Part Seventeen: Diagnosis
IFF
Tuesday, February 13, 2001
9:00 AM
"Did Jenna get off to school all right this morning?" Dr. Pfaff asked as Lee
and Amanda entered his office.
"Yes sir," Amanda replied. "We did consider keeping her at home today, but she
was feeling better and she wanted to go--to be honest I think she was glad to
get out of the house."
"That's very positive,Amanda," Dr. Pfaff said. "Jenna needs a regular
routine--we don't want school to become another place that she avoids. How did
she sleep?"
"There was just one nightmare," Lee said. "She didn't completely wake up--we
managed to calm her down in about thirty minutes."
"Really?" Dr. Pfaff raised his eyebrows. "That's encouraging."
Encouraging? Lee thought back to the soft whimpering-crying sounds that Jenna
had been making last night, the way she'd curled up in that protective little
ball--he closed his eyes briefly, fighting to control the emotions the memories
engendered.
"Lee?" Amanda touched his shoulder.
"What is it, Lee?" Dr. Pfaff asked.
Lee opened his eyes. "Nothing--it's nothing--I guess I'm just a little tired."
he looked at Dr. Pfaff. "You called us in here for a reason?"
Pfaff nodded. "I did--it's about Jenna--her diagnosis."
"Shouldn't Jenna be here for that?" Amanda asked.
Dr. Pfaff shook his head. "No, at this point it would only upset her--I don't
want her to label herself or think of herself as damaged in some way. We'll
introduce the concept gradually by telling her positive things she can do to
overcome the condition--but telling someone they have a stress disorder isn't
exactly the same as telling them they have the flu."
Stress disorder. He'd expected this, but actually hearing the words still felt
like a punch to the gut. Lee felt Amanda's hand slip inside his--he knew she had
to be feeling the same way.
"What kind of a stress disorder are we talking about here?" he asked the doctor.
"Post-Traumatic Stress Disorder," Dr. Pfaff said. "Otherwise known as PTSD."
"PTSD?" Lee repeated. "That's something that soldiers get--sometimes
agents--Jenna--she's barely twelve years old."
"Lee, PTSD is a psychological reaction to a trauma," Dr.Pfaff explained. "In
Jenna's case, her kidnapping, physical assault and attempted murder. The
nightmares, flashbacks, avoidance of things that frighten her--slight
regression, trouble sleeping, the hypervigilance, feeling like she can never
relax--they're all classic signs."
Classic signs--Lee felt numb inside. Amanda clutched his hand tighter as Pfaff
continued speaking.
"Technically the diagnosis is only made after the symptoms have gone on for more
than a month--so at the moment Jenna only has Acute Stress Disorder."
"ASD." Doctors, Lee thought sourly--they thought they could make everything
sound better by giving it a set of initials.
"Correct," Dr. Pfaff said. "But I'm going out on a limb to make the PTSD
diagnosis now--given the severity of Jenna's symptoms, I don't see them going
away completely within a month."
"How much time do you think it might take?" Lee asked.
"With therapy I think we're looking at a few months--perhaps a year at the most,
depending on how we progress."
A few months to a year. Lee ran his hand back through his hair. 'It isn't fair,'
he thought. 'Jenna doesn't deserve this--this isn't the way her life should be.'
"What--" his voice caught. Lee cleared his throat. "What kind of therapy?"
"I'd like to try cognitive behavior therapy," Dr. Pfaff said. "That's generally
most successful in these cases. It's basically the same thing that we've already
begun. Encouraging Jenna to talk about the event, getting her to face her fears
and helping her to relax--through exposure, response prevention and thought
challenging."
"How does thought challenging work?" Amanda asked.
"It means challenging the links between thing that frighten her and the things
that trigger her fear," Dr. Pfaff said. "Take, for instance Jenna's fear of
people standing over her--which she currently associates with the intent to
harm. With this therapy we can break that link--by exposing her to that fear and
helping her to see that one doesn't necessarily mean the other is going to
happen."
"But wouldn't exposing her to things that frighten her be dangerous?" Lee
asked. "Suppose it triggers another flashback?"
"Gradual exposure, Scarecrow--" Pfaff said. "You don't throw her in the water,
you take her hand and slowly lead her in--the more she's exposed the less
frightening it will seem."
"Is there anything we can do for her at home?" Amanda wondered. "Any way that we
can help?"
