Archive for September, 2009

What Is Couple Psychological First Aid?

Monday, September 28th, 2009

Nationally and internationally, the most endorsed response in the first hours and weeks after a traumatic event is Psychological First Aid.
Just as Medical First Aid is given immediately to a person to minimize injury and reduce future medical complications and disability, Psychological First Aid involves providing connection, safety, basic needs, information, and recognizing if professional care is needed as a way to reduce the possibility of longterm emotional impact.

Couples Psychological First Aid unfolds from an understanding of the power of attachment by researchers like Alan Shore (2003) . It causes us to recognize that in the immediate aftermath of crisis, disaster, and unanticipated loss, the presence of the partner, even their voice on a phone, has a more soothing physical and emotional impact than that of anyone else. Actually, couples often have a great deal to offer each other but they are often uncertain how to proceed or whether their presence even makes a difference.

Carey was hysterical when she learned that her younger brother, just 30 years old, had been diagnosed with late-stage lung cancer. Jack, her husband, was also stunned and not sure how to help. The only thing he could do was listen and hug her…While trying to understand her brother’s illness, Carey began to repeat, “This can’t be true. Who is healthier than my brother? You know him—he never even smoked! What happened? Tell me what you think happened.” Feeling the intensity of her pain but knowing he had no answers, Jack held Carey and said “Carey, I don’t know. I hear you—it’s too much to believe. He’s your brother, I know how much you love him and it just doesn’t make sense. It’s just too much.” ( Excerpt from Healing Together p.31)

Feeling helpless and upset himself,  Jack did not realize that he was  actually using Couples Psychological First Aid. The Four Principles of Couples Psychological First Aid include:

  1. Being a compassionate presence for each other
  2. Establishing physical and psychological safety
  3. Identifying and responding to needs
  4. Offering practical assistance and supporting coping skills

You may find as these are explained that you are already using some of these, that others seem too simple to make a difference …


Do Men and Women React Differently to Trauma?

Thursday, September 24th, 2009

A New York Times article on Jan. 7, 2005 reported on grieving parents in Sri Lanka who lost children in the Southeast Tsunami. It describes a couple. The mother, pictured with a group of women, is crying and talking about her daughters. The father,  who feels there is no value in dwelling on loss, asserts that “this is no time to give up” and focuses his energy on rebuilding the family home.

Their reactions speak to a gender stereotype that is perhaps crosscultural -  in the face of traumatic loss, women need to speak about what has happened, men need to do something about what happened.

Do men and women react differently to trauma? Yes. Does it mean one suffers more than the other? No. Do the differences confuse and often create more tension for couples? Too often.

In their 2006 review of 25 years of research on sex differences in trauma and post-traumatic stress disorder in the Psychological Bulletin, David Tolin and Edna Foa reported that although men have a higher risk for traumatic events, women suffer from higher rates of post-traumatic stress disorder. In their analysis they suggest that the different rates of PTSD may actually be a function of the fact that men and women manifest their emotional pain in different ways.

In the aftermath of a traumatic event, women are more likely to have feelings of anxiety and depression, while men are more likely to express distress and depression in terms of irritability, anger and increased alcohol consumption.

Adding to these gender differences are other factors that affect any person’s reaction to a traumatic event. They include the type of traumatic event (sexual assault, for example, is more likely to cause PTSD than many other events), the intensity, proximity and amount of time a person must endure an event (extended deployments, witnessing loss of buddies, extended time trapped in a disaster situation increase the reaction to trauma), childhood history, earlier traumas and the meaning of the trauma to a person.

When she suffered a miscarriage in the beginning of her third month, Lynn was devastated. Then in her late 30s, she was worried that this might be her only chance to have a child.  Often unable to concentrate or sleep, she would ruminate and blame herself for waiting until her career was set before starting a family.

Lynn was further …


Finding A Safe Couple Place in the Aftermath of Trauma

Monday, September 21st, 2009

Over the past 30 years as a couples therapist, I usually have met partners when they are suffering. Whether they have just been faced with a traumatic event or have struggled for years with chronic trauma and stress, they come because they are unable to find a way to be together without pain.

Accordingly, they are often surprised when, after each describes their reason for coming, I ask where they met  and why they decided to be partners.  If they hesitate, I follow with questions like:

  • So what was it about this guy that you liked?
  • What was it about her that attracted you?
  • What was she wearing the first time you saw her?
  • How did he ask you out on that first date?

In most cases there is a sudden, visible shift, if only for a few minutes, in the look and body posture of the two as they remember and share that romantic memory. Given what has been unhappily going on in their lives, they are often pleasantly surprised and sometimes shocked by those few minutes of a positive description or memory of the other – “I can’t believe you remember that green dress!”

