Case study: Trauma, constant high alert state

Name of Organization: CherringtonSawers

Age/Gender of Client: 12-year-old, female

Background

M, 12-year-old girl with history of trauma.

Bright and social, but struggles with emotional regulation and tends to present self in a false way. Struggles to socially engage beyond superficial and tends to seek out new people constantly to experience these easier interactions.

Struggles with expressions of emotion and prefers people “not to know her.”

Has had years of CBT-type therapy but is adept at telling therapist what they want to hear, and is very good at deflecting and avoiding difficult topics for her.

Presenting Problem

Hypervigilant and at a near constant high-alert state, M was struggling with the social demands of current grade and, as the situation was getting more difficult for her, she was retreating more and more to a state of “false.” She was telling people what they wanted to hear to avoid engaging, struggling to regulate, going from extreme highs to lows quickly, and not always in response to events.

Goals

• To help M regulate more effectively
• To help calm fight, flight, freeze response that seemed to be M’s default state in any stress situation
• To help social engagement with the hope of achieving more genuine interactions and social approaches.

Previously

M has participated in many years of counseling and therapy through various sources as a result of early childhood trauma. She is reluctant to participate in more therapy at this point in time, but agreed to try the SSP.

Comments on SSP Programming

M enjoyed the entire program, and was calmer and slept extremely well after the first night of programming.

Day 1: After listening, she was quieter and less “chatty,” but the conversations she had were appropriate without getting silly.

Day 2: M was noticeably quieter but happy. She tended to have more conversations rather than long monologue stories that take up air space without giving too much actual information.

Day 3: M was exhausted, came home early from school, reporting stomach pains, and slept all afternoon and evening. Despite this, she wanted to complete the music, and mood and regulation levels were good. She only talked when she had something to say. M reported two of her teachers pulled her aside today to ask, “What’s wrong?”

Day 4: M did not want to go to school this morning, as she had not completed an assignment. Usually, this would lead to a huge upset, but she was able to rationalize just going and facing the consequences. M is beginning to ask questions to clarify (which she rarely does) and is reaching out to touch briefly when communicating with someone (e.g. touching mom on shoulder), which she does not do. M is singing more around the house and is more spontaneous in expressions of happiness and gratitude.

Day 5 (and weekend following day 5): M is very happy and relaxed. Her whole face looks more relaxed, and people who know her report that “she just looks different.” Her communications are more interactive and more able to account for the “other” person in the interaction. Her stories about events are more organized and less convoluted. She is seeking out help and clarification, and asking for permission more easily. She reports “just feeling happy.” There are many more spontaneous hugs and she is much less quick to “react.”

Comments and Conclusions

Overall, the SSP has made some amazing changes to M’s demeanor and level of regulation. She seems more “open” and willing to engage in a more genuine way.

She is less reactive and is accepting situations in a calmer way. She is less “high” and less “low.” Her voice is more genuine and her use of fake voices is noticeably less at home. M is seeking out more social interactions, rather than seeking someone out to talk at them. She is listening more and clarifying, asking for permission, and checking in more than previously. She is smiling more and expresses, “I feel happy.”

Her family reports that everyone feels more relaxed due to her calmer state. M reports wanting to do SSP again as she enjoyed the time so much. (M also uses Dreampad when she feels she may need help to sleep.) Future plan is to use this program to maintain and continue to support regulation.