Saturday, February 18, 2012

Is Counseling Necessary to Cope with a Crisis?

In the past few months, I seem to be stumbling over the same question, but in various forms. Simply put, if you experience a life-altering event, such as the flood Irene, a divorce, death of a loved one, or the diagnosis of a serious illness, is seeing a therapist or counselor a requirement for adjusting and coping?

I’ve been mulling over this question for quite a while, but reading Is Grief an Illness? The Debate Heats Up pushed me to complete a blog post about it. The American Psychiatric Association is in the process of revising its Diagnostic and Statistical Manual of Mental Disorders (DSM) and there is consideration of including “bereavement” as a treatable illness, rather than a normal reaction to loss.

I may be a bit more sensitive to this issue for two reasons. First, I’m watching a “mental health” response in my state regarding Irene, which seems to be more about people making money versus anything that I’ve read in the literature as far as effectiveness. Second, I have several friends that are coping with significant loss. Telling them they need to “see someone” doesn’t seem to be all that helpful. In fact, it just makes them doubt their own ability to heal on their own.

Is this really an important question to ask? I think it is because our society’s dependence of turning just about everything over to the “experts” is not only disempowering, but in the case of dealing with loss, a normal part of life, the research just doesn’t support it. Oh, there is also the money piece. If we truly believe that the only way we can heal from loss is therapy, guess then only those with the right insurance or money can heal.

Soooo. The short answer to the question is “no.” Life altering events have taken place since we evolved as a species and there is considerable evidence that our brains are wired to help make adjustments and be resilient. In fact, mucking with the process might just make things worse.

Many well meaning people believe that when a disaster strikes, “you should see someone and don’t hesitate to tell family, friends and acquaintances accordingly.

In the case of natural disasters, such as the recent flooding from Irene, considerable amounts of money are being spent in my state on “crisis counseling for “victims.” Is this money well spent, or as one of our local ministers said, “can we get that money in concrete instead?” I receive weekly e-mails about mental health programs for “victims,” another term I hate and never use, yet I have a family that I’ve been trying for three months to get their floor laid so they can start using the lower level of their home. Which is more beneficial to this family-a) a session with a mental health professional or b) someone that can lay their floor? I’ll vote option b, but there’s more money available for a.

A few days after 911, a group of psychologists sent a letter to the American Psychological Association. Experts in trauma research and treatment, they wrote "In times like these, it is imperative that we refrain from the urge to intervene in ways that—however well-intentioned--have the potential to make matters worse....Unfortunately, this has not prevented certain therapists from descending on disaster scenes with well-intentioned but misguided efforts. Psychologists can be of most help by supporting the community structures that people naturally call upon in times of grief and suffering. Let us do whatever we can, while being careful not to get in the way." The message was clear, what may appear as abnormal behavior is actually a very normal reaction to a very abnormal set of circumstances. Gerald Rosen, a Seattle psychologist and one of the letter's authors said "The public should be very concerned about medical zing what are human reactions."

Ignoring the request, well-meaning crisis counselors were sent. Ultimately, this afforded a good opportunity to study how people deal with a major crisis and what type of help is most useful. Despite the influx of counselors into Manhattan, most New Yorkers received no therapy following the attacks. Furthermore, data from surveys taken after September 11th contradicted the early predictions that there would be widespread psychological damage.

In “The Other Side of Sadness,” George Bonanno, Professor of Clinical Psychology and Chair of the Department of Counseling and Clinical Psychology at Columbia University’s Teachers College, writes We can’t help but know that the pain of loss in is inevitable. Death and taxes, as the saying goes. Eventually, grief confronts everyone, and probably more than once in a lifetime. Yet, despite its ubiquity, most people know next to nothing about what to expect. Even people who have already suffered a major loss often do not know whether the grief they experienced was normal or whether they will experience anything remotely similar if they have to go through it again….The good news is that for most of us, grief is not overwhelming or unending. As frightening as the pain of loss can be, most of us are resilient.

Bonanno and his colleagues have studied a variety of traumatic situations, 9/11 terrorist attack, Hong Kong residents affected by the SARS epidemic, and those living under chronic stress in the Palestinian territories. In all of these situations, the common reaction to trauma is resilience. In fact, he estimates that only about 1 in 10 people will have “chronic” reactions to loss. Instead of grief counselors, Bonanno is looking for ways to promote resilience and positive emotion after loss. One way, interestingly, is smiling and laughter. The latter almost always has a positive effect.

Somehow we are missing a very important point-we are resilient and we are programmed to be that way. Freud’s “grief work,” and Kubler-Ross’s Five stages, have not been found to hold water when put to the scientific test. Yet, we continue to expect people to react in certain ways. We refer to bereavement as “work,” and in general are very judgmental about how people deal with loss and crisis.

So why is it that we want to turn what really is a normal part of life over to a specialist? Do we no longer trust ourselves to do what we’re wired to do? Are we afraid that we’re getting it wrong? Are we so fearful of loss in ourselves, we don’t want to bear witness to other people’s pain so better to let an “expert” deal with it?” Do we get a “kickback” for everyone we refer to therapy?

There are probably a host of reasons why we have become a culture where we want to find the expert to solve this or that problem. Actually, are we creating problems that don’t exist because there are “experts” that need something to do?

