Saturday, November 7, 2009

Secondary Trauma

Lord, have mercy.

We have endured another mass shooting in our nation, this time on a military base. It will take time to sort out the details of this horrible crime, but we are impatient to know: was this an act of terrorism? The shooter is a Muslim, and some have reported that he shouted to Allah as he fired his weapons. There will be a good deal to learn of this man in the weeks ahead.

Of great interest to me: he is a psychiatrist who worked with soldiers suffering with Post Traumatic Stress Disorder (PTSD). Mental health professionals of all kinds who regularly work with trauma survivors often find that hour after hour of listening to people recount horror is traumatizing. Without regular and systematic debriefing of their own work, therapists lose their own resilience and begin to suffer a secondary PTSD. They begin to show symptoms of chronic anxiety, restlessness, easy startle reflex, difficulty sleeping, intrusive images of trauma, and hypervigilance in the same way soldiers returning from battle can.


I wonder if this doctor, whose healing work helped soldiers return to their lives after battle, was waging a private battle of his own with nightmares, fears and overwhelming anxiety. Would he have been able or willing to share that suffering with others in the military? How are these fears linked to his natural anxieties about being deployed to the battle zone? Are there systems in place to have therapists working in PTSD debrief and consult with others about their cases and experiences?

Helping others recover mental health is not work for the faint of heart and mind. The very best healers understand that they are naturally effected by what they hear, and need help for their own pain. Perhaps this tragedy will highlight the continuing true costs of war: that the horrors of destroying others in battle don't stop at a nation's border. War is hell, and it exacts a toll far wider than we can imagine.

Oh God: hear our prayer.

Thursday, October 22, 2009

How To Marry Well

The best marriages are made by people who begin their relationship as friends and use friendship as their marriage model.

Do you know how to make and keep a friendship? Listen and talk, share work and pleasure, respond to a friend's bids for attention, and get some attention back? Laugh and enjoy each other, be flexible when things don't work out, fix your disagreements, stay loyal but open to other people in your friend's life?  If you do, and can keep these skills going with people your own age, you already know how to sustain a marriage.

The dramatic stuff of romantic attachment, the wash of sexual attraction, the focused desire for only that one partner: that biological experience, which is the core of nearly every popular song or relationship movie made in the last 50 years, is a piece of human experience, too. But it is crushingly brief. Most of us will only sustain that brain and body phase for 12-18 months. After that, we begin to readjust to a steady attachment that looks and behaves more like a close friendship than any other relationship we have. Friend with benefits? That's what a solid, happy, sustainable marriage is.


The best advice I give people (when they ask for it) about how to make a successful marriage is to take their time. I know that if they begin their relationship well, move into the infatuation phase, and begin to resolve that roller coaster with a deeper, more loyal friendship intact, they have a good running start on a happy union. This means that ideally, we should know our partner for a year or two before we marry. A lot can happen in two years. Exactly the kind of things that test the best of friendships, and expose our strengths and vulnerabilities to one another.

The best preparation for a happy marriage is not a long dating history, a series of broken engagements, or even one marriage after the other. The best marriages are made by those who have learned how to make and keep friendship relationships. Who'll will stand by you in difficult times, visit you when you're sick, and share their ice cream? That's who you want at your side when the real rubber meets the road: a dear friend. Your spouse.

Wednesday, October 14, 2009

Pastors are a Bridge

When I first began my private mental health practice, I knew one thing was certain: I needed to meet as many area clergy as I could. Today I had the pleasure of having coffee with an another local parish pastor. Thanks, C!

So many people still experience embarrassment, resistance and fear when it comes to seeking therapy for relationships, emotions, or behaviors, they stall when it comes to getting help. They may talk to their friend or family member. They may occasionally tell their physician about how they feel. But as they get ready to reach for help, they may also talk to their pastor.

Most pastors are great at emotional triage. Trained in basic listening skills, taught how to manage themselves in emergencies, experienced at handling emotions at funerals, parish clergy are the go-to folks in many people's lives when it comes to figuring out what to do when the going gets rough. I am honored so many people trusted their lives to me over my years in the parish. I learned early on to have a small group of trusted counselors I knew and to whom I could refer my parishioners who needed more help than I could give. I tried to think of myself as a link between suffering and help, and I kept in touch with those counselors on a regular basis.

Now, I strive to be one of those counselors that the pastors, ministers and priests around me trust. Someone they have met, looked in the eye, and gathered a personal sense of me for themselves. As I reflect on clients who have recovered well, who make the most progress in their personal goals, the ones who feel that therapy was a success: most have come to therapy via their pastors.

Thank you, Pastor, for being on the front lines in people's personal lives. You are under appreciated in our secular culture, and over-worked inside the special world of the congregation. You may not feel it often enough, but you are loved, respected and trusted by your members, and a lot of neighbors and strangers, too. Helping people navigate the details of mental health care is a compassionate gift you give. Thank you for trusting people you care to me, and to other therapists you know and trust. 

Oh, and one more thing: you are often neglectful of your own mental health. Don't forget to reach out for help yourself. Some of us know exactly what your life is like, and can be trusted as a confidential guide to increasing YOUR emotional health.  God's grace surround you!

