Hurricanes. Another mass shooting. Political crises. Seems anxiety is at an all-time high for us and our clients as chaotic events erupt around the world. How do you reassure clients and help them find hope in the midst of turbulent times? In this post, I’ll share what seems to be helping my clients and want to hear what’s helping you and your clients too.
Start with Psychological First Aid
For people who have been directly impacted by a disaster or mass tragedy, its best to start with practical help that meets their safety and survival needs. A 2004 landmark study published by Hobfoll et al. identified 5 essential elements that helped disaster victims avoid or overcome traumatic stress reactions. These 5 essential elements are: safety, calming, connectedness, self-efficacy, and hope.
People don’t typically come for therapy in the immediate aftermath of a tragedy because they’re too busy attempting to regroup and put their lives back together. For example, survivors of the 911 tragedy opted to get massage, acupuncture, and yoga– things that would calm their nervous systems, instead of accessing free counseling services that were offered to them. In addition, debriefing about the incident does not necessarily help people feel better. It’s telling the story in the company of supportive others that heals.
Human Connection Heals
Your calm, compassionate presence is the best medicine you can give someone in the aftermath of trauma. This fact was brought home to me by one of my clients named Vanessa who was in the Aurora, CO movie theater massacre in 2012. She wasn’t injured herself, but as she struggled to get away from the theater and find her car, she almost tripped over a woman who had been shot in the leg. Vanessa told me she felt helpless and ashamed because all she could think to do was hold the gunshot victim’s hand while her sister went to find medical help. She said, “I was in such shock, I couldn’t even think of anything to say. I offered to call her mother, which seemed to help her. But other than that, I just sat there quiet.”
Vanessa came to therapy for help with her survivor’s guilt. She didn’t know if the gunshot victim survived and expected she would never find out what happened to her. But, the following year when Vanessa was asked to attend a hearing for the case, she and this woman were reunited. As soon as she saw Vanessa, the woman ran to her and hugged her neck. Vanessa was so relieved she was alive. As they talked about how they’d been doing since the shooting, Vanessa dropped her head in shame, lamenting “I have post-traumatic stress and I wasn’t even shot. I can’t imagine how you’re doing.”
The woman grabbed Vanessa’s hand and said reassuringly, “Vanessa, I’m surprisingly okay. Sure, I’ve had a few nightmares and my leg still hurts at times. And, while I’m not planning on going to movie theaters any time soon, I really don’t dwell on the incident itself. Do you know what replays in my mind instead?”
“What?” Vanessa asked.
Looking tearfully into Vanessa’s eyes, she squeezed her hand and cried, “The kindness of a stranger who held my hand through all that horror. That’s what stands out for me, Vanessa.”
Vanessa was dumbfounded. All this time she’d felt so inept, but the research shows us that social support is the greatest buffer against developing PTSD and the best predictor of positive treatment outcomes. We don’t have to say the perfect thing, have all the answers, or be a master of the latest therapy tool for our clients to heal. At the end of the day, what matters is that we show up and communicate our intention to walk beside them and support them as best we can.
It’s The Relationship, Not The Therapy Method
In the book Trauma and the Therapeutic Relationship, Don Michenbaum reports all trauma therapies are equally effective and asserts,“the therapist’s adherence to evidence-based treatment manuals is not related to treatment outcomes. In fact, loose compliance that is tailored to the patient’s needs is the best treatment approach.” In other words, the evidence says the therapeutic relationship predicts therapy outcomes– period.
Similarly, a 1993 study by Hamilton and Coates revealed what trauma clients thought was helpful from their therapists. Nobody said, “The method my therapist used to reconsolidate my traumatic memories.” Instead they cited these qualities in their therapist helpful:
- “Listened respectfully and took me seriously.”
- “Believed my story.”
- “Helped me understand the impact of traumatic events on myself and others.”
- “Helped me see my strengths.”
- “Helped me plan for change.”
What was not helpful:
- “Gave advice that I did not wish to receive.”
- “Did not listen and did not have an accepting attitude.”
- “Dismissed or minimized the seriousness of my situation.”
Validate the reality of pain and confusion
Back-to-back tragedies like this can really get our amygdala going as we struggle with times of uncertainty. Rather than placate clients with platitudes, I found they were more comforted when I validated their foreboding feelings and gave them a place to freely air their concerns without judgment.
Sadly, after the Charlottesville riots, my African American clients told me they were afraid to go out in public alone for fear of being bullied or attacked. In contrast, my homosexual clients felt like they could only go out alone, fearing they would be accosted if they were seen with their partners and homosexual friends. Indeed one of my clients had to leave a fast food restaurant because two male customers began harassing her and her partner for being gay.
When clients looked to me for answers after the mass shootings in Las Vegas, I helped them consider ways to keep themselves safe and gave the usual advice that helps us cope during a national crisis: limit news consumption, do more self-care, and spend more time with people you love. But, I also admitted I was perplexed by these tragedies. I confessed that I felt angry and worried about our country too. My clients told me they were actually comforted by my candor. It didn’t exacerbate their fears at all. They felt like I was attuned with them, and said it was reassuring to know that I was “real” and “trustworthy.”
Helping clients take action
When something horrific happens, people tend to look for someone to blame. But, blame keeps us stuck in helplessness. It’s normal to be angry. Anger erupts when a deeply held value has been violated. My clients say it helps when we look underneath the blame to explore which of their deeply held values is being challenged. Then, we look for how they can take a small action to support that value and advocate for themselves and others. People get stuck in traumatic stress when they feel they cannot take an action.
Taking action counters feelings of helplessness, no matter how small that action is.
Some simply take action by spending more time with their children, family, or neighbors so they feel less alone. Others just decide to meditate more, start a garden, or spend more time in nature to remind themselves (and their brains) that they are not in an actual war zone at the moment and can still find moments of peace in this world.
Other clients have gotten more active in their communities. Some feel better writing to their congress people. Others feel better donating to a cause or getting involved in nonprofit group that supports their interests. Granted, it can feel like your small voice or contribution does little to curb the devastation of massive tragic events. But, it does. As I’ve said throughout this post, never underestimate the power of your presence. It’s the collective power of our voices that will bring about post-traumatic growth and positive change in this world.
Take care and keep the faith. You are making a difference.
P. S. What helps you cope? What kind of support do you need?
As therapists, we can become isolated and discouraged as we witness so much suffering. I hope to create a community where we can support and encourage each other. What do you struggle with? What have you found helpful in your work with trauma clients? What kind of support do you need?
Please drop me a line or leave a comment in the box below. I admit my busy schedule makes it hard for me to respond to each of you individually. But I am listening and want to offer what I can to help you feel like someone’s got your back and cheering you on.