Identifying and Managing Common Symptoms of Domestic Violence

railway-2439189_1920I have met with dozens of survivors of domestic violence since I first started providing counseling services as an intern and later as a licensed professional. Many times, survivors of domestic violence describe feeling detached or disconnected with other people and with themselves. Survivors often tell me they feel like they were a completely different person in the past, that they want to bridge their past and present “selves”, and they want to reconnect with who they “used to be.” This post identifies some of the symptoms teen and adult survivors of domestic violence experience that keep them disconnected and provides a few ideas about how to manage those symptoms.

Some symptoms of abuse are physical in nature. There may or may not be physical signs of injury, like bruises. Physical symptoms might include things like panic attacks, stomach aches, headaches, racing heart, suicidal behavior, shortness of breath, being easily startled, disturbed sleep, and increased use of alcohol or other substances. Physical symptoms begin having negative effects on the abused person’s life as they start using avoidance to manage the symptoms. People with constant fear and stomach aches, for instance, may start calling in to work or neglecting their job duties which can lead to financial problems or job loss.

There are also cognitive symptoms related to abuse that include unwanted thoughts and  mental images called flashbacks where survivors feel like they’re reliving an abusive moment. Unwanted thoughts can be triggered by anything in the environment that reminds the survivor of the abuse. Survivors may feel triggered by news reports, odors, sounds, people with an appearance or mannerisms similar to their abuser, or symptoms may seem to come out of the blue.

Emotional symptoms of abuse include feelings of grief, depression, guilt, anger, irritability, numbness, confusion, shock, exhaustion, fear, and self-doubt. Survivors who struggle to manage their emotional symptoms often find that their relationships with friends and family are strained since the survivors feel reactive and unable to maintain healthy connections with the people closest to them. Building communication skills can help survivors convey what it is they’re feeling. The process of abuse diminishes a victim’s connection with their own feelings. Abused people are often told, through words or actions, that their feelings don’t matter or aren’t real.

Another symptom of abuse people talk with me about includes a detached feeling, a loss of interest in things normally enjoyed like hobbies, work, or social activities. Most survivors I have talked with describe feeling as though they lost their sense of identity somewhere along the way with their abusive partner. Perpetrators of abuse take away a person’s sense of identity through manipulation and control leading the abused person to become increasingly isolated and sometimes unable to make their own decisions. I work with abuse survivors to explore the identity they want to have for themselves by discussing values, likes, dislikes, and things they might become interested in.

Survivors also describe finding healthy partners after leaving abusive relationships and how the new, healthy relationship feels scary and unfamiliar. Survivors in new relationships ask questions about how to communicate, how to stop using reactive behaviors, or how to open up and feel less guarded after building a wall of protection. It can help to explore what it means to have a partner who is supportive instead of mean or violent. Domestic violence can feel like the “norm” for some survivors so when they experience healthy relationships they may feel uncertain about how to navigate the new and different ways of connecting.

Maybe you or someone you know has some of these symptoms and have been involved with a violent partner and you’re wondering what you can do to manage these symptoms?

One idea is to use affirmations, tools to relax your thoughts and rewire your mind. If you’re noticing negative thoughts, or are still in an abusive relationship and receiving negative messages about yourself, affirmations can help reframe your thinking and can help address cognitive symptoms. Affirmations are a form of positive self-talk that help send different, positive messages about yourself to your brain. You can practice using affirmations daily. Here are a few examples:

  • “I am strong”
  • “I am learning how I want others to treat me”
  • “I deserve respect”
  • “I love who I am and who I am becoming”

Other suggestions are to use various self-care activities. Take care of yourself in some way every day by doing something that feels relaxing and nurturing. What do you like to do for fun? Eat a healthy diet that limits caffeine, sugar, sodium, and fat. Exercise to keep  your body in good physical and mental health. You might also seek out counseling or find a support group for domestic violence survivors as part of your self care.swing-1365713_1920

Having a safety plan in place can also provide a sense of reassurance that steps are in place to keep you safe if you decide to leave and can provide peace of mind. Because there is a risk of written safety plans being discovered by the abuser, your plan should be kept somewhere other than your home such as with a trusted relative, coworker, or neighbor. Safety plans can include the following but should be personalized to your needs:

  • copies of important documents like birth certificates, divorce papers, restraining orders, bank account numbers, etc.
  • money
  • medication
  • medical records
  • spare car keys
  • where you will go
  • people who will support you
  • what you will do with pets
  • what to do if there are weapons in the home

Having pre-planned steps to keep you safe, a list of supportive people and their phone numbers, ideas about where you will go and what to bring with you can help you feel prepared, ease some of the symptoms and stress involved with leaving an abusive relationship, and optimize your safety when you do decide to leave.

Symptoms of domestic violence can be physical, emotional, or cognitive in nature and can be managed in several ways, a few of which include using affirmations, self-care, and safety plans. If you’ve noticed any of these symptoms related to an abusive relationship, how have you worked to overcome them? What worked for you to manage symptoms? What kind of safety plan did you have in place?