Thursday, October 8, 2009

The Adolescent Effect: Part 2

Parents of adolescents don't have much fun.

Fun, for many parents of teenagers, is something they watch their children have. Fun at school, fun at the mall, fun on the playing field, fun at parties. What used to be happy times as a family with pre- and elementary school children has transitioned into good times  for the teens, and being the ones who not only pay for those, but also drive the kids to and from these teen-centered events. Having given up weekend after weekend, night after night, to manage my children's sports, music, church, school and friend events, I feel like an event planner. Always making things happen, invisible to the guests, never getting to sit at the head table or get out on the dance floor.

This is what many middle aged parents find when they get to the second decade of their children's lives. A child centered life, but with no emotional reward. No smiling toddler looking back at you as they climb up the slide. No proud 10 year old eager to show you off to their teacher or coach. Instead, the parent must now watch their child's back as they saunter, without a second glance, into the gym, store, house or ball field. The parent ready to drive, wait, and pick that child up when the event is through.


Do I sound resentful?

I have been thinking about my emotions around the lack of fun adult time in my life. Perhaps it has something to do with where we live, a suburb full of families in some stage of doing what we're doing. Years back, when I lived in a small town, adults made time for one another and the kids were expected to come along. One of my closest friends, having moved to Alaska, regularly reports her time spent with other adults in her small town, running, eating, fund raising, skiing, church building. What happened back in our shiny suburb?

I know for my husband and me, these years of chauffeuring came on slowly, incrementally, at the same time we had to manage some serious work and health issues. It was like an emotional tossed salad, trying to keep it all together. We managed to keep the whole one piece, but the pleasure in parenting? the joy in the week? I'm looking, but it's not so obvious anymore.

For families that don't have the funds to finance big vacation cruises, or a second home on the lake, these adolescent days are hard. There is no natural escape. Add into these adolescent effects a divorce, or an elderly parent, a job loss or a health or financial crisis and you see why most of the families I see in therapy are families with teens. We are adults without the focus of small children, adults without the freedom of retirement or the adjustment of an empty nest. We are hobbled, and stressed, and under-appreciated.

We are struggling to re-define ourselves and what brings us joy. If we look chronically worn to you, don't ask us to explain. Just give us a hand, and invite us to dinner. Without our kids.

Saturday, October 3, 2009

The Adolescent Effect : Part 1

As our children are neck-deep into adolescence, I'm trying to pay attention to what this developmental transition does to our family relationships.

We are pretty early in the game. Son is 16, daughter is 13. We have gotten here relatively unscathed, moving through most of middle school with solid parent/child connections, positive opinions of one another and every body part accounted for (not counting wisdom teeth, sports injuries or general repairs). But lots has changed, and what has changed is worth noting.

1.  We know less and less about our children's lives at school. Moving from a single class room in elementary school into the maze of middle and high school meant an immediate and dramatic change: I don't know my children's teachers. I have gone to what passes for parent-teacher conferences in our district only to spend about 10 minutes per subject talking to each teacher about my child in their class. A few of the teachers stand out in their effort to talk to me about my children, and that has made a difference in how I talk about them at home, and how at ease I am in communicating with them. Some really do a great job keeping in touch with emails, but most have as much substance in my consciousness as ghosts. I wouldn't know them to stumble upon them. I am no longer the advocate I used to be for my kid's educations. I have little to no real information on these teachers, and they me. That seems a huge loss for my family. I don't think of the teachers in my children's lives as people I share my children's education with. They have it during the school day, and I have given that influence up.

2.  We know even less about our children's friends and their parents. One of the more interesting things for me to observe in our family life is how friendships evolve. When the children were small, and we drove them everywhere, dropping them off for play time or events, we would spend time in the front halls of these homes talking with other parents and getting to know them personally. None of us would think of simply letting our 7 or 9 or 11 year old stay overnight with a family we hadn't at least met face to face. And that circle of friendships was relatively small and interconnected. But as our children have grown older, and their friendship circle wider, we have loosened our expectations about knowing the parents, and focused a bit more on trying to know the friends. We've learned that the apples don't fall too far from the trees, so if the child is solid and steady, we tend to believe the family is that way, too. This isn't always the case, of course. I know this well, both in theory and in fact, some children are more steady than their parents. And this has occasionally caused some real drama. But in general, we have shifted from a parent-centered to a peer-centered assessment of where our children spend their time.


3.  Our children still need us to be their fierce advocates, but in more subtle ways. Just when I think that our children no longer need me to do for them as much, to speak for them, to argue, plan or problem solve for them, I'm proven wrong. There is an adult they need to speak to, and they want me to do it. There's a plan they need to make, and it didn't get made, would I make it? There's an appointment, a game, a tryout, a field trip form, a PSAT, youth group, lunch money, library book, driver's ed class, special purchase, problem, or phone call that needs my help, my advice, my money, and my signature. Usually at the last minute, and often at my least flexible moments. But I have to hop to it, because in some ways, I am now the cleanup team. They have outgrown their childhoods, but haven't quite grown into their adult selves. And it's now my job, our job, to bend and flex in our parenting as they are in their development. We still defend and protect, just not so often and not so obviously.