Panic, Family Systems, and Psychoeducation

Sometimes it's easier not to blog at all than to try to explain systems in plain talk. But let's try anyway.

I'll just go stream of consciousness, if you don't mind, and you guys put it together, because there's so much work to do (other than this) and time is always nagging at me. I just grocery shopped, for example, something normal people just do, worry-free(not thinking about time) and did the self check-out. It all went fairly well, but as I left, it was clear-- a waste of time, self check-out, if you have a big order, if you're me.

And those beeps are louder when you're the one making them.

THE STORY:

Last night I got a call from a patient, one of the handfuls of patients I encourage to call me when they're under the influence of panic. The job, of course, is to teach the family to do this, to address the panic, to get myself out of the system. But often it is the family that is stirring the panic.

So the therapist has to treat the family members, too, for they have to know how they're doing it, stirring the panic, and they have to want not do it. Getting all of the above to happen requires time.

So we're not there yet, not last night, the family is just beginning to get the big picture, and the patient calls me, and it's good timing, actually, so I start a game of Spider and take the call, because for some crazy reason, I can play Spider Solitaire and concentrate on words at the same time. I'm no longer addicted to this game is the truth, rarely even play it, but FD started to play it, and as a result, I'm playing it again when I need something to do and have to concentrate at the same time, hear what someone's saying.

Or can't sleep and it's too late to learn anything and have canceled all the fashion mag scripts and am tired of reading and writing blogs.

Anyway, I talk her down via psychoeducation. The beauty and the beast of psychoeducation is that people want to know why things are happening to them, that's the beauty. But we can't explain it all on one foot, is the beast. And the irony is that although we know about the triggers, can recognize things that aggravate arousal, we can't explain everything, not that it isn’t a worthy endeavor to try. The investigative process, however, should be something you do in the office. But sometimes things need to be reinforced, and sometimes, in pre-panic mode, you get new insight, new information, never been told before, not yet processed.

Raw.

So I like to get that information, as long as it's before 9 o'clock.

I need it pre-panic because people can’t process rationally while under panic. Panic turns the brain to junk, basically. Which is why I say, Catch it pre-panic. If you’re going to call, call me pre-panic. We can head it off.

So we take a quick look at the thought, air it out and examine it, and we find, lo and behold, that someone else in the family has expressed the same thing in the past, the same negative thought.

And since personal boundaries just stink at some stages of life, certainly young adulthood, when the thought pops into our minds we don't know why it's there. It can happen that someone else’s thought becomes our thought. And this is really scary. The thought itself is scary, and not knowing where the hell it came from is scary, or why we have it. You can see how people think they're possessed.

But they're not. They just have poor boundaries.

Sometimes the person who has expressed the negative thought originally in the past is doing it now, in the here and now, stressing the patient unknowingly. Or maybe knowingly.

(As an aside, panic isn't always triggered by negative thoughts, and it’s not always about boundaries, it’s never always about anything. We're just looking at this slice of psychology right now).

So a family therapist will yank the original thought-keeper into the therapy, the one who also has this thought (usually a parent, but not always), or something similar, and will work on a multi-system level, will address this person's thoughts and how negative thoughts originated, how they still disturb, and how they are affecting others, meaning the identified patient, my patient.

And we can help this person cope without dragging vulnerable others into the coping process, polluting the identified patient's thoughts. We set all kinds of boundaries in therapy. Someone asked me to post on boundaries, and you see I can't, post on them in any generic way. There are simply too many.

Hopefully, depending upon how deeply the original thought-keeper suffers from features of personality disorders (how oppositional, usually, or narcissistic) we'll get a good result. Voila. Magic. Everybody begins to heal.

What if, however, you can't do that, can't get that other person in the family into therapy, can't engage the one still triggering emotional distress?

It's harder, but we help the identified patient with insight, understanding, and work towards behavioral change. We look at the negative thoughts and tag them as old stuff as unresolved childhood junk, and counter them. Ultimately it is about shoring up the boundaries of self, differentiating, becoming one's own person, impervious, if not insensitive, to the noise and distressing energy in the family. There can be so much of that.

Family therapists find at least one significant other, a sibling perhaps, or all of them if possible, and their spouses, educate everyone about the situation, the patient’s needs. We’ll have the patient do it as much as possible, tell over the psychoeducation that has been learned in therapy. This reinforces the learning. This is extremely intimate, you know, telling someone you have a problem and need that person to help you on occasion.

With time a person doesn't need anyone to reinforce rational thought. The brain will go there naturally, and you'll be okay.

And I'll miss that solitaire game, you know. But I lost it anyway.

therapydoc