Monday, August 10, 1998
11 am. Initial Session with Madeline Trent. Although it is my professional obligation to do so, I'm finding it very difficult to separate Madeline Trent the patient from Maddie Trent, the wife of another patient. I was surprised, when I met Ms. Trent, because she didn't match the image that I had of her from listening to Jesse. I was expecting a simple, soft, somewhat fragile woman rather than the strong, sophisticated, and somewhat cold woman who came to my office today. Madeline's feelings for Jesse don't seem nearly as potent as his feelings for her. While she may have initially loved Jesse, she told me that she doesn't feel that he's grown in the relationship as she has. Madeline feels the weight of the responsibility in the family and it presses upon her. Apparently, she doesn't think that Jesse is carrying his share of the burden. Madeline is twenty-six. Physically, she's tall and slender, with very dark brown curly hair and bright blue eyes. Her fingers are exceptionally long and thin, like the rest of her. It would be impossible, just by looking at her, to guess that she bore a child less than three months ago. She carried a bottle of water with her and sipped it throughout the session. Madeline was dressed professionally and fashionably, in a businesslike skirt and blouse. Her hair was styled and dressed and her make-up was carefully applied. Her demeanor seemed crisp and efficient even when she shed tears, although she seemed much more vulnerable and human when she talked about Natalie, her baby daughter. Madeline's primary complaint was that she's suffering from unendurable stress. Much of that stress can be attributed to the difficulty of being a new mother combined with being a professional woman seeking career promotion. On top of those substantial stressors, Madeline has to deal with the fall-out from being sexually assaulted last year by a serial rapist. A suspect is in custody after allegedly murdering another woman, and Madeline is expected to testify at the trial--but as a witness for the defense. Although she believes the suspect is guilty of the assault against her, she can't identify him. The defense believes that Madeline will make a good witness for their side, even given her hostility towards the defendant. I can only imagine how that must make Madeline feel. Apparently, Madeline's attacker did significant damage to Madeline's reproductive system and, given that, Natalie's birth was somewhat miraculous and is unlikely to be repeated. And Madeline hasn't told Jesse all the details of the assault. Now she is required by law to testify to those details in a courtroom full of strangers. She said that she feels that she'd rather die than testify. Madeline is also afraid that if the defendant fails to be convicted, he could come after her again. While some of her fears may be overblown, I'm afraid that most of them have a fairly reasonable foundation in fact.

Tuesday, August 18, 1998
12 pm. Second Session with Madeline Trent. This session was primarily for the purpose of giving Madeline permission to relax. If she thinks it's good for Natalie, she's willing to indulge herself with activities designed to relax her. But otherwise, she feels too guilt-ridden to allow herself to really relax, which I've found to be common among new mothers. Madeline said that she relaxes with manicures, pedicures, and scented candles. Although those wouldn't work for me, I encouraged her to take time to do those things on the pretext that Natalie would benefit from her mother's increased sense of well-being. I still felt that Madeline is keeping me at bay somewhat--she's struggling to feel comfortable in a therapeutic setting. So I'm not pressing as hard as I might, even though we clearly haven't established a close enough relationship to enable me to do much good. She did tell me that Jesse makes her laugh, and for the first time, I got some intimation that she really does love her husband.

Tuesday, September 8, 1998
12 pm. Third Session with Madeline Trent. Madeline describes her current situation with a degree of self knowledge that I found surprising. She feels a lot of stress in her life and I suggested that she try to eliminate some of the small stressors before tackling the larger ones. Madeline was amenable to my suggestion. She thought that a time schedule at home might assist her in relieving some worries that she has of not being able to spend enough time with Natalie. Madeline said that she was sometimes jealous of Jesse for being able to spend his whole day with Natalie. I'm considering administering a stress assessment exam to quantify her current levels of stress and track any improvement. We talked about Madeline's parents--they don't like Jesse and keep urging Madeline to leave him and return to them in St. Louis. Although Madeline has made it plain to them that she has no intention of breaking up her marriage and, furthermore, that such talk is intensely painful to her, they persist. Madeline talked about her friends from the Rape Crisis Center. She said that she needed them after the rape, but that, as time passed, she found that they allowed themselves to be continually victimized by the crime in that they couldn't move past what had happened to them. Madeline thinks that Natalie has helped her in moving on with her life. She admits that she was horrible to Jesse after the assault by taking out her anger and fear on him, and says that, although he doesn't understand what she went through, he's tried hard to show her his love and give her his support. I asked her whether the upcoming trial would help or impair her healing. She said she didn't know. She feels the fears and insecurities that she thought were gone being dredged back up to the surface, and she said that she's jumpy at work and has little patience for people generally. Madeline thinks that the more she talks about what happened the night she was raped, the worse her fears will become. I think it is likely to be exactly the reverse, but I would hate it if the first time she goes through a recall of that night's events was in a courtroom filled with strangers. I think we need to talk about these issues much more before she faces her ordeal at trial.

