitting room at eleven this morning. She is unwilling to meet elsewhere. Professor McGonagall has already been informed of the change in location however he felt it was probably better to for one of us to inform you directly.

-Harry Potter

P.S Currently there are four of us staying with Hermione in the Head's Dormitory, including her little sister, I highly doubt Hermione will do anything that could potentially traumatize Abby if she were to walk in without warning.

"Andy, what is the letter about?"

"I can't tell you. I am sorry, it's a magical patient. I will try to sort out how to bring you in on my other case but it's a very complicated situation. I have to talk with the guardian of my patient first."

I looked over at the clock and it read 10:00

"Ted, you have to see your next patient. I am going to visit my magical patient who sent me this letter before I have to visit my eleven o'clock patient. I love you and I will let you know what happens when I speak to the patient's guardian."

"I love you too. Just be careful, and if you need my I will reschedule my eleven o'clock just in case. "

With that I went to my office and grabbed a notepad and the materials I would need for Hermione's appointment and then apparated to the Leaky Cauldron, and from there I flood to the Minerva's office.

"Andy what are you doing here? You are an hour early."

"I apologize Minerva, however I needed to speak with you before Hermione's session. As you know, I am not able to officially make a diagnosis because that is something that only a Psychiatrist is able to do, however, my husband Ted, is a psychiatrist. I feel it would be beneficial to bring him on as part of Hermione's treatment team. I consulted with him without so much as informing him that this patient is magical, let alone any identifying information but I needed to talk over what the correct diagnoses could be with another mental health professional, as to enable me to select the most effective type of therapy. In the process of consulting with him, he became extremely concerned that after what occurred yesterday because I had not initiated a psychiatric hold. If he were aware of who the patient is, he would understand why that wasn't an option. Obviously I don't intend to disclose Hermione's identity without her consent, but I need both of you to agree, since in the muggle world she is still a minor, but in the magical world she is an adult."

"If Hermione is okay with you bringing Ted on as part of her treatment team I have no opposition to it. Is that all you needed to speak to me about?"

"Not quite, I was hoping we could discuss how you are handling things."

"It is just one thing after another, and right as things are busiest for me. It is probably better that way, seeing as it means I don't really have to think about how I feel."

"Minerva, you know how unhealthy it is to not take the time to process your emotions."

"I know Andy but it has worked well enough for me for many years."

"However, now you are not just taking care of yourself, you have your granddaughter who needs your help and if you are not taking care of your own mental health, how will you be able to help her with hers? The therapy that I think will work best for Hermione will work better with your involvement, it can work without it, but it does help if you are involved because you are there when I am not and can reinforce the things we work on in therapy."

"She doesn't even want to speak to me, I highly doubt that she will respond well to having me in her therapy sessions. Not to mention that come next week we will need to maintain the façade of our relationship being limited to a strictly teacher-student relationship."

"Most of the therapy will be separate sessions that cover the same information, but some will be together. The reason I am suggesting this is because studies have shown much better outcomes when caregivers are involved in the treatment, and one of benefits that has been observed with this type of treatment is that it has helped to improve the relationships between the caregivers and the children in their care. You will have a little time to make your decision, as I do not think it is wise begin this course of treatment until Hermione is stabilized, meaning that she is not actively suicidal, but I do think it would benefit Hermione. I understand you are concerned about protecting Hermione's privacy regarding the matter of your relationship, but as I am sure you know, in a school full of teenagers, it is highly unlikely that anything remains secret for long."

"I will consider it."

"That's all I am asking you to do. I have some information about this specific type of therapy that I will give you and Hermione during her session today. I also want to discuss with you what we can do to keep Hermione safe in the castle. I particular I want to know if is it possible to ward the Room of Requirement to notify someone if Hermione were to make use of it?"

"I don't know the answer to that question. I would have to speak to Albus and possibly Filius."

"Speaking of Filius, I would also suggest speaking to the other professors to see if they believe that their classrooms would require wards to prevent Hermione from getting access to something that could potentially cause her harm in there classrooms. I would think that Charms and History of Magic should be fairly safe however Potions and Herbology both use equipment that can be concerning since we know that she has been engaging in self-harming behaviors, however you should probably ask the other professors if they have any specific safety concerns."

"I should also ward the towers to prevent her from jumping from any of the towers."

"That is also a very good idea. In the second half of Hermione's session today, we will discuss together putting together a safety plan as a team to ensure that if Hermione is feeling distressed, she has a clear idea of the resources available to her in order to prevent the situation from escalating to a dangerous level. Should either you or Hermione need to reach me you can contact me using the floo or by owl, and if it is an emergency please do not hesitate to do so even if it is in the middle of the night."