If you’re not ready to seek counseling yet but want to talk with someone about abuse, the number for the National Domestic Violence Hotline in the United States offers 24/7 phone support: 1-800-799-SAFE (7233).

 

Inspired by the prompt: Overcome

Navigating Loss After Suicide

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On July 20, 2017 I found myself, along with hundreds of thousands of other music fans, shocked, saddened, and heart broken by the death of Chester Bennington from the band Linkin Park. I spent a lot of time crying and as I’m writing this post I’m still mourning the loss of one of my favorite musicians. For the past 17 years I’ve been singing along with Linkin Park while making dinner in the kitchen, driving around in my car, running, and when I attended their concert at the Gorge in George Washington in 2014. Their music has been a part of my daily life, and my world feels different without Chester in it.

As I watched fan and media reaction following Chester’s death, which was determined to be a suicide, I started noticing the suicide hotline number being shared (which is provided below), I saw fans sharing stories and posts on depression and addiction related to suicide, and I saw fans coming together in support of each other, the band, and Chester’s family, to help us all get through a terrible moment in our lives. People rallied together to support each other.

As a mental health counselor I feel compelled to provide information about ways people can successfully navigate the loss of someone after a suicide. This post focuses primarily on survivors healing after a completed suicide. For a post I wrote about suicide risk factors and warning signs click here. The current post provides resources and encouragement for ways to care for yourself if you’re a survivor of suicide loss or if you have been exposed to or affected by someone else’s suicide.

USE YOUR SUPPORT NETWORKS AND COMMUNITY RESOURCES

Research shows that, following a suicide, people find help through different forms of support that include both informal and formal avenues during their healing process. Informal supports are people like friends, relatives, spouses, partners, siblings, parents, neighbors, colleagues, and extended family. Formal sources of support include mental health counselors, clergy, primary care physicians, and even funeral directors.

In addition to people in your support network, using resources in your community can be helpful too. Survivors of suicide loss report they have found healing in the following ways:

  • attending suicide-specific bereavement support groups
  • reading books on suicide and grief
  • talking one-on-one with other suicide survivors
  • utilizing pastoral counseling
  • contacting advocacy organizations
  • taking prescribed medications

USE THE NATIONAL HOTLINE NUMBER

This is the number for the National Suicide Prevention Lifeline mentioned earlier: 1-800-273-TALK (8255). It is free, confidential, and available 24/7. The website has resources to help yourself and ideas about how to help someone you know if you think they’re struggling. There is also information on safety planning and help for different groups such as LGBTQ people, Veterans, youth, Native Americans, and those who are deaf and/or hard of hearing.

BE AWARE OF YOUR FEELINGS

After a suicide, those left behind often have a number of mixed feelings as they deal with the grieving process. Depressed mood, trauma, guilt, anxiety, high levels of distress, grief, shame, isolation, shock, denial, and anger are all common. If you notice that you continue feeling sad, lose interest in your favorite activities, feel worthless, lose your appetite or have sudden weight loss, eat more than you usually do, can’t concentrate, lose energy or motivation, can’t sleep, sleep much more than you normally do, or have suicidal thoughts, seek out professional help to determine whether you may be experiencing symptoms of depression. Talking about your feelings with another supportive person can create a feeling of solidarity and connection that can help you heal. Being mindful about what exactly it is that you’re feeling can help you decide how best to care for yourself. You may need different things if you’re feeling angry versus if you’re feeling sad for example.

TAKE CARE OF YOURSELF

After experiencing a loss it’s important to continue caring for yourself so you stay healthy physically, mentally, and emotionally.

  • Eat healthy food. Sometimes grieving people overeat because of stress or stop eating due to loss of appetite, take care of your body by keeping nutritious food available.
  • Let yourself cry if you need to, tears can be our body’s way of letting us know we care and that something or someone matters to us.
  • Get help from your formal or informal supports for negative feelings that linger on too long or that interfere in your daily life.
  • Do things that feel good and nurturing to you like walking in nature, taking a warm bath, or reading.
  • When you’re ready, engage in activities you enjoyed before the loss of your loved one.
  • Feelings may be difficult to put into words, try expressing your feelings through art, music, and writing.
  • Avoid trying to numb your feelings with alcohol or substances since these can worsen your situation.
  • Spend time with others to prevent isolation.
  • Give yourself permission to be happy.
  • You may feel something different every day, take care of yourself one day at a time.

Whether you have been indirectly exposed to someone’s death by suicide or have been directly affected and are bereaving the loss of a close friend or family member, there are helpful ways to navigate the loss. It is not necessary to feel isolated and alone in your experience, or, to borrow from Chester’s lyrics, it’s not necessary to “feel cold and lost in desperation.” If you’re someone having suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Please allow me one more quote from Linkin Park’s most recent album in which Chester sings:

“who cares if one more light goes out in a sky of million stars, it flickers, flickers,who cares if someone’s time runs out if a moment is all we are, we’re quicker, quicker, who cares if one more light goes out? Well I do.”

