PTSD

Please help me welcome two very knowledgeable ladies to my blog today. These ladies share vast knowledge on the topic of Post-traumatic Stress Disorder, more commonly known as PTSD.

 

Ellen Kirschman, MSW, PhD.

Ellen Kirschman, MSW, PhD.

First, welcome back Ellen Kirschman, PhD, Public Safety Writing Association buddy. Ellen has been on my blog before when we discussed Analyzing Cops. She is a PhD who has worked as a police psychologist for over thirty years.

 

Kathryn Jane

Kathryn Jane

 

And welcome Kathryn Jane, a Kiss Of Death writing buddy. Kathryn studied Human Psychology, Emergency Preparedness and Public Safety Communications in university and won a national scholarship by writing an extensive research paper on PTSD, Critical Incident Stress and Cumulative Stress Disorder as it relates to Emergency Services. As a certified Public Safety Communicator she trained in Emergency Police, Fire, Ambulance, and Airport dispatch, she has seen first-hand know how Critical Incidents affect everyone differently.

 

Ladies, thank you both for being on my blog today. There were a couple of reasons why I wanted to do this blog. First, I know there are lots of folks out there who have experienced PTSD at least once in their lives and some who live with PTSD on a daily basis.

PTSD is often associated with soldiers returning from war. But I want everyone to know that it can happen to anyone. Public Safety workers, victims of domestic violence, rape, victims of a natural disaster. I could go on and on with my list, but I think you get the point… It’s not just soldiers who suffer with it.

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After my son Eric’s death, I had some PTSD experiences. To this day when I hear a gun going off (and I live in the country, surrounded by avid hunters) I jump out of my skin. And anytime I hear someone has died from suicide, especially someone young, it takes me back to the day he died. I hope this blog will help others out there who are experiencing this and they will know they are NOT alone as well as where they can go for help.

Moving forward, can you ladies tell me, what is PTSD?

Ellen:

Post-traumatic stress disorder is a painful emotional condition that develops in some people following exposure to:

1) A single extremely disturbing event such as combat, crime, an accident, or a natural disaster.

2) A series of such events. The psychological disturbance created by this exposure is so great that it significantly disturbs or impairs a person’s social interactions, ability to work, or to function in general.

The diagnostic criteria for PTSD must include a clearly identified trigger such as the threat of death, serious injury, or sexual violation. This is in contrast to other stress-induced conditions like cumulative stress which is the result of a buildup of what might be called micro-insults.

Further diagnostic criteria require that exposure occurred in one of the following scenarios:

a) The individual experienced the traumatic incident directly.

b) Witnessed it first hand.

c) Learned that a close family member or friend was the victim of a threatened or actual violent or accidental death.

d) Experienced first hand repeated or aversive images of the traumatic event. This last criterion about repeated exposure is especially important for first responders who will attend dozens of disturbing events in their careers.

 

Kathryn:

To quote the academics:

“PTSD consists of three reactions caused by an event that terrifies, horrifies or renders a person helpless.”

1. Recurring intrusive recollections

2. Emotional numbing; constriction of life activity

3. A physiological shift in the fear threshold affecting sleep, concentration, and sense of security.

 

Ellen:

There are also four distinct clusters of behavioral symptoms that accompany PTSD:

Re-experiencing, Avoidance, Negative cognitions (tapes we play in our minds that are distorted) and moods, and Arousal.

The following composite example adapted from Counseling Cops: What Clinicians Need to Know (written with Mark Kamena and Joel Fay) shows how these four clusters can manifest in a police officer’s life.

 

Counseling Cops, What Clinicians Need to Know       “John responded to a call of a suicidal teenager. He talked to the young man who convinced John that the call was a prank and he was not suicidal. Minutes after John left on another call, the young man killed himself. John was devastated but couldn’t show his emotions. He was depressed and blamed himself (negative cognitions and mood). He couldn’t sleep and heard the teenager’s voice in his sleep. He believed the boy was calling to him because he had failed to save him (re-experiencing). At work he was terrified of getting deployed to another suicidal subject call and started missing work (avoidance). He was irritable with the public, his co-workers, and his family and received several complaints for being too aggressive on a mental health call (arousal).”

Kathryn:

In less academic terms:

PTSD means that a person is experiencing specific symptoms at least 30 days after a catastrophic incident. It is a NORMAL reaction to a ABNORMAL event, a bone deep reaction that affects mental health, physical health, work, spirit, family and friends.

PTSD can be experienced by someone who has faced a single incident (usually one that made them feel completely helpless in the face of death), or by continuous exposure to psychological trauma such as that experienced by emergency workers, military personnel, public safety workers, or victims of abuse.

Are there different types of PTSD? If so, what are they called?

Kathryn:

 

Critical Incident Stress is often confused with PTSD. CIS refers to the symptoms experienced in the days immediately following an incident.

 

 

 

PTSD refers to symptoms manifesting 30 days or more after the incident.

Critical Incident Stress can precede Post-traumatic Stress Disorder but it isn’t an expected progression.

