Caring for the Caregiver

            Last week, I went with a team from the Ateneo de Manila Department of Psychology in response to the psychological needs of our countrymen who were affected by the typhoon and ensuing flood that was Sendong.  In coordination with Xavier University, we conducted two 4-hour training sessions attended by volunteers, government workers, and staff of NGO’s who were working with those directly affected by the natural disaster. 

            At first glance, the situation in northern Mindanao struck me as a disaster that affected practically everyone.  From the time we were coordinating our trip, this was the picture painted to me.  And true enough, no one was spared among the people living in the areas of Cagayan de Oro and Iligan City, the cities worst hit by the natural calamity.  Whereas many were directly affected, losing homes and loved ones, a majority were indirectly affected, being related to or knowing people whose lives will never be the same again.  And this impression was confirmed when we began our training sessions by asking our participants to share their stories of their own experiences. 

            Each one had their own stories to tell.  Some stories were about their awakening from ignorance and apathy to realization and involvement.  There were many who never thought that such an event could happen in northern Mindanao, the so-called typhoon-free area of the Philippines.  And as soon as they learned of the extent of damage that Sendong wrought, they found ways of involving themselves in the relief efforts.  There were also stories of helplessness and panic in the midst of the events, such as one who received a phone call in the middle of the night from another who was on top of a three-storey building with flood waters rising fast from the second storey of the same structure. 

            Soon after one of our training sessions, one participant approached me to thank our team for our efforts.  She mentioned how she realized that relief workers also needed to tell their stories.  She mentioned the valuable lesson that people working with those directly affected by traumatic events also needed some kind of emotional support. 

            “Caring for the caregivers” is the phrase we use to call this practice.  In fact, this is a need that is often forgotten.  When we are giving and caring for others, we often overlook the need to take care of ourselves, if not receive care from others.  And yet, only when we feel that we are well are we able to care for others adequately.  As emotional and psychological needs may not be as basic as survival needs, providing for such needs entails that one is able to sustain more basic needs first. 

            And so, if you are taking care of others in one way or another, I wish to ask the following question:  How are you taking care of yourself?  

Helping Oneself in Times of Disaster

            Last Saturday, the most disastrous typhoon and flooding struck our brothers and sisters in northern Mindanao, affecting thousands of people.  For many people living in the capital, Manila, this is strikingly reminiscent of the flooding that the typhoon called “Ondoy” caused a couple of years back.  

            There are essentially two sets of psychological reactions that people experience when they are affected by such natural calamities.  One is the typical reaction that people experience to acutely stressful events.  I wrote about this in my 20 August 2010 entry on this blog.  The other is that of grief and bereavement due to the death of a loved one or the loss of something of value.  I wrote about grief reactions dated 26 March 2010.  Whereas stress reactions are quite normal reactions, grief is a process that needs to happen over time. 

            In dealing with acutely stressful situations such as typhoons and flooding, it is important to address the most basic needs first.  And so, we can go back to Maslow’s hierarchy of needs (see post 28 May 2010) to understand that basic survival needs should be addressed.  Making sure that there is food, water, shelter and clothing are essential here.  Soon afterwards, if not concurrent with this, is the need to establish safety and security.  When one’s life is threatened, the reassurance that one is safe will quickly help the individual re-establish one’s feeling of control over one’s life.  Only after this is established shall emotional and social needs become more apparent. 

            For people who were severely affected by a destructive natural calamity, here are some tips that can be helpful: 

·         Get back to rebuilding your life as soon as possible

·         Establish a predictable and regular daily routine (e.g., sleeping and waking, meals, self-care habits, etc.)

·         Share your thoughts and feelings with friends and family; seek their support

·         Accept the help of others

·         Do regular physical exercise

·         Despite the disaster and difficulties, think of what you can be thankful for

·         Connect with your God and pray

·         Do relaxation exercises (e.g., belly breathing, imagery, meditation, etc.)

·         Distract yourself with life giving activities (e.g., tell jokes and laugh, sing and dance, play games, engage in hobbies, etc.) 

·         Help others and volunteer your services to the community

Specific Learning Disabilities

            At 8 years old, Linda is having problems in school.  In fact, her teachers have noticed her challenges soon after she entered Grade 1.  No matter how her teachers taught her to follow the model on her penmanship notebook, she frequently reversed certain letters.  Up to now, she still struggles in reading.  She tends to read the first two letters of the word and guesses the rest of the word.  Using this strategy, she sometimes pronounces the word correctly, but she is more often unsuccessful.  Her teachers have called her a “slow learner” and her parents believe that she will outgrow her problems.  After all, she is able to deal with the other challenges she faces in school, and has a healthy set of friends. 

            From this story, there is a strong likelihood that Linda might have a condition called a learning disability.  This condition is characterized by a difficulty to learn a particular skill set that is usually acquired through one’s school attendance.  It is often limited to a particular skill area, such as, reading words and texts, understanding what is read, speaking, understanding language, writing and spelling, and dealing with numbers and math concepts. 