I do too, Chester. Suicidal thoughts can weigh heavily on a person’s mind and death by suicide directly and indirectly affects peoples’ lives every day. The American Foundation for Suicide Prevention reports that someone dies by suicide nearly every 13 minutes in the United States every day. I hope that by circulating information about ways to prevent and heal from suicide we can continue finding ways to keep one more light from going out.

Are you someone who has survived a loved one’s suicide or someone who has otherwise been affected by suicide? What have you found helpful in your own healing process after such a loss?

After the Attempt: Parents, Teens, and Suicide

back-1822702_1920Part of my job as a mental health counselor involves receiving calls from parents concerned about their teenagers following a suicide attempt. Parents sometimes call seeking help for their teens and other times they are looking for help for themselves to manage feelings.

A teen’s suicide attempt can significantly impact the whole family. Because there is often a stigma around suicide (a feeling of humiliation or shame) families find themselves wondering how to move forward following the incident. Parents feel unsure about whether they should talk to school personnel, how they should explain their teen’s absence from school or family functions when the teen has been hospitalized, and how to talk about the incident with the other children in the household. Parents call in a state of alarm, often fearful that their teen will try to commit suicide again or to discuss how powerless they felt in the aftermath of the attempt. Teens present for therapy usually wanting to examine ways to not be suicidal anymore.

According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death for young people age 15-24 years old and results in more than 4,600 deaths every year. My goal in this post is to identify some risk factors and warning signs of suicidal behavior and offer some ideas for getting help.

Risk factors that may increase the likelihood of suicide

These are some of the conditions that may increase the chances of a suicide attempt.

  • Having a mental health condition such as depression
  • Conflict with friends or family members
  • Abusing alcohol or drugs
  • Exposure to the suicide of a friend or family member
  • History of trauma, physical abuse, sexual abuse, or neglect
  • Being bullied
  • Having a family history of suicide
  • Previous history of suicide attempts

Warning signs of possible suicidal intention

Although there is no guaranteed method for predicting suicide, the following mnemonic phrase created by the American Association of Suicidology can be used to help identify warning signs for suicide potential. Keep in mind, however, that each person is different and some people with suicidal intentions may not show any of these symptoms.

  • “IS PATH WARM”
    • “I” is “ideation.” Is the teen actively thinking about suicide or expressing thoughts about suicide by saying such things as “I’m going to kill myself” or frequently talking about wanting to die?
    • “S” is “substance abuse.” Has the teen started using alcohol or drugs to cope or have a history of problems using substances excessively?
    • “P” is “purposelessness.” Does the teen think there is no reason to keep living or seem concerned about not having a purpose?
    • “A” is “anger.” Is the teen showing moments of rage or finding anger difficult to control? Is the teen looking for revenge on someone perceived to have caused their problems?
    • “T” is “trapped.” Does the teen talk about feeling like there aren’t any other choices or options except for death?
    • “H” is “hopelessness.” Is the teen negative about themself, others, or the future and seem reluctant to change in positive ways?
    • “W” is “withdrawing.” Is the teen withdrawing from from family, friends, and social interactions or talking about wanting to?
    • “A” is “anxiety.” Does the teen seem more anxious than usual or have trouble sleeping or relaxing?
    • “R” is “recklessness.” Is the teen engaging in life threatening activities without thinking about consequences? Teens do engage in risky behavior as part of this phase of human development, however, do the teen’s actions seem excessively dangerous or represent a change from the teen’s usual behaviors?
    • “M” is “mood.” Does the teen’s mood shift dramatically or excessively? Teens often have mood swings but do the mood changes seem out of the ordinary for the teen’s personality?

Protective Factors, Prevention, and Treatment

While there are circumstances that increase the likelihood of a suicide attempt, there are also conditions that may help protect people from such incidents.

  • A sense of connection with family or social supports
    • Connection with a healthy support network can decrease feelings of isolation
  • Medical and mental health treatment
    • Receiving professional help can add to sense of support and stability
  • Conflict resolution skills
    • Teens with abilities to solve problems may be less likely to consider suicide as an option
  • Cultural or religious beliefs against suicide
    • Beliefs about what may happen to one’s soul following suicide may deter a teen from taking their life
  • *Medication
    • *While medication may be an option to help stabilize moods and emotions, there may be an increased risk of suicide for teens with some medications. Teens may require additional medication management and supervision by a physician or psychiatrist. Parents and teens should be alert and observe any increases in suicidal thinking while taking medication.
  • A suicide hotline is available for those needing someone to talk to immediately. Parents and teens should call 911 in the United States if there is an immediate threat of suicide.
    • Suicide Prevention Lifeline 1-800-273-TALK (8255)

Counselors, parents, trusted adults, friends and other supportive people are available to you if you are a teen struggling with suicidal thoughts. Help is also available if you are a parent or family member of a teen who has made a suicide attempt. In my work with teens and parents, seeking counseling after a suicide attempt has helped individuals move forward as they process the incident and examine their experiences.

