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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About Those “Pandemic Pounds”

In the past few weeks, I’ve seen an increase in people discussing and writing about having gained weight since the event of the pandemic. Many of us have turned a corner from “acute crisis” to “settling in for the long haul,” and we’re taking stock now. We’ve also recently heard some public figures make critical remarks and references to others’ weight, which has only increased pressure on everyone who already struggles with body image or who experiences criticism about their bodies.

Just so you know, this is not a post about how to lose weight. This is a post about some steps to take if you are thinking about losing weight. This is because the first thing we often jump to when feeling unhappy about our bodies is restricting food intake (“dieting”). But that’s often literally the last thing to do! So please remember to consider these other factors FIRST before jumping to food restriction.

Sleep

Sleep is often one of the biggest factors in weight changes. Have you been struggling with sleep the past few months? Many people have, whether because of anxiety, depression, or change in routine. Sleep deprivation can change hormones: it reduces leptin and increases ghrelin, which can dramatically disrupt both appetite and metabolism. This can mean experiencing intense cravings and processing fuel differently.

Sleep deprivation also interferes with executive function, which means both cognitive and emotional processes are harder to manage. That can mean it’s hard to plan for and prepare the food you’d like to eat. It can also mean increased emotional eating, or in some cases loss of appetite because of anxiety or depression.

So first of all, make sure to prioritize sleeping enough and sleeping regularly before addressing your eating.

Exercise

After getting your sleep on track, next consider how you’ve been exercising (or not!)

Whether you’re an essential worker who’s been stressed and working extra hours, or you’ve been working from home, or you’ve been unemployed and out of your normal routine, your body needs the stress outlet of some kind of movement.

Often when people are worried about weight, they focus on exercise as a method of “burning calories.” There are a lot of good reasons to exercise, but “burning calories” is usually an unhealthy way to approach exercise. It’s often an approach that is self-punishing (“I must do an unpleasant activity because of my size!”) or contains elements of bargaining or paying for eating (“I can eat this food I like if I ‘pay’ for it by exercising!”) You don’t have to “pay” for eating with exercise.

A healthy exercise approach is to focus on improving heart function, improving lung capacity, gaining flexibility, metabolizing cortisol to decrease anxiety and regulate sleep, and attenuating depression. In other words, exercise to improve your physical and mental health. Not as a way to neutralize eating.

Nutrition

If you are not satisfied with the overall nutritional balance of foods you are eating, then you are certainly allowed to modify what you’re eating. But when changing your diet, it is important to remember that the goal is to first ADD components you believe you are not getting enough of. Maybe you feel you’re not getting enough leafy greens, or enough legumes, or protein, or calcium. Search out foods that will help to add those elements to the overall balance of your diet! It is acceptable to still eat other foods for enjoyment.

It can be hard to prioritize “adding in” foods, partly because we are constantly bombarded by puritanical, perfectionistic messages that we should be removing or restricting foods.

Checking in with Your Emotional Side

So you’ve stabilized your sleep, you’ve improved your relationship with exercise, you’re getting a better balance of the nutrients you need, and maybe that’s enough! Maybe you’re back to feeling okay!

–Or, maybe you still feel you’re eating more than you want to, or more than you think you “should.” What then? You’re doing all the “right stuff!” Why are you still eating more! Well, this is the hard part, as the emotional component of any behavior change usually is.

Whenever a behavior is difficult to change, there is usually some part of you that is using the behavior to feel okay. To feel safe, comforted, entertained, loved, awake, valued, to feel pleasure. Eating is such an emotionally layered action. We are not simply input/output mechanisms for fuel and activity.

What emotional need has food been fulfilling for you while you’ve been dealing with stress? Until you can find another satisfactory way to fulfill that emotional need, you will continue to use eating behavior as an emotional tool. No amount of calorie tracking, substitute sweeteners, or rigid meal-planning will sustainably alter that dynamic.

Something to keep in mind is that you can’t fool yourself about your own motives. What I mean by this is, you may be saying to others or to yourself, “I’m doing this for my own good! I need to restrict my food for my health!” but meanwhile there is part of you thinking “I’m going to restrict food because I should be punished [for existing, for taking up space, for using any resources, for having the “wrong” appearance].”  Or maybe there is a part telling you that it’s not okay to be fat, or maybe it’s calling yourself names.

Guess what? Until you can keep that part of you from bullying the part that is using food to feel better, it will only make things worse for all parts of you.

Ironically, the bullying part needs patience and tenderness to change, too. That bully part is usually trying to protect you from the criticism of important others. “If I criticize me first, then I won’t get criticism from others.” Let the bullying part of you know that you truly appreciate the protection, but that it’s not necessary any longer. You don’t need it to call you names or harass you.

When you are able to pacify the bullying part, then you will be able to more clearly hear the part using food as an emotional tool.

If that part of you is using food for comfort or safety, is there something else you can use sometimes to feel comforted or safe? If that part is using food to feel loved or valued, can you find some other ways to remind yourself you are loved and valuable? If that part has been using food to quell boredom, can it tell you some other things that might help you feel interested and alive?

Once you have examined the emotional underpinnings of your eating habits and your body image, then you can find more acceptance for yourself, and you can choose whether you want to change your behaviors. But in the meanwhile, remember that this body has carried you, and helped you survive and overcome everything that you have lived through so far. It deserves gratitude and care from you! And so do you, yourself.  ❤

The article linked below has more discussion about an emotionally balanced approach to eating:

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!

 

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!

 

Honoring 60 Years of Black Activism

Lancaster Black History Month Celebration!

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Juneteenth: “America can never be free until her people are free”

If you are interested to watch the proceedings live today, you can view them here:

 

Keep Yourself Sane When Things Feel Crazy

 

It’s easy to feel overwhelmed, anxious, and depressed about recent events. There are a lot of really overwhelming, scary, and depressing things happening! What can you do to maintain your balance, stay grounded, and keep a sense of optimism?

Dr. Glenda Russell is a licensed psychologist and researcher in Colorado with whom I had the great fortune to work during my training in Michigan. In the short video below, she has some really important and reassuringly concrete things to say about moving forward during frightening times.

This clip is only five minutes long, but it can really help.

 

Did you find this message encouraging? I hope so, and I hope you have friends and loved ones to connect with!

If you need additional support dealing with symptoms of depression, PTSD, or anxiety from a qualified therapist, please review our quick chart to see how you can access our therapeutic services from anywhere in Pennsylvania!

Postpartum Peer Support Helps Physical and Mental Health

Find parent-to-parent nursing support BEFORE your baby is born so you can get real help and information for when you need it most (instead of too late)!

Having support makes it far more likely that you will be able to successfully initiate and maintain nursing and lactation.

Nursing your baby is not only good for the physical health of you and your child, but is also very helpful in promoting bonding and mental well-being for both. And having regular peer support and validation helps to alleviate postpartum mental health issues!

Also, remember that LaLecheLeague International supports the lactation needs of nonbinary / trans parents!