If you’ve ever been in therapy, it’s pretty normal and common to wonder how your therapist feels about you. You may even wonder if he/she loves you! Watch this short video to see how I handled this valid and normal question.
A psychological Fitness for Duty Evaluation (FFDW) is typically employer driven and is initiated when an employee may be unable to safely or effectively perform their job functions and it’s reasonable to believe the cause could be ascribed to a psychological impairment or condition. It’s important to remember that a FFDE is DIFFERENT than a Pre-employment psychological evaluation, a stand alone clinical evaluation, or other types of forensic evaluations (like Worker’s Compensation). A FFDE is typically initiated for an employee that’s already been employed but his/her behavior has become troublesome. Some examples might include the following: 1) an employee has a history of good conduct but there’s a sudden onset of hostility, irrational speech, withdrawal, or isolation; 2) allegations of unexplained or excessive use of force; 3) threats of violence; 4) the employee displays behavioral problems that suggest difficulty with effectiveness or judgment; or 5) reports of bizarre off duty behavior. According to the American Disabilities Act (ADA), there are some conditions that allow the employer to initiate this type of examination of an employee. Notably, an employer can require a medical examination “as long as the examination or inquiry is shown to be job related and consistent with business necessity…or that an individual not pose a direct threat to the health or safety of other individuals in the workplace.” (ADA, Title I). After evaluating the employee, a psychologist can determine, that due to a psychological condition, it is reasonable to believe that the condition may prevent the employee from safely and effectively performing the essential functions of the position held by the employee. Alternatively, if the psychologist feels this standard is not met, the employee will be deemed able to return to their duties.
The deadliest mass shooting in modern US history occurred in the evening hours of Sunday, October 1st, in Las Vegas during an outdoor concert. By now we all know the details, the name of the shooter, some of his history, and many names of those killed. But do you also know anyone that survived this horrific incident? Maybe someone you know was there and survived the incident intact but with some cuts and bruises. Or maybe it was you? There were reportedly 22,000 in attendance at the concert so it’s safe to say that many people were impacted.
Because of the life threatening nature of the event in Las Vegas, it’s safe to say that thousands of people will walk away from the experience with not only cuts and bruises but also some confusing emotional responses. I’m here to talk about that.
Post-traumatic Stress Disorder (PTSD) is now a term heard by the general population more than ever before. Not only are many returning military veterans struggling with the symptoms of this disorder but also any individual who has faced a traumatic event certainly faces the likelihood of developing symptoms. If you, or someone you know, experienced the massacre on Sunday, you could potentially develop symptoms of PTSD and it’s important that you know what to do next.
Certain criteria must be met for the diagnosis of PTSD to be made. First, the individual has to experience, witness, or be confronted by an event that involves actual or threatened death or serious injury. The individual must ALSO respond by experiencing intense fear, helplessness or horror. If an individual was at the concert on Sunday, they will likely fit this description.
There are three categories of symptoms that point to someone potentially developing PTSD. The first category involves the individual repeatedly re-experiencing various facets of their experience. They ruminate about the sound of gunshots, for instance. They keep remembering the bodies they saw on the ground. They remember crying. They can’t seem to stop thinking about their experience, and they even probably dream about it. What’s important is that these thoughts are INTRUSIVE, DISTRESSING, and PERSISTENT. They can’t seem to stop brooding or ruminating.
The second symptom category is taking great lengths to avoid aspects of the trauma. This often takes the form of not wanting to talk about it, avoiding anything that might remind them of the event, including the news; avoid talking to people who were there with them, or some other reminder of the event. In this case, the person might avoid going to another concert, might avoid large crowds, or might avoid any sounds that remind them of the gunshots, like the sound of motorcycles or fireworks. Another example of something that might occur is the inability to recall an important aspect of the experience. For instance, their timeline is missing important sections and they can’t remember how they got from one place to the next.
And then finally, the third symptom category includes persistent symptoms of increased arousal. That’s a fancy way of saying difficulty falling or staying asleep, outbursts of anger or significant irritability, or an exaggerated startle response. The person is jumpy, easily startled, and feels constantly “on edge.”
If you, or someone you know, seem to fit these descriptions, there are some important things that can be done to make sure the symptoms don’t worsen. First, it’s absolutely essential to get help; specifically, professional help. A therapist who specializes in trauma is trained to help walk you through this experience. Some people reading this might be tempted to think they can do this on your own. THAT thought is absolutely false. The QUICKER you reach out for help, the more likely you’ll heal from this experience and more quickly. And a therapist won’t respond with clichés (i.e. – you should be grateful that you survived this!). Study after study indicates that talking through an event like what happened in Las Vegas is associated with a reduced risk of developing PTSD.
Secondly, it’s absolutely essential that you acknowledge you need help to your family and friends – and that you TALK to them. I say this with a caveat though. If there is a family member or friend that just doesn’t seem to know how to respond to your tears and distress; if they respond in a way that dismisses or invalidates your distress, then find a different friend or family member. Research after research study shows that one of the things that helps someone deal with a life-threatening event the most is the experience of being connected to those you love, of feeling heard and supported. In other words, you must feel socially supported.
Thirdly, try and return to your normal schedule as soon as possible. I know this may be hard for some. Traveling on the metro, listening to the song Jason Aldean was singing when the shooting started, working with large groups of people, or driving on the freeway next to motorcycles might bring back horrible recollections of the images, sights, and sounds that feel distressing and remind you of what happened. However, as best you can, try to return to your normal life as soon as possible. Over time, it’s like your psyche and brain need the predictability of your everyday life. And it will gradually get better.
