Managing Vicarious Trauma Across Professions

Archivist, oral historian, and genocide scholar Tim Hensley discusses his approach to managing traumatic material in the workplace:

Most caregiving and reporting professionals (health care providers, reporters, first responders, clergy, social workers, legal aid, and many more) interact directly or indirectly with the traumatic experiences of others at some point in our careers. But events of the past few months have increased this likelihood for all of us, in some cases with the force of a fire hose.

Furthermore, we are all dealing with our own increased stress and trauma, which leaves us with less bandwidth available to absorb the anguish of others.

In order for you to stay afloat and continue your trauma-oriented work, it is necessary to limit your amount of exposure to your carrying capacity.

This excerpt shows Tim’s method, which is organized, structured, and visual:

 


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While I personally don’t categorize sessions and activities visually in the  way Tim does, I do always maintain an idea of which sessions and activities are likely to contain material and experiences that are heavier to carry, and I spread my scheduling out in a similar way across a given week.

If you are in a caregiving or reporting profession, you may already be using a similar approach, whether explicitly or intuitively. If not, you might wish to examine your own process and how it is affecting you.

How can you know when it’s too much to carry? You have to notice how you’re feeling! This sounds incredibly simple, and yet many of us frequently push past our actual capacity into burnout territory. This can lead to illness, injury, depression, suicidality, and other life-disrupting outcomes. You may think it’s okay to push on–until it’s suddenly not.

It’s a case of “simple but not easy,” especially if you have always been taught to push through physical or mental discomfort in order to complete tasks. It’s considerably worse if you’ve always been taught you must put your own needs dead last after others’ needs.

Now is the time to de-condition that harmful approach!

You have gone beyond your carrying capacity if you are feeling:

  • Exhausted
  • Irritable
  • Weepy
  • Resentful
  • Stress-headachey
  • Pessimistic
  • Hopeless
  • Angry
  • Anxious
  • Disconnected
  • Dissociated
  • Craving substances

Once you are able to determine which pieces of your work tend to make these kinds of symptoms worse, that is when you can plan how to schedule your heaviest interactions such that you can recover in between.

Keep in mind, what may be light for someone else may sink you, and vice versa. This is never about what you “should” be able to carry–it’s about how it actually affects you in practice. No one can tell someone else what they “should” be able to bear.

Which brings me to the next difficulty for many: what if you are not the one doing the scheduling? What if the fire hose is never turned off? This is a physically and emotionally dangerous situation. It means that you’re in an environment that does not allow you to protect yourself, recover from injury, steward your health. If you are able to seriously discuss the issue with someone in charge, that may be helpful. But if they are dismissive, it is likely a situation that will be harmful to you in the long or not-so-long run.

What does it mean to recover in between? Again, this sounds simple but it is not always easy. You do things that help you feel better!

  • Sleep! And more sleep!
  • Basic exercise: walking, biking, yard work
  • Adequate nutrition
  • Enjoyable “vegging”
  • Creative outlet: music, gardening, knitting, hobby electronics, baking
  • And most important of all: someone supportive to tell about your experiences

This does not mean you must violate confidentiality or your HIPAA obligations or the sanctity of the confessional. It means to have someone with whom you can exchange understanding of how hard it is to do what you do, and express honestly how it’s affecting you. This may be a coworker ally,  spouse, friend, clergy, or therapist. But it’s very important and a big part of lightening the heaviness.

If you are not used to taking care of yourself “like you matter,” it is time to start practicing that skill right now, so you do not fall into burnout and illness.

Remember, you can’t give to others from an empty well! ❤

 

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Walking Through the Invisible Fire

What’s going on is pretty darn bad

As you have surely noticed, a lot of things really don’t feel okay right now. And a lot of us do not feel okay about that.

I’ve been hearing from people in health care doing their utmost to save those who may not survive and those who will not survive. I’ve been hearing from people trying to secure adequate storage space for human remains. I’ve been hearing from other therapists. From people who have gotten ill and been hospitalized. From those who are losing loved ones, losing jobs, losing savings, losing health insurance, and from those feeling trapped and scared and angry.

We are all facing an enemy that uses our greatest human strength in its attack against us: our connections with others. An invisible fire is burning through humanity, and we don’t know who is aflame, who will burn, and who will pass through unharmed. The uncertainty is nerve-wracking.

You may hear people saying “Humanity got through previous pandemics, it’s not the end of the world!” Well, yes…humanity survived, but we didn’t all get through those crises. Many died. And for those who died, it was the end of the world. (At least, this world.) And the world was permanently altered for survivors and their descendants. So this event is a true threat. It makes sense to feel distress.

