Think you have burnout? It might be vicarious trauma.

I’ve been meaning to write about this topic for a looong time. I’m working on updating a presentation right now about trauma informed care and vicarious trauma for some future lawyers. It got me thinking again, how many people out there think they have anxiety, depression, burnout, or compassion fatigue when really they are experiencing vicarious trauma? My guess is it is more than we would like to admit.

If in your job or daily life you frequently hear about terrible things happening to other people, you probably feel drained or overwhelmed. That is HEAVY stuff to hear and hold. It hurts when you want to just make it all better and you can’t. You find yourself shutting down at home and work, losing motivation, and feeling like you have no control. Eventually you start feeling vulnerable, are losing trust in others, and just can’t relate to people the way you used to. You become preoccupied with the “trauma stuff” - always thinking about what others have gone through, feeling guilty that you feel bad even though it didn’t happen to you, avoiding conversations or places or people that remind you of other people’s trauma, believing the world just sucks, and being on edge. These are symptoms of vicarious trauma.

A quote I doubt I will ever drop from any version of my presentation says

vicarious trauma is unavoidable and is the natural consequence of being human, connecting to and caring about our clients as we see the effects of trauma on their lives (Saakvitne, Gamble, Pearlman, & Tabor, 2000)

Unavoidable, natural - it seems we should be worried about the people who are NOT impacted by the trauma of other people. The good news though, is there are ways to prevent and manage the severity of vicarious trauma. You can do it yourself as an individual and organizations can make supportive changes. I’m going to focus here on the individual level.

Prevention

We know it is unavoidable if we hear about trauma a lot so one thing we can do is anticipate vicarious trauma and protect ourselves. This looks like making sure you have a balance in your life that works for you between work, rest, play, and socializing. It also includes finding ways to increase your own tolerance levels through things like journaling, getting emotional support from others, and going to counseling yourself. The other thing you can do is periodically measure where you are at, my preference is the Professional Quality of Life Scale because it is free and shows you where you are at in terms of compassion satisfaction, burnout, secondary traumatic stress (another phrase for vicarious trauma), and compassion satisfaction. I also really believe that using trauma-informed care can help prevent vicarious trauma but that’s a whole different blog, or course, or something :)

Treatment

First and foremost you have to have some empathy for yourself. Think curiously about the life you’ve lived thus far; the people and moments who have shaped you since childhood, what drew you to the work you do, what impact does trauma have on people, what impact is it having on you? Can you understand why you might be feeling or acting in a way that isn’t who you want to be right now? Maybe you feel like all your compassion is spent on everyone else - have empathy for that too.

Self-care

When it comes to self-care I have a lot of thoughts on the topic worthy of its own post but here we won’t get into that. Instead, think about what you can do to rest and relax. I’m talking about the things that help you calm and soothe your body and mind. For me this is yoga, a slow walk in nature, or sitting with a cup of tea or coffee in a quiet place. Also think about what you can do for enjoyment. It doesn’t have to be something calm or relaxing, the only requirement is that you actually feel good while you are doing it. This is where I like to go on a hike, long bike ride, or dance. Lastly, you want to think about what re-energizes you. Maybe it is some of those things in your list already but you might find other things lift your spirits and give you energy. For me, this is where I need music - a concert, voice lessons, karaoke, anything with energizing music. What does self-care need to include to work for you?

Escape

I know what you are thinking - sweet, I can just pretend it doesn’t exist and it will be fine. Sorry, but nope. When I say escape I don’t mean total avoidance, I mean sometimes we just need a break from it all. We might need to physically or mentally escape after hearing about something really awful. That’s a good time to get out for your lunch break or coffee if you can. The only requirement is you escape to something that is NOT work or trauma related.

At work

A lot of this comes at the organizational level but there are still some things you can do as an individual. If you are able, try to balance your trauma and non-trauma work. You might be able to take other types of cases or spend time teaching others. Find other professional activities where you can be involved; maybe you can get the ball rolling on making your organization more trauma informed. Get involved in advocacy at the level you are comfortable with. Find what is possible and master the possible. I try to master trauma-informed care practices at an individual level; get really really good at what you can do. Get supervision or consultation from peers. Try to make a work routine to the extent possible to make your day more predictable and feel like you have some control. Set some reasonable boundaries on what work comes home (if any) and how much you work.

