The Courage of Everyday Living

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I got rear-ended this week (fortunately all the damage was to the car and not to the people). The driver was uninsured, the car they hit has been in our family for barely three months. To say that this is a pain in the rear is an enourmous understatement. And I noticed that my self-talk after the accident included thoughts like this: "Maybe I should have just stayed home, because then none of this would have happened." and "It's so unfair that they chose to drive without insurance--I was following the rules!"

What I really meant by that was, "Maybe if I lived in total cloistered isolation, I'd be safe from the random accidents and bad stuff that can happen out there in the world, because playing by the rules doesn't seem to keep me safe." I hear variations of this from my clients on a regular basis. I hear this theme about the past: "If I hadn't taken a chance on that relationship, I wouldn't be hurt right now." or "If I hadn't tried for that job, I never would have had to deal with this difficult boss." I hear the same thing about the future: "I don't know if I should reach out to that person/apply to that college/take charge of my health because I'm not sure that it will work out."

The difficult reality that I have to confront for myself, and that I often invite clients to confront with me, is that we don't get any guarantees. Each of us is going to face challenges and experience loss--even if we "play by the rules" or "do everything right. There is a lot of pain out there, and it doesn't appear to follow any rules of "fair" or "right." And there is not much that we can do to control when or how we experience life's "random bad stuff" whether it's a car accident, a tornado, or a heartbreak.

For most of us, this is a hard reality to accept. The idea that we can't fully protect ourselves from bad stuff is frustrating, and sometimes frightening. It's no surprise that our frustration and fear result in self-talk that encourages us to "play it safe," "hide out," or "avoid risks." This is the kind of self-talk that prevents us from taking risks in relationships, pursuing jobs that are fulfilling, and following our dreams. It is the kind of self-talk that limits us in the name of trying to protect us. And for many of us, this fear-based self-talk is pretty persuasive. After all, it offers the promise of avoiding pain by avoiding risk. Especially if you have recently experienced a loss (or a rear-ending!).

But the idea that we can protect ourselves by simply not taking risks is false. When we avoid risk in order to try to "stay safe," we are creating small, un-fulfilling lives for ourselves. We're letting our potential go untapped. We're missing chances for rewarding relationships. The reality of this false safety is isolation--which is truly harmful.

So today, I want to recognize each of you who had the courage to get up this morning, leave the house, connect genuinely with another person, learn something new, apply for a job, plan a trip--to live life. Everyday living takes continuous choices, which require continuous courage. And after a setback or a loss, the choice to engage in the activities of everyday living requires a higher level of courage.

If you're struggling with this courage, there is all kinds of great support out there. Call a psychologist, talk to a friend, connect with an online support group. You're not alone in your fear, and there is room to grow and change.

This morning, I got in the car and drove again. What brave everyday living activity have you done recently? Please share so that we can cheer you on!

When "Helpful" Isn't--Part Two

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In a response to the original "When 'Helpful' Isn't" post, Twitter user @BookMD said something that made me take notice. In fact, her response absolutely nailed something that I tried to articulate in the original post, but I feel like it is important enough to merit a "Part Two."

Before I launch into that, let me review my list of sample un-"helpful" responses:

* Everything happens for a reason.
* This is part of a bigger plan.
* You can have another baby (get married again, apply for another job, etc).
* You just need to think positive.
* It will feel better tomorrow.

Here is the concept that @BookMD pointed out. While there is power to thinking positive, to looking at the bigger picture, to having hope . . . it is very hard to access that intellectual power when you are FEELING intense pain or loss. And when someone offers an intellectual response when you are in the midst of feeling pain, that creates a disconnect.

In the original post, I described this disconnect as "feeling dismissed." As I have reflected further, I think that the emotional experience of these unhelpful responses can be more insidious and damaging than "feeling dismissed" implies. The disconnect that is created when an intellectual response is offered to emotional pain can create a sense of being judged.

The sense of being judged can arise because these unhelpful responses, which I have also heard described as "stock," "cliche" or "pat," do not actually acknowledge the feelings and experiences of the person in pain. There is not a space in these responses where the pain can be seen and validated. Worse, there can be an implication that the person in pain is somehow responsible for their pain. Clients describing moments of "unhelpful" help report that they often ended up feeling as though it was their fault that they are hurting. My clients say that they walk away from those kind of responses feeling that if they were more positive, hopeful, tough, etc, they would just be able to banish their pain.