"Encourage her to talk about her fears--what happened--even if she needs to talk
about the same event over and over--I'm not saying that you need to interrogate
her, but you can ask her about it and if she needs to talk just be there for
her." Pfaff looked at Lee pointedly. "Don't overreact to what you hear--just
listen and be supportive."
Lee ran a hand back through his hair. "What about her nightmares?"
"Hopefully the therapy will help to lessen the nightmares," Dr. Pfaff opened his
desk drawer, rifling through a stack of papers. "In the meantime, try to keep
everything as calm and quiet as you can around bedtime--avoid any triggers that
you're aware of, and if she does dream, reassure her that she's safe and
encourage her to talk about it--even to write it down if she likes."
"Is that all we can do, sir?" Amanda asked.
"I realize that it doesn't seem like a lot--but it can help and it does work."
Dr. Pfaff pulled two sheets of paper from his stack, handing one to Lee and the
other to Amanda. "Along with the breathing exercise, here's another relaxation
therapy you can try out with Jenna before bedtime--it may help as well."
Lee stared down at the sheet in his hands. Progressive Muscle Relaxation. "This
will help?"
Dr. Pfaff nodded. "It'll improve her sleep and should also help her with the
physical symptoms, the headaches, nausea--all of those things are caused or
exacerbated by her anxiety--by her inability to relax. In time we'll be able to
teach her to use these techniques to calm herself."
"I was searching on the internet," Amanda said. "They said that another type of
therapy is creative visualization--would that work with Jenna?"
"It's a possibility," Dr. Pfaff said. "But that would be for later on down the
road once we know everything we're dealing with--all of what she experienced
during her trauma--at this point visualization might make things worse. This
isn't going to be an easy road back for Jenna--but I really do think we'll get
there."
SMK SMK SMK SMK
"At least we know what we're dealing with now," Amanda said as they entered the
Q-Bureau, locking the door behind them. "That's something, anyway."
Lee sighed. "Yeah--I mean, I think I had some idea already, with her
symptoms--I've been through things like that in the past. Still, hearing it out
loud was--"
"Yeah, I know." Amanda said quietly, letting her arms wrap around him, pulling
him close. For a few minutes they stayed that way, silently drawing strength
from their closeness.
"You must have had some idea too." Lee's voice broke the silence. "To go
searching on the internet."
"Well at this point I'm pretty much desperate for anything that will help me to
help her," Amanda admitted. "But yeah, it did cross my mind--I thought about the
stuff I went through after Birol--Dr. Pfaff helped me with that--I really do
think he'll be able to help Jenna."
"Jenna shouldn't have PTSD, Amanda," Lee broke the embrace as he began to pace
the room. "She shouldn't even be thinking about traumas--she's only a
child--it's just not right."
"Lee, I feel the same way. We are making progress, though. Getting her to open
up--we now know why she's afraid of being alone in the room with someone--and
that he didn't--"
"Maybe he didn't, but he overpowered her, made her feel terrified and
helpless--in a way that's just as bad." Lee's fists clenched. "If you'd seen
her--the fear in her eyes--she was shaking like a leaf at the mere thought of
that bastard. I'd like to be alone in a room with Johnston for five
minutes--just to give him a taste of his own medicine--see how he likes feeling
the way my daughter's feeling."
"That wouldn't really help Jenna, though, would it?"
"No," Lee admitted. "But I'm still not satisfied that nothing else happened--not
until I hear every detail." He sank into his desk chair, surprised to find that
he was shaking. "If only I'd been able to stop this--"
"Lee, I thought we agreed that we were going to stop focusing on the past. Jenna
needs our help now, remember?"
"I know, I know," Lee said. "And I know my guilt can hurt her, but--it's just
hard to stop feeling this way--like I failed her somehow."
"Well that's what Dr. Pfaff is here for." Amanda knelt beside her husband.
"When's your next session?"
"Tomorrow morning--though I really don't know what good it's going to do."
"Listen to me." Amanda's eyes looked deep into his. "Dr. Pfaff believes that he
can get Jenna through this and so do I, but you have to believe it too."
"I'm trying."
"Keep trying--because that's the only way we'll get through this--and we will."
Author's Chapter Notes:
Disclaimer: All publicly recognizable characters, settings, etc. are the property of their respective owners. The original characters and plot are the property of the author. The author is in no way associated with the owners, creators, or producers of any media franchise. No copyright infringement is intended.