After LCL President Jeanne Demers opened the proceedings (as we all enjoyed a rather well prepared meal), Board Chairman Mike Fredrickson, in his inimitable style, bestowed this year’s Volunteer Aware on Richard Soden, who has devoted so much energy not only to LCL but to lawyer assistance programs on a national level.  Executive Director Rodney Dowell provided a rousing summary of LCL’s work over the past year (including the addition of several new LCL Support Groups around the Commonwealth) and its current projects.  Introduced by LCL Clinician Barbara Bowe, guest speaker Michael H shared his fascinating and moving recovery story, leaving those of us in attendance with a sense of gratitude as we capped this fine evening and took our first steps into LCL’s year to come.

LCL psychologist Dr. Jeff Fortgang will facilitate this group, which will meet on the following Fridays at 12:30 pm:  June 28, July 26, August 6, August 23, September 6, and September 20.  You must be pre-registered for this group.  Contact Dr. Fortgang at DrJeff@LCLMA.org or at (617) 482-9600.

Some of us will react in a stronger and more prolonged way than others.  Post-Traumatic Stress is a term coined in the aftermath of the Vietnam war, when some veterans, years afterward, continued to react as if they were in the midst of combat.  (Such syndromes were previously called “battle fatigue,” “shell shock,” etc.)  Clinicians later realized that they saw a similar constellation of symptoms among people who had endured or witnessed traumatic or abusive experiences in childhood.  Post-traumatic features include:

• Hyper-vigilance and exaggerated startle response;
• Intrusive images of the events (in nightmares or while awake);
• Intense distress when exposed to cues representing the event;
• Feelings of detachment or unexpected anger or tears;
• Avoidance of thoughts, feelings, people or places associated with the trauma;
• Problems with concentration and memory

For some or possibly most people, these phenomena begin to fade within a month or so.  For others, they may persist, or even surface years later.  As you might expect, the condition is generally more severe when the traumatizing circumstances continue over time, e.g., a child whose sexual abuse went on for years, or a solder in continuous combat for months or years.  Although we are currently dealing with the events of one day (or a week, depending on how you look at it), we are also dealing with echoes of other attacks dating back at least to 9/11, and with our sense of not knowing what to expect next, and when.

We are also grieving for those whose lives were lost.  Most of us did not know them, but it feels now as if they are part of our extended family.  You have probably heard of the so-called “stages of grief” (which in reality vary greatly among people): denial, anger/guilt, sadness/despair, acceptance and hope.  Acceptance are hope are hard to find, yet ultimately there is no other healthy choice.

Both post-traumatic and grief reactions are normal in the short run.  They become clinical concerns when they persist over a period of months or years, or if they severely interfere with daily functioning.  Even normal reactions, however, frequently cannot be handled solely through avoidance or “stiff upper lip.”  Most of us need to talk to each other repeatedly about what we’ve experienced and how we feel about it.  But different people make their way through this process at different rates of speed; they should be invited but not forced to talk, and their feelings should be heard and accepted, not judged or “fixed.”  And not everyone is ready to listen, either.

We have seen on many occasions that trauma and loss can actually bring about some positive results, and, as the President and others have noted, that was evident in Boston right away.  Our confidence to face any challenge has been bolstered.  Our values may turn away from the superficial and toward what is truly important.  We may better appreciate our friends and family and realize that we are “all in this together.”  Perhaps we more fully experience and appreciate each day.  Finally, the aftermath of a catastrophe may actually help us finding meaning in what we choose to do, personally and in our profession.  May we all find new perspective and inspiration.

Beyond returning to a sense of normalcy, the ultimate goal is also to empower ourselves as individuals and as communities to be a force for healing.  While depressive symptoms are normal following any significant loss, positive action is one of the most effective antidotes.  As we have already seen, it enables many people to live heroically amid extremely adverse and dangerous circumstances, deepening rather than dulling their sense of humanity and compassion.  Here are some additional strategies to help us move beyond feelings of sadness and powerlessness:

• Respect your own feelings and your own process of adjustment.  As intrinsically social beings, most find it helpful to share their reactions and feelings with others.  Talk with friends and family.  Journal, talk to a counselor or clergy person, write a letter.  Stoic avoidance or denial of feelings can result in physical, psychological or behavioral symptoms later on.  Everyone experiences tragedy differently, so don’t expect yourself or anyone else to recover in the same way or at the same rate.
• Remember that no feeling is either good or bad; it is simply data about how something is affecting you.  How you express the feeling, however, can be helpful or harmful.  For example, most of us are likely to experience some level of anger in reaction to these events; anger is infused with energy that can be directed constructively, while of course thoughtless, destructive venting of anger makes one a participant in the same negative energy from which terrorism itself derives.  (Unexpressed anger is thought by many to fuel depression.)
• Take extra good care of yourself and those nearest and dearest to you.  Stressful events, especially catastrophic events, impose strains on the mind and body that can be mitigated by adequate sleep, healthy diet, appropriate exercise, social interaction, quiet time, prayer or meditation, and laughter.
• Take time to re-evaluate what’s important to you.   Re-order priorities and modify your life accordingly.  Reach out.  Enjoy time with family members.  Mend or strengthen relationships.  Seek professional or clerical help if necessary.
• Balance your need for news and information with activity that permits a complete change of focus and mood: listen to music, play with the kids, ride your bike, walk in the woods.
• Find ways to make a difference in your daily routine.  Show kindness and patience in how you drive, treat strangers, interact with family or co-workers.  Volunteer to help in local services, i.e., Red Cross, shelters, literacy programs, Big Brother or Sister.
• Educate yourself; be involved in democratic processes, support sound national policies that serve American values and promote peace, truth, justice and understanding rather than violence.
• Utilize spiritual resources.  In a broad sense, this can include a faith community, 12-step program, meditative practice, etc.  Devoting time to such activities, states of mind, and connectedness to community has been shown to be beneficial to physical and mental health.  The familiar 12-step slogan “One Day at a Time” can be particularly helpful in getting through periods of high stress and change.

The process of adjustment to a major life disruption, though it varies in form among individuals, is a universal human experience.  It permits a psychological restructuring, eventual acceptance, and ability to move forward creatively and constructively, often with greater compassion, a broader vision of self, and a stronger commitment to one’s role in the world.

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

• American Psychological Association on Response to Trauma
• American Psychological Association on Recovering from Disasters
• National Association of Social Workers (Mass. chapter) on Guidelines to Help Children Deal with Tragedy.

Jeff Fortgang, PhD

For years now, with the exception of a couple of nationwide insurance plans (which seem to cover facilities largely in Florida) as well as specially configured union plans for individuals such as pilots and pro athletes, health insurance covers very little in the way of inpatient treatment – generally limited to medically necessary detox (only when necessary to mitigate withdrawal symptoms).  Sometimes it is possible to get insurance to cover a subsequent couple of weeks in a “partial hospital” or “intensive outpatient” program (consisting typically of 3 to 5 clinic visits per week, each lasting from about 2 hours to about 6 hours), and in a few places one can also arrange to reside on site while attending a partial hospital program – these approaches are much less costly than rehabs, and provide a diluted version of some of the same benefits.

A more traditional rehab will cost over $30,000 for a month’s stay; do not expect your Blue Cross, Tufts, Harvard Pilgrim, etc. policy to cover it.  There are programs that cost somewhat less (e.g., with reduced lengths of stay or staffs consisting mainly of counselors with less in the way of medical care).  And if a person needs a sobriety-oriented residence as a next stage of recovery, there is also a 2-tiered world – very comfortable accommodations for those who can afford to spend well over $1000 a week, or relatively rough [but sometimes life-saving] halfway house environments (with long waiting lists) for those without wealth.  (More to come at a later date.)

Jeff Fortgang, PhD, LADC-I

(It’s three blocks from the Harvard  Square T-stop (take the Church Street exit, cross Church Street and go North. An MBTA bus, 77, stops outside the front door, the Everett Street stop going North, the Chauncy Street stop going south.)

Contact: Lottie 617-482-9600

If you are reading this article, you have taken the crucial first step. You are facing the fact that you need to look at the situation, your reduced income, straight on. The most important thing you can do always, but certainly when your means of income has been reduced, is face the situation. Ignoring, running from, or putting off facing reduced means will only make matters worse. So, congratulations, just by thinking of how to handle this time makes you leaps and bounds more prepared than a lot of people. Below are the big questions to consider and resources to assist.

1. What money do you have now?  Take a look at possible sources of money you available to bring you through this time.  A. Cash in bank accounts is the most ideal.  B. Stocks and mutual funds in individual investment accounts that can be sold are an option, but doing so has tax consequences – a capital gain if there has been an increase in value and a capital loss if there has been a decrease. Liquidating stocks and mutual funds in retirement accounts have high penalties and tax consequences. Please check with a tax person before choosing these options. C. Available credit limits on credit cards are even less ideal as the interest rates are high. Think about if you can use your credit card for expenses that you will be able to pay back within the month with unemployment benefits or money from a part-time job. D. Borrowing is an option. There may be someone in the position to help you through this temporary situation, but consider this option carefully. Paying back what you borrow will be crucial to the relationship.

2. What money can you save? Look at what you can save such as cheaper food bills, cutting cable plans, or taking public transportation. You may have auto-payments or auto-saving plans set up that you can no longer afford such as monthly amounts put into a bank account. It may be a good idea at this time to remove auto payments of bills so you will have greater control of when you pay certain bills.

While you are trying to reduce your spending, remember one expense will increase, the money you spend looking for a job. It takes money to drive, park, print necessary paperwork, dress for a job interview, and attend networking events.

3.  Time your inflows and outflows of cash. While you are culling through your expenses, create a monthly budget of expenses. I like to make my budget not just with amounts, but showing days I pay for items. Think of paying bills as outflow and any money receive as an inflow. By showing which days there are inflows and outflows you can see if you need to delay the payment of bills to a certain day.

Call the customer service number found on bills and ask to rearrange amounts owed to lesser amounts and/or different days of the month. Remember it is always an option to ask for different payment dates. Also, you may be able to change the payment amount.

4.   Enjoy your life, even without spending money.  Remember this time, although it is a trying time, is part of your life so try to think of inexpensive ways to still do what you like to do. Perhaps it is the time to try cooking because eating out is expensive. Universities, libraries, and bookstores have free speaking events. Museums have free days and evenings. Free concerts are held in all sorts of venues. You can check out DVD’s at the library. A content person with interests will likely interview well.

5.  Resources for dealing with limited finances

http://www.usa.gov/citizen/topics/family/help-for-difficult-financial-times.shtml

http://www.nfcc.org