Time and Attention

Chance Agrella-freerangestock.com The past or future can be hot spots for people who are in treatment as a result of a loss (death, career, marriage, identity) or trauma.  In the grief and loss groups I facilitate, I spend a few sessions on the subject because attention away from the present can be a barrier to adaptive grieving.

Living in the past, or rather, replaying it over and over again, typically leads to sadness, anger and regret.  Focusing exclusively on the future typically leads to anxiety and fear. The former has to do with guilt and inadequacy while the latter centers on safety and predictability. To be clear, there is a difference between reminiscing (past), planning (future) and ruminating on the two.

While we encourage remembering in our work with clients; not all remembering is good- it depends on how you go about it.  “Remembering”, to assign responsibility or “undo” the event in our thinking is generally harmful because it can create a series of movies that act as evidence to our “mistakes”.  While reasonable and focused planning is necessary, constantly being on guard against future losses or harm is the product of or can lead to hypervigilance; we prioritize safety in a way that disproportionately affects other parts of our lives.

Folks who struggle with loss and trauma sometimes play the “what if” game. Having behaved differently before or in response to the loss or trauma may or may not have produced a different result.  Even if the result were different it may not have been more desirable. Survivors of sexual trauma may struggle with having  “given up” during the trauma – feeling ashamed and inadequate about the fact that they did not fight long enough. In reality, not fighting after being overpowered may be a reasonable choice a survivor makes during the traumatic event as it represents a shift in strategy from trying to stop the act to surviving the act.

Other survivors may struggle with the position they feel they placed themselves in just before the trauma; feeling “stupid” or responsible for the act. Most acts of sexual trauma (90+%) are committed in environments familiar to the survivor by a person known to the survivor.   To have expected the event would have required more than hypervigilance; like having a sixth sense.  Survivors of trauma who hold on to this expectation in their understanding of the event may be more prone to hypervigilance or re-enactment – placing themselves in unsafe situations as way of gaining mastery over the original trauma.

It’s unreasonable to expect someone to just turn the thinking off in the early stages of treatment . The ability to turn it off is a desirable mid- long term goal; but in the short term objectives may have more to do with shifting attention away from the past and future or thinking about each in ways that do not consume time, impact functioning or trigger unsafe behaviors.

With regard to grief, one strategy involves creating time in your schedule to remember a loss while allowing yourself permission not to think about the loss until your appointment with it. The appointment can include  journaling, art, prayer, looking at photo albums with family members, a church service, a therapy session or support group – anything that is action oriented, time limited and most people would describe as healthy and reasonable. Anticipatory anxiety about the approach and the distress involved with tolerating the activity can be mitigated by engaging in activities such as attentive breathing or exercise before, during and after the activity.

With regard to physical or sexual trauma, “thinking” about it should probably be handled in a context that prioritizes safety with access to expertise or help readily available.  Support groups or therapy  can be the appointment that provides opportunities to work through the trauma. In our practice, work involving trauma occurs within a framework of a highly structured and guided process that seeks to mitigate the risk of unsafe emotional escalation.  It begins with increasing capacity to tolerate memories of the event by learning and reinforcing coping skills then, when a person feels ready, directly addressing the event through some form of exposure therapy.

The “appointment” with the loss or traumatic event allows survivors access to a credible holding ground – it gives them a receptacle they can use to contain the material when it’s not safe or convenient to think about.  Thinking about therapy or any other safe activity in this manner can help increase the credibility clients give to attentional coping skills like mindfulness or “stop’ techniques because we are speaking to their desire to address the events while giving them “permission” to get relief from the material.

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