Nationally and internationally, the most endorsed response in the first hours and weeks after a traumatic event is Psychological First Aid.
Just as Medical First Aid is given immediately to a person to minimize injury and reduce future medical complications and disability, Psychological First Aid involves providing connection, safety, basic needs, information, and recognizing if professional care is needed as a way to reduce the possibility of longterm emotional impact.
Couples Psychological First Aid unfolds from an understanding of the power of attachment by researchers like Alan Shore (2003) . It causes us to recognize that in the immediate aftermath of crisis, disaster, and unanticipated loss, the presence of the partner, even their voice on a phone, has a more soothing physical and emotional impact than that of anyone else. Actually, couples often have a great deal to offer each other but they are often uncertain how to proceed or whether their presence even makes a difference.
Carey was hysterical when she learned that her younger brother, just 30 years old, had been diagnosed with late-stage lung cancer. Jack, her husband, was also stunned and not sure how to help. The only thing he could do was listen and hug her…While trying to understand her brother’s illness, Carey began to repeat, “This can’t be true. Who is healthier than my brother? You know him—he never even smoked! What happened? Tell me what you think happened.” Feeling the intensity of her pain but knowing he had no answers, Jack held Carey and said “Carey, I don’t know. I hear you—it’s too much to believe. He’s your brother, I know how much you love him and it just doesn’t make sense. It’s just too much.” ( Excerpt from Healing Together p.31)
Feeling helpless and upset himself, Jack did not realize that he was actually using Couples Psychological First Aid. The Four Principles of Couples Psychological First Aid include:
- Being a compassionate presence for each other
- Establishing physical and psychological safety
- Identifying and responding to needs
- Offering practical assistance and supporting coping skills
You may find as these are explained that you are already using some of these, that others seem too simple to make a difference or that some feel too difficult to try. Much as you would with any First Aid Kit, reach for what you can. As you proceed you may notice other useful things.
Being a Compassionate Presence is demonstrated by “just being there,” “the gift of containment” and “active listening.” In the case of Carey and Jack, by just being there to hug Carey, Jack was letting her know that he would be there and accept her no matter how she felt, a connection that helps reduce hyperarousal and stress. Jack’s quiet listening (he didn’t know what to say!) helped contain her overwhelming feelings. Just having your feelings heard by someone you trust helps contain them. It is as if someone else is holding them for you. The way in which Jack put himself in Carey’s shoes and verbalized what she seemed to be feeling (“I don’t know,” “It just doesn’t make sense”) is a good example of active listening. This empathic way of listening and responding without judging, solving or minimizing was first suggested by Carl Rogers in 1969. It is a way to be empathically attuned to your partner – something more important than any solution can offer.
Establishing Physical and Psychological Safety – Because the mind-body connection is very powerful, one of the most important things after truama is reducing the degree and duration of stress on your minds and bodies. The questions I always ask couples to consider are: Are you sleeping? Are you eating? and What are you doing to relax? Essentially recovery involves “resetting your body rhythms.”
I suggest that couples watch and guide each other gently. No one needs to be reminded that they are not sleeping, eating or relaxing – they know it! Normalizing the disruptions of body rhythms, modeling different behavior in yourself, going for a medical consult if needed, inviting your partner for the walk around the block or even halfway, suggesting a ride to the beach even though it is winter, inviting the other to go to the mall even if you hate shopping, are steps forward.
In the case of Hank and Cathy, her refusal to eat, much less cook, after the loss of their son was responded to by Hank’s somewhat desperate attempt to replicate her recipes. When Cathy said she was uninterested in trying the meals, he asked if she would just sit with him while he ate, which gave him an opportunity to gently ask her where he went wrong with the pasta. She started tasting a little and smiling a bit. She was still too heartsick most of the time to eat much – but she couldn’t completely ignore his non-stop efforts.
Identifying and Responding to Needs In the aftermath of trauma,the best focus for needs is ” he, she and we.” Essentially this means keeping a balance of care for self, partner and the relationship you share. Most partners try to keep an eye on the other’s needs – but this is not always easy. Communicating your own needs is crucial and may help your partner consider his or hers. It is not selfish – it is clarifying. Sitting back to see if the other remembers or somehow knows your need is a no-win situation.
Often, if the particular trauma has happened only to one partner, the other becomes the forgotten one by self and other. This is the missed recognition that whether it happens to one or both, trauma affects both because they are partners. He needs you to go to the gym and you need him to play cards because fueling self empowers you to be able to care for the other people in your life.
In most cases the aspect most forgotten are the needs of the ” We.” Who is thinking as a couple when you are relocated or grieving? It is not easy but it will nurture something important – your relationship. It doesn’t take much to bring in a thread of a couple’s bond – two cups of the favorite coffee shared, the surprise of a CD of old songs in the car, a text message sent and received with love – why? Because what you had and have as a couple will help you through this.
Offering Practical Assistance and Supporting Coping Skills– In the aftermath of trauma, people often have trouble concentrating or focusing on tasks they had performed with ease. There is a shutdown of the ” thinking” part of the brain to optimize the fight-or-flight response to the crisis you just faced. When couples can recognize this about each other they really can step up and step back for each other in a way that is supportive and restorative for both.
In the case of Alice and Joe, when she returned to work a week after her mother was killed in a car accident, it was as if work took all her energy. She seemed unable to get to the kids’ homework or the bills – things she had always done. Without saying much, Joe just started picking up the slack. Feeling guilty at first, Alice soon started to relax and could tell Joe what a difference his help made.
Couple Psychological First Aid is meant to give you both a way to think about, respond to each other and support the bond you share. Remember – Recovery from trauma is not an event. It is a process.
For Further Reading
Shore, A.N. (2003) Affect Regulation and The Repair of the Self. New York: W.W. Norton
Rogers, C. 1989. The Carl Rogers Reader. New York: Houghton Mifflin.