Ellen:

There is also a category of trauma known as complex trauma. In simplest terms this refers to people who have histories of childhood abuse. John, in the prior example, grew up in an abusive, sometimes violent, home. As the oldest child, he believed it was his role to protect his younger siblings. The terrible burden John carried in childhood amplified the shame and failure he felt for not preventing the teenaged boy from killing himself. His feelings of helplessness were an echo of the helplessness he felt as a child.

 

What are the Symptoms of PTSD:

Symptoms fall into four categories: emotional, physical, behavioral and cognitive.

Emotional symptoms might include: numbness, irritability, depression and so on.

Physical symptoms can range from elevated blood pressure to a variety of medical problems with no diagnosable medical cause.

Behavioral symptoms involve sleeping problems, changes in personal habits, eating patterns, or use of drugs and alcohol.

Cognitive symptoms include difficulty concentrating, poor memory, problems with mental tasks and details, difficulty making decisions.

Kathryn:

The range of PTSD symptoms is wide and diverse.

  1. Debilitating flashbacks or slide-show type memories
  2. Trouble with concentration and problem solving
  3. Suicidal thoughts and feelings
  4. Feeling alienated and alone
  5. Anger and irritability
  6. Guilt, shame, or self-blame
  7. Hyper-vigilance
  8. Feelings of mistrust and betrayal
  9. Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  10. Inability to remember important aspects of the trauma
  11. Loss of interest in activities and life in general
  12. Feeling detached from others and emotionally numb
  13. Insomnia – Difficulty falling or staying asleep
  14. Difficulty concentrating
  15. Feeling jumpy and easily startled
  16. Nightmares
  17. Feelings of intense distress when reminded of the trauma
  18. Intense physical reactions to reminders of the event
  19. Withdrawal
  20. Irritability
  21. Sense of a limited future, don’t expect a normal life span
  22. Questioning the meaning of life
  23. Questioning of faith

What types of treatments are out there for folks who have PTSD?

Kathryn:

There are a wide variety of treatments. Among them, Cognitive-Behavioral therapy and EMDR seem to be quite successful. The use of service dogs has become very popular for people dealing with PTSD.

Ellen:

Cognitive behavioral therapy (CBT) is especially helpful in the treatment of trauma. In simplest terms, the central hypothesis of CBT is that our thoughts or cognitions cause our emotional reactions. The goal of CBT is to challenge these negative thoughts and distorted beliefs, rescript them into positive cognitions, and gradually help clients reengage in activities they have been avoiding. CBT requires active participation by the client, including systematic desensitization (approaching the feared object or situation in gradual steps), tracking triggers and negative thoughts, journaling, relaxation, and meditation.

Prolonged exposure therapy (PE) is based on the principle that anxiety diminishes in the absence of danger. This is a structured treatment, lasting 8-15 sessions of 90 minutes each during which time the client retells the story of her traumatic experience over and over. It includes homework, journaling, education and breathing exercises.

Eye movement desensitization and reprocessing (EMDR) is based on the theory that traumatic memories are stored in the brain differently than non-traumatic memories. Under the direction of a therapist, the client processes the carefully targeted memory by stimulating both sides of the brain using alternating hand tappers, ear tones, or light bars or the therapist’s hand as it moves from left to right.

Virtual environment (VE) uses technology to create visual, auditory and olfactory reproductions of a traumatic event using lifelike avatars. It seems to work well with combat vets by recreating field experiences.

Post-traumatic growth (PTG) involves the client reappraising his or her experience in terms of growth and resilience. This is accomplished by employing some of the building blocks of positive psychology such as listing the positive consequences of the disturbing event and keeping a gratitude journal. Rather than focusing on the negative, PTG theorizes that many people become stronger, more compassionate, and more appreciative of life after a traumatic incident.

Two other recognized approaches to trauma do not necessarily include mental health professionals. Psychological first aid is an approach for assisting people in the immediate aftermath of disaster and terrorism. The goal is to reduce initial distress and to foster short- and long-term adaptive functioning. The Red Cross, the community and faith based organizations are often trained to provide this service.

Peer support offers victims the opportunity to talk with others who have survived similar traumas and are willing to assist the newly victimized.

Are there any medications that can help with PTSD symptoms?

Ellen:

There are many medications that can help. I recommend seeing a psychiatrist or a prescribing psychologist because they are the experts in medication used to treat psychological conditions. Some medications provide relief very quickly while others take several weeks to get into the system. There are also medications that help with sleep difficulties and nightmares. Be patient. Because everyone has a unique metabolism and neurological structure, it can take time to find the right medication at the right dose. Don’t be afraid to tell your prescribing doctor about side effects because they can be adjusted.

Are there any studies out there to predict what types of people may become more affected by PTSD than others?

Kathryn:

In the last 10-15 years there have been several studies done that looked for predictors of PTSD among emergency personnel (Police, Paramedics, Firefighters, etc.), and some interesting trends and risk factors have been identified.

1. People who deal with trauma by mentally disengaging, using wishful thinking and practicing dissociative tactics may be at risk of developing PTSD.

