Posts Tagged ‘family’

The Sandy Hook Tragedy

Tuesday, December 18th, 2012

Like most of you, I have shed many tears over the recent tragedy in Newtown, Connecticut. I grapple with the overwhelming senselessness of it all. I can barely process the unspeakable pain that will haunt the families who have lost their cherished, innocent children, mothers, daughters or siblings. I have only an intellectual understanding of the trauma that will haunt the survivors who witnessed the massacre, as well as the lasting impact it will have on their entire community. As images of funerals, tiny coffins, and grieving loved ones infiltrate the media, the tears resurface and I continually shake my head in disbelief.

As a clinician who has an expertise in trauma, many colleagues have asked me for guidance in handling this horrific event with clients. When tragedy strikes, I think we are hardwired to immediately ask “why?” It is untenable to not have an answer. Not having answers increases our sense of helplessness about a situation that has already left us feeling vulnerable and disempowered. In this case, asking “why” could lead to important conversations about mental illness, lax gun control laws and the frightening accessibility of assault weapons and bullets, the impact of dysfunctional family dynamics, missed red flags that were indicative of sociopathy or untreated trauma, etc. But in the end, there is an inherent senselessness to these tragedies, and no answer ever really satisfies.

Instead, I’d like to offer some things to keep in mind when processing these kinds of events, particularly with our clients. Many people who have prior histories of trauma interpret these tragedies as “proof” or “evidence” that the world has been and always will be an unsafe place. This can create a downward spiral of cognitive and emotional distortions, and I think it’s important to help clients maintain a sense of balance or perspective while still giving them the opportunity to express their fear, grief or anger. When we overgeneralize and think “everyone is evil” or “every environment is unsafe,” our lives and relationships get marginalized and we become re-victimized.

It is easy to focus on what we can’t control, and to obsess about how scary that is as we go through our daily lives. The counter-balance is to remind our clients of what they can control and to help them stay pro-active in those arenas. I believe the best responses to acts of evil are acts of kindness. Encourage your clients to do something that honors the memory of those children and keeps alive the notion that there is still goodness in the world. Whether it’s signing a petition to change gun control laws, advocating for the increased availability of mental health resources, donating money or services to help the stricken families and community of New Town, or reading to children who are hospitalized during the holidays, “doing something” is what helps us attach meaning to these kind of senseless crimes. It is also a way to help clients recognize the difference between their past experiences- when they were truly powerless- and the present- when they can respond and make a difference.

As we compassionately help our clients navigate their emotions, remember to help them keep alive feelings of gratitude. Tragedies are opportunities for us to focus on what we do still have, and to reconnect with the people and relationships that are often taken for granted. In the earliest stages of tragedy, it seems impossible to focus on gratitude. Our anger and grief can trump everything else. But when we are ready, there is great healing to be found by re-embracing and acknowledging all that we have to be grateful for in our lives.

Lastly, the issues of faith and spirituality can be sorely tested during these times. Clients can feel legitimately “betrayed” by a higher power that “allowed” something so awful to happen. My belief is that God is not in these heinous acts. He gives us free will and the choice to harm others is a choice that man makes. God is in the aftermath: the grace, resiliency and inner strength we eventually discover in ourselves. He is in the newfound meaning and possibility of healing and growth that can follow in the footsteps of trauma. He is in the “coming together” through beautiful acts of kindness and support that this community and other communities around the country and even the world will discover, in time. Prayer and faith can be great sources of comfort. So even when we are angry with God, we are still connected to God. And that relationship can sustain us even in our darkest times.

Below are links to documents from A Practical Guide for Crisis Response in Our Schools: Sixth Edition and Comprehensive Acute Traumatic Stress Management, both publications of the American Academy of Experts in Traumatic Stress. They include useful information for assisting professionals in addressing the emergent psychological needs of those impacted by this tragic event.

Practical Suggestions for Assisting Children in the Aftermath of a Tragedy

Teacher Guidelines for Crisis Response

Parent Guidelines for Crisis Response

How Do People Respond During Traumatic Exposure?