This is what we call state-dependent memory.  State-dependent memories are registered in a highly charged, very emotional state like that of physical attraction. Their recall brings back the positive body memory and emotional state associated with the event when we experienced it. We might think of these as the positive imprints of connection that get lost in the face of the indelible imprints of trauma and its fallout.

Traumatic events “trap” people in time.  They wall off the past and make the future seem impossible.  Trauma always involves loss and for couples trauma often steals the “we” they once were. Recovery from trauma requires establishing safety, remembering and mourning and reconnection. While all of these components are crucial, there really is no rigid sequence to these stages.  In fact, from that very first meeting, I am inviting couples to go back to empower themselves, so they can go forward. If a couple can find some strategies for feeling physically and psychologically safe together as they journey through recovery, it will fortify them.

An initial strategy for doing this is “Finding A Safe Couple Place,”  an exercise in the book, …


How Do Trauma Symptoms Make Sense?

Thursday, September 17th, 2009

You wake at 5 a.m., unable to fall back to sleep. You notice that your partner has no patience for anything, including you. You  find yourself dreading phone calls even from your closest friends. And you wonder:  How can these reactions be normal?

Combat stress, a cancer diagnosis, a car accident or a sudden job loss are events that can jolt us physically, neurochemically and emotionally.  It is common for people to respond to such distressing events with three clusters of symptoms : Intrusion or re-experiencing; hyperarousal; and constriction, numbing and avoidance.

These symptoms often appear within the first days after a trauma. They usually are very intense at first but eventually subside. Sometimes, however, these reactions are delayed.  Couples  who pull together in the crisis, manage  the deployment,  or work side by side after the storm are baffled when things become tense and symptoms erupt four months after Iraq, when the hospital stay is over, when life is supposed to go on.

You may recognize some of these reactions in yourself or your partner. You may be worried about post-traumatic stress disorder (PTSD), a persistent pattern of these symptoms lasting more than a month  for which you may seek professional help. Even in such cases, understanding these symptoms as normal responses to an  abnormal situation will help you manage their impact on your relationship. Let’s consider them.

Re-experiencing symptoms are  like being caught in the indelible imprint of the traumatic moment. It is as if the hospital scene, the oncoming truck, or the explosion are playing over and over again,  in the form of  a nightmare, a flashback,  a frightening thought or a traumatic memory. Although bewildering and disturbing, such repeated intrusions are actually the mind and body’s way of assimilating or fitting  an incomprehensible experience  into your  existing life schema.

Recognizing re-experiencing as a common response may change your reaction.  When you realize that your wife is watching  reruns in bed to avoid closing her eyes and seeing the accident scene,  you may be less likely  to feel rejected, get mad or blame her for sleep problems. Perhaps you will watch some of the reruns together, remind her that you are next to her,  validate the memory as common after the car accident. You might even ask if she wants to talk about the traumatic memory. According to traumatologist Judith Herman,  “the action of telling the story in the safety of a protected relationship can actually produce a …


Can Couples Survive Trauma?

Sunday, September 13th, 2009

We are all aware in the media as well as  through personal contacts of relationships that seem to have failed in the aftermath of tragic loss, combat stress, natural disaster or trauma of some kind.  It makes us wonder -Can a couple survive trauma? Can they hold on to their bond in the face of  unimaginable pain and loss? The answer is “Yes” . While a couple’s relationship will often suffer the greatest blow in the aftermath of trauma – it can often be the greatest source of support, resilience and recovery. This is the theme of the blog ” Healing Together for Couples.”

Traumatic events are unexpected and unimagineable. They are those moments in life that no one sees coming.  They are frightening  and often overwhelming.They can make us question ourselves, other people, even God. ” How did this happen?” Traumatic events affect relationships because they rob partners of their sense of safety and trust. They alter what was familiar.   Whether the trauma has happened to one or both partners, the relationship often becomes shaken.When a partner is hurt, grieving, having nightnares, too angry to speak or too sad to hope both partners struggle and suffer. For a time they seem unable to find the ” we” they once were.

After working with couples for years, we found that when couples understand the nature of trauma and its impact on them, when they are able to make meaning of what they are experiencing,learn new strategies, remember their resiliencies, they are bettter able to cope and heal as individuals and as a couple.

Recovery after trauma is a process. It is the journey that you never expected to take.  Empowering yourself by understanding what has happened is the crucial first step in this journey. For now start by remembering – you have traveled together before. Yes you may fight along the way, you may get lost, you may even wonder if you should keep going – but if there are rest stops, food for body and mind,  a little music, some unexpected laughter, you will  find the strength and strategies to stay connected  -  you will find the road for healing together.


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Suzanne Phillips, Psy.D., ABPP & Dianne Kane, DSW are the authors of Healing Together: A Couple's Guide to Coping with Trauma and Post-Traumatic Stress. Pick up the book today!

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