Feeling disconnected?

Connection can be defined as an interaction between two or more people where each person feels empowered and understood. It is commonly thought that people are born with a need for connection. Research in neuroscience shows that our brains can actually grow through healthy connections!disconnect

Disconnection, on the other hand, is a type of interaction where misunderstanding, lack of empathy, or even a sense of danger occurs. Disconnection can happen in many ways. We might experience an acute disconnection when we feel like the other person in the relationship is not responding to our attempts to connect. For example, if one partner says, “this is a great view!” and the other person doesn’t respond or simply says “mm hmm” the first partner may feel like their partner isn’t responding very well to their attempt at connection. If the second partner were to answer “yeah, I think so too” or even “I disagree, our last hike had much better views” chances are that the first person will feel heard and more connected because there is more room for ongoing dialogue. Moments of disconnection are common in relationships and many are minor and can be repaired.

A second type of disconnection is chronic, where the sense of disconnection escalates and one person in the relationship exercises power over another person who feels increasingly hurt and disconnected. The less powerful person begins feeling unsafe sharing parts of themselves and becomes fearful of bringing their true self into the relationship. As the disconnection increases it becomes less and less likely that growth will occur within the relationship and repair becomes more difficult. Examples of this might include a teen who changes to fit in due to a desire to be part of a group or an abusive relationship where one partner has power over the other and the less powerful partner tries to change to appease the more powerful partner.

Traumatic disconnection is a third form of disconnection. In traumatic disconnection a person with a history of trauma feels triggered by a sense of disconnection and becomes unavailable for connection because of a heightened emotional state that leaves them feeling unsafe. The triggered person may remain in a state of disconnection until a sense of safety can be restored. For example, someone who has been emotionally abused may experience traumatic disconnection when a friend says something that feels hurtful and immediately leads the abuse survivor to feel unsafe.

If disconnection occurs repeatedly and without repair, a person may experience a feeling of what is known as condemned isolation in which they sense that they are alone and excluded from the social community. A person experiencing condemned isolation often blames themselves for the situation and feels unworthy of healthy relationships.

Through Relational-Cultural Therapy (RCT) a counselor can create a safe environment to begin exploring connection and disconnection in various relationships. A therapeutic relationship can help identify thoughts and behaviors that lead to growth and connection and those that lead to disconnection and hurt feelings. Through the therapeutic relationship it becomes possible to rework ideas about relationships. As people in therapy gain a sense empowerment and connection they increasingly experience what are referred to as the five good things: zest, worth, clarity, productivity, and desire for more connection. These five good things are qualities that encourage growth within relationships. Once people have experienced growth and positive change in their personal lives, they sometimes want to share these newly discovered qualities with others in the community. They may build relationships with neighbors or coworkers or through volunteer work. In doing so, the community benefits from the changes made at the individual level. Personal growth becomes community growth!

Jbmti.org has more on Relational-Cultural theory and therapy.

 

Inspired by the Daily Prompt: Connected

3 Stages of Survival: Moving from Victim to Survivor and Beyond

Following the trauma of domestic violence people are often identified as victims. Victimhood is only one stage in the recovery process. The stages aren’t linear, they don’t proceed in a straight line. I often tell the people I work with that progress is often one step forward two steps back. The following identifies the various stages of survivorhood: victim, survivor, and thriver.

Stage 1: Victim

Victimization by a domestic violence (DV) perpetrator often leads a person to feel worthless and incapable. Domestic violence is about controlling another person and depleting their sense of power. Control and power over another person can take the form of physical, emotional, sexual, or financial abuse.

People who are victims often have low self-esteem, feel a sense of shame and worthlessness, and may not feel that they deserve nice things or that they deserve to be treated respectfully by others. Victims may be hypervigilant, always expecting a threat, and feel guarded. People in the victim stage of healing often feel alone, selfish, numb, damaged, confused, and hopeless. It’s common for perpetrators to isolate victims from friends and family. Isolated, lonely people with low self-esteem are easier to control and maintain power over.

Victims of DV are often afraid to tell their stories for a number of reasons. They may fear that their partners will retaliate or be fired from their jobs. Victims may believe that their stories are not worthy of sharing. It is also common for people in the victim stage to feel overwhelmed by their past as they come to recognize the struggles they have endured. DV victims commonly have difficulty setting healthy boundaries and find themselves wrapped up in drama and unhealthy relationships with toxic, unsafe people. Victims tend to put their own needs last and often have difficulty communicating in ways other than being passive or sometimes passive-aggressive. Victims tend to believe that suffering is just the way things are and have a hard time finding joy. Victims also frequently turn to substance abuse or codependent relationships to help them feel like they are doing okay.

