Monday, August 3, 2020

Trauma is "Too Much, Too Fast"

I’m considering this post my personal emotional check-in/answer to the question I posed at the end of my previous post.

Back in April I was feeling “overwhelmed” (if I had to choose just one word) when I wrote this post.  Everything was “too much, too fast”.  I’ve been through hard times before and I’d like to think that I’m more patient than the average person, but lately rather than feeling overwhelmed I’ve found myself feeling annoyed and irritable.  I hate the uncertainty in the world and I’m sick of feeling “trapped” inside.  And then, of course, I immediately feel guilty for feeling that way because suffering is relative and there are those who actually are in a trapped situation- kids in abusive or neglectful homes who could benefit from the safety net of public schools opening, women in domestic violence situations who can’t as easily get away from their perpetrator, or the children and families still in detention centers or living in cages.  A cage has got to be the epitome of being trapped.  

My heart is usually drawn, first and foremost, to children and youth who are suffering.  I have admittedly never been interested in working with the elderly- as needful a population as they are.  However, I must admit that I’ve become much more aware of the mental and physical trauma that the senior citizes around the world are currently facing- not to mention financial concerns.  If anyone has a right to complain about lack of connection, feeling trapped, or facing the realistic possibility of death from COVID-19 it’s the elderly. 

I have two elderly parents right now in their late 80s who, fortunately, are still able to be very much connected to and supported by their children, grandchildren, and great grandchildren.  Although my parents have some risk factors in addition to their age, their health is currently stable.  My in-laws, however, who are roughly the same age as my parents, have faced some unique challenges over the past year including having to sell their home of decades and moving into an Assisted Living Center where they could both have access to 24 hour care since their children were not realistically able to provide that to them. [That’s the condensed version of the story anyway- omitting numerous falls, an emergency brain surgery, children taking turns to care for them in their home, and a convalescent period at a rehabiliation center before one of them was able to transition to Assisted Living]. 

My in-laws have adjusted well to their new living situation, but they are both currently struggling with feeling “trapped” as their facility has been on lockdown the past several months.  As upscale and nice as their particular facility is, I overheard my mother-in-law liken the helpless feeling she had of not being able to have visitors in her suite or not being able to leave the facility except for medical appointments and other necessities as being in prison.

Last month I was having a conversation with my mother-in-law (we can visit with them outside their windows or through glass if we want to go in person) and it became evident to me that in addition to the new stress and uncertainty she is facing surrounding COVID restrictions and precautions, she is also still grieving her former independence and home.  Speaking of her home she said, “I don’t believe I’ve ever shed more tears over having to say goodbye to my home than I even have over a living person who has died.”  I hadn’t quite understood the enormity of her grief and loss until I heard her say that.  Because the circumstances leading up to selling her home and moving into an Assisted Living Center were due to an unexpected event and her transition happened within months without much time to process everything, it fell into the category/definition of trauma being “too much, too fast.” 

When I heard my mother-in-law express her grief I also thought of the thousands of children in foster care who- at a moment’s notice- are moved from their homes without time to say goodbye, are given a garbage bag to collect their essentials, and are placed into a stranger’s home in cases where they can’t be placed with relatives.  “Too much, too fast” certainly applies to refugee families who are willing to leave their homeland under dangerous circumstances without much except the clothes on their backs in order to escape poverty, violence, exploitation or government oppression. 

On a personal level of experiencing “too much, too fast”, since I wrote an update four months ago, a couple of significant things have happened in my life.  These aren’t necessarily bad/traumatic things, but they have required much effort and encompass a lot of CHANGE:

-              - I finished up my Masters Degree in Social Work!  Which means, among other things, that I will have more time to read and write just for fun than for a graded assignment or research.

-                -I had a virtual job interview and I will be starting a new position in the Fall doing what I did at my last internship- providing therapy to children and adolescents- most of whom are in the foster care system or have been adopted.

    -Our family moved into a bigger home.  We’ve been looking for homes for three or four years now so although our move wasn’t necessarily unexpected or due to financial hardship or job loss, we certainly didn’t envision that our next move would coincide with a pandemic! 

-       Because we now have more space, we are in a position to house elderly parents, if needed, or to host another foster child or two.  (The prospect of housing not just one but two elderly parents certainly influenced our decision to start the school year out virtually rather than in person).  Although I still feel like we’re getting settled into our house, I am also aware that other populations- including the elderly, children in foster care, or refugees- are at particular risk for going through “too much, too fast” without needed supports in place.  I don’t know for certain who exactly will be joining our household over the next year or two, but I’m a firm believer that if you have more than you need, then you share.         


