- Heather B MacIntosh PhD
Coupling and Trauma in the Context of COVID-19
A headline in the Guardian online jumped out at me this morning, “Lockdowns around the world bring rise in domestic violence”. This followed appeals from child protection agencies for people to be on the alert for children who may be at risk for abuse and neglect in the context of social isolation. Couples in distress and children out of school or childcare, may be at increased risk for violence, neglect and abuse as couples and families retreat from the normal structures of life, childcare, school, and workplaces and hunker down in their homes, isolated and locked in.
As a psychologist and researcher who works with couples dealing with stress and trauma, I am worried. I am worried about the mental health consequences of the physical isolation that may last for a long time and, I am also very worried about the impact on couples and families of being cut off from their normal supports and being isolated together in their homes.
These news items have compelled me to write and share some thoughts on how this pandemic may affect couples and families and to suggest a few strategies to help reduce the level of distress and conflict that may arise in isolation.
Big T and Little T Trauma
All of us are living in a traumatizing time that can send us into states of overwhelming emotional distress that can wipe away our capacity to concentrate, manage our daily lives and emotions, and resolve conflicts in our relationships. For the past couple of weeks, I have been talking to patients, students, psychotherapists I supervise, colleagues, and my own therapist. Universally, we are all in a situation where more is being asked of us as our resources are reduced by the practical realities of having no childcare or many of our usual supports. The emotional realities of this distressing time can thrust us all into states of fight, flight, or freeze, the kinds of emotional responses typical of responses to trauma, all the while confined and isolated with partners and families.
We often talk about “Little t” traumas and “Big T” traumas to differentiate the stresses and traumas of life that give us a detour but do not destroy us, from the traumas that wipe away our sense of reality, humanity and faith in the world. A Little t trauma might be something like breaking up with a partner, losing a job you cared about, the death of a parent or loved one, or a failure to accomplish a long held goal. Big T traumas may be experiences like childhood sexual abuse, neglect, a life threatening accident or exposure to severe traumas by first responders or members of the military in combat. Any one event can be experienced as either a Little t or Big T trauma depending on a person’s developmental stage, the context of their lives and past experiences that may make a person particularly vulnerable or resilient in the face of a traumatic event.
Little t traumas are experiences that are devastating and can pull us off course. This crisis will affect us all and, for many, the covid crisis will fall into this category of trauma. Some will become infected but recover, family members may be at risk but come through, and workplace, family, and financial challenges may be significant stressors that are alleviated as this crisis wanes.
For many, especially those with a prior history of trauma, the covid crisis will represent a Big T trauma. Couples and families may be facing the Big T traumas of serious, life threatening illness, an overwhelmed health care system that may not be able to provide lifesaving care to everyone who needs it, and the death of loved ones, often without being able to be by their side or to say goodbye.
We are all of us experiencing aspects of the classic “fight, flight or freeze” response and, yet, it’s hard to flee when you are in quarantine or isolation, so, for many, all that is possible is fight and freeze and this is worrisome when we think about couples and families in isolation.
In the midst of this global crisis, shut away from physical connection and community, many of us are being called to work more, interacting through online platforms, while juggling children running around at our feet as we face an uncertain future, manage our anxiety about staying healthy and figure out what to make for dinner.
Couples have also been stripped of the usual routines of work outside the home, childcare and school. Now, together 24 hours a day, often in confined spaces where there is little privacy and, if we are following the public health recommendations for social distancing and social isolation, there is no place to go for a breath of privacy. This can be a recipe for escalating conflict, triggering old traumas and painful memories and even risks for violence and abuse. I have spoken with those in distress having experienced abuse in childhood, as a young child with nowhere to run, no one to turn to, and nowhere to hide. These are folks who have worked hard in their healing as an adult and many have found their way into new relationships and built a life for themselves, free of abuse, and then, wham, confined to their homes, even if it is a well-loved home, unable to come and go at will or find a moment to themselves. This is a perfect storm opportunity for those old traumatic memories, feelings and fears to come raging in.
Imagine then, facing all of this stress and uncertainty and being in a couple relationship that is already in trouble, being in conflict and barely managing to hold it together before this retreat into isolation. Imagine being a couple on the brink of separation and, all of a sudden, being thrust into living in isolation together. Add to that the compounding impact of coming into this pandemic in distress in your relationship and with a history of prior trauma, perhaps childhood abuse and neglect, that makes tolerating and managing the deluge of fear, stress and heightened arousal feel impossible and intolerable.