At home

A routine at home can be helpful too; it does not have to be elaborate or rigid, just enough to let you feel like you have a handle on things. If you live with someone create rituals at home - maybe you eat dinner together every Friday or have a regular game night. Some sort of ritual that helps create connection is best. Find and get social support from friends, family, and partners. Volunteering can be helpful too if it fits it your life balance. Other personal strategies include limiting your media exposure and practicing mindfulness.

Transformation and Meaning

If you are hearing about trauma a lot at some point you probably decided that helping people is important to you. It is easy to lose hope and lose your “why” when vicarious trauma hits. It is vital to find or re-discover the meaning in what you do and why you are doing it. We can find meaning and hope by creating it ourselves, connecting with others, helping in building community, and being mindful of the positives. We can look within ourselves and others to find meaning. Consider the importance of your work, the people you care about, and the people who care about you. If you are a spiritual or religious person reconnect with that aspect of yourself.

There are very positive aspects of working with trauma too. We can feel good and fulfilled knowing the work we do changes lives. We increase our ability to reframe negative experiences. We grow through the people we work with hearing stories of courage and resilience. We find hope for the future. We can even develop vicarious resilience as we recover from vicarious trauma.

Would you like to hear more about how I might be able to help you with vicarious trauma? Set up a call so we can chat soon!

How to Get Mental Health Help

You’re wondering - is it worth the anxiety to get help?

If you are too anxious to click a button, send an email, or make a call to get help, this one is for you. Even when you don’t think of yourself as an anxious person it can be highly anxiety-provoking to reach out for help. Maybe you’re worried you’ll sound dumb. Or you think you’ll feel worse after making contact. Perhaps you just aren’t sure if you are ready to reach out.

I’ve helped many friends and clients with getting started. I’ve researched places to get help, helped people make the call, gone to intake screening appointments with friends, taken people to the hospital, and encouraged many people to get help. I know how it can take weeks, months, even years for some people to get help. I get it - It took me multiple searches over months and then even more weeks after to reach out to a counselor when I thought I needed one.

You can calm your nerves enough to do it, even if you are still anxious. It is totally normal to feels this way. In fact, I’ve met very few people who haven’t expressed at least some nervousness about reaching out. In my own practice I try to make it as easy for you as I can, you click a button, provide some very basic contact information, and schedule a call at a time that works for you. I work hard to keep this schedule up to date, so I never have to reschedule your initial call. Then, I call you at our scheduled time. If for some reason I don’t reach you I leave you a voicemail and send an email, just in case you really still need a call. If not just ignore me 😊

The good news is once you make the call or click the button you usually feel a little relieved afterwards. And it is definitely a weight off your shoulders when you find the right person. The bad news is you have that anxiety now. Here are my suggestions on how to get yourself to reach out based on my personal and professional experience.

1.      Break everything into small chunks or goals

You are already thinking about all the pieces of finding the right person and getting the help you need so break it down into each little piece. Deciding if you really need help , getting an idea of what you need , searching for that person, making a list of people to contact, actually contacting as many people at a time as you are comfortable with (even if it is just 1). Make sure your goals are reasonable. How much time do you need to decide if you need help? Who (if anyone) do you need to talk to, to help you make that decision? How much time do you have or want to dedicate to searching for someone? How “perfect” does this person need to seem for you to take the next step? How much time do you need to work yourself up to click the button or make the call? How much time do you need to calm down afterwards? How many times can you realistically reach out in a day, week, or month?

2.      Ask a friend or loved one

I’ve already hinted at this one in the first step but, reaching out to someone you know first can make it easier to reach out to a stranger. You can do this at any step in the process. Maybe you need help breaking things into small chunks. Maybe you want some help for deciding what you need or who would be a good fit for you. Or you want some moral support beside you when you make that first click or call.

3.      Do your research

Figure out what you think you want or need. Then, think about who would be a good fit for you – what do you NEED in a counselor, psychologist, or psychiatrist? Maybe you care about their gender, religious affiliation, race, ethnicity, language, sexual orientation, acceptance or understanding of certain pieces of your identity. Maybe you are more concerned about their approach, availability, or insurance. When you are ready to search, consider multiple options – suggestions from friends, family, or doctors; google searches, and directories such as psychology today and therapy den. As you are searching make your list of people you think could be a good fit for you. It is okay if this takes time, especially if you live in an area with tons of mental health services.