Collective Trauma & Collective Support

Hey Readers, How’s everyone holding up?  I came across a quote last month which really spoke to me and I wanted to share it now.  What struck me in this quote is the definition of trauma as “too much, too fast.” which is such an accurate description of all of the changes that have taken place in our world, nation, and our personal lives since mid-March of this year.

Another unique and somewhat comforting aspect of this quote is the fact that we are all undergoing a “collective” traumatic experience right now.  Many times trauma can be so personal in nature that very few people are even aware of the silent struggles an individual may be going through.  “In the quiet heart is hidden Sorrow that the eye can’t see” is a line from a favorite Hymn of mine that describes this concept.

What makes this past year and global pandemic different from other kinds of trauma is that everyone is suffering to some degree and it’s not something that can be kept hidden.  One might think that because everyone is having to adapt to change it would make us more united and sympathetic towards each other.  Sadly, I have observed many instances where I’ve found just the opposite is true- especially in online interactions and in social media where judgments, criticisms, debate, and even conspiracy theories take precedence over empathy, encouragement, civil dialogue, and problem-solving.

Don’t get me wrong, I think the internet can be a great tool for connection and many are craving that connection and are especially in need of interaction right now.  I’ve also found it interesting that although both my husband and I would describe ourselves as introverts, we’ve both really missed interacting with others face-to-face on a regular basis.  I admittedly have not left the house much at all over the past 4 or so months.  Here’s something I shared on my personal Facebook profile regarding that:

Last week I had to get my driver’s license renewed and my husband came along to do a couple of errands as well.  I scheduled my appointment with the DMV early in the morning, so I decided to get a much-needed haircut before returning home.  My husband needed a trim and he and I were the only ones in the hair salon, and afterwards he was teasing me about how gabby I was with the lady cutting my hair.  I am usually much more of a listener than a talker, but apparently I was so excited to interact with someone in person that I guess I just kept going on and on- whereas other times I may have thought “Just cut my hair- no need to ask me questions.”  That was also definitely the first time I’ve been asked to wash my hands before getting a haircut and had a mask covering my face the entire time.

Going back to the quote that I shared: “Of course you aren’t as productive, feeling foggy, or wondering how you can possibly go through so many waves of emotions all in the same day.”  YES!  I love the validation that it’s natural to experience many different emotions in such a short time.  I know that my physical energy, productiveness, and moods have greatly fluctuated from day to day.  It’s okay to have ambivalent feelings.  For example, I love my children dearly and I find it so ironic that earlier this year I was feeling so guilty/resentful for not having more time apart from my schooling and work to spend with them.  And now that we’ve been quarantined together for almost five months there are days when they absolutely drive me CRAZY and I just need to go in a different room to have my own space.  School this year will be another huge adjustment as we recently made the decision to enroll our kids in online learning for at least the first term or two and then we’ll play things by ear.

At the beginning of this post I asked a question: How’s everyone holding up?  It wasn’t a rhetorical question!  I often hold a check-in at the beginning of my counseling sessions with younger clients with the objective of them simply being able to identify what they are feeling, often times with the aid of a visual chart.  Let’s consider this a group check-in.  Using the image below or however you feel like- comment how you’re doing, what your biggest challenge or right now is, or what you’ve found helpful to make it through each day.


Tuesday, July 28, 2020

Ready to Start, Ready to Learn, Ready to Help

Fifteen years ago my husband and I went through the training to become foster parents through our state.  This summer my husband and I finished up the training (and are 90% done with the licensing requirements!) to foster through a private agency for a slightly different demographic than we have fostered in the past- I'm sure I'll write more about that experience sometime in the future. 

Last year the following article was published in the December 2019/January 2020 issue of Foster Roster, a magazine sent out to foster parents in my region.  The article was written by the man who was our trainer over a decade ago and as I read it a lot of memories came flooding back- specifically surrounding the word "nervouscited" which is a great way to describe how I was feeling back then and how my husband and I are feeling now as we embark on a slightly different fostering path.

I'm sharing this article now for anyone who may need to hear any part of its message- wether you're just starting out on your journey to become a foster parent or are a veteran or have been considering the possibilities of fostering, or you have found your way here for whatever reason.

Ya’ Know, I’ve Been Thinking… By: Brian Young, Education, Utah Foster Care 

 Every month when I walk into a classroom for Class 1, at one of our region’s DCFS buildings, I look around the room at a group of new faces…. that have absolutely no idea what’s about to happen to them. You all remember that night, right? You were so “nervouscited” to finally start your foster care journey, which I understand, that you didn’t even notice that some of your spouses, if you had one there, were glaring at me with a “I can think of 100 places I'd rather be” face, which I also understand. 