So, what does this mean? How can we best get through this time of physical isolation while maintaining our relationships and wellbeing? I have a few suggestions for things that couples might consider as they try to get through this time.
Seven Strategies to Manage Couple Covid Crisis
1. Compassion and Harm Reduction
The first thing we need to emphasize is compassion, empathy, and acceptance. We are limited in our resources to deal with a crisis when the world is on fire, and compassion, empathy and acceptance can be in short supply.
One of the things that we have learned from the research on a form of treatment called Traumatic Stress Debriefing is that trying to use a new coping strategy or trying to force someone to do something that isn’t natural or comfortable for them, has the potential to worsen the impacts of traumatic experiences.
For instance, when first responders were put in two groups, the first group had to attend a debriefing meeting after any major trauma and the second group could choose to go to the debriefing meeting or to go home and spend time with family or do whatever felt right for them, be it going to the gym for a run or baking a loaf of bread.
The results showed that those who were given the choice about what to do after exposure to a major trauma developed fewer and less severe trauma symptoms than those who were forced to attend the debrief. So, while, for many, the debrief was helpful, it was only helpful when that was what fit for them, what felt comfortable and natural.
With this in mind, then, it is important for couples and families to not try too hard to develop new strategies for dealing with distress and anxiety during this time of physical isolation but, rather, to allow people to default to their comfortable or natural strategies where these do not cause overt harm. While in normal times we might want to help someone working on disordered eating patterns that were developed in the context of a traumatic childhood, during a global pandemic, if someone defaults to some problematic eating behaviours that are not overtly harmful to themselves or others in the immediate term, it may be best to have compassion and empathy for those strategies and, as a couple or family, to try to find what are called, harm reduction strategies, rather than trying to insist that everyone eat a lot of broccoli.
This is a delicate line to walk, as you can imagine. For instance, in the context of problematic drug or alcohol use that may be a self-soothing strategy developed in the context of trauma, these can lead to harm to the person themselves or their partner and family. Other behaviours that might feel soothing and help with anxiety and triggers such as self-harming or sexual behaviours born in trauma and that trigger or distress a partner may also have the potential to cause irreparable harm to the person or their partner and it will be important for couples to be as straightforward, honest and compassionate with one another as they try to manage the potential for escalation of problematic but soothing behaviours to insure that everyone stays safe.
During this time of physical isolation, many organizations are offering their services and supports through online platforms. Alcoholics Anonymous and Al Anon offer online meetings and other resources are available online for support in managing other behaviours that might lead to harm over the longer term.
2. Acknowledging Attachment Styles
Everyone has a way of relating to others that develops through their experiences with early caregivers. These ways of relating are called an attachment styles. Attachment styles tend to be fairly consistent through life and while we can work on developing stronger feelings of safety and security in our relationships, if our default way of being attached to others is by feeling very anxious about that relationship or by keeping some distance to be able to tolerate being attached, in the context of major stress and trauma that default way of attaching is likely going to rear its head.
For those who tend toward being anxious in their ways of being with a partner, it might be important to schedule some time away from a partner for both of you to have a break from the hum of stress and fear. This might be time alone for listening to music, writing in a journal or playing an instrument, or taking a nap. This will also give a partner a bit of space to breathe and reconnect with their own overwhelmed self while you take time to reflect and develop stronger capacities to soothe yourself.
For those who tend towards the avoidant in their ways of being with a partner, it will be just as important to acknowledge this and make a date with your partner each day. Yes, I know, your partner is six feet across the room on their computer but, what I’m talking about is turning off the computers, stopping work, putting down the phone and spending ten minutes connecting around what is happening in your worlds. We all know that it can be incredibly lonely in a crowd.
Frequently, in couple relationships there is one of each, an avoidant and an anxious, which, when compassion, empathy and acceptance are available, can be a kind of balance in challenging times as one partner holds the couple together, like the glue, and the other partner keeps feelings and distress manageable.
3. Call me Seymour
Another strategy, especially for couples who were already dealing with distress and conflict in their relationships may be to try an old therapy trick called externalizing. Externalizing is a strategy where a couple is able to see a problem, like the covid-19 pandemic, as something external to their relationship and to see it as a foe they can fight together.
Living in isolation with your partner and family, dealing with ongoing conflicts, the added stress of being there 24 hours a day, and the overwhelm of living through a global pandemic, can make it hard to keep conflict levels from escalating.