What our experiences are and how we are dealing with them – it’s okay

Whatever we may have already been struggling with has been exacerbated: loneliness, depression, illness and disability, social issues, financial issues, employment, relationships. Meanwhile, many of the life trajectories we were working on in the hope that they would provide us with security, stability, and balance, have been upended. Exposed as transient, fragile, or even inconsequential: careers, money, possessions, self-image, institutions, political and social dynamics. These are great losses that may leave us feeling anchorless, or make the world feel frighteningly unreal.

For many there is also a cognitive dissonance between feeling the background hum of constant threat, while other parts of life continue apace as though nothing is happening and things are normal. “When your world falls apart, some things stay in place” (Billy Bragg). This dissonance can be crazy-making too!

With all that is happening, many people are experiencing an increase in symptoms. Some new, and some familiar. Many are symptoms of depression, anxiety, or past trauma. But please know that you are not alone in this. The most common symptoms I’ve been hearing about in the past few weeks are:

Sleep issues: insomnia, exhaustion, hypersomnia.
It’s hard to sleep when you’re feeling threatened. It’s not surprising many are having trouble falling asleep or staying asleep. If you are sleeping more than usual, it is partly because you have so much more to process, and that is exhausting!

Dreams: increased vivid dreaming (or increased memory of dreaming), not necessarily nightmares, either. We have a lot to process lately and it’s spilling into our nighttime hours.

Impaired executive function: forgetfulness, loss of concentration, unusual time perception (speeding up or slowing down).

Dissociation: losing track, losing time, spacing out, not being present, feeling numb, feeling unreal or that the world is unreal.

Hypervigilance: being easily startled, easily woken, heightened anxiety about possible contagion and contamination.

Grief and anger: we have incurred countless losses, individually and as a society. It is not wrong to grieve losses or to feel anger about them. It’s understandable.

Guilt: This has been a big one for a lot of people! Specifically, guilt about productivity, guilt about parenting, survivor guilt, and free-floating guilt. Please understand that unnecessary guilt is a symptom of both depression and anxiety, but it’s a feeling that makes it especially easy to buy into the content, so we tend to think it’s real.

Regarding the productivity guilt: your value as a human being is not your productivity. The most important thing you are producing is someone who survived the pandemic! If you come out of this alive, and with your children alive, you did it!

This is the earliest reference I can find, but we all know this statement by now. You’re not “working from home,” you’re at home, working under a global crisis.

Furthermore, you are not obligated to somehow optimize yourself. You never have been! But this is a good time to finally understand that at a deep level. It’s an especially ludicrous expectation right now.

Many people are struggling with unhealthy coping mechanisms right now: drinking and substance use, eating behaviors, self-harm. But the first thing is to cope. To get through this day, and this night, and the next. So if you are using unhealthy coping mechanisms, instead of beating yourself up about it, allow yourself first to cope. And then start working on adding in some of your healthier coping mechanisms. All behaviors, even dysfunctional ones, are adaptive in some context. Sometimes an unhealthy coping mechanism is healthier than not coping at all.

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Future directions & hope

Listen, we don’t get to choose what arc of history we occupy, only what role we play in that arc. You are living through a historical event that you did not choose.

A lot of things are not okay right now, many of us aren’t okay with that, and it’s okay to feel that way. It’s reasonable to feel distress. We are all walking through this invisible fire, but what matters most is how well you walk through the fire (Charles Bukowski). You can still choose what role you will play.

Humans have an immense capacity to take something good and positive out of surviving even the most horrific events. Things we always heard could not be done are now being done: work flexibility, distance learning, accessibility, financial and personal support. Meanwhile, things we always heard were implacably crucial, are turning out to be not so important. Deadlines! Attendance! Fees! Work pants!

Many more people who are in a tough spot now suddenly understand that we all need support and we are all mortal. We are all vulnerable. This kind of insight can be a turning point for great change. This is a liminal space in which we can effect that change.

It’s easier to see the real rock-bottom truth from here. Human connection is still our most important strength, even without physical proximity. We take care of each other: family, friends, neighbors, community, churches, local government and organizations. Our strength comes from sharing via those systems. Power comes from the people. You are the people! So let this radicalize you, rather than leading you into despair (Mariame Kaba).

Let this radicalize how you treat others: What can you do to help reshape an inequitable system? Is there some way you can help support those who are already marginalized, on whom the bulk of the crisis falls? The illness and death, the job loss, the financial hardship, the limited access to resources. If there is to be a new normal, what social improvements do you want to help solidify?

Let this radicalize how you treat yourself: Learn that your value does not lie in your ability to produce. Learn to treat yourself as well as you would treat an honored guest, a close friend, or even a beloved pet. If there is to be a new normal, what habits do you want to bring back from this experience? What deserves to be left behind in the ashes?

Walk this invisible fire with compassion, flexibility, and acceptance. Acceptance for others, but also for yourself.  ❤

Intersectional Life Counseling and Psychology offers remote video sessions for PA residents, as well as sliding-scale rates from $70. Please EMAIL if you would like to schedule or have any questions!

Flattening The Curve – Sessions Go Online This Week!

Dear clients, friends, and community members,

In light of recent recommendations from the medical community and state government to reduce social contact and public exposure in order to help reduce overall spread of the novel coronavirus, therapy sessions will be moving online as of the upcoming week (Monday 3/16/20). Let’s work together to #flattenthecurve and keep our community healthy!

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Thera-Link is a secure, HIPAA-compliant, appropriately encrypted platform that a number of clients have already been using since early 2019. Clients have joined therapy sessions using their computers and/or phones, and have so far usually reported it to be very easy to use.

Current clients will be contacted individually with the necessary information to join their therapy sessions this week. New clients* are also still welcome to schedule sessions!

Intersectional Life Counseling and Psychology offers remote video sessions (in-office sessions suspended temporarily) for PA residents, as well as sliding-scale rates from $70.

Please email us if you would like to schedule or have any questions!

(*Please note: clients MUST be in PA during sessions due to licensure and legal issues.)

StayHomeGame

Stay Home Simulator by Brendon Chung @BlendoGames

Flattening The Curve – Sessions Go Online This Week!

Dear clients, friends, and community members,

In light of recent recommendations from the medical community and state government to reduce social contact and public exposure in order to help reduce overall spread of the novel coronavirus, therapy sessions will be moving online as of the upcoming week (Monday 3/16/20). Let’s work together to #flattenthecurve and keep our community healthy!

waitingroom2

thera-link-mug

 

 

 

 

 

Thera-Link is a secure, HIPAA-compliant, appropriately encrypted platform that a number of clients have already been using since early 2019. Clients have joined therapy sessions using their computers and/or phones, and have so far usually reported it to be very easy to use.

Current clients will be contacted individually with the necessary information to join their therapy sessions this week. New clients* are also still welcome to schedule sessions!

Intersectional Life Counseling and Psychology offers remote video sessions (in-office sessions suspended temporarily) for PA residents, as well as sliding-scale rates from $70.

Please email us if you would like to schedule or have any questions!

(*Please note: clients MUST be in PA during sessions due to licensure and legal issues.)

StayHomeGame

Stay Home Simulator by Brendon Chung @BlendoGames

Keeping Your Balance in the Apocalypse

If you have been feeling worried about illness recently, you are definitely not alone. Even people who don’t normally experience health anxieties are affected by news regarding the novel coronavirus, COVID-19. Ships quarantined, cities locked down, schools closing, hospitals overwhelmed. Much of what we hear is the absolute worst of the news, and for now at least the rest is largely unknown.

An endless wave of bad news can certainly increase depression, while facing an unknown can increase anxiety,  so the situation is a recipe for increased stress on everyone’s mental health. In addition, we are carrying the weight of experiencing others’ stress and worries as well. It’s not only a nationwide mental health stressor, but a worldwide one.

It’s common for PTSD symptoms and anxiety symptoms generally to spike during times of crisis, especially for those who are in vulnerable marginalized groups. This is true whether or not you have a trauma history that is specifically related to the crisis itself. So you may be experiencing more symptoms such as insomnia, panic attacks, melancholy or dread, fibromyalgia, hives, flashbacks, migraines, dissociation, suicidality, agorophobia, or obsessions and compulsions, to name a few of the common ones.

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What to do first:

As in any times of crisis, there are four basic elements of self-stabilizing, beginning with the body.

First of all, you need sleep! If you are experiencing insomnia, address this first. Sleeplessness makes everything else hard to manage, both physically and mentally. You may use self-help methods or you may seek professional support from a therapist if your insomnia is entrenched.

Another aspect of stabilization is to make sure you are eating: get enough healthy fuel. If stress has activated disordered eating such as restricting or bingeing, don’t ignore it. Address it directly.

