Crisis Managemet Questions

The Three “What” Questions of Crisis Management

I recently attended a meeting of Mental Health care providers who provide parenting classes for divorcing couples with children. During the meeting, one of the participants shared one of the tools that she uses to help the parents conceptualize how to manage the stress of “crisis” moments. She called it one of the principles of “Reflective Practice,” and to think of it as the most important three “what” questions to ask yourself when something distressing occurs. Specifically, the three questions are: “WHAT happened?”; “So WHAT?”; and “WHAT now?” 

WHAT HAPPENED? This refers to an honest, objective assessment of the event without adding value judgment or other extraneous thoughts about it. Not minimizing or catastrophizing about the event, but describing it realistically. For example, if there has been an accident, describe it. Describe injuries if they occurred. If there has been a fight or disagreement, just describe it. What happened, who did what to whom? Stick to the facts. 

SO WHAT? This refers to the actual consequences of the event, not how you feel about it. If you had an argument with someone and the two of you are not talking, describe it. Refrain from using energy thinking about how the person is a jerk or much you wish you could get even with him or her for treating you badly. If you or someone you care about suffered a financial hardship and paying bills is going to be a problem, describe it. It does not include feelings and judgments such as how unfair it is. Those things might seem very important to you, but they don’t help you actually manage or cope with the situation. 

NOW WHAT? This stage refers to planning what you need to do now given the situation that results from what has already passed. If there is a rift in a relationship that you want to repair, what steps can you take to repair it? If someone has hurt you and is likely to hurt you again, what steps are needed to keep yourself safe? If there has been an accident with injuries, what steps are needed to help heal the injuries in the best manner possible? If you are facing a financial hardship, what steps are needed to cope with it?

Dealing with events or crisis in such a way will free you from the chains that emotional crisis (different from the actual physical effects of the event) place on you. If it helps, write it down using the three “what” questions to help you sort out your response. You will find that a lot of what we think about in stressful situations keeps us from being effective, and actually helps keep the stress, and therefore the suffering, going.

Mark E. Hankla, MA

Children and Trauma

Do children react differently to trauma than adults?

The answer is yes. In adults some of the symptoms of trauma include night mares, flash backs, avoiding thoughts or feelings associated with trauma, detachment, feeling numb, depression, and anxiety.

When children experience a trauma, their reactions may look much different from adults. Younger children may regress. They may revert back to immature behaviors. For instance a child may begin bed wetting, having accidents during the day, or use baby talk. They may act out their scary situation with toys. They may also become clingy. Older children who experience trauma may act out, be defiant to authority, and have an excessive need to control things (and people) around them. They may have anger outbursts, they may steal or hoard items like food or lie. They may lash out at the very people who are attempting to help them. Sometimes, people who don’t understand what is happening in this situation, view the child as a trouble maker, they may think that the child is choosing to be “bad”.

If a child was abused by someone they knew or loved, they may have difficulty having trusting, loving relationships with their safe caregivers. They may unconsciously feel the need to test these relationships to see if the caregiver will protect them. Sometimes they may actually set themselves up to be rejected. For example, a child (who was abused in the home by a family member) may feel distrust of the remaining parent even though that parent stopped the abuse as soon as it was discovered. The child may focus his or her anger at the remaining parent, testing the limits, saying hurtful things, and at the same time be very clingy and dependent upon that parent. As a parent or caregiver in this situation, it can be very frustrating and exhausting.
 

If you are caring for or parenting a child who has been traumatized, please be patient and understanding.  While kids need consistent limits, they also need nurturance, kindness and understanding.

Laurie Patton

 

Coming soon: Tips on how to deal with a traumatized child.

Bill of Rights Part 3

A Recovery Bill of Rights for Trauma Survivors, Part 3

 

Here is our lastest installment in the series.  I found this worthwhile for therapists as well as clients and hope you do too. 

For the integrity of your personal communication you have the right to…

Ask for explanation of communications you do not understand.

Express a contrary view when you do understand and you disagree.

Acknowledge your feelings, without having to justify them.

Ask for changes when your needs are not being met.

Speak of your experience, without apology for your uncertainties.

Resolve doubt without deferring to the views or wishes of anyone.

 

Bill

Recovery Bill of Rights

A Recovery Bill of Rights for Trauma Survivors, Part 2

In my last entry I posted the first part of Thomas V. Maguire’s recovery bill of rights.  This is the second installment.   I hope you find it interesting.