4.      Rehearse your call or draft your email if necessary

You probably write and re-write your emails or texts and say what you want to say in your head before you make a call. (I promise, I am not in your head, it really is that common!) You can do this before making your call or email for mental health services too if it is not as simple as a click. You might practice it on your own or pretend you are making the call with a trusted person.

5.      Try some calming strategies

You might want to think about some calming strategies. My go-to is deep breathing for at least 2-3 minutes. You should do what works for you. You can use apps such as Calm or Headspace to help guide your breathing or meditation. You can also look on youtube for things like “guided meditation” “guided imagery” “progressive muscle relaxation” and “calming music.” There are other strategies too, but these tend to be the easiest for people to use quickly.

6.      Make contact

Immediately after using your calming strategy, make the contact. You can do it! The worst that will happen is you rule someone out on your list. Even if you panic on the phone, the person will either 1) be able to manage it and you know they are probably a good match or 2) can’t handle it and you take them off your list of people. If your contact is me, you can schedule your call here otherwise, head over to that list you were making!

7.      Relax again if needed and reward yourself for taking such a big step!

You did it, hooray! If you are still really amped up, go back to those calming strategies that worked for you. Then, do something to celebrate because you already are on your way to feeling better. Every step big and small matters.

Signs you might have a mental illness

After my last blog about what kind of help you might need, I heard from a few people I should do one explaining at the different types of providers and licenses. I’ll get there, I promise. But first, I think I might have put the carriage before the horse. What if you aren’t even sure if you need help? How do you know?

We are all going to feel bad or uncomfortable sometimes in our lives – sadness, stress, worry, thinking we hear our name being called occasionally, some impulsive decisions here and there – these are all things that everyone experiences at some point and are part of being human. And I am NOT in the business of turning every little thing into a diagnosis. Even for the “small” things that are less intense or don’t require an evaluation, counseling can be helpful.

But these and other things can become problems when they are interfering with our lives. They might even mean you have a mental health diagnosis and you could benefit from testing. This is probably the biggest sign that you might need to get some help – whatever the problem, it has gotten strong, intense, and just does not go away – it feels like it is running your life. It is getting in the way of relationships, school, work, or all those things.

So, here are some signs you should look for help. These are not the only signs, but it is a good place to start. Keep in mind anytime is says “odd” or “unusual” you want to compare it to what is “normal” for your culture.

Behavior problems

1.      Impulsive risky behaviors (spending, sexual behavior, substance abuse, gambling)

2.      Frequent and dangerous sexual acting out

3.      Frequent or intense physical aggression to others

4.      Frequent or intense destruction of property

5.      Frequent or intense verbal aggression to others

6.      Sexual aggression to others

7.      Frequent and intense tantrums in children

Mood problems

1.      Excessive worry or fear that you can’t control

2.      Extreme sadness or loss of interest

3.      Thoughts of self-harm or thoughts of suicide

4.      Intense and frequent mood changes

5.      Increasingly easily agitated

6.      Frequently feeling empty or numb

7.      Feeling very on-edge and easily frightened

Relationship problems

1.      Trouble understanding or relating to other people

2.      Difficulty getting along with others

3.      Lack of empathy for others

4.      Changes in sex drive (in either direction)

5.      Strong feelings of fear or suspicion of others

6.      Trouble making and keeping friends

7.      Difficulty maintaining relationships

8.      Intense fear of rejection

Thinking problems

1.      Problems with memory or confusion

2.      Trouble speaking so that others understand you because your thoughts are jumbled

3.      Significant problems paying attention

4.      Unusual beliefs about having personal powers of understanding or influencing that others find odd

5.      Decrease in your functioning at work or school

6.      Often thinking about bad experiences from the past

Physical problems

1.      Flashbacks or nightmares related to past bad experiences

2.      Headaches, aches, and pains that your doctor cannot explain

3.      Intense preoccupation with weight or appearance

4.      Severely restrictive eating

5.      Making extreme efforts to lose weight when not medically necessary

6.      Changes in weight and appetite

7.      Changes in sleep and need for sleep

8.      Fatigue and tiredness even with enough sleep

Other problems

1.      Feeling disconnected or like things aren’t real

2.      Unusual behavior

3.      Seeing or hearing things that others do not see or hear

4.      Substance abuse

5.      Inability to carry out daily activities

The more of these problems you have, the more likely it is there is something. What we know about mental health is generally the earlier you get help, the better. Early help can prevent things from getting worse and help you feel better sooner.

