Essential Workers & COVID: Time and Space for You

By Concentric Psychotherapist Kylie Cherpes, LCSW, MFT-IT, CYT

In times of great stress, such as now with the COVID-19 pandemic, we each find that we have our own unique way of getting through. Some people find comfort by burrowing in at home and disconnecting from constant reminders of their fears. Others juggle between caring for their vulnerable loved ones and carving out time to connect with the support that they themselves need. Some turn their stress into energy towards solving problems or creating something new. While others hit the ground running, called to serve their community. Though we are all under cumulative stress and doing our best to face changes in our day-to-day norms, some, such as Essential Workers, are being impacted exponentially. Essential Workers are being asked to do more and risk more, all while having less access to what would normally help them respond to and recover from their stress.  

Essential Workers continue their work in environments physically underprepared for a pandemic. In a time that feels precarious, Essential Workers are asked both to stay calm and to stay flexible while managing ever-changing recommendations on how to keep their workplace, selves, and families safe. They spend hours reading, learning, and preparing protocols and responses to “what-if” scenarios that breed uncertainty and anxiety. Even after all of the precautions they take, they wonder if it will be enough to keep their work-family safe. When they leave work to go home they find it hard to relax as guilt, worry, and fear about possibly carrying the virus home to their loved ones enters their mind. Though they may have reached for their family and friends for help, love, and reassurance before, it now seems too risky. Where they would go for support and stress relief before, like churches, gyms, bars, and social outings, are no longer options. And even when there is time for it, it is hard to get restful sleep. 

When unable to respond to stress, especially on-going (chronic) or traumatic stress, the body, mind, emotions, and spirit start to show wear and tear. Those under chronic stress may notice that raw feelings such as fear, anger, helplessness, and sadness seem to be lingering, or other common changes such as an increase in irritability, numbness, bitterness, or detachment (that “spaced-out” or “distant” feeling). Chronic stress can also show up as headaches, stomach aches, and muscle pain, or changes in appetite and sleep. Sometimes those under chronic stress may not even be the first to notice the impact it is having, but instead, those closest to them do. For instance, slips in memory or ability to recall information, mistakes at work that used to be uncommon, or shifts in hygiene and self-care regime may be noticed by work colleagues. Family and friends of those under chronic stress may see their loved one’s constant exhaustion, zoning out, adopting an abnormally cynical outlook on life, or lacking the ability to find pleasure in things they had once experienced as enjoyable. 

As therapists, we can close gaps in the care being offered to Essential Workers by providing access to the mental and emotional support they deserve. To support Essential Workers’ day-to-day functioning and healing, we hold space for them to process and release stress and trauma. Just as each Essential Worker has their own unique way of responding to their stress and trauma, each therapist has their own unique approach and is able to tailor care to each individual they work with. Whether it be brief or long-term, therapy is a safe place for self-expression and a secure place to find relief from fears, anxieties, anger, and sadness. Further, therapy is a place of creativity and strategy, used for building coping skills to reduce distress and restore feelings of stability and hope. 

At this time, we know that the Coronavirus is not going away anytime soon and that things may indeed get worse before they get better. We also know Essential Workers will continue to be asked to bear the brunt of this pandemic with limited space (time, resources, and support) to respond to their stress in their own unique ways. It is not an option to wait to address the physical, mental, emotional, and spiritual needs resulting from the chronic and traumatic stress being endured by our Essential Workers. Unaddressed chronic and traumatic stress does not just go away, it accumulates. As therapists, we see the effects of these stressful days mounting on our Essential Workers, and we respond to say, “We are your Allies.”

Special Announcement: During April through May 2020, Concentric Counseling & Consulting is offering short-term telehealth and virtual video counseling to Essential Workers during these challenging times due to Coronavirus (COVID-19). We are all incredibly grateful for all that you do and we want to give back! You can use your health insurance for teletherapy. Also, for those who do not have insurance coverage or have certain insurance plans and have endured financial hardship due to the impact of COVID, we are offering sliding fee and pro bono to a limited number of Essential Workers.

How to Open a Door When Coronavirus is Closing our Doors

By Concentric Owner Jennifer Larson, LCPC, NCC

Originally posted in The Sounds newspaper, Volume 43, Number 15 on April 4, 2020 and later in published in the Illinois Mental Health Counselors Association (IMHCA), a division of Illinois Counseling Association (ICA), News Update. Click here.

You know the saying “When One Door Closes, Another Door Opens”? During this time, we can’t help to notice closed doors everywhere, from schools to restaurants to places of worship to retailers. Even our home doors are closed, keeping others away and containing us inside.  It may seem overly optimistic to think this quote holds true during this extraordinary and challenging time with COVID-19 knocking on everyone’s door.  Alarm bells are sounded within us daily, the threats are real and experienced by so many, and some of us feel our life has been hijacked.  So how can we during this time envision doors opening up or experience something positive from all of this? 

I am by no means suggesting doors are flying wide-open given the sheer number of doors that are literally closed and even locked. But, if you can take a moment to pause, focus and be intentional, you may find that you can open doors to otherwise missed opportunities. 

Psychotherapist and author Esther Perel states when faced with our own existential anxieties it can open the door to fully living.  Some of us may have been living life on auto-pilot depriving ourselves of certain reflections, experiences or opportunities. So, what does living fully exactly mean?

It can mean a lot of things, but to start, it can mean experiencing each moment and each day in the here-and-now noticing and appreciating all of life’s offerings. Perhaps you had been more disconnected from yourself, no longer appreciating your talents, thoughts, feelings and your body’s capabilities -- which you can now fully appreciate.  Or taking a moment to get out of your head to be fully present and connected with another person can offer you an opportunity to be transported, experiencing life through a different lens other than your own.  Also, fully activating your senses can bring about a subtle, yet powerful sense of fully living.  Consider next time you take a walk outside, notice all of your surroundings paying attention to each of your senses. Notice your positive feelings as you attune to your senses.  

Shawn Achor, an educator, researcher, and author, offers a number of research-based ways to live a happier life. One of them is to take a few minutes each day to write down 1 positive experience within the last 24 hours and provide 3 rich details about that experience. Also, write down your gratitudes, giving specific details.  And reach out to someone to fully express why you appreciate them.  We know giving to others not only makes us feel better, but helps the person on the receiving end feel happier too.

And last, what is something you can look forward to when the shelter-at-home Executive Order is lifted and you can bust out the sheltered seams?  Will it be something specific such as dining at your favorite restaurant?  A ritual or practice you will reacquaint with again?  For me, it will be telling myself “I get to go here or I get do this” which represents a door opening into seeing how choice and freedom are true gifts.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey.