INTRODUCTION

Schechter and colleagues offer us a sensitive, empathic report of their engagement with Nancy, the mother of Alisa (5 years) and Libby (8 months), from the time of the first encounter in the emergency room to discoveries about their lives and traumatic experiences, through therapy and follow-up.

The case study reports a history of trauma and abuse in Nancy's life, a complex psychiatric history, and a hopefully successful series of interventions, including individual psychotherapy for Libby's older sister, for Nancy, and for Libby and Nancy together for an infant-mother intervention. This included “three videotaped visits: (1) an in-depth interview of Nancy about Libby and Nancy's own history, (2) a parent-child play paradigm one week later, and (3) a videofeedback intervention with Nancy alone two weeks after that.” The goal of these interventions included increasing “the likelihood of verbal self-reflection and effective communication, as opposed to unreflected – in this case, medicalized – action [e.g. somatic ataques, and PTSD physical symptoms] and consequent disruption of psychological meaning.”

The pathway through which Nancy encounters professionals who may be able to help her is via the emergency room (ER), and other medical care situations. Nancy returned to the ER two more times after an initial visit, and some staff began to question the previous diagnosis of epilepsy and medications given to treat epilepsy.