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!)

Current Events, Mental Health, Practice News, Self-care

People keep asking why I’m continuing to see clients in person both uptown and at the home office. It’s simple, really: the therapist’s office is the only safe space some people have. Many who might have used work to escape volatile, toxic, abusive, or outright dangerous home situations are now being told to stay home and not come to work — meaning they are trapped in the very situations that threaten them the most.

It’s unclear what protocols local shelters are enacting in a time of pandemic, but the anxiety levels around exposure and uncertain shelter occupancy arrangements will also serve to keep the vulnerable from getting clear of a dangerous home environment.

It’s the darker side of quarantine, isolation, and the desperately-needed social distancing practices: yes, we’re trying to flatten a curve and spare hospitals and treatment centres from overloading, but we’re also trapping some of the most vulnerable people in their own worst nightmares, caging them with their abusers for an indefinite period of time.

So yes, if my office is the one safe space that remains open to them, then I will take every precaution I can to protect us all for as long as I can. I will disinfect everything I can and keep to a reasonable distance across the room, but come hell or high water, for those that need us — we’ll keep the lights on for you as long as we safely can.