How might getting help improve your life?

If you are ready to get some questions answered, schedule a call with me so we can see if I can help. If not, I’m happy to direct you to someone who is a better fit.

Do I need Counseling, Medication, or Testing?

Sometimes you know SOMETHING is wrong but you don’t know what will help. You keep going back and forth wondering if you need support for your mental health. When you finally decide that you do need some help, you get overwhelmed by all the options, don’t know what or who you need, and end up shutting down. I’ve heard this pattern a lot. Keep reading to get a clear explanation of some of the TYPES of services available (not all from me!), and how they might fit you.

Counseling/Therapy

This is for people who have some ideas of what they want to get from talking to a professional about their concerns. They probably have some idea of what their concerns are and might have some insight into their problem. For example, you might know that you worry a lot more than other people and seem to worry about everything. You can’t stop overthinking things and it is starting to get in the way of living. Then we would know to focus on anxiety in counseling and check for any trauma that might be related to your anxiety. Counseling is the right place for you. For this you are looking for a professional counselor, clinical social worker, marriage and family therapist, psychotherapist, or psychologist. (explaining the difference in these would need another blog post!)

On the other hand, if you just know that something is wrong but have no idea what (or have too many ideas!) you might not want to jump right into counseling. If counseling has not worked for you in the past and you aren’t sure why, maybe don’t start with counseling until you identify what the problem was. If professionals have thrown many different diagnoses at you, try getting an accurate diagnosis first. Which leads to the next type of service –

Testing/Evaluation/Assessment

Admittedly, some of my bias is going to come out here because I LOVE testing. I don’t think everyone needs it though, as you can see above. A counselor can figure out a “working” diagnosis for many people which is likely to be accurate. But sometimes it gets tricky. If the counselor doesn’t have experience with your diagnosis, they might miss it. Or you might be one of those people who have a lot of overlapping symptoms that can look like other diagnoses. You might even have new, worrisome symptoms such as feeling like things aren’t real or feeling very paranoid. Testing is also what you want if you think you’ve been misdiagnosed or are worried that something else is being missed, like Autism. People get testing for other brain-based concerns such as dementia, learning disorders, and intellectual disability too. My preference and advice for people looking for an evaluation is to find someone who is thorough. Especially when you are worried that something has been missed or something is wrong with you – you don’t want this to be brief, rushed, and full of screening checklists. It should include an interview, observations, testing/measurement with reliable and valid tools, and ways of getting information from other sources with your consent. A full explanation of what is involved in a psychological evaluation is at another one of my blog posts- here. For this service you are most likely looking for a psychologist or neuropsychologist. Still not what you need? Maybe you are thinking about -

Medication Management (psychiatry)

Ok, now my bias is really going to show so I’ll just be straightforward with it. I believe medication is very beneficial for some people. I also believe it is not for all people, and unless things are bad enough that you can’t benefit from or get to counseling it might not be the best first option. This is because for some problems, such as anxiety, we know most people who start medication will end up not engaging in counseling and won’t learn the lifelong strategies for coping. That being said, I believe in each person’s ability to make informed decisions for themselves about what treatment they want and need.

You need medication management if you are looking for someone to prescribe a medicine to help you feel better. Most medicines for mental health concerns help people feel “moderately better” as told to me repeatedly by a psychiatrist I used to work with professionally. This means it is not a miracle cure. So yes, medicine can make you less depressed, less anxious, less sad, hear less voices, be less paranoid but it generally does not make most people with mental health disorders 100% symptom free. Knowing this is important for managing your expectations for what medicine can do for you. Of course, you should always talk to whoever is prescribing your medicine for what you should expect and important things like potential side effects. So if you are wanting medicine to get yourself to testing or counseling, to supplement your counseling, or for your primary treatment, medication management is what you are looking for. Depending on the complexity of your concerns, you might be able to get what you need from your medical provider. If not, look for a psychiatrist or psychiatric nurse practitioner.

