Saturday, April 11, 2020
It's been hard. I wrote about ambiguous loss in the shock of the first week: the loss of normal life, sharing my office with lovely clients of all ages, the feeling of familiar comfort and even the way I recognized cues in my body. The onset of sudden and high stress is a different reality for perception, reaction and problem solving and I experienced not being able to find orientation in my bodily perception and emotional world as an ambiguous loss.
The last three weeks have been about frequently reorienting to my grounded centre while changing every system that makes up the infrastructure of life: grocery shopping, kids' appointments and school, work tasks like new consent forms and new billing systems for contracts. It's exhausting to have to find new processes and rhythms in so many facets of life while under the stress of worrying about loved ones or the potential impacts of the pandemic. There is a lot of work that goes into managing emotions and trying to up-regulate enough to get going again after a rest or to manage bubbling irritability that rises from inevitable road blocks that need yet more problem solving.
And in addition to the initial ambiguous losses and the changing systems, there are very real losses for many: cancelled events like grads, weddings and vacations; job loss; being able to visit loved ones in nursing homes and hospitals. Before this is over, many of us will be impacted by the death of a loved one from the virus. And as we all hear, the end of life with this virus is a lonely ending. Many people have already experienced those very real losses.
I don't think you need convincing that these are hard times. So how do we find peace? How do we find something between a high stress state and what has set in more recently for many: low-energy, irritability and numbing out.
Bessel van der Kolk is a preeminent trauma specialist and in a recent webinar he compared the preconditions of trauma to the elements of physical isolation. These are:
Lack of predictability
Loss of connection
Numbing out or spacing out
Loss of sense of time and sequence
Loss of safety
Loss of a sense of purpose
To improve our well-being and mitigate the impact of mental trauma arising from physical isolation, there are some habits we can develop. As a trauma and attachment focused therapist, these make sense to me. Some are more applicable to one person or one family over another. Take what fits for you and leave the rest. (And check out www.BesselvanderKolk.com for more information.)
Lack of predictability: Create a schedule/ rhythm/ routine. If you don't want to set specific times, have a list of activities that you plan to get through every day. They don't have to be Pinterest projects, just the basics. And create a calendar with events: who will you video chat next Friday in lieu of after work drinks or an event out? Have something to look forward to. Talk to your friends and enlist their creativity for planning a fun on-line event together.
Immobility: When our nervous system is activated, it wants to move. The irony is that we are all being told to stay home. To discharge the build up of tension in our bodies we need to take action: exercise, do a big clean, have a dance party with your little kids or your cat. And if that seems like a lot: shower, change your clothes and cook a meal. Moving is important.
Loss of Connection: We are pack animals. We create a synergy in our connection with others and we are used to doing that in the physical presence of others. van der Kolk says: "when we cry, we're supposed to get a response; when we laugh, someone is supposed to laugh with us. Those are the rhythms of life by which we develop and sustain ourselves." So when you are connecting on-line with family and friends, hang out together via video for a little bit. Tell stories and play music or games and eat together to mimic the experience of what it's like when you are together in person.
Numbing out versus Mindfulness: Ask any professional who works with people-- addiction and violence are real concerns right now. We need to try to notice ourselves and observe what is going on so we can be in a place of choice. The alternative is being a ball of reaction: lashing out or numbing out. Mindfulness practices are abundant online. I appreciate the work of Kristen Neff, Rick Hanson and Peter Levine for the therapeutic application of mindfulness-- which remember is just being aware of me in my world and the world around me. In times like this, we will default to our original self-protection emotions and strategies. That makes sense, but we don't have to get stuck there. We can come back to being present. Counseling can significantly help with coming back to the awareness of our self.
Loss of sense of time and sequence: In trauma, time stops. The joke for this pandemic time is we don't know what day it is or time of day- this is particularly true if you have been laid off from paid work. The response here is similar to the strategies above: develop a schedule/ routine/ rhythm and a mindfulness practice like meditation. van der Kolk says: "live with an inner sense that every moment is different from the last."
Loss of Safety: This one is a big one for me. A portion of my counseling work is with kids who live out of parental care, involved with Children's Services. I talk to care providers a lot about how to help a child *feel* safe. We know that scared and stressed adults scare kids so finding a calming breath and loving touch between family members is crucial. Consider when you feel safe and what helps you to feel safe. I have a few, but one of my stranger ones is, in my comfy chair with blankets on me, I have taken to adding a 'throw' sized very soft blanket around my shoulders and on top of my head in a way that I can turn my head and rest my cheek on the soft fabric. I'm sure it looks silly, but the full set-up is like a cocoon and I exhale deeply in this comfy contained safe place. When do you feel safe? With whom do you feel safe? Set that up for yourself.