            There are many names that specific learning disabilities are called.  Some people refer to them as “learning disorders,” and others call them “learning discrepancies.”  Still some use the words “learning problem.”  There are also specific names to certain learning difficulties.  Some of the more common names include the following:  “dyslexia” for a reading problem, “acalculia” for a math difficulty, and “dysgraphia” for a writing problem.      

            Of course, children learn many of the skills taught in school over time.  Many children typically fumble with language, reading, writing, and math and master the various levels of competency and fluency required over the years.  Nevertheless, teachers often have a sense of a particular student’s difficulties when most of the children in the same class have already mastered a skill that had been taught, and this one (or two) student(s) still struggle with past lessons.  This is often the time when a student may get referred to consult a specialist. 

            Children with specific learning disabilities are also quite intelligent, and they wonder how it is that their classmates are already able to master certain skills, whereas they are still struggling.  Although specific learning disabilities are fairly limited in scope to the lags in the particular learning area, this often has emotional and social repercussions for the child.  As children develop their sense of competence and self-concept, unaddressed lags can cause persistent feelings of frustration.  This can affect a child’s emotional life and peer relationships. 

            Specific learning discrepancies are said to be conditions rather than an illness.  That means that it is not something one develops.  It may really be caused by the way a child’s brain is wired.  Because of this, there are currently no medications or quick fixes that will address these problems.  Interventions are often long term, as it entails teaching the child habits that would help them cope and deal with their difficulties. 

            As such, there are many specialists who can help children with specific learning problems.  The primary interventions are educational, usually conducted by specialists trained in addressing each specific learning disorder.  A reading specialist might be one of these professionals.  Another is a teacher trained in special education.  Speech and language pathologists are also involved in language deficits (both listening and speaking).  Psychologists, counselors, psychiatrists and developmental pediatricians are often support professionals who help identify and address issues that may accompany the learning disability. 

            In time, Linda was referred to a psychologist, and is now undergoing daily educational interventions.  She is beginning to learn to read, and is coping better with the demands of her school. 

Name Game in Emotional Management

            For many of us, going to school meant learning the basics of math, reading, and writing.  Day in and day out, we engaged in one drill after the next to master these basic skills for learning.  Seldom did we talk about feelings in classrooms, as if these internal experiences are not really important.  In fact, we need to learn about our feelings.  Like most learning, this is not something we innately know.  And only when we know the full range of our emotional experiences can we start to venture into managing them. 

            Feelings are hard to control.  They come and they go.  Oftentimes, we have little direct power over our emotional reactions.  Three extreme feelings that get in the way of healthy living are rage, depression, and anxiety.  In separate entries, I have written about each of these.  These are feelings that we might experience intensely, and we often do not know how to help ourselves.  As children, we might have even been disciplined when we expressed these emotions.  And so, many of us have learned over time to hide them and pretend they never exist.  This is certainly a denial of the emotion, rather than its management. 

            Ironically, the first step towards managing one’s emotions is acknowledging it.  We need to give it a name for us to know how to handle it.  One of the greatest mistakes many people make is to deny their feelings and hope that they go away forever.  This seldom happens, as emotions have a life of their own.  They need to be acknowledged in order for them to take their course. 

            After acknowledging our feelings, we might want to decide what to do with it.  When we understand our thoughts that occur with these feelings, we have a better understanding of the power of these feelings over us.  Doing relaxation exercises help us calm ourselves down in times of intense emotions.  Only when we are able to think rationally can we really make a good decision about what to do about our feelings.  That sounds paradoxical, but true.  Thoughts have a role in emotional management.  If only to take a break from our feelings for a short time, we might also do something to distract ourselves.  We can practice ABC-DEF (as explained in this blog dated 10 August 2010) to manage feelings more effectively. 

            On the 7^th of December 2011 (Wednesday), my colleague from PsychConsult, Inc., ZsaZsa Briones, PhD, and I will be facilitating a post-conference workshop at the SMX entitled “Bago Maghalo ang Balat sa Tinalupan:  Teaching Children to Effectively Manage their Feelings.”  It is one of the many workshops on offer after the 2-day “Ako Para Sa Bata-The Manila Conference:  Creating a Safe and Caring Environment for our Children.”  We hope to incorporate the principles and practices of effective emotion management that we need to practice and teach our children.  You may view details from this link <http://www.speedycourse.com.ph/events/4597/ako-para-sa-bata-the-manila-conference---creating-safe-and-caring-environment-for-children>. 

Working with Other Professionals

            Janet was diagnosed with Autism when she was about 4 years old.  Her parents brought her to a Developmental Pediatrician who made the diagnosis then.  She was then referred to various other professionals.  She initially saw a Speech and Language Pathologist to help her with her speech.  At 4, she was barely able to say words clearly, much less say phrases or construct sentences.  After a couple of months of intensive speech therapy, she was then referred to an Occupational Therapist.  She appeared to have delays in being able to control both her big muscles and her small muscles.  Her gait and coordination was also not very good, and her attention span was rather short.  Janet eventually had to enter a school that could accommodate her special needs. 