Helpful Information During and After a Traumatic Event

Re-Envisioning the Holidays

Monday, October 29th, 2012

By Susan A. Osofsky, LCSW

I was standing in our popular shopping district today watching the annual Halloween Zombie Walk, delighted by the creativity of all the young people dressed as the “Walking Undead”. There were elaborate, grotesque costumes on the serious faced actors as they literally dragged themselves down a mile long street and back up again, while onlookers stood with startled expressions. It’s an event open to anyone who has the courage to make themselves look hideous and happily flaunt it. Although I look forward to this event each year, I can’t help but wonder how many of the zombies were excited to participate and how many were displaying what they truly felt as they considered the upcoming holiday season.

How can we approach our holidays this year without feeling like a zombie? If aliens landed on earth during this time of year, what would they see? Would families be standing around the piano singing about dreaming of a white Christmas, lovingly sharing homemade gifts and talking about how they can contribute to peace on earth or would they see the stressed faces of people pretending to enjoy each other’s company, hoping they can afford to make the payments on the credit cards they used for the gifts under the tree?

No matter what your religion or spiritual tradition, consider making this holiday season a more meaningful experience. Perhaps you can go back to the original texts of your tradition and embrace the real meaning behind your holiday. All great religions teach love and compassion toward others and toward oneself. Try being compassionate toward yourself by taking some quiet time to contemplate how you might move through the holidays in a way that reduces rather than increases stress. Here are possible actions you can take to approach the holidays in a less stressful manner:

1. Do something to maintain balance in your life on a daily basis; take a warm bath, do long slow stretches, go for a power walk, dance around the house, meditate, focus on some of the things in your life that bring you joy. Yes, you do have time for this– if you choose to make it.

2. Consider giving gifts of service such as: a 2 hour house cleaning, a car wash, a 1 hour back rub, a gourmet home cooked meal, babysitting for an evening, dog walking or anything that you enjoy doing and think the recipient might appreciate. If you are crafty or like to bake, perhaps you can make your own gifts, rather than spending money you’ll later regret.

3. If your holiday memories are fraught with unpleasant experiences, remind yourself that when you were a child you had to go along with whatever was happening in your home. Now that you’re an adult, you can create your own traditions, and invite whomever you choose.

4. Spend the holidays with those you love. You don’t have to suffer through long periods of time with those that disrespect you. If you’re away from loved ones, consider inviting other “holiday orphans” to your home for a pot luck holiday celebration.

5. Try to lower your expectations. Remember, the people you grew up with are still the same folks they always were. They’re not going to change just because it’s a special occasion. If someone is being offensive, politely excuse yourself, go for a walk, use the restroom, and if necessary you can always head back home. If things are not going the way you had hoped, remember “this too shall pass”, then plan to do your holidays differently next year.

6. Breathe Deeply and Often.

As more of us approach the holidays with a different state of mind and intention, our positive energy might spread to those around us. We may not be able to change the world but we can definitely stand tall, appreciate the love we have to give and embrace our aliveness. We don’t have to become the “Walking Undead”.

I hope your holiday season is filled with all the love you have to offer.

Susan Osofsky is in private practice in Richmond, VA., specializing in the treatment of OCD, anxiety disorders, eating disorders and trauma. Click here to learn more about Susan.

Off to College- A Lesson in Attachment

Wednesday, September 5th, 2012

Those of you who have trained with me in the past, are well aware that I take great stock in the impact that either secure, insecure, ambivalent, avoidant or disorganized attachment styles have on a child’s emotional, neurological, and psychological development. The research is powerful and convincing: dysfunctional attachment patterns play a major role in affect dysregulation; impedes the functions of an infant’s developing per-frontal cortex; profoundly interferes with the resolution of trust vs. mistrust and the subsequent relationship dynamics of intimacy; and increases the likelihood that self-destructive behaviors will be employed to self-soothe and dissociate from unresolved feelings of worthlessness and despair. As a therapist working with adult survivors who were not allowed to successfully attach because they had emotionally unavailable, abusive or mentally ill caretakers, I see the long-term effects of poor attachment every day in my practice.

But this week, as my husband and I helped move our youngest son into his first college dorm room, while watching other parents and loved ones lug box after box, engaging in the same exhausting and emotional endeavor, I was reminded of the power of healthy, secure attachments. Clearly, growing up with loving and safe relationships makes it possible for young adults to fully individuate, and begin the extraordinarily exciting and frightening next chapter in their lives. I saw those glimmers of excitement and fear in the eyes of many incoming Freshman. And I noticed, with relief and joy, how my son and so many others allowed their families and friends to help usher them into this life changing experience. My son let me hug him as many times as I wanted to-and felt that he needed to be hugged. He let my husband take the lead when it came to connecting devices to electrical outlets or hanging up posters with the right tools. We all made his bed and hung up his 50 sweatshirts. And down the hall, his friends allowed their parents to do the same things.