A few months ago, I had a couple looking at me with a different face. It was more like a, “I think I remember you,” face and they asked, “Wasn’t it you that was teaching 15 or 16 years ago when we went through this the first time?” I nodded my head, smiled and thought, “I've been doing this for 20 years and feel, really old.” 

It’s made me think about a lot of things; how much child welfare has changed in our great state over the past 2 decades, how much more we know about how to better help kids and families who find themselves dealing with a situation and system they’d rather not be in, how frustrating and sad it is that sometimes it doesn’t work out the way we wanted or hoped, and how frustrating and sad it is, in a different way, that sometimes it does.

I think what’s been coming to my mind the most is all of you. With a little quick figuring and guesstimating, in the last 20 years, I've met over 3,000 families, roughly 6,000 people who had one thing in common - they had decided that sharing their lives with traumatized children and their families was something they wanted to do, without really even knowing what that meant. But there you were, ready to start, ready to learn, and ready to help. 

I say it every month in class, “People who don’t understand fostering really can’t help you understand and deal with the challenges of fostering.” But I also realize that people who don’t understand fostering, can’t fully appreciate those who do it either. 

You’re an odd bunch, you know that, right? You come to this to help, usually not realizing that “helping” means bringing these kiddos into your homes, lives and families, with all the “stuff ” that comes with them. You give them your heart, your time, your patience, your money, and sometimes whatever was left of your sanity, with the idea that if all goes well, you’ll be able to then watch them walk back, with a piece of your heart, to the family they came to you from. That’s if you have a “normal” case, whatever that means anymore. Add to that the extra stress of a case where it’s a constant battle with a bio-parent, a challenge to work with agencies who are sometimes having to work under a different set of rules than you, and sometimes they, would like, situations beyond your control that make you want to question the one thing you can control, whether you keep doing this or not. And you do. 

Now don’t go getting all misty-eyed on me, we’ll always have more work to do to stay focused. I know when I sit in meetings with DCFS and hear that foster parents are frustrated with, or not participating in efforts towards determining if reunification will work, or deciding way before a judge does that adoption really is the best plan for a child they’re caring for, or want a child moved, because the very behaviors that made sense while we talked about them in class, are now somehow unacceptable in actual real-life practice, we’ll always have more work to do. 

With all that said, what it comes down to, for me, is that I've had 20 years to work with some amazingly odd people. Thank you for trying, even when it seemed like a waste of time. Thank you for hoping, even when it seemed hopeless. Thank you for not saying out loud, in that moment of borderline rational thought, what you were thinking in that family team meeting, knowing you would have regretted it when you calmed down a bit. Thank you for helping those children you brought into your lives know it was ok to trust a parent again. Thank you for stretching your parameters a little, deciding that 9-year-old boy you said yes to really is kinda close to your initial request for girls only, from birth to 3. And the fact he’s a package deal with a 6-year-old sister, when you requested one child only, really is kinda like one, kinda. 

See? I told you, you are odd. 

Thanks and not just from me not that long ago I sat in a meeting with Melonie Brown, our Regional Director, who looked at me and said, “We love our foster parents! It’s crazy what we ask them to do. To take these kids in and love them like their own, give so much of themselves to help them, and then give them back. It’s just crazy, but we love them for doing it!” 

That obviously doesn’t mean there won’t be disagreements, challenges and frustrations, but know your efforts, even though it might seem so, aren’t going unnoticed. Even if you’re not hearing it, I am. 

One last time, thank you. I appreciate the opportunity to be a small part of your journey through the craziness. Even those of you who were staring at me that first night of class with something other than a look of excited anticipation on your face. Thanks for still being here.

Thursday, April 16, 2020

Things Can't Be Awesome All of The Time

        Sometimes inspiration can be found in the most surprising of places. Tonight I let my kids stay up way past their bedtime and watch too much TV.  I was trying to finish up one of my final papers of the semester and decided to stay in the same room with them and type while they were watching The Lego Movie 2 on Netflix.  I hadn't seen it before and wasn't paying much attention except to make an occasional glance towards the screen.  I stopped typing mid-sentence towards the end of the movie when I was so unexpectedly touched by the lyrics to one of the songs (to the tune of "Everything is Awesome" from the first movie) that I literally made my 12 year old rewind the movie and pause it while I got all of the words written down on my computer.

Everything is definitely not awesome in the world right now.  We are in the middle of a global pandemic which has drastically changed the economy and people's mental health- not to even mention the obvious fatalities and physical consequences of the widespread virus. 

On a personal level I'm making the transition to unexpectedly homeschooling my kids while trying to finish up my graduate degree which won't even have an official graduation ceremony because numerous plans have been cancelled, put on hold, or turned upside down.  

In addition to the world dealing with collective grief and loss surrounding this latest strain of the coronavirus, I had the heartbreaking experience of recently saying goodbye to my child and adolescent clients from my internship who have already experienced so much grief and loss in their short lives.  I felt guilty for their sakes but relieved that I can have more time to focus on the needs of my children who must be my first priority right now.

I keep vacillating between worrying about my own concerns and then feeling guilty that I'm not in more of a position to help others who are in crisis- specifically those who don't have the luxury of staying home from work because work means putting food on the table for their families or those who are staying home when home is not necessarily a safe place to be.  When it was announced that schools would be closed I immediately thought of the kids who count on school as their safe place (or at least a place to be fed when they may not otherwise be.)  "Child abuse rates are going to be on the rise" I told my husband.  Same with domestic violence.  What must it be like to have to be told to stay safe at home when home is more like a prison for some people?

Last week I finished up a course of immunosuppressant medication to treat an autoimmune flare-up because apparently when I don't admit that I might be experiencing some stress my body is sure to tell me.  I worry about people with underlying medical conditions and those who are more vulnerable, including my elderly parents and my in-laws in their locked down Assisted Living Center. I feel like my own immediate family and the members under my own roof are the only ones that I really have any semblance of partial control over.  In addition to the anxiety and uncertainty surrounding COVID-19, members of my household and residents of my state have also been dealing with the aftershocks from a recent earthquake (which isn't a usual occurrence since this isn't California!)  

All I can do is focus on what things I have control over and which blessings I can be grateful for.  Some days I do better than others.  It's just a fact that some days are going to be easier than others and I need to cut myself some slack on the days when I don't have the emotional or physical energy or motivation to get out of my pajamas, make three home-cooked meals for my family, find a way to be physically active, and organize every single cupboard or nook and cranny in my house while making sure that my kids complete their schoolwork in addition to keeping up with my own school assignments.

Some days you just have to let go of unrealistic expectations and come up with ways to go from "awesome" to "not bad" as these inspiring and reassuring lyrics from The Lego Movie 2 reminded me tonight:

Tuesday, December 31, 2019

2019 Hiatus & Update

You might be in your final year of graduate school if. . .

You have only written four blog posts IN ONE YEAR!

Yep, I’m still here.  I’ve just taken a brief hiatus as I focus on balancing my graduate studies with my family life and working part-time.  I’ve been made painfully aware that it’s impossible to be “perfect” in all areas of one’s life- something’s got to give and be put on the back burner.  And this blog has definitely been put on the back burner over the past couple of years.

The good news is that I am starting to see the proverbial “Light at the End of the Tunnel” as this Spring I will be finishing up my graduate studies and required hours of supervised internship experience to receive my Masters in Social Work.   Eventually, after 4,000 MORE supervised hours and passing the licensing exam I will be an LCSW (Licensed Clinical Social Worker).

          I am currently working in my second internship placement and I am quite satisfied with both the population I serve and the work I am involved with.  I felt a loss last year, as well as a bit of guilt, when we came to the decision to close our foster care license after 12 years of fostering.  Then in 2019 I was presented with a job opportunity (at my current internship) which seemed to fill that particular “void” of helping children in the foster care system without necessarily being a foster parent.  

        At my current practicum placement I not only get to work with children and adolescents in the foster care system, but with their caseworkers, their foster parents, their biological parents (in some cases), as well as a few Guardians ad Liteums and judges on occasion.  More specifically, I have been trained to conduct mental health assessments and provide in-home therapy to these children and their families.  To learn more about the type of modality I’ve been trained in and use, which is both trauma-informed and attachment-based refer to this post.  Other modalities I draw from in my work with clients are Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Parent-Child Interaction Therapy (PCIT), and Trust-Based Relational Intervention (TBRI).
          Although I can’t and won’t give details about my experiences for obvious reasons, I’d like to provide some general observations (not necessarily in any particular order) of things I’ve learned over the past year in my therapeutic role to children and families impacted by being placed in state custody.  I feel like I could honestly write an individual post for each one of these observations, but for the sake of space and time these summaries will do for now:

-      Caseworkers have a tough job- witnessing a lot of emotional pain and having high caseloads.  It's challenging to work with clients who are court-ordered and don't believe they need any services.   It’s not surprising that child welfare workers have a heavy turnover rate.

-    I appreciate relatives who are able to step up and open their homes to becoming Kinship Placements- especially grandmas, who forfeit their role as grandparent to that of “parent” to their grandchildren in what could be their years of retirement.  In some cases, these grandmas are the bedrock and/or savior of their family

-      Parentification isn’t just about taking care of younger sibling’s physical needs: (getting them dressed or to school on time, and making sure they have enough to eat), but there’s an emotional aspect a well where the child feels responsible for their parent’s emotional needs.

-   Regarding parentification and patterns I’ve seen, many children from early to middle childhood (grade school) continue to worry about and feel false responsibility for their parents who are or have been absent from their lives due to substance abuse struggles and/or mental illness, and readily excuse and overlook any dysfunction on the part of their parents.  However, by the time these same children reach adolescence or young adulthood they are more prone to be filled with resentment for caring for younger siblings for so long and/or they become tired of having the roles reversed after constantly worrying about or covering for their parents for so long.

-      Attachment is everything.  Children can become hurt, broken, and damaged in relationships (especially in family relationships) but healing can take place with the proper interventions and resources, including supportive relationships.

-     So many disorders can be preventable because of early traumas and one’s family life.  One semester when I had a class delving into the DSM, I would find myself immediately jumping ahead to the section of “Risk Factors” for disorders to find just how many disorders are influenced or precipitated by neglect and abuse, including Oppositional Defiant Disorder, Conduct Disorder, Borderline Personality Disorder, Reactive Attachment Disorder (which is probably the most obvious) but trauma and stressor-related disorders and Depressive and Anxiety Disorders.  
 I believe it’s more important to treat a person than a diagnosis.  And although diagnoses are helpful in formulating a Treatment Plan or understanding which symptoms to focus on (and are necessary for Medicaid reimbursement), a person is much more than their diagnosis.

-   I wish Developmental Trauma were an officially recognized DSM-V Disorder because although it has similarities with other traumas the attachment and trust component require such specialized care and a unique approach.

-      It is essential to understand that someone’s developmental age may be vastly different than their chronological age.  It was very insightful to me to read a very comprehensive neuropsychological evaluation of one of my clients from a developmental psychologist who measured different aspects of one’s IQ.  I realized that I needed to approach this client in a different way based on his developmental age.

-      Symptoms of ADHD and Trauma can look a lot alike.  Sometimes it’s hard to unravel the two- especially if both exist.

         (I got this graphic off of Pinterest- don't know where exact credit should go)

-      Just like “It takes a village to raise a child” , it takes a team to work together for children in foster care.  I’ve been able to attend Child and Family Team Meetings in a new role this past year- as a therapist versus a foster parent- but my observations are the same:  There are so many facets of support to a youth in state custody: physical health, mental health, schooling, other opportunities- that the more professionals and caregivers can step forward and come together in behalf of a child, the more hope and resources there are for the child.  

    I was touched to be able to attend one CFTM where not only the teacher and after-school coordinator of a client were present, but the principal of the school as well.  In a different meeting, a Transition to Adult Living Coordinator was there to help the youth who was preparing to age out of the system.  In other meetings nurses are ready to make sure all appointments or physical concerns are followed through with.  I even discovered that my state has a specific nurse assigned to oversee any youth who are prescribed psychotropic medications.

-      School is children’s work- where they spend most of their day.  Because of that, I’m grateful for trauma-informed classrooms and sensitive teachers.

-      Because I’m a social worker, I try to get the “big picture” of what’s going on in a client’s life: not just their mental health, but their physical health, their social environment, their school, etc.  Having said that, I would like to learn to incorporate more physically-based interventions (besides just deep breathing and meditation- maybe somatic experiencing or sensorimotor techniques) with my clients who have sleep problems- particularly insomnia, or who have a lot of muscle tension as a result of past traumas or whatever reasons.  I feel so frustrated for children and adolescents who can’t relax because muscle aches and insomnia seem like “old person problems”.  Many of these kids have tried melatonin which may help them get to sleep but they cannot sustain restful sleep.  And then they're expected to go to work (school) the next day and perform like nothing is wrong!

-      I use various assessment measures when conducting Mental Health Assessments with clients for the first time, but I recently started using the ACEs- not necessarily because it will give me a diagnosis, but because it helps me to gather a more complete social history of the client.  After one session this year, I was both amazed and saddened that I came across one client who had an ACES score of 9 (out of 10). He had experienced all but one of the adverse childhood experiences.  As I was driving home from work that night and the enormity of what my client had been through sunk in with me I wanted to cry.
    On a more hopeful note, here are some protective factors to help mitigate a high ACES score: