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Similar a 14174_PTSD and Family Relationships_VHA Caregiver Training
Similar a 14174_PTSD and Family Relationships_VHA Caregiver Training (20)
14174_PTSD and Family Relationships_VHA Caregiver Training
- 1. PTSD and Caregiving: Communication, Parenting and Self-Care Presenter Name Presenter Title Presenter Name Presenter Title
- 2. What best describes your relationship with the Veteran for whom you are caring? A. Parent B. Spouse/Partner C. Child D. Sibling E. Friend F. Other Family Member Poll Question
- 3. Knowing You’re Not Alone Hope for the Future Supporting Veterans, Caregivers, and Their Families
- 4. Areas of focus Communication Parenting Self-Care
- 5. Poll Results What best describes your relationship with the Veteran for whom you are caring? A. Parent B. Spouse/Partner C. Child D. Sibling E. Friend F. Other Family Member
- 6. Poll Results What best describes your relationship with the Veteran for whom you are caring? A. Parent B. Spouse/Partner C. Child D. Sibling E. Friend F. Other Family Member
- 8. Avoidance Afraid to address what happened to them Family members fearful of examining the event
- 9. Reactions Knowing that something terrible can happen can make people feel fearful Trauma reactions change how a survivor feels and acts This change affects everyone in the family Very often trauma survivors feel “on edge” due to preoccupation with staying safe
- 10. Interplay of Reactions Family members often feel upset that their loved one has gone through a trauma How the trauma survivor and family member communicate about their reactions is important “She thinks I’m weak” “He is always withdrawn from us”
- 11. The following are forms of relational stress that are commonly experienced. Have you experienced any of the following in your relationship? A. Arguments and feeling on edge B. Feeling cut off and lonely C. Feelings of guilt, anger or embarrassment D. Fearful of moving forward with activities you are interested in E. Several or all of the above Poll Question
- 12. Guidance for Caregivers Be cautious about showing doubt about Veteran’s story Be cautious about asking interrogative questions
- 13. “I am sorry that this has happened to you.” “You are not alone,” or “This has happened to other Veterans.” “That must have been very frightening.” DO express care and concern: normalize trauma reactions, say things like: validate the experience:
- 14. The following are forms of relational stress that are commonly experienced. Have you experienced any of the following in your relationship? A. Arguments and feeling on edge B. Feeling cut off and lonely C. Feelings of guilt, anger or embarrassment D. Fearful of moving forward with activities you are interested in E. Several or all of the above Poll Results
- 15. The following are forms of relational stress that are commonly experienced. Have you experienced any of the following in your relationship? A. Arguments and feeling on edge B. Feeling cut off and lonely C. Feelings of guilt, anger or embarrassment D. Fearful of moving forward with activities you are interested in E. Several or all of the above Poll Results
- 16. &Relationship Dangers High divorce rates Increased risk of partner and child abuse Risk to partner’s mental health PTSD
- 17. “We” versus “You” Approach to PTSD Communal coping—associated with healthier relationships—How “we” deal with problems Communal view—coping with problems as “We” Communication—“On the same page” about problems Communal action—Partners discuss and both take action in addressing problems Communal coping Associated with healthier relationships—How “we” deal with problems Communal view Coping with problems as “We” Communication “On the same page” about problems Communal action Partners discuss and both take action in addressing problems
- 18. Communication Strategies Passive Assertive Aggressive
- 19. Listening Empathy Hearing the other person out “We” approach to problem solving It may be the PTSD, it may not “Walk a mile in someone else’s shoes” Respect &
- 20. Listening Strategies Ask clarifying questions Paraphrasing Tone of voice Body language Attentiveness Eye contact Facial expressions VerbalNon-verbal
- 21. Take a time out! This allows both partners to calm down and collect their thoughts. But there are rules. Strategies to De-escalate Arguments
- 22. Code word or sign Set a time to reconnect Plan ahead
- 23. PTSD&Parenting
- 24. You know your Veteran and child the best Take into account your child’s age and development You Know Best
- 25. What impact can PTSD symptoms have on parenting? What may a child’s experience of these symptoms be? Impact of PTSD on Parenting and the Child’s Experience
- 26. Depression Emotional Numbing Irritability Anger outbursts Panic attacks
- 27. A research study with married OEF/OIF Veterans who were referred to mental health treatment in VA found … reported difficulty reintegrating with their family 75% (Sayers, Farrow, Ross, & Oslin, 2009)
- 28. felt “like a guest within their home” 41% A research study with married OEF/OIF Veterans who were referred to mental health treatment in VA found … (Sayers, Farrow, Ross, & Oslin, 2009)
- 29. A research study with married OEF/OIF Veterans who were referred to mental health treatment in VA found … reported “their children acting afraid or not being warm towards them” 25% (Sayers, Farrow, Ross, & Oslin, 2009)
- 30. Parenting difficulties were greater among Veterans with PTSD (Sayers, Farrow, Ross, & Oslin, 2009) A research study with married OEF/OIF Veterans who were referred to mental health treatment in VA found …
- 31. Does your family talk about your Veteran’s PTSD or mental health concerns? A. Yes B. No Poll Question
- 32. If you’re like a lot of families, NO one talks about it.
- 33. Barriers to talking with children about PTSD You don’t know how to explain it to your children Talking about it is painful You feel shame, guilt, and embarrassment You worry about how your child will perceive you You are afraid your children may tell others
- 34. Poll Results Does your family talk about your Veteran’s PTSD or mental health concerns? A. Yes B. No
- 35. Poll Results Does your family talk about your Veteran’s PTSD or mental health concerns? A. Yes B. No
- 36. with children about mental health issues is encouraged Direct communication
- 37. How to prepare… Discuss what/when/how openly with your Veteran Do your homework
- 38. Regularly open the discussion Timing is everything Encourage children to ask questions and share feelings
- 39. Be hopeful yet honest Start the conversation Encourage sharing and Be aware of your and your Veteran’s feelings Pay attention to your child’s reaction Starting the conversation … slowly questions
- 40. Avoid sharing details of Veteran’s traumatic event(s) Help child understand specific symptoms and how to cope
- 41. Daddy feels uncomfortable in large groups. That’s why we take two cars when we go to family gatherings – it allows him to leave early if he wants to. “
- 42. Mommy is really sad today. She wants to come to your soccer game tonight, but doesn’t feel well enough to come. I bet she’ll look forward to hearing the details when you get home and I’ll be sure to take some pictures! I know you may feel disappointed – she does too! Depression can be tough for all of us. “
- 43. Talking to your child… “You cannot ‘catch’ PTSD” “Many helpful treatments available” “You are not to blame” “I don’t have all the answers”
- 44. What are some red flags that I may need to explore professional help for my child?
- 45. Comments about self-harm Aggressive / violent behavior Admission to psychiatric unit Inability to maintain employment/schooling Severe depression/ withdrawal VETERAN Red Flags
- 46. Comments about hurting self or others Depression/Anxiety Regressive behaviors Increased clinginess and crying Aggressive behavior Changes in sleeping/eating/weight/energy Changes in school behavior CHILD Red Flags
- 48. Avoiding isolation Maintaining a social life Maintaining pleasant activities Sleep, diet, exercise Spirituality Self-CareCaregiver
- 49. Slide 22: HOPE – some graphic here
- 50. Being a parent is challenging PTSD affects everyone It is important to talk to your children about it Maintain family routines, rituals, one-on-one time Self care is important to get yourself through the tough times Ask for help
- 52. National Center for PTSD Website www.ptsd.va.gov Ask the Presenter
Notas del editor
- Caregiver Support Coordinator www.caregiver.va.gov
- P1: remind audience that poll is completely anonymous
- Engaging Building trust and safety Support Network
- How each family member impacted by PTSD How you might handle different situations that come up Adult/couple communication, summarizing in relationship to Vet and Caregiver Move outside energy that PTSD creates in home and care for selves
- P1: remind audience that poll is completely anonymous
- P1: remind audience that poll is completely anonymous
- Brief statement about this section
- If the trauma is associated with shame (for example, rape), they won’t talk about the event
- P1: remind audience that poll is completely anonymous Arguments Caregiver feels cut off, lonely Feelings of guilt, anger, embarrassment Caregiver curtails activities Caregiver on edge Difficulty focusing on conversations, remembering leads to arguments Caregiver at risk for distress
- Do not appear to doubt or disbelieve the Veteran’s account of what happened. Do not ask questions or make statements that suggest that you hold the Veteran responsible for traumatic experiences, like: “What were you doing in a place like that?”
