Dear Therapist:
My wife works as a nurse in a local New Jersey hospital. Needless to say she has been working very hard and endured a lot over the last 6 weeks. She has seen a lot off suffering and death unfortunately. She has worked tirelessly as an advocate for hospitalized patients and their families but has not always been successful. She acknowledges that she might need some counseling when this is all over but says now is not the time “we are still in middle”. She has taken the approach of “let’s get through this first”. I wonder is if this is the most healthy approach? Given that I don’t know how practical it is for her to go for counseling now, I wonder what I can be doing to prevent her from developing PTSD from her experiences, as I’m sure she is at very high risk for it. What advice can you give those who have been on the front lines of this crisis (and their families)?
Response:
As you mention, this has been a very trying time for many of us. We probably all know people who have been tragically lost to the Covid-19 pandemic. It stands to reason that those people who are working tirelessly (both physically and emotionally) within the healthcare system will typically feel the stress more than most.
Post-traumatic stress most often affects people after the stressors are no longer in evidence. This is partly due to the fact that during stressful times our unconscious mental defenses are activated, allowing us to deal with crisis situations. Therefore, we often react very differently post-crisis than during the crisis itself. Some people feel little or no emotional distress during what should be a stressful time, only to react very strongly after it is over. Others feel similarly both during and after. Yet others are highly stressed during crises, but deal very well in the aftermath.
Generally speaking, we all deal with stress differently. We feel differently, our triggers and defenses are different, and our reactions to stress can vary greatly. For many people, it can be difficult to process and deal with emotions in the midst of a crisis. This doesn’t mean that they shouldn’t do so, but they may not see a significant positive effect. For others, working through their feelings while in crisis mode can be a great help. The point at which someone should seek help to deal with their emotions is a personal decision. Although you can encourage your wife to speak with someone, it is ultimately up to her.
It sounds as if your wife is at high risk for developing post-traumatic stress. This, however, is different than developing PTSD. Post-traumatic stress (without the “disorder” designation) is simply the emotional reaction that we all have to things that cause us stress. This is normal, and is to be expected. It is the way in which your wife’s emotions are processed and managed that will determine any long-term impact. If she is able to work through her feelings in an adaptive way, there should be no lasting ill effects.
Your wife recognizes that she might need counseling after the crisis is over. This likely means that she is introspective enough to acknowledge her emotions and her limits. Hopefully this will lead her to seek help when she needs it. At this point, you can do is to encourage your wife to discuss her experiences, thoughts, and emotions. She can speak with you, another family member, or a friend. Expressing her feelings can help your wife to process them in a better way, thereby reducing the need for any extraneous (possibly harmful) defense mechanisms that may later make it more difficult for her to move past any lingering issues.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Brooklyn, NY | Far Rockaway, NY
author of Self-Esteem: A Primer
www.ylcsw.com / 718-258-5317
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