Tuesday, September 15, 1998
12 pm. Fourth Session with Madeline Trent. I felt it was important to spend the session today giving Madeline some tools to handle her stress levels. I filled out a social readjustment rating scale for Madeline in blue ink and came up with 200 points. She added an additional 180 points in red ink. On that scale, 250 points would indicate someone who was severely overstressed. With both of our markings, Madeline tipped the scale at 380 points. I told Madeline about some research into body clock cycles and stress and urged her to try some basic relaxation techniques. Obviously, she has a considerable problem in trying to get back into an adequate sleep/wake rhythm when she is nursing a baby at night. I wanted her to try to give some of that responsibility to Jesse, but she was reluctant to do so--she likes to nurse Natalie. We spoke a bit about endorphins and neurotransmitters, and she seemed enthused about working on the things we discussed during the session.

Tuesday, September 22, 1998
9 am. Telephone Call from Madeline Trent. Madeline called to cancel her appointment. I'm concerned because she's scheduled to testify on behalf of her attacker on Friday, and I don't think she's adequately prepared. She seems to feel that she might not be called at all, and her attorney seems as if she's also putting her head in the sand. I'm afraid that if Madeline is called, she'll not stand up well under the pressure.

Tuesday, October 6, 1998
12 pm. Fifth Session with Madeline Trent. Madeline was able to describe in some detail the events of her attack. She described one of the most vicious and sadistic rapes I've ever heard. Madeline's attacker broke into her house. In addition to raping and sodomizing her, he cut her breast with a knife, tried to introduce dye into the wound, defecated on her, burned her labia and clitoris with a lit cigarette, kicked her in the ribs, smashed her head into a wall, and held her face over a burner on the stove. Physically, she suffered a concussion, bruised ribs, internal injuries, a torn rectum, and physical damage to her vagina. Apparently there was even more, because her obstetrician told her that it was unlikely that she would be able to have children--a prediction that was fortunately proven false. Madeline is clearly suffering from post traumatic stress disorder. During the session, I guessed she was suffering from some hallucinations related to the event and she was shocked at my perspicacity. She admitted that she had been afraid to tell me about them because she feared she may really be losing her mind. She told me that she's had six or seven episodes: sometimes she imagines that the wound on her chest is bleeding, or that the stove lights itself. I asked her to keep me informed--if the hallucinations start to rise in frequency, I'd like to know about it. She also told me about an incident where she ran into a male co-worker suddenly and experienced an intense and violent fear reaction. I tried to explain what was going on. Obviously, the trial has brought forth events which Madeline has tried hard to suppress. As it turned out, Madeline didn't have to testify. The attacker entered into a plea bargain on the day of trial whereby he pled guilty to manslaughter and sexual battery rather than rape and murder. Madeline has understandably strong revenge fantasies surrounding her attacker. However, given the circumstances of the attack as she related them to me, I didn't feel that her assertion that she wasn't conscious long enough to recognize the face of her attacker was particularly credible. But given the intensity of the session, I didn't confront her on this point. Madeline's justifiable rage surrounding these events has barely begun to be expressed. We have a lot of work to do to try to lessen some of the emotional power these events have over Madeline.

Tuesday, November 3, 1998
12 pm. Sixth Session with Madeline Trent. Madeline came in and she had obviously been crying. Her eyes were blood-shot and puffy and her nose was decidedly red. She told me that, since the attack, she's found herself suddenly crying with no apparent reason. I assured her, of course, that sudden bouts of crying was common after a traumatic event such as the rape, even after several months have elapsed. But she is tired of hearing how things will get better with time and wants to know how long she's going to be like this. Obviously, there are no easy answers. Her relationship with Jesse is clearly suffering. She told me herself that she's been snapping at him without cause. I told her that the fact that she recognizes that she's not being fair to him is a good step towards resolving the problem. But she interpreted that as being on Jesse's "side." She told me that, even before she was assaulted, she and Jesse had grown somewhat apart. She's annoyed that he still works in a bookstore and is consumed with his motor scooter instead of being more ambitious and aggressive. Madeline told me about how they fell in love and got married. She recounted a bit about her parents' negative attitude towards Jesse, especially after the car accident where she lost the baby. She told me that she started to see Jesse through her parents' eyes and saw that some of the criticisms they leveled against him were legitimate. Madeline told me about a man who worked where Madeline worked in St. Louis. He was clearly making a play for her, and Madeline was tempted. But she refrained from cheating on Jesse and, instead, made a decision to pursue a job with SII, and move out to San Francisco. Madeline's primary motivator didn't seem to be Jesse alone, but rather an unwillingness to break down the forms of marriage through divorce. Perhaps that's unfair; that was merely an impression. Madeline puts it different--that she understands every relationship hits some bumps and that the people in the relationship should work hard to resolve those bumps, rather than just giving up. Madeline suggested that we spend our next session talking about her parents.

Tuesday, November 10, 1998
12 pm. Seventh Session with Madeline Trent. Madeline arrived today about half an hour late for her session. She was accompanied by her friend, Sammy, who was somewhat flamboyantly stoned on marijuana. Madeline, too, was clearly under its influence. Sammy embarrassed Madeline intentionally by telling me about their Cheech and Chong routine and by disclosing that Madeline has a vibrator she anthropomorphises as "Big Bubba" and whose existence remains unknown to Jessie. Madeline told me that she hasn't smoked marijuana since college and she tried to give me a joint, which I waved off. I told Madeline that she wasn't in a condition which favored therapy and suggested that we end the session early.


Button to Madeline Trent's Patient File Madeline Trent's Patient File
Button to Jesse Trent's Patient File Jesse Trent's Patient File
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