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Chapter Eight

INITIAL SESSION NOTES Patient: Dylan Braun Treating therapist: Dr. Stuart Morley

I spoke with Dr. Karen Shields, lead therapist who worked with Dylan during the three-month period he was placed in full-time care at Clive House Psychiatric Residential Treatment Facility (state of California). Shields’ observations are in line with my initial diagnosis of C-PTSD (Complex Post Traumatic Stress Disorder). Mainly:

1) Dylan’s exposure to multiple traumatic events over an extended period.

2) The challenges Dylan appears to exhibit in forming healthy relationships (issues with trust and intimacy). Particularly concerning is his ambivalence/mistrust of women, ingrained in him by his kidnapper (Eli), and his extreme delusional beliefs about women being conniving, sexually predatory, and the root of all evil.

3) Some difficulty recalling important aspects of certain traumatic events (mainly, the murders he witnessed as a child and possibly as a teen)

4) Coping mechanisms and survival strategies Dylan has developed that were adaptive in the traumatic environment of his life with Eli (his kidnapper), but that are mostly maladaptive in his current relatively “normal” life.

5) A fragmented/distorted sense of self

6) Dissociative symptoms—particularly moments of feeling detached from his body and/or environment

7) Dylan’s difficulty managing and regulating emotions. Particularly concerning are his intense and unpredictable emotional responses, most notably the jarring contrast between his out-of-control rage when he first learned of his kidnapping and his mother’s murder—compared to the closed off, withdrawn behaviors he’s exhibited more recently.

I explained to Dylan’s father (Philip) that, compared to PTSD (which he had heard of), C-PTSD is linked to ongoing trauma as opposed to one single incident, and is characterized by a more extensive set of symptoms. I informed him we may need to keep some sessions shorter and adapt their duration to Dylan’s mood and how he handles heavier topics as they come up.

My initial observations on Dylan are as follows:

Dylan has an acute tendency to retreat from psychological pain and vulnerability, using avoidance as a defense against traumatic distress. This coping mechanism exhibits itself in the way Dylan sometimes pretends the trauma he’s experienced hasn’t affected him to any significant degree and/or minimizes the damaging and hurtful experiences of his past. Painful anecdotes are often discussed in an emotionally detached manner, often using the pronoun “you” instead of “I” when he recounts anything from his past (ex: when asked how he felt about his kidnapper not allowing him to ask anything about his mother growing up, Dylan’s response was: “It wasn’t a big deal. You just dealt with it.”)

Feelings of shame and disillusionment cause Dylan to sometimes hide any effects or details of his traumatic past, even regarding his kidnapper. When touched upon, Dylan often attempts to explain/dismiss/marginalize his treatment under Eli’s care. As is common in cases of this type, Dylan wavers between feelings of betrayal and anger towards his abuser—and wanting to protect him, still viewing him at times as his real “father” figure.

Because Dylan grew up not being able to trust his primary caregiver, out of necessity/survival, he compensated by becoming fully self-reliant. In a case like this one, it is normal for a child to grow up viewing his self-reliance as a strength and any dependency or placing of trust in others as a weakness. As such, Dylan views his entire world in black and white, seeing people as either strong or weak. Anyone showing vulnerabilities = weak. Anyone closed-off and self-reliant (such as himself) = strong.

Focus of sessions in the next few weeks will be on slowly posing questions to Dylan about his past. How he answers those questions is not important at this stage, as the intent of the questioning is merely to nudge him into thinking about his ingrained assumptions related to his trauma, and for him to start analyzing them, even if he ends up only doing so on his own time, outside of therapy.