Externalizing the problem can help the couple come together around the crisis rather than turn on one another in their fear and distress. Try giving your conflict a name. I know, it sounds stupid but, really, naming the distress and conflict that begins to arise in the context of the covid-19 crisis can make it all seem a lot less troublesome and more manageable. I like the name Seymour for this pandemic, troublesome but manageable fellow.
If you can both agree to accept the importance of being able to step away, breathe and reconnect when arousal has settled, either of you can say something like “Seymour seems to be getting a little out of hand”, which is a cue for both of you to take a time out and see if you can do something that will help you calm and settle. Perhaps it would be to read a story with a child, watch a little Netflix or even go out for one of those socially distanced walks on your balcony.
4. Soothing and Seeking Safety
If traumas from the past are being relived in the present in response to all of the fight, flight or freeze responses firing inside of you and the fear created by the pandemic, or if old traumas are being triggered by the living circumstances in which we all find ourselves, it will be essential to do all you can to stay on the side of light and not fall into the darkness.
I know that for those who have experienced childhood traumas, traumas that were inescapable due to their age and stage, traumas that were often perpetrated in their homes by family members who the child should have been able to trust, being unable to leave the house or feeling trapped in isolation can be terrifying.
On the one hand, it’s okay to use whatever strategies you used as a child to soothe and settle yourself, if they aren’t going to hurt you or those around you. On the other hand, this could be an opportunity to try turning to your partner, if your partner is a safe and loving person you have been trying to fall into and trust already.
Our research has consistently shown that telling our partners things about our traumatic pasts as they relate to how we are frightened or triggered in our relationships in the present, really helps our partners respond to us in empathic and loving ways. This can help couples build trust and start to share more and more of their lives with one another. Maybe try to take the risk to try something new in sharing more about your fear and distress if you feel safe enough.
5. Try Something New
I know, I just told you that it is okay to default to old strategies for soothing and settling yourself if you are feeling overwhelmed and having difficulty managing your emotional distress. However, at a time when we are physically distanced from one another, I have been amazed by the innovative generosity of artists, writers, musicians, healthcare providers and others who have shared their services online, in many cases free of charge in an attempt to bring us together as a human community that continues to engage creatively with one another. This could be the time to try an online yoga class, a creative writing class, attend a virtual choir singalong, or any of the remarkable buffet of online and virtual content that has been made available to us during this crisis. You might be surprised to find a new strategy for managing traumatic memories, feelings and fears. And, if it doesn’t work for you, there are no consequences for walking away from a one-time online dip into the buffet of possibilities.
6. Seek Safety If Necessary
Self-isolation is a public health recommendation and it is very important if we are going to flatten the curve of the spread of the Covid-19 virus. However, these are recommendations based on an assumption that it is safer for you to be in your home than out of it. If you are not safe, emotionally or physically, it is okay to seek safety and, if necessary, to leave your self-isolation situation where you are staying with your partner or family.
It is important to note that women’s shelters are open during the covid-19 pandemic and if there is a risk of violence to a woman or a child. The shelter safe website provides referrals to shelters across Canada.
There are very few resources available for men who are living with interpersonal violence. This website provides access to webinars and educational material as well as contact information for the few resources that are available to men.
If you or your children are at risk of violence in the immediate term, call 911.
7. Reach Out
If you are simply feeling too triggered and frightened to stay inside, go for a walk, observing social distancing recommendations. When you find your way home, wash your hands and then take a look online for mental health resources in your community. Many or most therapists are currently working online through Zoom or other platforms and may be available to help you talk through the situation in which you find yourself. Each province has a College for psychologists and many also have College for Psychotherapists and Couple and Family Therapists. These are good resources for finding licensed mental health providers in your area. And, there is always the Psychology Today therapist finder service that can be searched by geographical area and area of practice.
E Mental Health provides information and referrals for services available throughout Canada.
Stay safe, hug your quarantine mates and seek help if you need it.
Dr. Heather B MacIntosh is a psychologist and Associate Professor and Director of the MScA Couple and Family Therapy Programme at McGill University where she is the recipient of the H. Noel Fieldhouse Award for Distinguished Teaching. Dr. MacIntosh is the author of the recently released book: Developmental Couple Therapy for Complex Trauma: a Manual for Therapists by Routledge Press, a treatment manual outlining her evidence based treatment model for working with couples dealing with the impacts of complex trauma, as well as a number of peer reviewed articles and chapters in the area of trauma and couple therapy.