Of course, it was all very bittersweet, but I knew that he was going to thrive and I believe that a large part of that is because of the loving and consistent foundation we have given him at home. I marveled as he reached out to brand new kids and a roommate who is still a stranger. He did it effortlessly, trusting that his overtures would be respected and his kindness reciprocated. His fundamental belief that he is worthy and the world will be responsive and supportive of his endeavors will help get him through new challenges. And as we tearfully parted (ok-I was the most tearful- but my son did say he would have been ‘upset’ if I didn’t cry) my husband and I watched as “packs” or groups took shape- kids reaching out to kids they didn’t know-walking somewhat aimlessly around the campus- but already needing and seeking out new attachments to help buffer them through their college experiences.

For your clients, young and old, who were deprived of safe attachment, know that the therapeutic relationships you forge with them and sustain throughout treatment are so reparative and so healing. We buffer them in similar ways, helping to usher them into and through the exciting and fearful next chapters of their lives.

How has the therapeutic relationship strengthened a sense of attachment for your clients, and the ways in which you have seen clients thrive when that attachment is sustained in healthy ways?

A Quick Primer on Early Primary Relationships

Wednesday, September 5th, 2012

By, Kate Oliver, MSW, LCSW-C

Attachment is the relationship people develop with our early caregivers that shape how we form connections to other people throughout our lives as well as the lens through which we view the world. We are all born relying completely upon adults to meet our needs. Humans rely on parents to ensure survival longer than any other species for basic nourishment and caretaking making our connection to our caregivers incredibly important.

As infants, while relying on our caretakers, we are also building the neurotransmitter systems in our brains. When babies look into the eyes of their parents, literally thousands of neurons per second get activated. The building of this neuron wiring sets up the foundation of our attachment system or structure. When you think of it this way, it is simple: if baby gets her needs met “enough,” she develops what we would call a secure attachment, if baby does not get her needs met “enough” she develops what we would call an “insecure” attachment.

A securely attached child tends to think more along the lines of: the world is a safe place, I am loving and loveable, adults are reliable and my choices make a difference. Children with insecure attachments tend to think more along the lines of: I am bad, when I trust people I usually get hurt or disappointed, my choices don’t make any difference. In the classification of insecurely attached children there are two categories. I see these categories as insecurely attached with a structure (anxious or avoidant) and insecurely attached without structure (disorganized). This distinction is important because if a child tends to have an anxious/avoidant style of attachment, you are more likely to be able to predict behaviors and their response to different challenges. However, with a disorganized structure, because the child has no system for tackling issues in place at all, it is incredibly difficult to predict what the child will do in a given situation. Prediction is difficult because they do not have any consistent way of tackling a problem.

While attachment is a concept that was first studied by Bowlby back in the 1950’s and developed upon by Mary Ainsworth, more recently clinicians have begun working to find methods to help children with insecure attachments to repair their attachment style. Clinicians such as Daniel Hughes, and Art Becker-Wideman, who utilize Dyadic Developmental Psychotherapy, and Glen Cooper, Robert Marvin, Kent Hoffman and Bert Powell, the creators of the Circle of Security intervention, have begun the fascinating work involved in working to help with this often overlooked and minimized issue. In more ways than ever before, clinicians have the opportunity to learn about not only the importance of attachment-based therapy but the methodology for effectively treating children with a disturbed attachment style.

What’s the extent to which you have seen disorganized attachment patterns in children and how do you work with them in therapy?

Living in a Virtual War Zone: The Children and Adolescents of Domestic Violence

Wednesday, April 25th, 2012

Written by, Denise Tordella, M.A., LPC

A 2006 survey of American households revealed that nearly 30% of children, many of whom are very young, live in homes where there is some form of intimate partner/domestic violence. Children and adolescents who witness or experience trauma, including domestic violence, display increases in stress hormones comparable to those displayed in combat veterans. This research finding makes sense from the perspective that these children and adolescents are living in a virtual war zone! Children and adolescents may experience long term effects from chronic exposure to domestic violence which may include: impaired academic performance; reduced levels of motor and social skills; behavior problems; substance abuse; self-harming behaviors; changes in brain physiology and function; and emotional difficulties including depression, anxiety disorders and post-traumatic stress disorder.