Regardless, these are some things to think about when you or someone you are close with experiences a significant loss:

Don’t judge yourself or others in how a crisis is handled. The chances are very good that you or they are doing exactly what needs to happen and ultimately will be just fine. Feelings can be very intense and people do what may appear to be very odd, scary and/or strange. In fact, it can be pretty frightening so it is comforting to hear that you are having a “normal response to a very abnormal situation.” The intense pain does lessen as you adjust to the situation.

The experience is what it is. When my mother died, while I was deeply saddened, I didn’t find myself consumed by grief in the same way a friend of mine did when her Mom passed. It didn’t mean that I loved my mother less or that I didn’t “deal with it,” as some people thought. We just dealt with it differently. Recently I read an article about President Lincoln’s reaction when his son Willie died at 11 years of age. The President was so devastated that people close to him wonder whether he would be able to carry on, but on February 24, [four days after the death of his son] the New York Evening Post reported, accurately or not, "Mr. Lincoln . . . is again at his ordinary duties, spending, not infrequently, eighteen out of the twenty-four hours upon the affairs of the nation." Mary Todd Lincoln had a very different reaction. Mary was devastated -- so much so that Lincoln worried for her health. "She took to her bed for three weeks, and for months 'the mere mention of Willie's name sent her into paroxysms of weeping.'

• Laughter helps a lot.
It does wonderful things to the brain to help reduce stress

Since our brains work best on exercise, according to John Menino, the author of “Brain Rules,” a walk, hike or some other activity is a great idea.

A drink now and then isn’t a bad thing, but turning to alcohol to deaden the pain creates more problems and can be quite lethal.

Connect with other people. We are social beings and we need strong connections to stay healthy. It just amazes me how all sorts of people came to the funeral and visited the family after my friend’s son died. People told her that they’d be checking in with her in a month or so, made promises to get together etc. but only a few made good on their word. She asked me several months after the event, “what am I suppose to do, call them up and ask them when they’d like to get together? Gee maybe they’d like to go out with me, because who knows, maybe I’ll break down and cry for them.” She said this in such a humorous way, we both ended up laughing-a very healthy and healing thing. However, the situation is real. Visit people who are grieving. They need connections. If you are having a bad day, ask someone to meet you for coffee, take a walk, watch a movie etc.

Cut them some slack but treat them as normal as possible. When I was working on the National Spinal Cord Hotline, the woman I was working with expressed her incredible frustration about how her friends treated her after her injury. She was a paraplegic, but as she pointed out, “just because I can’t walk doesn’t mean I can’t think.” She said, “I didn’t know my injury required me to have new friends. They no longer call to tell me their problems because they don’t want to upset me.” She welcomed the opportunity to be “upset” for someone other than herself. By treating her so different, she did ultimately replace the old friendships with people who fully understood the give and take required. Clearly use your judgment on this one about what you say and when.

Take a break. You don’t have to think about this 24/7. People need to be reminded that they can do something else This is where doing something with your hands can help to significantly lower stress. I learned how useful this was when one of the women I worked very closely with lost her young son from AIDS. Several months went by and, at her request, I ran a beading workshop for the HIV+ women’s support group. All of the women had significant loss in their backgrounds. Several had lost husbands, everyone had close friends that had died and all of them were dealing with significant reactions to medications. My friend called me later that night to thank me and tell me this was the best she had felt in months. She bought herself a bunch of beads. When the pain of the loss was more than she could deal with, she’d make earrings or something else. As it turned out, she had incredible artistic skills that she never realized.

Channel the loss into something positive. I am on the board of the McCostis Scholarship Fund, which provides snow sports scholarships for our local kids. Someone that worked with Sue McCostis designated the charity as a place to donate after her husband died. That was the beginning of our having “named scholarships.” We now have four of these, all of which were started in less than a year of the person’s passing. This is definitely a win/win. Our board meetings are social events filled with laughter and positive remembering. People find comfort in seeing a legacy, doing something constructive, and the kids are so grateful for the help. I can’t help but brag a little about one of our gals that the Pete Noyes Scholarship has funded for a number of years. She is now our state champ in alpine racing for her age group. At a recent benefit, the first thing she did was to thank the board members for helping her all these years. We think Pete would be very proud of her.

If someone is actively talking suicide get them immediate help. Contrary to the old notion that “grief takes as long as it takes,” if someone is still despondent after six months they need professional help. In the case of Mary Lincoln, she was someone that could have benefited by professional help particularly after her husband’s death. Six months of deep anguish and pain can really take their toll on a person. There's a downward spiral that gets out of hand, and the person is really not functioning. They're probably barely functioning at work; they're probably not going out; they're probably sitting with a lot of anguish all day long, and that's exhausting and debilitating. Often that's accompanied by health problems because our immune systems really can only take so much, and our immune systems begin to fail . Bonanno

Finally, keep in my mind the comments I made from the first post I wrote on this blog. It is probably not wise to start a book or blog by saying, “ I’m not an authority on the subject you are about to read.” Yet, this is an important point because when it comes to healing and well being; you are the best authority on you. No matter how helpful I think something might be, if it doesn’t work for you, it doesn’t work for you. No more and no less. No need to say “I really tried but…” In short, if you feel you need therapy by all means get it.

Additional posts relating to this topic

Understanding Grief

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