The reality is that our feelings exist. They exist even if they are uncomfortable to us or others. They exist even when there are logical reasons for them to dissipate. They exist on their own terms, regardless of the needs or expectations of those around us. So offering someone who is feeling pain an intellectual response is generally not helpful. Sometimes, it can even cause additional hurt.

In the first post on this topic, I explored some of the reasons that people might respond in unhelpful ways, as a well as a short list of suggestions for more validating responses.

I want to reiterate that the most helpful response when someone in pain is often taking the time to listen to their experience. Most folks in pain do not need someone else to help them interpret their feelings, or to try to make meaning out of their struggle. The most healing gift is the permission to feel and express those feelings honestly.

What barriers have prevented you from offering "helpful" help in the past? How have you overcome them? What was the most helpful response you received while in pain?

When "Helpful" Isn't

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I want to you to take a moment and think about a moment in life when you were hurting. Did you hear anything like this offered as support or comfort?

* Everything happens for a reason.
* This is part of a bigger plan.
* You can have another baby (get married again, apply for another job, etc).
* You just need to think positive.
* It will feel better tomorrow.

I could go on and on. My guess is that anyone reading this who has experienced a major loss or disappointment has heard at least one of the above statements, or things that sound just like them. These statements represent a sample of the things that people say as a response to pain or loss. It's not unusual for these statements to come from someone who is very close to you, someone that you thought you could count on for support. As you think about your loss and the responses you experienced, try to remember how you felt after those responses. Did you feel heard? Supported? Dismissed? Invalidated?

While responses like the sample statements above may be intended to convey support, or to help us think beyond our pain, that's not how they often feel. Many people who are in pain feel dismissed or unheard when they receive these sorts of responses. Whey they describe their experiences to me in session, they report these feelings with some degree of confusion. Why does a response that is intended to be helpful feel so unhelpful?

I believe that the there are two primary reasons that these types of responses feel unhelpful. The first is that they are generalized. They do not acknowledge the uniqueness of our experiences. So being told that "everyone goes through this" may feel dismissive. The second is that these types of responses function as a signal that the person in pain should contain themselves. They do not create a space where any of the grief feelings are acceptable. These types of responses do not validate and normalize feelings of pain. So, if these responses aren't genuinely helpful, why are they so persistent?

There are several reasons for this. The first is that many people feel overwhelmed or helpless in the face of intense pain or loss. So they respond with a platitude. This is not a lack of caring--it's simply a reflection of the respondent's own discomfort with pain. I touched on this issue briefly in my post on "What Makes Therapy Different?"

The second reason that a friend or acquaintance may respond to pain or grief with an unhelpful generalized response is their own internal load. If someone is feeling rushed or pressured or overwhelmed, they often function on auto-pilot when faced with another's pain.

When an "unhelpful" response to pain or loss comes from someone that cares for us, it is most often a reflection of their own pain. It is incredibly hard to watch someone that you love be in pain. Most of us have a strong urge to try to decrease the intensity of the pain. While that urge is understandable, it is important not to respond in dismissive ways.

So, if the most common responses to pain or loss are actually unhelpful, what can we do to respond with support and validation? Here are a few basic suggestions:

1. Listen. Don't jump in, don't try to console, don't try to help the person in pain see the "bright side." Just listen, and create a safe space for their feelings.

2. Ask questions. Sometimes a person in pain needs or wants a distraction. Sometimes they want permission to just get some of their experience out in the open. By asking questions, you give them space to define their needs.

3. Be aware of your own limits. If someone's pain is more intense than you can handle, encourage them to reach out to a psychologist or other additional support.

4. Did I mention listen??

How about you? What was the most helpful response you received during a time of pain? What was the least helpful?

Complicated Grief: Surviving Suicide

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This is the second in a series on complicated grief. The first post in this series explored the challenges of surviving perinatal loss. Today, I'll be exploring how the suicide of a loved one can also lead to complications in the grieving process.