Now, you “just” have to find the right person.

There are a lot of ways to find a mental health provider such as personal recommendations, google search, and therapy directories. Here in Boise I’ve heard a lot of people unfamiliar with directories, but a lot of counselors and psychologists are on them - check out sites like Therapy Den or Psychology Today where you can filter out the ones that don’t fit your needs. The important part is finding the right person for YOU. The relationship you have with your counselor is one of the most important parts of counseling success so please, if you find yourself with a counselor that you do not feel comfortable with either address the problem with them or switch! So, when you are looking, I have some tips/questions to ask yourself.

Do they offer a free brief consultation (usually no more than 20 minutes)?

This is more common for people who are not in-network with insurance companies and not at huge agencies– these are people who want to make sure that together you make a good fit for their service. Sometimes they find you need someone else because they can’t do what you need; if that is the case they often will have someone they can refer. In that phone call you can usually tell if someone is going to be a good match for you or not just by how you feel by the end of it.

Do they have some expertise or experience in the issue you want to address?

Yes, mental health providers are trained broadly, but they do their best work when in their area of passion and expertise. Some are also trained specifically to work with a certain diagnosis or population. I see it like getting my hair cut by the right person. All hairstylists can cut hair but nobody without experience or training in curly/wavy hair is gonna touch mine!

Does the way they schedule fit with your schedule?

Some counselors keep a consistent weekly appointment, others have a little flexibility, and others will never see you at a consistent day and time – what do YOU need? The same is true for psychiatrists and psychiatric nurse practitioners, although they likely will not see you weekly except possibly at the start. Psychologists usually either do a a full day of interviewing and testing or split it into two days. They might give immediate feedback or wait until the report is finalized. What is your preference?

Are you looking for a certain type of counseling or medication management?

Some people with trauma histories are very specifically looking for EMDR, but not all counselors are doing it. If you have anxiety there is a good chance cognitive behavioral therapy (CBT), exposure therapy, or mindfulness-based practices would be a good fit for you. Some psychiatrists or psychiatric nurse practitioners work in a way that includes some counseling while others only check on symptoms and side effects.

Do they specialize in your age group?

This might be more or less important to you but some people say they see all ages yet clearly based on their profile, website, or office primarily see a specific age group or type of person such as kids, 20-somethings, moms, retirees (see how this lost could keep going?). The same is true with medication management, especially if you are taking a child - you want to know they are knowledgeable about treating kids!

I hope reading through this helped you decide what you need. If that answer is a thorough psychological evaluation, schedule a call with me to see if I’m the right fit for you.

What happens in a psychological evaluation?

If you are thinking about psychological testing you probably want to know what an evaluation will look like.

You are nervous about making an appointment. What will happen? What will we talk about? Will it even make sense to me? What if they don’t answer the questions I have? How long will it last?

I’ve done enough evaluations to lose count so I know what method works for me and the people who like to work with me. I’ll break down what I usually do so by the end you’ll feel less scared about making that appointment (everyone has at least a little worry about these things!)

Most psychological evaluations involve talking to the psychologist about yourself and symptoms such as anxiety and trouble sleeping in an interview, doing some questionnaires about yourself, and possibly some activities that look at how your brain is working. By the end, you should be given feedback. Professionals sometimes have different workflows, but I can tell you how I do it here in Boise. (P.S. This starts after the process of seeing if I’m the right person for you and making an appointment.)

Sun setting at Canyonlands National Park

Sun setting at Canyonlands National Park

Psychological Interview

First, you come in to talk with me about your concerns and share important background information. Depending on the questions we have, this interview will take between one and two hours. If you have trouble talking about yourself (maybe speech or memory is one of your concerns), I will ask your permission to talk to someone who knows you well to make sure we are getting good information and not missing anything important. Honestly, I like to do this even when you can talk about yourself all day - it always helps to get another perspective! If you are still worried about exactly what we’ll talk about, here is a list of things I ask about and a short explanation for why I ask them.

Your current concerns

I hope it is obvious that I care about what is bothering you, and there might also be concerns that others have for you – these could be things like worrying too much, never feeling happy, always being on-edge, trouble sleeping, feeling distant from others, having trouble with relationships, struggling to cope with stress or other problems.