"I appreciate that Andy, but I can hardly ask you to be available to Hermione and I all of the time and I highly doubt that you do this for any of your other patients."

"Minerva, you aren't asking me to, I am offering because due to the circumstances in the magical world, it is not possible for her to be hospitalized in a pediatric psychiatric unit that would be able to provide the care that she needs without putting her life or the lives of others in danger. However, I feel that I would be remiss in my obligations to offer her the best possible care if I do not ensure that she will be able to receive care in a crisis, despite the circumstances that make it impossible to utilize the conventional systems that provide care to patients struggling with mental illnesses. Furthermore, it is hardly your place to suggest that I am doing too much for her given how much you did for me when you were under no obligation to do so. I seem to recall you writing me hall passes that I could simply add the date and time on so that I could freely travel to and from your office even after curfew. "

"That was simply fulfilling my obligation as an educator to ensure that gender based violence didn't compromise my student's access to education and the support that she needed to be successful."

"Which is precisely why I am making myself available whenever she needs me. I am currently the only mental health professional that is treating her, and I want to ensure that she receives the care that she needs given the magnitude of the trauma that she has been through. Which brings me to my next point; I would like you to fill this out. This is the parental version of the evaluation I am going to ask Hermione to complete today. The results of these evaluations will enable help to guide Hermione's treatment plan."

"I thought we had determined that you would be meeting with her daily."

"We did, however, given her reaction to the idea of daily intensive therapy, I feel that after she is initially stabilized, a different approach might work better."

"What kind of approach are you suggesting?"

"I think that Hermione is a prime candidate for Trauma Focused Cognitive Behavioural Therapy or TF-CBT. This is a fairly new approach, and should the evaluations confirm that she could benefit from this new treatment approach, we would be meeting once a week for 90 minute sessions, with about half of those sessions would be sessions where we would all meet together, should you agree to take an active role in her treatment and on the weeks where sessions are not combined you would each have your own sessions. I will explain this more in depth when we meet with Hermione, however it would be great if you can fill out the evaluation I handed you so that I will have time to score it before Hermione's session."

Minerva quickly got to work filling out the evaluation, and handed it back to me about fifteen minutes later. I quickly scored it while Minerva waited with bated breath.

"Minerva, I won't be able to give you my answer until after Hermione fills out her version of the evaluation, if her responses are similar, and you are both on board, we can begin this treatment as soon as I can ascertain that she is not actively suicidal."

"If you are certain that this is best for Hermione, I will do whatever you ask of me."

I looked over at the clock and saw that it was already 10:45.

"I must be going Minerva, I need to meet them in Severus's sitting room in fifteen minutes. I shall see you in approximately forty-five minutes."

I briskly walked in the direction of Severus's quarters, when I saw Hermione flanked by Harry and a boy that I didn't recognize. I wasn't going to acknowledge that I had seen them, but that was out of my control the minute Harry noticed me.

"Good morning Andy" Harry greeted cheerfully.

"Good morning Harry and Hermione" and looking at the third teenager "Good morning, I don't believe that we have met before. I am Andromeda Tonks, but you can call me Andy, what is your name?"

"Neville Longbottom ma'am"

"It's a pleasure to meet you Neville. Now would you three happen to be willing to show me the way to Professor Snape's sitting room? I am afraid I don't quite know where that is."

"Sure, just walk with us since that's where we are heading anyways." Harry responded politely.

We walked mostly in silence the rest of the way, and upon reaching the entrance to Severus's sitting room I thanked the boys for their assistance and suggested Hermione take a seat, while I found Severus.

I found him brewing a batch of what appeared to be vitamin potions. I cleared my throat to get his attention before I began speaking.

"Severus is it possible to summon a house elf to bring tea and biscuits. I find it helps keep people calmer."

"I think it is preferable if you used the kettle that I have in my kitchen area and brought out the tin of biscuits that Minerva dropped off earlier. Hermione doesn't agree with using house elves."

"Thank you Severus for your help and for making me aware of her opinions on house elves."

"It is no trouble."

It was eleven o'clock on the dot when I returned from the kitchenette with tea and biscuits. I set them down on the coffee table and sat down across from Hermione.

"Good Morning Hermione. How are you today?"

"I am okay I guess."

"That doesn't sound like you are okay. Would you care to tell me what is on your mind?"

"A lot, I felt like I was being smothered by my grandmother and now she won't even directly send me an owl to remind me of my appointment today. She sent the owl to my friend Luna. I honestly don't trust her or Madam Pomfrey right now because they have seemed determined to confine me to places where they can keep a very close eye on me as much as possible and its stifling."

"Is that why we are meeting in Professor Snape's sitting room?"

"Yes, Professor Snape has been really good to me even when nobody else was and he offered to let me use his sitting room for this session because he figured I might be more comfortable here because he would be around in the event that something were to escalate with my grandmother. I sometimes wish that Professor Snape were my guardian instead because he generally gives me space."

"Perhaps the reason Professor Snape gives you your space is because Professor Snape is not your guardian and doesn't have the authority to make decisions on what is best for you. Whereas your grandmother is acting as your parent, a role that I must remind you she has never actually had to perform before, Professor Snape is merely an adult who cares about you. It is understandable why you have developed a bond with Professor Snape, seeing as most teenagers will clash with their parental figures on matters of what is best for them, and since that isn't his responsibility he hasn't done anything to upset you. You also mentioned she didn't contact you directly to remind you of our session today. Did she give you give any reason for that decision?"

"She said that she doubted that I would read the letter."

"Would you have read the letter?"

"Probably not, although it took Harry pointing out how she must be feeling in this situation for me to admit that she had made the right call by owling Luna instead of me."

"What did Harry say that made you admit that she made the right choice?"

"He pointed out all the emotions she is probably feeling as a result of the situation. He reminded me this probably brings up a whole host of traumatic memories for her and that it probably frustrates her that she just doesn't know how to help me and that she is worried that if she doesn't keep an eye on me, I will end up killing myself."

"Now that you've brought up the topic of suicide, could you tell me about what happened yesterday that led your grandmother to urgently contact me?"

"I had a nightmare, and afterwards my grandmother spent the night in my room keeping an eye on me. It was excessive in my opinion and I ran off to the Room of Requirement to cut. A house elf who I had asked to bring me some items caught me and then apparated me to my grandmother's chambers where I passed out from blood loss after apparently nicking a vein."

"So you didn't intend to commit suicide?"

"No, I mean I didn't really care if I were to die or not, but that was not the goal."

"How do you feel about dying now?"

"I am not actively looking to die if that's what you are worried about, a few days ago I was, but with my sister around, I can't risk her being the one to find me. I can't guarantee that I wouldn't consider it if she were gone, but well she is around I am not trying to kill myself."

"Are there other things that make you want to stay alive?"

"Well there is still the ongoing war which Harry needs me to help him win and I also have my friends."

"That's good to know Hermione. Since we have established that you are not actively planning to commit suicide in the near future, I would like to evaluate you to see if you would be a good candidate for a specific type of therapy. If you could fill out this evaluation for me." I said handing her the adolescent version of the form I had Minerva fill out. It took her about five minutes to fill out the form and on looking it over, I was not surprised to see that my suspicions were confirmed.

"Hermione, have you ever heard of Post Traumatic Stress Disorder? Its also known by the initials PTSD."

"Isn't that something that soldiers get?"

"It can be however it is not limited to soldiers. PTSD can affect individuals who have experienced any form of traumatic experience."

"So what does this have to do with me?"

"Based on the questionnaire that you filled out I am fairly certain that you are suffering from PTSD. I am not sure if you are aware of the difference between a psychologist and a psychiatrist, but as a psychologist I am not qualified to make a formal diagnosis, but I would like to have my husband, Ted, who is a muggleborn psychiatrist be brought onto your treatment team, so that at the very least a formal diagnosis can be made, however I will not do this without your permission."

"What is the benefit of involving a psychiatrist?"

"Therapy in some cases can be more effective when combined with medication, however I cannot prescribe medication because that is something that only a psychiatrist is able to do. Involving Ted in your treatment offers the opportunity for us to potentially use medication along with talk therapy, it also means that in the event of a crisis there is an additional professional who is familiar with your situation who can be called upon should I be unavailable."

"Will I have to actually meet with him?" Hermione asked with the fear evident in her voice.

"There will be times when that will be necessary but we can always have someone you trust in the room with you. At the very least you should be introduced to him so that you at least know who he is in the event that for some reason or another I am unavailable. If it is determined that you would benefit from medication therapy you would have to meet with him more regularly, however at the present time we are not planning to use medication in your treatment, it is more keeping our options open." Hermione visibly relaxed at hearing that she could have someone accompany her if she were meeting with Ted.