Defining Complicated Grief
Complicated grief is grief that is triggered by a loss that is out of context with normal, developmental losses. For example, the death of a parent when you are in your 60s is a painful event, and it is developmentally appropriate. The death of a parent when you are in your 20s is unexpected and out of context, so your experience of grief may be more traumatic. Another indicator of complicated grief is that the normal emotions of grieving (e.g. sadness, denial, anger) may be felt with greater intensity or may last longer than expected. Finally, complicated grief can occur in situations where the loss has a negative effect on your social support system.

Surviving Suicide
The term "suicide survivors" is often used to describe the immediate family and close friends of those who have committed suicide. This term may also include care-givers or others who are connected to someone who completes a suicide. Sometimes, the family and friends of a person who attempts suicide, but does not complete it, may have parallel experiences. Suicide survivors often experience all the components of complicated grief.

Loss Out of Developmental Context
Everyone knows that they will lose loved ones to death. These losses can occur in multiple ways. A loved one can die of cancer, heart attack or other illness. They might die in a car wreck or other accident. They may even die of old age. However, with all of these types of death, people who are left behind are able to understand that their loved ones did not choose their deaths.

The primary feature that sets deaths by suicide apart is that suicide is ultimately seen as a choice. Even the language used to describe suicide (e.g. "committed suicide") implies the element of choice or control exercised by the person who died. The sense that "they chose to leave" is a primary feature that places loss by suicide outside of the normal developmental context of loss.

Emotions of Greater Intensity
The same feature that sets suicide loss outside of the normal loss context is a primary reason that many suicide survivors experience their grief emotions at higher intensity. When it feels as though a loved one has chosen to die, to leave, that can strengthen the intensity of emotional reaction.

Some survivors of suicide deal with very strong denial. They cannot bring themselves to accept that a loved one's decision was a choice. You may feel the need to find an external source of blame. They may also cope with the loss by focusing only on the good memories or the strengths of their loved one. When asked about feeling angry or abandoned, they may react strongly in defense of the person who committed suicide.

Many suicide survivors also struggle with guilt and unanswered questions. They may feel as though they should have "known" or "done more." Even if their loved one left a note, most survivors of suicide have additional questions about the motivation behind that decision. The guilt can be nearly paralyzing, as they struggle to understand a decision that makes no sense to them.

One of the most challenging emotional experiences for suicide survivors is anger. While anger is a normal part of our grief emotions, anger after suicide is often more complicated. Anger after a suicide may be directed at ourselves for "not knowing." Self-directed anger may be complicated by guilt. It may be directed at a third party (case manager, school, etc.) because they did not prevent the suicide. But the most difficult level of anger is the anger survivors may feel is anger at the loved one who committed suicide. For many suicide survivors, this anger is so intense that it can feel like it entirely wipes out the memories of positive parts of the relationship (at least in the short term).

Challenges with Social Support
Surviving suicide can be also be difficult because survivors may not feel able to utilize their normal social support network. This can happen for several reasons.

When one member of a family has committed suicide, the rest of the family may struggle with openly sharing their pain within the family. Family members may be dealing with different emotions at different times. Survivors may be sensitive to "upsetting" one another by talking about their pain.

Because suicide is viewed as a choice, there is a lot of social stigma around discussing death by suicide. This stigma can impact social support in several ways. Some friends or family may not know how to address the suicide, and so may appear to be unaware of survivors' pain. They may choose not to discuss their loss because they are protecting the memory of their loved one--survivors do not want them to be remembered or judged by that single choice.

Finally, the intense emotions that many suicide survivors face may make it difficult for them to get support from their normal social support network. Survivors may be concerned about overwhelming those around them. They may be worried about how feelings of guilt, anger, or loss may reflect on their loved one. Survivors may simply not have the words to describe what they are experiencing.

Getting Support
Losing a loved one to suicide can create complicated grief. It is important for survivors to find the right type of support as they navigate the challenges of being a suicide survivor. Whether seeking individual therapy, family therapy, or a survivor support group, many suicide survivors benefit from being able to explore all the components of their grief in a safe, supportive environment.

Resources
If you have survived the suicide of a loved one, or are concerned that someone you care for may be at risk of suicide, here are some resources:
Suicide Awareness Survivor Support
International Association for Suicide Prevention
Books by and for Suicide Survivors

Please reach out for any support you need!