2. A wide range of organizational and job stressors that could increase the risk among emergency workers were identified as:

a. Management inadequacies in the areas of training provided

b. Lack of recognition of a job well done and fairness in promotion

c. Personal disquiet over media reports

d. Long shift hours versus familial demands

e. Introversion

f. Emotional fatigue

g. Lack of outside interests such as hobbies

h. Social detachment outside of the job

 

I’ve learned a bunch from you ladies! Thank you both so much for appearing on my blog and talking about a very important topic that affects a lot of folks.

 

Books by Ellen Kirschman include:

Counseling Cops, What Clinicians Need to KnowscOw9ilac_cover_smilaff_cover_sm

 

 

 

 

 

And Ellen’s website www.ellenkirschman.com where you can catch up on all of her appearances and new books she has in the works!

Be sure to check out Kathryn Jane’s Emergency Preparedness Class being offered through KOD. http://goo.gl/v3dZ7p Books by Kathryn Jane include:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Daring to Love is being offered on Brenda Novak Auction for Diabetes Research. Here’s the link: http://goo.gl/WND1VZ Kathryn Jane’s website is: http://kathrynjane.com

 

 

Below are some resources the three of us put together.

Until next time,

Happy Writing

Diane Kratz

 

Helpful Resources

Websites:

The American Psychological Association offers a great deal of information about trauma and other topics in psychology. They also can connect you with psychologists in your area. www.apa.org .

The Battle Buddy Foundation is funded by veterans to serve veterans. The Battle Buddy Foundation will pair veterans with service dogs and assist veterans suffering from PTSD with the many challenges they face on a daily basis. The Battle Buddy Foundation will also promote the reintegration of Combat Veterans back into society and the work force. http://www.tbbf.org/

Element Behavioral Health Creating Extraordinary Lives is a facility that offers treatment programs for PTSD and other mental health problems.

http://www.elementsbehavioralhealth.com/trauma-ptsd/animal-therapy-ptsd-treatment/

The First Responders Support Network (www.frsn.org)  sponsors six day retreat for first responders suffering with post traumatic stress injuries. The program is peer driven and clinically guided. They have graduated more than 700 first responders. FRSN also sponsors three retreats for the spouses and significant others of first responders. More info about both is available at www.wcpr2001.org

PTSD Foundation of America Providing Healing For The Unseen Wounds Of War is a website that offers programs like Warrior Groups, fellowships for combat veterans and their families to share their experiences, testimonies of healing, compassion and hope in overcoming the invisible wounds of war. Participants are required to be military combat veterans or family members of those who have served in combat and be willing to face the challenges of managing post-traumatic stress and related conditions. Camp Hope provides interim housing for our Wounded Warriors, veterans and their families suffering from combat related PTSD in a caring and positive environment, one-on-one mentoring by trained mentors, and a national outreach program for PTDS sufferers and their families.

http://ptsdusa.org/what-is-ptsd/

Saddles For Soldiers Program is a program for veterans to reduce the suicide rate, provide a safe place to relax, learn new skills, assist in reintegration, provide life skills, provide referral, establish a bond with an animal, and to provide short and long term care in an holistic approach. This is a free service for veterans and their families. http://saddlesforsoldiers.org

The Ranch Treatment Center provides comprehensive trauma treatment for survivors of childhood and/or adult trauma of all types, including PTSD.

http://www.recoveryranch.com/treatment-programs/trauma/

The Refuge Treatment Center offers a12-step based program that treats each person as a unique individual. They believe trauma is centered in the nervous system and telling the story in a nature setting helps the nervous system process the trauma.http://www.therefuge-ahealingplace.com/ptsd-treatment

The National Institutes of Health is a website that offers up to date information and statistics on PTSD.

http://www.nlm.nih.gov/medlineplus/magazine/issues/winter09/articles/winter09pg10-14.html

Timberline Knolls Residential Treatment Center is a residential treatment center for women that offers therapeutic interventions for trauma.

http://www.timberlineknolls.com/trauma

Veterans and PTSD is a website that offers Veterans statistics from a major study done by the RAND Corporation: PTSD, depression, TBI, and suicide. http://www.veteransandptsd.com/PTSD-statistics.html

US Department of Veterans Affairs on The National Center for PTSD– revisions in the DSM5. This is helpful for researchers, providers and helpers.

http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp

The National Center for Telehealth and Technology, www.T2health.org, offers a number of free mobile apps that assist those with PTSD or stress management.

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Facebook Support Groups and Pages:

https://www.facebook.com/HeroesAreHuman Canadian and they deal with emergency service workers and Canadian military.

https://www.facebook.com/battlebuddyThe Battle Buddy Foundation (TBBF) was founded by Veterans to Serve Veterans suffering from PTSD and other war related injuries.

https://www.facebook.com/ptsdusaFoundation of America is a non-profit organization dedicated to supporting combat veterans and their families with post- traumatic stress.

https://www.facebook.com/ptsd.home – PTSD support and global awareness.

