crisis recovery

Current Events, Mental Health, Practice News

So, here’s another truth about being a therapist at this particular moment in human history (last week’s behind the curtain view was a humorous one; this one’s a little more serious). Most therapists work from what’s called a “trauma-informed” perspective, meaning we are “treating a whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand [current] behaviors and treat the patient.” We also take into account the differences between trauma as a disruptive event, and complex trauma, which is “a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape.”. In other words, we’re good at coming in when the client is ready to do the work of unpacking or changing the way past events have, or continue to disrupt their current life.

…AFTER THE FACT.

We sometimes get lucky enough to be available as someone is processing an event in progress, like working to escape an abusive relationship or dealing with a loved one as they are dying. But even in those circumstances, we’re on the outside of the experience looking inward, a stable neutral presence that can help anchor and support clients in distress.

Hard truth time: ain’t none of us trained to deal with global epidemics and crises on this scale AS THEY ARE HAPPENING and AS THEY ARE ALSO HUGELY IMPACTING *US*.

We sometimes get called in very soon or immediately after a crisis event happens, but we’re not usually enmeshed in it ourselves. Right now, however, we’re supporting our clients and colleagues (many of whom are themselves in identical unfamiliar circumstances) in working through virtual channels, working from home, dealing with children and partners underfoot all the time in quarantine… while dealing with exactly those same issues ourselves. As I wrote last week, we’re all in this together, but like medical health professionals, having been determined by the government to be “essential services” therapists are ALSO working long hours to make sure we keep our own shit under wraps enough to be an effective support for our clients right now.

I don’t tell you this to make us seem like superheroes, because I can assure, we’re still pretty human (see last week’s post for proof of that). I tell you this because there’s a need to understand that while we’re doing the best that we can, we’re really not trained for this, either. Many of us are cobbling together what we know of trauma care with what we know of working with high anxiety and (where appropriate) basic CBT tactics to hold the intrusive, fear-laden thoughts at bay. The problem is, when we’re living through an honest-to-god global pandemic, the actual worst-case fears and risks are both absolutely legitimate, and pretty terrible… and the clients aren’t the only ones seeing that. The therapists are living and breathing those concerns and fears right alongside you.

The definition of complex PTSD keeps coming back to me as I watch people adjust to the new normal, including a persistently-high state of stress/worry/concern/anxiety/fear about the what-ifs. When you’re living in a dangerous time, there isn’t any form of escape other than to just “live through it”, no matter how long it takes. And being in that persistent state over the longterm always exacts a toll; it’s not going to be the same for everyone, nor will it manifest in the same timeframe for everyone. But it’s there. And we have to take that into account when we’re dealing with ourselves and our clients, not just in the future and after the fact, but right now. Today. In this moment.

The best tool I’ve got right now is working with people to normalize and validate everything in their maelstrom of feelings; to shorten down their personal event horizons and look specifically, and exclusively, at what is in their power to do TODAY? What will make them feel better TODAY? It’s not that I don’t want to sustain a sense of hope for the future, but we have to keep hope in the context of daily-fluctuating uncertainty. We need to frame it in an understanding that our current heightened state of curve-flattening mitigation tactics will take WEEKS yet, if not MONTHS, to drop the infection rate back to near-zero (because as long as there IS a new-case reporting rate, we ALL remain at risk; that’s just how viral pandemics work). I’m watching friends and clients intellectualize that timetable, but the truth of what their lives will look like is barely just starting to take hold on an emotional level, especially knowing that the pandemic is only the trigger for an economic crisis of equally epic proportions to come. This kind of uncertainty really eats away at a person’s sense of grounding and control.

It eats away at ours, too. Trust me on that.

We’re in a high-stress, high-uncertainty scenario not of our own making and even less under our control. The odds of this crisis *creating* complex trauma responses for a large number of individuals is likely high, because it’s a longterm situation and it’s inescapable. The challenge for us as therapists is that we can’t wait for this scenario to be over before we’re needing to put boots on the ground and be effective. We can’t wait until we get ourselves clear of this scenario before we wade in to offer support to others. When I say, “we’re all in this together”, I mean it quite literally. As therapists, for once we are not apart from your crisis; we may have our own responses to what’s going on, but we are also up to our eyeballs in it. We’re as uncertain, as stressed, as anxious, as terrified, as exhausted as you may be.

