John Flynn
I've been looking forward to this afternoon since Tamara asked me if I'd join her and Jamie for a working lunch to discuss one Anastasia Grey.
Having been Christian's doctor all these years I know Anastasia well, possibly more than she knows herself sometimes. But Ana is guarded, she's never let me into her head despite the fact I've always known that she suffers with low self-esteem and a lack of confidence. I know Christian has tried to persuade her to see me a few times over the years. I'm pretty sure Christian almost carried her here against her will after she had Phoebe, apparently she really struggled with how much her body changed after her second child.
In my heart, I knew there was a background there. However, she never let me in. Learning about her history with Stephen Morton and the relationship with her mother has made a lot of the behaviour Christian has told me about now make so much more sense. I mean Christian didn't even know to tell me. Christian has always told me everything, we've kept in touch all these years and met regularly even though Christian didn't need therapy with me anymore. After Ana came along and he truly engaged with addressing his past. Ana helped loads, but Christian would still see me every a couple of months just to chat and go over things, he used me as a soundboard. The first few years of marriage were hard for him because he didn't understand the etiquette of a normal relationship, but he soon found his feet.
"I've ordered Chinese." Tamara smiles as I join her and Jamie in the office. I am really looking forward to this, as a psychiatrist, it's rare to work with others, discussions about patients are usually done with confidentiality and protecting privacy in place and with Christian and Ana and the NDAs, there has never been anyone I can bounce around a discussion about them with. So it's great that I finally have this scenario to work with.
"Sounds great." I say placing my notes down at the table. They're notes on both Christian and Ana because Christian has been seeing me regularly since the assault and he's given me his consent to share the information with Tamara and Jamie to support in Ana's treatment.
Ana. Goodness if she'd have given me the opportunity to speak with her a decade ago I may have been able to help her. The relationship she's had with her mother has had a detrimental impact on her psyche. It's a shame that she didn't let me.
"You ok?" Jamie asks as I take a seat just as the door goes to signal the food has arrived.
"Yes I'm well and you?" I ask her and she smirks. She knows my mind was a million miles from here. "I was just thinking about Ana." I admit.
"Ana." She nods and I guess she's been as preoccupied recently with Ana.
We have some food first and make small talk, the weather, our families and once we've eaten and pushed our trays to one side, we open our notebooks to talk about our joint patient.
"So, as I told you on the phone Ana is engaging again." Tamara says and I think we're all relieved that that's happened sooner rather than later.
"How is she?" Jamie asks jumping straight in there.
"She's struggling. She's still fighting with the want to return to normal, she's angry with everyone and everything. She's engaging but how much is yet to be determined." Tamara says and I'm intrigued by that, Ana came to her so she's got to want to engage.
"Christian and Ana came to see me together after a failed attempt by Ana to be intimate with Christian." Tamara explains. "What I didn't want to tell you on the phone is while they were here Ana had a flashback when Christian touched her shoulders and she slugged him."
"So that's where the bruise came from." I chuckle. Christian has avoided telling me where the angry purple bruise on his cheek had come from.
"She was cornered into admitting she isn't coping and to start up with me again. But I think she's still hesitant so I don't know how much she's actually taking on board when we're talking." Tamara explains and I see that it now makes perfect sense. Ana may not want to engage especially if she doesn't yet fully feel that she needs therapy.
"Is traditional talking therapy the right way to go then?" Jamie asks.
"I don't know. Maybe in conjunction with alternative therapy but I don't know how receptive Ana would be to that." Tamara says and I can see she's struggling to deal with this on her own.
"I could get her out under false pretences. Ask her if she wants to catch up and go for a hike." Jamie says and Tamara immediately shakes her head.
"Trust is a huge thing with Ana right now. She would see right through you and then stop trusting you." I say already figuring out what's going on in Tamara's head.
"But maybe I could suggest it. Ask her to contact you to go walking for a meditative purpose rather than in the traditional talking therapy sense." Tamara says and I nod in agreement, that could work. I know Ana likes to walk to clear her head.
"Christian told me that after an incident with the OBGYN that Ana needed to walk, she didn't want to get in the car to go home and only got in the car when the security promised to drive them to the nearest park so she could walk."