Books

Guilford Press: If you know a first responder with PTSD, you might find Ellen’s books helpful: I Love a Cop: What Police Families Need to Know and I Love a Fire Fighter: What the Family Needs to Know. Both are available in print or as e-books from your favorite vendors.

Therapists working with police officers may be interested in Counseling Cops: What Clinicians Need to Know. Guilford also publishes Life after Trauma: A workbook for Healing by Dena Rosenbloom and Mary Beth Williams, Guilford Press. (www.guilford.com).

New Harbinger (www.newharbinger.com) publishes self-help books for the lay reader. They have several titles on trauma.

If any of my readers know of a PTSD resources they feel was useful, please e-mail me at: authordianekratz@gmail.com and I will add them to my list.

Blog edited by: Sally Berneathy

 

 

 

 

 

 

 

 

Surviving Christmas Grief

English: A Christmas Tree at Home

English: A Christmas Tree at Home (Photo credit: Wikipedia)

Today I am sharing something not too many of my writer family knows about me. I lost my sixteen year old son, Eric, in 1996 to suicide.  I’d love to report that I’m over his death, but the truth is, his death is something I know I will never get over. But I have learned to deal with my loss of him.

Eric and Chrustmas

My daughter Courtney, me, and my son Eric on Christmas Eve.

December is hard for me, and I know it is for countless others who are dealing with the loss of their loved ones. Eric’s birthday was December 7. Last year my daughter gave me my first granddaughter born on his birthday.

Charlotte Joann born December 7, 2012.

Charlotte Joann born December 7, 2012.

Ms. Charlotte Joann is named after my mother who died two years after my son. In the span of two years, I lost two people I loved.

Mom and Christmas 2

My mom with all her grandkids. Eric is the curly headed boy with glasses and Courtney is the dark- headed beauty in red.

For years after my mom died, I’d break out her tree even though it was so old the limbs wouldn’t stay in their holes and my husband had to put yarn around it to attach it to my wall so it would stand up straight and not fall over. It was my way of keeping her with me during the holidays she loved so much. Two years ago, I finally bought a new tree and was able to let Mom’s go. But it took time.

And then there are Eric’s homemade ornaments, my treasures he made me in school. As I hang them on my tree I’m brought back to a time when he was alive, and I begin to grieve for him all over again.

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Eric made me this star in second grade.

Seeing holiday family movies or Christmas commercials can trigger grief. The family dynamic has changed. The holidays have become a painful reminder of what we’ve lost.

I want to take this opportunity to acknowledge those of us who grieve and to offer some expert advice to those going through this process.

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Today I have Dr. Debra Holland as my guest. Debra is a corporate crisis/grief counselor who consults with companies that have experienced robberies, accidents, sudden deaths, and other critical incidents. She received a master’s degree in Marriage, Family, and Child Therapy and a PhD in Counseling Psychology from the University of Southern California (USC) and is a licensed Marriage and Family Therapist.

Dr. Holland worked for American Airlines after 9-11, counseling flight crews and staff. She counseled the victims and families of the Metrolink train wreck in 2002. In 2005 she volunteered as a mental health relief worker in Louisiana for the victims of Hurricane Katrina. She also volunteered as a mental health relief worker during and after the 2008 fires in California. In 2011 she counseled the Superstorm Sandy victims in New Jersey.

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Debra, New York Times and USA Today bestselling author, has written The Essential Guide to Grief and Grieving, published by Alpha Books. She is currently writing Aftershock: How Managers Can Help Employees Cope With the Death of an Employee.

She is here to help us understand the various kinds and levels of grief, how people are trained to experience grief, and ways to get through the pain and achieve some level of comfort.

Thank you, Debra, for sharing your vast experience today on my blog.

Can you explain how society deals with grieving people?

Debra: In our society, we don’t really know how to deal with grief, and thus we tend to avoid discussions about bereavement and loss. When it comes to a death, there is nothing we can say or do to fix the “problem” like we can in most other circumstances, and that leaves people feeling helpless. Most people either say time-worn and unhelpful platitudes, avoid those who are grieving, or both.

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The death of a child or a suicide (or in your case the death of a child by suicide) is even more difficult to talk about because the situation is so complex and tragic. The death of a child is a parent’s worst nightmare. Other parents don’t even want to think about such a tragedy, much less talk to a grieving parent.

People who are grieving often feel isolated, which makes them feel worse. What others need to know about the bereaved is that you don’t need to use words to offer comfort. Silent support and listening can be very helpful.

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When I was writing the chapter on the death of a child for my book, The Essential Guide to Grief and Grieving, every single parent I interviewed cried when he or she talked about the child no matter how long ago the death had happened. In one of my first interviews, I apologized to the mother for bringing up the painful subject that caused her tears. She said that any time she had a chance to talk about her daughter Megan was a “good day” even if she cried.

One man told me that after his 25-year-old son died in a car accident, the most comfort he received was a visit from an acquaintance. The visitor didn’t try to talk. He just listened. The bereaved father talked about his son for an hour and showed his visitor the family photo albums. That time of sharing meant so much to him.