And we’re still here. If you need us, we’re keeping the lights on for you as long as we can, and hopefully all the way through.

(Both my home office and Bliss Counselling are still open and seeing clients, BTW. We’re only doing virtual sessions via Zoom or phone for the duration, but WE ARE OPEN!)

Uncategorized

Okay, so we’re all slowly crawling out of what for many is week two of Pandemic Life, though for many of us it’s been varying degrees of “longer”. People who aren’t used to the enforced stillness and introversion of being trapped at home for extended periods, extroverts especially, have already started climbing the walls. Even introverts, suddenly faced with having to spend ALL THIS TIME with their families under the same roof, in the same rooms, even in the same conversations, are struggling.

And frankly, if the data models are to be believed, we’re still only just getting started. It took FIVE MONTHS for China to start seeing declines in the daily new case reports, and they were way ahead of North America when it comes to trying to lock down the exposure vectors. So buckle in folks… we’re in this for the long haul.

Many of you who are clients of therapy have already had the conversation with your therapist about moving to phone or video platforms to continue work. I grew up working in IT so the occasional stint of working from home (WFH) doesn’t phase me, and Webex (phone/video) conferencing is a legitimate way of life for techfolk. But for those of you new to this level of disconnect in your connection channels, it’s going to add a level of strain to work that may already be hard to do for any number of reasons. Trust me when I say, however, that your very-human therapists might be struggling to adapt to the necessity of the times as much as you are.

We’re all trying to find humour and silver linings in a time when so much feels beyond our control, or lost to uncertain, distant end dates (the American President’s staunch insistence that this somehow magically will all be over by Easter notwithstanding). SO I thought I’d share some things that are making things a little lighter from OUR side of the video conferences, just to help keep things in perspective, and assure everyone that we’re all in this together.

It’s a really cool thing to see these slim slices of people’s home lives. I’m learning about my colleagues’ and clients’ pets and children, and which ones will shamelessly fart in front of cameras (the pets and children, NOT the colleagues and clients… so far).

Sometimes your working-from-home therapist’s head is going to look suspiciously like a cat’s head. Possibly like a cat’s butt. This is not an optical illusion.

It’s a perfectly reasonable thing to suspect that your therapist may not be wearing pants in a video session. It might be a tad declass? to ask, though.

Your therapist isn’t ACTUALLY doing therapy from San Fransisco or the bridge of the Enterprise, he just accidentally turned on the backgrounds feature in Zoom Mobile and can’t figure out how to turn it off again.

Why yes, we DO sometimes wear a unicorn onesie to work, why do you ask?

You can mostly trust that’s just coffee. Mostly.

No-one can tell if your therapist wears the same ensemble to work three days in a row. Or four. Or five. We might also have to stop and think about whether we’ve showered today or not.

Therapists with kids at home themselves are going to be SO VERY HAPPY TO SEE YOU AND TALK WITH YOU, ONE ADULT TO ANOTHER. Cut them some slack. They’re in the same boat as many of their parenting-at-home clients, right down to interrupting sessions to tell small people not to set each other, themselves, or the dog on fire.

By the end of next week, some of us might have forgotten how to drive to work. On the upside, in between client sessions and naps, some of us are busy reacquainting ourselves with kitchen and household appliances we didn’t even know we owned.

Naps are totally a thing for adults. Who knew?? (Well, clearly not the adults with children at home, I suspect. Sorry…[not really].) The only thing better than napping on the office sofa is napping in my own bed.

In some ways, the virus is only one side of the social upheaval we’re going to have to manage, and the one therapists are least trained to deal with. It’s helping people observe and mitigate how we react when trapped either in isolation, or together with others in close quarters for indefinite periods of time, getting on each others’ nerves, and lacking the usual recourses and escape mechanisms to cope–THAT’s something we’re already on the alert to catch and mitigate as tempers and tolerances shorten.