"Wait what happened with the OBGYN?" Tamara asks and I realise Christian has shared something with me that Ana hasn't shared yet with Tamara. It's vital she knows though.
"Ana and Christian went for a sonogram and Christian was asked to leave the room. My understanding is the doctor discussed doing an internal examination with Ana to check how she was healing following the assault and Ana agreed to do it there and then. She flashbacked as soon as the exam started and left in floods of tears. Christian said Ana took it hard that she couldn't go through with the exam and so even said she wanted a c section.
"She hasn't told me any of this." Tamara sighs. "This is what I mean by her not engaging. I've asked her about flashbacks and panic attacks and she told me about some incident at work and an issue with someone at a coffee shop. A flashback when getting an intimate examination is so important especially with her being pregnant because she's going to need more of those exams sooner rather than later. Damnit this is what is frustrating me. I can't help her if she isn't honest with me." I feel for Tamara. This is exactly the problem we have with patients that are admitted against their will they don't want to work with you. You can't help someone with therapy unless they want to help themselves and it sounds to me like Ana still isn't quite admitting that she's not ok.
"What do I do John?" Tamara asks.
"Well, I think asking her to walk with Jamie is a good start. Other than that keep pushing."
"Has she talked about the rape yet?" Jamie asks and I look at Tamara who shakes her head. That's interesting, very interesting.
"Maybe Jamie that's something you could work on with her if she's receptive. If she's blocking it out, then that's going to play a huge part in her being unwilling to accept that she's having symptoms of trauma." I say and Tamara and Jamie nod in agreement with me. We've seen this in trauma patients. Ana isn't an anomaly that we haven't seen before!
"She's minimising. Everything is fine. It's not a big deal. Other people have had it worse. Could you imagine if we could actually ask her friends and family how she's responding to them when they ask how she is, what kind of answers they've been getting." Tamara says scribbling on her legal pad.
"Christian says she'll mention it very casually and refers to it as an assault more than say she was raped." I explain as it was something that frustrated Christian, we spent an hour just discussing the importance of words for those suffering trauma. "Plus she's got a firey little temper."
"Do you think she's in denial?" Jamie asks.
"No." Tamara responds at once. "She can't deny what happened outright because too many people know."
"Is she rationalising?" Jamie then goes on to ask, clearly trying to get a good picture of how Ana views the rape in order to be able to frame any conversation appropriately.
"Yes I would say so." I say. "She can't deny the assault happen but she's definitely downplaying the seriousness, she's refusing to accept the detrimental effect it's had on her, she wants the normality of life and wants everyone to believe that she's ok. Ana has always been someone who minimises but usually anything positive. Like when she had her babies and people told her she did amazing she liked to say it wasn't a big deal, her achievements, the first time she got an author onto the New York Times best-seller list even though Christian said she poured blood sweat and tears over the novel when I congratulated her she said it had nothing to do with her."
"That's a self-esteem issue." Tamara replies and I nod in agreement. I've always known Ana has self-esteem issues and I think that stems from her relationship with her mother now I know that there is an issue there.
"Do you think that tackling the self esteem would help her face the trauma?" Jamie asks thoughtfully. It's obvious her mind is working a million miles a minute.
"No. But if you successfully deal with the trauma she may be willing to deal with her self esteem." I reply. Fortunately, I know Ana well and so can guide a lot of this conversation.
"Ok so my thinking is this. When I see Ana next week I'll try to persuade her to see Jamie as well as work on getting her to discuss her traumatic symptoms. Jamie if she gets in touch with you or maybe so not to jinx it I'll say when she gets in touch with you. You can work on getting her to discuss the rape and then to stop the minimisation and John I guess you will continue to work with Christian and support him in supporting Ana?" Tamara looks happy to have a plan to love forward already.
"Yes I will encourage him to continue with validation, ensuring she knows she can talk to him and to continue the intimacy you've encouraged." I know about the intimacy stuff that Tamara encouraged from my last session with Christian.
"Ok this sounds great." Tamara beams and I think she's relieved she can turn to us about Ana because she'd be frustrated if she was alone having to work this. Bouncing thoughts and ideas around with other people is a huge step.
I just hope it works and sooner rather than later. Ana deserves to recover from this and as fast as possible too.