Loss of a sense of purpose: The easy fix for this is to help others. I know how hard it is right now and how awful the world looks with every news item or social media scroll AND I can't help but believe that this is the time for us to shine as a dominantly compassionate species. Add something to your window that is interesting for the pedestrian's walking by; call an elderly neighbor or friend and offer some service; see what charitable act you can take that will help someone.
And care for your self with purpose. Write out your activity list for the day and week and follow it (being gentle with your self). I know that lots of days it will be enough just to shower and connect with someone but on the days you have it in you, what act of helping- yourself or someone else- can you do?
I see you. I know it's hard. And I know we will get through this. If you think having a video or phone counseling session would be helpful, consider reaching out. And in the meantime- take care of yourself. You're important and needed in this world.
Friday, March 27, 2020
And then I was going to read out Brene Brown's Manifesto of the Brave and Brokenhearted:
There is no greater threat to the critics
and cynics and fear-mongers
Questions and group discussion.
:-) Thanks for reading it. I hope I get to present it. I even had ideas to modify it for non-profit care providing agencies and public school teachers. Stupid covid and global pandemics.
Dear___[your first name here]____,
I see how hard you are working to not lose your cool. I hear that you have lost your cool. I know how hard that first week was: How much school work needs to get done? How can you get more vitamin-rich food into your picky eaters? How can you find a minute to grab a shower? How do you explain Coronavirus and Pandemic to a child who suddenly lost their family visit this week? What about all those field trips and outings that were planned? How does video technology work and what device can be used?
How do keep the group home clean when there is a 13 yo AWOL'ing every night and returning every morning? How do you keep up with the changing demands when the routines of your group home were turned upside down literally overnight. You have staff away sick and your throat feels scratchy and the new cleaning regime is a full-time job to itself. How will you get through this?
And that's on top of you trying to make meaning out of the things you suddenly just lost because we landed in the Age of Physical Distancing and also support other important people in your life.
I first gave the talk in April 2017 to the BSW Supervisor's during their end of year appreciation luncheon. Leanne Hilsen, from the Faculty of Social Work at U of C, Edmonton Division asked me to do it and it was an unpaid gig. She introduced me to the work of Vikki Reynold's a kick-ass social worker from Vancouver. Vikki was supposed to be the key note speaker of the conference this morning. There was a 'come full circle' feeling that didn't get to complete itself. There is a weird dissatisfaction from that open end. I hope to complete it.
When I gave the talk in 2017 I was mostly talking to people who didn't directly work with people receiving services- they were supervisors and a handful of professors and we were on Saskatchewan Drive upstairs at the Faculty Club- far away from the proverbial front lines. And social workers were feeling good- we had an NDP government and a handful of our own Registered Social Workers in power! Life was good! And when I talked about our collective professional struggles including the political, I'm not sure if they could relate.
Fast forward to September 2019 when I wrote up the proposal to re-do this talk for a larger social work audience-- the UCP were in power and delaying their budget until after the federal election in October. I started to prepare the talk as the budget of deep cuts were announced, unions and others were organizing and we were all noticing the chasm between those of us who remember the Klein years of the 1990's and those who only knew the stories. The divided world of Alberta politics versus social justice and human rights was flared.
And then COVID. Or Fucking Covid (FC) as I like to call it.
We need the shame resilience more than ever. There are so many "front lines" now. And we are paying attention to them in top priority and missing some of the many other important ones. Right now we are preparing for the physical disease- as we should be-- and health care truly is the front line. And we recognize the front line of 'essential services' as never before: grocery store staff, pharmacies, store cleaners, delivery people and the trucking industry. These are so important! These are all about the physical necessities and staying alive.
There are social and economic implications to this virus that we are only seeing the ice berg tip of right now because we are in early days. We see the 'front line' of services to the most vulnerable people- in Edmonton that's the shelter set-up at the Expo Centre for people without a place to call 'home'. And the social workers and other community workers who are risking their own health to show up for those in need.
And we have the Federal government staff who working to get Canadians financial benefits as soon as possible. They are creating and rolling out a brand new benefit on the fly within only a few weeks.
The front line I see are the kinship care providers, foster parents, child and youth care counselors and case managers who are continuing to provide services to the children who are out of parental care. These vulnerable children are sensitive to the stress of adults, acting out or inward when their environment triggers them. As FC (remember, that's Fucking Covid) drifts further into our communities, these people continue to care for the children under circumstances much more difficult than normal.
So many homes were set-up to function well WITH community supports- school, respite weekends, rec centre passes, therapy and other professional support, FAMILY visits. These same children with their sensitive stress response systems have lost any bits of life that helped to calm and regulate them. (An entire post could be dedicated to the losses of these vulnerable children and the impact of temporarily losing family visits.)