Medical

There are a lot of reasons this is important; so many medicines and hormones can impact how you are feeling, head injuries can change us, and there are a surprising amount of medical concerns that can cause psychological symptoms. It is also helpful to know what medications you’ve tried (if any) and how they have worked (or not).

Education and Work

This gives me information about how concerns might be impacting these areas of your life

Substance Use

I know this is scary but some of this information can tell me things like how you cope and if using a substance or withdrawal might be impacting how you are doing. It is super common for people with mental health concerns, especially trauma, to also use substances so I always ask. Which leads me to…

Trauma

You can see my last post for an explanation of trauma. I find that people don’t talk about it unless asked; which means it gets overlooked. Trauma leads to a lot of things in different people – anger problems, relationship issues, depression, anxiety, the list goes on. I can’t make the best recommendations for you if I don’t know whether or not trauma happened and how it might impact you.

Current Potential Symptoms

These are things like how you are feeling, what you are doing/not doing, sleep concerns, eating and appetite problems, thoughts of hurting yourself or others, and unusual experiences like seeing or hearing things that other people don’t see or hear. I always ask about everything because people sometimes don’t share unless asked directly.

Current Life

This is basics like who you live with, who you talk to, how you spend your free time, and who you are in a relationship with. I also ask about what parts of your identity are important to you (and how much detail you want me to know), such as sexual orientation, gender identity, religious beliefs, race, ethnicity, language preferences, immigration status – context can be really important to understanding the big picture!

This list is not exhaustive, but hits some of the big points. Each interview I do is a little bit different based on you and your concerns 😊 You might hope after talking about all that, we don’t just jump right into testing. I think it makes for a very draining day for some folks, so lucky for you - I don’t.

Canyonlands National Park arch with blue sky

Canyonlands National Park arch with blue sky

Psychological Testing

After the interview, I will plan what questionnaires and activities we should do to answer our questions. You’ll know the general things I want to look at more closely before you leave my office after the first interview. If there are any questionnaires that you or people you give permission for to answer online, I will send those out shortly after your interview. The rest of the questionnaires and activities we’ll complete at my office 1 week after your interview. In between these meetings I’ll be trying to contact anyone you gave me permission to talk to (such as a counselor, doctor, lawyer, or someone else who we think needs some input into your evaluation).

The assessments (and how much time they take) will be different depending on your questions . If you are worried about how your brain is working (like memory, attention, or concerns about your brain working too slow) I’ll likely do an intelligence (IQ) test with you and maybe one for executive functioning (this is basically your ability to plan, organize, and monitor your thoughts and behavior). I would also have you or someone who knows you well to do some questionnaires about your ability to function in the world and take care of yourself (also called adaptive skills) and your executive functioning (it is better to have more than 1 source of information when I can get it!).

If you have questions about why you are sad, worried, fearful, have intense up and down emotions, or keep getting into bad relationships then we’ll probably just do some questionnaires; some of those have to be done in my office. The questionnaires will ask a lot of questions and look at your personality and symptoms to make sure we aren’t missing anything. Common questionnaires I use are the MMPI-2-rf, PAI, and TSI-2. For people who speak Spanish many of the scales I use also are available in Spanish (hooray!) and when they are not available I try to find a good alternative.

Understanding your Results

Within 1-2 weeks after completing the assessments and questionnaires I’ll have your report completed and you’ll come to my office for 1 hour so you will feel clear about the results and confident in your next steps.

I do my best to answer all your questions during our feedback session. If I think counseling will be helpful I will give you specific recommendations for the type of treatments that are likely to work and if I know of anyone will include specific people. I also give you strategies that you can use at home, work, or school. If you find books or apps helpful I can usually recommend a few of those as well. You’ll get an electronic copy of the report (pdf) so you can share it with whomever you think makes sense (like your doctor or psychiatrist if you see one) and so you don’t have to remember everything we talk about in the feedback session.

Occasionally, the problem you have is something I have specialty in treating (anxiety or trauma) AND you really want to use me as your counselor. If I have any openings and we all agree it is a good fit, I am happy to do that.

Whew! I know that was a lot of information. But you’ve made it this far; you’ve got answers about the process.

Are you ready to get some answers about yourself?

Click to schedule a free 15 minute call with me to figure out if I’m the right person to help you and book your appointment. If I’m not your person, I’m happy to help point you in the right direction!