            Clearly, a few professionals are involved in making sure that Janet’s needs are met.  This is not unusual, particularly with children who have special needs.  Some questions that come to mind when a few professionals are involved in serving the same person are as follows: 

-   To what extent should the professionals work together?  Is it enough that progress reports get passed on from one professional to another or should there be a greater collaboration and coordination among these professionals? 

-   If they are to coordinate, how often should they meet and what should they discuss in these team conferences? 

-   How can parents and guardians get involved in all these collaborations?  What roles do family members have in these situations? 

-   When there are decisions to be made, who makes it for the client?  To what extent can medical professionals recommend appropriate educational environments for these youngsters?  When there are conflicting opinions, who has the last say?     

            The questions I am raising above are very pertinent questions both for professionals like myself who work with various clients seen by different professionals concurrently, and clients and their families.  Unfortunately, there are no easy answers to many of these questions.  In the end, the primary stakeholder in any situation is the client.  When this client is a child, parents take the lead in making sure that the best interests of the child is protected at all times.  At the same time, all professionals must have this in mind as well. 

            Maximizing the team collaboration among various professionals in the Philippines is a huge challenge.  With various professionals working in different settings and hardly having a common venue to meet and discuss common clients, clients and their families may find themselves taking at least some effort to coordinate various professional services.  Many families also lack the necessary knowledge and resources to even do this.             

            My colleagues and I in PsychConsult regularly experience the challenges of closely collaborating with various allied professionals who work with both children and adults alike.  Because of this, we have chosen to discuss this important matter as our main program in celebration of our 10^th anniversary.  We entitled our round table discussion “Enriching Filipino Minds and Hearts: A Multidisciplinary Collaboration among Allied Mental Health Practitioners.”  Various professionals and stakeholders will be there to express their views on the concept of professional collaboration, and how these are translated into everyday practice.  Speakers are also invited to express ideas and strategies on further improving this collaborative thrust. 

            You are invited to attend this free event, which will be held at the Ateneo School of Medicine and Public Health on Saturday, 26 November 2011, from 1-5pm.  For more details, visit our website at www.psychconsult.com.ph or our Facebook account named PsychConsult Grp.  Do pre-register by calling Chona at 4212469 or 3576427 or sending an Email to psychconsult@gmail.com. 

Hoarding

            Glenda hardly invites people to her house.  She lives alone and is ashamed of how it looks.  Her entire apartment, albeit small, is just full of things that she is unable to dispose.  She keeps thinking that she will find some use for her things some day.  She keeps all sorts of objects, from old magazines and newspapers to souvenirs she picked up from the different places she has been.  She also finds herself buying many things she does not really need, which only add to the pile of things in her house.  Because of all her things, she can hardly move around her house.  In fact, she has chairs and furniture that cannot be used because they are just piled up with various objects. 

            Glenda is said to be hoarding.  This is a habit that ranges from a common fear of not having something when the need arises to a debilitating pattern of hoarding for its own sake and being unable to let go of the cycle.  Some of us might buy a few more of a certain product for fear that stocks might run out, and consequently end up with more items in our cupboards than is really necessary.  This habit can reach an extreme when one is unable to distinguish the value of different items, holding all items as equally valuable and being unable to let go of any of them. 

            When the pattern of hoarding becomes so extreme that clutter in one’s living area gets in the way of using space and furniture efficiently and one is unable to distinguish the relative value of the items being stashed, a more serious problem can be considered.  Hoarding can be considered a subtype of Obsessive Compulsive Disorder.  Obsessive doubts often give rise to anxiety that the hoarding habit temporarily assuages, which can repeat itself to form a kind of coping pattern. 

            Ironically, many people who suffer from this pathological habit of hoarding often do not understand why they do it.  In fact, this is one question they keep on asking themselves.  The real causes of Obsessive Compulsive Disorder is likely to be an interaction among biological (meaning both biological and neurological) and learned behaviors from childhood.  The anxiety that these people experience has been reported to be at a very young age. 

            Treatment is often a combination of the use of medications and psychotherapy.  In psychotherapy, people who suffer this behavior are often taught to deal with their feelings in more effective ways.  Their hoarding behaviors are also directly addressed in helping them address their anxious feelings more effectively.  They are also taught various strategies in gradually lessening their hoard and slowly managing their clutter. 

            Learning to moderate one’s standards by accepting that less than perfect is “good enough” is fostered among these people.  Discriminating between more important matters that need more detailed attention and other concerns that can be set aside indefinitely (e.g., medication and money vs. extra towels and old newspapers) is crucial in recovery.  Ultimately, these people need to define for themselves what is just “good enough.”  This will then determine the extent to which they will stash on some items, but maybe not on most. 

            It’s a long and difficult road to recovery for Glenda, but with continued treatment and conscientious effort, she can get better manage her anxiety and deal with her hoarding behavior more effectively.