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Diane: In my family, when my son died, my husband dealt with his death differently than I did. My mother cried constantly and I couldn’t be around her because I knew how badly he had hurt her. I couldn’t deal with her pain because mine was so raw. My daughter was three years younger (12 years old; her birthday is March 24, he died on March 13) than my son, who was sixteen when he took his life. I tried to talk to her about the feelings she was going through, and she refused to talk to me about him or her feelings. Now, seventeen years later, she told me she didn’t want to hurt me, and I now know her feelings. It only took seventeen years!

What are the differences between men and women, younger and older, on how they cope with loss?

Debra: First of all, everyone copes with loss differently based on their gender, personality, the type of loss, past history with loss, and other life circumstances. In general, men tend to not talk about their feelings, so sharing their grief can be very difficult for them. Also they might feel they have to be “strong” for their families. Don’t make the mistake of thinking that he’s not deeply feeling the loss because he doesn’t talk about it.

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A husband and wife might mourn differently, so they don’t feel on the same page with their grief. He might feel anger, and she might cry every day. Understanding this about your spouse or other family members is what’s important.

Children can feel protective of their parents, especially if mentioning the death makes their parent cry, something they might never have seen until the death happened. They also become “lost” in the grief of the rest of the family.

For that reason, it’s important to discuss the idea of crying not being bad–that even if mommy cries, talking about the loved one is comforting. Also provide nonverbal ways for children to express their feelings such as drawing pictures or writing in journals. A grief support counselor or group can be helpful because it provides a safe place outside the family for the child to process and express his or her feelings.

Diane: Is there a difference in the way a person grieves because of the circumstances of what caused the death? Two years after my son’s death I lost my mother who had been ill for a long time. I experienced her death quite differently than my son’s death, which was unexpected. Though I grieved for Mom, in a way I was happy to see her go because she wasn’t suffering anymore.

Debra: Absolutely. As you mentioned, the relief from suffering is a huge comfort. Your mother was no longer in pain, nor were her loved ones suffering in watching her go through the dying process. Also, I’m sure you had time to prepare yourself for her death, to have necessary and important conversations about the past, and to say good-bye.

With a sudden death, which there is no preparation, no chance to say good-bye. The shock can take a long time to wear off. And in the case of suicide, there are so many other feelings and questions which complicate the grief.

Diane: I can say now, seventeen years later, I’m on a different level in my grief than I was 10 or even 5 years ago. I no longer cry every time I think about him. I can finally think about what his life was about and not linger so much on the “why” or “how” he died.

Debra: As a loving parent, you will think about him and miss him and sometimes cry for the rest of your life.

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Diane: Thank you! ((HUGS))

Your book, The Essential Guide to Grief and Grieving, talks about the different levels of grief. Can you explain what those are?

Debra: The term “Stages of Grief” frequently is spoken and written about when actually no such process exists. Grief doesn’t flow in an ordered process from one stage to the next. Instead, it’s very messy and complex. Your emotions and reactions can shift from moment to moment and day to day. It’s like riding a rollercoaster that has plenty of loops and even goes backward. What’s important is to be kind to yourself on the journey and not to have expectations for how you (or others) SHOULD feel.

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Diane: For me, the holidays are a triple whammy.  I drag out my homemade Christmas ornaments my son made for me in school, my son’s birthday is December 7, and my mother WAS Christmas. She absolutely loved it. She decorated, cooked, and had more holiday spirit than everyone I’ve ever known. I still try to keep our family together, but it’s been hard. I am not my mom or my dad (we lost him in 2004). We went from a family where we had to do three Christmases in one day to trying get family members together for one.  At times it feels like we are losing each other.

Debra: In addition to your grief over the deaths of your loved ones, you are mourning the loss of the holidays you had—grieving a time and place—as well as people. Your fears about the family and future holidays can also make the present ones more difficult.

I suggest you discuss your concerns with your family and invite them to be honest with you and each other—regardless of how it might make you feel. They can’t share concerns and feelings if they think you’ll cry. Reassure them that your tears are not a reason to hold back on communication.

childrensroom.org

childrensroom.org

Perhaps on some level many of them feel there is too much pain associated with Christmas. Maybe other issues need to be addressed. Maybe you can do something else as a family that happens at another time of year, which will affirm your bonds, so you don’t feel like you are losing each other.

Dr. Debra’s Tips for Weathering the Holidays

 

Share how you’re feeling with trusted loved ones, especially the way your grief has changed or deepened due to the holiday.

Reduce your stress. This isn’t the year to worry about a perfect celebration. Only do what you feel is necessary.

Ask for help. Others will be happy to step forward to lend a hand. Let others know specifically what you need. Don’t say, “Can you bring something for dinner?” Do say, “Can you bring dessert for 10 people?”

My mom bought this for him after he died. I now hang it on my tree in memory of them both.

My mom bought this for him after he died. I now hang it on my tree in memory of them both.

