Emotional First Aid
By Janet Buell

Helen was considering suicide when her daughter, Gail, asked me to come to her house. Gail was shocked to discover Helen was hoarding her pain pills with the intent to accumulate enough of them to end her life.

Helen had been diagnosed with ALS, a progressively debilitating and usually fatal illness. As a long-time trauma counselor, I had frequently worked with people who had terminal illnesses and it was always a challenge. Helen surprised me though. Her suicidal thoughts were not because of her own future; her fears were for her husband, who was performing more and more caregiving tasks. Helen was afraid that her long-term illness would have a crushing effect on her husbandís health and spirits. Helen had nursed her first husband though his long and ultimately fatal illness so she knew exactly what Frank would be up against in his attempts to care for her as the disease took its toll.  Helen felt so strongly about this that she preferred to be dead rather than cause her husband, Frank, such stress.

I soon discovered that the roots of Helenís concern could be found in an event that had happened more than ten years earlier. Although Helen loved her first husband dearly, the five years she spent caring for him after his stroke left her exhausted and feeling alone. She had given up her job to nurse him, a job she loved dearly. She had wanted to care for him at home and kept him there even when he expressed a willingness to move to a nursing home. Helen remembered only too well the moments of exhaustion, frustration, and even resentment as her own life had been eaten up by the need to provide full-time care. She didnít want Frank to endure such pain although he was insisting that he wanted to provide all her care himself.

What else could she do, Helen wanted to know. She didnít want to face the time when he might resent the sacrifices he would have to make. Most of all, she felt her exchange with him would be out of balance and this feeling was at the core of her desire to die. Already Helenís disease had robbed her of almost all of her mobility and she knew that at the rate it was progressing, she would be unable to talk before another year was up. When Helen expressed her regret that she hadnít taken the overdose of pills already, I knew she needed help quickly.

My years of working with terminally ill people had taught me that we might need a two-pronged approach in handling this situation. Certainly I needed to talk to Frank about allowing Helen to move to a nursing home when the appropriate time came. We needed to help him understand that Helen did not want to see him so overburdened with her care that he was suffering, too. We also needed to find a way that Helen could exchange with Frank so that she could contribute something to his wellbeing.

Helen was a good person who had spent most of her life helping children as a teacher. Like most of us, she wanted to give as well as take in life. Her mind was still intact even while her body was being destroyed by her illness. None of us wants to be put in a position when we can only take and no longer give in life. It was very noble and loving of Frank to want to care for her at home, but he needed to acknowledge her spiritual and emotional needs as well as her physical ones. And he needed to confront his own needs as well.

As I interviewed Helen with an eye toward what she might be able to do that would be helpful to her husband, I learned that Frank had experienced a very difficult childhood that he was reluctant to discuss. Part of his reason for insisting that Helen remain at home throughout her illness was that he had been abandoned by his mother as a child and he perceived leaving Helen in a nursing home as a form of abandonment. One of the few abilities Helen still had was her ability to speak and to listen. With her agreement, I taught her some simple techniques to help Frank. These techniques, which are similar to physical first aid procedures, teach lay people to provide effective emotional first aid to friends and loved ones. Helen was an apt pupil and learned the techniques quickly. Using them, she was able to encourage Frank to talk about childhood experiences and discover some of the decisions he had made at the time when the events had occurred.

One of Frankís many realizations was that he had made an important decision at the age of nine. Feeling bereft by his motherís desertion, Frank had vowed that he would never be a person who would walk out on someone else. He also realized that this decision had caused him to hang on to relationships in the past long past the point where it benefited him or the other person. It was a tremendous relief to Frank to be able to have conversations each evening where he remembered his childhood and talked out all those times in the past. Equally wonderful was the effect it had on Helen. She felt able to be useful and enjoyed so much watching Frank experience relief and genuine happiness. With the return of this feeling of usefulness, her suicidal thoughts vanished.

I had planned, once I had helped Helen find a way to feel useful again, to speak with Frank about taking actions that might be needed to lighten his load as a caregiver.  I found, however, that there was no need to do this in the end. The coupleís close communication had helped them work out a plan for Helenís care. Frank had realized that the most important moments of the day were the ones when they were talking on a deep spiritual level and he continued to talk to Helen even after she had lost the ability to speak. At Helenís funeral, Frank described those conversations as some of the happiest moments of his life.

What does this story have to do with those of you who are providing care for someone who has lost their mental abilities? Itís wonderful when the person you are caring for has the ability to help you, too, because it gives tremendous happiness to someone who is very ill to still be able to feel useful. But that isnít possible when the illness has stolen their ability to think clearly or communicate fully. Almost all caregivers find that the illnesses they must deal with every day remind them of earlier events in their lives when they suffered other losses or traumas. That fact, plus the fears engendered by the loved oneís illness, makes a caregiver a prime candidate for some emotional first aid. Just as physical first aid, in the form of CPR, can save a life, so emotional first aid can make a life worth living. Pick a friend from a support group who is willing to work at learning a few simple techniques and pair up to help each other out. By taking turns asking and answering the questions in the procedure below, you can each provide tremendous help and support to the other. What follows is just one of the simple techniques available. Try it out with a friend or loved one.

Directions: Take turns with your partner asking and answering the set of questions below. As you ask the questions, follow these few simple rules: listen, donít talk; be compassionate, not critical; show great interest; be persistent; acknowledge responses with a simple ďokĒ or ďuh huh.Ē  

  • Recall a time when you were unable to help someone. Tell me about it. Did you make any decisions at that time?

  • Recall a time when you succeeded in helping someone. Tell me about it. Did you make any decisions at that time?

  • Recall a time when you did not receive effective help. Tell me about it. Did you make any decisions at that time??

  • Recall a time when you received effective help. Tell me about it. Did you make any decisions at that time?

If you would like a copy of The Emotional First Aid Manual, send a request to Innovations Press at P.O. Box 4800, Mission Viejo, CA 92690 or order online at www.innovationspress.net. If the cost of the book ($19.00) is prohibitive, let the publisher know, as funds have been donated to provide copies to anyone who cannot afford one.   

Janet Buell has spent over 25 years doing full-time trauma counseling and is certified by the International Association of Trauma Counselors. Janet is the author of seven books including the recently released ďThe Emotional First Aid Manual.Ē She has also been a caregiver..

Contributing authors to the book include psychiatrist Dr. Frank Gerbode, psychologist Dr. Robert Moore, and past president of the International Association of Trauma Counselors Dr. Will Foreman.


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