Just then a knock could be heard on the door, followed by Minerva entering the room.

"Welcome Minerva, and thank you for joining us. Before we start discussing the elephant in the room, I think that we should discuss the new treatment plan. Based on the evaluations that you both filled out for me, I believe that Hermione would be a good candidate for a fairly new type of therapy called Trauma Focused Cognitive Behavioral Therapy. This is a fairly short course of therapy lasting on average 12 to 16 weeks. We will meet once a week, either all three of us or in a one on one session for 90 minutes each week. The goal of this treatment method is to improve the symptoms of PTSD while also addressing problems resulting from externalizing behaviors. What makes this different from the traditional treatment options is that it also works with the caregivers and helps the caregiver to develop skills to better support their dependent. By the end of this type of therapy patients and their caregivers are equipped with the tools they need to address the residual symptoms of PTSD in a healthy way. Do you have any questions?"

"Why are we drastically reducing the amount of time she will spend in therapy when symptoms are only getting worse?" Minerva asked.

"Correct me if I am wrong, but I am assuming that it would be preferable to have Hermione's PTSD under control before she gives birth to her child. While conventional therapy can be effective at addressing PTSD, given the time constraints it would be better to use a short-term type of therapy. This type of therapy also includes homework that will reinforce the things that we will cover in her therapy sessions. Do either of you have any other questions?"

"Not really" Hermione answered.

"What do you think about this plan Hermione?"

"Well I think I will prefer this to the original plan."

"Hermione, if you would like to begin with this course of therapy we can start either this week or next week depending on your preference."

"I think I should start it this week, although not today."

"That's fair, how does Thursday at 3:00pm sound?"

"That works for me."

"Minerva when would be a good time for your session?"

"Are you available on Friday afternoon?"

"I can do that, is 3:00pm good for you?"

"That will be fine."

"Now that we have your next appointments scheduled, shall we discuss your relationship with each other, and specifically happened yesterday? Hermione would you like to start?"

"First of all, I was not trying to kill myself, that was an accident. I just felt so confined. I understand that you are worried about me but please remember that I am going through a lot of things right now and I need some space."

"Hermione, you know that I am new to being a grandparent and as you know I have never really been a parent. I am attempting to step into the role of a parental figure to you in the aftermath of a traumatic event. It is not easy to become a parent in any circumstances, let alone under the circumstances that have led to me assuming this role. Part of being a new parent is worrying and given the fact that you are self-harming, I don't know exactly how to keep you safe and still give you the space that you want. I just don't know how to help you and I fear that any mistake I make could be potentially put you in danger."

"Now that both of you have made your feelings known, I would like to address a few things that were mentioned. Minerva, part of what we will be working on in your sessions will be parenting skills, which should help you to be able to more effectively help Hermione in your role as her caregiver. We also will be working on developing a safety plan. Hermione, once we have a safety plan in place, it is likely that you will be given more freedom within the castle."

"How soon can we make this plan?" Hermione asked eagerly.

I looked down at my watch and realized it was already 11:55am. "I am willing to work with you on this now, but this will take longer than the five minutes that we have left in our session for us to finish this but we would have to stay a little longer than we were originally scheduled for. It will also take at least a few hours to implement."

"If it will take time to implement it, can we please start it now." Hermione asked.

"Minerva, would that be okay with you?"

"I would also prefer to implement it as soon as possible."

"Alright then, lets begin." I spent the next half hour with them discussing the plans for how to keep Hermione safe. Eventually the plan sounded fairly similar to what we had discussed before Hermione's session, as we would have to wait until we had the opportunity to discuss with Hermione's professors of any potential threats in their classes before we could make any final plans.

I said goodbye to them and returned to my office to meet with my other patients before going home for the day. I was quite pleased with how well the session with Hermione and Minerva went and fairly confident that they were both fully onboard with the treatment plan.

Authors note 2: Again please review, I think in the next chapter I will have Andromeda drop the bombshell on Ted about who her mysterious patient is. I would have added it in this chapter but its almost 2:00 am here and I need to get some sleep, as I have been a bit on edge since the minor earthquake that happened Thursday morning (somewhere around a 3.8-4.0). It didn't do damage but I have never been in a place where I felt an earthquake before and I wanted to make sure I am prepared for the next one since I apparently live near a fault line now. Again PLEASE REVIEW because it really helps motivate me to write when I am being lazy. Also please vote on the poll, pairings are a long way off but I want to start planning it into the story arc.