Find a way to memorialize your loved one. Set out a special candle. Hang their stocking with the others and have everyone write a letter to the deceased. You can read them together on Christmas morning. Make an ornament with their picture on it or buy one that represents them in some way. Include the deceased in a family prayer.

Don’t let others direct how you should spend the holidays. Just because someone thinks it would be best for you to go away for the week doesn’t mean it’s right for you.

Be of service to others. Helping others is a way to give new meaning to the holiday and help you feel better. Prepare and serve food at a homeless shelter or organize a gift drive for some needy families and deliver the presents yourself.

Realize that you might feel overwhelmed and exhausted, both from your reactions to the loss and from the stress and hectic pace of the holiday. As much as possible, get to bed early and take naps.

You don’t have to pretend to be happy. If you think your sadness might be a problem for others, have a little talk with them beforehand about how you and they will handle your feelings.

Spend time with people who are supportive and caring. By now, you know who among your friends and family is supportive and who’s not. Gravitate to the understanding ones and avoid the others.

During the holidays, you can’t help but think about and miss your loved one. However, try as much as possible not to dwell on your pain. Imagine your loved one being present in spirit. Instead of his or her absence, focus on the presence of the other family members. Your loss helps remind you of how precious time is with your family. Appreciate and love each one of them.

Diane: If you haven’t read Dr. Holland’s book, The Essential Guide to Grief and Grieving, you really should. It gives concrete advice to help the healing process of grief. It is also very helpful for those who counsel the grieving as well as those who’ve experienced loss.

Buy link:  http://www.amazon.com/The-Essential-Guide-Grief-Grieving/dp/1615641114 .grief

Thank you so much, Debra, for sharing my blog today. You certainly helped me and I think this topic will help  many people.

Debra: Your welcome!

You can also connect with Debra at:

Website: www.drdebraholland.com.

Twitter:  https://twitter.com/DrDebraHolland

Facebook: https://www.facebook.com/debra.holland.731

Facebook Fan Page: https://www.facebook.com/pages/Debra-Holland/395355780562473#

My thoughts are with all of you who have lost someone. Please know you are not alone. Be good to yourself.

Peace be with you and your family,

Diane Kratz

Below are book and web resources taken from Debra’s book as well as a few I have used. These can help you or someone you love cope with grief, not just during the holidays, but every day.

Books:

101 Ways You Can Help: How to Offer Comfort and Support to Those Who Are Grieving by Liz Aleskire. http://www.amazon.com/101-Ways-You-Can-Help/dp/1402217560

Parentless Parents: How the Loss of Our Mothers and Fathers Impact the Way We Raise Our Children by Allison Gilbert. http://www.amazon.com/Parentless-Parents-Mothers-Fathers-Children/dp/B0057DC6AC

The Grief Recovery Handbook: Action Programs for Moving beyond Death by John W. James and Russell Friedman. http://www.amazon.com/Grief-Recovery-Handbook-Anniversary-Expanded-ebook/dp/B001NLKYIS

When Bad Things Happen to Good People by Harold S. Kushner. http://www.amazon.com/When-Things-Happen-Good-People/dp/1400034728

The Grieving Garden: Living With the Lost of a Child by Suzanne Redfern and Susan K. Gilbert. http://www.amazon.com/The-Grieving-Garden-Living-Death/dp/1571745815

The Worst Loss: How Families Heal from the Death of a Child by Barbara D. Rosof. http://www.amazon.com/The-Worst-Loss-Families-Death/dp/080503241X

One Foot in Heaven by Heidi Telpnet. http://www.amazon.com/One-Foot-Heaven-Heidi-Telpner/dp/0982678436

Healing Grief: Reclaiming Life after Any Loss by James Van Praagh. http://www.amazon.com/Healing-Grief-Reclaiming-Life-After/dp/0451201698

Websites:

www.aamft.org (American Association for Marriage and Family Therapy) A national website for professionals and couples looking for marriage and family advice.

www.aarp.org/famililies/grief_loss (American Association of Retired Persons) Grief and loss articles, support for seniors.

http://www.afsp.org (American Foundation for Suicide Prevention) A national group website that provides support, education and advocacy for the prevention of suicide. It also has a page where you can honor your loved one who lost his or her life to suicide.

www.cancer.net (Cancer resources, including help for planning end of life care.

www.aplb.org A website for pet loss.

www.compassionatefriends.org A nonprofit, self-help support organization for families who have lost a child. (This group helped me tremendously!)

www.grief.net A website for helping people move beyond loss.

www.griefwork.org  (The National Catholic Ministry to the Bereaved) A faith-based bereavement ministry.

www.memory.com A website for creating an online memorial.

www.suicidology.org (American Association of Suicidology) Help with all issues suicide, including those grieving the loss of a loved one due to suicide.

www.try-nova.org (National Organization for Victim Assistance) Assistance for victims of crisis and crime. You can also call 1-800-TRY-NOVA.

Blog edited by Sally Berneathy!

Analyzing Cops

Ever wonder where law enforcement officers and their families go for help for mental health issues?