We’re doing our best to keep up with the rising challenges of social lockdown and massive life disruptions. Please remember, however, that most of us aren’t trained for this kind of live-rolling, global-level-disruptive crisis, so we’re on a learning curve right alongside our clients. We’re doing our best to provide as much continuity of care to you as we can, so take the technical glitches and challenges in stride and be patient as we all figure out how best to weather what’s happening. Remember that we’re all human, we’re all fallible, we’re all facing fear/uncertainty/doubt in spades, and we’re all probably already feeling some degree of the strain. (Massive shout-out to the medical workers and emergency-response folks on the very front lines of this, BTW. I see you.) So remember to be gentle with yourselves, each other, and us as this situation unfolds.

We’ll take care of each other as best we can, all right?

Relationships, Uncategorized

A friend of mine recently asked me for my thoughts about the process of recovering relationships after a particularly disruptive and emotionally demanding situation. Specifically, how do we put Humpty Dumpty back together after a crisis has demanded all of our time and energy and focus and resources to be focused on something other than the “us”? In the aftermath of the storm, what happens then? How do we process who we’ve become on the other side while still holding the relationship together?

The answer to this question is a little complicated in that “recovery” as a process is largely contingent on two principle factors: the crisis context, and the individual resiliency of the relationship members. (I’m going to deliberately leave aside the issue of recovering from infidelity; in my not-so-humble opinion, the definitive work on recovering from that particular crisis is Janis Abram-Spring‘s book, “After the Affair”.)

Context is difficult to address as a general factor. One partner losing a job or dealing with an extended period of unemployment is a very different kind of crisis than, say, the death of a child or the diagnosis of a debilitating or fatal illness in a child or a partner. Different contexts paired with differing resiliencies (which will determine our coping strategies) often define what kinds of support we NEED to navigate both crisis and recovery… but don’t tell us what happens when we lack those resources.

Relationships are, ideally, organic and evolutionary things, in that they are meant to change over time (individual resistances to change notwithstanding). What a crisis situation does, potentially, is to force some kind of emotionally intense change on the relationship in a relatively short period of time; it often happens without warning, and therefore with little or no preparation (emotional or otherwise). The speed and degree of crisis will strain even strong and healthy relationships; in dysfunctional ones, crisis exacerbates whatever weaknesses already exist and strains what little tolerance we have for upheaval to, and sometimes past, breaking points.

Navigating recovery also looks different when the precipitating crisis was about something internal the relationship that disrupted or threatened default expectations about the attachment (discovering a partner is a drug user or alcoholic, spent all your joint savings on a questionable investment without consulting you, or is not-so-closeted Trump Supporter, for example), versus something that happened external to the relationship that managed to impact all members of the relationship to some degree (losing a job or being required to uproot and move across the continent for a job, or sudden issues with extended family members, for example).

It’s a common thing to hear people describe how their relational communication either saves or burns them in crisis situations. We already know that our communication skills are generally only as good as our ability to know what it is we’re trying to communicate in the first place, so there’s no way to know if in a crisis we’ll magically transcend our general day-to-day patterns or not. Therefore, in the post-crisis-recovery stage, it’s a reasonable assumption that whatever we were able to do under extreme circumstances will revert to whatever our baseline interactive styles were, after the fact.

Sometimes, having seen how we can band together and work well in crisis, makes that post-crisis reversion a lot harder to bear. Sometimes, if we don’t navigate the crisis itself terribly well, it really drives home the parts of the relationship that don’t work effectively in ways that we can no longer easily ignore. Either way, afterwards, things are often different, and many people don’t know what to do when confronting differences that don’t point towards the relationship being “better, stronger, faster” for having survived the storm.

There are some really important things to remember or consider from a relational standpoint when we’re confronting the aftermath of a storm:

Everybody’s wrung out and exhausted. This means very few of us are at cognitive functioning’s peak capacity. After any kind of exertion, bodies and brains need a break. There may be day-to-day necessities that must be addressed, but no-one’s going to be doing them gracefully in the aftermath. Cut yourself and your partner(s) some slack for a while to be less than “on”.

Recovery times vary. Just because you and your partner(s) are ostensibly in the same relationship, that’s never going to guarantee we all process events, crisis and otherwise, the same way to the same degree or in the same time frame. You may be ready and raring to go with a good night’s sleep; someone else may be weeks in the recovery trough before they can poke their heads back up. Make sure you check your assumptions that other crisis parties will be working “just like you” in the aftermath.