No one has a contract with Children's Services that says they agree to quarantine with the children in their home or group care facility.
And until recently none of these agencies and homes had a "Pandemic Policy."
And now with FC, these front line caregivers are going ahead and trying to adapt to a new reality. We don't know how it is going in all the homes of all the families who are now inside with their children, but we do hold a higher standard for the foster parents and group care staff to ensure that these vulnerable children are cared for. These are unprecedented circumstances and they are working beyond the role they ever agreed to take on.
And this is where we need shame resilience more than ever. When our nervous system is activated and collapsing though the early days of trying to find our way into this new way of being, we will make mistakes. And when we do, can we be kind to ourselves and know that our best (even when we don't have a lot) is in fact enough? To keep trying is our goal NOT getting it right every time. I will say more about this when I get to writing up the workshop I am not presenting today.
I'll stop here for now. Feel free to write your thoughts from your perspective and experience about the front lines you see, are experiencing or appreciate.
Saturday, March 21, 2020
I have SO much to be grateful for, but I will not shame myself for having feelings about losing my "normal life" (AL #1).
Until Sunday evening I was planning to have a modified-in-cleaning, but still regular-work-week.
And then they closed the schools.
I had planned that when the schools closed I would stop seeing people in my lovely office space. (I love sharing my office space- it's warm and cozy and I try my best to make it comfortable above all else. AL #2)
So quickly and under high stress I started to figure out video platforms for Tuesday morning while seeing the last of my in-person adults and rearrange my quickly changing calendar.
People also planning on "normal life" up and until Sunday evening cancelled their appointments. The mom coming to tell me about her family's mental health needs and begin some counseling services left a voice mail saying "I just don't have the mental space to talk about what I was coming in to talk about." (Yeah, I hear ya. Of course. No problem.)
And as my calendar started to fill up with the red bar of "cancelled" across the top of each session, I could feel my mobilized social worker heart move into decisive and concrete action: find a video platform; join groups related to telehealth counseling on social media; consider briefly ethical issues of secure platforms being down and decide some needed the counseling session more than they needed me to say, "I'm actually not allowed to use Facetime for mental health-type services." Ok, go- crisis mode. Mental health triage.
Intermittently I would struggle to keep the problem-solving part of brain going in the face of so many moving pieces and problems to solve. I had SO many lists of what needed to be done to adjust to this new reality. I know many of you did too.
By Wednesday I had figured out what device and located where in my office would work best for talking comfortably with the 'normal' visual distance of an in-person session. (The answer is the art table with a lap top on the top of a sticker basket.)
I felt so strangely tired after only a few video sessions in a row. I read from other therapists later, that we are straining harder to be present and attune when we are doing it across the screen. That made sense to me. My whole body was tight with focus different from in-person sessions where I am intentionally relaxing my body.
And that might be ambiguous loss #3, understanding the workings of my own internal sensations. Stephen Proges coined the term interoception to name this sense. I am highly practiced at looking inward and knowing where my conscious mind is relative to the situation and my emotional state; how my body is feeling and what I need or do not need.
BUT this week! What is that feeling?! And that one? WTF! I don't like that!
(Thank goodness for sessions-- when I focus on being present for someone else, that is still a familiar feeling even with the changed medium. Stay present and with the internal world and words of the person with you. Got it. Check!)
But the in-between times it's being overwhelmed with concern and frozen at the same time. It's feeling stuck and not even quite sure what list needs to be made. Its knowing I want to act, but feeling completely stuck in how to take the smallest step. In a phrase, it's activation and collapse.
These are not normal times. And my body responded as it was meant to-- for survival. Being overwhelmed to a certain degree will move us to be mobilized BUT only for so long in duration or intensity and then we move on to immobilization/ collapse. This is the foundation of Porges Polyvagal Theory. My experience was intense energy spent to be present in video sessions, writing emails and making phone calls and then at the end of the day, collapse.
My typical work evening routine includes sitting in my favorite chair with a tea tray and watching something neutral or funny on Netflix or other media. I often listen to music and write depending on what I am feeling or need. This week, I was completely unable to have any sensation in my ears or eyes at night. I couldn't find comfort in a show or a song because I couldn't tolerate the stimulus. So strange. (AL #4- comfort activities). Oh! That hits a nerve! How many of you have lost routine comfort activities- gym, rec centre, swimming pool, social outings, window shopping, cafe sitting? Yikes! Everyone of us is feeling that!
That's my view. What's yours? What hard-to-define and lost-without-closure-or-meaning-making loss are you feeling? You're welcome to comment from your own perspective about your own experiences if you would like. Be nice, of course. We're all in this together, friends.
Friday, March 20, 2020
Help people feel safe and you will change the world.
Take care friends.