- Do express your care and concern: “I am sorry that this has happened to you.” Do normalize trauma reactions, say things like: “You are not alone,” or “This has happened to other Veterans.” Do validate the experience: “That must have been very frightening.”
- Arguments Caregiver feels cut off, lonely Feelings of guilt, anger, embarrassment Caregiver curtails activities Caregiver on edge Difficulty focusing on conversations, remembering leads to arguments Caregiver at risk for distress
- CLICK TO NEXT SLIDE - DO NOT DELETE
- Concepts, not definitions
- Assertiveness is a key component of communicating effectively Passive VS Assertive VS Aggressive—what’s the difference? Assertiveness = Respecting yourself by communicating your needs while also respecting the rights and needs of the other person
- Hearing the other person out “We” approach to problem solving It may be the PTSD, it may not “Walk a mile in someone else’s shoes” Respect
- Verbal Ask clarifying questions Paraphrasing—telling the speaker what you heard Tone of voice Non-verbal Body language—leaning forward slightly, legs uncrossed Attentiveness—not looking at the clock or fidgeting Eye contact with the speaker Facial expressions—smiling, looking interested, appropriate reactions to topics
- Multiple slides Take a time out! This allows both partners to calm down and collect their thoughts. But there are rules: Have a code word or sign for taking a time out Set a specific time to reconnect and continue the discussion. This should be within 24 hours of initiating the time out Develop these guidelines for taking a time out with your partner before the first time you use it
- Multiple slides Take a time out! This allows both partners to calm down and collect their thoughts. But there are rules: Have a code word or sign for taking a time out Set a specific time to reconnect and continue the discussion. This should be within 24 hours of initiating the time out Develop these guidelines for taking a time out with your partner before the first time you use it
- PTSD can have ripple effects on all parts of the family [image of mobile?] Now we’re going to shift our focus to your role as parent. May include some tips that will be helpful for your veteran as a parent, but focus is primarily on you as caregiver. We hope to Encourage reflection about what it may be like for your veteran to effectively parent in light of his/her symptoms of PTSD Consider how your child may respond to the PTSD symptoms in your veteran Provide some tips about talking with your children about PTSD
- Information presented today based on our research and combined over 50 years of clinical experience. However, YOU know your veteran and your child the best, and the general ideas may not apply to your situation. Take what is helpful and don’t worry about the rest! All of these ideas must take into account your child’s age and development.
- Consider the following common symptoms of PTSD High levels of anxiety Discomfort in crowds Hypervigilance (“on edge”) What impact can they have on parenting? What may a child’s experience of these symptoms be?
- Depression Emotional Numbing Irritability (general low-level frustration) Anger outbursts Panic attacks Every veteran, child, and family is unique….but it’s helpful to consider how tough it can be to be a good parent when struggling with mental health symptoms, as well as some common kid reactions.
- A research study with married OEF/OIF veterans who were referred to mental health treatment in VA: 75% reported difficulty reintegrating with their family 41% felt “like a guest within their home,” 25% reported “their children acting afraid or not being warm towards them,” Parenting difficulties were greater among veterans with PTSD. (Sayers, Farrow, Ross, & Oslin, 2009).
- A research study with married OEF/OIF veterans who were referred to mental health treatment in VA: 75% reported difficulty reintegrating with their family 41% felt “like a guest within their home,” 25% reported “their children acting afraid or not being warm towards them,” Parenting difficulties were greater among veterans with PTSD. (Sayers, Farrow, Ross, & Oslin, 2009).
- A research study with married OEF/OIF veterans who were referred to mental health treatment in VA: 75% reported difficulty reintegrating with their family 41% felt “like a guest within their home,” 25% reported “their children acting afraid or not being warm towards them,” Parenting difficulties were greater among veterans with PTSD. (Sayers, Farrow, Ross, & Oslin, 2009).
- A research study with married OEF/OIF veterans who were referred to mental health treatment in VA: 75% reported difficulty reintegrating with their family 41% felt “like a guest within their home,” 25% reported “their children acting afraid or not being warm towards them,” Parenting difficulties were greater among veterans with PTSD. (Sayers, Farrow, Ross, & Oslin, 2009).
- Confusion (I don’t understand it, how can I explain it to my children?) Talking about it brings back bad memories and is painful Shame/guilt/embarrassment Fear being seen as “weak” and losing child’s respect Fear they may tell other people What else?