“Recovery” may mean different things to different people. Even if you came through the same set of circumstances together, everyone may see the situation differently, and there may be differences in how each of you responds to the crisis. It’s safe, therefore, to assume that recovery will look and play out differently to all involved. In the counselling room we see a variety of responses to crisis, from utter emotional chaos to absolute emotional disconnection–sometimes in the same relationship. Sometimes one party falls apart while another steps up to deal with the logistical details to pull everyone through the crisis; in the aftermath, one party may need therapy, and the other needs an equal opportunity to fall apart in a delayed emotional response. Maybe they both need therapy. Maybe there’s a grief or health-recovery process involved (how many of us catch a cold or other transient sickness once a period of stress eases off?) Some partners need to keep talking to process what happened, while others just want to forget or let go and move on, leaving the turmoil of crisis times in the rearview as quickly as possible.

Even if crisis brought us closer together in the moment, recovery might not keep us there afterward. Tied to the idea that recovery might mean different things, is the idea that who we are in crisis does not always indicate who we are, or might become, in the aftermath. If partners have differing tolerance for emotional intensity, for example, then what they are willing to handle during a crisis might be far more intensity and vulnerability afterwards, so they retreat; it’s safer, it demands less, it’s familiar and predictable than trying to integrate and sustain what we managed to handle during the storm. We perhaps communicated with great purpose and clarity when the situation demanded our full attention, but left to our own devices we see that as being too much work, too much vulnerability, too much of something we don’t want to face even without the pressure of a crisis.

Navigation in the aftermath is, obviously, not going to be an easy thing.

As with any kind of change process introduced into a relationship framework, there are some strategies that might ease the strain change will introduce.

Offer your partner(s) opportunity to reflect with you on what happened: what went well through the crisis, what you would all want to do differently in future, what you might need to do to improve resilience as individuals or as a relationship.

Discuss what each of you needs for recovery, and how best to go about getting those needs addressed effectively. This is especially crucial if you discover you need different things. If one of you needs to talk and the other just needs to forget, for example, then clearly there won’t be a lot of comfort, and possibly a lack of consent, to force “talk processing” on unwilling or unavailable partners.

Discuss expectations. Once you have all articulated recovery needs, make a plan for what meeting those needs can look like, so that everyone knows what part they can or need to play, what costs might affect the relationship, what kinds of interactions might be required (especially if they are different from pre-crisis norms). This is a negotiation process; we all have expectations for ourselves and those around us, but those around us may not always be aware of those expectations, which makes it challenging for them to meet us in them. Maybe they can help us address our underlying needs but NOT in the way we expect. It’s most useful if we can allow openness to how our needs get addressed as a collaborative process; a partner may not be able to meet our expectation exactly as expressed, but if they know what need we’re tying an expectation to, they may be able to suggest an alternative that works for everyone. And especially on the heels of a potentially resource-exhausting crisis, this negotiation process may be extra-challenging. Be patient and gentle all around. As you wouldn’t push someone in recovery from surgery to commit to doing too much too fast, don’t push anyone recovering from an emotional or relational crisis that way, either.

Recognize that intimacy and vulnerability are choices we make every day, sometimes moment-to-moment. If the crisis was something that introduced or increased distance in a relationship, then it can be hard to feel like we want to come back into connection afterward. If we feel unsupported or abandoned by our partners through a crisis situation, we’re going to have to find ways of articulating and addressing that hurt–even if we consciously choose to not make an issue of it ourselves and just “forgive and forget”–before we can focus on the relationship or reconnection. There may have to be some emotional work done to figure out why a partner wasn’t where we needed or expected them to be in crisis, and we may have to balance our own hurt/disappointment/frustration with understanding why they couldn’t be in the fire with us as we wanted them to be. At the end of the day, though, we each choose for ourselves whether we sustain the distance exacerbated by crisis, or introduce connection bids and repair attempts.

Crisis can introduce a lot of upheaval in a very short period of time; crisis recovery by design happens at a slower pace, allowing for reflection and redefinition, and retooling of current process where necessary. Knowing whether all parties involved are even starting from the same place in defining what is or is not a crisis is the first step in determining how best to get clear of stormy waters and into a calmer state. Give yourselves time, then work out what directions you need to go, individually and as a relationship, at a pace you can each sustain. Don’t allow crisis recovery processes to become the trigger for another round of crisis!