Exercise: If you already have a reasonable exercise program, do your best to maintain it. If you have begun to isolate, try just taking a 10-minute walk daily. Even mild exercise will help both your body and mind feel better and more able to handle whatever stresses are arising. Also, being outdoors and seeing other people can remind you that human life is continuing and you are still part of a mutually supportive, helpful society.

Which leads to another important aspect, that of social support. It’s important to connect with supportive others, in whatever format you can. Even if you must work from home, you can text or email or talk on the phone with someone. Make sure to do this daily!

Maintain Your Routine and Stay Connected

In the broader sense, counteract a sense of helpless disaster by focusing your perception on the many thousands of highly capable and caring people in every possible area of life–health care workers, emergency workers, researchers, spiritual leaders, parents, neighbors, friends–who are planning and preparing to support, save, and take care of all of us as best they can. Maybe you are one of those people!

Remember that your fellow humans feel a sense of care and responsibility towards you, just as you feel towards them. We protect and help one another to get through. And as Mr. Rogers famously described, “looking for the helpers” is a good way to reassure yourself in a crisis. Becoming one of the helpers yourself–even in a small, neighborly way–can help you to feel less powerless.

When you have stabilized your primary needs as best you can

The next step is to do your emotional self-care. First of all, accept your emotions. It is reasonable to feel scared or angry or any other emotion in a crisis. So have acceptance for whatever those feelings may be, and find ways to comfort yourself.

The trick, however, is to not buy into the cognitions that anxiety or depression may generate. Recognize that if your thoughts are becoming dreadful, it’s likely you are experiencing catastrophization or similar cognitive distortions. One way to reframe this for yourself is to recognize what you have control over (sensible interventions and planning) and what you do not have control over (worldwide events).

If it is something that you do have control over (sensible hygiene, having medications and basic supplies available, planning alternate child care / work locations, rescheduling travel), then implement those things. But worrying will not help you with the implementation.

If it is something you do not have control over, then again–worrying will not help. You may feel afraid and it is worth talking through the fear with someone. But you may need to let go of a sense that you must control the situation in order to survive it. Much of this is out of your control and anyone else’s! Seek solidly data-driven, practical sources of information rather than sensationalized or over-minimized sources. This will help you know what to actually prepare for.

The worry protocol includes not only contagion, but another common anxiety: financial fears. For some, this is regarding recent stock market drops, and for others, simply the ability to pay rent each month when society is disrupted or they could become ill. Again, the worry protocol holds: sensibly plan and implement the parts that you can. The parts that are out of your control may happen or they may not. If they do happen, you and others will do your best to recover and repair as soon as you are able. You may or you may not incur losses, but you will deal with those if they occur.

So…in order to keep yourself emotionally stable:

Take good care of yourself, accept your emotions, manage your cognitions, make practical plans that are based on reality, relinquish control of the uncontrollable, maintain your routines as best you can, and find some way to become a helper. If you are struggling with these issues, consider seeing a therapist to help you sort through them!

Intersectional Life Counseling and Psychology offers remote video sessions for PA residents, as well as sliding-scale rates from $70. Please EMAIL if you would like to schedule or have any questions!

 

Your Loved One Has Dissociative Identity Disorder?

If you have a loved one who has Dissociative Identity Disorder (AKA “multiple personalities”), you may have felt uneasy or even frightened at times. It can be disconcerting to think you do not really know who they are. It may be awful to think of the traumatic experiences they survived that led to the dissociation.

This is partly because for many people, the only understanding they have of Dissociative Identity Disorder comes from sensationalized depictions in movies or TV, showing DID experiencers as unpredictable, deceptive, violent–nearly supernaturally so!

But it’s important to take a pragmatic approach to understanding this experience and not to exoticize or blame your loved one.

In other words, they are not an exotic disorder. They are not their traumatic experiences. They are not possessed. They did not “cause” the disorder. They did not ask for nor deserve the trauma during which it developed. They aren’t “faking.” They are not a case for you to manage. They are a regular person who needs love, acceptance, and healing.

Everyone has “parts” –different personality presentations and experiences that are expressed in different situations. We all act at least somewhat differently at a job interview than at the club, or at church, or with a close friend who is very accepting, or in class, or around a judgmental neighbor, or around a secret crush.

The main difference is that for those who have DID, those different presentations have become dissociated from each other: there is a disruption of the underlying thread of memory and consciousness that most of us have between all our parts.