Stage 2: Survivor

Once a person begins moving away from unhealthy and violent relationships with an abuser, they can begin reflecting on their experiences in a safe environment. As they recognize the struggle they have survived they begin searching for reasons why this experience happened and how they can heal. People in the survivor stage view themselves as both wounded and healing and begin gaining a sense of hope. A grieving process may take place as the survivor comes to terms with the different losses that have taken place.

Survivors are often eager to tell their stories and want to talk about all the aspects of their experience in their attempts to heal. Support groups can be a great help for people in the survivor stage since they want to share their stories and hear others’ experiences as well. Survivors begin learning ways to set healthy boundaries and explore what is safe or dangerous in their relationships. Through their curiosity and sharing of experiences with others, survivors begin identifying patterns, which can become goals to begin changing. Change takes time for survivors and doesn’t happen overnight or in a matter of weeks. Whereas victims tend to believe that suffering is normal, survivors begin gaining a sense of hopefulness and relief as they see a journey leading them forward.

Survivors also learn to laugh again. They have a healthy sense of humor and can find moments of joy. Instead of needing substances or codependent relationships, survivors can begin regulating their emotional pain and may seek out therapy to explore the new and uncomfortable feelings that have been numbed or disregarded before. Survivors begin learning about a wider range of emotions.

Stage 3: Thriver

Although many people feel satisfied reaching the survivor stage, others believe that there is still more to go on their journey and these people become thrivers. People in the thriving stage have a sense of gratitude for this new found life that seems to be overflowing with miracles and wonderment. Instead of feeling isolated, thrivers feel a sense of connection with others and the universe. Thrivers have healthy connections and are both independent and interdependent. Thrivers have a sense of pride in their ability to care for themselves. They live in the present moment and understand that emotional pain passes and can be learned from.

Thrivers set healthy boundaries with others and protect themselves from toxic people but are also capable of living with an open mind and heart. Thrivers place their own needs first as they recognize that helping others requires care for themselves first. Thrivers create peace instead of chaos and find joy around them. They use healthy humor and feel a range of positive and negative emotions which helps them feel alive and genuine.

Each of the first two stages takes time move on from and some people feel quite content and happy living life in the second stage. Some people experience great difficulty moving from victim to survivor stages and even become more comfortable staying in the victim role. The victim role offers familiarity. Oftentimes when I meet with survivors of DV who have entered into what seem to be healthy relationships, they describe feeling fear and confusion because they don’t know how to cope with a healthy partner and it feels scary. Survivors have often learned a number of coping skills during the victim stage to get through a violent relationship and learning to be in healthy relationships can require learning or building on a whole new set of skills. Reaching out for support is common for survivors and many of them turn toward family and close friends.

More can be found on these stages in the book: Surviving Domestic Violence: A Guide to Healing Your Soul and Building Your Future by Danielle F. Wozniak, PhD, and Karen Allen, PhD.tree-338211_1280

Inspired by the daily prompt: Survival

A Brick Wall or a Yellow Brick Road?

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Working with traumatized individuals I often hear people say they have trouble getting beyond an emotional “wall” they have built. We create these walls as a defense to protect ourselves after we’ve been hurt by someone. A wall can act as a strict boundary that says “keep out” or “no trespassing.” As I listen to people talk about the walls they’ve built to keep themselves safe, I also hear them express hope that these walls might come down because they feel very isolated behind them. Our walls  can become prisons. Some people say they would be happier if they could just remove a brick or two. This post is to help you try to visualize what a happy life might look like beyond your wall.

Imagine your wall and picture each brick you have placed. When did you first start building your protective wall? What do you remember about the first brick you laid that started your wall? How has your wall kept you safe? How has your wall been a barrier to healthy relationships or other things you want for yourself? What kind of boundaries would you prefer to set with others without the help of your wall?

What if you could lay that wall down and see that it creates a brick road stretched out before you. (Think Wizard of Oz with the yellow brick road spiraling it’s way outward.) Maybe you’ve been building your wall higher and higher for some time now and, as you think about laying that wall down, you see that it extends for miles ahead. Because you have been stuck behind this wall for so long, you might find that you feel both excited and terrified about where this road might lead. Because this is your road (you built it after all!) you can travel on it at whatever speed you want to. You can run full speed ahead without looking back, or maybe you prefer to take your time and slowly explore everything along the way.

Where would you like this new road to take you? Who would you like to travel alongside you as you journey down this road? Again, because this is your road, you don’t have to take anybody with you that you don’t want to and nobody can join you unless you invite them. What would you like to see along the journey down your road? What activities would you most like to take part in now that you’re no longer behind that wall?

Maybe you’re someone who has been building a thick, sturdy wall instead of a tall one. This type of wall might make a good bridge if you tipped it over, helping you cross deep, scary trenches. Maybe you’ve been in those trenches before and your bridge gives you safe passage now. Where would you like your bridge to take you? What would you like your bridge to connect you to? What would you leave behind as you cross your bridge? How would you feel about leaving those things behind?