PTSD Awareness Month

Did you know June is national PTSD awareness month? It is also Pride Month! And Men’s Health Month! And National Safety Month! (and probably more that I don’t know about!)

The one I want to talk about today is PTSD awareness, not because it is more important than any of the others, but because PTSD (or at least trauma) is part of almost all of my work.

Actually, there is tons of overlap between PTSD and LGTBQ folk, men, and safety.  For example, LGBTQ youth experience higher rates of trauma (such as bullying, harassment, traumatic loss, physical and sexual abuse, and societal stigma, bias, and rejection) than their peers. And while women are more likely to be diagnosed with PTSD, men are more likely to experience a trauma and are less likely to get counseling in general. Also, trauma seriously impacts our ability to feel safe.

So what is PTSD? Good question, since I keep using that acronym, let’s start there - the long term for it is Posttraumatic Stress Disorder.

People might develop PTSD after experiencing something awful or tragic, where their life or someone else’s life or well-being is threatened; we call this a trauma. Sadly, trauma is super common in our world. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives according to the VA. Some examples of trauma are sexual assault, child sexual abuse, serious accidents, physical assault, combat, disaster, or witnessing death or injury. Others that are less physical in nature still have a strong impact, and I would argue the impact is often deeper or more complex; examples include things like childhood neglect (not getting your basic physical, emotional, or social needs met), verbal abuse, stalking, social rejection (of yourself or your community), and hearing about the details of trauma that happen to others.

Experiencing a trauma does not automatically mean you will have PTSD. Although you might still have some reactions that relate to what you experienced, and those reactions might pop up at any time. If you have PTSD you will have symptoms across multiple categories in addition to having witnessed or experienced a trauma.

The easiest way to explain PTSD it to describe it as a disorder of being stuck in the trauma.

People have different ways of being stuck in bad experiences. It can look like frequently reliving or re-experiencing things related to the trauma. You might be avoiding memories and reminders of what happened. You may notice changes in your thoughts and feelings that are directly related to what you experienced. And you might find yourself being highly reactive or on-guard. If this paragraphs sounds familiar to you, you probably have been feeling lonely too. Please know that you aren’t, 70% of adults in the U.S. have experienced trauma and up to 20% of those people go on to develop PTSD; that means literally millions of people are experiencing this. The good news is there is effective counseling for PTSD such as cognitive processing therapy (CPT) and trauma-focused cognitive behavioral therapy (tf-cbt). There is also growing evidence for EMDR.

Discovering if you have PTSD is the first step towards getting getting over it (and yes, research supports effective treatment for both adults and kids!) A psychologist can diagnose PTSD - if you are worried you might have it, schedule a free 15 minute chat with me to see if testing or counseling might be right for you. You don’t have to be stuck forever!

Mental Health and Mass Shootings

It happened again today, at a school again too.

I want to be surprised, but I think at this point I would be more surprised if it did not happen.

I am going to need to take care of my mental health today, and you might too. I will be posting more resources about that on my Facebook page. But for now, since it is mental health awareness month, I'd like to focus on that.

We like to think we know a lot about gun violence. But the truth is that what we know is limited because research on gun violence has been limited for a long time. And the information we do have depends on how people define "mental illness" and "mass shooting."

I am not going to say that a mass shooter is someone who is mentally well. I think we can agree that someone who is mentally healthy does not see mass shooting as the best plan of action. However, I do want to clearly state that being mentally healthy and not having any mental health diagnosis are not the same thing.

A person can have a mental health diagnosis such as Major Depressive Disorder, Schizophrenia, Bipolar Disorder, etc. and be mentally healthy. They can be taking good care of themselves, seeing a therapist, taking prescribed medication, have a good support system, know their personal signs of worsening and have a plan to follow, purposefully keep themselves away from weapons if that has been a concern. A person can also have no mental health diagnosis and not be mentally healthy. They might misuse substances, have anger issues, not learn how to manage their emotions, not be taking care of themselves, or simply have never sought treatment. 

We do know a couple things about gun violence and mental health that seem pretty clear. One is that death by gun by suicide is actually more common than death by gun by homicide. But again, a diagnosis does not mean suicide and no diagnosis does not mean no suicide. We also know that there is a relationship between domestic violence and gun violence.

