The AAMFT Blog

Chronic Stress Responses in People of the Global Majority: Exploring Somatic Therapy Interventions and Modern Clinical Approaches

 

By Octavia Neal, LMFT 
Treasurer-MFT’s Working In Trauma 

 

Chronic stress is a pervasive issue that affects diverse populations, but people of the global majority—a term used to describe those from historically marginalized racial, ethnic, and socio-economic backgrounds—often experience unique stressors that exacerbate their mental and physical health challenges. Understanding these chronic stress responses and exploring effective interventions, such as somatic therapy and modern clinical approaches, is crucial for improving the well-being of these communities. 

 

Key Definition: People of the Global Majority 

People of the Global Majority refers to those racial and ethnic groups that are numerically dominant worldwide but are often marginalized in societies where they represent a minority. This term emphasizes that, globally, people of color form the majority, challenging the notion that they are outliers or minorities. The concept seeks to shift the perspective from a deficit-based to a majority-based framework, recognizing the systemic challenges faced by these groups as a result of historical and ongoing inequities (Sims, 2020). 

 

Chronic Stress in People of the Global Majority 

Chronic stress is the continuous activation of the body's stress response system due to persistent external or internal stressors, which can lead to long-term health consequences such as cardiovascular disease, weakened immune function, and mental health disorders (American Psychological Association, 2021). 

Causes and Examples: 

• Socioeconomic Inequality: Persistent economic disparities often impact People of the Global Majority, leading to chronic stress from financial instability, job insecurity, and lack of access to quality healthcare and education (Williams & Mohammed, 2009). 

 

• Racism and Discrimination: Systemic racism and everyday microaggressions contribute to ongoing stress by creating hostile environments and undermining opportunities for advancement (Sue et al., 2012). 

 

• Historical Trauma: The collective memory of colonialism, slavery, and other forms of oppression continues to affect communities through intergenerational stress and trauma (Brave Heart, 1998). 

 

Somatic Therapy Interventions 

Somatic therapies offer a promising approach for addressing chronic stress, especially for individuals from the global majority. These therapies focus on the connection between the mind and body, emphasizing the role of physical sensations in processing and managing stress. Several somatic therapy techniques are particularly relevant for addressing chronic stress responses: 

1. Somatic Experiencing (SE): Developed by Peter Levine, SE aims to help individuals process traumatic experiences and reduce stress by focusing on bodily sensations. SE involves guiding clients to become aware of their physical responses to stress, helping them process and release stored trauma. This approach is beneficial for people of the global majority who may have experienced historical and personal traumas (Levine, 1997). It is important to note that these principles resonate deeply with historical and traditional practices used by Indigenous peoples around the world. Indigenous cultures have long understood and utilized the connection between the body and working through the physical sensations linked to past traumas. (Ex. Native American tribes such as the Lakota and Hopi that used the practice of sacred circle ceremonies to connect to physical sensations and the natural world. Often involving drumming, dancing, and storytelling (Deloria, 1995). 

 

2. Body-Oriented Psychotherapy: Techniques such as Sensorimotor Psychotherapy integrate body awareness into therapeutic practice. By focusing on physical experiences, therapists help clients access and process unresolved emotions and stress (Ogden, Minton, & Pain, 2006). For people of the global majority dealing with the cumulative effects of discrimination and trauma, these methods offer a holistic approach to healing.

 

3. Trauma-Sensitive Yoga: This practice combines traditional yoga techniques with trauma-informed principles to address both physical and emotional stress. Trauma-sensitive yoga helps individuals reconnect with their bodies in a safe and supportive environment, which is particularly beneficial for those experiencing chronic stress due to trauma or discrimination (Van der Kolk, 2014).

 

Benefits of Somatic Therapies: 

1. Holistic Approach: Somatic therapies address the physiological aspects of stress, helping individuals manage their stress responses in a more integrated way.
2. Empowerment and Agency: These therapies promote self-awareness and personal empowerment, enabling individuals to take an active role in their healing process.
3. Creation and Maintenance of Safe Therapeutic Environment: Many treatments can often trigger destabilization via re-experiencing of traumatic events through disclosure. Focusing on somatic interventions can give concrete skills to use to mitigate the physical symptoms of trauma/chronic stress response instead of feeling overwhelmed by them. 

 

Modern Clinical Approaches 

Modern clinical approaches to chronic stress in people of the global majority are evolving to address both the psychological and systemic factors contributing to stress. Some effective methods include: 

Culturally Competent Therapy: This involves understanding and respecting clients' cultural backgrounds and incorporating this knowledge into therapeutic practice. Culturally competent therapists are trained to recognize the impact of systemic inequalities and address them in therapy sessions (Sue et al., 2012). For people of the global majority, this approach can help bridge gaps in understanding and support healing in a culturally sensitive manner. This should also be a part of continuous education for any provider who is connecting with any who identifies as part of the global majority.  

Trauma-Informed Care: Trauma-informed care is a framework that recognizes the prevalence of trauma in individuals’ lives and seeks to create a safe and supportive therapeutic environment. This approach emphasizes safety, trustworthiness, and empowerment, making it particularly effective for individuals dealing with chronic stress from trauma or discrimination (Substance Abuse and Mental Health Services Administration, 2014). Active practice and observation of this framework often has difficulty being implemented in large systems or inundated systems of care.  

 

Mindfulness-Based Stress Reduction (MBSR): Developed by Jon Kabat-Zinn, MBSR is a structured program that teaches mindfulness meditation techniques to manage stress. MBSR has been shown to reduce stress, improve mood, and enhance overall well-being, making it a valuable tool for those experiencing chronic stress (Kabat-Zinn, 1990). 

 

Combining Somatic Therapies with Modern Approaches 

Combining somatic therapies with modern clinical approaches, such as somatic experiencing techniques with trauma-informed care, can address both the physiological and emotional aspects of stress. Similarly, incorporating mindfulness practices into culturally competent therapy sessions can enhance clients’ stress management skills while respecting their cultural contexts. 

There has been success in using these integrative, collective approaches. A community mental health clinic serving a diverse urban population implemented a combined approach using somatic therapies and trauma-informed care. Clients participated in somatic experiencing sessions to address their stress responses and engaged in culturally competent therapy to explore and resolve underlying issues related to systemic discrimination. The clinic also offered mindfulness workshops as part of their stress management programs. This integrated approach resulted in significant improvements in clients' mental health and well-being, demonstrating the effectiveness of combining these methods (Rothschild, 2000). 

Chronic stress for people of the global majority is a multifaceted issue that requires a nuanced approach to treatment. By integrating somatic therapies with modern clinical practices, mental health professionals can offer effective interventions that address both the physiological and emotional components of stress. Somatic therapies, such as somatic experiencing and trauma-sensitive yoga, provide valuable tools for helping individuals manage their stress responses. When combined with modern clinical approaches like culturally competent therapy and mindfulness practices, these therapies offer a holistic framework for improving mental health outcomes for people of the global majority. As we continue to develop and refine these methods, a focus on both individual and systemic factors will be essential for creating supportive and effective mental health care for all communities. 

 

 

 

References 

-American Psychological Association. (2021). Stress: The Different Types of Stress. Retrieved from APA 

-Brave Heart, M. Y. H. (1998). The Return to the Sacred Path: Healing the Historical Trauma of the Lakota. Journal of Human Behavior in the Social Environment, 1(1), 1-21. 

- Deloria, V. (1995). Red Earth, White Lies: Native Americans and the Myth of Scientific Fact. Scribner. 

-Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Dell. 

- Levine, P. A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books. 

- Marmot, M. (2004). Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy. Bloomsbury Publishing. 

- Ogden, P., Minton, K., & Pain, C. (2006). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment.  Norton & Company. 

- Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Norton & Company. 

- Sims, D. (2020). The Global Majority: A Radical Reimagining of Diversity. Journal of Critical Race Theory, 3(2), 12-24. 

- Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. SAMHSA. 

- Sue, S., Cheng, J. K. Y., Saad, L., & Rivera, D. P. (2012). Racial Microaggressions and the Stress Process: Theory, Research, and Clinical Implications. American Psychologist. 67(7), 532–544. 

- Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. 

- Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20–47. 

-Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20-47. 

Transgenerational Trauma: A Memory of a Therapist to Be

“Can you just slow down? Can you drive slower?” cousin Mary requested as she sat beside me.

“I can,” I assured her as I dropped my speed. “But we’re on the highway and I have to keep up.”

It was 1964 and at that time I had no idea what post-traumatic stress could be, notwithstanding the fact that Mary was in and out of symptoms. Freeway speeds and moving vehicles connected deeply with her past and were the source of major anxiety.

In 1933, she was one of the primary initiators of the Underground in her home village of Gorlice, Poland. When the Nazi’s came for her, they dragged her down the street by her hair. As an elementary school teacher, her additional crime was going to the homes of Jewish children to keep them current with their lessons.

In the Bergen-Belsen concentration camp, she lived in the ranks of political prisoners and was sterilized without anesthesia, abused, and used as a slave. One of her imprisonments was at Ravensbruck, a concentration camp for women. Barely past girlhood herself, and living in her own trauma, she worked to protect the young girls from harm, such as beatings and rape. She taught them how to hide and become invisible. Girls started referring to her as Matka, meaning “mother” in Polish. Liberated from the horror by British soldiers, this freedom fighter, my mother’s first cousin, was now sitting beside me as we rode down the highway. On a shared sacred journey, we were traveling towards the Greater Pittsburgh Airport.

The current mission was about another flight from oppression, as we were off to welcome Mary’s sister, who would be arriving from Warsaw. Cousin Stepha was a nursing instructor, and in recent times had been through the Soviet version of imprisonment.

Stepha and her fiancé made the mutual decision that they would not marry in a country that was behind the Iron Curtain. When they tried to escape by breaching the border, her supposed husband-to-be succeeded, and she was apprehended. Once released from a Soviet labor camp, my family was able to acquire a six-month visa on her behalf for medical reasons. I’m uncertain as to how long it had been since these two sisters had seen each other.

Wearing a thread-bare jacket, Stepha disembarked from the plane. There was a visible warmth between the two women accompanied by a noticeable stiffness in their greeting. It’s as though they were in shock. It was evident that they didn’t know quite what to do or say. There was difficulty finding words.

During World War II, messages from the Underground would relate days and times for the transport of prisoners. Stepha and her family would buy tickets to the train hoping to make eye contact with her older sister, Mary. It was too dangerous for them to speak to her.

And Stepha was no stranger to the train. At the age of 14, it was her mode of travel for transporting goats. Boldly arguing with Nazi guards, she would tell them that she must travel with the goat because her “friend (to whom she traveled) was sick” and could only drink goat’s milk. But the “friend” she spoke of was the Warsaw Ghetto, and the goat would serve as food amidst intentional attempted starvation.

It wasn’t so much about what these two women would say to each other at this reunion, but more about where to start. As we waited for luggage, it was understood by Stepha that I am the child of her cousin, Maryann. She hugged me and proclaimed in Polish, “I am in the free land!”

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Supporting Indians in the Diaspora

Compiled by Ulash Thakore-Dunlap with content provided by Kavita Pallod Sekhsaria, Jessica Joseph, and Sudha Nagarajan

The news and images coming in from India around the COVID crisis are alarming, saddening, and heartbreaking. While the news has caught the attention of many, for Indians in the diaspora, it has created a frustrating type of helplessness, as we navigate how to help family and friends living thousands of miles away while managing our own pandemic needs. To add to all of this, things seem to be "looking up" in some ways for certain communities in the US, as many are able to access vaccines and feel safer meeting with friends and family, the disease is still marking its presence in far too many homes.

Compiled here are support resources for MFTs working with South Asian clients who are either from India, have family in India, or part of the South Asian diaspora:

Connect

• Connect them with resources where you can, and,  if you are able, donate to mutual aid funds and organizations that you and your community trust.

Resist Misinformation

• Resist misinformation firmly and non-judgmentally. This is particularly important around vaccine hesitation. Use the CDC to ground your responses in what we know about the coronavirus. 

Listen

• You may go back and forth between having guidance and suggestions, and feeling overwhelmed by the lack of answers. For the first, let your loved ones guide you in what they need, whether it is a distraction or a chance to share their distress. For the second, remember that you don’t have to have all the answers, and that you may need support yourself

Affirm

• While fixing isn’t always an option, the power of listening and affirming is immense. Avoid minimizing or refuting in validating your loved one’s experience. 

 

As you’re working on finding ways to support clients and loved ones, remember that it’s important to support yourself, because you can’t pour from an empty cup:

Recognize Capacity

• Be honest and fair with yourself about what you can do. Beating yourself up, or putting yourself in position to develop resentment because you pushed yourself too hard fiscally or otherwise isn’t the solution. The balance between doing what you can, and accepting the limits of what you can do is really hard, but you owe it to yourself to try to find it.

Honor Feeling Out of Control

• Acknowledge what you can and cannot control. Go back to remembering your capacity, and address what you can control. Practice acceptance of what you can’t. 

Control Your Intake

• While the situation is upsetting, watching the news for several hours of the day isn’t going to add to what you can offer or control. Know your bounds so that you can be fair to yourself.

Recognize Feelings of Guilt

• Many of us may be experiencing a form of guilt around the safety we’re feeling ourselves, and helplessness about what we can do. Try to be kind to yourself through this, as your guilt won’t erase any one else’s suffering and may make it harder for you to take care of yourself. 

Adapt Coping Strategies

• Your regular supports for stress may be the ones that are unavailable. Recognize this, and that you can still develop other supports to take care of yourself - even if they are unfamiliar and even if they are not ideal.  This might mean reaching out to new friends; tending to your basic needs like feeding yourself, drinking water, and taking rest; or considering therapy or online support spaces.

This is a difficult time, but as we support each other and take care of ourselves, we’ll emerge stronger. Please see Resources Guide for India and COVID-19 Crisis for a list of resources, and infographics translated into Punjabi and Hindi.

 

Ulash Thakore-Dunlap (she/her), is a LMFT and is full-time faculty and Diversity of Equity and Inclusion at the Wright Institute, MA Counseling Psychology program and maintains a private practice in California supporting Asian clients.

Getting to ‘Mile Twenty’

By Laurie L Charlés, PhD, LMFT

AAMFT Clinical Fellow and Approved Supervisor

At the start of the pandemic, I wrote a blog post for the AAMFT website: Five Local and Global things to Remember Now. It was put online March 17th, at the “start,” at least for me, of the Covid-19 pandemic. I had been quite deep in thought about all things global and local when I wrote it, as I was completing a book on working internationally, and multilaterally, as a family therapist. Multilateral, a term more utilized in international politics rather than family therapy, is about collaboration, and about working together across borders and sovereign states on global issues. Systemic thinkers are natural multilateralists—i.e. skilled at lateral engagement, ie. able to work across multiple settings, inclined toward collaboration. Multilateralism is a key part of success to overcoming global issues, as nations must work together alongside each other and across many disciplines to deliver sustainable solutions to their citizens. It is a mindset very much needed in a global emergency.

The pandemic is a global event; indeed, that is what the term pandemic refers to, an epidemic/outbreak of disease across multiple countries and continents. However, as systemic family therapists keenly noted last week at AAMFT 2020--the national conference that broke virtual ground and which I thought was a fabulous success--not everyone’s local pandemic is the same. Your global “zip code” matters, so to speak. Inequities are especially graphic and vivid in complex emergencies, in whatever zip code they occur. A pandemic is just such an emergency, but it is different in Beirut than it is in Boston. Its global universality adds unique layers of specific urgency onto locally pre-existing conditions. Inequities are illuminated in sharp relief. The inequities may appear as if they occurred “overnight;” however, it is only that what is perhaps hidden or less obvious “before” the emergency is more striking and graphic “during,” and most certainly will be, “after.” Systems thinking promotes our ability to understand this figure/ground narrative very well. It is a mindset very much needed to respond to a global emergency.

Where do you “start” your pandemic? At what point in history? For me, it started on March 11th, the day the WHO named it a pandemic. However, for some of my colleagues in Geneva, it was January 30th, 2020, when it was named a PHEIC, a public health emergency of international concern. For a client I saw recently, from Wuhan but now living in the U.S., and whose family is still in China, the start date was late 2019. Yet another client’s pandemic “start” is March 24th, 2020, the day the Commonwealth of Massachusetts established its stay-at-home-order, which meant they could no longer go to work.

Naming the historical moment of a presenting problem’s “start” is a key question for brief systemic family therapists, and a routine practice we’ve shared for decades in the field. Now, when I ask a client’s experience of the pandemic, an orienting question as simple as “How are you doing, right now?” is loaded with meaning. What seems simple is immediately complexified, rightly so, mirroring the global context (and living history) of the client’s response to the emergency. Systemic practitioners are keenly able to address this dichotomy.

In the pandemic’s early days, I was asking clients many questions about their acute health, and the immediate impact of Covid-19 on their work and personal lives. Often, I also asked about their emergency planning. Having lived through a previous PHEIC, I have a ready set of questions about preparedness, response, and recovery. Today, I find I ask more about the lessons learned, so far, at this point in the client’s pandemic process. It is never too early for me to ask about lessons learned; even as the emergency is ongoing, we can talk about how to use what we've learned so far, an individual question to bring to our collective mind to "Build Back Better."

My therapy work is 100% virtual where I live, and although I am licensed in more than one state, most of my clients come from the Commonwealth of Massachusetts, the home of the Boston Marathon, which began in 1897 and now has an average of 30,000 registered entrants each year. Thus, it is not unusual for me to have clients who are marathoners. Yet, I am always awed anew by each one, because of their amazing skill set, discipline, and spirit. One of these clients, during the pandemic, and after the 2020 Boston Marathon cancellation, had to quickly adapt their training plan, because even without the marathon to register for, they knew, for sure, they’d definitely run it again. But marathon training in the dense city of Boston is not easy during a pandemic; my client’s runs could only last four or five miles before their mask became ineffective, or when unmasked humans began invading their space. My client persisted, with great creativity, adapting runs and workouts accordingly to the changing environmental conditions. Although the constraints were new, the client’s goal remained the same: They wanted, most of all, to get to “Mile Twenty.” After that, the 26.2 goal was in sight. As we continued talking through the pandemic, the reference to “Mile Twenty” took on a broader meaning, beyond the Marathon’s starting line at Hopkinton, and as a way to look at how we are globally responding to Covid-19.

And when it comes to “Building Back Better” in my own professional day to day life? I am not yet at Mile Twenty, but I am deeply engaged in the effort to get there. I created something new to work on, a multilateral (international) family therapy exhange project that is both simple and complex at the same time. A colleague and I were awarded a grant to develop guest expert panels to explore how communities are working with family systems to promote psychosocial resilience during the pandemic. So far, we have hosted eight of these panels, with guest experts and colleagues ranging from our respective homes in the U.S. and Sri Lanka, to places as far afield as London and Afghanistan; Windhoek and Guatamela; Libya and Spain and Port-of-Spain; New York City, the Seychelles, Nigeria, and more. From a variety of sectors and disciplines, our panelists share their pandemic view on families and systems from where they live and work. Together, we are learning what global family systems and psychosocial resilience looks like during Covid-19 from many points on the globe. We will continue the conversation until March, 2021. Things will look different then. I look forward to us getting there.

 

 

Laurie L Charlés, PhD, LMFT, was a consultant for the World Health Organization Mental Health Response team in Conakry, Guinea, during the Ebola Virus Disease outbreak in 2015. A consultant & trainer for systemic family therapy projects in international humanitarian relief contexts, low and middle-income countries, and conflict-affected states, she is currently Project Lead for Global Family Systems & Psychosocial Resilience, a Rapid Response to Covid19 project funded by the U.S. Department of State. Her forthcoming book, International Family Therapy: Multilateral Systemic Practice in Mental Health and Psychosocial Support, will be published by Routledge later this year.

MFTs For Systemic Change

Originally posted in the Family TEAM community, a network of advocates who are interested in furthering MFT policy interest.

Our country is in a state of emergency. The COVID-19 pandemic and the recent outcry from people of color and people against racial injustice serve as a symptom of the deep-rooted reality of our society. This dual crisis has begun to uncover the ugly truths of an inadequate system that the United States of America was built upon.

Leaders and government officials discuss this as a systemic problem that requires more than basic change. I hear a need for Systemic Change. Who knows more about how to introduce systemic change than systemic thinkers? Marriage and family therapists are trained to not only see problems systemically but to invoke Systemic Change.

Viewing the current state of our country through a systemic lens, it is evident that one person cannot be blamed for the problem. Not one community is the problem. Not one governmental official is the problem, nor one political party be blamed for the problem. Most importantly, not one race is the problem.

However, what is clear is we are all affected by the problem.

We understand when our clients sit in front of us, their difficulties are not only connected to their immediate circle. Their issues are also related to societal concerns. Our communities need Marriage & Family Therapists to rise out of our comfort zones and do the work outside of the therapy room. It is time for our work to be done on a macro-level. We are privileged with a systemic insight into society's influences on our clients. We must not continue to be bystanders to our clients' needs for systemic change.

As Marriage and Family Therapists, we can no longer limit our abilities to individuals, couples and families. We must begin to expand our reach to both national and global levels. Our society is calling for a systemic change. I recognize this as a direct call to Marriage & Family Therapist to become global agents of change.

I believe that we, as Marriage & Family Therapists and Marriage & Family Therapist Trainees, have the answers. I know that we have the ability to heal the country and create the systemic change that our country desires. America needs our expertise.

Join me in raising our profession to leadership. We are experts in the area of Systemic Change, and this is a call to action for Marriage & Family Therapist and Marriage & Family Therapy students.

With the current state of our society, I implore you to reflect on how your bystander stance inhibits the growth of your clients and the Marriage & Family profession? How does this stance hinder your personal growth?

I ask you to answer these questions.

What is your role as a Marriage & Family Therapist?

What can our profession do on a macro-level to create Systemic Change?

If you would like to dialogue about MFT’s about creating systemic change on a macro-level please join us on Facebook group MFT’s for Systemic Change or email me at  [email protected]

Shacoya Graham has always been a social activist at heart.

Having the privilege to travel alongside families during their fertility journey has expanded her value in trust, empathy, and humility.  During her career in the medical field, she witnessed a gap between medical and mental health, this inspired her desire to bridge the gap by advocating for Mental Health & Wellness.

Shacoya Graham obtained her bachelor’s degree in Human Services from Queens University of Charlotte and recently completed her Masters of Marriage & Family Therapy degree from Pfeiffer University. She is excited to connect with people to create healthier individuals, families, and communities. 

[Resource] Disastershock: How to Cope with the Emotional Stress of a Major Disaster

This week, we would like to highlight a resource on AAMFT’s Coronavirus Resource Page.  Disastershock: How to Cope with the Emotional Stress of a Major Disaster has a systemic, trauma-informed, and evidence-based foundation, making the manual an excellent resource for marriage and family therapists who work with children of all ages. Download the manual, available in four languages.

This resource was produced by AAMFT members who serve on the board for the Institute for School-Based Family Counseling and are part of the Disastershock Global Volunteer Team, which has members from 16 countries. 

In addition to our year-round advocacy and educational opportunities, the COVID-19 pandemic has mandated AAMFT’s quick response in equipping our profession with resources to adapt to the present situation. The Disastershock manual and other resources for MFTs relating to practice and telehealth are available at www.aamft.org/coronavirus.

11 Tips for Couples in Quarantine from Marriage and Family Therapists

Living through a global pandemic presents unprecedented situations that affect every aspect of daily life. For couples, spending nearly 24 hours a day together while trying to work from home, homeschool children, and keep up with basic needs is a challenge to maintaining our mental and emotional well-being, much less a healthy, thriving relationship.

At the core of marriage and family therapists’ philosophy is the principle that relationships matter. An MFT sees the intricate connectedness of the stresses from your environment to your relationships and can offer valuable insight on maintaining healthy relationships while under pressure.

Here are eleven tips for couples in quarantine from members of AAMFT’s Couples and Intimate Relationships Network. Many marriage and family therapists are offering telehealth and we encourage you to Find a Therapist if your relationship or family needs help. 

 

In this time of sheltering in place with loved ones, it is important to give one another the benefit of the doubt that each of you is doing the best in the current situation. Other crucial actions are doing acts of kindness towards one another as well as communicating about your appreciations and needs. Planning your schedules each day to help one another balance self-care, work, couples time, family time, teaching, and parenting will help you plan tag-teaming and manage stress.  Kathleen Shack, M.S., LMFT, Alpharetta, GA

 

I have enjoyed watching clients differentiate time together by asking each other “in” (instead of out). They create intentional time to do an activity that helps them join and bond.  Sometimes this includes something lighthearted such as a game, or a movie.  Other times it includes something a little more emotionally invested like a relationship check in.  Taking the time to make the time together different than time in the same space seems to have helped! Leslee Bry, LCMFT, Frederick, MD

 

Whether it's your family or your marriage, while quarantined, think of yourselves in a bunker with a common enemy swirling around outside. You're not at home doing nothing. You are home protecting yourself and your loved ones and adapting as best you can to a crisis. This is the most important thing you can do right now. Dr. Marni Feuerman, LCSW, LMFT, Boca Raton, FL

Couples and COVID19

Written by: Michele Weiner-Davis

Several weeks ago, I told my husband about my plan to shop for food and supplies in case the Coronavirus reached pandemic proportions.

He smirked and said something like, “You’re so predictable,” referring to my tendency to worry about dire outcomes. I’m just wired that way.

Not to be deterred, I took off to Costco and once there, filled my cart until I could feel the adrenaline stop pulsing through my body. Upon learning about my Costco mother lode, I became the brunt of my family’s jokes.

Fast forward to the last few days. No one is laughing anymore.

Especially not the couples in my practice.

I spent several hours on the phone today with a couple in crisis from California.

Married for 8 years, John, a physician, and Rita, a journalist, had not been able to stop arguing for three days. Their hostility was growing exponentially.

When asked what had been going on between them, it quickly became apparent that the issues identified were merely red herrings; something deeper had hijacked them emotionally.

And it was this.

John and Rita had completely different perspectives about the risk involved with the current COVID-19 situation. Because of his medical background, John felt that, while they should not panic, he and Rita should make immediate changes in their lifestyle to minimize risk to them and their two young daughters.

For John, this meant other than his work responsibilities, he and Rita should limit contact with the public- no socializing with friends and family, staying home as much as possible, stocking up on food and supplies from online sources, and following mainstream medical advice regarding regular handwashing and sanitizing surfaces at home.

Rita, on the other hand, while not oblivious to the health risks, believed that with diligence and sufficient caution, their chances of contracting the illness was slim. She didn’t agree with John’s plan to fully limit social contact, especially for their toddlers who had frequent playdates. Also, Rita was close to her parents and felt grandparent visits were a major bonus in their daughters’ lives.

During our two-hour call, Rita repeatedly asked, “When does the cure become worse that the illness?”

5 Local and Global Things To Remember Now

Last Wednesday, working at my computer, I happened to catch Aiysha Malik, a Mental Health Officer at WHO in Geneva on Twitter doing a live Q & A about mental health and #Covid19. I know Aiysha from other projects at the UN level; I recognized the hallways and workspaces where she was filming, because I had worked in them, too. In the clip, which I encourage you to
watch, Aiysha talks about all the things systemic folks know and all the things systemic folks do, including the use of language to de-stigmatize, how to talk to children during the outbreak, and how to be reflexive in your self-care. Systemic family therapists often don’t realize all the ways we are recognizable at the global level. If you listen to Aiysha, you’ll see us, too. Indeed, Ms. Malik is one of many people I’ve met at the UN level who is intimately aware of the implications of applied systems thinking, and how families and family therapy are such a key part of any one person’s mental health.

As I watched and listened to Aiysha, I thought: I would love to see my fellow family therapists looking and listening and thinking about this kind of outreach, perhaps using it to augment their work during #Covid19, and then perhaps creating moments of their own, to be shared and exchanged for our learning. There are many things we cannot control at the moment, but also, many things that we can. We benefit in times like these to see and share important outreach and leadership between us, in AAMFT, from local and regional bodies, and within our own individual communities. No matter if our primary world is digital or analog, or our geolocation is here or there, or quarantine or isolation or six feet of separation, indeed we are all in this together, as the Director General of WHO put it in today’s situation report.

Conflating Mental Illness and Violence is Stigmatizing and Counterproductive

In the hours after the horrific mass murder in El Paso on August 3rd, Texas’s Governor Greg Abbott suggested that “mental health is a large contributor” to violence. After a second shooting in Dayton, Ohio on August 4th, the President stated, “mental illness pulls the trigger.” Suggesting mental health is a causal factor in violence has become a common trope after our increasingly common mass shootings. The public, and the media, quickly follow, and mental illness is blamed. As a mental health provider, I should welcome calls for greater mental health access – I regularly come up against the limits of treatment availability and gaps in adequate coverage. However, it is for exactly this reason that it is incumbent on me to specify that mental illness is, in fact, NOT a large contributor to violence.

In fact, few people with mental health issues are violent. The most common mental disorders – depression and anxiety, for example – are not associated with violence. Research has repeatedly found that severe mental illness, including schizophrenia and bipolar disorder, does not predict future violence. A recent study of data from almost 40 years of research on the topic concluded that the risk was so low that, in order to prevent one stranger’s homicide, 35,000 patients with schizophrenia deemed to be at high risk of violence would need to be placed into individual treatment. In total, only about 3-5% of violence in the U.S. can be attributed to mental illness. In other words, even if the proportion of violence caused by mental disorders was prevented, approximately 96% of violence that currently occurs would continue.

Moreover, people experiencing mental illness are much more likely to be victims of violence. Though statistics vary, it is evident these persons are at much greater risk of being violently traumatized than the general population, and that this risk has increased over the last 40 years. It’s also probable that these crimes are less likely to be reported. Worse, the victimization and experiences of trauma perpetrated against people with mental illness contribute to worse mental health outcomes and symptom severity.

Lastly, mental illness is not an excuse for bad/aggressive/violent behavior. The two are not synonymous. The most recent estimates suggest 20% of adults in the U.S. have a diagnosable mental illness. Yet, these tens of millions of Americans are not full of hatred, racism, and hostility. Conflating mental illness with terrorism is inaccurate and impedes progress in either area.

Given the unlikelihood of mental illness predicting future violence, perpetuating the belief that people with mental disorders are dangerous is incredibly stigmatizing. Moreover, discrimination related to these baseless stereotypes prevents people who need care, and their families, from reaching out for help. It is possible to promote greater access to mental health care without reinforcing this bias. Focusing on mental illness, broadly, instead of discussing factors that are actually predictive of violence – such as substance use, childhood physical abuse, intimate partner violence, youth, male sex, access to weapons – prevents meaningful change. At a time when change is imperative, further scapegoating of mental health is unwarranted, counterproductive, and harmful.

 

Sarah Woods, PhD, LMFT-Supervisor is an Assistant Professor and Director of Behavioral Health in family medicine, based in Dallas, Texas. She is a families and health researcher emphasizing integrated behavioral health in primary care. This research dovetails with her focus on advocacy specific to mental health access, especially for underserved populations. 

Email: [email protected]. Twitter: @swoodsieb