- CLICK TO NEXT SLIDE - DO NOT DELETE
- However, children (all people, actually!) fear what they do not understand. Children tend to be very perceptive. They know something is going on They make up reasons for upsetting situations, often blaming themselves So…we strongly encourage direct communication with children about mental health issues.
- Discuss openly with your veteran regarding what/when/how to talk with your kids. It’s best if it can be an entire family conversation. Do your homework (reading, talk with your doctor or trusted friends, check out resources) to help be prepared This will not be a one-shot conversation. Regularly open the discussion, encouraging your children to ask questions and share feelings as they arise. Pick a good time for the conversations. As they say, timing is everything!
- Be hopeful yet honest with your children. Start the conversation slowly. Avoid sharing more than one or two ideas at a time Encourage your child’s open and honest expression of worries, feelings, and questions. If you or your veteran become overwhelmed and experiencing very strong emotions, you may want to take a break, calm down, and continue the discussion later If your child starts becoming tearful, quiet, or scared, pay attention! He/she is telling you something! Stop sharing information and check in with him/her.
- Helpful messages to share with your children Avoid sharing details of the veteran’s traumatic event(s); doing so can upset and confuse the child Help the child to understand the veteran’s specific symptoms and how the child can cope when the veteran is struggling
- Note that the child cannot “catch” PTSD – it is not contagious! Emphasize that there are many helpful treatments available (you may share if you/your veteran are getting help) Tell your children that that they are not to blame – they didn’t do anything wrong It’s ok to say you don’t have all the answers!
- Red flags for when your child may need additional support Although some children whose parent has PTSD develop anxiety or sadness themselves, most do well. Many children have layers of support-you as a caregiver, teachers, coaches, ministers/clergy, counselors, etc. However, you may want to consider exploring professional help (counseling) if these situations arise: Examples of Specific Veteran Behaviors that can Be Especially Difficult for Children: Comments about self-harm Aggressive / violent behavior (to pets, children, partner, household items, etc.) Veteran is admitted to psychiatric unit Veteran is unable to maintain employment/schooling (cannot engage in roles) Severe depression resulting in significant withdrawal from family activities
- Sample Child Behaviors that may Indicate they could benefit from professional help Any comments about harming him/herself or others Signs of depression or anxiety Regression (e.g., wetting the bed long after they have passed this stage) Significant increase in clinginess or crying Aggressive behavior (to siblings, household items, peers, parents, pets) Considerable changes in sleeping, eating, weight, or energy levels Change in school behavior (grades, behavior problems, etc.) NOTE: These behaviors may reflect distress in your child. However, remember they may be related to a variety of issues, not solely the veteran’s PTSD.
- Fostering close relationships with children Continue family traditions, discipline, and structure Spend a few minutes of one-on-one time with each child on a daily basis. Play with your children at their level, doing the activities they most enjoy. Instill a sense of being loved by both parents / caregivers Foster supportive relationships between the children and people outside the immediate family.
- Being a good parent means taking care of yourself! Make time for regular physical exercise. Eat a balanced diet and try to get adequate sleep (7-8 hours per night). Work to create some alone time every day. Practice regular relaxation techniques, such as deep breathing, prayer/meditation, and muscle relaxation. Get active in your own hobbies. Commit to working on relationships with people that matter to you Dedicate time, effort and energy to your relationship with your veteran. You are modeling healthy relationships for your children.. Connect with supportive friends and family members. Although exchanging text messages and chatting on Facebook can be great, there’s nothing like spending quality time together, even if it’s just a short chat over coffee. You need people who affirm you and can support you in the sometimes challenging journey of parenting Engage in spiritual practices/activities and church/house of worship activities if that is meaningful for you.
- **play on words about rewriting your story? Or new chapters? Or turning a new page?
- Being a parent is challenging, and can be even tougher when a family member is dealing with PTSD or other mental health concerns. PTSD can have ripple effects on family relationships. Children can respond in a variety of ways. At some level, your children can sense/tell when family members are struggling. It’s important to TALK about it (at a level appropriate for your children!). Work to keep a strong relationship with your children through regular special time, consistent family routines and rituals Everyone has tough days, mental health issues or not! There are many things you can do to help yourself get through the rough patches. If you and your child are struggling, ask for help! It’s much easier to get back on the “right” path when your difficulties are small than when they’ve spun out of control.
- Public & Professional