So today, think about how you are going to take care of yourself or others, and make a commitment to think critically when you see people "taking sides" between if it is a gun problem or a mental health problem - there is a lot of grey in between and the truth is, the answer is rarely black or white in the real world.

 

Cure Stigma

Mental health awareness continues this month! My last post got you thinking about how we define mental health. Now, let's talk about stigma. NAMI (the National Alliance on Mental Illness) is taking on stigma this month with their Cure Stigma campaign. NAMI also has some wonderful suggestions on how to help reduce stigma here. Unfortunately, we create and reinforce stigma daily. When we don't understand a person's behavior we say they are "psycho" or when someone's mood changes we call them 'bipolar." Then, we avoid talking about it when a person actually has mental health concerns and needs help. The truth is that the words we use (and don't use) matter because of the meaning behind them. In this case we are sending the message "there is something wrong with you" and "if there really is something 'wrong' with you, don't talk about it." We are building stigma in a BIG way by using words and diagnoses when they don't apply to the person and by sending the message that those words and diagnoses are bad. We are building stigma when we refuse to talk about mental health. Let's start talking and thinking about the message we are sending! I try to do a lot of things to keep my table level - talk to friends, practice yoga, sing, read, bike, sit in the sun, listen to happy music, build my "tribe." What are you doing to support your mental health? 

How do you think about mental health?

Take a moment and look at a table near you - how level is it? Mental health, especially that of children, is like the levelness of a table. I learned this analogy years ago from Frameworks Institute at a conference. They write

One way to think about mental health for children is that it’s like the levelness of a piece of furniture, such as a table. And that levelness can depend on the table, the floor it’s on, or both. Just as levelness allows a table to function properly, the mental health of a child enables them to function in many different areas. When children’s brain architecture develops in an environment of toxic stress, it’s like a table on an uneven floor. And tables can’t make themselves level; they need attention from experts who understand levelness and stability and who can work on the table, the floor, or even both.

Many people think about mental health only in terms of if you have a diagnosis or not; if not you are considered "healthy." What I have learned from doing evaluations and counseling is that the truth is we are ALL somewhere on a spectrum of mental health, and it is not just a diagnoses or lack of one that places you on the spectrum.

 

 

Empathy only unlocks the door

Recently, I wrote about empathy being the key. But we still have to turn the knob, open the door, walk through, and deal with what is on the other side of the door.

Sometimes just having empathy and not knowing what to do with it can make us feel strong emotions. Vulnerable, weak, scared, sad, angry, the list goes on. No matter what the situation is, there are two steps that you can almost always fall back on (there are always exceptions!).

First, manage your own reaction

This step is extremely important for us to be able to take any other steps. If we are overwhelmed with emotion, that emotion is going to drive our behavior. If we are angry, we are going to yell. If we are vulnerable or weak, we are probably going to get defensive. If we are sad, we are burdening the one we want to help with our sadness. Sometimes those intense emotions can shut us down and cause inaction. Acknowledge how you are feeling, accept your feelings in that moment, and take steps to manage your reaction to your feelings. Managing your own emotions might mean taking some deep breaths, going for a walk, doing an enjoyable activity, listening to some calming music, or another strategy you have found that works for you.

Then, validate the emotions of the other person

How many times have you wanted someone to know that someone else "gets it" or to feel like someone truly sees you? If you are using empathy correctly to really understand how someone might be feeling, remember that the intensity of what they are feeling is probably more intense than what you are feeling. Sometimes we really aren't able to imagine what the other person might be feeling, but we can validate that too. The easiest thing to say is often "I can't even imagine what you are feeling right now." I remember years ago a client saying they disliked a previous therapist because the therapist had said "I understand what you are feeling" when there is truly NO WAY the therapist could possibly have felt the intensity of what that person felt. The truth is sometimes we really cannot understand unless we have experienced it ourselves, especially if it involves something extremely traumatic. In other situations, you might try to label the emotion and add something like "and my guess might be wrong or only scratching the surface" another option is "I am here to listen if you want to talk." It can be easier with young children to simply label the emotion "you look angry right now, it is okay to be angry." Regardless of which message you pick, the goal is letting the person know that emotions, as intense as they may be, are okay to experience.

 

Stay tuned for more!

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