Meet Ellen Kirschman, MSW, PhD., who I am thrilled to have on my blog today! Ellen has worked as a police psychologist for over thirty years.

Ellen Kirschman, MSW, PhD.

Ellen Kirschman, MSW, PhD.

Can you tell us something about your background?

I’ve been a police psychologist for over 30 years. I started out as a clinical social worker and eventually got my PhD. My dissertation was titled “Wounded Heroes.”

It was what we call an intensive case analysis of three officers all of whom began their careers in good mental health and wound up retiring on stress related disability retirements – kind of a cross between Sigmund Freud and Mickey Spillane.

Dareen Mcgavin as Mickey Spillane

Dareen Mcgavin as Mickey Spillane

Sigmund Freud

Sigmund Freud

People ask me all the time if I’m married to a cop or a fire fighter. I’m not. I like to keep clear boundaries between my work and my personal life.

My husband is a retired contractor and a talented photographer. He took that great author photo of me. We love to travel, cook and hang out with friends. In addition to writing and holding workshops, I train peer supporters and volunteer at a wonderful organization, the First Responder’s Support Network.

We hold retreats for psychologically injured officers and their families. If your readers are interested, they can go to www.frsn.org to learn more. My husband also volunteers at FRSN, cooking for the Spouses and Significant Others (SOS) retreats.

Are there any differences you’ve found in counseling police officers vs. Joe Citizen?

You have to earn a cop’s trust. That’s hard work. Cops are protectors and may try hide some of their most pressing issues because they don’t want to injure their therapists. They are skeptical about the value of psychotherapy and the worry more than the average client about confidentiality. In particular, they are concerned their departments will find out they are in treatment and this will jeopardize their jobs as well as their standing with co-workers.

Tell me about your new book, Counseling Cops, What Clinicians Need to Know.

Counseling Cops, What Clinicians Need to Know

I co-wrote this book with two colleagues, Mark Kamena and Joel Fay, both of whom are psychologists and retired police officers. Our collaboration made the book so much richer than it would have been had I written it alone. As lead author, I was responsible for blending our voices into one readable narrative using  plain English, not psycho-babble, to describe various dimensions of the police culture, de-mythologize cops as super-human or super-aggressive, and challenge clinicians to examine their own biases. We talk about the prevalent mental health issues cops and their families experience and offer evidence based strategies we know will work for these problems and this culture.

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rapgenius.com

Our aim is to help clinicians become culturally competent to treat this unique population. Police officers are very reluctant to seek counseling, fearing it means they are weak or crazy. When their suffering is so great that they finally reach out for help, they deserve to be treated by clinicians who understand them and the culture in which they work.

For example, one of our clients needed treatment after two terrible shooting events. The first question his new therapist asked him was, “Are you ready to stop being a trained killer?”

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investigations.nbcnews.com

This was a very inappropriate statement and upsetting to the officer who felt himself to be the victim of these two events. Needless to say, he didn’t return to that therapist and would have given up on therapy completely had a peer supporter friend not helped him connect to a therapist who understood cops.

As a therapist, I can see the value in reading this book. The book is grounded in clinical research, extensive experience, and you have a deep familiarity with police culture, this book offers highly practical guidance for psychotherapists and counselors.

You vividly depict the pressures and challenges of police work and explain the impact that line-of-duty issues can have on officers and their loved ones.

ct.counseling.org

ct.counseling.org

You offer numerous concrete examples and tips showing how to build rapport with cops, use a range of effective intervention strategies, and avoid common missteps and misconceptions. And you have practical approaches to working with frequently encountered clinical problems such as substance abuse, depression, trauma, and marital conflict, which the book discusses in detail.

When making an assessment, clinicians are trained to consider the whole of their client’s assessments. This would include the police culture. Can you explain what a  police culture is?

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Hard to do in just a paragraph or two. Let me approach the question by listing the attributes of people who want to be cops. They are action oriented, rule abiding folks who value emotional control and structure. Like social workers, they want to make a difference in their communities. They have great senses of humor, a bit coarse for some, but it’s what gets them past the ugly stuff, and they see plenty of ugly stuff.

coppschicago.com

coppschicago.com

They are comfortable working in a para-military setting, taking and giving orders. They are decisive, sometimes a bit too black and white.  They love variety, take great pride in their work, and are fiercely dedicated to each other. They are protection oriented and may have assumed the role of protector or rescuer in their families as they were growing up. They are extroverted, perfectionistic and have high standards for themselves and others.

phyang.org

phyang.org

They are great in a crisis and rate high on mental toughness, at least when they are first hired. although for some, this can change over time. They are willing to use physical means to achieve a desired end and they are courageous enough to do what the rest of us couldn’t or wouldn’t.

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Policing is also a story culture. Stories are how cops transmit norms, values, tactical wisdom, and model behavior. I have hundreds of stories circulating in my head. They are wonderful teaching devices and fodder for my new career as a mystery writer.

Can you explain what an FFD is, when they are used and why they are needed?

The acronym stands for Fitness For Duty.