If your wall is too tall or too thick, and you can’t imagine stepping out from behind it right now, what if you choose to remove a brick or two? What is the first thing you would hope to see? Every brick has a story, or reason, for being added to your wall. What is the first brick you would like to work on removing from your wall? Although your wall has been helpful in many ways, what annoys you about your wall?

Feel free to reflect on the questions here and comment with your thoughts about the emotional walls we build or comment about your own wall you’ve built.

 

 

Post inspired by the daily prompt: Brick

 

10 Tips on Finding a Counselor

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April is Counseling Awareness month! Entering counseling can feel like a scary or daunting process. You may have a number of questions. Maybe you’ve given some thought to seeing a counselor but have felt uncertain about what to do. Or, maybe you’ve avoided the process because it feels too overwhelming trying to decide where to begin. This post provides some tips to help you find a counselor who will be a good fit for you and hopefully eliminate some of the uncertainty around getting started.

Here are 10 tips on finding a counselor who is a good fit for you:

  1. Check therapist directories such as PsychologyToday and GoodTherapy.org Both sites allow you to filter the type of counselor you’re looking for by zip code, insurance coverage, issues of concern, and more. These sites promote counselors with verified credentials.
  2. Contact your health insurance company and ask whether mental or behavioral health is covered, there is oftentimes a phone number for these services on your insurance card, or you may visit your insurance company’s website and search for a provider there.
  3. Talk with friends and family, chances are someone you know is already seeing a counselor or has seen one in the past and they might have recommendations
  4. Talk to your doctor, they may have a go-to provider or a list of providers to refer you to.
  5. Check to see if your employer offers an Employee Assistance Program that provides a limited number of free mental health sessions for employees.
  6. Do a Google search for counseling or therapy in your area using specific key words you want help with such as “depression” or “teen counseling.”
  7. Call a few counselors. Many counselors offer a free initial consultation either in person or over the phone. Speak with a few of them to help you decide who you might feel most comfortable with and to get a sense of what you’re looking (and not looking) for. If a counselor wants to schedule you while you’re still trying to decide, just let them know you’re not ready to schedule yet and you’d like more time to think about it.
  8. Visit counselors’ websites. You can shop around and learn about the counseling services you’re interested in before you pick up the phone to call anyone. On many websites you can find out information about fees, insurance, and the counselor’s approach to helping.
  9. If you schedule with a counselor and discover afterward that it’s not a good fit you can always let your counselor know you don’t think it’s working. Your counselor may be able to refer you elsewhere, adjust the treatment to better meet your needs, or explore with you where the feeling of disconnection might be coming from. Unless you’ve been court-ordered to attend counseling, you have a right to stop going whenever you want and for whatever reason.
  10. Check your local colleges, places of worship, mental health agencies, or family crisis agencies to see if they offer counseling and if you are eligible for services.

Uncertainty and avoidance are two possible barriers to getting started with counseling and can prevent you from getting the help you need. Since April is Counseling Awareness Month, hopefully this post has increased your awareness about how to find a counselor and given you some suggestions to help you feel more confident when you’re ready to reach out and begin the counseling process.

10 Types of Trauma

When you experience a traumatic event it can change your beliefs about yourself, other people, the world in general, and your future. Trauma creates fragmented memories that are often sensory in nature. This means that we oftentimes don’t remember every detail of a traumatic event, but bits and pieces of the trauma become stored throughout our body in the form of mental images, smells, tastes, sounds, or touch. Following a trauma you may notice feeling triggered by something in the environment that causes you to recall parts of the event. Triggers may include loud noises, the smell of certain food cooking, or seeing a vehicle that resembles one involved in an accident. The result of having fragmented memories and changes in your beliefs might be that you notice feeling angry, fearful, distrustful, shameful, anxious, and other negative emotions.

You may experience traumatic events at any point in your development including childhood, adolescence, adulthood, and old age. This post describes ten types of traumas that may affect you or someone close to you over the course of your lifetime. Most people do not experience long term impairment following a traumatic event and it is possible to experience healthy growth following a traumatic incident and build resilience.

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Natural-Caused

Natural traumatic experiences can affect a small number of people in a neighborhood or a larger number of people within a community. The following are some examples of natural-causes of trauma.

  • Tornadoes
  • Lightning strike
  • Wildfires
  • Avalanche
  • Earthquakes
  • Volcanic eruptions
  • Hurricanes
  • Floods
  • Famine
  • Landslides

How you respond to natural-caused trauma depends on how much devastation has occurred, the extent of loss, the amount of time it takes you to get back to daily activities, and the accessibility of services in your area. Having relief services available following a natural-caused traumatic event can greatly reduce the traumatic stress and aid in the recovery process.

Human-Caused

Human-caused trauma are those caused by human behavior. These types of trauma can be accidental or intentional. Here are some examples of human-caused traumatic events.