To guard your personal boundaries you have the right to…

Speak or remain silent, about any topic and at any time, as you wish.

Ask for help in healing, without having to accept help with everything.

Take action to stop a trespass that does not cease when challenged.

Choose to accept or decline feedback, suggestions, or interpretations.

Be touched only with, and within the limits of your consent.

Challenge any crossing of your boundaries.

 

Bill

Recovery Bill of Rights

A Recovery Bill of Rights for Trauma Survivors

Thomas V. Maguire published a recovery bill of rights with the National Council for Community Behavioral Healthcare.  I thought I would pass it along in some installments.  Here is the first, I hope you find it useful. 

By virtue of your personal authority you have the right to…

                Manage your life according to your own values and judgment.

                Direct your recovery, answerable to no one for you goals or progress.

                Gather information to make intelligent decisions about your recovery.   

                Seek help from many sources, unhindered by demands for exclusivity.

                Decline help from anyone without having to justify the decision.

                Believe in your ability to heal and seek allies who share your faith.

                Trust allies in healing so far as one human can trust another.

                Be afraid and avoid what frightens you.

                Decide for yourself whether, when and where to confront fear.

                Learn by experimenting, that is, make mistakes.

Bill

Rumination, Mindfulness, and Being in the Moment

One of the most common issues my clients struggle with in therapy is rumination. Rumination can be related to a wide variety of issues and types of emotional responses. For instance, we may feel we’ve been wronged or slighted by someone we “thought” we could trust and ruminate about how and why that person did the perceived dirty deed. During the ruminating the event is played over and over and the initial emotional response is experienced again and again.

Another example would be focusing on a “possible” future event that would be hurtful even though the actual likelihood of the event is inflated due to worrying. I’m sure almost everyone has had the experience of interacting with a family member or friend who was irritable or short with you, and then wondering what you might have done to offend or upset them (even though it may not have anything to do with you at all). What often happens next is rumination about why the other person is upset plus worrying about the next interaction. In this example there are an infinite number of possible scenarios for future interactions to ruminate about, and I will bet none of the ones you imagine are positive, causing negative emotions like anxiety, sadness, anger, and maybe even fear. Consequences for this rumination can include being distracted from current activities which in turn can have any number of negative effects.

Rumination is analogous to suffering and is something we can learn to reduce. There are usually distinct thought patterns that can be identified that can be changed and counteracted. Judgmental thoughts such as “if only,” “why,” “it shouldn’t have,” or “it should be” are often part of rumination. Replacing judgmental statements with acceptance and non-judgmental observation of facts can slow down and counteract rumination. Try visualizing an event you ruminated about in the past and then saying to yourself two types of statements. First say: “That was a very sad and hurtful thing that happened to me.” Then say: “Why does that always happen to me?” Do they feel different to say? Which one sounds like a statement that lets you move on? Which one leaves you feeling unsatisfied and needing to pursue an answer again and again? Learning how to reduce or stop ruminating thoughts will reduce your stress and improve your life.

 

Mark E. Hankla

Taking Hold of Your Mind

People experiencing trauma related problems often say that they have difficulty controlling their thinking.  They may describe being bothered by thoughts that keep intruding on their thinking, or impulses to do things that might be harmful.  Obsessional thinking or going over the same thought repeatedly is another disturbance that can be a big problem.  These, as well as other disturbances in the process of their thinking are often described by our clients. 

While there are a variety of ways to address problems with the thinking process, using mindfulness skills is one that most people can learn and practice.   In her skills training manual, Psychologist Marsha Linehan devotes a major section to mindfulness skills which she titles “taking hold of your mind.”  I find this a fitting title because many people describe the experience of thinking problems as feeling like their mind is out of control. 

One of the first skills that Dr. Linehan covers is called “observe, just notice” which falls into the category of easy to say, difficult to do.  The skill involves observing your thoughts without getting caught up in what they are.  Dr. Linehan says to “…watch your thoughts coming and going, notice each feeling, rising and falling like waves in the ocean.”  I have found another useful metaphor to be that of standing beside a river watching your thoughts and feelings come floating down from upstream, drifting across in front of you and continuing to float downstream out of your awareness.  These and other observe techniques can be very helpful in learning to be in greater control of your thinking.  They are not very easy to use at first and coaching and a lot of practice is usually needed.  I think the time and effort taken to learn and use them is worth it.   I’ll describe more mindfulness skills in future posts.

Bill Bonacker