Police employers have a legal duty to ensure that cops under their command are mentally and emotionally fit to perform their duties. Failure to do so can result in serious breaches of public confidence, danger to the officer in question and his or her co-workers, citizens in the community and the department’s reputation.

Circumstances that trigger a request for a FFD vary greatly. Some relate to on-duty actions (excessive force, emotional outbursts, repeated problems with judgment, reckless behavior and so on).

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Others may pertain to egregious off-duty conduct such as intoxication, driving under the influence, drug abuse, domestic abuse, stealing, and other behaviors that raise questions about the officer’s fitness to serve. Suicide attempts, psychiatric hospitalization or a disability claim for mental health injuries will also trigger an FFD.

An FFD is a complex and lengthy procedure often entailing numerous legal complications. It is painful for the officer and should never be used as punishment or in lieu of discipline. The requesting agency should be able to articulate the problematic behaviors in question. The FFD examiner can be a psychiatrist or a psychologist.

Unlike therapy, the client is the requesting agency, not the officer.  Under these circumstances, the officer has no confidentiality.

What types of mental conditions do you see often of with police officers? 

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thepainbehindthebadge.com

Post traumatic stress injuries. We call them injuries because disorder sounds so permanent and we know that, with the proper care, cops can and do recover from trauma. Cops experience a whole range of common psychological problems, just like the rest of us:  substance abuse and addiction, relationship problems, panic attacks, sleep disturbance, depression, and anxiety.

What are the suicide, domestic violence, and PTSD statistics within this group of clients?  

Some of these statistics are hard to find. For example, statistics around suicide are controversial and there is disagreement among professionals.

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blogs.psychcentral.com

The most important statistic, in my opinion, is that cops are two to three times more likely to kill themselves than to be killed in the line of duty.

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abcnews.go.com

That’s alarming. The prevalence of PTSD is also debatable, but certainly less than we see in returning combat veterans.

On the other hand, combat is time limited, cops work for 30 years, so they have plenty of exposure to trauma. Soldiers don’t get sued for going to war, but cops get sued a lot.

techcrunch.com

techcrunch.com

Trying to find out about domestic abuse is also difficult. What I do know is that psychologists are doing a better job of screening out applicants with the potential to commit abuse.

What would you like to see changed or improved? 

Good question. I would like to see every agency, big and small, have a confidential peer support program, family orientations at first hire and again every five years, a chaplaincy program,

supervisors who are knowledgeable about spotting mental health issues and compassionate when talking to their officers, and easy access for officers and their families to culturally competent, confidential, low cost counseling.

As a writer, I can also see where this book would help me in understanding my fictional LEO character’s flaws, inner thoughts and would help me construct the conflict.  Can you tell us how your book can help writers create more believable LEO characters?

I can’t tell you how many writers tell me they have dog-eared copies of my first book, I Love a Cop: What Police Families Need to Know, on their desks.

ilac_cover_sm

Written for families, this book describes what police families experience and what they can and can’t do to help themselves. It’s true to the popular bumper sticker that says, “If you think it’s tough being a cop, try being married to one.” Their are literally hundreds of stories in I Love A Cop, all of which provide grist for the writers mill.

Counseling Cops, What Clinicians Need to KnowCounseling Cops: What Clinicians Need to Know will give writers a deeper understanding of the emotional and psychological challenges facing officers and their families. The book is also filled with with stories as well as  a suggested dialogue. Readers can  learn what good and bad therapists say during a counseling session. I’ve tried hard in  both these books to  describe officers as three dimensional human beings who are both the same and different from the rest of us, not like the one dimensional characters you see on TV.

scOw9In Burying Ben readers will see police psychologist Dot Meyerhoff struggling to find her footing in the Kenilworth police department as a civilian, a woman, and a politically liberal character whose allegiance to the cops is shaken by memories of her father, a student activist, who was beaten and injured for life by police. Her world and her sense of self is shattered when Ben, a rookie cop she is counseling, unexpectedly commits suicide and leaves a note blaming her. Readers tell me they rarely read a book told from the clinician’s perspective.

Thank you so much Ellen for joining me here today! I’ve had so much fun and learned so much from you. I’ve read Burying Ben and I’ve almost finished Counseling Cops: What Clinicians Need to Know.  Although I’ve never counseled a cop, I will keep this book on my professional bookcase alongside my DSM-5 and treatment planners, as a resource.

Any Questions? Ellen will be checking in all day, so ask away!

Until Next time,

Happy Writing,

Diane Kratz

You can order Ellen’s books from Guilford Press, Amazon, Barnes and Noble, and more of your favorite vendors, in print or as an e-book.

You can connect with Ellen at:

Counseling Cops, What Clinicians Need to KnowscOw9ilac_cover_smilaff_cover_sm

Website: http://www.ellenkirschman.com

Facebook Fan Page: https://www.facebook.com/EllenKirschmanBooks?ref=br_tf

Goodreads: https://www.goodreads.com/author/show/333996.Ellen_Kirschman .

Blog Edited by: Sally Berneathy