  • Structural collapses
  • Plane crashes
  • Gas explosions
  • Oil spills
  • Gun shootings
  • Arson
  • Terrorism
  • Sexual assault/abuse
  • Domestic violence
  • Human trafficking
  • Home invasion

There is a difference in the way people perceive natural versus human-caused events. Natural events are often perceived as unavoidable whereas human-caused events are considered to be either intentional or unintentional. Following any type of traumatic event, people often feel a sense of anger, loss, frustration, fear, and sadness. When a trauma is perceived as intentionally harmful and human-caused, the event is often experienced as more traumatic and people attempt to make sense of the perpetrator’s personal characteristics and motivations for performing the act.

Individual

An individual trauma is one in which the traumatic event is experienced by one person. This type of event can be a one-time occurrence such as a physical attack or it could occur multiple times such as with repeated assaults. If you’ve experienced an individual trauma, you may feel that you don’t have the support in your community that is provided when larger, group traumas happen. It can be difficult for many individual survivors to disclose what has happened to them and you may feel isolated, shameful, or secretive about what happened to you if there is no validation or comfort available to you.

Group

Group trauma refers to types of traumatic experiences that affect specific, small groups of people. This type of trauma affects groups such as first responders, firefighters, emergency medical personnel, commercial fishing crews, and military service members. Group trauma survivors are more likely to experience repeated trauma and tend to only discuss the trauma experiences with other members of their group.

Group survivors have great influence over other group members. They may encourage others to repress their traumatic experiences or discourage other members from seeking help if there is a sense of fear that the group may be shamed. Members may also discourage help-seeking if they believe that acknowledging the trauma will mean having to manage the repressed feelings that could surface. In other instances, groups can create a strong, supportive environment that can help members handle multiple traumas, aid in making adjustments over time, manage traumatic stress symptoms, and address mental and substance use disorders.

Historical

Historical, or generational, traumas are those that directly affect specific cultures and may indirectly affect the generations that follow. Examples of historical trauma include enslavement of African Americans, the forced assimilation of American Indians, the extermination of Jews during World War II, and genocide in Rwanda.

Historical trauma can lead to a loss of cultural knowledge, language,and identity. Additionally, it is associated with a reduced sense of well-being, depression, grief, traumatic stress, domestic violence, and substance abuse.

Mass

Mass traumas affect a large number of people and can be natural or human-caused events. This type of traumatic event may result in significant loss for individuals and communities. Examples of mass trauma include tsunamis, nuclear reactor meltdowns, earthquakes, and mass shootings. This form of trauma often challenges the available resources of the affected communities and makes it difficult to respond in a timely way. Mass traumas often result in chain reactions in which one trauma can lead to another. Following the initial destruction of a mass traumatic event, such as a hurricane, people may have difficulty meeting basic needs of receiving food, water, shelter, and safety as they are displaced from homes. In mass traumas it may seem as though you are no sooner trying to adapt to one trauma when another traumatic event occurs.

Mass traumas can create a sense of community and decrease the sense of isolation that occurs with individual trauma. People often feel more confident asking for help because others around them are getting help too.

Interpersonal

Interpersonal traumas are those that occur between people. Interpersonal trauma commonly happens between people who know each other such as partners or families and includes physical abuse, sexual abuse and assault, domestic violence, elder abuse, and teen dating violence.

Political Terror and War

Terrorism is a human-caused type of trauma with a goal of creating uncertainty and fear within communities. Terrorism leads to fear around the unpredictable nature of terrorist acts, increased security, and intensified suspicion about groups of people or cultures. War threatens the health, well-being, and livelihoods of communities.

Refugee Experiences

Refugees are people fleeing their homelands because they have experienced fear and persecution there. They may be differentiated from immigrants who choose to leave their homes in search of new prospects for themselves or their families. Refugees may have been exposed to torture; witnessed deaths due to execution, starvation, or beatings; and experienced imprisonment, fear, loss of property, separation and/or loss of family members. Following their migration out of their homelands, refugees may also experience difficulty assimilating and adjusting to their new environments in their host country, feel socially isolated, and experience traumatic stress. Communities that are receptive and provide social support with culturally responsive services may help alleviate the development of mental illness and substance use disorders among refugees.

System-Oriented Trauma and Re-traumatization

System-oriented trauma and re-traumatization occurs when treatment settings, service providers, or agencies recreate a traumatic experience for individuals, sometimes without realizing they are doing it. System-oriented traumatization might occur if staff is unaware of a client’s traumatic history, an agency fails to screen for trauma history prior to treatment, providers discount or minimize reports of abuse, or if agencies impose strict policies and rules without allowing clients to respond or question them.

Providers who plan for the risk of re-traumatization by creating trauma-informed policies and procedures and responding sensitively to traumatized clients and their histories can achieve more positive outcomes with the people they serve.

Resilience

There are a number of qualities that can encourage resilience, the ability to adapt to adversity, among trauma survivors including having strong family bonds, having a spiritual or religious practice, valuing friendships, utilizing humor and creativity, helping others, creating routine, and maintaining certain belief systems. Learning and building resilience can help you in your journey toward overcoming trauma.

