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Helping A Combat Vet Face His Vulnerability - Page 2

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This wasn’t going well. As a therapist who practices Emotionally Focused Therapy (EFT), I was asking what I hoped were evocative questions, trying to call forth his inner world, which was exactly what he was trying to avoid. Even though I knew a lot about the military—I was a military dependent, did my internship with the Army, and worked with postcombat service members and their partners in EFT-based weekend retreats—I felt like an outsider with Josh.

As he continued with the radio chatter, I noticed how tight his jaw was, and how hard it seemed for him to swallow. In EFT, the foundation of all interventions is empathic responsiveness, so in my effort to stay attuned with him, I allowed his experience to bring up for me past moments in my life when I’d tried to suppress what I thought were unacceptable feelings of pain or fear by clenching my own teeth and tightening my jaw to avoid crying. I became acutely aware of how uncomfortable it is to be experiencing wired-in emotions without any understanding or desire for them.

But having some sense of what Josh must be feeling didn’t mean I could connect with him. He remained tensely remote, and when he did talk, Jennifer was often looking away. She looked exasperated and said how frustrating she found his terse remarks. The only time she talked directly to him was to beg him to get with the therapy program—“Please, Josh. Just start talking. We’ll never get better if you don’t start talking.” This only made him double down in his withdrawal. Sitting rigidly, looking straight ahead, he remained on high alert. He told me that he didn’t feel safe in sessions and, frankly, wasn’t expecting to feel safe.

Faced with his obdurate stillness, I lost any connection with my usual emotional points of reflection—expressed sadness, anger, anxiety—which are so important to building an alliance and beginning to understand a client’s experience. He gave me nothing to reflect back. It was clear that I had to slow myself, and the process, down. I put myself in his position and thought, if I were he, what would I want to know? I assured him the door and windows were unlocked and that he was free to leave anytime. To make myself and therapy safely predictable, I described the way EFT works. I told them that the emphasis was on their interactions as a couple, and that I was working on the behalf of the relationship, not “taking sides.” EFT, I said, is never about fault and blame, but about how partners can learn to reach for each other in moments of need. I added that I wanted to help them both learn how to be there for the other. “We all need to know our loved ones have our backs,” I said.

Being more cognitive with Josh seemed to help. I noticed that he was marginally more receptive to this explanation about the process than he’d been to my attempts to get him to engage in the process, so I also began talking about EFT research. This clearly interested him and, for the first time, he opened up enough to ask me to describe the empirical research in detail. I talked about the effectiveness rate of EFT and he nodded affirmatively in response. I described EFT’s clearly delineated process of nine steps and three stages, and assured him that our process research had demonstrated what changes lead to effective outcomes and how to create those changes in session. Although not always a typical starting point of EFT, this educational, explanatory approach not only seemed to engage him, it made me feel a little more competent and confident.

As I was talking to Josh, I saw tears seeping from Jennifer’s eyes and rolling down her cheeks—which he didn’t seem to notice. I turned to her. “I see your tears and see that you’re touched. What are these tears connected to?” She shrugged and looked away, seemingly not wanting to say more. “Tears of frustration?” I conjectured, using a common EFT intervention (when clients can’t name their own emotion, we’ll often suggest possibilities). “Yes,” she said, “frustration.” “And, helplessness?” I wondered tentatively. She nodded her head. I continued, “I’m wondering—can you help me here? You’re so longing for Josh to open up, to share. You’re so ready to learn how to be there for him. Do I have that right?” I asked gently.

She cautiously said, “I ache to feel married again. I haven’t felt married since he came home. I had such high hopes and such huge anticipation. And, now, just eight months later, we’re so far apart. There’s so much space between us; I do feel frustrated and helpless.”

Upon hearing about Jennifer’s frustration and helplessness, Josh stated somewhat defiantly that he was considering another deployment—“going downrange”—since “at least I feel trained to fight that enemy.” Meanwhile, at home, the real enemy was the negative pattern of interaction he and Jennifer were caught in, increasing the emotional isolation for each and leading to mutual blame. In EFT, we help a couple see this enemy to their relationship, and help them link arms to fight it together.

To bring his attention back to the moment in therapy and away from the idea of another deployment, I started talking about how important his wife must be to him. This was risky since he might well go deeper into his shell, or even indicate that his wife wasn’t nearly as important to him as his buddies. But by highlighting the significance of the attachment—a common tactic for EFT therapists—I was putting their distress in the context of their relationship. I said to Jennifer, “Your partner is so important to you that when you can’t get a connection, you up the ante by getting clingy?” To Josh, making one last try at couples therapy, I said, “For you to come into this foreign and potentially risky environment all because Jennifer wants an emotional connection with you—she must be very special to you; as special to you as your battle buddies are, I imagine.” He agreed with a nod of his head and a slightly perplexed look on his face. This tiny indication that he was beginning to accept the therapy process and my highlighting the significance of their attachment was enough to give me a sense of hope.

At the beginning of session four, desperate to help Josh feel safe enough to continue, I shared with him what I’d learned from working with other Army and military couples. “Going downrange, I know you got all this training about how to shut down your fears in order to complete the missions. But coming home, it seems to me that nobody trains you how to put your weapon down, metaphorically speaking. Of course, you turn your weapon in, but you still have your guard up, preparing for the next round of incoming.” I said. He actually seemed intrigued, so I continued, “The skills you learned to survive war now need to adapt so you can be with your wife. The mission has changed, and I want to help you learn how to be successful with this new mission: connecting with your wife—for the benefit of both of you.”

