Jane is a 54-year-old married Black female. She has two adult children who are 25 and 31. She currently lives with her husband of 33 years in their single-family home. Jane is seeing you today due to a car accident that occurred 18 days ago. According to Jane, “I thought I was going to die! And my life has been in chaos ever since the car accident.”
Jane described the car accident she was involved in 2.5 weeks ago. She reported that she was on her way home from work driving along the four-lane, 55 mile-per-hour road she drives any time she leaves her home. Her home is located on a small road that can only be accessed from the four-lane highway. Approximately 10 miles from home, Jane reported that she saw a car jump over the grass median and come speeding down the highway going the wrong direction. The third car in front of her hit the oncoming car head on. This caused the two cars in front of her to slam on their brakes and resulted in a 15-car pileup on the highway. When Jane hit the car in front of her, her car veered off into the right-hand ditch that runs along the highway. When her car hit the ditch, it flipped twice, and she landed upside down on the side of the highway. Due to the damage sustained by her car, Jane was unable to exit her vehicle and was trapped upside down in her car for approximately 45 minutes. During that time, she could hear individuals screaming, calling for help, and there was a general scene of chaos due to the accident, yet it appeared distorted in her mind. During the 45 minutes she was trapped in her car, she was strapped in her seat belt which pressed against her chest making it difficult for her to breathe. She also landed in an awkward position which made it unable for her to move her head which very painful. During her time in her car, she stated she felt like she was having a heart attack, and that she was being suffocated slowly. Upon recalling this, she stated “I really felt like I was going to die.” Once emergency workers arrived on the scene, she was extracted from the car and taken to the local hospital. There she was treated for multiple broken ribs, a broken arm, a bump on her forehead (was not diagnosed with a concussion) and multiple bruises and abrasions and released after 24 hours. Jane stated, “The doctors and nurses told me over and over that I was so lucky to have walked away from that accident with as few injuries as I had. But I must be honest, I don’t feel lucky! I feel scared all the time and I don’t know if my life will ever be the same.” Jane added that three people died in the accident. She saw one of the individuals who did not survive being extracted from their vehicle as she was taken to an ambulance and stated, “I wonder why I lived, and they did not.”
Since the accident Jane has been having memories of the accident multiple times per day. She stated, “I will be trying to concentrate on something completely nonrelated to the accident, like at work, and a memory of the crash will suddenly overwhelm me.” Jane reported that the memories she struggles with the most is the image of the car crossing the median and hitting the first car head on and of her heart beating fast and not being able to breathe while she was trapped in her car. She also articulates that when she has these memories, she thinks about what she could have done differently to avoid the entire experience. In the past two weeks she has had nightmares of the accident at least five nights per week. She stated these nightmares wake her up and then she has difficulty returning to sleep due to the anxiety she feels. Jane stated “the nightmares are extremely distressing. I was already having difficulty sleeping since the wreck. After a nightmare I will not go back to sleep for the rest of the night. I just cannot calm down.” She stated that every night since she was discharged from the hospital, she has had a difficult time falling asleep. She stated under normal circumstances she would fall asleep within 15 to 20 minutes of going to bed and sleep all night, getting 8-8.5 hours of sleep. Since the accident it takes her up to two hours to fall asleep and she struggles to stay asleep even on nights that she doesn’t have a nightmare. She has been getting under 5 hours of sleep per night. Jane reported that she’s also been very irritable since being released from the hospital. She stated “I become angry very easily, when normally I am laid back and pretty relaxed. My husband is being very tolerant, but the people I work with are starting to voice that I need to get some help.” She shared she often “snaps” at people without intending to and then feels guilty and ashamed for doing so. She also reported that her work performance has decreased due to an inability to concentrate. She stated, “I feel tense, keyed up, anxious and distracted all of the time since the accident.”
In addition, Jane reported that she has had three incidents in the past three weeks where she felt like she was reliving different parts of the accident. She stated that during these times her heart would race, she would get sweaty, and lose the sense of where she was for a few minutes. These incidents cause her anxiety and fear. She stated, “In the past three days I have started to worry about these overwhelming experiences… that they will become more frequent and longer.” Jane also reported that since the accident she has not driven a vehicle. She can her drive herself to work in the extra car but when she approaches the car, she became very fearful and runs back into the house. She stated that she feels completely overwhelmed by the idea of driving the car and has asked her doctor to write her a medical excuse to not drive for the next 8 weeks. Jane stated that she returned to work 5 days after the accident and her husband has been driving her. She stated that this is OK right now, but her husband’s job will not allow him the time to do this for much longer without the medical excuse.
When she is in the car with her husband she startles easily. If a car in front of them taps on their brakes, she will jump, grab the armrest, and scream. She stated this is annoys her husband and she is somewhat embarrassed by her response. She also tends to be very tense when she’s in the car and looks around continually for other vehicles that are getting too close. In the last three days she has noticed she is constantly looking around, worried about her safety in general. Jane stated “I have found another way to get to work without going on that highway. I had someone tell me that there is a small dirt road that will take me out to another highway and loop me around to the main part of town where I work. They think it’ll take me an extra 90 minutes to get to work. Once my husband is no longer able to drive me to work, I’m going to find that dirt road and spend the extra 90 minutes. I just don’t know if I’ll ever be able to get back on that highway driving a car.” Jane stated that prior to the accident she spent a lot of time in her car going to work, visiting friends, and socializing. She stated that she has not had a social life since the accident due to her overwhelming fear up driving on the highway. She feels guilty because she has not attended church since the accident.
Jane has a bachelor’s degree in business and works full time as a systems analyst for a large company. She has been at her job for 15 years and has been promoted several times due to her excellent job performance. Jane reported she has multiple friends at work, in the community, and at church. She stated prior to the accident she was very involved in the community and in her church. The fear of driving, the recurring memories, the lack of sleep, and the overwhelming anxiety have kept her from her normal activities which she highly enjoyed. Jane has a good relationship with her husband, who she reported is being very kind and supportive. Her fear of driving has required him to spend many extra hours in a car during the work week, which she feels guilty about. She has not seen either of her children outside of her home since the accident which she reported is unusual. She stated that if she could, she would quit her job and stay at home where she knows she’ll be safe. She reported feeling worried that her friends will break off the relationships due to her being irritable and unavailable and that her life will never return to the way it was before the accident. She reported hopelessness about the situation and being very sad when she thinks about losing all her friends.
Jane reported believing in God and that her spiritual life was a central focus of her life. She stated “I just cannot figure out why God would do this to me. Why he let me get into that wreck! I am not a bad person… so why is he punishing me?” Jane reported that she has been attempting to pray but is struggling to focus. She also has not been able to engage in Bible study due to having to travel to church. She reported these experiences often leave her feeling shame and guilt for not “trusting in God more” and questioning why He would allow such a terrible thing to occur.
Jane reported no history of health problems, is on no medication, no past mental health diagnosis, and has no history of alcohol use or other substance use. Jane has a large family of origin and is the middle child of seven. Her parents live in the same town as she does. Under normal circumstances she visits them every few days but has not seen them since the accident. She reported “I feel so guilty because I am neglecting my parents. I promised to help them as they got older… and here I am feeling sorry for myself and not helping them.”
Jane was open to the idea of individual counseling but expressed fear over driving to her appointments. She stated that she would need to check with her husband and see if he could drive her. Jane reported her goals for counseling are to “get over” this experience and be able to be self-sufficient and drive again, while not relying