Many times the question that people ask is, “Why doesn’t she just leave?” By the time the family reaches the point where this question is being asked, the family is deeply entrenched in the cycle of violence and abuse. The mother and children are living in a constant state of fear and anxiety and they are dominated by responses of flight, fight or freeze. The neurobiological impact of trauma and the emotional, cognitive and behavioral adaptations that the family makes impacts their ability to makes decisions, develop safety and exit plans, and to fundamentally believe in their own ability to find safety. The ability “to leave” is profoundly trumped by the need “to survive”.

The coping strategies that families develop may help them survive the abuse and violence in their lives and those strategies will often go on to create patterns that wreak havoc on the rest of their lives.

On June 1st, at my workshop at the Institute entitled, “The Impact of Domestic Violence on Children and Families,” we will identify maladaptive coping strategies that families develop to manage their reactions to abuse and violence. We will identify interventions that reinforce positive and nurturing parenting skills and explore stress reduction strategies to address the neurobiological, emotional, somatic, and cognitive aspects of traumatic stress they have experienced. We will focus on enhancing self-regulation skills and skills that support social and peer group competence. We will focus on collaborating with families in their healing from domestic violence by supporting secure attachment between children/adolescents and their non-abusive parent as we enhance their safety and stability.

When Clients Don’t Leave Dysfunctional Relationships…..

Sunday, March 25th, 2012

Is this scenario familiar to you? You are working with a client who has spent a great deal of time complaining bitterly about a relationship that doesn’t meet his or her needs, yet they cannot seem to ever fully extricate themselves from it. They may describe dynamics of emotional neglect or abuse; feeling invisible, invalidated, bullied, or ridiculed. There may be verbal abuse including name calling, yelling or a steady barrage of demeaning messages. The psychological abuse of a partner who plays head games, make them feel inferior, discounted or “crazy” can be just as debilitating. Oftentimes, substance abuse, compulsive gambling or shopping, sexual addictions, eating disordered behaviors, workaholism, toxic extended family dynamics, an inability to commit or sustain intimacy are thrown into the mix as well. The ante is upped even more when clients allude to scenarios of domestic violence. And we sit with our clients week after week, listening to their pain narratives and witnessing, even feeling, their suffering and unhappiness. We try to provide comfort, resources, strategies for change, validation for their feelings, even permission to contemplate leaving the relationship- and our clients won’t budge!

Our counter-transferential responses can legitimately range from frustration and anger to fear, anxiety, confusion and self-doubt. What starts out as an inquiry about the client’s issues can often morph into a questioning of why WE can’t get them to see the light, leave a bad relationship and get on with their lives. The clients who “sometimes” see the light- before it grows dim again- can be even more challenging! They nod their heads in agreement during the session, write down the resources and homework assignments, practice asserting themselves in role plays with you, and leave sessions stoked and inspired to make a difference in their lives. Then they come back the next week, reporting that either they’ve changed their minds because “things are good again” or they never integrated the concept of the relationship being troubled or abusive once they left your parking lot.

Obviously, in situations of domestic violence where our clients or their children are fundamentally unsafe, we need to educate, cheerlead, connect our clients to resources, make a report to the appropriate authorities, if necessary. But even in these cases, clients often go back to the abuser, forgive the alcoholic, cancel the restraining order, give the serial cheating boyfriend or girlfriend “one more chance.” And our counter-transference intensifies! These are some of the most difficult cases and they require a special amount of self-awareness and self-care in the clinician. We have to work hard to not give up on them, not pass judgment, and not take it personally when our clients choose to stay in these kinds of relationships. We have to re-double our efforts at psycho-education: exploring the dynamics of co-dependency, the re-enactment of family-of-origin trauma or neglect, the insidiousness of emotional abuse, the lure of the “honeymoon phase,” the power of learned helplessness, the definition of “healthy” love and intimacy. This work takes time, patience, good boundaries, unconditional positive regard and solid ego-strength on the part of the clinician. When all is said and done, I hold out hope that the healing power of the therapeutic alliance and the ways in which it can model safety, trust, emotional intimacy and healthy communication will win out in the end!