I tried to normalize couples therapy by telling him that many of his comrades were also seeking it—even if they might not reveal it to their buddies. I told them how much I respected their profession and their sense of mission. Since therapist transparency is a hallmark of EFT, I admitted that I didn’t think I had the courage to go to war myself: “Facing that constant threat and fear would have dismantled me emotionally.” To my surprise, both responded positively to my admission of vulnerability. Josh’s mouth turned upward in the first smile I’d seen from him, and he even began to chuckle a bit, saying, “Oh, you’d learn how to survive. We all did eventually.” Jennifer smiled, too, and said, “We all wondered how we’d endure it all—it’s scary, and it does change you.” She then went on, “War changes everyone impacted by it, and I’ve been so afraid that Josh wasn’t going to see how his deployments changed him and us. I guess that’s why I got so clingy.”

This conversation was a real shift in the therapy. Over the next few sessions, Josh talked about his own experience without the usual radio chatter. As he spoke, his face moved and softened, his eyes opened a bit, and he looked directly at me. He told me how, after redeploying, he’d ended up in a hospital bed with a sudden seizure, which after three weeks in the hospital and a battery of tests, proved to be caused by the stress of coming home and being emotionally ill-prepared for life away from the wars. He talked about how his wife constantly cried at his bedside, making him feel totally inadequate. “Her tears were worse than any threat of an IED,” he said. “I felt more helpless lying in that stupid hospital bed than being a sitting duck in a broken vehicle outside the Green Zone. I kept reminding her that I didn’t die!” Jennifer teared up as he was sharing this, and he looked at her and said, “See—why are you crying? I don’t get it.”

I said, “Let me see if I can clarify the message of Jennifer’s tears.” Turning to her, I said tentatively, “Your tears now, and probably back in the hospital, are all about how important he is to you? How vulnerable you’ve felt being home alone, worrying about him daily while he was overseas, and then worrying about him, for different reasons, once he was home?” She nodded positively while dabbing her cheeks with tissue. “It’s been so hard for you to try and contain your feelings . . . they end up seeping out,” I said in a very soft, low voice.

She nodded again and said, “These tears are about my love for him, my hope for our future, how vulnerable I’ve felt for almost two years now. I’ve tried to hide them—I thought in the hospital I did a pretty good job of hiding them,” as she looked at him. “I didn’t want them to increase the stress on you, but this whole thing has been so hard on me, too.”

I added, “You’d felt so alone, you’d missed him so much, and now he was finally home, but in a hospital bed. It’s been so much to tolerate—so many strong feelings, which any of us would have.”

She nodded and tentatively looked toward her husband again. As she did so, he looked back at her. This was the first time he’d looked at her since therapy had begun.

I slowed the moment down. “Josh, as you see Jennifer looking toward you tentatively, and I see you looking back, what do you feel going on inside of you?”

“I see her sadness, I hear her sadness, and it makes me realize how much she cares,” he said.

“Right,” I said softly, “How much she cares for you. What’s that like to notice how much she cares for you?”

He took a deep breath. “Pretty amazing, actually. I didn’t realize the depth of her feelings, or how much she’d gone through while I was downrange. I’m starting to see how hard it was on both of us, and how much we haven’t talked about this at all.” Jennifer smiled upon hearing this and looked at him.

As he talked about those weeks in the hospital, he said he now realized that he’d been “held together by Scotch Tape.” He continued, “I held it all together for my guys. I was the one who had to be there for them. I remember once when one of them asked me how I was doing, I just said, ‘fine.’ I had to be fine for my guys. There’s no way I could even let myself wonder if I was really doing fine.” The seizure, he admitted, forced him to see that he wasn’t exactly OK. “Looking back,” he said, “I was way more overwhelmed than I even realized. There’d been no time to think about all that I went through, but clearly my brain was full and got all scrambled.” Much to my relief, once he opened up, Josh seemed willing to continue talking, and our sessions became more fluid.

A few sessions later, I began exploring Josh and Jennifer’s coping strategies in distressing relationship moments: his shutting down and retreating and her turning up the emotional heat and pressuring him. Josh was quiet for a moment and then began describing going on autopilot about a week and a half after being on the ground in Iraq. He noticed he wasn’t feeling anything, even when two buddies got hit by an IED. Not being able to feel worried him initially. When he and his unit were camping behind a mosque, he found a bottle of shampoo on the ground and washed his head and face in cold water to try to shock some feelings out of himself. “I knew enough to know that not feeling anything when your buddies get smoked was a bad sign,” he remembered. When shocking himself out of it didn’t work, he figured he’d just better get used to the condition.

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  • Comment Link Wednesday, 28 November 2012 13:23 posted by Kathryn Rheem

    Thanks, Jennifer, for your message about the common challenge of working with all different types of people/clients who cope by shutting down on their emotions. Your point is very salient.

    Many thanks for reading the article and best wishes,
    Kathryn Rheem

  • Comment Link Sunday, 01 July 2012 20:22 posted by Jennifer Gracie

    While shutting down is a coping style which combat veterans may be particularly susceptable to, it is not limited to combat veterans and I found this an encouraging article as to ways of working with a shutdown client. Thank you for keeping this real and showing how challenging this can be for the therapist and all concerned.