Identify intergenerational patterns regarding alcoholism/substance use, depression or mental illness, neglect, abuse, or other trauma. What do these patterns indicate, and why might they be continuing across generations?
Explain your plan for exploring these intergenerational patterns of trauma with the client. How would you create a safe place for discussion, ask questions and actively listen in a sensitive manner, and educate the client.
Lewis is a 35-year-old African American male. He is seeking therapeutic services after his wife, who was 8 weeks pregnant with their second child, and his 2-year-old son were killed by a drunk driver 2 years ago.
Lewis
During the initial session, Lewis states, “I just can’t trust people anymore. I used to love meeting new people. And now I feel like I can’t trust them. Folks that know what happened to my family, they look at me different. Like they’re waiting to see if I might crack or break down, or how I’m going to keep going.” Lewis states he is seeking therapy because he has developed anxiety and no longer has any desire to engage with people because of his discomfort with what he identifies as “awkward conversations” in social situations.
Trauma
The day of the traumatic incident, Lewis came home in the mid-afternoon and found his wife frustrated from her efforts of potty training their 2-year-old. She wanted to go for a walk with their son to relieve frustration for them both. Lewis checked the app that he used to track weather for his athletic training job and told his wife that she had a 30-minute window before some thunderstorms were going to be in the area. They left, and Lewis “hung out on the couch watching some TV to decompress from the day.” Lewis reports that after 40 minutes had passed and the rain started, he became concerned. He states that he took his car to look for them, “just in case they didn’t want to keep walking in the rain.” He did not see them, so he went back home. They weren’t there, and so he went out to look for them again. He saw some fire trucks and police cars a few blocks from their house but didn’t think anything of it.
Lewis states that after an hour and a half passed and he still had not heard from his wife, he went to the area where the fire and police were located to see what was going on. When he arrived at the scene, he saw a small crowd of neighbors and more response vehicles than the first time he had passed. Lewis reports that he started to cross the street to join the crowd when he noticed his wife’s shoe in the middle of the road. He states that his heart started racing, he could no longer hear any noises, and he raced across the street. When he approached the police officers, they informed him a driver impaired by substances had hit both his wife and child and was going so fast that the car went through the side of a church building just off the road.
Current Situation
Lewis is currently single, living with two roommates (who are graduate students at a local university), and works full-time as a physical trainer. Lewis states that his work is no longer rewarding for him and that he “just shows up every day. I mean, I do my work, and nobody at work knows how I feel. But it all feels pointless.” Lewis has a few friends from college that he identifies as supportive and states, “they don’t treat me different or like I am going to break.” Lewis states he tried dating someone a few months after his wife died but felt it was too soon, as he found himself comparing the new relationship to that of his wife. Lewis reports that he is now drinking both more frequently and in greater quantities than before the incident. He states drinking lets him “find some quiet when everything always feels so loud.”
Lewis reports that feelings around the traumatic grief of his wife and child were somewhat delayed as he only took 3 days off after they died—and those days included planning and attending their funerals. Lewis reports he did not want to lose sight of the goal of completing his PhD as he and his wife “sacrificed so much time together for me to finish this degree. We were supposed to do so many things once I finished the program. I didn’t want to dishonor my wife by not finishing the PhD.” He finished his doctoral degree 8 months after his wife and child died.
Family
Growing up, Lewis states that he did not experience physical, emotional, or sexual abuse and that he had stressors typical within most families with two working parents and three children. Lewis reports that his parents had verbal arguments periodically with no presence of domestic violence. When he was 14 years old, his parents separated for a few months, during which time he continued living with his mom. Lewis reports his mom experienced significant anxiety that often led her to hold perfectionistic standards of both herself and each of the family members. While his parents were separated, Lewis’s paternal grandfather, with whom he had a very close relationship, died. Lewis states, “I think that was what brought my parents back together. They started talking more and then reconciled their relationship.” Lewis’s grandfather was an avid baseball fan and the inspiration behind him going to college to become a personal trainer to work more closely with baseball.
Lewis reports that he has “good” relationships with both his brother and sister and states, “We used to talk once a month or so, but since my wife and child died, we have been talking at least once a week or more. Unlike Mom and Dad—I used to talk to them a lot more often, but now…now I feel like I have to support them in their grief and it just takes so much energy. I avoid talking to them much at all and, when we do, I try to talk for 5 minutes or less because otherwise we start talking about feelings…and I just can’t do it right now.”
Moving Forward
Lewis reports that he no longer has a sense of who he is as a person. He states that he attempted to go to a support group for grief and the group leader asked for mothers and fathers to raise their hands. Lewis states, “I didn’t know what to do. I no longer have my son or my unborn child. Am I still a father?” He further states he previously had a very clear vision of his 5, 10, and even 20-year life goals and plans, but now finds himself wondering if he should stop working to travel, hike, and write about his experience. He states, “Do I date again? Do I have more children? I have no idea how to move forward.”
Lewis reports that he now has anxiety about meeting and getting to know new people because he is uncertain how they will respond when he shares his story. He no longer enjoys small talk and has no desire for superficial relationships. Lewis is now using social media more often because he does not have to invest much emotionally, and it is more anonymous; however, he identifies that the time he spends on social media is now interfering with him taking care of responsibilities around the house.
Lewis reports that he spends quite a bit of time outside of work alone in nature, which is fine, he says, until there is a threat of a thunderstorm, which brings increased anxiety. Thunderstorms “take me right back to that day.” Additionally, Lewis reports that he is involved with his church and actively volunteers at their soup kitchen and with the medical outreach team. He states, “Spending my time that way actually means something.”