If you have experienced trauma, how have you adapted in healthy ways? How were you able to build your resilience? What helped you recover along the way? If you’re a provider, how do you provide trauma informed services that are sensitive to the needs of survivors to prevent re-traumatization?

Reference

Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series 57. Chapter 2. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Employee Assistance Programs: A Free Counseling Resource

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Did you know that many employers offer programs for counseling as part of the benefits to their employees? Employee Assistance Programs or “EAPs” provide temporary, brief counseling services that are meant to help employees manage problems that might interfere with job performance. EAP counseling services are usually provided at no cost to employees and oftentimes include other members of the household as well.

EAP providers can address many common problems employees have that are personal or work-related such as depression, anxiety, conflict with coworkers, difficulty performing job duties, substance use, and relationship problems. In some instances, such as when job performance is suffering, employees may be mandated or strongly encouraged by their employer to attend EAP services.

The following are some examples of companies providing EAP services:

  1. Magellan
  2. First Choice Health
  3. ComPsych
  4. Aetna
  5. Life Services

If you’re unsure whether your company offers EAP benefits you can check with coworkers, your employer, your human resources department, your company benefits package or policy manual. Many organizations have brochures, posters, or fliers around with the EAP phone number you can call.

Once you contact the EAP you will be provided a name or list of names for mental health, behavioral health, or chemical dependency providers in your area who help with the specific concern you have. Depending on the EAP, you will either contact the mental health counselor yourself or the EAP representative will call the provider, authorize services, and connect the provider with you. The number of sessions typically authorized is between 3-8. The services you receive are confidential. In instances where you’ve been mandated to attend EAP services, your employer may be informed of whether or not you participated as requested and informed of the status of your progress by the EAP representative. Confidentiality is also limited if you threaten to harm yourself or someone else.

You may wish to continue services beyond the authorized number of EAP sessions, in which case you can choose to use your health insurance coverage or pay for ongoing services yourself. Check with your counselor and insurance company to determine whether the counselor is a provider with your insurance if you want to continue meeting using your health coverage. Not all counselors accept insurance and some only accept specific ones. Another option is to pay for the services out of pocket and then ask your counselor to provide you with a document that you give to your insurance company for reimbursement.

EAP services can be a helpful way to address personal or occupational problems in a short amount of time. A common barrier to receiving the service is that many employees are unaware that the benefit is available. Services are generally brief, solution-focused, and can help you maintain your work-life balance.

Fear-less

Life Without Fear

How would your life be different if you were incapable of feeling fear? We all feel fear from time to time. If we’re out hiking and we see a bear it’s likely we’ll have a sense of danger and feel fear. We have an identifiable source of our uncomfortable feeling: the bear. If you were incapable of feeling fear, you might approach her while she’s hunting for food with both her cubs. It’s likely you wouldn’t have a very good outcome in this situation!

KONICA MINOLTA DIGITAL CAMERALike all emotions, fear has a purpose. It’s job is to protect us from dangerous situations.

People who struggle with trauma-related conditions frequently feel as though they’re living in a constant state of fear. It’s like they are seeing the bear over and over and it feels very real even though the bear is no longer there. This can be where anxiety begins. Fear is something we feel when there is an imminent, identifiable danger. Anxiety is a feeling of tension occurring  when we think about danger. Anxiety is about your thoughts of danger, fear is about a visible source of danger. For trauma survivors, a life without fear may seem like a blessing! Waking up one morning and not feeling any fear may seem like a miracle for some who live with fear on a daily basis. However, some amount of fear can help protect us.

Types of Fears Survivors May Have

  • Fear of sleeping due to nightmares
  • Fear of being judged by service providers
  • Fear of more abuse by a perpetrator
  • Fear of losing close relationships
  • Fear of not being believed
  • Fear of trusting others
  • Fear that your reactions will be unpredictable
  • Fear that life will end early or suddenly
  • Fear that the traumatic event will happen again

Managing Fear

The goal when working with fear is not to become fearless but to fear less. Recovery from trauma is possible if you work actively to make changes. The following are some ways to begin managing your trauma-related fears.

  • Identify triggers
  • Gain awareness of the connection between the trauma and its consequences
  • Use healthy coping skills
  • Build social support
  • Practice spirituality
  • Access community resources (legal, mental health, advocacy, medical, etc.)
  • Maintain a daily routine
  • Recognize positive moments to build optimism
  • Pay attention to your self-talk and use positive language

Positive personal growth is possible following trauma. Some individuals are able to gain a new sense of meaning or purpose in life after a traumatic event. Others share lessons they learned from their difficult experiences and provide valuable education about recovery. Keep in mind that fear is there to protect you. Learning how to manage fear takes time. Survivors are generally resilient and capable of developing skills that can help manage symptoms and possibly prevent long term problems.

 

~Inspired by the daily prompt Fearless Fantasies ~