And lastly, try and remember that your feelings are going to be all over the place. They will also feel confusing. You’ll likely feel both heartbroken and guilty. You’ll feel sad. You'll feel angry. These are NORMAL feelings/responses to an ABNORMAL event. It makes sense that you would feel sad, right? People were KILLED at this event. That is sad. It’s also heartbreaking that innocent people who were enjoying something benign like a country music concert are now no longer alive. It’s also normal that you would feel guilty. You survived. Others didn’t. That’s going to take some time to journey and process.
My last thought – don’t go this alone. Get help, reach out to those you love and need. Life will return to some normalcy eventually but for now it’s important to get the support and help you need.
"Choose life." That's God's call for us, and there is not a moment in which we do not have to make that choice. Life and death are always before us. In our imaginations, our thoughts, our words, our gestures, our actions ... even in our nonactions. This choice for life starts in a deep interior place. Underneath very life-affirming behaviour I can still harbour death-thoughts and death-feelings. The most important question is not "Do I kill?" but "Do I carry a blessing in my heart or a curse?" The bullet that kills is only the final instrument of the hatred that began being nurtured in the heart long before the gun was picked up..."
Psychotherapy is for “Crazy People” – or is it?
Although many of Sigmund Freud’s theoretical ideas have since been debunked or altered in significant ways since his lifetime, one the ideas of his that I find still relevant today is the idea of defense mechanisms. I say this because I see them emerge all the time in my psychological practice. Defense mechanisms operate at an unconscious level and help ward off unpleasant feelings (i.e. anxiety) for the individual. Freud’s original list included such defenses as projection, regression, displacement, and denial. (More have been added since his time!) It’s important to note that even healthy people use different defenses throughout life. For instance, sublimation can be useful. Sublimation is turning an uncomfortable feeling into something acceptable – like turning aggression into boxing or marathon training. It can be an adaptive response to an uncomfortable feeling. A defense mechanism becomes pathological only when its persistent use leads to maladaptive behavior such that the physical or mental health of the individual is adversely affected. For example, an individual who experiences social anxiety may avoid so many social situations that her/his ability to engage in normal adult behavior becomes compromised. Perhaps the individual has dreams and goals for his/her life but can never take the steps toward their fruition, leaving them feeling stuck and depressed. One of the defense mechanisms I most often see is that of Withdrawal – or what I like to call avoidance. Withdrawal entails removing oneself from events, stimuli, and interactions to avoid being reminded of painful thoughts and feelings. The common stigma attached to psychotherapy is that it’s for “crazy folks.” Or that it’s an endeavor only to be pursued for “weak” people. On the contrary, pursuing and committing to the process of psychotherapy actually takes a lot of courage and has consistently been shown to result in greater psychological health and more contented human beings. Believing that therapy is only for weak or crazy people is actually a perfect example of a defense mechanism – it’s finding a very creative way to avoid an uncomfortable situation BECAUSE of the difficult feelings that can emerge with authentic self-reflection. Once an individual begins therapy, it’s also not uncommon to see missed or cancelled sessions (always for VERY good reasons, mind you!) or discussing safe topics and avoiding the more difficult ones. The human being is very creative and often committed to avoiding the very thing that needs to be addressed. Hopefully, with the assistance of a safe and genuine psychologist, people can overcome humanity’s natural tendency toward avoidance and face their pain (or difficult feelings), allowing themselves to experience greater freedom and healing.
Happy National Psychotherapy Day - 9.25.14
Fight Therapy Stigma
Educate the Public
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Stay tuned for video from last week's therapy storytelling event in Pasadena, California, “Moments of Meaning.” In our first public event, we gathered six local therapists to talk about the most incredible moment from their practice (de-identified, of course). It was like a TED talk or Moth Radio Hour for psychotherapy, promoting and demystifying psychotherapy one moving story at a time. They’ll be edited and ready to go viral soon!
"I'm pleased to support National Psychotherapy Day and honor the therapists and patients who courageously travel together on this most intimate, meaningful and big-hearted journey." - Irvin Yalom, M.D.
Psychotherapy is a mysterious art, and this mystery scares some people away. One in four Americans are afflicted with mental illness, but many avoid seeking help because of the shame and stigma about having and treating these problems. We’d like to present one entertaining, educational, and meaningful solution.
On Friday, September 19, a group of Pasadena therapists will demystify psychological treatment by giving a glimpse behind the doors of their own practice through a spoken-word performance. In the tradition of TED Talks or the Moth Radio Hour, these are funny, moving, engaging ten-minute stories from six real clinicians — client information appropriately disguised to protect confidentiality, of course.
This event is presented by the San Gabriel Valley Psychological Association (SGVPA) to raise awareness and funds for the San Gabriel Valley chapter of the National Alliance on Mental Illness (NAMI-SGV), in honor of National Psychotherapy Day. There will be wine, light appetizers and live music during intermissions to promote a festive, meaningful evening for all in attendance.
Please join us for “Moments of Meaning” at the Senior Center in Old Pasadena (85 E Holly) on Friday, September 19th from 7 to 9pm. The cost is $15, and seats are limited. Email to RSVP: firstname.lastname@example.org