An important thing to remember is that while you may not like one or some of your loved one’s parts (and you don’t have to!), there are no “bad” parts. Every part’s feelings are a valid expression, even if not every part’s wishes should be acted on.

Nothing your loved one experiences is beyond the understanding of humans generally. You don’t need to be an expert in Internal Family Systems to connect with them. It’s useful to have some information, but primarily, just be a human with a loving connection. ❤

If you are interested in reading more in-depth about Dissociative Identity Disorder from someone who experiences it, here is an essay that is addressed to therapists but may also be useful for others who have loved ones with this type of dissociation:

TEN STEPS TO BECOMING A DISSOCIATION-FRIENDLY THERAPIST

 

 

Immigrant Families Finding Therapy

Because of the many layers of stresses and even traumas associated with immigration, immigrants and their families may face high levels of mental distress. This includes things such as traumatic events that were severe enough to make them leave their home country in the first place, as well as the great difficulties in adjusting to a new and sometimes hostile environment.

In today’s social and political climate, stresses and traumas are higher than ever, making mental health support even more crucial. But as challenging as getting started with therapy can be, it can be even harder for immigrants and their families.

This piece by Lauren Hodges explains why, and offers MANY great suggestions to help you or a family member get mental health support!

 

 

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You Are Not Your Trauma

 

An early experience of trauma can have effects that you may not start experiencing until adulthood. It can feel “crazy”! But having PTSD symptoms doesn’t mean that you will always feel that way. It means that you have emotions and reactions that are ready to be processed so that you can begin healing.

While healing from trauma can be a lifelong process, you can often start feeling better in many ways right away! You are still a whole, worthy human being, rich in the capacity to enjoy life in your own ways.

If you are ready to start processing, please review our quick chart to see how you can access our therapeutic services from anywhere in Pennsylvania!

 

You Are Already Worthy!

 

Calling yourself “lazy” or “unproductive” is usually an internalized message of shame from your formative years. The message is “If you would just ‘will’ yourself to do more, then you would be acceptable and worthy. Otherwise, you must just be a bad, unworthy person.”

The fact is, you are already acceptable and worthy, without doing anything to “earn” that worth. Now, you might feel better or happier if you were doing certain things, and they are certainly worth trying, to see if that is the case.

But feeling terrible about yourself is not a good motivator for anyone! In fact, it is likely to worsen your exhaustion, depression, anxiety, insomnia, and concentration, which will make it even harder to do whatever it is you would like to be doing.

If you are ready to start healing your self-worth, please review our quick chart to see how you can access our therapeutic services from anywhere in Pennsylvania!

 

Mental Health: Accepting Healing Over Time

 

Valarie Ward has written a good breakdown of how pop mental health writing is often not only unhelpful, but perpetuates stigma and judgment. Treatment–whether chemical, cognitive, or situational–can support and help to heal mental health, but it’s not a magical instant “cure.”

It’s useful to find the type of treatment or intervention that is most helpful and supportive to YOU. It doesn’t mean you’re “doing it wrong” if you still have symptoms or flare-ups. It means that humans are biological, not mechanical objects that can have new parts swapped in for an instant fix. [See: PTSD as chronic illness]

There is nothing wrong with trying to find things that help you feel better and function better. We encourage you to explore treatment modalities!

But the danger in chasing a “cure” can be the idea that if it’s not “cured,” then we just aren’t trying hard enough. Plenty of people with mental illness and injury hear this message from well-meaning friends, family, and loved ones, though sometimes in different words.

“You’ve been in therapy for weeks/months/years, why isn’t it helping?”: If it’s truly not helping, then of course try something else, or something additional!

But often this really means “I’m upset that you’re not ‘cured’ yet.” Unfortunately, we may also internalize these messages ourselves, which just means that we have found another “should” with which to beat ourselves up; another way to use perfectionistic standards against ourselves.

Instead, notice how far you’ve come since you started working on your healing. Even if it has only been a few days, I bet you already learned some things that help you to comfort yourself or to reframe your thoughts in a healthy way that hurts less!

And if you’ve been working on healing for a while, I bet you are experiencing more days during which you can get out of bed. Or get out of the house. Or days you can do some meaningful work or play. Or days you can spend time with your children. Or fewer days spent in the hospital. Or a better ability to see yourself having a future. Or a few more relationships that are going a little better than they used to. I bet you’ve already done a lot more healing than you think!

So instead of beating up on yourself for not suddenly being “cured” or “fixed,” take stock of how your healing really is progressing, and be proud of yourself. ❤