Jessica, age 11, was brought to therapy by both her parents. Jessica was very sporadic. She had questions about all of the games and toys in the therapy room. She jumped from one corner of the room to the other in order to see each toy up close. Jessica’s parents informed me that Jessica’s older sister was hit by a car and was hospitalized for nearly dying. Jessica witnessed her sister flying through the air and tumbling down the hill in front of her house. Since her sister’s accident, Jessica has been having difficulty concentrating, she’s been having nightmares every night, she’s been throwing temper tantrums, has been hypervigilant, and has had an exaggerated startle response when she is near moving cars.

Post-traumatic stress disorder (PTSD) is an anxiety disorder. PTSD can occur after someone has witnessed or experienced a traumatic event that involved their belief of being threated of injury or death. Traumatic events could include car accidents, rape, assault, war, natural disaster, etc. The stress caused by trauma can affect all aspects of a person’s life, including mental, emotional and physical well-being. Jessica witnessing her sister almost die is a traumatic incident that has lead to PTSD. Her sister’s accident dismantled Jessica’s sense of safety.

When working with a child who has been through a traumatic incident, it is important to remember that trauma could elicit such intense fear, anger, shame, and helplessness that the child feels overwhelmed. Overwhelming emotion can delay the development of age-appropriate self-regulation. With Jessica, it was critical to note that the traumatic experience she witnessed had been stored in her body in the form of physical tension. Her hyper-arousal manifested in the form of increased heart rate, difficulty concentrating, and worrying about her safety. She became very jumpy around cars and even threw tantrums. When her mother attempted to stop Jessica from shaking near a passing car, I encouraged her to instead allow Jessica to shake until her body came to a rest. Releasing the stored trauma memories could be very helpful in getting the experience out of her body. Rather than feeling helpless and immobile, Jessica was able to get out of her frozen state.

I initially provided Jessica and her parents with psychoeducation about PTSD and what it could look like. After building a positive therapeutic relationship with Jessica, I assisted her in acquiring coping skills that felt comfortable for her. Jessica, for example, enjoyed deep breathing techniques and drawing/writing about her feelings, but did not enjoy practicing muscle relaxation techniques. After she was able to put her coping skills to use, I assisted Jessica with her PTSD by exploring thoughts & feelings about the trauma. I helped her deal with any feelings associated with the trauma, such as sadness and fear. I supported her in recalling the event, expressing feelings, and helping her in gaining some sense of control over the experience. Jessica decided to draw out her trauma memories and also used puppets to act out the trauma that she witnessed. She was able to use the puppets to tell her version of the story, starting with how she reacted to her sister’s accident, to the hospital visit, all the way through when her sister came back home. Use the coping skills and talking about the trauma also helped Jessica to concentrate better at school and decreased the nightmares she was having.

In addition to having individual therapy, it was also helpful to bring in Jessica’s parents into the session. I assessed her parents for PTSD symptoms. I met with Jessica’s parents separately to give them a separate space to also process the trauma memories, in order for them to be more emotionally available and supportive of Jessica’s therapy and process.

Author's Bio: 

Cristina Mardirossian, M.A. is a Licensed Marriage and Family Therapist working in private practice in Pasadena, California. She is dedicated to providing psychotherapy for families, individuals, and adolescents, focusing on trauma, grief and loss, parenting, depression, and anxiety. For additional information please visit Cristina can be contacted at or (818)434-6051.